### ASQ:SE-2 Information ## 2 Information for ### for Health Care Providers # Health Care Providers The Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2), is a series of nine parent-completed questionnaires for screening children from 1 month to 6 years of age. ASQ:SE-2 assists with monitoring children’s social-emotional development and identifying potential social or emotional issues. ASQ:SE-2 is a companion tool to the Ages & Stages Questionnaires, Third Edition (ASQ-3), which is designed to screen children’s developmental skills. ##### ASQ:SE-2 CUTOFF GUIDANCE There are three possible ASQ:SE-2 results based on the child’s total score in relation to the cut-off. These are indicated as follows in the score interpretation section of the ASQ:SE-2 Information Summary: • ***The child’s total score is in the dark area. It is above the cutoff. Further assessment with a*** ***professional may be needed. A total score that is above the cutoff indicates a need for further*** evaluation and/or additional follow-up actions. This “refer” area on the scoring graphic is above the statistically derived cutoff score. • ***The child’s score is in the lightly shaded area. It is close to the cutoff. Review behaviors of*** ***concern and monitor. A total score in the lightly shaded area, called the monitoring zone, indi-*** cates a need for monitoring and may require follow-up actions for items of concern. The “moni- tor” area on the scoring graphic identifies children whose performance falls close to the cutoff score. Note: If the child being screened is a girl, consider a referral for further evaluation if her score is in the monitoring zone. Data collected in the renorming of ASQ:SE-2 indicated that girls’ total scores overall were lower than boys. • ***The child’s total score is in the white area. It is below the cutoff. Social-emotional devel-*** ***opment appears to be on schedule. If there are no concerns about the child’s behavior,*** a total score below the cutoff indicates that the child’s social-emotional development is on schedule at this time. This is the “low or no risk” area on the scoring graphic. ##### ADDITIONAL RECOMMENDATIONS Please carefully review the following important recommendations and considerations. • This screening tool should be used in a preventive manner. For children whose ASQ:SE-2 scores are above cutoffs, respond immediately rather than waiting to see if children’s social- emotional skills improve over time. Consider saying, “It’s best not to wait. Let’s play it safe and make a referral now.” • High scores on ASQ:SE-2 do not necessarily indicate a mental health diagnosis or eligibility for early intervention/early childhood special education (EI/ECSE) services. Carefully review with a child’s parent or other primary caregiver a score above the cutoff, regardless of diagnoses or eligibility. • Pay close attention to individual item scores of 10 points (indicated with an X beside the item response box) or 15 points (an X combined with a parent’s checked concern for that item). • When discussing concerns with caregivers, avoid using terms that may provoke anxiety, such as *abnormal or atypical. Use phrases such as above the cutoff or monitoring zone when discussing* results with concerns. The ASQ:SE-2 developers—and many health care providers—suggest a direct conversation with caregivers, ideally face to face, about any behavioral concerns. • Thoughtfully interpret ASQ:SE-2 results in combination with ongoing developmental- behavioral surveillance. • Elicit and address caregivers’ concerns (e.g., “Can you tell me more about . . . ?”) • Review the child’s developmental milestones or ASQ-3 results over time • Consider pertinent biological factors (e.g., prematurity, low birth weight, in utero drug exposure), environmental risks (e.g., parental depression/anxiety, parental drug abuse, exposure to domestic violence), and protective/resiliency factors • Carefully observe parent–child interactions during the physical exam • Make observations while promoting healthy development and behavior (e.g., literacy promotion and other anticipatory guidance as recommended by the American Academy of Pediatrics) • Be sure to interpret and make decisions about ASQ:SE-2 results with consideration to fami- lies’ cultural contexts. Family expectations about behavior and child development may differ from those of professionals. In general, when parents complete ASQ:SE-2, the item responses should reflect the parents’ beliefs, expectations, and concerns about their children. It is impor- tant to actively involve caregivers in any decision making to determine what next steps, if any, should be taken. • The health care provider’s ongoing surveillance decisions should not override the caregiver’s concerns, or results above the cutoff, and thereby negate the need for parent-centered learn- ing activities, a community-based referral, or other interventions. • Recognize that there are many different actions that can be taken if ASQ:SE-2 scores are high or there are parent concerns. Examples include referrals to the following: the local EI/ECSE agency, an early childhood mental health provider or program, a multispecialty comprehen- sive evaluation, an evidence-based parenting program, family counseling, and in-office par- ent education/anticipatory guidance. When concerns arise, ongoing surveillance (or a care coordinator/patient navigator) should be used to work with the parent to determine the most effective next steps. • Cross-sector collaboration and care coordination between health care providers and community-based agencies and other early childhood disciplines may be necessary to swiftly link children who are at risk and their families to a wide assortment of community resources. ##### BACKGROUND INFORMATION ON ASQ:SE-2 Normative data for ASQ:SE-2 were established based on a nationwide sample of more than 14,000 children. Research conducted on the validity of ASQ:SE-2 compared results with other parent- completed diagnostic measures, such as the Child Behavior Checklist, and/or a child’s medical or behavior-related diagnoses (e.g., autism spectrum disorder, attention-deficit/hyperactivity disorder, anxiety disorder, oppositional defiant disorder). The distribution of scores on this tool was positively skewed. For example, the 48 month question- naire had a range of scores from 0 to 350—a median of 45. Cutoffs for questionnaires were deter- mined using a statistical procedure (i.e., receiver operating characteristic curves) for nonnormal distributions. Visit www.agesandstages.com for more information about ASQ:SE-2, including the technical report.