Using the ASQ with Diverse Families

Ages & Stages Questionnaires®, Third Edition (ASQ-3™)

and Ages & Stages Questionnaires®:

Social-Emotional (ASQ:SE)

Cross-Cultural Considerations in the use of the

© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

A child grows in and through contextually based relationships, and assessment of her

developmental status is affected by her cultural context as well as the perspectives of the examiner and the reporting caregivers.

Kathy Hepburn, Georgetown University Center for Child and Human Development


• 115.8 million identify as minority race or ethnicity (2012, Esri)– 52.8 million Hispanics – 39.5 million blacks – 15.2 million Asians/American Indian/Pacific

Islander• By 2050, whites no longer in the majority• 40% of children under 5 will be Hispanic

U.S. Demographics


From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Objectives

• Describe ASQ-3 and ASQ:SE

• Discuss cultural considerations in using screening tools

• Present research on cross-cultural uses of ASQ

What are ASQ-3 and ASQ:SE?

• Parent- or caregiver-completed screening tools that encourage parent/caregiver involvement

• Series of questionnaires for children ages 1 month to 5½ years

• Tools to accurately identify children at risk for developmental or social-emotional delay


What are ASQ-3 and ASQ:SE?


ASQ-3 and ASQ:SE Domains

ASQ-3• Communication• Gross motor• Fine motor• Problem solving• Personal-social

ASQ:SE• Social-emotional development


Screening Assessment• A brief assessment procedure 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

• Answers the question: "Does the child need further evaluation?"


Why Screen?

ClearlyTypical

Under Detected

?

Adapted from Macias, M. (2006) D-PIP Training Workshop

ClearlyAtypical


Why Screen?

ClearlyTypical

Under Detected

?

Adapted from Macias, M. (2006) D-PIP Training Workshop

ClearlyAtypical


Screening: Potential challenges if process is not sensitive

• Over-referral of children for special education services

• Under-referral of children who could benefit from special education services


Features: Cultural Adaptability

• Flexible administration methods (ASQ-3 and ASQ:SE)

• Alternative materials may be used (ASQ-3)

• Scoring permits omission of inappropriate items (ASQ-3 and ASQ:SE)

• Normative sample includes diverse populations (ASQ-3 and ASQ:SE)


• Ability to reframe questions if needed to emphasize “intent” (ASQ-3 and ASQ:SE)

• Assesses parent concerns (ASQ-3 and ASQ:SE)

• Subjectivity is inherent in behavioral assessment (ASQ:SE)

• Allows for multiple caregiver completion (ASQ-3 and ASQ:SE)

Features: Cultural Adaptability


Cross-Cultural Considerations in the Screening Process


What issues may arise when: 1) Meeting and introducing

concept of screening2) Administering tool3) Communicating

results/follow-up ideas4) Interpreting scores/making

referrals

Cross-Cultural Considerations in the Screening Process


• What issues may arise introducing screening?• What is the family’s home language? • Who should be at the meeting? • What are possible family customs? (e.g.,

greeting, dress?)• How does the family feel about screening?• Do you need an interpreter or cultural

broker?

Cross-Cultural Considerations: Introducing Screening


How might culture or values influence these activities?• Feeding, Dressing• Reading and Writing Tools• Scissors, beading

• Playing with Toys• Blocks, stuffed animals,

shopping carts, mirrors• Sports (e.g., balls)

Cross-Cultural Considerations: Administering Screening Tools*

Adapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research and Practice. CUP Partnership, Alberta, Canada.


• Who should be involved in discussion?• What are appropriate follow-up activities?• In some cultures, a mother "playing" with

her child may not seem appropriate• As a helper, you bring your “best remedy.” • Are community referral agencies familiar

with, sensitive to family culture?

Cross-Cultural Considerations: Communicating Results, Follow-Up


Gather information from family members when concerns arise:• Is there a problem?• Why is there a problem?• What do you think caused the problem?

