evaluating reliability and use of the ages and stages

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EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES QUESTIONNAIRES: THAI IN NORTHEAST THAI EARLY CHILD CARE SETTINGS by PRASONG SAIHONG A DISSERTATION Presented to the Department of Special Education and Clinical Sciences and the Graduate School of the University of Oregon in partial fulfillment of the requirements for the degree of Doctor of Philosophy December 2009

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Page 1: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

QUESTIONNAIRES: THAI IN NORTHEAST THAI EARLY

CHILD CARE SETTINGS

by

PRASONG SAIHONG

A DISSERTATION

Presented to the Department of Special Educationand Clinical Sciences

and the Graduate School of the University of Oregonin partial fulfillment of the requirements

for the degree ofDoctor of Philosophy

December 2009

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11

University of Oregon Graduate School

Confirmation of Approval and Acceptance of Dissertation prepared by:

Prasong Saihong

Title:

"Evaluating Reliability and Use of the Ages and Stages Questionnaires: Thai in Northeast ThaiEarly Child Care Settings"

This dissertation has been accepted and approved in partial fulfillment of the requirements forthe Doctor of Philosophy degree in the Department of Special Education and Clinical Sciencesby:

Jane Squires, Chairperson, Special Education and Clinical SciencesDeanne Umuh, Member, Special Education and Clinical SciencesErin Barton, Member, Special Education and Clinical SciencesKathie Carpenter, Outside Member, International Studies

and Richard Linton, Vice President for Research and Graduate StudieslDean of the GraduateSchool for the University of Oregon.

December 12,2009

Original approval signatures are on file with the Graduate School and the University of OregonLibraries.

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© 2009 Prasong Saihong

111

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An Abstract of the Dissertation of

Prasong Saihong for the degree of

in the Department of Special Education and Clinical Sciences

to be taken

IV

Doctor of Philosophy

December 2009

Title: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

QUESTIONNAIRES: THAI IN NORTHEAST THAI EARLY CHILD CARE

SETTINGS

Approved: _Jane Kaplan Squires, Ph. D.

Due to the lack of a screening and early identification system, preschool children

who live in rural areas in Northeast Thailand have no opportunity to receive specialized

educational services. Most children are identified as having disabilities at school age or

older. In this study, the 24-,30-, and 36-month intervals of the Ages and Stages

Questionnaires (ASQ), a parent-completed screening system, were translated and

evaluated for reliability and use in Northeast Thai early childcare settings. The study

purpose was to investigate the reliability and utility of the Ages and Stages

Questionnaires: Thai (ASQ: Thai). Reliability studies included an investigation of

internal consistency, test-retest reliability, interobserver reliability, and comparison of

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v

differences between U.S. and Thai scores. Utility studies included surveys of satisfaction

of parents/caregivers and early childcare staff as well as brief interviews with

parents/caregivers and early childcare staff.

Subjects included 267 children who were 2-3 years old; 267 parents/caregivers;

49 early childcare staff; and 5 early childcare professor experts. The subjects were

recruited through the Department of Curriculum and Instruction, the Faculty of

Education, Mahasarakham University. Results addressing the reliability and use of

ASQ: Thai were promising. Internal consistency (p = .58 -.89) results were adequate as

well as test-retest agreement (p > .90). A comparison between the ASQ: Thai sample

data and the U.S. normative sample found that there were some differences in range,

mean, median, interquartile range, and cutotT scores. The back translation of the ASQ:

Thai appeared to be adequate in comparison to the original version, as well as culturally

appropriate. Early childcare staff and parents/caregivers felt that the ASQ: Thai was easy

to use and understand and was culturally appropriate, and they gained knowledge about

child development. Early childcare staff and parents/caregivers suggested that the ASQ:

Thai should be used in early childcare settings with children when they enter the

program.

Future research on the ASQ: Thai is needed. Increased study of cultural,

language, and disability issues are areas for further study.

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VI

CURRICULUM VITAE

NAME OF AUTHOR: Prasong Saihong

PLACE OF BIRTH: Srisaket, Thailand

DATE OF BIRTH: May 31,1974

GRADUATE AND UNDERGRADUATE SCHOOLS ATTENDED:

University of Oregon, EugeneNorthern Illinois University, DeKalbMahasarakham University, Maha Sarakham, Thailand

DEGREES AWARDED:

Doctor of Philosophy, Early Intervention, 2009, University of OregonMaster of Arts, Social-Cultural Anthropology, 2003, Northern Illinois UniversityBachelor of Arts, English, 1997, Mahasarakham University

AREAS OF SPECIAL INTEREST:

Early interventionEarly identificationEarly childhood teacher trainingFolklore and early childhood developmentStorytelling for early childhood education

PROFESSIONAL EXPERIENCE:

Presenter, the Talk Story Conference, Honolulu, Hawaii, 2009

Presenter, The Use of an Activity-Based Intervention approach (ABI) forChildren with and without Disabilities, Honoring the Child, HonoringEquity 8: Young Citizen(s), New Citizenship(s) Conference, the Centrefor Equity and Innovation in Early Childhood (CEIEC), Melbourne,

. Australia, 2008

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--------------------- ------- --------------

Vll

Trainee, the National Early Intervention Longitudinal Study (NEILS) Data BaseTraining Workshop, Department of Special Education, the University ofMaryland, 2008

Trainee, Using ASQ to Screen Young Children for Developmental Delays, EarlyIntervention Program: Training Workshop, the University of Oregon, 2006

Trainee, Using ASQ: SE to Assess Young Children for Social-EmotionalDifficulties: Training Workshop, Early Intervention Program, theUniversity of Oregon, 2006

Trainee, AEPS®: A Linked System of Assessment, Evaluation, and Intervention:Training Workshop, Early Intervention Program, the University ofOregon, May 2006

Trainer and Organizer, Brain-Based Learning Training Workshop, MahasarakhamUniversity, 2006

Lecturer, School of General Education, Institute of Social Technology SuranareeUniversity of Technology, Thailand, 2004-2005

Presenter, Storytellers & Storytelling in Northeast Thailand, Asian Storyteller ofCongress, Singapore, 2004

Coordinator, Singapore International Foundation for Youth Expedition Project,Suranaree University, Thailand, 2004

Coordinator, Singapore International Foundation for Youth Expedition Project,Mahasarakham University Thailand, 2003

Graduate Research Assistant, the Center for Southeast Asian Studies, NorthernIllinois University, DeKalb, Illinois, 2001-2003

Presenter, Council on Thai Studies Annual Conference, Northern IllinoisUniversity, DeKalb, Illinois, 2001

Presenter, the Seattle Storytelling Festival, Seattle, Washington, 2001

Participant, the American Anthropology Association Meeting, Chicago, Illinois,2001

Teaching Assistant, Western Languages and Linguistics Department, Humanitiesand Social Sciences Faculty Mahasarakham University, Mahasarakham,Thailand, 1999-2000

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viii

Assistant Director, Mahasarakham Storytelling Project, MahasarakhamUniversity, Thailand, 1998-2000

Visiting Researcher, Center for Asian and Pacific Studies (CAPS), University ofOregon, Oregon, 1999

Presenter, Council on Thai Studies Annual Conference, University of Wisconsin­Madison, Wisconsin, 1998

Presenter, Annual Conference of the American Folklore Society, Portland,Oregon, 1998

Presenter, Storytelling as Prevention Conference, the Health Department ofTacoma, Tacoma, Washington, 1998

Presenter, the Third Annual National Festival, the Australian Storytelling Guild,Sydney, Australia, 1997

GRANTS, AWARDS AND HONORS:

International Cultural Service Program (ICSP) Scholarship, Office ofInternational Affairs, University of Oregon, 2006-2009

Department of Special Education, the University of Maryland Grant, the NationalEarly Intervention Longitudinal Study (NEILS) Data Base TrainingWorkshop, 2008

Professional Development Scholarship, Mahasarakham University, Thailand,2006-2009

Graduate Research Assistantship, Center for Southeast Asian Studies, Northernillinois University, DeKalb, 2001-2003

John F. Kennedy Foundation of Thailand Grant, Thailand, 1996

PUBLICAnONS:

Saihong, P. (2008). Storytellers and storytelling in Northeast Thailand.Storytelling, Self, Society: An Interdisciplinary Journal ofStorytellingStudies, 4, 20-35.

Saihong, P. (2003). Storytellers in northeast Thailand. Unpublished master'sthesis. Northern Illinois University, DeKalb, IL.

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IX

ACKNOWLEDGMENTS

The success of my study and my research is due to the helps of and supports from

many people and organizations. First of all, I wish to express sincere thanks and

appreciation to Dr. Jane Squires who advised, supported, and assisted me throughout my

doctoral program. I am grateful to her and Dr. Erin Barton for their assistance in the

preparation of this manuscript. In addition, special thanks are due to Professors Deanne

Unruh and Kathie Carpenter for being such supportive committee. I also would like to

pay special thanks to Early Intervention Program staff, which provided administrative

assistance. I would like to thank Mr. Ray Peterson, Ms. Choojit Chaibunrunag, and Mr.

Kim Sua for their friendship and help with my lodging in the first few years of my study.

I would also like to thank Ms. Yvonne Young, my storyteller friend, who provided a

place for me to stay until I finished writing this manuscript. I would like to thank the

Elliott family for being my friends and family. I am grateful for the financial supports

from Mahasarakham University as well as the Office ofIntemational Program,

University of Oregon, which provided scholarships for my tuition and stipends. Without

their supports, I could not have been here. My sincere thanks must also go to Dr.

Wajuppa Tossa, Mr. Wiset and Jantho Tossa, Grandma Panja Tossa, and Dr. Margaret

Read MacDonald. They consistently encouraged me to work hard and keep up on with

my study. Lastly, I would like to thank all of the students and staff at the Curriculum and

Instruction Department, Mahasarakham University, as well as the children and staffs at

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the child care centers who participated in and helped me in my research study. Their

cooperation made my research study done successfully. I would like to make a promise

that I will bring the knowledge I had learned from my participants and the Early

Intervention Program, UO to help early childhood education in Thailand.

x

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For my parents, who encouraged their children to have best education; my sisters, whosacrificed themselves for my education;

and Dr. Margaret Read MacDonald, my teacher and mentor.

Xl

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xu

TABLE OF CONTENTS

Chapter Page

I. WTRODUCTION 1

Early Childhood Special Education Movement in Thailand 3

Comparison of Early Intervention Systems in the U.S. and in Thailand 4

EIlECSE System Model................................................................................... 6

Assessment System for Young Children in the U.S, 8

Screening System for Young Children in Thailand 10

Purpose of the Study and Research Questions................................................. 12

Summary ] 3

II. REVIEW OF THE LITERATURE......................................................................... 15

Theoretical Framework of an Effective System for EIlECSE 16

Historical and Legal Foundations 17

The Theoretical Basis ofEIlECSE 21

Current Preferred Practice......... 23

Assessment in Early Intervention 25

The Linked Assessment ModeL............. 27

Standard 1: Utility...... 28

Standard 2: Acceptability....... 28

Standard 3: Authenticity 28

Standard 4: Equity...................................................................................... 29

Standard 5: Sensitivity 29

Standard 6: Convergence..... 29

Standard 7: Congruence 29

Standard 8: Collaboration 29

Test Adaptation in Early Childhood Screening 32

Childrearing and Child Development Needs in Thailand........ 35

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Chapter

xiii

Page

Environment for Childrearing and Child Development............................. 35

Moral and Cultural Development 36

Early Childhood Education System 37

EIlECSE System in Thailand........................................................................... 38

Family Involvement and the EIlECSE System in Thailand............................. 40

Developmental Assessment Systems for Young Children in Thailand 41

A Thai Screening System................................................................................. 43

Summary 43

III. METHOD OF STUDY 46

Participants....................................................................................................... 47

Children...................................................................................................... 48

Parents/Caregivers......... 49

Teachers/Early Childcare Staff.................................................................. 49

Setting 50

Protection of Human Subjects 50

Measures.. 52

Ages and Stages Questionnaires: Thai (ASQ: Thai) 52

Family Information Survey........................................................................ 53

Early Childcare Staff/Teacher Information Survey................................... 53

Parent Utility Survey.................................................................................. 53

Early Childcare Staff/Teacher Utility Survey............................................ 53

Interview Questions 54

Procedures..... 57

Phase I: Development of the ASQ: Thai................ 57

Step 1: Translation and Back-Translation............................................ 57

Step 2: Review and Editing by Experts 57

Phase II: Reliability Study of the ASQ: Thai............................................. 58

Step 1: Recruitment of Participants 58

Step 2: Training for the Use the ASQ: Thai 59

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Chapter

xiv

Page

Step 3: Recruitment of Preschoolers and Their Parents....................... 61

Step 4: Early Childcare StafffTeachers Complete the ASQ: Thai....... 61

Step 5: Computing Reliability Study of the ASQ: Thai for EarlyChildcare StafffTeachers............................................................. 61

Step 6: Computing Reliability Study of the ASQ: Thai for Parents.... 61

Phase III: Utility Study of the ASQ: Thai.................................................. 62

Step 1: Early Childcare StafffTeacher Utility Survey.......................... 62

Step 2: Parents Complete the Parent Utility Survey... 62

Data Analysis 65

Research Question I: Is the ASQ: Thai a Culturally AppropriateInstrument to Screen Preschoolers for DevelopmentalDelays in Thailand? 66

Research Question II: What Is the Reliability of the ASQ: Thai? .. 67

Internal Consistency............................................................................. 67

Test-Retest Reliability........................................................................ 68

Interobserver Reliability.... 68

Research Question III: Are There Differences Between the Scores ofNortheast Thai Children of 24-,30-, and 36-Month ASQ: Thai andThose of U.S. Children on the ASQ? What Are the Differences?...... 69

Research Question IV: What Is the Utility of the ASQ: Thai, asEvaluated by Parents/Caregivers and Early ChildcareStafffTeachers? 70

IV. RESULTS 72

Participants : 72

Children :. 72

Parents/Caregivers 73

Teachers/Early Childcare Staff..... 77

Cultural Appropriateness 78

Results of the Back Translation...... 78

Results of the Panel of Experts Review.................................................... 79

Results on Parent Satisfaction Survey.... 82

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xv

Chapter Page

Results of the Early Childcare Staffffeachers Satisfaction Survey.... 83

Reliability........ 85

Internal Reliability 85

Test-Retest Reliability 88

Interobserver Reliability........ 90

Differences between the Scores ofthe U.S. ASQ and ASQ: Thai 92

Utility 102

Utility of Parents/Caregivers 102

UtilityofECStaff 104

Knowledge of Screening Instruments 105

Opinions about the Instrument............ 106

Interview with Parents/Caregivers and EC Staff 107

Understanding of Child Development and the Early ScreeningProcess........................................................................................... 107

What Parents/Caregivers and EC Staff Learned from the Use ofthe ASQ: Thai 109

Suggestions from Parents/Caregivers and EC Staff in the Use of theASQ: Thai III

Summary 112

V. DISCUSSION 113

Participants 114

Cultural Appropriateness 115

Research Question I: Content Validity of the ASQ: Thai 115

Reliability...... 117

Research Question II: Reliability of the ASQ: Thai 117

Internal Consistency............................................................................. 117

Test-Retest Reliability 118

Interobserver Reliability........... 118

Differences between the U.S. ASQ and the ASQ: Thai 119

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xvi

Chapter Page

Research Question III: Differences Between the Scores of NortheastThai Children of 24-, 30-, and 36-Month ASQ: Thai and Those ofU.S. Children on the Same ASQ Intervals 119

Utility..... 120

Research Question IV: Utility ofthe ASQ: Thai 120

Parents/Caregivers' Time Use and Assistance Needs 120

Parents/Caregivers' Implementation.................................................... 120

EC Staffs Time Use 121EC Staffs Implementation 121

Limitations.......... 122

Implications............................................................................................ 123

Research..................................................................................................... 123

Practice 124

Suggested Practice for a Thai Screening System 124

Suggestion Practices for EI/ECSE Personnel Preparation 126

Application of Best Practices to an EI/ECSE System in Thailand...... 128

Personnel Training............................................................................... 129

Conclusion 130

APPENDICES 132

A. LETTER OF INVITATION: FACULTY OF EDUCATION,MAHASARAKHAM UNIVERSITy 132

B. LETTER OF INVITATIONS TO SCHOOL DIRECTORS, EC STAFF,AND PARENTS/CAREGIVERS......................................... 135

C. CONSENT FORMS 144

D. THE ASQ: THAI PROTOCOLS 151

E. THE ASQ: THAI, ENGLISH BACK-TRANSLATION 171

F.SURVEYS 177

BIBLIOGRAPHy............. 193

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LIST OF FIGURES

1. Linked System Approach................................................................................. 8

2. A Linked Assessment-Goal Development-Intervention-EvaluationApproach to Early Intervention. 26

3. Was It Easy to Understand the Questions? 82

4. Were the Questions Appropriate for My Child's Age? 82

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XVlll

LIST OF TABLES

Table Page

1. Strengths and Limitations ofthe Linked Assessment Model.... 30

2. Measures, and Respondents, and Schedule............................ 55

3. Developers of the ASQ: Thai........................................................................... 58

4. The Use of the ASQ: Thai Training Schedule 60

5. List the Frequency, Duration and Data Collection Method for Each

Activity 63

6. Describe the Research Hypothesis (es) or the Research Question(s),Outcome Measure, & Analytical Strategy................................................. 65

7. Interview Questions for Parents/Caregivers and EC Staff............................... 71

8. Demographic Characteristics of Children in the ASQ: Thai Sample 73

9. Demographic Characteristics of Families in the ASQ: Thai Sample 75

10. Demographic Characteristics of Teachers/Early Childcare Educators 77

11. Summary of Early Childcare Staff/Teachers' Satisfaction Survey: Opinionon ASQ: Thai 84

12. Cronbach's Coefficient Alpha for the 24-,30-, and 36- Month ASQ Thai 86

13. Correlations between Domains and Total Score for the ASQ: Thai's ECStaff Scores........................ 87

14. Correlations Between Domains and Total Score for the ASQ: Thai'sParents/Caregivers Scores.......................................................................... 88

15. Means and Standard Deviations between Time 1 and Time 2 of theParent/Caregiver Report and Correlations 89

16. Means and Standard Deviations between Time 1 and Time 2 of the EarlyChildcare Staff/Teachers Report and Correlations 90

17. Means and Standard Deviations between the Early ChildcareStaff/Teachers and Parent/Caregiver Reports and Correlations 91

18. The Range, Mean, Median, Interquartile Range, SD, and Cutoff Scores ofthe 24-, 30-, and 36-month ASQ: Thai from Northeast Thai EC Staffand U.S. Data 92

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Table

XIX

Page

19. The Range, Mean, Median, Interquartile Range, SD, and Cutoff Scores ofthe 24-,30-, and 36-month ASQ: Parents/Caregivers Data....................... 96

20. The Comparison of the Percentage of Thai and U.S. Children Who HadScore below the U.S. ASQ Cutoff: EC Staff Completed........................... 100

21. The Comparison of the Percentage of Thai and U.S. Children Who HadScore below the U.S. ASQ Cutoff: Parents/Caregivers Completed 101

22. Summary of Parents/Caregivers' Satisfaction Survey 103

23. Summary of Early Childcare Staff/Teachers' Satisfaction Survey: Time ....... 104

24. Summary of Early Childcare Staff/Teachers' Satisfaction Survey:Knowledge of Screening Instruments 105

25. Summary of Early Childcare Staff/Teachers' Satisfaction Survey: Opinionon ASQ: Thai 106

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1

CHAPTER I

INTRODUCTION

Early intervention/early childhood special education (EIIECSE) services are

essential for preventing the development of major disabilities (Hill et aI., 2004). For

children identified as at risk, interventions began early are likely to be more successful

(Bowe, 2007). Children who are identified as developmentally at risk should have the

right to receive free services based on each individual's needs. Unfortunately, most

children identified as disabled who live in rural areas in Northeast Thailand lack the

opportunities to receive EIIECSE service. They are often identified at an older age and

have to live with their disabilities for the rest oftheir lives.

