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An Introduction to Ages & Stages Questionnaires®: Social Emotional
(ASQ:SE): A Parent-Completed, Child-Monitoring System
for Social-Emotional Behaviors
Presenter: Teri Pinto, Dept. Mental Presenter: Teri Pinto, Dept. Mental Health,Health,
Office of Children’s ServicesOffice of Children’s Services
Alabama Assuring Better Child Health and Alabama Assuring Better Child Health and
Development Screening InitiativeDevelopment Screening Initiative
[email protected]@mh.alabama.gov
205-941-9904205-941-9904
Objectives
Define and discuss the benefits of developmental screening.
Describe features of the ASQ:SE.
Score the ASQ:SE.
Describe ASQ:SE cutoff scores.
Interpret ASQ:SE information in relation to other referral considerations.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
What is the ASQ:SE?
Parent- or caregiver-completed screening tool that encourages parental/caregiver involvement
Series of questionnaires for children ages 3 months to 5 ½ years
Tool to accurately identify children at risk for social-emotional delay
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Efficacy
Test Sensitivity: 71-85%
(Need further evaluation for delay)
Specificity: 90-98%
(Probably do not have a delay)
ASQ:SE Addresses Seven Areas
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Behavioral areas
Definition
Self-regulation Ability/willingness to calm, settle, or adjust to physiological or environmental conditions
Compliance Ability/willingness to conform to the direction of others and follow rules
Communication Verbal/nonverbal signals that indicate feelings, affect, internal states
Adaptive Ability/success in coping with physiological needs
Autonomy Ability/willingness to establish independence
Affect Ability/willingness to demonstrate feelings and empathy for other
Interactions with people
Ability/willingness to respond to or initiate social responses with caregivers, adults, and peers
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
ASQ:SE MaterialsPublished by Paul H. Brookes Publishing Co. http://www.brookespublishing.com http://www.agesandstages.com 1-800-638-3775
Materials include The ASQ:SE User’s Guide and ASQ:SE Questionnaires (box
set or CD) ASQ:SE in Practice videotape
Available in English and SpanishCase studies, questionnaires, and a technical report about the ASQ:SE are available on the publisher’s web site.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Types of Assessment
Screening assessment
Diagnostic assessment
Curriculum-based (programmatic, ongoing) assessment
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Screening Assessment
A brief assessment—similar in theory to health screenings such as a quick hearing or vision screen—designed to identify children who should receive more intensive diagnosis or evaluation from local Early Intervention (EI), Early Childhood Special Education (ECSE), health, and/or mental health agencies.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Diagnostic (Professional) Assessment
An in-depth assessment of one or more developmental areas to determine the nature and extent of a physical or developmental problem and determine whether the child is eligible for services (e.g., EI).
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Curriculum-Based (Programmatic, Ongoing) Assessment
An in-depth assessment that helps to determine a child’s current level of functioning. This type of assessment can Provide a useful child profile Help with program planning Identify targeted goals and objectives Be used to evaluate a child’s progress over time
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Monitoring
Developmental surveillance (screening at frequent intervals) of at-risk infants and toddlers not known to be eligible for special health or educational services; similar in theory to a person with diabetes monitoring his or her blood sugar
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Screening
Not near cutoffsBeyond cutoffs
Eligible for services
Near cutoffs
Professional
assessment
Not eligible for services
Continue to monitor (rescreen) and use curriculum-based
assessment to develop learning plans
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Incidence of Children Identified as Having a Disability by Age
Infants: 2.4%
Preschool-age: 5.8%
School-age: 11.6%
Source: http://www.ideadata.org, 2005.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Why Screen Social-Emotional Behaviors?
Social-Emotional Research
Links exist between earliest emotional development and later social behavior (Cicchetti & Cohen, 1995a, 1995b; Reynolds et al., 2001).
Behaviors, even in infancy, signal the need for intervention (Shonkoff & Phillips, 2000).
Links exist between early risk factors, poor outcomes, and violence (Conroy & Brown, 2004).