• What can be done?• What interventions would be

appropriate?

• Who can help?

Recommendations for Practitioners


Consider the following:• Scores (ASQ-3 & ASQ:SE)• Was an adaptation of ASQ-3/ASQ:SE used?• Overall Responses & Parent Concerns• Additional Factors (e.g., health, setting, stress)

-Family culture, home language

Cross-Cultural Considerations: Score Interpretation and Referrals


Recommendations for PractitionersAdapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research

and Practice. CUP Partnership, Alberta, Canada

• Consider families’ pre- and post-immigration experiences

• Use cultural brokers and interpreters• Ask families about cultural expectations of

early development• Clarify language and meaning of each items

and reframe questions


• Incorporate non-standardized methods into the screening process

• Interpret screening results with caution and integrate relevant cultural data

• Debrief the results with the family, determine appropriate follow-up together

• Throughout the process, validate the family’s cultural belief system

Recommendations for PractitionersAdapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research

and Practice. CUP Partnership, Alberta, Canada


• Learn about one’s own cultural framework, world view, power and privilege position

• Think about “culture” from your family history, community, training, and work setting

• What values, beliefs, or “cultural messages” did you receive about family interactions and childrearing?

Recommendations for Practitioners: Self Awareness


BE AWARE OF YOUR THOUGHTS• Children who come to school dirty are…• Parents who smoke are …• Parents who sleep with their kids …• Children arrive in school in best dress …• Parents who carry their children all the time …• Families who don’t read to their kids …• Parents who talk negatively toward their children are …• Mothers who breastfeed their babies past age of 1 year…• Children who are overweight …• Angry family members who don’t trust helping professionals …

Recommendations for Practitioners: Self Awareness


• Research on Early Childhood Screening in Immigrant and Refugee Families in Canada

• Rebecca Gokiert (PI)• Great Resource! • Cross-Cultural Handbook•Downloadable PDF from

www.cup.ualberta.ca

Community-University Partnership (CUP) for the Study of Children, Youth, and

Families (Alberta, Canada)


Research


Selected Translations/Adaptations of ASQ-3 and/or ASQ:SE

Aboriginal AustralianAfrikaansArabicBengaliBulgarianChanganaChinese (Simplified)ChuukeseCzechDanishDutchFinnish

FrenchGalicianGeorgianGreekHmongHungarianItalianJapaneseKinyarwandaKoreanMarshalleseNorwegian

Portuguese (Brazil)Portuguese (Portugal)RussianSomaliSwahiliSwedishTagalogThaiTurkishUkrainianUrduVietnamese

For more information about translations, visit http://agesandstages.com/what-is-asq/languages/


http://agesandstages.com/what-is-asq/languages/



28

Functional

LinguisticMetric

Cultural

Factors to Consider in Adaptations (Peña, 2007)


• National Study • Providers Surveyed: (6) Home visitors, mental health specialist, public health providers• Measured Utility (usefulness) of ASQ:SE• Majority Satisfied • Areas with most diverse expectations or confusion: self-feeding activities, floor time questions

Can ASQ:SE be used with families from diverse cultural backgrounds?

(D. Lyman, W. Njoroge, D. Willis, 2007)


Cultural variations found most often in areas of:• Self Regulation• Attachment • Feeding/Toileting Training

Can ASQ:SE be used with families from diverse cultural backgrounds?

(D. Lyman, W. Njoroge, D. Willis, 2007)


ASQ-3 Spanish

Refined Spanish Translation:• Reflects all changes to ASQ-3 English

• Translation reviewed by a panel of experts—focused on issues of dialect, idioms, etc.