EIIECSE is not well known in Thailand. Services and supports are mostly limited

to and focused on sensory and severe disabilities only, such as people with hearing or

vision impairments and people with severe impairments. Most children at a young age

have not been identified nor have received any services, although they are at risk of

developmental delays. Due to Buddhism beliefs, parents will let those problems go

unaddressed because those children are considered to have had bad karma in their

previous lives. Until this decade, in Thailand, EI/ECSE was known as "'Inclusive

Practice" or "Inclusion Education" (Carter, 2006). Inclusive practice or inclusion

education is understood by early childhood educators and teachers as the acceptance of

children with disabilities into regular classroom settings. The Education Management for

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2

Individuals with Disabilities Act 2008 specifies that all schools must accept all children

without any conditions. Unfortunately, EI/ECSE is still not involved in the process of

screening each child who may need extra help. If that child can be identified in any given

early childcare setting, barriers to that child receiving special help will eventually fall.

The Ministry of Education of Thailand (MOE) issued an education reform bill in

1997 under which the development of early childhood education was included in the

development of a core curriculum and appropriate practices for early childhood

programs. The effect of this reform makes all children from three to five years old

eligible to receive childcare services from local programs which are located in each sub

district council. MOE has not developed, however, any behavioral and developmental

screening system for children who will enter these early childcare programs. Behavioral

and developmental screening services occur at local public health centers and public

hospitals. However, this screening rarely happens unless the public health care staff sees

obvious symptoms of disabilities; only then will the screening test occur. In other words,

it may then be too late for the child if he is identified as disabled after the preschool

years.

Since there have been no prior research looking at an early identification system

in Thailand and little knowledge about how to develop early identification instruments,

there is a critical need for developing information on effective early identification

systems. The results will be useful to other countries that are beginning a special

education inclusion program in their early childcare centers in elementary schools and

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3

other childcare settings. Most importantly, ECSEI EI services will expand and be

accessible to most people who live in rural areas.

Early Childhood Special Education Movement in Thailand

The Ministry of Education in Thailand has overseen the reform of Thai early

childhood education since 1993. The first move in 1997 established early childhood

education services for all pre-kindergarten children at all public elementary schools. The

second move was to provide guidelines for best practices in early childhood education in

1998. Last was to legalize the Thai National Education Acts ofB.E. 2542 or 1999 (NEA)

that provided for the regulation and management of education in general. This law

specifically defines and makes provisions for early childhood education as well as early

childhood special education. In Section 10, the law specifies that all individuals shall

have equality and equal opportunities for free-of-charge education. Significantly,

individuals with disabilities shall have free-of-charge services beginning at birth or at

first diagnosis, and "these persons shall have the right to access the facilities, media,

services, and other forms of educational aid in conformity with the criteria and

procedures stipulated in the immaterial regulations" (S. 10, 1999). In Section 18, the law

provides for the regulation of early childhood settings and practices which consist of

early childhood development institutions, schools, and learning centers (S. 18, 1999).

Section 18 also regulates the beginnings of inclusion education in all Thai schools which

then was mandated in the Education Management for Individuals with Disabilities Act of

B.E. 2551 or 2008.

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4

It is significant that the Thai National Education Act 1999 mandated the Basic

Education and Early Childhood Education Standards to certify equality in the education of

all Thai children. These early childhood standards regulate best practices for early

childhood education in all developmental domains based on a child-directed approach and

environmentally appropriate settings. In addition, the act urges all agencies to collaborate

to work for all children. Recently, the Ministry of Education passed the Education

Management for Individuals with Disabilities Acts of RE. 2551 (MOE, 2008). This law

mandates that all public schools adopt an inclusive approach which provides for special

education services for children with disabilities. Significantly, the law covers several

aspects, including that all children with disabilities have an Individual Education Plan (IEP)

and urges government agencies to provide services and assistive technology for individuals

with disabilities. This will be the first step toward the development of comprehensive early

childhood special education in Thailand.

In summary, laws and regulations in the special education field have just begun to

be mandated in Thailand. The laws and regulations urge government and nongovernment

agencies to provide appropriate practices, policies, plans, research, and pilot projects for

early childhood development. In the future, laws will need to outline the best practices for

early childhood development and take into account traditional child-rearing practices in

Thailand.

Comparison of Early Intervention Systems in the US and in Thailand

Unlike in the US, different belief systems and practices in Thailand affect current

early childhood special education! early intervention (EI/ECSE) practices. However,

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5

since the Ministry of Education of Thailand established the Bureau of Special Education

Administration (BSEA) in 2001, the Thai EIIECSE system has tried to be as close to the

US EI/ECSE system as possible. However, the Thai system has both differences and

similarities when compared to the US system.

Even though the US Constitution did not specify EI/ECSE services or school

requirements for children from birth to age six, it did state the equality of treatment for all

citizens and regulated laws and services for all (Bowe, 2007). The legislation and

policies of the U.S. EIIECSE system have been stated clearly in laws for 40 years. As

part of U.S. legislation, EIIECSE policy provides for optional services for children with

disabilities and their families as well as for prevention of disabilities (Hill et aI, 2004).

The Individuals with Disabilities Educational Act (IDEA) is the hallmark legislation for

provision of special services in the U.S. IDEA regulates the services for all children with

disabilities from birth to age 21 including for those children in early intervention and

early childhood special education programs. For infants and toddlers, the law requires

each state to identify and evaluate each child. IDEA regulates federal, state, and local

agencies to playa role in the EIIECSE system (SEC 619).

In the U.S., the EIIECSE system has its own clear legislation and policy. In

Thailand, the government is still working on the role of the legislation and policy. Before

1997, special education was known as education for individuals with deafness, blindness,

or severe disabilities, with separate schools for each kind of disability. After Thai

educational reform was started in 1997, the Ministry of Education of Thailand legalized

the Thai National Education Acts of RE. 2542 (1999) (J'JEA). The Thai National

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6

Education Acts provided for the regulation and management of education in general, but

not clearly for EIIECSE. However, the Thai NEA did begin to provide for some aspects

of early childhood education as well as some in early childhood special education.

In 2008, the first light for EI/ECSE system shone in Thailand when the Education

Management for Individuals with Disabilities was mandated and used in the Thai

educational system. The main focus of the law is to provide education for individuals

with disabilities in any school system in Thailand; all schools must accept all children

with disabilities. The law mandated that all schools must have special education teachers

to work with the children. Unfortunately, the law did not specify any services for

children from birth to age eight, and the law did not specify how much funding the

government will spend on the EI/ECSE programs or how much funding each province

will receive from the government.

Legislation and policy in U.S. are different. The U.S. system is clear and

supportive; the Thai system is as yet not organized and does not provide supportive

services for EIIECSE. Hopefully, the law will be developed and adjusted to fit into Thai

society.

EIIECSE System Model

Program models in the U.S. have been evolving during a long period of time,

including various models for the EIIECSE system. Briggs (1997) suggests four models:

unidisciplinary model, multidisciplinary model, interdisciplinary model, and

transdisciplinary model. In the U.S., the transdisciplinary model is the recommended

practice for the EI/ECSE system. In the transdisplinary model, a child and his family are

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7

the center of the team. The team collaborates in working, sharing, and making progress

in order to serve the child and his family's needs and satisfactions (Brigg, 1997). The

team members include all specialists who work with the child; the team cannot ignore the

knowledge held by the family. All family opinions, stories, ideas, or expertise are

included in the team members' evaluation and analysis. Team members cannot work

alone; they have to work together as a collaborative team. In Thailand, program models

are likely to be unidisciplinary models. When parents take their child to receive services

from professionals, the parents will be separated from their child and sometimes are

asked what happened to their child. For the evaluation and analysis, the professionals

often come to their own conclusions.

The linked system model shown in Figure 1 include a philosophical perspective

and an operational set of guidelines for professionals that address the mission, content,

methods, and applications for linking at assessment and early intervention (Bagnato at aI.,

1997). For children from birth to age five, the linked model consists of four basic

elements: 1) screening and assessment, 2) goal development, 3) intervention, and 4)

evaluation (Bricker, 2002; Squires & Bricker, 2007; Bagnato et aI., 1997). Assessment

is a process of establishing a baseline or entry-level measurement of the child's skills and

desired family outcomes and assumes that a child needs further services or care (Bricker,

2002). Assessment procedures will combine observations, direct tests, and reports from

the parents, caregivers, and professional team. Therefore, assessment is the first

procedure of the linked system that will relate to the child's goal development,

intervention plan and evaluation or monitoring.

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• ScreeninglAssessment

• Evaulation

• GoaldevelopmentIIFSP/IEPs

• Intervention

8

Figure 1. Linked system approach. Adapted from Squires, J., & Bricker, D. (2007). An

activity-based approach to developing young children's social emotion competence.

Baltimore: Paul H. Brookes.

Assessment System for Young Children in the U.S.

In the assessment procedure for children from birth to age 5, screening is the first

step. Screening is defined as a brief assessment procedure to identify children who should

receive more intensive diagnosis or assessment (McLean et aI., 2004).

Screening is a quick assessment of the child. If a child is determined to be at risk

or with developmental concerns, the child will be asked to participate in a comprehensive

diagnostic evaluation with the professional assessment team, which is linked to step two.

In step two, Bricker (2002) suggests diagnostic evaluation and standardized norm-

referenced tests be used. The diagnostic evaluation test will determine if a child

identified as at risk from the screening process is eligible for services. Next is step three -

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9

- linking to a programmatic or curriculum-based assessment for determining IFSP/IEP

goals and intervention strategies. Programmatic or curriculum-based assessment

formulates a functional and generative IFSP/IEP goal for each child according to his/her

abilities. Program goals and intervention plans also are generated through the use of a

curriculum-based assessment during the goal development phase for the IFSP/IEP.

Evaluation is the process of comparing the child's performance on selected

intervention goals/objectives before and after intervention and comparing the family's

progress toward selected family outcomes. Evaluation is the final process in a linked

system. In an effective evaluation process, the professionals gather to discuss progress

on the child's and family's outcomes/objectives. Family involvement should be included

in this process as well as throughout the linked system. Effective steps for the evaluation

process include: 1) What are the goals ofthe child and family to be monitored over time

and criteria for success?, 2) How are data collected?, 3) Who will collect data and where

and when?, 4) How frequently are the data to be collected, such as weekly, monthly, or

quarterly?, and 5) How are the data discussed to make effective program decisions?

(Squires, 2007)

The assessment system in Thailand is different from that in the U.S.. Most Thai

children do not receive assessment services. The Thais believe that children will show

their disabilities when they are in school, except for blindness or other severe disabilities.

Thus, many disabilities are not identified until children are in school. For example,

children with learning disabilities (LD), attention deficit hyperactive disorder (ADHD)

and autism spectrum disorder (ASD) are not identified until children enter the school

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.---------------------_.. - -_ .._--

10

system. Most children who receive services from the special education provincial service

center are the ones with severe disabilities and most parents must make a trip to different

centers to obtain these services. Therefore, it is important to develop an effective

assessment system. The adaptation and development of a comprehensive screening

system appropriate to Thai culture might be a first step towards improving the early

identification system.

Screening System for Young Children in Thailand

Thailand does not specify a policy for developmental and behavioral screening in

the system for young children. However, both the Ministry of Public Health (MPH) and

the Ministry of Education (MOE) have started a screening project. Two agencies from

MPH provide screening for young children. First, the Department ofMental Health

provides a website for a developmental screening checklist for parents and teachers

(http://www.dmh.go.thltest/cesd/child/). The screening tool is an adaptation of the tool

based on Denver II and Ten Questions. This tool assesses children from six months to

six years of age. Second, the Department of Mental Health provides screening

instruments for behavioral and mental health screening for young children. For very

young children, the Department of Medical Science has established the Thailand National

Neonatal Screening Program (http://www.dmsc.moph.go.thl).This program implements

neonatal screening as one of the health issues for public health care services. With

limited govemment funding, the program provides services for only 13 centers in 13

provincial cities.

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MOE established the Bureau of Special Education Administration in 2003. This

organization supervises special education centers in all 76 provinces. Roles and duties of

the organization are to collect, study, analyze, and collaborate toward the conception of

proposals, policies and plans for the education of people with disabilities and those who

are disadvantaged, in accordance with the National Education Plan, the Basic Education

and Early Childhood Education Improvement Plan, and other relevant national policies.

For the assessment system, the organization provides an assessment form for identifying

disabilities in clients in each province. The organization does not, however, specify a

screening system. The organization merely mentions to schools that each school should

screen children for disabilities in order to receive the services from a special education

center (http://special.obec.go.thl).

Currently in Thailand, when a child is detected as having disabilities or being at

risk, the child's family will have several choices for receiving intervention services.

Rajanukul Institute provides services for children with autism. Children with vision or

hearing impairments will search for institutes that provide services which are limited and

scattered all over Thailand. Special education centers provide IEPs for children who

receive services. Some centers provide an intervention classroom for those who have

disabilities. Overall, the assessment system for developmental and behavioral screening

has not widely developed or publicized and it has a limited presence in some areas.

Because it is based on a new knowledge base, the proposed screening system must be

officially studied in order to assure effective services in Thailand.

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Purpose of the Study and Research Questions

Early Childhood Special Education/Early Intervention involves the provision of

services, support, and education for children with disabilities and developmental delays

from birth to five years old (Sandal, McLean, & Smith, 2005). Screening children at a

young age is one of the missions in this field. The purpose of this study is to determine

and investigate the psychometric properties and the utility of a screening system

using an adapted version of a widely-used screening test, the Ages and Stages

Questionnaires: Thai (ASQ: Thai), in early childcare settings in Northeast Thailand.

This system has great potential for adaptation in Thailand. The ASQ is a screening

instrument that investigates young children's developmental and behavioral areas

(Squires & Bricker, 1999). The original ASQ was translated into Thai and used in a

screening system in early childhood education programs in Northeast Thailand. The

ASQ: Thai was back-translated by an English professor; then it was reviewed by

early childhood professors and special educators in order to study the cultural

appropriateness. For the study of reliability and the use of the ASQ: Thai, the

investigator first recruited participants from early childcare centers and elementary

schools in Northeast Thailand. The participants consisted of children between the

ages of24 to 36 months (2-3 years) and their parents and early childcare staff/teachers.

Secondly, the investigator asked parents and early childcare staff/teachers to complete the

ASQ: Thai on each child. Finally, interviews were conducted with approximately 25

parents and early childcare staff/teachers. Questions covered the utility and the

usefulness of the ASQ: Thai as an early identification instrument in the Thai system. The

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13

data obtained included scores from the ASQ: Thai and information from the interviews

from the parents and early childcare staff/teachers. The scores were used for

investigating the psychometric qualities of the ASQ: Thai. The interview data helped

determine if the ASQ: Thai can be used in an early identification system for enhancing

child development for parents and childcare staff/teachers in Northeast Thailand. Four

research questions included:

1. Is the ASQ: Thai a culturally appropriate instrument to screen preschoolers for

developmental delays in Thailand?

2. What is reliability of the ASQ: Thai?

• Internal consistency

• Test-retest reliability

• Interobserver reliability

3. Are there differences between the scores ofNortheast Thai children on the 24, 30,

and 36 month interval of the ASQ: Thai and those ofD.S. children on the ASQ?