By third grade, programs for children with antisocial behavior are mostly ineffective (Greenberg et al., 2003; Walker, 2004).
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Developmental-Organizational Framework
Source: Cicchetti, 1993ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Age Stage of development Behaviors 0Š12 months Attachment Regulation
Recognizable states Attachment Communication
12Š30 months Autonomy and self-development
Differentiates between self and others, real and make-believe Use of pronouns - Exploration Self-control; rules
30 monthsŠ7 years Establishing peer relations Empathy Gender differences Identification of friends Interest in other children
Developmental-Organizational Framework
Source: Cicchetti, 1993ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Age Stage of development Behaviors 0Š12 months Attachment Regulation
Recognizable states Attachment Communication
12Š30 months Autonomy and self-development
Differentiates between self and others, real and make-believe Use of pronouns - Exploration Self-control; rules
30 monthsŠ7 years Establishing peer relations Empathy Gender differences Identification of friends Interest in other children
Developmental-Organizational Framework
Source: Cicchetti, 1993ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Age Stage of development Behaviors 0Š12 months Attachment Regulation
Recognizable states Attachment Communication
12Š30 months Autonomy and self-development
Differentiates between self and others, real and make-believe Use of pronouns - Exploration Self-control; rules
30 monthsŠ7 years Establishing peer relations Empathy Gender differences Identification of friends Interest in other children
Activity
What is the intent of the questions on the ASQ:SE?
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Behavioral areas
Definition
Self-regulation Ability/willingness to calm, settle, or adjust to physiological or environmental conditions
Compliance Ability/willingness to conform to the direction of others and follow rules
Communication Verbal/nonverbal signals that indicate feelings, affect, internal states
Adaptive Ability/success in coping with physiological needs
Autonomy Ability/willingness to establish independence
Affect Ability/willingness to demonstrate feelings and empathy for other
Interactions with people
Ability/willingness to respond to or initiate social responses with caregivers, adults, and peers
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
ASQ:SE Features
Features of the ASQ:SE
6-, 12-, 18-, 24-, 30,- 36-, 48-, and 60-month intervals
Between 19 (6-month) and 33 (60-month) scored
questions on each questionnaire
3- to 6-month administration window on either side of
interval age
No need to use CDOB or adjusted age for children born
prematurely
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Features of ASQ:SEQuestionnaires are written at a fourth- to fifth-grade reading level.
Each questionnaire includes open-ended questions related to eating, sleeping, and toileting.
All intervals include the question, “Is there anything that worries you about your baby (child)? If so, please explain.”
Each interval also includes the question, “What things do you enjoy most about your baby (child)?”
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Features of the ASQ:SE
Competence and problem behaviors are targeted.Externalizing and internalizing behaviors are targeted.
Scoring Options Points Most of the time 0 or 10 Sometimes 5 Never or hardly ever 0 or 10 Is this a concern? Yes = 5
High scores falling above empirically derived cutoff points are indicative of problems.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
ASQ:SE Score Information (N=2861)
Interval Range Median Cutoff
6-month 0–115 16.7 45
12-month 0–145 25.0 48
18-month 0–255 26.0 50
24-month 0–220 28.4 50
30-month 0–300 35.2 57
36-month 0–220 35.0 59
48-month 0–280 36.0 70
60-month 0–275 35.0 70
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
ASQ:SE
Case Study
Introducing the ASQ:SE to Parents
“This questionnaire asks questions about your child’s social-emotional growth. Your answers will help me determine what type of information I may be able to gather for you.”
“Some of the questions are not very specific; just answer based on your feelings or opinions about your child’s behavior.”
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Introducing the ASQ:SE to Parents
• Review response options: Most of the time: Child is performing behavior
most of the time or too often. Sometimes: Child is performing behavior
occasionally but not consistently. Rarely or never: Child is not performing or
rarely performs the behavior.
• Discuss the “concerns” option.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Administering the ASQ:SE
Have parents complete the questionnaires as independently as possible.
