# Guidelines for Cultural and Linguistic Adaptation of ASQ®-3 and ASQ®:SE-2 Thank you for your interest in translating and adapting the Ages & Stages Questionnaires®, Third Edition (ASQ®-3) or the Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ®:SE-2). ASQ-3 and ASQ:SE-2 are widely-used developmental and behavioral screening tools that are completed by parents or others familiar with the child. The questionnaires include easy-to-answer questions about a child’s development from ages 1 to 66 months (ASQ-3) or 1 to 72 months (ASQ:SE-2). Comparing a child’s score on the questionnaires with empirically-derived cutoff points shows how closely the child’s development matches that of other children of the same chronological age. ## ABOUT THE GUIDELINES Since ASQ-3 and ASQ:SE-2 were developed in the United States (US), the data used to study their psychometric properties and to set cutoff points came primarily from families and children living in the US. Many researchers and practitioners, both inside and outside the US, are interested in translating and adapting the ASQ-3 and ASQ:SE-2 for use with families from diverse cultures who speak other languages. The tool developers and the publisher and copyright holder, Brookes Publishing, support use of the ASQ- 3 and ASQ:SE-2 with diverse families around the world. In many cases, Brookes Publishing grants permission for translation and adaptation of tools. However, translation and adaptation of a tool for another culture requires planning and review. These guidelines outline the process for translating and adapting ASQ-3 and/or ASQ:SE-2 into a language other than American English and suggest ideas and considerations for each tool’s cross-cultural use. Adapting a measure for another culture requires careful consideration to make sure it is used correctly (Ball & Janyst, 2008). Screening or assessment tools that are not culturally appropriate may produce misleading or negative results with unintended consequences (Musquash & Bova, 2007). The developers and publisher of ASQ-3 and ASQ:SE-2 believe in the importance of cultural fit and strongly urge you to consider the guidelines that follow. These guidelines cover three areas: 1) cultural considerations, 2) linguistic considerations, and 3) interpreter guidelines. This document also has a section on the importance of collecting data to establish new cutoff points appropriate for the culture and language for which the tool is being used. Appendix A outlines the steps in the recommended translation process. For more detailed instructions regarding adaptation and translation, see the ASQ-3 User’s Guide (Squires, 2009; pp. 43–44) or the ASQ:SE-2 User’s Guide (Squires, 2015; Appendix G, pp. 283–285). ## CULTURAL CONSIDERATIONS 1. Examine whether the purpose of ASQ-3 (i.e., to assess children’s developmental status through parent completion of a questionnaire) or ASQ:SE-2 (i.e., to assess children’s social-emotional competence through parent completion of a questionnaire) aligns with the cultural values and beliefs of the community. 2. Consider the experience of the community with previous assessment and evaluation projects and how these experiences might affect how ASQ-3 and/or ASQ:SE-2 are introduced and adapted. 3. Examine the instructions for using ASQ-3 and/or ASQ:SE-2 and change the instructions as necessary to ensure appropriateness for cultural norms and values of the community. 4. Examine each ASQ-3 and/or ASQ:SE-2 item and change the content as necessary to ensure cultural appropriateness for the community. 5. Revise scoring criteria to reflect culturally relevant experiences and norms. ## LINGUISTIC CONSIDERATIONS 1. Focus on keeping the developmental skill level being assessed consistent with the original item rather than translating each item word-for-word. 2. Use simple words and phrases to ensure that parents and practitioners understand each item. 3. Consider using additional illustrations and examples to reflect item changes or to improve caregiver understanding. 4. Do not include activities that are unfamiliar or offensive to the community. 5. Examine variations in dialect to ensure the translation is appropriate for the specific community. 6. Complete a back translation to ensure accuracy. 7. For ASQ-3, consider substituting new Communication items to appropriately accommodate differences in the grammar of the language. ## ESTABLISHING CULTURALLY APPROPRIATE CUTOFF POINTS ASQ-3 and ASQ:SE-2 cutoff points are used to determine if a child is developing similarly to same-age peers. The adopting of a measure into a different culture requires careful consideration to ensure appropriate use. The developers and publisher of ASQ-3 and ASQ:SE-2 request that those who wish to translate them to use them outside the US study the guidance offered in this document and refer as needed to other references listed in Appendix B. ## RESEARCH AND METHODOLOGICAL CONSIDERATIONS FOR TRANSLATIONS Pena (2007) recommends four critical areas to assess equivalence of test translations: linguistic, functional, cultural, and metric. Functional equivalence ensures that the instrument and the elicitation method allow examination of the same construct in the test. Cultural interpretations may affect how different families report information. ## GUIDELINES FOR USING INTERPRETERS Many programs may not have access to translated questionnaires. Providers will need to work with interpreters who can translate ASQ-3 and/or ASQ:SE-2 items directly for the family. ## Prior to Administration 1. Read through ASQ-3/ASQ:SE-2 with the interpreter or give the questionnaire to the interpreter to allow them sufficient time to understand the items. 2. If you or the interpreter are unclear about the skill measured by the item, discuss it with someone who is familiar with child development. 3. If a certain item is not culturally appropriate, discuss it with someone who is familiar with child development and the culture to find relevant substitutes. ## During Administration 1. At the beginning, introduce yourself through the interpreter; explain the purpose of ASQ-3/ASQ:SE-2 and that the screening is confidential. 2. Limit the amount of information given. 3. Speak slowly and clearly. Talk directly to the family rather than to the interpreter. 4. Encourage the involvement of caregivers and the interpreter. 5. While completing the questionnaire, regularly check with the family to ensure cultural relevance of the items. ## After Administration 1. Respond to all final concerns and questions from the family. 2. Note the items that the family found confusing or culturally inappropriate. ## FINAL THOUGHTS ASQ-3 and ASQ:SE-2 can be used successfully with families and children from diverse cultures and across many linguistic backgrounds if appropriate steps are taken to adapt and/or translate the screening tools for such use. In addition to these cultural, linguistic, and interpreting guidelines, please see Appendix A, Recommended Translation and Adaptation Process, for further information about steps to follow. ## Appendix A ### Recommended Translation and Adaptation Process Step 1: Obtain permission from Brookes Publishing. Step 2: Translate forward. Step 3: Translate back. Step 4: Compare the back translation with the original English version. Step 5: Modify the forward translation. Step 6: Pilot the translated version. Step 7: Modify the pilot version. Step 8: Use the final translation of ASQ-3 or ASQ:SE-2. ## Appendix B ### References Associated with Cultural Adaptation and with Translation of ASQ-3/ASQ:SE-2 1. Ball, J., & Janyst, P. (2008). 2. Bian, X., et al. (2010). 3. Campos, J., et al. (2010). 4. Clifford, J. et al. (2017). 5. Dionne, C., et al. (2004). 6. Janson, H., et al. (2004). 7. Pena, E.D. (2007). 8. Squires, J., et al. (2009). 9. Squires, J., et al. (2015). 10. Tsai, H.A., et al. (2006).