Download - Using the ASQ with Diverse Families
Ages & Stages Questionnaires®, Third Edition (ASQ-3™)
and Ages & Stages Questionnaires®:
Social-Emotional (ASQ:SE)
Cross-Cultural Considerations in the use of the
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
A child grows in and through contextually based relationships, and assessment of her
developmental status is affected by her cultural context as well as the perspectives of the examiner and the reporting caregivers.
Kathy Hepburn, Georgetown University Center for Child and Human Development
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• 115.8 million identify as minority race or ethnicity (2012, Esri)– 52.8 million Hispanics – 39.5 million blacks – 15.2 million Asians/American Indian/Pacific
Islander• By 2050, whites no longer in the majority• 40% of children under 5 will be Hispanic
U.S. Demographics
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Objectives
• Describe ASQ-3 and ASQ:SE
• Discuss cultural considerations in using screening tools
• Present research on cross-cultural uses of ASQ
What are ASQ-3 and ASQ:SE?
• Parent- or caregiver-completed screening tools that encourage parent/caregiver involvement
• Series of questionnaires for children ages 1 month to 5½ years
• Tools to accurately identify children at risk for developmental or social-emotional delay
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
What are ASQ-3 and ASQ:SE?
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
ASQ-3 and ASQ:SE Domains
ASQ-3• Communication• Gross motor• Fine motor• Problem solving• Personal-social
ASQ:SE• Social-emotional development
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Screening Assessment• A brief assessment procedure designed
to identify children who should receive more intensive diagnosis or evaluation from local early intervention (EI), early childhood special education (ECSE), health, and/or mental health agencies
• Answers the question: "Does the child need further evaluation?"
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Why Screen?
ClearlyTypical
Under Detected
?
Adapted from Macias, M. (2006) D-PIP Training Workshop
ClearlyAtypical
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Why Screen?
ClearlyTypical
Under Detected
?
Adapted from Macias, M. (2006) D-PIP Training Workshop
ClearlyAtypical
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Screening: Potential challenges if process is not sensitive
• Over-referral of children for special education services
• Under-referral of children who could benefit from special education services
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Features: Cultural Adaptability
• Flexible administration methods (ASQ-3 and ASQ:SE)
• Alternative materials may be used (ASQ-3)
• Scoring permits omission of inappropriate items (ASQ-3 and ASQ:SE)
• Normative sample includes diverse populations (ASQ-3 and ASQ:SE)
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• Ability to reframe questions if needed to emphasize “intent” (ASQ-3 and ASQ:SE)
• Assesses parent concerns (ASQ-3 and ASQ:SE)
• Subjectivity is inherent in behavioral assessment (ASQ:SE)
• Allows for multiple caregiver completion (ASQ-3 and ASQ:SE)
Features: Cultural Adaptability
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Cross-Cultural Considerations in the Screening Process
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
What issues may arise when: 1) Meeting and introducing
concept of screening2) Administering tool3) Communicating
results/follow-up ideas4) Interpreting scores/making
referrals
Cross-Cultural Considerations in the Screening Process
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• What issues may arise introducing screening?• What is the family’s home language? • Who should be at the meeting? • What are possible family customs? (e.g.,
greeting, dress?)• How does the family feel about screening?• Do you need an interpreter or cultural
broker?
Cross-Cultural Considerations: Introducing Screening
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
How might culture or values influence these activities?• Feeding, Dressing• Reading and Writing Tools• Scissors, beading
• Playing with Toys• Blocks, stuffed animals,
shopping carts, mirrors• Sports (e.g., balls)
Cross-Cultural Considerations: Administering Screening Tools*
Adapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research and Practice. CUP Partnership, Alberta, Canada.
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• Who should be involved in discussion?• What are appropriate follow-up activities?• In some cultures, a mother "playing" with
her child may not seem appropriate• As a helper, you bring your “best remedy.” • Are community referral agencies familiar
with, sensitive to family culture?
Cross-Cultural Considerations: Communicating Results, Follow-Up
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Gather information from family members when concerns arise:• Is there a problem?• Why is there a problem?• What do you think caused the problem?
• What can be done?• What interventions would be
appropriate?
• Who can help?
Recommendations for Practitioners
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Consider the following:• Scores (ASQ-3 & ASQ:SE)• Was an adaptation of ASQ-3/ASQ:SE used?• Overall Responses & Parent Concerns• Additional Factors (e.g., health, setting, stress)
-Family culture, home language
Cross-Cultural Considerations: Score Interpretation and Referrals
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Recommendations for PractitionersAdapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research
and Practice. CUP Partnership, Alberta, Canada
• Consider families’ pre- and post-immigration experiences
• Use cultural brokers and interpreters• Ask families about cultural expectations of
early development• Clarify language and meaning of each items
and reframe questions
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• Incorporate non-standardized methods into the screening process
• Interpret screening results with caution and integrate relevant cultural data
• Debrief the results with the family, determine appropriate follow-up together
• Throughout the process, validate the family’s cultural belief system
Recommendations for PractitionersAdapted from Cross-Cultural Lessons: Early Childhood Developmental Screening and Approaches to Research
and Practice. CUP Partnership, Alberta, Canada
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• Learn about one’s own cultural framework, world view, power and privilege position
• Think about “culture” from your family history, community, training, and work setting
• What values, beliefs, or “cultural messages” did you receive about family interactions and childrearing?