Some questions on the ASQ:SE, such as those regarding eating problems (for all intervals) and perseverative behaviors (for children 18 months and older) may require clarification.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Scoring the ASQ:SE
Determine a child’s total score:# of questions with X ___ x 10 = ____# of questions with V ___ x 5 = ____# of concerns ___ x 5 = ____
Total points on each page = ____
Transfer points on each page to the ASQ:SE Information Summary.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
ASQ:SE Omitted Item(s)Try to obtain answers from the family.It is okay to omit up to 2 items for the 6- to 18-month questionnaires and up to 3 items for the 24-month and over questionnaires.See The ASQ:SE User’s Guide for additional guidance.
Calculation:
Step 1: Divide the total score by the number of questions answered on the ASQ:SE. For example, 105 total points/30 questions = 3.5 points.
Step 2: Add this number, which is the average score for items on this questionnaire, to the total score to get a new total score. For example, 105 + 3.5 = new total score of 108.5 points.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Review Questionnaires with Parent(s)
Discuss the child’s strengths, and reinforce positive parent–child interactions.
Discuss items that individually score 10 or 15 points.
Discuss answers to open-ended questions.
Review the child’s score, and compare it to the cutoffs. Remember that cutoffs on the ASQ:SE are very different
from those on the ASQ!
Discuss referral considerations.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Referral Considerations
Time/setting factorsDevelopmental factorsHealth factorsCulture/family factors
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Interpreting ScoresThe “sometimes” issue
The subjectivity issue
Validity of report Teen parents Parents involved in protective services First-time parents/isolated parents Parents actively involved with drugs and alcohol Parents with mental illness
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Questionable Scores
Have another caregiver complete the ASQ:SE.
Gather additional information:Observe the child.Use a professionally administered screening tool.Assess parent–child interactions.Assess the caregiving environment.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Possible Follow-up
Below cutoff: Provide ASQ:SE activities and monitor the
child.
Close to cutoff: Follow up on concerns. Provide information, education, and support. Re-administer the ASQ:SE. Make referrals as appropriate.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Possible Follow-up
Above cutoff: Refer to EI/ECSE. Refer to local community agencies:
Feeding clinic Church groups Community groups, YMCA, Birth to Three Parenting groups Early Head Start
Refer to primary health care provider. Refer for mental health evaluation.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Communicating Screening Results
Assure the family that the discussion is confidential.
Review the purpose of screening.
Avoid terms such as test, pass, or fail. (instead, use below cutoff or near cutoff)
Review the ASQ:SE and explain area scores.
Emphasize child and family strengths.
Provide specific examples of concerns.
Invite parents to share their observations and/or concerns.
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Communicating Screening Results*Prepare for the meeting carefully: Make notes about behaviors. Note information you need to gather (e.g., health
history) from the family. Role-play the conversation with a peer. Select a private, comfortable place to meet. Consider cultural or language issues. Know your community resources. Be calm!
* Source: Hilton/Early Head Start Training Program, Sonoma State University
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Infant Mental Health InterventionsDeborah Weatherston
Wayne State University, Merrill-Palmer Institute
1. Concrete service assessment or assistance2. Emotional support3. Developmental guidance4. Early developing relationship support5. Infant–parent psychotherapy**6. Advocacy
**Requires a trained mental health professional
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
The ASQ:SE User’s Guide
Excellent resource
Includes information on scoring and interpreting scores
Provides activities and case studies
Covers all topics in depth
ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
SummaryScreening tools can help bridge communication with families.
Screening tools can assist in making referrals to community agencies.
Referrals should be based on a variety of considerations in addition to scores.
Social-emotional issues are very complicated.
Use available resources to make decisions about what steps to take after screening.ASQ and ASQ:SE Training Materials by Jane Squires, Jane Farrell, Jantina Clifford, Suzanne Yockelson, and Elizabeth Twombly.Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved.For more information about the ASQ and ASQ:SE, go to http://www.agesandstages.com.
Jane Squires, Ph.D.,Jantina Clifford, Ph.D., orLiz Twombly, M.S.University of Oregon541-346-0807http://eip.uoregon.edu
For more information, please contact: