# Design Options for Home Visiting Evaluation

## MEASUREMENT TOOL BRIEF

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

### Overview

Many Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program grantees have proposed to use the Ages & Stages Questionnaires®, Third Edition (ASQ-3™) and/or the Ages & Stages Questionnaires®: Social-Emotional (ASQ:SE) to measure progress on Benchmark Area 3 (School Readiness & Achievement) constructs. This document describes the ASQ-3 and ASQ:SE and outlines appropriate uses of the instruments in meeting MIECHV Benchmark Area measurement requirements.

### The ASQ-3

The ASQ-3 is a screening tool designed to identify infants and young children (ages 1 – 66 months) who may be eligible for early intervention or early childhood special education services. It screens children to assess if they are displaying typical development for their age.

The ASQ-3 consists of questionnaires to be completed by parents or other primary caregivers who know the child well (e.g., grandparents, foster parents, child care providers). Parents complete one of 21 questionnaires based on their child’s age (2, 4, 6, 8, 9, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42, 48, 54, and 60 months). These questionnaires can be completed during a home visit or on their own and shared with the home visitor later.

The ASQ-3 User’s Guide recommends initial screenings at 2 and 4 months, followed by screenings at 4-month intervals until 24 months, and semi-annual screenings until 5 years.

**Areas of the ASQ-3:** Each ASQ-3 questionnaire includes 30 developmental items clustered into five areas/subscales:
- **Communication:** Child’s babbling, vocalizing, listening, and understanding
- **Gross Motor:** Child’s arm, body, and leg movements
- **Fine Motor:** Child’s hand and finger movements
- **Problem Solving:** Child’s learning and playing with toys
- **Personal-Social:** Child’s solitary social play and interactions with others.
  
### Administration of the ASQ-3

Questionnaires can be distributed through the mail, at health clinics, or during home visits. Parents are encouraged to observe their children's behavior and use objects around the house for some items on the questionnaire.

### Scoring of the ASQ-3

Scoring takes about 2-3 minutes and can be completed by trained staff. Items are scored based on responses: 10 points for "yes," 5 for "sometimes," and 0 for "not yet." Each area can total 60 points. If scores fall below a specific cutoff, further assessment for the child is recommended.

### Psychometrics of the ASQ-3

**Reliability:** Various methods have assessed reliability:
- **Test-retest reliability:** 92% agreement on classifications from parents completing two questionnaires within two weeks.
- **Inter-rater reliability:** 93% agreement between parent ratings and those of a trained examiner.
- **Internal consistency:** Moderate to high across 20 different age intervals.

### The ASQ:SE

The ASQ:SE assesses children’s social and emotional competence and is designed to complement the ASQ-3. It screens for social or emotional developmental needs in infants and young children (ages 3-66 months).

**Areas of the ASQ:SE:** Each questionnaire covers seven developmental areas:
- **Self-regulation**
- **Compliance**
- **Communication**
- **Adaptive functioning**
- **Autonomy**
- **Affect**
- **Interaction with people**

### Scoring of the ASQ:SE

Scoring can be done manually or through a web-based system. Each item is scored 0, 5, or 10 points, with higher scores indicating potential concerns. Recommendations for referral for diagnostic assessments are provided based on scores.

### Use of the ASQ-3 and ASQ:SE for MIECHV Benchmark Area Measurement

The ASQ-3 and ASQ:SE should be used to report on the percentage of children scoring above or below cutoffs, rather than numerical score comparisons over time.

### Costs for the ASQ-3 and ASQ:SE

As of 2012, the ASQ-3 Starter Kit costs $275, and the ASQ:SE Starter Kit costs $225. Training for the administration of these tools is highly recommended and separate costs apply for seminars.

### Guidelines for Using the ASQ-3 and ASQ:SE to Measure Benchmark Area 3 (School Readiness and Achievement)

| Construct | Item(s) | Additional Considerations |
| --- | --- | --- |
| Parent support for children's learning and development | | Not applicable |
| Parent knowledge of child development | Completion of ASQ-3 and ASQ:SE questionnaires over time | Completion of tools shows parent understanding of their child’s developmental progress. |
| Child communication, language and emergent literacy | ASQ-3: Communication area | Items focus on oral communication, requiring additional instruments for comprehensive literacy assessment. |
| Child’s general cognitive skills | ASQ-3: Problem Solving area | Problem-solving area relates to cognitive skills but is not specifically focused on them. |
| Child's physical health and development | ASQ-3: Gross and Fine Motor areas | Open-ended questions also assess physical health education. |