Ages

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Ages Stages Questionnaires Social-Emotional
A New Tool for Identifying Social-Emotional
Difficulties in Young Children

• Jane Squires
• University of Oregon
• Eugene, OR 97403-5253
• jsquires_at_uoregon.edu
• website eip.uoregon.edu
• December, 2003

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Objectives of Presentation

• Define screening
• Present issues/considerations related to
  assessing childrens social-emotional behaviors
• Describe Ages and Stages Questionnaires
  Social-Emotional (ASQSE)
• Discuss scoring/interpretation of scores and
  referral issues

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What is the ASQ system ?

• Parent/Caregiver completed screening tools
• Series of questionnaires for children 3 months
  to 5 years
• Identifies children in need of further
  assessment
• Developmental concerns(ASQ)
• social-emotional concerns (ASQSE)
• Encourages parent involvement

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ASQ System 2 Components

• ASQ
• Communication
• Gross Motor
• Fine Motor
• Problem solving
• Personal-social
• ASQSE
• Social-Emotional development
• ASQSE initiated in 1995, published in 2002

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Ages Stages Questionnaires Social-Emotional

• Created as a result of a call from the field
• Developed by a multidisciplinary team at the
  University of Oregons Center on Human
  Development
• Originally titled the Behavior-Ages and Stages
  Questionnaires (B-ASQ)
• Research continues to be conducted on the ASQSE

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Uses of ASQSE

• (Screening) To help guide decisions about
  referrals for further assessment
• Monitor childs social-emotional development
• Determine information/support services families
  may need
• Bridge communication between parents and
  professionals about childs behavior

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Screening

• A brief assessment procedure designed to identify
  children who should receive more intensive
  diagnosis or evaluation
• Early intervention (EI)
• Early childhood special education (ECSE)
• Mental health/social service
• Health systems

.
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Diagnostic 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 if the child is eligible for early
  intervention or mental health services.

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Curriculum-Based Assessment(Programmatic,
On-going Assessment)

• An in-depth assessment that helps to determines a
  childs 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 child progress over time

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Monitoring

• Developmental surveillance
  (screening at frequent intervals) of at-risk
  infants and toddlers not known to be eligible for
  special health,educational or mental health
  services
• Similar in theory to a person with diabetes
  monitoring blood sugar

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Screening
Beyond (Above or Below) Cutoff
Not Near Cutoff
Near Cutoff
Diagnostic Assessment

• Continue to Monitor
• Provide information, support
• Refer to other agencies
• Use Curriculum-Based Assessment to develop
  learning plans

Eligible for services
Not Eligible for services
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Barriers to Assessing Social-Emotional Development

• Lack of screening tools
• Lack of knowledge
• Variety of terminology
• Complexity of issues
• Lack of services
  
  

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Types of Behavioral/Social Emotional Assessment

• Parent (e.g, ASQSE) or professional report of
  childs behavior (e.g., PKBS)
• Parent stress assessments (e.g, PSI)
• Parent/child interaction scales (e.g., N-CAST)
• Combination tools (e.g., FEAS)
• Structured environmental scales (e.g., HOME)

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Examples of Child-focused Screening Tools
(Infant/Toddler)

• Infant Toddler Symptom Checklist
• Temperament and Atypical Behavior Scale (TABS)
• Ages and Stages Questionnaire Social Emotional
  (ASQSE)

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Examples of child-focused screening tools
(Preschool)

• Conners Rating Scale
• Carey Temperament Scale
• Social Skills Rating System (SSRS)
• Early Screening Project (ESP)
• Preschool Kindergarten Behavior Scales (PKBS)

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The Ages and Stages Questionnaires Social
Emotional
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Features of ASQSE

• 6, 12, 18, 24, 30, 36, 48 60 month intervals
• Competence and problem behaviors targeted
• 3-6 month administration window on either side
• 4th to 5th grade reading level
• From 19 items (6-month interval) to 33 items
  (60-month interval)

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Developmental-Organizational Framework
(Cicchetti, 1993)
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Features of ASQSE

• Parent/Caregiver completed.
• Available in English and Spanish
• Companion tool to the ASQ questionnaires
• Each interval has a separate summary sheet, with
  cutoff on the page.

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Features of ASQSE

• 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
• Scores are totaled and compared with
  empirically-derived cutoff points.
• High scores indicative of problems

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Features of ASQSE

• Open-ended questions
• Questions related to eating, sleeping, toileting.
• All intervals include question Is there anything
  that worries you about your baby (child)? If so,
  please explain.
• Tell me what you enjoy most about your baby
  (child)?