What are the differences?

4. What is the utility of the ASQ: Thai, as evaluated by parents and early childcare

staff/teachers?

Summary

No comprehensive studies of a parent-completed screening test have been

undertaken in Thailand. In addition, low-cost and economical methods for screening are

needed, especially in rural regions such as Northeast Thailand. Further, screening as the

first step in a linked system approach is critically needed to develop a comprehensive

EI/ECSE system in Thailand. A screening test widely used and respected in U.S. will be

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14

adapted by the researcher into Thai and made appropriate for that culture. This tool

might provide the impetus for establishing a central system ofEllECSE assessment,

intervention, and evaluation. Since there is very little research on the development of

programs for early childhood educators in Thailand, this research may boost the skills of

childcare staff in early intervention as well as increase attention to early childhood

education. Further, study results will begin to inform various people in Thai society such

as school administrators, teachers, and parents about the importance of early detection,

early child development, and quality early childhood education.

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15

CHAPTER II

REVIEW OF THE LITERATURE

Thailand is located in the middle of Southeast Asia and has a population of

around 65 million (http://www.dopa.go.th/). With a change in government 80 years ago,

Thailand became democratic, a constitutional monarchy. Thailand is divided into 76

provinces under the centralizat~onof the Thai royal government in Bangkok. Laws and

regulations originate from the central government and are then administered through

government agencies in each province. Likewise, services associated with Early

Intervention/Early Childhood Special Education (EI/ECSE) have to be established from

Bangkok under the Ministry ofEducation of Thailand (MOE). According to the report

from the Ministry of Education of Thailand, 3,411 students have been identified as

individuals with disabilities; they are classified as "handicapped." This report has also

indicated almost 400,000 preschoolers and kindergarteners are living in at-risk and poor

environments (http://www.moe.go.th/). So far, there have not been enough services for

this portion of the population in Thailand. However, the Ministry of Education founded

the Bureau of Special Education Administration (BSEA) in 2001. The Thai EI/ECSE

system is modeled closely to the EI/ECSE system model in the United States. In

addition, the Education Management for Individuals with Disabilities Act was launched

in 2008, which constituted the practice for special education in Thailand. Support in

terms of teaching personnel and established systems for individuals with disabilities have

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16

not yet met the demand. Thus, there is an urgent need for building a comprehensive

EI/ECSE system, including an early developmental screening system in Thailand. The

system will help to create a capacity for teachers and other personnel in understanding

appropriate child development theory, establishing system guidelines, and providing

support to families and children. Most importantly, the system will enforce the law, and

the work of special educators will be more effectively and widely dispersed throughout

all parts of the country.

This chapter presents a review of the literature including theories of child

development, historical and theoretical foundations, and information about EI/ECSE

service delivery systems. Background information on child developmental screening

systems in Thailand is also included. This literature review starts with the definition of

child development theory. Next, current practices for child with developmental

difficulties are explored. A theoretical framework of an effective system for E1/ECSE is

discussed next. Descriptions of childrearing practices in Thailand as well as early

childhood education follow. Finally, developmental assessment for young children in

Thailand and the significance of the adaptation of the Ages and Stages Questionnaires

(ASQ) into Thai are explored.

Theoretical Framework of an Effective System for EI/ECSE

E1 focuses on providing services and education settings for children with

disabilities, children with developmental delays, and children who are at risk for delays,

and their families from birth to age three. ECSE deals with children who are three to six

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17

years of age (Squires, 2004) with disabilities or at risk for disabilities. This literature

review includes both EI and ECSE practices, theory, and background information.

Evidence from EI/ECSE services has shown that the earlier intervention can serve

children and their families, the better the children will develop their capacities to manage

their routines and live their lives independently (Meisels & Shonkoff, 2000). The

approach and delivery of such programs depends on a family's particular situation. For

example, a child with autism and a child with Down syndrome need to be served in

different ways both in terms of the disability and in terms of family needs.

Even though today EI/ECSE serves many children with disabilities and their

families, parents in the past have needed to speak up for their children to be able to

receive the same educational rights as children without disabilities. This section will

discuss the historical and legal foundations ofEI/ECSE including parent rights, the

theoretical basis of EI IECSE, and current preferred practice.

Historical and Legal Foundations

Specialized services originated in Europe during the l700s to help reduce barriers

to young children with disabilities (Bowe, 2007). Programs started in the U.S. for the

same reasons. Both children with disabilities and their parents faced the obstacles of

being different from typically developing children and families. Being excluded from the

mainstream, children with disabilities did not have the same access to the educational

system as did typically developing children. The civil rights movement in the U.S.

formed the basis of the struggle for rights for children. In the 1970's legislation that now

impacts children with disabilities, such as the Individuals with Disabilities Education Act

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18

(IDEA, 2004) was passed to help in eliminating barriers for those children with

disabilities, as well as to help them to get access to the educational system.

Background legislation for IDEA for children with disabilities was enacted first in

the 1960s. Even though the federal government's role in special education was initially

limited, there was a major turning point for federal support of education in 1965 when

Congress passed the Elementary and Secondary Education Act (ESEA). This Act and its

subsequent amendment made a large amount of funds available to serve children with

disabilities from 3-21 years old. The Bureau ofEducation for the Handicapped was

founded and received funding for research and development projects to improve special

education services. Later, the Handicapped Children's Early Education Assistance Act of

1968 (later called IDEA) represented the first major federal recognition of the specific

importance of early education and special education. The purpose of this legislation was

to support model program development throughout the nation (Fallen & Umansky, 1985;

Bowe, 2007).

In 1974, the Education of the Handicapped Amendments of 1974 (PL 93-380)

added the requirement that states needed to set goals for serving all children with

disabilities from birth to 21 years of age (Linder, 1983). The landmark legislation, the

Education for All Handicapped Children Act (EAHCA) of 1975 (PL 94-142), mandated

that states provide all school-age children with disabilities a free and appropriate public

education (FAPE). The law also stated that children should be educated in the least

restrictive environment (LRE). Sadly, preschool-age children were not included under

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Part B of this act, except in states that already provided public services for typical

children at that age in public preschool (Dunlap, 1997; Bowe, 2007).

Congress then passed an amendment to EHA (PL 98-199) in 1983. From 1977

through 1983, states and communities throughout the nation were beginning to expand

special education services by including children from birth to five years old. Then, the

1983 amendments provided grants for statewide coordination and planning for services

for young children with disabilities, including allocations for children from birth to age

three. The Handicapped Children's Early Education Program (HCEEP), now known as

EEPCD, continued to help create support and different delivery styles for EIIECSE

(Bowe, 2007).

The 1986 amendments (PL 99-475) helped EIIECSE become an actuality. To be

eligible to receive federal funds, all states were required to create a plan to provide

appropriate services to all children under the age of six. Part H, now known as Part C,

was not well funded but provided the foundation for the new program, called early

intervention (Bowe, 2007).

In 1990, PL 101-476 renamed the fundamental legislation from the Education of

the Handicapped Act (EHA) to the Individuals with Disabilities Education Act (IDEA).

In addition, the Americans with Disabilities Act (ADA) was enacted and as a result

people with disabilities were able to have more accessible communities and

transportation. The ADA also prohibited discrimination against people with disabilities.

In Section 504 of the Rehabilitation Act, Congress mandated responsiveness to some

disabilities that were not covered under IDEA. Children with disabilities in particular

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20

had access to early childhood programs, including child care centers and Head Start

programs (Bowe, 2007; Hemmeter, Smith, & Mclean, 2005).

With the 1991 IDEA amendments (PL 102-119), Congress provided a seamless

transition between Part C from birth to age 3 and Part B from 3 to 21 years old. The act

also allowed Part B to serve toddlers with disabilities and toddlers with developmental

delays under the age of three, even though such toddlers are not under the Part C

program. This law also recognized the need for cultural competence and family

involvement (Bowe, 2007).

The 1997 Revised IDEA amendments (PI 105-17) refined the early childhood

special education provision. Part C provided grants to states serving toddlers from birth

to age three who were developmentally delayed or at risk for such delays, and gave

families the right to an Individual Family Service Plan (IFSP). Part B required that

children with disabilities who were in the range of 3 to 21 years old receive a free and

appropriate public education under an Individualized Education Program (IEP). Section

619 of Part B provided free and appropriate services to children with disabilities between

the ages of 3 and 5 and continuity of special education services for children moving out

of Part C (Bowe, 2007; Hemmeter, Smith, & Mclean, 2005).

IDEA is a guide for appropriate care; services, support, needs, and education for

young people with disabilities by thorough systematic child find efforts. The law

requires identification of young children with disabilities by early childhood specialists.

Therefore, screening instruments and diagnostic instruments were created and developed

in order to provide appropriate services and support for individuals with disabilities.

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21

According to IDEA, services and support are provided for both individuals with

disabilities and their families as a primary goal of education programs. As services and

support are continued and developed, they become more recognizable and supported in

society. These laws and services helped all individuals and children with disabilities to

be accepted and recognized in society.

The Theoretical Basis of EIIECSE

EI/ECSE has a philosophical base that undergirds services for children with

disabilities to develop in the five domains of development; adaptive, cognitive,

communication, physical, and social-emotional. This applied philosophy helps children to

develop in a holistic manner (Bowe, 2007). Major theorists have focused on children's

development from different perspectives. Developmental theory can generally be

grouped into four major perspectives; the developmental perspective, the transactional

perspective, the family involvement (ecological model), and the educational perspective

The developmental perspective emphasizes a child's development from a

maturational perspective and theorizes growth as series of stages. An important theorist

of this school, Jean Piaget, believed that children's thought processes were different from

those of adults. Piaget suggested that children have their own learning styles by exploring

their world or interacting with environments. They are able to create stages of learning

themselves from organization, adaptation, and accommodation until they become more

independent by themselves. Each step of learning explains their adaptation to

environments and their learning new skills when the environments are changed (Piaget,

1971 ).

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22

The transactional perspective emphasizes the quality of the environment as a vital

factor to the development of young children (Sameroff & Chandler, 1975). Related to the

transactional perspective, Vygotsky believed in the social context of learning and

demonstrated how the environment is important to children's development (Vygosky,

1978). He showed how interactions between children and caregivers should be

encouraged so that children can learn not only how to communicate by using language,

but also be taught about their culture and cultural differences. Caregivers are crucial for

scaffolding children's learning. Furthermore, a reciprocal relationship between children

and caregivers can help to create a positive environment in which children can develop

continually (Sameroff & Chandler, 1975). Erikson, another key theorist related to the

transactional perspective, explained that children begin to learn in the stage of trust vs.

mistrust, which is meaningful for them and helps them transition to the next stage. If

positive environments are available, children can first extend their trust to caregivers,

which is a required fundamental allowing them to develop steadily into trusting adults

(Erikson, 1959; Kohlberg, 1981).

Bronfenbrenner (1979) described how the ecological system model or family

involvement model can be part of linking each person in society together and can assist in

expanding the relationships of people to be more connected (Bronfenbrenner, 1979). The

child is embedded in a family, community, and culture and learns as a result of

interactions with the people and units in the system. These systems are potent realities

and influences on the family and the child.

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At final theory is the educational perspective, which includes many approaches

and practices. One particularly important perspective for EIIECSE is Activity-Based

Intervention (ABI). Pretti-Frontczak and Bricker (2004) explain how ABI approach can

help children with disabilities to learn.

The main purpose of intervention for young children with disabilities or childrenwho are at risk for disabilities is to assist them in the acquisition andgeneralization ofcritical developmental skills so that they can, to the extentpossible, achieve independent functioning across environments ... an approach isspecifically designed to help children reach their individual goals within thecontext of daily activities (p. 22).

Piaget was also influential in the educational perspective in the way that he

postulated that children learned. He stated that children easily learn when they are

allowed to participate or interact fully in their environment. In addition, behaviorism

(Skinner, 1938) is another approach in this perspective that can help intervention to be

more efficient -- development occurs when a child is being rewarded for appropriate

behavior, imitation and modeling, and stimulus association.

These theories help to form a foundation that assists in providing appropriate

services to young children. Based on these theories, a solid literature supports evidence

based practices for intervening with preschool children with developmental delays and

their families.

Current Preferred Practice

Early childhood approaches enable teachers and parents to better intervene with

children, particularly children with disabilities, who need more focused care and

strategies to achieve optional outcomes. Continued assessments and observations help to

develop effective intervention and strategies. Setting intervention goals to help children

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24

to develop is a second priority. Many intervention approaches have been developed to

help children with disabilities to learn at their own pace, such as ABI. In the preschool

classroom, children can be provided with activities to expand their skills in fine motor,

gross motor, adaptive, cognitive, social communication, and social areas (Bricker, 2002).

Classroom interventions can help children with disabilities be able to participate in

activities with other people; such as typically developing peers. Inclusion of children

with disabilities with typically developing peers helps to increase their educational

progress. Additionally, current legislation and regulations in the U.S. playa role in

supporting children with disabilities to become more proficient in their skills and to live

their lives independently in society.

In the U.S., appropriate practices have expanded and provide services for children

with disabilities on every corner. Koegel and LaZebnik (2005) reported a successful EI

project for children with Autism Spectrum Disorder (ASD) (Koegel & LaZebnik, 2005).

Koegel and LaZebnik explained how the project succeeded in decreasing the age at

which children with ASD were identified and received early intervention. In the project

approach, staff worked with the community to create community awareness for the early

signs of autism. The project also worked with families. Koegel and LaZebnik (2005)

stated that families always feel supported by being involved in working with their

children via the community-based intervention and support agencies and concluded that

the model of community and family intervention should be replicated nationwide.

The Early Childhood Coordination Agency for Referrals, Evaluations and

Services (EC CARES) is on example of a successful local service delivery program. EC

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25

CARES provides early intervention and early childhood special education services to

infants, toddlers, and preschool-age children in Lane County, Oregon. When a child is

determined to be eligible, EC CARES sets educational services and appropriate goals.

The EC CARES team works with the child's family in order to make educational

placement and service plans for the child. The child and the family receive various kinds

of services based on the child's needs such as horne visits, parent-toddler classes,

community preschools, specialized preschool classrooms, and speech therapy in either

groups or community preschools. The child's progress is monitored frequently by the

specialists, family, and EC CARES team.

Assessment in Early Intervention

Assessment is necessary for quality EI/ECSE services. The assessment procedure

combines observations, direct tests, and reports from parents, caregivers, and a

professional team. Therefore, assessment is the first procedure of the linked system that

will relate to the child's goal development, intervention plan (IFSP/IEP) and evaluation

or monitoring.

Bricker (2002) provides a linked system approach as a best practice model. Four

phases in this approach are 1) assessment, a process of collecting information for

identifying and diagnosing if a child has a delay or disability, 2) goal development, a

process of determining a child's IFSP/IEP and intervention content, 3), intervention, a

process of implementing IFSP/IEP goals for the child in a classroom or any service

settings, 4) evaluation, a process ofmonitoring the progress of the child in skill areas that

the child needs to improve (Bricker, 2002). In this model, family/caregivers collaborate

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26

with professionals and work together for the child. Collaboration of the family starts at

the goal development phase. The family shares ideas, knowledge, and helps

professionals to make appropriate goals. Significantly, family/caregivers can help

monitor the child's progress during the intervention. Figure 2 shows a linked system

approach in which one family and professional collaborate in linked assessment,

intervention, and evaluation.

FamilyICafcgivupa1~

Proressmmcobbor'ltton

~

~'1~ t 7~\Goa1~ ~\

\~ ~/Intervention

Figure 2. A linked assessment-goal development-intervention-evaluation approach to

early intervention. Adapted from Bricker, D. (2002). Assessment, evaluations, programs,

systems. Baltimore: Paul H. Brooks.

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27

The Linked Assessment Model

In the linked assessment model, Bagnato et al (1997) reviews six main assessment

models: (1) criterion-referenced assessment, (2) convergent assessment, (3)

functional/adaptive assessment, (4) authentic/performance assessment, (5) dynamic

assessment, and (6) play-based assessment. Criterion-referenced assessment, specifically

curriculum-based assessment, is commonly used in early intervention programs because

it can be used in a linked system model with assessment, intervention, and evaluation

(Bagnato et ai., 1997). Convergent assessment "refers to the synthesis of information

gathered from several sources, instruments, settings, and occasions to produce the most

valid appraisal of developmental status and to accomplish the related assessment

purposes of identification, prescription, progress evaluation, and prediction" (Bagnato et

ai., 1997, p. 18). Authentic performance assessment refers to realistic or natural tasks

used in the assessment procedure. Dynamic assessment is active engagement of the child

in the task, with the emphasis on "leaming-to-leam" strategies to foster independent

problem solving, and recommendations for arranging instructional techniques. The

functional/adaptive assessment model is for use in the assessment process of young

children with severe disabilities in order to increase a child's competence in interacting

with people and object in child's environment (Bagnato et ai., 1997). In addition, this

assessment helps provide the appropriate interventions for each child's ability. The play­

based assessment model involves parental and professional observations ofthe child in

his/her play session in natural settings (Bagnato et ai., 1997). They observe a child using

his own toys, playing in playground, or interacting with other children. In addition to

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28

making the linked system model for assessment effective, Bagnato et al. (1999) discussed

eight standards for assessment.

Standard 1: Utility

How useful is an assessment? The assessment must not focus just on the numbers

of the test, the diagnosis or the materials, but assessment is much more useful when it

identifies more specifically the skills, actions, or characteristics that can be targeted for

change. Assessment should be evaluated using these three questions:

1. Is the assessment useful for identifying instructional and therapeutic

objectives?

2. Is the assessment useful for selecting methods or approaches for teaching or

therapy?

