Successfully screening children who don’t come from English-speaking families: Part 1

A Q&A with ASQ® co-developer Kimberly Murphy

There’s a lot of planning that goes into ensuring screenings with non-English speaking families are productive, accurate, and culturally relevant—and as we learn from ASQ co-developer Kimberly Murphy, it’s not always as simple as providing a translated questionnaire. Here she answers some important questions you may have as you plan for a successful bilingual screening.

Planning ahead is essential for successful bilingual screening

What’s the difference between adapting and translating an ASQ questionnaire?

If you need to screen a child whose family does not speak English or is not bilingual enough to ensure clear and accurate communication, you will need to make accommodations to ensure the questionnaire can be completed accurately. This could take a few different forms.

Kimberly Murphy, ASQ co-developer

Adapting a questionnaire involves working with an interpreter or someone else familiar with the family’s culture and language to review and modify questionnaire items if needed so that the translation can be linguistically equivalent and culturally appropriate.

Why should programs take the time to adapt questionnaires to a family’s culture, and are there potential consequences of not doing so?

Translating a questionnaire relies upon a person who is fluent in both English and the target language and culture translating questionnaire items from English to that target language, as a first step in the adaptation process. These are not simply word-by-word translations; a nuanced approach that includes item adaptation as necessary is required to ensure the items make sense and are culturally appropriate.

When English is the first language

When English is the first language, we can quite easily discover adaptations that need to be made during conferences or home visits because it’s part of the usual conversation. In a non-English speaking family, you’d want to know about possible differences ahead of time so you don’t cross barriers right when you walk in the door. Missteps can influence the provider-family relationship in a negative way. For example, there may be items on a questionnaire, such as those about self-feeding or looking in a mirror, that a particular culture may not allow their child to do. By simply asking about these topics, the parent may feel as though you want to make their child perform the skill—which they may find intimidating and view as forced cultural change.

Additionally, including an item that isn’t culturally relevant will not give an accurate picture of the child’s development, which can also strain the provider-family relationship. For example, there may be items in the Communication domain that ask questions specific to the English language structure and development that will not be relevant in the target language. Consider if a speech-language pathologist (SLP) or other specialist may need to be consulted to identify equivalent items that demonstrate early language development in the target language.

Should an interpreter be present when the family completes the questionnaire, even if they are using one of the available translations?

A family could certainly complete ASQ on their own if the appropriate translation is available and literacy is not an issue. You will also need an interpreter who is bilingual and bicultural to be present when you review the results with the family. What we want to avoid is the check-off task where a family receives a questionnaire with no introduction and no follow-up occurs after it’s completed. While it may take extra steps and resources, building a positive relationship with every family is key to ensuring young children receive the support they need for healthy development.

Do I have to use a trained interpreter? Can the child or another family member serve in this role?

In general, having the child, another family member, or even a neighbor serve as an interpreter for ASQ screening is not the best choice, for a few different reasons. First, if we look at best practices in screening—regardless of the situation or language—the home visitor or developmental specialist is seeking to create a relationship with the parent or caregiver. Using another person within the family or close to the family could seem like a practical solution, but without planning or checking into the family’s culture and practices, the practitioner can unknowingly undermine that relationship or prevent it from flourishing.

Another consideration is the accuracy of a screening—getting relevant and important information that allows the practitioner and parent to support a child’s next steps and development together. As part of the screening process, it’s also likely that you’ll need to make modifications to questionnaire items to account for cultural differences and/or family routines. With planning ahead of screening, having a trained and impartial interpreter can help ensure accuracy.

How can I prepare my interpreter for the screening?

Make sure your interpreter has had an opportunity to talk with the screening administrator and review ASQ beforehand. This way, any questions about the intent of the questionnaire items can be answered before the family is involved. At the very least, do a brief review with the interpreter at least 20 minutes before getting together with the family. Assuming your interpreter is both bilingual and bicultural, they should be able to point out any items that might not be culturally appropriate for the family, which will give you a chance to discuss how those items can be modified or omitted during the screening.

Can the interpreter use an English ASQ questionnaire with the family or should I provide a translated version?

If possible, providing a translation will be really helpful for both the interpreter and the family because it allows a joint reference between the interpreter and parents. Just as you would when using an English questionnaire with English-speaking families, when parents and provider can use the written items as a joint reference, it makes conversation to clarify the intent of an item much easier. This also helps the parent and provider to modify an activity to something more familiar to the family and child, if needed.

Using a translated ASQ also helps the interpreter. You can imagine the challenge of trying to interpret in the moment each of 30 items, plus overall questions, all while making allowances for cultural and linguistic differences. When possible, it’s much more helpful having a translated version to start with!

When working with non-English speaking families, are there any considerations around scoring that I should be aware of?

Yes. The cutoffs on both the ASQ-3 and ASQ:SE-2 were based on U.S. norms using samples of American children and typical U.S. daily routines and prekindergarten learning. Therefore, when reviewing and interpreting results after a translated version has been used or an interpreted session has occurred, extra consideration for interpreting scores is necessary.

For example, you might be working with a family who has recently immigrated and has experienced trauma or not had access to a normal home life. ASQ items assess activities that are done as part of daily routines in stable environments. It wouldn’t be unusual in this scenario if a child’s scores show at risk results right away, but this isn’t necessarily cause for immediate referral. The child/family situation can be considered individually, according to their circumstances. You may decide the best approach is to keep working with the family to encourage the child’s development and rescreen at a later point. General ASQ best practices still apply. If a child of any language hasn’t had an opportunity to practice an activity, give them an opportunity and time to practice skills, and rescreen to follow up.

About Kimberly Murphy

Since 2012, she has been working with researchers in the U.S. and around the world to translate and adapt ASQ and ASQ:SE in many different cultures and environments. Working together with the ASQ developers, several adaptations from this work have been piloted for use in U.S. populations, leading to the publication of ASQ-3 in Vietnamese and Arabic. Simplified and Traditional Chinese translations of ASQ-3 will publish in Fall 2018.

Helpful Resources

Brookes Publishing offers various translations of both Ages & Stages Questionnaires (ASQ-3 and ASQ:SE-2) as well as access to plenty of resources that can help you work better with families and facilitate your own modifications and adaptations.