• Clearer wording to improve utility for Spanish-speaking parents


32

Item Functioning DIF analyses• 27 out of 90 items functioned differently

across groups• Older age intervals—24, 30 months• Difficulty of items represented evenly

across language versions• Minor revisions to a few items

recommended

ASQ-3 Spanish: Research


ASQ-3 Scores

• MANOVA: For each of the 3 intervals (9, 18, and 30 months)

• Language was statistically related to the weighted multivariate combination of DV measures in each age interval

• ANOVA showed statistically significant mean differences between groups• 9 m: version on communication and personal-

social • 18 m: version on personal-social• 30 m: version on fine motor

ASQ-3 Spanish: Scores


34

• Items easy to understand• Clear, easy to respond • ASQ-3 interesting, helped think about

children’s development• 87% indicated would not introduce any

changes• Pomes & Squires, under review

ASQ-3 Spanish: Readability and Utility


• Developed cutoff points based on national sample

• Adaptations to some items (e.g., chopsticks)• In general, mean scores similar to U.S. (only

10% of means had > 5 point difference)• Differences found in communication,

problem-solving, personal-social• Fine motor skills means lower in younger

children, then surpassed U.S. sample at 36 -60 months

ASQ Research: KoreaHeo, Squires, & Yovanoff (2008)


• French-Canadian (Quebec)• High validity and reliability• Used in child care centers, pediatric offices• ASQ, 2nd Edition, French• Dionne and colleagues (2004, 2006)

• Netherlands (Dutch)• Translation and adaptation of 48 months• High validity and utility• Completing remainder of 3rd edition (ASQ-3)• Kerstjens, Bos, and ten Vergert (2009)

ASQ Research: Canada and Netherlands


ASQ Research: China

Chinese (Shanghai; complex characters)• In general, minor differences in

means• Most differences in Fine Motor• Lower mean scores between 4 and

27 months, higher after 27 months• Children born in winter walked later

than children born in spring/summer


Equador

• Flower growing region• ASQ administered to children as well as

growth measurement, blood test• Children 24-61 months residing in high-

exposure communities scored significantly lower on gross motor skills compared to low exposure group

38

ASQ Research: EcuadorHandal, Lozoff, Breilh, & Harlow (2007)


% of Children Displaying Developmental DelayRelated to Proximity to Flower Fields

Communication

Gross

motor

Fine m

otor

Problem so

lving

Socio

individual

05

101520253035404550

Community CCommunities A and BPe

rcen

t del

ay


• Minnesota--statewide• ASQ:SE on small PDAs, paper

www.patienttools.org• Screened 10,000 children• Adapted scoring options for Hmong (4

point scale)• Extremely low cost—start up was most

costly part• High satisfaction by programs and

parents• Identified between 5-28% of children• Foundationforsuccess.org

ASQ:SE Research: USA on Hmong, Somali populations


• ASQ-3 and ASQ:SE have been used successfully with families from diverse cultural backgrounds

• Important to consider the family’s culture in the process of screening

• Research supports the use of these tools with families from diverse cultural backgrounds

In Summary


ASQ-3™ & ASQ:SE Training Institute

June 5-7, 2013Hyatt Regency Grand Cypress

Orlando, Florida

Register: www.brookespublishing.com/asq-institute/

1-800-638-3775Receive $50 off each registration with code

ATI50. Must register by May 14, 2013.

Would you like to learn more? Attend the

http://www.brookespublishing.com/asq-institute/

On-Site Training

• Training seminars at your location provided by ASQ experts

• Introductory seminars and Training of Trainers

• 1 – 3 days

• 10 – 30 attendees

• Learn more at www.brookesonlocation.com


Thanks for joining us!

To order:www.brookespublishing.com1-800-638-3775

To learn more:http://www.brookespublishing.com/resource-center/screening-and-assessment/asq/


http://www.brookespublishing.com/

http://www.brookespublishing.com/resource-center/screening-and-assessment/asq/




For More Information, Please Contact:

Jane Squires, Ph.D.,Liz Twombly, M.S., or Jantina Clifford, Ph.D.University of Oregon541-346-0807eip.uoregon.edu www.agesandstages.com


Education

Using the ASQ with Diverse Families