3. Is the assessment useful for detecting change after intervention?

Standard 2: Acceptability

Acceptability of assessment, or social validity, refers to the perceived value or

appropriateness of assessment. Three levels inc1uded: (1) acceptability of identified

intervention goals, (2) acceptability of assessment methods, and (3) acceptability of

changes detected by assessment.

Standard 3: Authenticity

This standard refers to how real or authentic the materials and assessment are.

Authentic materials examine real functioning in real situations. Naturalistic observation,

behavior rating scales, interview inventories, and curriculum-based measures are

examples of authentic content.

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Standard 4: Equity

Equity refers to the equality of opportunity, not necessarily equal circumstances.

For example, for instruction, equity would mean supplying children with learning

materials and arrangements that accommodate for sensory, motor, affective, or cultural

differences for "standard" children.

Standard 5: Sensitivity

Assessment materials must be used that are appropriate for each circumstance,

culture, and that meet diverse children's needs.

Standard 6: Convergence

Assessments should not be conducted only one time with a particular child but

should include measurement conducted from many perspectives, times, settings, and

sources. Assessment should be done in collaboration with parents and professionals.

Standard 7: Congruence

Congruence requires that materials be developed and field-tested with children

similar to those being assessed. For example, an assessment for children who are blind

should be done with materials developed with and accommodating blind children.

Standard 8: Collaboration

Collaborative assessment involves sharing efforts, providing materials "friendly"

to parents and other professionals, and actually depending on the contributions of others

to produce the information needed for collaborative decision-making.

These are suggestions and guidelines of an effective linked assessment model.

Strengths and limitations of the linked assessment model are summarized in Table 1.

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Table 1

Strengths and Limitations ofthe Linked Assessment Model

Strengths

Step 1: Screening

Screening can determine whether most

children are learning in an expected

manner.

Screening can identify children who need

additional support.

For the social emotional problems,

screening can identify social emotional

problems or potential problems which link

to determine social emotional competence.

Screening infants and young children can

identify developmental delays and

disabilities.

Limitations

Step 1: Screening

Screening may not detect a child's disability

when s/he is an infant. So fast intervention

may not occur.

Screening may identify some concern as a

result for family. The family may ignore

the result and wait until the real disability

shows when their child grows up.

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Table 1 (continued).

Strengths

Step 2: Diagnostic evaluation

The diagnostic assessment will help to

determine whether the child has a disability

or developmental delay that meets the

criteria specified by the state to receive

special education services.

The diagnostic assessment will determine

what kind of disability a child has, which

will link to appropriate intervention

strategies.

31

Limitations

Step 2: Diagnostic evaluation

The diagnostic assessment needs qualified

assessors; some areas may not have such

assessors to conduct the assessment.

The diagnostic assessment needs

interdisciplinary or multidisciplinary

professional team; some rural areas may

lack services. The linked system may not

occur.

Some decisions from the test results may

not be applicable in some cultures;

ignorance or denial of the family may

occur.

The assessment process itself may not be

authentic to the child's ecological system;

inaccurate results may occur.

Assessment may cause anxiety for parents

who have a child with a disability. They

may be concerned about where to get the

services or where the professionals are.

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Table 1(continued).

Strengths

Step 3: Programmatic assessment

Limitations

Step 3: Programmatic assessment

For the curriculum-based assessment, it will The requirement ofIFSP/IEP from the

help professionals and parents develop

IFSP/IEP goals. The assessment results

will help the professional team work with

the family collaboratively.

The assessment is an ongoing process.

Children will be assessed over the time they

are receiving their intervention. The

assessment will keep track of the child's

progress and records.

programmatic assessment could create a

burden for childcare staff and the family. If

the intervention strategies may not be well

implemented.

Test Adaptation in Early Childhood Screening

Test adaptation, included in the standards of equity, sensitivity, and authenticity,

refers to the preparing of tests in one language and culture for use in a second language

and culture (Hambleton, 2005). Test adaptation contains activities, items, and cultural

references from the original test. However, a test adaptation needs to be done according

to the cultures where it will be used, as well as following the recommended standards

from assessment (Hambleton, 2005).

Due to advanced research and practices, there are about 45 countries using

mathematics and science tests in 30 languages that were based on the U.S. test projects

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33

(Hambleton, 2005). Test adaptation has shown and be an effective way for testing school

achievement and child development. Hambleton (2005) studied cross-cultural tests that

were used in other languages, stressing several elements to ensure acceptance of the test.

Test development, test score equating, and test score norming are important to make the

adaptation more sophisticated (Hambleton, 2005). To make the test adaptation equal to

the target culture, the test needs to use in the right concepts, words, and expressions that

are culturally, psychologically, and linguistically appropriate to the second language and

culture. Referring to guidelines from the American Educational Research Association

(AERA), American Psychological Association (APA), and National Council on

Measurement in Education O\JCME) Standards for Educational and Psychological

Testing, Hambleton suggests careful adaptation including providing the sources of error

or invalidity in test adaptation.

The following are important standards for test adaptation (see in Hambleton,

2005, p. 5).

Standard 6.2. When a test user makes a substantial change in test format, mode ofadministration, instructions, language, or content, the user should revalidate theuse of the test for the changed conditions or have a rationale supporting the claimthat additional validation is not necessary or possible.Standard 13.4. When a test is translated from one language or dialect to another,its reliability and validity for the uses intended in the linguistic groups to be testedshould be established.Standard 13.6. When it is intended that the two versions of the dual-language testsbe comparable, evidence of test comparability should be reported (p. 5).

Most importantly, Hambleton gave three broad categories which include (1)

cultural/language differences, (2) technical issues, designs, and methods, and (3)

interpretation of results. For the first category, he mentioned that the second language

.......

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34

and culture should be of equivalent construction in order to reduce communication bias

during the test administration. For the second category, the test adaptations should select

and train translators who have specialty in the field and know the process of translation

and how to judge the design of the test. Thus, both a forward and backward translation

should be completed for an accurate translation (Hambleton, 2005). Finally, the test

should be evaluated through field research an~ data collection.

The appropriateness of the language and culture in early intervention assessment

has been specifically examined. Barrera (1996) suggested that assessment procedures

should provide various dimensions of socio-cultural diversity that relate to the families of

young children. Test adaptation should have the role of a "culture-language mediator" in

interpreting across socio-cultural differences (Barrera, 1996). Bergeson et aI. (1999)

discussed language and culture affecting behavior, information-gathering strategies, tests,

and referral process. Lynch and Hanson (2004) discussed that when the cultural

competence was increased, the assessment process and strategies were improved. She

continued by noting that the assessment tools should include proper instructions for

cross-cultural competence. Santos (2002) suggested that assessment and the information

gathering process should provide knowledge in how to confront racial, linguistic, and

cultural biases in the school system and teaching styles of educators.

Assessment in early intervention is unique in its use (Shaw et aI., 2004).

Assessments need to provide sensitivity to the multitude of cultural and linguistic

variations in children and their families. They should provide for appropriate procedures

during the assessment process as well (Shaw et aI., 2004). In test adaptation, the process

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II

I

35

of transferring language and culture from one language to a second language is

challenging. However, test adaptation of assessment tools should result in a non-biased

view ofthe child's linguistic, cognitive, and adaptive abilities.

Thailand is a diverse culture, in need of adapted, accurate tests to form the basis

of an EIIECSE system. The Thai child development culture will be described next.

Childrearing and Child Development Needs in Thailand

Several aspects discussed below include: (1) the Thai environment related to

childrearing and early development (2) morality and cultural support, and (3) the Thai

educational system. The needs and problems surrounding child development in Thailand

are also discussed.

Environment for Childrearing and Child Development

Children in Northeast Thailand have grown up surrounded by nature and natural

resources. Children have a variety of chances to explore the places surrounding them.

Children can go to the rice fields and the community forest to play. Sometimes, they go

out with their parents to work and find food. In addition, children are watched by

community members. Most villages and communities in Northeast Thailand are tied

together by a kinship relationship (Amomvivat et ai., 1990). Most families are extended

families which include grandparents and relatives. When a family has a child, other

members in the family will help raise the child. Amomvivat et ai., (1990) reported the

different functions of each member in a family, the father was the family head with duties

to protect, find food, and give moral support for the children; the mother took care ofthe

house work as well as the children. However, sometimes the mother has to work on a

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36

construction site or in a remote area; the grandparents then have a role in helping the

parents to raise the children.

Moral and Cultural Development

Amomviat et al. (1990) also reported that parents and elders teach their children

to believe in Buddhism by taking them to temples and Buddhist ceremonies. Parents

make sure that the children understand the ideology of Bun and Baab, which are related

to good and bad actions. Moreover, they teach children to respect seniority. Parents

prefer that children respect people who are older. In addition, parents like children to be

humble and to obey their elders at home and in school. If the children do not do such

things, they are considered to be misbehaved children. Children in Northeast Thailand

have the chance to follow their parents and grandparents to temple for Buddhist Lent or

for the Buddhist monks' food offering. In this way, children are influenced in the

Buddhist teaching which will make them good Buddhists. Khemmani (1994) showed

that an ideology of moral and cultural development is very important in the child-rearing

practices in Thailand. This researcher found that Thai children were raised under the

motivation of Buddhist principles, cultural principles, and early childhood education

principles. Children are expected to have a spiritual foundation. First, for Buddhist

principles, Khemmani reported that children were taught to follow the Buddha's

teachings, including the understanding of the nature of human beings and the spiritual

basis. Most of all, children were taught to practice following Buddhist's virtues such as

being a good person, knowing cause and effect, being temperate.

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37

Early Childhood Education System

In the school system, children are taught to love Thai language, arts and culture.

They also have to be generous, dignified, well-mannered and courteous in their behavior

and good manners. Khemmani (1994) stated that these principles of early childhood

education affect child development. According to Khemmani, children learn by

modeling, through a supportive environment, positive reinforcement, play,

communication, and nurturing based on their maturity and readiness. In the Thai school

system, children learn and develop their cognitive skills in various environments and

interactional stimuli (Amomvivat et ai., 1990). Children learn from parental responses to

their child's curiosity, self-help skills, work skills, play and games, and through adults'

role play. Secondly, children mature in their emotional and social development

according to their family relationships and social contacts (Amomvivat et ai., 1990;

Khemmani, 1994). Most Northeast Thai parents believe that their children develop in

stages of emotional and social development according to their ages. Most importantly,

children learn from their parents and people in the society.

These aspects of childrearing and child development have initially been applied to

early childcare settings. However, some problems have occurred. First, according to

Khemmani (2006), Thai children are not always physically cared for. She reported that

children still suffer from malnutrition, disease, infection, toxic substances, and accidents.

Significantly, some children with disabilities have been abandoned in regular school

settings. Amomivat reported that as far back as 1990, the Ministry of Education provided

a plan for regular teachers in early childcare settings but there was not enough structure

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38

for children with disabilities. Second, Khernmani (1993) noted that caregivers were

always not effective at childrearing. Parents and caregivers did not have enough

knowledge and understanding of appropriate early childhood practices. Therefore, many

children with disabilities were neglected or became their parents' responsibilities. Third,

the governments did not provide appropriate programs for children who lived in rural

areas (UNESCO, 2004). Previous studies reported that childcare services (the building

and the centers) had been provided by the government, but personnel development

including teacher training was still rare (Khemmani, Tantiwong, & Vidhayasirinun,

1995). UNESCO (2004) reported that the Thai government agencies, such as the

Ministry of Education and Ministry of Labor and Employment, organized and required a

certain standard for childcare programs and caregivers, as well as kindergarten teachers,

but this has not been sufficient. Services, support, and education for children and their

families are still far from the reach of children in many remote areas. UNESCO (2004)

suggested that a variety of childcare teachers should develop qualifications in order to

develop appropriate and effective child development practices. Last, other compounding

factors include external problems such as the changing of the structure of society,

including women being forced into the workplace.

EIIECSE System in Thailand

Many agencies work for children, including the educational system, medical

system, child welfare, social welfare, and Buddhist temples. Collaboration among

agencies who work for young children in Thailand is almost non-existent; each agency

works independently with its own procedures and methodology. For example, when a

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39

child goes to a clinic for treatment, information about the child will not be sent to the

educational system or child welfare agency. This non-collaborative model creates

missing links for the child's service program. Ideally, all information from a child's

record should be shared and included in any services that the child receives, once the

family gives permission, but that seems to rarely occur in Thailand. The ideal EI/ECSE

system for Thailand can be developed, but it has to recruit and develop knowledgeable,

devoted, and enthusiastic staff to work in EI/ECSE settings.

For intervention strategies, religious bias about bun, good karma, and baab, bad

karma, will need to be put aside. An attitude about the best progress for each child's

outcome should replace the beliefs in good and bad karma. Parents or staff who work for

the child will first have belief that each child can develop to hislher own physical,

intelligent action, and social-emotional repertoire. Presently, it is believed that a child's

disabilities might come from the parents' or the child's bad karma. Thus, having a child

with disabilities reflects the parent's bad deeds in the past. Other people often look down

on the parents; thus parents are ashamed. This attitude is very important because when

staff or parents find out that their child has a disability, they will first try to deny, ignore,

and then refuse to recognize this child has special needs. They might treat their child like

a typical one and not give him/her individualized help, which could make the disability

more serious. To begin to solve this problem, parents must not feel ashamed of their

child's disabilities and others must not discourage the parents; support is needed. When

this bias has disappeared, it will make the intervention more workable and successful for

all. Intervention plans and strategies can then be implemented in order to facilitate

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40

optimal outcomes for each child. The staff can be more skilled in using targeted

intervention strategies effectively.

Family Involvement and the EI/ECSE System in Thailand

Family involvement in educational programs in Thailand looks very different

from practices in the U.S. In the U.S., the family often works alongside the professional

team and the family and their child are the center of the evaluation process (Bailey,

2000). The family is asked for their recommendations, consent, and expertise about their

child (Bailey, 2000) and plays a significant role in the system, such as working with their

child according to the IEP/IFSP plan (Bowe, 2007). However in Thailand, most of the

program models for EI are professionally-centered models. Parents always believe in the

professionals, such as teachers, pediatricians, and friends who have experience. Usually

they are not involved in the development or teaching of their child's programs. When

they find "something wrong" with their child, they most likely go to see the pediatrician

or public health care staff in their district. If their child has some behavioral problem or

social emotional problems, they will ask the teachers or elders to teach their child.

Currently, it is difficult to highlight the strengths of the EI/ECSE system in

Thailand, since there are so few services for young children with disabilities. However,

the strengths of the Thai society system and the relationship of people in Thai society

helping and sharing with each other, will greatly enhance and contribute to the system in

the future. Needs for EI/ECSE in Thailand now include: (1) qualified personnel for

EI/ECSE, (2) a quality of screening, assessment, evaluation, and program evaluation

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41

system, (3) ongoing EI/ECSE services, and most importantly, (4) an enthusiastic trained

staff who are willing to work for all young children.

Some possible strategies that will meet the needs of an EI/ECSE system in

Thailand include the following:

1. Create a system for EI/ECSE personnel preparation.

2. Create a screening system for early identification of delays.

3. Create an assessment, evaluation, and programming system.

4. Train childcare staff and teachers to use screening and assessment tools.

5. Train all early childhood teachers on the practices for young children with

disabilities.

6. Show effective projects in the EI/ECSE system to the Thai government in

order to get more funding for an EI/ECSE system.

7. Recruit trained skilled administers to direct an EI/ECSE system

In Thailand, change will come. Since special education has been legalized this

year, an experimental program and research can be conducted in the future. Currently,

there is no government agency to start an EI/ECSE program. Changes will come to

EI/ECSE in Thailand in the future.

Developmental Assessment Systems for Young Children in Thailand

The Thai government does not specify a policy for developmental and behavioral

screening system for young children. However, both the Ministry of Public Health and

the Ministry of Education have started screening system projects. Two agencies from the

Ministry of Public Health currently provide screening for young children. First, the

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42

Department of Mental Health provides a website with a developmental screening

checklist for parents and teachers at http://www.dmh.go.th/test/cesd/child/. The

screening tool is an adaptation of the tool based on Denver II and Ten Questions and

assesses children from 6 months to 6 years with 9 intervals and 6 "yes" and "no"

questions on a checklist. Second, the Department of Mental Health has screening

instruments for behavioral screening and mental health screening for young children. For

very young children, the Department of Medical Science established the Thailand

National Neonatal Screening Program (http://www.dmsc.moph.go.th/). The program

implements neonatal screening as one of the health issues for public health care services.

With limited funding and government investment, the program provides services for only

13 centers in 13 provincial cities.

The Ministry of Education established the Bureau of Special Education

Administration in 2003. This organization supervises all 76 special education centers.

Roles and duties are to collect, study, and analyze the conception of proposals, policies

and plans for the education of people with disabilities and the disadvantaged in

accordance with the National Education Plan, the Basic Education and Early Childhood

Education Improvement Plan, and other relevant national policies. The assessment

system distributes assessment forms for clients with disabilities in each province. The

organization does not specify anything about a screening system; it just mentions that

each school should screen children for disabilities in order to receive services from a

special education center (http://special.obec.go.th/).

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According to the recent intervention and evaluation system in Thailand, when a

child is detected as disabled, at-risk, or disadvantaged, the child's family has several

choices for receiving intervention services. For example, Rajanukul Institute provides

services for children with autism. Parents of children with vision or hearing impairments

have to look for appropriate institutes which are limited and scattered all over Thailand.

The special education center provides IEPs for children who receive services. Some

centers provide an intervention classroom for those who have disabilities.

A Thai Screening System

Overall, the system for developmental and behavioral screening is very limited in

scope. Because it is a new concept and system, any screening system must be officially

studied in order to be implemented in any single Thai area.