Recommendations for Practitioners: Self Awareness
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
BE AWARE OF YOUR THOUGHTS• Children who come to school dirty are…• Parents who smoke are …• Parents who sleep with their kids …• Children arrive in school in best dress …• Parents who carry their children all the time …• Families who don’t read to their kids …• Parents who talk negatively toward their children are …• Mothers who breastfeed their babies past age of 1 year…• Children who are overweight …• Angry family members who don’t trust helping professionals …
Recommendations for Practitioners: Self Awareness
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• Research on Early Childhood Screening in Immigrant and Refugee Families in Canada
• Rebecca Gokiert (PI)• Great Resource! • Cross-Cultural Handbook•Downloadable PDF from
www.cup.ualberta.ca
Community-University Partnership (CUP) for the Study of Children, Youth, and
Families (Alberta, Canada)
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Research
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Selected Translations/Adaptations of ASQ-3 and/or ASQ:SE
Aboriginal AustralianAfrikaansArabicBengaliBulgarianChanganaChinese (Simplified)ChuukeseCzechDanishDutchFinnish
FrenchGalicianGeorgianGreekHmongHungarianItalianJapaneseKinyarwandaKoreanMarshalleseNorwegian
Portuguese (Brazil)Portuguese (Portugal)RussianSomaliSwahiliSwedishTagalogThaiTurkishUkrainianUrduVietnamese
For more information about translations, visit http://agesandstages.com/what-is-asq/languages/
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
28
Functional
LinguisticMetric
Cultural
Factors to Consider in Adaptations (Peña, 2007)
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• National Study • Providers Surveyed: (6) Home visitors, mental health specialist, public health providers• Measured Utility (usefulness) of ASQ:SE• Majority Satisfied • Areas with most diverse expectations or confusion: self-feeding activities, floor time questions
Can ASQ:SE be used with families from diverse cultural backgrounds?
(D. Lyman, W. Njoroge, D. Willis, 2007)
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Cultural variations found most often in areas of:• Self Regulation• Attachment • Feeding/Toileting Training
Can ASQ:SE be used with families from diverse cultural backgrounds?
(D. Lyman, W. Njoroge, D. Willis, 2007)
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
ASQ-3 Spanish
Refined Spanish Translation:• Reflects all changes to ASQ-3 English
• Translation reviewed by a panel of experts—focused on issues of dialect, idioms, etc.
• Clearer wording to improve utility for Spanish-speaking parents
From ASQ-3™ and ASQ:SE Training Materials by J. Squires, J. Farrell, J. Clifford, S. Yockelson, E. Twombly, and L. Potter © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
32
Item Functioning DIF analyses• 27 out of 90 items functioned differently
across groups• Older age intervals—24, 30 months• Difficulty of items represented evenly
across language versions• Minor revisions to a few items
recommended
ASQ-3 Spanish: Research
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
ASQ-3 Scores
• MANOVA: For each of the 3 intervals (9, 18, and 30 months)
• Language was statistically related to the weighted multivariate combination of DV measures in each age interval
• ANOVA showed statistically significant mean differences between groups• 9 m: version on communication and personal-
social • 18 m: version on personal-social• 30 m: version on fine motor
ASQ-3 Spanish: Scores
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
34
• Items easy to understand• Clear, easy to respond • ASQ-3 interesting, helped think about
children’s development• 87% indicated would not introduce any
changes• Pomes & Squires, under review
ASQ-3 Spanish: Readability and Utility
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• Developed cutoff points based on national sample
• Adaptations to some items (e.g., chopsticks)• In general, mean scores similar to U.S. (only
10% of means had > 5 point difference)• Differences found in communication,
problem-solving, personal-social• Fine motor skills means lower in younger
children, then surpassed U.S. sample at 36 -60 months
ASQ Research: KoreaHeo, Squires, & Yovanoff (2008)
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• French-Canadian (Quebec)• High validity and reliability• Used in child care centers, pediatric offices• ASQ, 2nd Edition, French• Dionne and colleagues (2004, 2006)
• Netherlands (Dutch)• Translation and adaptation of 48 months• High validity and utility• Completing remainder of 3rd edition (ASQ-3)• Kerstjens, Bos, and ten Vergert (2009)
ASQ Research: Canada and Netherlands
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
ASQ Research: China
Chinese (Shanghai; complex characters)• In general, minor differences in
means• Most differences in Fine Motor• Lower mean scores between 4 and
27 months, higher after 27 months• Children born in winter walked later
than children born in spring/summer
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
Equador
• Flower growing region• ASQ administered to children as well as
growth measurement, blood test• Children 24-61 months residing in high-
exposure communities scored significantly lower on gross motor skills compared to low exposure group
38
ASQ Research: EcuadorHandal, Lozoff, Breilh, & Harlow (2007)
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
% of Children Displaying Developmental DelayRelated to Proximity to Flower Fields
Communication
Gross
motor
Fine m
otor
Problem so
lving
Socio
individual
05
101520253035404550
Community CCommunities A and BPe
rcen
t del
ay
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• Minnesota--statewide• ASQ:SE on small PDAs, paper
www.patienttools.org• Screened 10,000 children• Adapted scoring options for Hmong (4
point scale)• Extremely low cost—start up was most
costly part• High satisfaction by programs and
parents• Identified between 5-28% of children• Foundationforsuccess.org
ASQ:SE Research: USA on Hmong, Somali populations
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
• ASQ-3 and ASQ:SE have been used successfully with families from diverse cultural backgrounds
• Important to consider the family’s culture in the process of screening
• Research supports the use of these tools with families from diverse cultural backgrounds
In Summary
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.
ASQ-3™ & ASQ:SE Training Institute
June 5-7, 2013Hyatt Regency Grand Cypress
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For More Information, Please Contact:
Jane Squires, Ph.D.,Liz Twombly, M.S., or Jantina Clifford, Ph.D.University of Oregon541-346-0807eip.uoregon.edu www.agesandstages.com
© 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.