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Research Studies

• Validity
• Reliability
• Utility
• Conducted between 1995-2001

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ASQSE Sample

• 3014 questionnaires
• National sample
• Ethnicity
• 59 White
• 9 Black
• 9 Hispanic
• 6 Asia Pacific Islander
• 2 Native American
• 16 Mixed

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Age N Median Means
Cutoff 6 331 16.7 22.5 45 12
339 25.0 27.7 48 18 307 26.0 34.6 50 24
441 28.4 35.4 50 30
289 35.2 48.6 57 36 408 35.0 49.9 59 48
447 36.0 55.7 70 60
299 35.0 49.1 70

• ASQSE Means, Medians, and Cutoffs

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Range, means, standard deviations and cutoffs

• Range Means SDs Cutoff 6
  0-115 22.5 22.5 45 12 0-145 27.7 21.7 48
  18 0-255 34.6 33.5 50 24 0-220 35.4 30.0
  50 30 0-300 48.6 45 57 36
  0-220 49.9 45.9 59 48 0-280 55.7 55.2 70
  60 0-275 47.5 49.1 70

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Concurrent Validity

• Comparison of ASQSE classification with
  standardized tools
• Achenbach Child Behavior Checklist
• Vineland Social Emotional Early Childhood (SEEC)
• Comparison of ASQSE classification with
  social-emotional diagnosis
• DSM-IV
• DC0-3
• EI/ECSE Behavioral Diagnosis

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ASQSE Cutoffs Based on ROC (N 1043)

• N Cutoff Sens Spec Agree
• 6 71 45 78.6 98.2 94.0
• 12 85 48 71.4 97.2 93.0
• 18 99 50 75.0 96.6 93.9
• 24 152 50 70.8 93.0 89.5
• 30 115 57 80.0 89.5 87.8
• 36 179 59 77.8 93.0 89.9
• 48 174 70 76.9 94.6 92.0
• 60 171 70 84.6 95.8 94.0
• Overall 78.0 94.5 91.8

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ASQSE Reliability

• Test-retest
• Parent at time 1 and 2
• N 367
• 94 agreement

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UtilityParent satisfaction survey (N731)

• How long did it take to complete the
  questionnaire?
• 70 Less than 10 minutes
• 28 10-20 minutes
• 2 More than 20 minutes
• It was easy to understand the questions?
• 97 Easy
• 3 Sometimes
• 0 Not easy

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Utility

• The questions were appropriate for childs age
• 96 Yes
• 3 Sometimes
• 1 No
• The questionnaire was...... (check all that
  apply)
• 57 helped me think about my childs behavior
• 56 was interesting
• 27 was fun to do
• 19 didnt tell me much
• 1 was a waste of my time
• 1 took too long

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Administering ASQSE
Format Selection

• Method(s)
• mail-out, home visit, interview
• Setting(s)
• child care setting
• pediatric waiting room
• Intervals
• all
• selected

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Administering ASQSE

• Have parents complete as independently as
  possible. Some questions may require some
  clarification
• (All intervals) Eating problems
• (18 months and older) Perseverative behaviors
• Review answers to questions

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Scoring the ASQSE

• Determine childs total score
• of questions with x ___ x 10 ____
• of questions with v ___ x 5 ____
• Concerns ___ x 5
  ____
• Total points on each page ____

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Review questionnaires with parent

• Discuss items that individually score 10 or 15
  points.
• Discuss answers to open-ended questions
• Discuss referral considerations
• Review score and compare to cutoffs
• Remember that cutoffs on ASQSE are very
  different from ASQ!

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Referral Considerations

• Time/Setting Factors
• Developmental Factors
• Health Factors
• Culture/Family Factors

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Interpreting Scores

• The SometimesIssue
• 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

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Possible Follow-up

• Below Cutoff
• Provide ASQSE activities monitor.
• Close to Cutoff
• Follow up on concerns
• Provide information, education and support.
  Re-administer ASQSE.
• Make referrals as appropriate.

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Possible Follow-up

• Above Cutoffs
• Refer to EI/ECSE
• Refer to local community agencies
• Feeding clinic
• Church groups
• Community groups (e.g., YMCA, Birth to Three)
• Parenting groups
• Early Head Start
• Refer to primary health care provider
• Refer for mental health evaluation

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Culture-Specific Awareness Understanding

• Consider diversity within cultural groups as well
  as between cultural groups
• Gather culture-specific Information
• Study, read, use cultural guides, participate in
  daily life, learn the language, learn parenting
  caregiving practices
• Culture specific issues and intervention
• Make no assumptions about concerns, priorities
  resources!

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Cross-Cultural Communication

• Adapt to style that is comfortable for the family
• Consider nonverbal behavior
• eye contact
• facial expressions
• proximity and touching
• body language, gestures
• Sensitive use of translators, interpreters

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ASQSE Users Guide

• Excellent resource
• Covers all topics in depth

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To order ASQSE

• ASQ Users Guide and Questionnaires 125 for
  set
• Paul Brookes Publishing Company
  www.brookespublishing .com
• Great website
• Case studies, examples of questionnaires
  available
• Technical Report on-line
• 1-800-638-3775

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In Summary

• Early Identification is critical for improving
  developmental outcomes.
• ASQSE can assist in making referrals to
  community agencies.
• Social emotional issues are very complicated.
• Interdisciplinary, community-based teams can
  assist in decision-making.
• No one should feel as though they should have all
  the answers.

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• For more information please contact
• University of Oregon
• Early Intervention Program/ASQSE Project
• 5253 University of Oregon
• Eugene, OR 97403-5253
• 541-346-0807
• Project Staff Jane Squires,Liz Twombly, Sue
  Yockelson, Jantina Clifford