Unlike neither Part C from IDEA in the U.S., the Thai National Education Act

(1999) nor the Thai Special Education for Individuals with Disabilities Act (2008)

authorizes or requires a screening process for all children from birth to 6 years. The

current screening system has been developed by the Ministry of Public Health and

Ministry of Education as a means to establish an early childhood education system. It is

not the government's plan at this time to further develop and expand this system.

Summary

EI/ECSE standards provide recommended methodologies and approaches to help

identify and prevent delays in children's development. Early identification can help to

maximize children's potentials, reduce harmfulness from at-risk environments, and

encourage critical skills in young children (McLean, 2004; Squires, 2007). One important

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44

methodology in EIIECSE is the early identification process including systematic

developmental screening. To develop a screening system in Thailand, a valid and reliable

instrument must be based adapted instrument and the field trials for this instrument should

be conducted. With development of an effective, adapted screening test, parents and

teachers will have an appropriate tool for early identification and to help identify concerns

about the children or lags in their development. Early identification will assist with

improving developmental outcomes. In the United States, federal legislation, the Individual

with Disabilities Education Acts (IDEA), supports and authorizes EIIECSE service (Bowe,

2004). IDEA outlines guidelines for a way of thinking and developing practices for this

professional area (Sandal, McLean, & Smith, 2000), with great potential to be adapted in

other countries

In contrast, EI/ECSE is less known in Thailand and legislation needs to be passed.

Services and support are limited and focused only on specific impairment cases, such as

deafness and blindness. There is no law or legislation to support educational services for

young individuals with disabilities. Now is the time to begin work on EI/ECSE in

Thailand.

This study aims to offer a best practice model for beginning an EIIECSE system

in Thailand. This model includes adaptation and study of a screening instrument, the

ASQ: Thai. Developing a screening system will help early childcare staff and teachers

to identify children with delays in a classroom. Accordingly, effective screening will

assist with improving outcomes of young children in Thai early childhood centers. This

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45

model will service and inform the Thai government about a potential screening system

that may have applicability to all ofThailand.

This study will investigate if the adaptation and use a screening instrument, the

ASQ: Thai, can be successful in early childcare settings. As part of an early identification

system, this study will investigate (a) an adapted instrument for screening young children,

(b) a model for best screening practice, (c) utility as rated by the users, and (e) cultural

appropriateness of the instrument and the model.

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46

CHAPTER III

METHOD OF STUDY

The ASQ: Thai version was developed and adapted from the ASQ (Bricker &

Squires et aI, 1999). The ASQ is a screening instrument used to assess young children's

developmental and behavioral areas. As the ASQ is a cost effective and easy to use

developmental screening instrument for monitoring the development of young children

from age 2 months to 60 months (Squires et aI., 1999), it is a worthwhile tool to use for

children in Northeast Thailand. The purpose of this study was to determine and

investigate the reliability and use of the Ages and Stages Questionnaires: Thai (ASQ:

Thai) in early childcare settings in Northeast Thailand. Results from this research will be

used for future development of this tool and will be a part ofa new strategy in working

with young children, emphasizing a child development perspective for parents.

In the study, the subject population had the best ability to determine culturally

relevance and accurate practices for a child's developmental evaluation. If early

intervention is identified as a need for some children, child outcomes may be improved.

Parents' benefits may include the opportunity to participate in assessment, receive

information about their child's development, and contribute to early intervention

research. Benefits for early childcare staff/teachers include learning about the

development of a specific child in their program, and the opportunity to gain

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0.

47

knowledge about and use of the screening process, which will help them better,

understand the children in their program.

A reliable and culturally relevant screening instrument that can be used in early

childhood education and early childhood special education in Thailand may be the

outcome of the study. The instrument will assist parents and teachers in an increased

understanding of child development as well as the identification for early intervention of

children who are at-risk or who have developmental delays. Importantly, this is a first

",' step in developing a high quality screening system for all young children. In addition,

some best practices for children with developmental delays, those who are at-risk, or who

have disabilities will be highlighted and taught and may assist with developing high

quality educational systems for young children.

The study focused on examination ofthe ASQ: Thai in the areas of(1) the cultural

appropriateness of the instrument, (2) reliability, and (c) utility. Participants, procedures

for recruitment, protection ofhuman subjects, selected tests and measures, methods ofdata

collection, and data analysis will be described in this chapter.

Participants

Participants consisted of 1) children ages 24-36 months (2-3 years old) in preschool

settings, 2) their parents/caregivers, and 3) their teachers/early childcare staff. Participants

were recruited in early childcare settings and kindergartens from four provinces in

Northeast Thailand: Mahasarakham, Khonkean, Roi-et, and Kalasin. The participants came

from villages, district towns, suburbs ofbig cities, and big cities.

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48

There were several processes of the recruitment. First, the researcher contacted the

faculty ofEducation, Mahasarakham University for the incooperation. The Faculty of

Education provided helps by giving the permission to the researcher to use a conference

room for the Use ofASQ: Thai Training. Moreover, the Faculty ofEducation allowed

staffs and university students in early childhood education program to assist in the training

and participating of the research study. The Faculty ofEducation also assisted in recruiting

early childhood educators by sending letters of invitation to early childcare settings. From

this process, 49 early childcare staff/teachers (EC staff) were recruited, and training on

ASQ administration was conducted. Then, the research asked EC staffto recruit children

and their families to participate in the research study. EC staff looked their children and

they selected children and families based on families' volunteering. Each family signed the

consent form before the data collection occurred. In the search ofparticipants, random

sampling was not used; participants were chosen based on potential to fully participate..

The details ofeach participant group are described next.

Children

Preschoolers in Northeast Thailand were selected; 267 children ages between 24-36

months (2-3 years old) were recruited by teachers or childcare staffs in childcare settings in

elementary schools, sub-district early childcare centers (under the supervision ofdistrict

councils), and private early childcare centers. Early childcare staff/teachers who attended

the ASQ: Thai training also selected children who received early childhood care services

from their childcare settings. In selecting children, early childcare staff/teachers confirmed

age, language spoken, and disability status from the school records, and then they sent an

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49

informed letter to each child's parent/caregiver. Most children attended childcare centers

in elementary schools in Northeast Thailand.

Parents/Caregivers

Parents/caregivers of267 preschoolers who live in Northeast Thailand were invited

to participate in this study. The term "parents" included the preschoolers' biological

parents, grandparents, aunts, uncles, and legal guardians. All parents were able to read,

write, and understand Thai, the official language of Thailand. The parents or caregivers

signed an informed consent letter, an in absentia form and any other appropriate forms

before any data were collected.

TeacherslEarly Childcare Staff

Forty-nine teachers (i.e. early childcare staff) who provide early childhood

education services in kindergartens and early childcare settings participated. Three

categories were recruited in this group: a) in-service teachers, b) pre-service teachers, and

c) early childcare staff. In-service teachers were defined as regular teachers who had an

early childhood teacher position in public elementary schools and private kindergartens.

One teacher in each school was invited to attend a workshop on the use ofASQ: Thai.

"Pre-service teachers" was defined as early childhood teachers, most of who will be

in the last year of the early childhood education program in the Department of Curriculum

and Instruction, Faculty ofEducation, Mahasarakham University. About 30 pre-service

teachers were invited for this study to provide early childhood education in public

elementary schools. Finally, "early childcare" staffwas defined as the early childhood

personnel who work for the departments ofearly childhood education in sub-district

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50

councils or other educational areas as well as the early childhood personnel in sub-district

health centers, or district/provincial hospitals. About 15 early childcare staff were invited

to participate.

Setting

Thailand has five regions: North, South, Central, West, East, and Northeast. The

five regions are diverse in cultures, languages, and geography. Early childcare settings in

Northeast Thailand were the main focus in this research. The settings for administration of

the ASQ-Thai were determined by the type of the early childhood education setting. Only

those which accept children from 24 -36 months (2-3 years old) were chosen. For example,

elementary schools that provide early education for children two years old and kindergarten

for children three years old ~ere included. Settings included district early childcare

centers, private early childcare centers, and provincial special education centers. The

geographical distribution of the childcare settings were varied, and located in villages,

district towns, provincial towns, and communities or suburban areas.

Protection of Human Subjects

The researcher asked for approval for the study from the University of Oregon

Institutional Review Board prior to the recruitment ofthe subjects. In Thailand, the

researcher asked for approval for the study from Mahasarakham University, the educational

areas in the four provinces, and the provincial hospitals in the four provinces.

Before the data collection started, parents/caregivers and teachers/early childcare

staff were asked to sign a consent form. The parents/caregivers also signed an in absentia

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51

form in order to let the teachers/early childcare staff complete the ASQ: Thai on their

children.

Participants' names were coded with identification numbers to protect

confidentiality. After the data collection was finished, the names, addresses, phone

numbers, emails, and any personal information were separated and kept in a secure

location. Data will be kept for three years in case of any further requests from the

participants or for further study and will then be destroyed.

During the interviews, risk of participating in the study may have included

parental discomfort. Parents were asked to discuss the process of using the ASQ: Thai.

If the parents became uncomfortable at any time, the investigator would stop the

interview and offer the parent the choice of discontinuing. The investigator was available

to speak with parents or early childcare staff/teachers any time. The investigator's

contact address, phone number and email were given to the participants for further

follow-up or concerns.

In this study, the investigator asked parents and early childcare staff/teachers to

provide private information, such as income, education level, ethnic backgrounds, or

spoken language, which may have caused them some discomfort and embarrassment. To

prevent these risks, the investigator informed the participants that their names would not

appear on any survey forms and transcriptions. Instead, identification numbers and

pseudonyms would replace their real names. In addition, the investigator informed the

participants that their information, data, and scores were treated as confidential and were

to be stored in locked files accessible only to the investigator. Consent forms with

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52

identifying information were kept in a locked file separate from the data. Data collectors

were trained to maintain confidentiality and the privacy of participants.

Measures

Six measures were used in this study: 1) Ages and Stages Questionnaire: Thai

(ASQ: Thai), 2) Family Information Survey, 3) Early Childcare Staff/Teacher

Information Survey, 4) Parent Utility Survey, 5) Early Childcare Staff/Teacher Utility

Survey, and 6) Interview Questions.

Ages and Stages Questionnaires: Thai (ASQ: Thai)

For this research, the researcher developed and pilot tested the Thai version of the

Ages and Stages Questionnaires (ASQ), adapted from the Ages & Stages Questionnaires

(ASQ): A Parent-Completed, Child-Monitoring System, Second Edition, created by

Squires et al (1999). The ASQ is one of the most highly rated screening tools and is

widely used in both school and medical settings in the United States, Korea, and China

(Heo, Squires, & Yovanff, 2008) and China (Bian, 2009).

The ASQ is a screening instrument administered to children from 1 to 66 months

of age in order to determine if a child has a developmental delay. Five domains of the

test include communication, gross motor, fine motor, problem solving, and personal­

social, each consisting of six items. Each item has three boxes, indicating "yes," the

child performs the item, "sometimes," and "not yet," and each item has a point value of

10,5, or 0, respectably. The total score for each domain is 60; the cutoff scores for each

domain were calculated at two standard deviations below the means score of the sample.

American derived cutoff score were used initially by the investigator.

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53

Family Information Survey

Information about a child's gender and birth date, parents' spoken language,

education level, age and monthly income were collected in the Family Information

Survey. Any concerns the family had about their children's development were also

requested.

Early Childcare Staff/Teacher Information Survey

Information about the early childcare staff/teacher's age, education level, and

length of time working with children, income, and gender were gathered. The survey

also included the teacher's reasons for being an early childhood educator and readiness

for being early childhood education personnel. The survey asked about the resources

available in early childhood centers for working with children with atypical development.

Parent Utility Survey

The survey asked about parent's degree of satisfaction with the ASQ: Thai, after

they had completed it. Questions included the length of time that parents/caregivers used

for completing the ASQ: Thai, the understanding of the items, and the need for assistance

while they were completing the tool. In addition, the survey asked whether the ASQ:

Thai made sense to them and whether the tool should be used for every child in Northeast

Thailand. The survey also asked whether the tool should be changed in any way in order

to make it relevant to a Northeast Thai context.

Early Childcare Staff/Teacher Utility Survey

This survey explored the perceptions of the early childcare staff/teachers about

the utility, content validity, and cultural appropriateness of the ASQ: Thai. The survey

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54

also asked whether the early childcare staff requested the help of parents/caregivers in

completing the tool, and whether they would like to use the ASQ: Thai to assess each

preschooler entering early childcare settings. In addition, the early childcare

staff/teachers were asked to help determine if the test items were appropriate for

Northeast Thai children and to comment on how to improve the tool. The survey asked

them to make suggestions for making the tool relevant to the Northeast Thai context, and

for ways to improve the tool.

Interview Questions

Five parents/caregivers participants (N=5) and five early childcare staff/teachers

(N = 5) were randomly selected for interviews. Each interview was about 15 to 20

minutes long. The interviewees were encouraged to describe their backgrounds, how

they raised their children, how they worked with their children at home, and how they

structured their classroom at school. The interview also asked them explicitly about the

ASQ: Thai. Questions included experiences that they had while they completed the

ASQ: Thai, the ideas that occurred to them while completing the test, and the future use

of the ASQ: Thai. Most importantly, the participants were asked if they believed that the

ASQ: Thai could make assessments for their children's development, and could enable

them to seek the appropriate services for their children. The results of the interview

suggested ways to improve the tool to be responsive to and appropriate for a Northeast

Thai context.

Table 2 describes measures, respondents, and schedule used for data collection.

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Table 2

Measures, and Respondents, and Schedule

Measure Description Respondent Schedule

The Thai version of Screening instrument, administered to children from birth to Parents/Teachers/E After consent

the Ages and Stages 60 months of age in order to determine if a child has or does arly Childcare gathered

Questionnaires not have a developmental delay and to assess the severity of Staff

(ASQ: Thai) any delay that may present.

Family Information Questionnaire to collect family demographic information Parents/Caregivers Before ASQ: Thai

Survey data collection

Early Childcare Questionnaire to collect early childcare staff/teacher Teachers/Early Before ASQ: Thai

Staff/Teacher demographic information Childcare Staff data collection

.-Information Survey

Parent Utility Questionnaire to measure the parents' perception of the Parents/Caregivers After ASQ: Thai

Survey utility of the ASQ: Thai data collection

Vl·Vl

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Table 2 (continued).

Measure

Early Childcare

Staff/Teacher

Utility survey

Description

Questionnaire to measure early childcare staff/teachers'

perception ofthe utility, validity and cultural

appropriateness of the ASQ: Thai

Respondent

Teachers/Early

Childcare Staff

Schedule

After ASQ: Thai

data collection

Interview Questions A set of questions used for in-depth interviews with parents Parents/Caregivers After ASQ: Thai

and teachers/early childcare staff Teachers/Early

Childcare Staff

data collection

Vl0\

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57

Procedures

Procedures consisted of three phases. First, completion of the translation and

adaptation of the ASQ: Thai included translation and back-translation of the ASQ: Thai

which was reviewed by a language expert. The second phase was the study of the

reliability of the ASQ: Thai, including completion of the ASQ: Thai by

parents/caregivers and early childcare staff/teachers with children in early childcare

settings. The last phase included the interviewing of parents/teachers about of their use

of the ASQ: Thai. Five participants from both the parent and teacher groups participated

in an interview. Study procedures are summarized in Table 3.

Phase I: Development of the ASQ: Thai

Step 1: Translation and Back-Translation. The translation team translated the

original ASQ from English to Thai which was then adapted as the instrument. A first draft

of the translation was completed and sent back to the team to check for accuracy of the

language and the context ofThai culture, as some items may not correspond with a Thai

cultural context. After the translation had been adapted, it was sent to an English professor

in the department of Westem Languages and Linguistics, Mahasaarakham University

Thailand to translate back into English.

Step 2: Review and Editing by Experts. Five early childhood educators and special

education specialists were invited to participate in this step. The participants received

packages of the 24-,30-, and 36-month intervals of the ASQ: Thai. The participants were

asked to give feedback, suggestions, and comments in order to make the ASQ: Thai

appropriate for Northeast Thai children. They then sent the ASQ: Thai and their comments

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58

back to the investigator. Finally, a review panel was organized with the participants invited

to discuss the cultural appropriateness of the ASQ: Thai. At the end of this process, the

investigator and the team revised the ASQ: Thai into the final version to be used for data

collection in this study. Table 3 describes the developers ofthe ASQ: Thai.

Table 3

Developers ofthe ASQ: Thai

ASQ: Thai's Duty

Name Job 1 2 3

Prasong Saihong Researcher .J .J

Dr. Nalinee Cherwanitchakorn Pediatrician .J

Dr. Wajuppa Tossa English Professor .J

Srikanyaphat Rangsiwarakul Early childhood professor .J

Sudares Rattanathaworn Early childhood professor .J

Wimonnut Laowisarnsarano Early interventionist

Sirisom Phataraphongsit Children nurse

Ornanong Sanitlun Early childhood educator

4

Notes: 1= Translator, 2 = Editor, 3=Back-translator, 4=Early childhood expert

Phase II: Reliability Study of the ASQ: Thai

Step 1: Recruitment ofParticipants. The Faculty of Education, Mahasarakham

University assisted in participant recruitment. The Dean of the Faculty ofEducation had

agreed to cooperate with the researcher by announcing this study to the student-teachers

who were working on their pre-service studies in early childcare settings and kindergartens

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.-------~. ----- ----------

59

and encouraged them to participate in the study. Approximately 30 student teachers/pre­

service teachers were recruited.

