The ASQ-3™ (agesandstages.com) is a questionnaire-based developmental screening tool designed and developed in the USA for use by early childhood educators and health care professionals. It is widely used in many countries and is highly valid, reliable and accurate.
It can be parent-completed or used as part of an in-person or phone interview. It relies on parents and caregivers as experts and enables developmental delays to be captured early while also highlighting strengths.
“The validity of [the] ASQ-3 has been studied more than any other screener. Psychometric studies based on a normative sample of more than 18,000 questionnaires show high reliability, internal consistency, sensitivity, and specificity. From ‘How reliable? We’ll let the data tell the story.’)
Language and context have always been barriers to adopting mainstream practice in remote areas – but with modifications, we found we could use the ASQ-3 questionnaires as the base for building a more culturally appropriate version of the tool for Australian Aboriginal children.
We selected and carefully studied seven questionnaires from the ASQ-3 for adaptation, in collaboration with Aboriginal community members, cultural and linguistic experts, remote health practitioners and early childhood development experts in the Northern Territory.
Findings of the study informed the development of the ASQ-TRAK. For more information see Adaptation of the Ages and Stages Questionnaire for Remote Aboriginal Australia.
The ASQ-3 consists of 21 questionnaires developed to measure children from 1 month to 5½ years. It is designed to be parent-administered or administered by interview.
Each questionnaire has 30 items grouped into five areas: communication, gross motor, fine motor, problem solving, and personal–social. They also include general health questions. For full details, visit www.agesandstages.com.
The ASQ-TRAK is based on seven of the 21 ASQ-3 questionnaires. A number of modifications were made. The ASQ-TRAK:
- is shorter, having excluded the general questions
- is written in plain English
- includes an explanation of the overall questionnaire and of each domain
- has illustrations for every item
- is designed to be administered by interview, encouraging the parent or caregiver and child to demonstrate each item
- has items that have been modified to be more culturally appropriate and draw on materials that are available in remote communities.
The screening ages – 2 months, 6 months, 12 months, 18 months, 24 months, 36 months and 48 months – align with routine ‘well-child checks’ undertaken in the Northern Territory (where the ASQ-TRAK was developed), which require developmental screening as part of the check.
The ASQ-TRAK kit includes a flip-chart with colour illustrations for each of the seven questionnaires, for parents or caregivers to view during the interview process. This has been found to be a very valuable modification that acts to engage parents and caregivers in the process.
The ASQ-TRAK was translated into the local Aboriginal languages in regions where the adaptation took place. For more information, see Adaptation of the Ages and Stages Questionnaire for Remote Aboriginal Australia.
The ASQ-TRAK is designed to be used in all settings in which the ASQ-3 can be used. It can be used by:
- health professionals, including Aboriginal Health Practitioners, Remote Area Nurses, Child Health Nurses, GPs, Paediatricians or Allied Health Specialists
- early childhood educators, including in Families as First Teachers programs.
It is not designed to be administered by parents and families, although they are encouraged to be actively involved in the interviews.
The ASQ-TRAK is easy to use and generally requires little training. However, it is recommended that the points included in the ‘Guide to using the ASQ-TRAK’ are considered when training staff. Although there is no official training program currently on offer, if you have a training need, please register expressions of interest on our Contact us page.
As part of the original adaptation study, we developed a training workshop for Aboriginal Health Practitioners and other remote health practitioners who had little or no child-health training. For more information, see Culturally Appropriate Training for Remote Australian Aboriginal Health Workers: Evaluation of an Early Child Development Training Intervention or Contact us.
The ASQ-TRAK is a developmental screening tool intended to identify children with potential developmental difficulties who should be referred for a more in-depth assessment.
Screening tools may not be sensitive enough to accurately measure change over time or the impact of an intervention. To read more about the use of screening tools for other purposes, see Developmental Screening Measures: Stretching the Use of the ASQ for Other Assessment Purposes.
Validation refers to the process of gathering of evidence to support the interpretation and use of an instrument, and the decisions we make based on that instrument. Current perspectives consider validity in terms of degree, as opposed to a tool being "validated" or "not validated". Validation is an ongoing process in which a number of sources of evidence can offer support for the validity of an instrument.
We have been collecting evidence regarding the ability of the ASQ-TRAK to accurately screen for developmental difficulties. We are doing this by comparing children’s performance on the ASQ-TRAK with their performance on a structured developmental assessment which acts as a criterion measure (the Bayley Scales of Infant and Toddler Development or the Battelle Developmental Inventory). So far, over 100 Australian Aboriginal children across the Northern Territory have participated in this research.
Our results indicate that the ASQ-TRAK is able to detect children with developmental difficulties with a similar accuracy to the structured developmental assessment against which it is compared. The ASQ-TRAK is also producing similar accuracy statistics as the original ASQ-3. (However, the validation study for the ASQ-3 was conducted in the US and we are not able to assume equivalent validity for Australian Aboriginal children.)
We have published the preliminary findings (Pilot Validation Study). However, we still plan to collect more evidence for the validity of the ASQ-TRAK through 2017 and 2018. If you are already using the ASQ-TRAK and would be willing to share the data that you are collecting or if you would like to be involved in ongoing research, please contact us.
The ASQ-TRAK is available in the following languages:
- modified English,
- two Yolngu Matha languages (Dhuwaya, the language of instruction at Yirrkala school, and Djambarrpuyngu),
- Western Arrarnta.
The ASQ-TRAK modified English version costs $385 (incl. GST) plus delivery. For orders of the Aboriginal language version, the cost will depend on the number of copies you need. Contact us for this information.
The ASQ-TRAK is now being used in Northern Territory, South Australia and Western Australia in health services and education settings. Below are details of examples of how the ASQ-TRAK has been adopted in two different settings.
The ASQ-TRAK in Early Education:
The Northern Territory Department of Education has chosen ASQ-TRAK as the most appropriate developmental screening tool for Indigenous children in their Families as First Teachers (FaFT) program. Following a successful trial in four remote communities — Alekerange, Numbulwar, Yirrkala and Maningrida — the Department of Education will implement the ASQ-TRAK throughout FaFT sites in the Northern Territory in 2017.
"Information obtained from developmental screening will improve our understanding of children’s development and inform program planning - enabling targeted learning activities to be developed for individual children. The process of doing ASQ-TRAK is fun and very engaging, involving parents in their child’s ongoing development."
Ms Regina Thompson, FaFT project manager
The ASQ-TRAK in Health Services:
The ASQ-TRAK is being trialled in South Australia, in the Child and Family Health Service (CaFHS) in 2017. It will be used at the Port Adelaide, Morphett Vale (metropolitan) and Port Augusta (rural) CaFHS sites and also by the CaFHS nurses providing a visiting service to the Anangu Pitjantjatjara Yankunytjatjara (APY) lands. Aboriginal Cultural Consultants, Child Health Nurses and Early Childhood Intervention Coordinators will deliver the screen alongside caregivers and their children.
"The ASQ-3 is already being used as a developmental screening tool by CaFHS staff, but we’re looking forward to trialling the ASQ-TRAK with Aboriginal children across these 4 services."
Dr Deepa Jeyaseelan, Paediatrician, Child and Family Health Services