The faculty of education also provided help for the researcher to contact elementary

schools, early childcare settings, and early childhood departments in four provinces. The

Faculty of Education authorized the letter of invitation to be given to those early childhood

agencies, inviting each early childcare setting to send a staff member to join the ASQ: Thai

training. Approximately 30 early childhood teachers and early childcare staff were

recruited.

After the recruitment had been done, those participants were asked to sign the

consent form which indicated that their participation was completely voluntary. No one

withdrew from this project at this point.

Step 2: Training for the Use the ASQ: Thai. The training was organized for two

days. All pre-service teachers, in-service teachers, and early childcare staff were required

to attend the training before they administer the ASQ: Thai. The training mainly focused

on how to use the ASQ: Thai. However, the significance and knowledge of early

development and developmental delays were discussed in order to facilitate understanding

of the use of the tool. The training also included information about the meanings and

administration of the items on the ASQ: Thai and guidelines for introducing the ASQ: Thai

to parents. The schedule of the training is described on Table 4.

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Table 4

The Use ofthe ASQ: Thai Training Schedule

Date/Time Topic

November 1,2008

60

8.30 - 8.45 AM

8.45-9.30 AM

Opening

Introduction to Early Intervention/Early Childhood Special

Education

1.00-2.00 PM

2.15-3.00 PM

9.45-10.30 AM Screening Assessment and Early Identification System

10.30-11.45 AM Introduction to the Ages and Stages Questionnaires (ASQ) and the

Ages and Stages Questionnaires: Thai (ASQ: Thai)

Using the ASQ: Thai: Gross Motor and Fine Motor Domains

Using the ASQ: Thai: Communication and Problem Solving

Domains

3.000-3.30 PM Using the ASQ: Thai: Personal-Social Domain

3.30-4.00 PM Questions and daily evaluation

November 2, 2008

9.00-10.00 AM Group discussion on the ASQ: Thai

10.15-11.50 AM Practice and use ofthe ASQ: Thai (role play on assessment, home

visit, and conversation with parents)

1.00-2.00 PM

2.00-3.00 PM

3.00-3.30 PM

Implication of the ASQ: Thai

Instruction of research study assistance

Evaluation and closing

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61

Step 3: Recruitment ofPreschoolers and Their Parents. A letter of invitation was

sent to schools and early childcare directors in order to inform them ofthis study. After

schools or early childcare centers had agreed to participate, early childcare staff/teachers

asked their students to pass a letter of invitation to their parents. The 267 parents who

agreed to join the study were asked to complete the ASQ: Thai with their children at home.

If they were not clear about what the instrument was asking, they could ask for assistance

from early childcare staff/teachers at schools and early childcare centers.

Step 4: Early Childcare Staff/Teachers Complete the ASQ: Thai. After parents

signed their consent forms, 49 early childcare staffs completed the ASQ: Thai for 267

children age 24-36 months by themselves. Each of them completed approximately 5-10

ASQ: Thai on children in their classroom. They completed the questionnaires at schools

and early childcare centers or at children's home with parents/caregivers present.

Step 5: Computing reliability Study of the ASQ: Thai for Early Childcare

Staff/Teachers. Randomly selected early childcare staff/teachers were asked to complete a

second ASQ: Thai within two months of their first administration. Ten to fifteen children

each from the 24-month, 3D-month, and 36-month intervals were retested.

Step 6: Computing Reliability Study of the ASQ: Thai for Parents. Forty parents

completed a second ASQ: Thai on their children. They were asked to complete the ASQ:

Thai within 4-6 weeks of their first administration. Ten to twenty children each from the

24-month, 3D-month, and 36-month intervals were retested. Approximately 60 children

were asked to participate.

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62

Phase III: Utility Study of the ASQ: Thai.

Step I: Early Childcare Staff/Teacher Utility Survey. Sixty early childcare

staff/teachers completed the early childcare staff/teachers utility survey. They received the

survey after they finished completing the ASQ: Thai. They returned it to the investigator

by mail. Five of the teachers were selected for interviewing.

Step 2: Parents Complete the Parent Utility Survey. Early childcare staff/teachers

asked parents if they liked to complete the utility survey after they finished completing the

ASQ: Thai with their children. If they agreed, teachers would send the survey home with

their children. The parents returned it by mail or in person to the teachers. Ifparents were

not clear about the survey, they could ask for assistance from teachers and early childcare

staff at their children's schools. In addition, five parents were selected for a short interview

in order to get in-depth information for the utility study.

In Table 5, it describes the list the frequency, duration, and data collection method

for each activity.

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Table 5

List the Frequency, Duration and Data Collection Methodfor Each Activity.

Week completed

Activity Time used Participant 1 2 3 4 5 6 7 8 9 10 11 12

Translation 1 month Investigator & team*

Back translation 1 week An English professor*

Review and edit by 1 month Early childhood educators

experts Special education

specialists*

Revision of ASQ: Thai 1 week Investigator*

Recruitment of participants 1 month Investigator*

Training for the use ofthe 2 days Investigator & Early-..j

ASQ: Thai childcare staff/teachers

Complete the ASQ: Thai 15-20 60 early childcare

minutes staff/teachers & 250 parents -..j -..j -..j -..j -..j -..j -..j -..j -..j -..j -..j

0\VJ

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Table 5 (continued).

Week completed

Activity Time used Participant 1 2 3 4 5 6 7 8 9 10 11 12Retest the ASQ: Thai 15-20 Early childcare staff/teachers

-.J -.J -.J -.J

minutes & 40 parents

Utility surveys 5-10 minutes Early childcare staff/teachers-.J -.J -.J -.J -.J -.J -.J -.J -.J -.J -.J

& parents

Interview 20-30 Early childcare staff/teachers-.J -.J -.J -.J

minutes & parents

Note: * These activities occurred before the data collection period.

0'\~

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65

Data Analysis

In this section, research questions, outcome measures, and analysis strategies were

explained. The outcome measures were used to answer the research questions and to assess

the independent and dependent variables. Analysis strategies helped to interpret the

findings. At the final part of this section, the research Hypothesizes or the Research

Questions, Outcome Measure, & Analytical Strategy are summarized in Table 6.

Table 6

Describe the Research Hypothesis (es) or the Research Question(s), Outcome Measure, &Analytical Strategy.

Research Question Outcome Measure

Is the ASQ: Thai a culturally Translation of the

appropriate instrument to screen original ASQ into Thai

preschoolers for developmental delays Back translation by an

in Thailand? English professor

Expert review panel

Analytical StrategyPercentage of

agreement

Summary of the

suggestions from

experts

What is the reliability ofthe ASQ:

Thai?

Internal consistency

Test-retest reliability

Interobserver reliability

ASQ: Thai Cronbach's

correlation

Pearson correlation

T-test

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66

Table 6 (continued).

Research Question

Are there differences between the

scores of Northeast Thai children of

24-, 30-, and 36-month ASQ: Thai and

those of U.S. children on the ASQ?

What are the differences?

Outcome Measure

ASQ: Thai

ASQ

Analytical Strategy

ANOVA

2 SD for Thai cutoff

score calculation

Difference between

means, SD, & cutoff

of ASQ: Thai and

2009 American ASQ

score

What is the utility of the ASQ: Thai, Utility Survey

as evaluated by parents/caregivers and Interview

early childcare staff/teachers?

Descriptive statistics

Summary of

interview results

Research Question I: Is the ASQ: Thai a Culturally Appropriate Instrument to Screen

Preschoolers for Developmental Delays in Thailand?

To answer this question, several tasks were completed. First, the editing and

adapting of the ASQ: Thai were conducted by the researcher and a translation team. The

team consisted of early childhood education professors from Mahasarakham University and

a pediatrician from Bangkok Hospital. Second, a back translation was made by an English

professor from Mahasarakham University. Third, the updated ASQ: Thai and

measurement checklist were sent to early childhood education specialists and childhood

special education specialists, and pediatricians. These experts analyzed whether each item

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67

was appropriate and fit into the Northeast Thai cultural context. Specialists were able to

answer whether they "agree," "not agree," and "please make an improvement," for each

ASQ: Thai items. In addition, at the end of each item there was a space for adding

suggestions and other comments. Fourth, a panel of experts conducted a review session.

They reviewed the tool and discussed cultural relevance of the ASQ: Thai. They also gave

suggestions for improvements, or for making the ASQ: Thai more relevant for use in the

Northeast Thai cultural context.

Descriptive statistics summarized results from the questionnaire. The results from

this process provided information on whether the ASQ: Thai was a culturally appropriate

instrument that can be used to assess preschoolers in Northeast Thailand. The process also

provided confirmation of the cultural appropriateness and content validity for use in the

early childcare settings in Northeast Thailand.

Research Question IT: What Is the Reliability of the ASQ: Thai?

Investigation into the reliability helped to assure that the instrument was consistent

and useful for referral and decision-making (Salvia & Ysseldyke, 2(06). Reliability refers

to the investigation into which scores are free from errors. If the ASQ: Thai 24-, 30-, and

36-month intervals have few internal errors and have consistency across settings and

examiners, then the ASQ: Thai has high reliability. Reliability in this study included 1)

internal consistency, 2) test-retest reliability, and 3) inter-observer reliability.

Internal Consistency. To determine internal consistency, the ASQ: Thai was

analyzed for correlations and consistency across the items. Correlation analyses and

Cronbach's coefficient alpha were calculated. The Cronbach's alpha of .70. Alpha

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68

(Cronbach) is a model of internal consistency, based on the average inter-item correlation.

Cronbach's Alpha measured how well a set of variables or items measured a single,

unidimensional latent construct (Cronbach, 1951). An F-test is a statistical test in which

the test statistic has an F-distribution if the null hypothesis is true. It is most often used

when comparing statistical models that have been fit to a data set, in order to identify the

model that best fits the population from which the data were sampled (Lomax, 2007). To

analyze this property, SPSS 15 software was used to calculate coefficient alpha.

Test-Retest Reliability. Test-retest reliability test included the Paired-Samples T

Test procedure in which the means of two variables were compared for a single group. The

procedure computed the differences between values of the two variables for each case and

tested whether the average differs from O. Observations for each pair should be made

under the same conditions. To determine test-retest reliability, the two sets of scores from

the parents/caregivers as well as from the early childcare staff/teachers were compared.

Selected parents/caregivers and early childcare staff/teachers completed the tool twice in a

2-months time period. To obtain a Paired-Samples T Test, the SPSS software was used for

the analysis. An agreement of 90% between scores from the first and scored completion

would be considered as reflecting high interobserver reliability.

Interobserver Reliability Interobserver reliability is the measurement ofpercentage

agreement between classifications based on the questionnaires by two groups of observers

(Landis & Koch, 1977). An interobserver reliability analysis using Pearson's correlation

coefficients was performed to determine consistency among observers. To obtain to

statistics, SPSS software was used. In this study, the two sets of scores from

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69

parents/caregivers and early childcare staff/teachers were compared. An agreement of 90%

would be considered as high reliability.

Research Question III: Are There Differences Between the Scores ofNortheast Thai

Children on the 24-,30-, and 36-Month ASQ: Thai and Those of US. Children on the

ASQ? What Are the Differences?

Means scores of the 267 Northeast Thai children were compared with the US. data

held by the Early Intervention Program, University of Oregon. The comparison indicated

many differences in item statistics between Northeast Thai and American children. The

means, standard deviations, cutoff scores, ranges, medians, and range of the 24-month, 30­

month, and 36-month Northeast Thai data were compared with the 2009 American data. In

order to determine differences between the ASQ: Thai and American scores, the means

domain scores of the ASQ: Thai sample were compared with the means domain scores of

the US. sample 2009. This process used an analysis of variance (ANOVA) in order to

analyze differences across domain scores and intervals for both samples. Statistically,

ANOVA is a collection of statistical models, and their associated procedures, in which the

observed variance is partitioned into components due to different explanatory variables

(Ferguson & Takane, 2005 and gives a statistical measure of whether the means of ASQ:

Thai score and American ASQ score were equal or different; p < .05 is considered as

significant.

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70

Research Question IV: What Is the Utility of the ASQ: Thai, as Evaluated by

Parents/Caregivers and Early Childcare StafflTeachers?

Utility is based on the satisfaction and feedback from the parents/caregivers and

early childcare staff/teachers who completed an ASQ: Thai satisfaction survey.

Satisfaction surveys provided information on the opinions, perceptions, and response to

the use of the ASQ: Thai by parents and teachers. Percentages were calculated in order

to summarize items from the survey forms. Interviews were conducted in order to more

thoroughly explore some of the questions. In the interview sessions, the interviewees

were selected based on the availability and ease to be visited. Each of them signed an

audio consent form for recording. In the interview process, note taking had been done

with the recording. Later, the record of each interview was transcribed and summarized.

From the interview, responses were summarized for each question. The data from the

surveys and the interviews were summarized as descriptive statistics and in narrative.

The samples of interview questions are shown at Table 7.

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71

Table 7

Interview Questions for Parents/Caregivers and EC Staff

No. Question

1. Tell me about your child, explain about your child, what is strength,

weakness?

2. How do you keep up with development in each month?

3. Did you child have developmental problems? If yes, how did you solve the

problems?

4. How can you notice or identify if your child has a concern?

5. Who do you trust most about your child development?

6. Did you know about screening instrument before? If yes, what kind, did

you bring your child to take the screening test?

7. When you take your child to a doctor, could you tell me what did the

doctor do with your child for screening?

8. Tell me about how, what do you do to tell about your child development?

How can you tell if your child had a concern?

9. How did you feel when you were completing the test to your child?

10. Have you seen a test like the ASQ: Thai before? If yes, what is it, how do

you know it, did you child take the test?

11. Do you think the ASQ: Thai can help your child development? How?

12. Do you think the ASQ: Thai should be given to all Thai children? Why?

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72

CHAPTER IV

RESULTS

The results of the study are described in this chapter. There are four main

outcomes worth noting. First demographic information is presented. Second, the

appropriateness of the translation and culture are discussed. Third, the psychometric

qualities are described including reliability (i.e., internal consistency, test-retest

reliability, and interobserver reliability), and analysis ofthe differences between the

scores of the U.S. ASQ and ASQ: Thai. Finally, the utility results for the ASQ: Thai are

summarized.

Participants

Children

Children between the ages of22 and 26 months were administered the 24-month

age interval ofthe ASQ: Thai; children between the ages of 27 and 32 months were

administered the 30-month age interval; and children between the ages of 33 and 39

months were administered the 36-month age interval study. Children were recruited by

teachers and early childcare educators from their early childcare preschool classroom.

Demographic characteristics ofthe participant children are summarized in Table 8.

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73

Table 8

Demographic Characteristics ofChildren in the ASQ: Thai Sample (N = 267).

ASQ: Thai Interval

24-month 30-month 36-month

Questionnaire Questionnaire Questionnaire

n % n % n %

Gender

Male 30 54.55 53 51.96 59 53.64

Female 25 45.45 49 48.04 51 46.36

Total 55 100.00 102 100.00 110 100.00

Parents/Caregivers

A total of267 parents/caregivers completed the 24-,30-, and 36-month age

intervals of the ASQ: Thai. All parents were recruited by their children's teachers and

early childhood educators. Some parents/caregivers were recruited by teachers or early

childcare educators at their children to schools or childcare centers; and others were

recruited during home visits. Informed consents were signed by parents prior to data

collection. Parents/caregivers were asked to provide personal information, including

respondent status, ethnicity, language, income, and income resources.

The majority of respondents who participated were fathers or mothers (215 for

80.5%) and 40 (15%) were grandparents. For ethnicity and languages, a total of267

(100%) families claimed their ethnicity as Thai; a total of219 (82.02%) specified using

the Thai language in communication and 48 (17.98%) specified using the Lao language.

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74

For the parents'/caregivers' education level, the majority reported that they had received

bachelor degrees (n = 103), while others had achieved either Mathayom 6 (Grade 12

diploma) (n = 60), Mathayom 3 (Grade 9 diploma) (n = 25), or Prathom 4 (Grade 4

diploma) (n = 25).

Regarding income levels, 39.33% (N =105) earned around 1,000 to 6,000 baht or

30-175 U.S. dollars per month ($1 =35 baht); 30% (N = 79) earned around 6,000 to

15,000 baht or 175 to 429 U.S. dollars per month; 15% (N = 39) earned around 15,000 to

30;000 baht or 286 to 860 U.S. dollars; ten percent (N =30) earned more than 30,000 baht

or 860 U.S. dollars per month. The sources of income were from various places

including government support, selling crop products such as rice, cassava, sugar cane,

and trading. Demographic characteristics of the families are presented in detail in Table

9.

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75

Table 9

Demographic Characteristics ofFamilies in the ASQ: Thai Sample (N = 267).

ASQ: Thai Interval

24-month 30-month 36-month

Questionnaire Questionnaire Questionnaire

(n =55) (n =102) (n = 110)

n % n % n %

Respondent

Father/mother 45 81.82 87 85.29 83 75.45

Uncle/aunt 3 5.45 2 1.96 0 0.00

Grandparent 4 7.28 10 9.80 26 23.64

Sibling 3 5.45 3 2.94 0.91

Ethnicity

Thai 55 100.00 102 100.00 110 100.00

Language

Thai 47 85.45 90 88.24 82 74.55

Lao 8 14.55 12 11.76 28 25.45

Education level

Graduate 2 3.64 8 7.84 7 6.36

Bachelor 19 34.55 40 39.22 44 40.00

Certificate 4 7.27 6 5.88 10 9.09

Mathayom 6 (grade 12) 14 25.45 30 29.41 16 14.55

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76

Table 9 (continued).

ASQ: Thai Interval

24-month 30-month 36-month

Questionnaire Questionnaire Questionnaire

(n =55) (n =102) (n = 110)

n % n % n %

Mathayom 3 (grade 9) 9 16.36 6 5.88 10 9.09

Prathom 6 (grade 6) 4 7.27 9 8.82 4 3.64

Prathom 4 (grade 4) 3 5.45 3 2.94 19 17.27

Income Source

Selling crop products 17 30.90 21 20.60 35 31.80

Monthly income 21 38.20 47 46.10 36 32.70

Trading 7 12.70 26 25.50 24 21.80

Other 10 18.20 8 7.80 15 13.60

Income/month (baht)

Less than 1,000 7 12.72 7 6.86 0 0.00

1,000-6,000 13 23.65 32 31.37 60 54.55

6,000-15,000 20 36.36 37 36.27 22 20.00

15,000-30,000 8 14.55 15 14.72 16 14.55

More than 30,000 7 12.72 11 10.78 12 10.90

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77

Teachers/Early Childcare Staff

A total of 49 teachers/early childhood educators attended the ASQ: Thai training.

All were recruited by letter of invitation from the faculty of education at Mahasarakham

University. Demographic information on the teachers/early childhood educators is

described in Table 10.

Table 10

Demographic Characteristics ojTeachers/Early Childcare Educators.

Level of education

B.A. in Early

childhood Education

In-service training

Certificate in ECE

Length of experience

1-2 years

2-3 years

Income

1,000-3,000 baht

6,000-10,000 baht

TeacherslEarly Childcare Educators (n = 49)

n

6

39

4

35

14

35

14

%

12.20

79.60

8.20

71.40

28.60

71.40

28.60

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78

Cultural Appropriateness

Several processes were followed in order to observe the content validity of cultural

appropriateness. In the beginning, the researcher and translation team translated and edited

the ASQ. This included adapting it to be appropriate for Thai cultural and linguistic

contexts. After that, the final adapted edition was translated back into English in order to

proof and compare the accuracy with the original version. To answer the question of

cultural appropriateness of the ASQ: Thai, this section will describe the results of the back

translation, the review by a panel of experts, and suggestions for improvement from the

parents/caregivers and early childcare staff/teachers.

Results of the Back Translation

The back translation was completed by Dr. Wajuppa Tossa, who is an English

professor at the Faculty of Humanity and Social Science at Mahasarakham University. In

Dr. Tossa's back translation, there were several points that differ from the original version.

First, the structure of sentences was changed. For example, in the instruction section, the

original version says, "On the following pages are questions about activities children do."

When translated back, it said, "The following questions are about activities that children

do." Another example is on the 30-month interval, communication domain item 5. The

original read, "Without giving him help by pointing or using gestures, ask your child... ";

the back translation said "Can your child follow two instructions in a row for

example, ... correctly without help of any kind." Second, Thai grammar is different from

English. When translated into Thai, "can" the transitive verb is added in Thai. Therefore,

in the back translation version, most items had the phrase "Can your child make ..." instead

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79

of "Does your child make ... " Third, some terms, objects, or equipment in the original

version were used as borrowing words, for example, blocks and ball. Fourth, the names in

the original were changed into Thai names in order to make more sense in Thai. Therefore,

the back translation version used the Thai names that are different from the original. Next,

some conjunction or transition words appear in the back translation version. For example,

the words "but," "even though," "then," and "or" were used when translated back. An

example sentence is in the 30-month interval; Personal-social domain, item 2. The original

version is; "Does your child use a spoon to feed himself with little spilling?" The back

translation read "Can your child use a spoon to feed himlherself even though he/she spills

some food? " Finally, the back translation used "he/she" and "himlherself' when a sentence

refers to the child instead of using only "he" and "himself' as in the original version.

The back translation of the ASQ: Thai appears to be adequate in comparison to the

original version. The translator pointed out that the ASQ: Thai was trying to keep the

structure of each sentence parallel to the original. As a result of the excellent back

translation, there were no major concerns on the comparison ofthe two versions. However,

the translator suggested that the ASQ: Thai should be read and edited by professionals who

offer services in the early childhood education and special education fields.

Results of the Panel of Experts Review

The panel of experts was asked to verify the cultural appropriateness and content

validity of the ASQ: Thai. There were two steps in this process: using a checklist, and

participating on a panel discussion. Ten invitations were sent out to recruit the experts in

early childhood/special education; five responded.

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80

In the checklist, the five experts were asked to input how much they agreed on each

item of the ASQ: Thai. They were asked to complete a survey regarding the language

appropriateness and the cultural appropriateness of the ASQ: Thai for Northeast Thai

clients. The checklist consisted of4 rating scales: 1 = Poor, 2 = Fair, 3 = Good and 4 =

Excellent. For each item on the checklist, the experts mostly agreed to rate 3 = Good for

both language and cultural appropriateness. In the panel discussion, they agreed that the

ASQ: Thai was appropriate to a Northeast Thai cultural setting. In addition, they agreed

that the activities in the ASQ were typical practices in Thai early childhood development.

However, they asked for some changes in words and new terms that were more appropriate

to Northeast Thai environments and changes to some cultural aspects that would match

Northeast Thai child rearing practices.

In the discussion panel, all experts suggested these following concerns and changes.

First, on the 24-month interval, Fine Motor domain, item 4, the experts suggested the

clarification of a light switch that was used in the activity. The experts made the

clarification that it should be a switch from a fan. They gave the view point that children

were generally not allowed to tum a light switch or any kinds of switches and that a fan

switch was safe. Second, the experts suggested that Thai teachers or parents who live in

urban areas prefer to use the more polite suffix in front ofa pronoun, such as "Khun," a

polite suffix to address a person. The experts prefer to use "Khun" in front ofthe words

"Mother," "Father," "Teacher," "Grandma," etc. Next, the experts made the comment that

normally Thai children (who were taught in the Thai school system) like to call themselves

by using their nicknames and when children call their friends, they usually use the friends'

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81

nicknames. They suggested the item on the Personal-Social domain, item 6, 24-month

should stick with the nickname of the child instead of using "I."

The next concern is cultural appropriateness. The experts singled out some objects

and actions that are used in the activities. They found that on the interva130-month,

Communication domain, item 5, the question asked a child to put a pair of shoes on a table

and put a book under the table. They pointed out that Thai children were taught to respect

books and all kinds ofknowledge sources and therefore would not feel comfortable placing

a book under the table. They also pointed out that Thai children also learn that showing

shoes in front of another person is not polite. Therefore, they suggested to change the

command phrases from "put the shoes on the table" to "put the shoes under the table" and

"put the book under the table" to "put the book on the chair." Finally, the experts

suggested adding more o~jects, tools, toys, and equipment that could be found in the local

areas. They suggested adding "cut straws" instead of "beads." They discussed that the

ASQ: Thai was friendly to all parents. They expected that when an assessor met a parent

and her child, the parent would easily be able to look for objects and tools to work with her

child.

At the end of the discussion, the experts agreed that the ASQ: Thai was the best tool

to use to screen young children. Besides these concerns, they believed that the ASQ: Thai

will be a good starting tool improving for child development at area in Northeast Thailand.

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82

Results on Parent Satisfaction Survey

A total of 173 parents responded to the survey. They were asked to complete two

questions relating to the cultural appropriateness of the ASQ: Thai. First was asked,

"Was it easy to understand the questions?" The second question was, "Were the

questions with three choices appropriate for my child's age?" Each question had three

answer choices which were "Yes," "Sometimes," and "No." In response to the first

question, 67.10% (N = 116) parents/caregivers agreed that the questions were easy to

understand and 32.90% (N = 57) answered "Sometimes." For the second question,

46.20% (N = 80) parents/caregiver answered "Yes" and 53.80% ( N =93)

parents/caregivers answered "Sometimes." Figures 3 and 4 show the percentage of

answers of the parents/caregivers on cultural appropriateness of the ASQ: Thai.

• Yes[J Some il

• YesDSometin

Figure 3: Was it easy to understand the

questions?

Figure 4: Were the questions appropriate

for my child's age?

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83

Results of the Early Childcare Staff/Teachers Satisfaction Survey

A total of 49 early childcare staff/teachers responded to the survey. They were

asked to complete three questions relating to the cultural appropriateness of the ASQ:

Thai. These were: 1) "Were the questions appropriate for the children's ages?"; 2) "Was

the language clear and easy to understand?"; and 3) "Were the questions culturally

appropriate?" Each question had three answer choices: "Yes," "Sometimes," and "No."

Table 11 shows the percentage of early childcare staff/teachers answers on the cultural

appropriateness of the ASQ: Thai.

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Table 11

84

Summary ofEarly Childcare Staff/Teachers' Satisfaction Survey: Opinion on ASQ: Thai

EC staff/teachers' responses

The questions were appropriate for the children's ages:

ASQ: Thain %

Yes

Sometimes

No

Total

The language was clear and easy to understand:

Very much

Sometimes

Not confident

Total

The questions were culturally appropriate:

Yes

Sometimes

No

Total

20

29

00

49

22

27

o

49

25

24

o

49

40.80

59.20

0.00

100.00

44.90

51.10

0.00

100.00

51.00

49.00

00.00

100.00

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85

Reliability

Internal Reliability

Cronbach's coefficient alpha is a model of internal consistency based on the

average inter-item correlation and measures how well a set of variables or items measures

a single, one-dimensional latent construct (Cronbach, 1951). According to Cohen (1960),

an alpha of .80 is a strong agreement, .60-.80 is a good agreement, and .40 - .60 is a

moderate agreement. Cronbach's coefficient alpha was calculated for area scores on

individual questionnaires. Two sets of sample scores were calculated, early childcare

staff/teachers' scores and parents/caregivers' scores. For the communication area, alphas

ranged from .79 at 30 months ofEC staffs scores to .85 at 24 months ofEC staffs scores

and at 36 months of parents/caregivers' scores. For the gross motor area, alphas ranged

from .76 at 24 months of parents/caregivers' scores to .89 at 36 ofEC staff and

parents/caregivers' scores. For the fine motor area, alphas ranged from .75 at 24 months

ofEC staffs scores to .88 at 36 months of parents/caregivers' scores. For the problem

solving area, alphas ranged from .75 at 36 months ofEC staffs scores to .89 at 30

months of parents/caregivers' scores. Last, for the personal-social area, alphas ranged

from .58 at 36 months ofEC staffs scores to .79 at 24 months of parents/caregivers'

scores. Table 12 presents the alphas of the EC staff and parents/caregivers.

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Table 12

Cronbach's Coefficient Alphafor the 24-, 30-, and 36- Month ASQ Thai

86

Interval and domain

24-month (n =55)

Communication

Gross motor

Fine motor

Problem solving

Personal-social

30-month (n = 102)

Communication

Gross motor

Fine motor

Problem solving

Personal-social

36-month (n =110)

Alpha (EC Staff)

.85*

.79*

.75*

.85*

.77*

.79*

.79*

.79*

.87*

.75*

Alpha (Parents)

.82*

.76*

.81 *

.88*

.79*

.80*

.80*

.82*

.89*

.75*

Communication

Gross motor

Fine motor

Problem solving

Personal-social

Note. * The Cronbach's alpha of .70

.82* .85*

.89* .89*

.86* .88*

.75* .81 *

.58* .64*

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------- - - ---

87

Pearson Product Moment correlation coefficients were calculated between the

developmental area and overall scores across questionnaires. Scores between all domains

in both EC staff and parents/caregivers were significantly correlated at p < .01.

Correlations between total score and individual domain scores ranged from .40 to .60.

Results are shown in Table 13 and Table 14.

Table 13

Correlations between Domains and Total Score for the ASQ: Thai's EC StaffScores

Gross Fine Problem PersonalArea Communication motor motor solving -social

Communication

Gross motor .51

Fine motor .49 .55

Problem solving .57 .59 .65

Personal-social .60 .51 .55 .66

Overall .44 .43 .48 .60 .53

Note. N=267. All correlations are significant at p <.01.

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88

Table 14

Correlations between Domains and Total Score for the ASQ: Thai's Parents/CaregiversScores

Gross Fine Problem Personal-Area Communication motor motor solving social

Communication

Gross motor .50

Fine motor 048 .54

Problem solving .62 .53 .62

Personal-social .64 046 .50 .66

Overall .50 040 AS .60 .56

Note. N=267. All correlations are significant at p <.01.

Test-Retest Reliability

Test-retest reliability was measured by comparing the results of two

questionnaires completed by parents/caregivers and EC staff in a 2-month time period.

The total scores from the parents' results were compared to the second completed set

from the EC staff. The percentage agreements of the parents/caregivers completed scores

for each area were higher than 90% or p > .90. And there were no differences greater

than 5 points. Test-retest reliability of parents/caregivers is as shown in Table 15 and of

EC staff on Table 16.

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Table 15

ASQ Mean and Standard Deviations between Time} and Time 2 ofthe Parent/CaregiverReport, and Correlations.

M M

(SD) (SD)

ASQ: Thai Domain (n = 58) Time} Time 2 Pr

Communication 54.48 52.84 .94**

(8.87) (7.73)

Gross Motor 52.93 51.72 .98**

(10.52) (9.89)

Fine Motor 45.86 45.78 .96**

(13.48) (12.66)

Problem Solving 50.86 50.43 .99**

(11.21) (11.09)

Personal-Social 52.16 51.03 .96**

(7.62) (7.12)

89

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90

Table 16

Means and Standard Deviations between Time 1 and Time 2 ofthe Early ChildcareStajjlTeachers Report, and Correlations.

M M

(SD) (SD)

ASQ: Thai Domain (n = 58) Time 1 Time 2 Pr

Communication 53.36 51.72 .95**

(9.57) (8.41 )

Gross Motor 50.95 50.52 .98**

(10.53) (10.37)

Fine Motor 43.45 43.45 .96**

(12.33) (12.18)

Problem Solving 48.62 47.41 .96**

(10.38) (9.83)

Personal-Social 51.12 50.43 .95**

(7.38) (6.96)

Interobserver Reliability

Interobserver reliability was examined by comparing children's classifications

based on questionnaires completed by parents/caregivers with the classifications based on

questionnaires completed by EC staff. A total of 267 questionnaires were completed

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91

across children from the 24-months to 36-months intervals. Interobserver reliability

measured percentage agreement based on two classifications; Pearson correlations were

used for measuring both association and mean differences between raters were calculated

for measuring the significance of the association and mean differences between raters.

Mean scores, standard deviations, and Pearson's coefficients correlation for

parents/caregivers and EC staff are shown in Table 17.

Table 17.

Means and Standard Deviations between the Early Childcare StafJITeachers andParent/Caregiver Reports, and Correlations.

M M

ASQ: Thai (SD) (SD)

Domain (n = 267) EC Sta.fJITeachers Parents/Caregivers Pr

Communication 53.95 53.11 .79

(9.20) (9.77)

Gross Motor 52.88 51.69 .76

(10.97) (10.63)

Fine Motor 45.21 44.14 .84

(13.23) (12.94)

Problem Solving 49.14 47.85 .86

(13.61) (12.94)

Personal-Social 51.66 50.26 .78

(9.16) (8.84)

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92

Differences between the Scores of the U.S. ASQ and ASQ: Thai

Two hundred sixty seven children ASQ: Thai completed by EC staff and

parents/caregivers in Northeast Thailand were compared to the U.S. data. The range,

mean, median, inerquartile range, and cutoff score of the 24-month, 30-month, and 36-

month ASQ from Thai and U.S. data are represented in the Table 18 for Thai EC staff.

Table 18

The Range, Mean, Median, Interquartile Range, SD, and CutoffScores ofthe 24-,30-, and36-month ASQ: Thai from Northeast Thai EC Staffand Us. Data.

Interval & domain n Range Mean Median Interquartile SD Cutoff

24 Communication

Thai 55 20-60 51.91 55 10 10.61 30.69

U.S. 1,434 0-60 51.26 60 10 12.99 25.17

Differences -20 00.65 -5 00 -2.38 5.42

Gross motor

Thai 55 20-60 51.09 55 15 10.87 29.35

U.S. 1,434 0-60 54.72 60 10 8.33 38.07

Differences -20 -3.63 -5 5 2.54 -8.72

Fine motor

Thai 55 10-60 41.00 45 20 12.63 15.74

U.S. 1,434 0-60 51.70 55 15 8.27 35.16

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93

Table 18 (continued).

Interval & domain n Range Mean Median Interquartile SD Cutoff

Problem solving

Thai 55 0-60 41.55 45 25 15.92 9.71

U.S. 1,434 0-60 49.42 50 10 9.78 29.78

Differences 00 -7.87 -5 10 6.14 -20.07

Personal-social

Thai 55 15-60 47.91 50 15 10.96 25.99

U.S. 1,434 0-60 51.17 55 15 9.74 31.54

Differences -15 -3.26 -5 00 1.22 -5.55

30 Communication

Thai 102 20-60 54.26 60 10 8.66 36.94

U.S. 950 0-60 53.81 60 10 10.26 33.30

Differences -10 0.45 00 00 -1.60 3.64

Gross motor

Thai 102 20-60 . 52.75 55 10 10.10 32.55

U.S. 950 10-60 53.53 55 10 8.71 36.14

Differences -10 -2.01 00 5 1.39 -3.59

Fine motor

Thai 102 10-60 44.26 45 15 12.59 19.08

U.S. 950 0-60 46.79 50 20 13.77 19.25

Differences -10 -0.78 -5 -5 -1.18 -0.17

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94

Table 18 (continued).

Interval & domain n Range Mean Median '. Interquartile SD CutoffProblem solving

Thai 102 0-60 47.94 55 20 14.37 19.20

U.S. 950 5-60 50.17 55 15 11.55 27.08

Differences 5 -2.23 00 5 2.82 -7.88

Personal-social

Thai 102 15-60 51.26 55 10 9.47 32.32

U.S. 950 0-60 51.87 55 10 9.93 32.01

Differences -15 -0.61 00 00 -0.46 0.31

36 Communication

Thai 110 10-60 54.68 55 5 8.89 36.90

U.S. 995 0-60 51.93 55 10 10.43 30.99

Differences -10 2.75 00 -5 -1.54 5.91

Gross motor

Thai 110 5-60 53.91 60 5 11.74 30.43

U.S. 995 0-60 54.70 60 10 8.84 36.99

Differences -5 -0.02 00 -5 2.90 -6.56

Fine motor

Thai 110 0-60 48.18 50 25 13.51 21.16

U.S. 995 0-60 47.10 50 20 14.49 18.07

Differences 00· 1.08 00' 5 -0.98 3.09

'," .

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95

Table 18 (continued).

Interval & domain n Range Mean Median Interquartile SD Cutoff

Problem solving

Thai 110 15-60 54.05 60 10 8.95 36.15

U.S. 995 0-60 52.00 55 10 10.85 30.29

Differences -15 2.05 5 00 -1.73 5.86

Personal-social

Thai 110 25-60 53.91 55 10 7.05 39.81

U.S. 995 12-60 52.83 55 15 9.74 35.33

Differences -13 1.08 00 -5 -2.69 4.48

The range, mean, median, interquartile range, and cutoff score of the 24-month, 30-

month, and 36-month ASQ from Thai and U.S. data are represented in Table 19 for

parents/caregivers.

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96

Table 19

The Range, Mean, Median, Interquartile Range, SD, and CutoffScores ofthe 24-,30-, and36-month ASQ: Parents/Caregivers Data.

Interval & domain n Range Mean Median Interquartile SD Cutoff

24 Communication

Thai 55 20-60 51.27 55 10 11.23 28.81

U.S. 1,434 0-60 51.26 60 10 12.99 25.17

Differences 20 00.01 -5 00 -1.76 3.64

Gross motor

Thai 55 20-60 50.18 55 15 10.05 30.08

U.S. 1,434 0-60 54.72 60 10 8.33 38.07

Differences 20 -4.54 -5 5 1.27 -7.99

Fine motor

Thai 55 10-60 39.73 40 20 11.80 16.13

U.S. 1,434 0-60 51.70 55 15 8.27 35.16

Differences 10 -11.97 -15 5 3.53 -19.03

Problem solving

Thai 55 0-60 41.55 45 20 14.56 12.43

U.S. 1,434 0-60 49.42 50 10 9.78 29.78

Differences 00 -7.87 -5 10 4.78 -17.35

Personal-social

Thai 55 15-60 47.82 50 15 10.17 27.48

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97

Table 19 (continued).

Interval & domain n Range Mean Median Interquartile SD Cutoff

U.S. 1,434 0-60 51.17 55 15 9.74 31.54

Differences 15 -3.35 -5 00 0.43 -4.06

30 Communication

Thai 102 15-60 53.77 55 10 9.02 35.73

U.S. 950 0-60 53.81 60 10 10.26 33.30

Differences 15 -0.04 -5 00 -1.24 2.43

Gross motor

Thai 102 20-60 51.52 55 15 9.69 32.14

U.S. 950 10-60 53.53 55 10 8.71 36.14

Differences 10 -2.01 00 5 0.98 -4.00

Fine motor

Thai 102 5-60 43.28 45 20 12.38 18.52

U.S. 950 0-60 46.79 50 20 13.77 19.25

Differences 5 -3.51 -5 00 -1.39 -0.73

Problem solving

Thai 102 0-60 46.67 50 20 13.97 18.73

U.S. 950 5-60 50.17 55 15 11.55 27.08

Differences -5 -3.5 -5 5 2.42 -8.35

Personal-social

Thai 102 15-60 50.25 55 11 9.50 31.25

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98

Table 19 (continued).

Interval & domain n Range Mean Median Interquartile SD Cutoff

U.S. 950 0-60 51.87 55 10 9.93 32.01

Differences 15 -1.62 00 -1 -0.43 -0.76

36 Communication

Thai 110 5-60 53.41 55 10 9.62 34.17

U.S. 995 0-60 51.93 55 10 10.43 30.99

Differences -5 1.48 00 00 -0.81 3.18

Gross motor

Thai 110 5-60 52.60 60 10 11.71 29.18

U.S. 995 0-60 54.70 60 10 8.84 36.99

Differences -5 -2.1 00 00 2.87 -7.81

Fine motor

Thai 110 5-60 47.14 50 25 13.35 20.44

U.S. 995 0-60 47.10 50 20 14.49 18.07

Differences -5 0.04 00 5 -1.14 2.37

Problem solving

Thai 110 15-60 52.09 55 15 9.12 33.85

U.S. 995 0-60 52.00 55 10 10.85 30.29

Differences -15 0.09 00 5 -1.73 3.56

Personal-social

Thai 110 25-60 51.50 50 5 7.15 37.20

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99

Table 19 (continued).

Interval & domain n Range Mean Median Interquartile SD Cutoff

55 15u.s.

Differences

995 12-60 52.83

-13 -1.33 -5 -10

9.74

-2.59

35.33

1.87

The comparisons of the identified children (children who had below cutoff score

from Thai and u.s. data are shown on Table 20 and 21.

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Table 20

The Comparison ofthe Percentage ofThai and us. Children Who'Had Score Below the us. ASQ Cutoff: EC StaffCompleted

Communication Gross motor Fine motor Problem solving Personal-social

Cutoff %ID Cutoff %ID Cutoff %ID Cutoff %ID Cutoff %ID

24 months 25.49 38.34 35.40 29.91 31.81

Thai 7.27(4) 14.54(8) 43.63(24) 21.82(12) 7.27(4)

U.S. 7.70 4.00 5.70 2.90 4.90

30 months 33.33 36.14 19.23 27.13 32.00

Thai 2.94(3) 12.74(13) 13.72(14) 13.72(14) 4.90(5)

U.S. 5.90 6.00 3.60 5.40 4.80

36 months 30.96 36.96 18.03 30.21 35.18

Thai 3.63(4) 12.72(14) 2.72(3) 2.72(3) 3.63(4)

U.S. 5.90 6.20 5.30 6.80 7.10

Notes: Thai sample population: 24-month (n = 55), 30-month (n = 102), and 36-month; U.S. sample population: 24-month

(n =1,445), 30-month (n = 952), and 36-month (n = 996). In parentheses () = the number of Thai children who had score

below the U.S. ASQ cutoff.......00

Page 120: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

Table 21

The Comparison o/the Percentage o/Thai and Us. Children Who Had Score Below the Us. ASQ Cutoff: Parents/CaregiversCompleted.

Communication Gross motor Fine motor Problem solving Personal-social

Cutoff %ID Cutoff %ID Cutoff %ID Cutoff %ID Cutoff %ID

24 months 25.49 38.34 35.40 29.91 31.81

Thai 5.45(3) 14.54(8) 36.36(20) 21.81(12) 12.72(7)

U.S. 7.70 4.00 5.70 2.90 4.90

30 months 33.33 36.14 19.23 27.13 32.00

Thai 3.92(4) 10.78(11) 2.94(3) 11.76(12) 11.76(7)

U.S. 5.90 6.00 3.60 5.40 4.80

36 months 30.96 36.96 18.03 30.21 35.18

Thai 3.63(4) 9.09(10) 11.18(2) 2.72(3) 3.63(4)

U.S. 5.90 6.20 5.30 6.80 7.10

Notes: Thai sample population: 24-month (n = 55), 30-month (n = 102), and 36-month; U.S. sample population: 24-month (n

=1,445), 30-month (n = 952), and 36-month (n = 996). In parentheses () = the number of Thai children who had score below......0

the U.S. ASQ cutoff.......

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Utility

For this research question, the reported utility from parents and EC staff is the

main finding. Results are summarized from 1) parents/caregivers and EC staff

satisfaction surveys and 2) from interviews with parents/caregivers and EC staff.

Utility of Parents/Caregivers

Parents/caregivers were asked three satisfaction questions. Overall,

parents/caregivers reported 10-20 minutes for answering the questionnaire or about 48%

(n = 83). They also thought the ASQ: Thai was interesting and helped them to think of

their child development. The results are represented in Table 22.

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Table 22

Summary ofParents/Caregivers' Satisfaction Survey

ASQ: Thai

Parents/caregivers' responses n %

Time consuming

Less than 10 minutes 23 13.30

10-20 minutes 83 48.00

20-30 minutes 42 24.30

More than 30 minutes 25 14.50

Total 173 100.00

Assistance needs

Yes 68 39.30

Sometimes 19 11.00

No 86 49.70

Total 173 100.00

Opinions

Was interesting 73 42.20

Helped me think about my child's development 88 50.90

Took too long 10 5.80

Was a waste of time 2 1.20

Didn't tell me much 0 0.00

Total 173 100.00

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Utility of EC Staff

Table 23 represents time spent by EC staff to conduct the assessment for each

child. Over 70% felt it was not too time consuming. The results are represented in Table

23.

Table 23

Summary ofEarly Childcare StafJITeachers ' Satisfaction Survey: Time

ASQ: Thai

Parents/caregivers' responses

Time to use

Less than 10 minutes

10-20 minutes

20-30 minutes

More than 30 minutes

Total

Is it time-consuming?

Yes

Sometimes

No

Total

n

19

19

11

o

49

2

12

35

49

%

38.80

38.80

22.40

0.00

100.00

4.10

24.50

71.40

100.00

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Knowledge of Screening Instruments

Table 24 summarized EC staff rating of the knowledge of screening instruments.

Over 85 % reported they gained more experience on child development due to using the

instrument. The results are represented in Table 24.

Table 24

Summary ofEarly Childcare StajjlTeachers' Satisfaction Survey: Knowledge ofScreeningInstruments

ASQ: Thai

Parents/caregivers' responses n %

Did you hear about any screening instruments before this

research?

Yes 7 14.30

Sometimes 4 8.20

Never 38 77.50

Total 49 100.00

Did you learn more about child development from using

the tool?

Yes 42 85.70

Sometimes 7 14.30

No 0 0.00

Total 49 100.00

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Opinions About the Instrument

The opinions of the EC staff about using the ASQ: Thai are summarized in Table

25. Most are positive opinions on each question. Nearly three fourths said they would

consider using the ASQ: Thai in the future and 90% felt it was helpful for screening.

Table 25

Summary ofEarly Childcare StajJlTeachers' Satisfaction Survey: Opinion on ASQ: Thai

ASQ: ThaiEC staff/teachers' responses

Is the tool easy to implement?

n %

Yes

Sometimes

No

Total

How confident are you with the results of the screening tool?

33

16

00

49

67.30

32.70

0.00

100.00

Very much 28 57.10

Sometimes 21 42.90

Not confident 0 0.00

Total 49 100.00

Would you consider using this questionnaire in the future?

Yes 36 73.50

Sometimes 13 26.50

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Table 25 (continued).

ASQ: Thain %EC staff/teachers' responses

No

Total

Do you think that this questionnaire is helpful for screening?

Yes

Sometimes

No

Total

Interview with Parents/Caregivers and EC Staff

o

49

44

5

o

49

00.00

100.00

89.80

10.20

00.00

100.00

Open-ended questions were asked of parents/caregivers and EC staff in order to

understand more about their knowledge and opinions on child development and the early

screening process. Ten participants attended the interviews. The results of the interviews

are provided in the following categories.

Understanding of Child Development and the Early Screening Process. EC staff

discussed their knowledge of child development from preservice and inservice training.

They had spent at least four years learning about theories and applications of child

development. They confirmed they gained confidence for working with children as a

result of completing the ASQ: Thai. When asked to describe how many developmental

areas exist in child development, they gave the answer of four areas: 1) physical

development, 2) emotional and mind development, 3) social development, and 4)

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cognitive/ mental development (Ministry of Education, Thailand, 2003). According to

the core early childhood education curriculum, early childcare staff must provide

activities that support all four areas (Ministry of Education, Thailand, 2003). In working

with the ASQ, they said that they had gained new knowledge on child developmental

theories. In the ASQ, there are five developmental areas which assess a child's

development in each stage of age (Squires & Bricker, 1999). They agreed that the

instrument gave them more details on child development. When they were asked how

many screening tools they knew about, they said there were no tools that were used with

their children. They added that they had known mostly routine checklists, health

progress checklists, and the four developmental area checklists from the Ministry of

Education, Thailand (Ministry of Education, Thailand, 2003).

For parents, most of them said they did not know much about new child

developmental theories. They knew that if their child could talk, walk, eat, and play

normally, they had a normal child. But when a problem occurred with their child, they

would have access to a pediatrician or a public care provider who provided services in a

district hospital or a sub district health care center. For their children's education, they

expected their child would be learning from schools. They also expected that the school

would teach their child how to write, calculate, and speak English. When asked about the

early screening instrument, they had not known any kinds of screening instruments

before. They knew that their child would have a booklet for the health care record from a

health care provider.

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What Parents/Caregivers and EC Staff Learned from the Use of the ASQ: Thai.

Parents/caregivers and EC staff agreed that the ASQ: Thai contained useful questions that

raised much awareness about child development as well as helping with concerns they

might have about childhood problems. For EC staff, they found that they had been

exposed to new issues that had not existed in child development in Thailand. One staff

member discussed that parents who lived in one rural area did not have any awareness

about teaching their child's gender awareness. The parents did not tell their child

whether she/he was a boy or a girl. Children just told their names when the staff asked

"Are you a boy or a girl?" She said that parents never thought this was an issue. For her,

it was a good point to teach children to know about their gender because it would help

children learn about themselves, which is important for their social development. In

addition, EC staff found that the screening instrument gave them more insight about child

observation. Before using the instrument, they had just provided games, lessons, or

activities for children. They knew that all children in their classrooms could do certain

activities. After using the ASQ: Thai, they had gained more ideas about how to observe

and informally assess children. They said they had to observe how a child kicked a ball,

touched a ball, rolled a ball, threw a ball, and walked up the stairs. They added that some

children could not kick a ball. They realized that if children could not do an easy task,

they had to teach them and provide time for the child to practice the skill.

EC staff found that the screening tool made them understand more about child

development milestones. Because ofthe ASQ: Thai, they found they could understand

child development at each stage. Moreover, EC staff found that the screening instrument

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helped them to gain knowledge about working with children. TheY.had more knowledge

of how to identify which children had disabilities. They found they could add more

activities to their teaching repertoire. They gave as an example that "some children

cannot use their fingers on a pencil, they cannot write, but the parents force them to learn

how to write" or "some children cannot roll or kick a ball, but the parents did not see that

does not matter with their children." The teachers realized that according to the ASQ:

Thai, some children may be delayed in their development. They mentioned that all

children should have preparation for their readiness to learn. They found that the

screening tool alerted them to what activities children should practice and be able to do.

Besides those points, EC staff discussed children with disabilities in their schools.

After using this tool, they learned that they had to talk to parents who had a child with

disabilities. They had more awareness about working with those children. They also

tried to point out these issues related to children's disabilities to school masters, directors,

and their coworkers.

Before using the instrument, parents/caregivers just had concerns about their

children acquiring academic skills from the school lessons, even young children at 2

years old. However, after using the ASQ, they had many questions about general child

development. For example, one parent discussed her child's social issues. Her child

could not speak or repeat a sentence after her. Sometimes her child did not make eye

contact while talking. She asked ifher child had any problems. One parent talked about

the fact that her child did not pay attention in the classroom. Her child just sat alone

while other children played together. From the interviews, the parents had learned that

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preparation for readiness for all developmental areas was significant for child

development and later academic learning.

Suggestions from Parents/Caregivers and EC Staff in the Use of the ASQ: Thai.

All parents and teachers suggested that the questionnaire should be used by teachers,

because teachers were with the children for the whole day. Moreover, parents/caregivers

strongly suggested that the screening should be given at a child's intake interviews when

each child entered the first year of school. Parents/caregivers hoped that the ASQ would

facilitate progress in child development. EC staff agreed that the items in the instrument

could help them to understand the stages of development of children in each age level.

They suggested that each school should the screening instrument use with children,

especially at the beginning of each school year. Parents and EC staff suggested that the

ASQ: Thai could focus the attention of teachers and parents to work together. They also

expressed that the ASQ: Thai could help the parents and EC staff sees how their children

are growing, and what areas they should focus on in their child's development. As

parents found the screening instrument alerted them about their child's developmental

problems, they suggested that all intervals of the questionnaires should be used for their

child in school. Parents also said they would welcome working with teachers in the

screening process to facilitate getting the best results for their child.

To use ASQ: Thai, The EC staff suggested that it should be used at the beginning

of each term in order to check each child's development level. Then, the instrument

should be used again if there were concerns about any of the children. They agreed that

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children should be assessed every school tenn. EC staff also suggested that parents

should be involved in the screening process as well.

Summary

Interviews with parents and EC staff suggested that the ASQ: Thai changed the

attitudes ofEC staff and parents/caregivers. The ASQ: Thai focused their attention on

child development issues. Moreover, it made them feel confident that they had provided

appropriate supports for their children. The instrument also helped them gain new

knowledge on child development and made them think of potential developmental

problems in their children.

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CHAPTER V

DISCUSSION

Several agencies provide services and support for early intervention/early

childhood special education (EI/ECSE) in Thailand, but research and study for early

childhood development and assessment processes are not well developed as yet. There

remain limited services and supports for children and their families who live in remote

areas. Therefore, the adaptation of the ASQ system is significant as a starting point for

an early identification system in Thailand.

This research study has investigated and determined the reliability and utility

of a screening system using an adapted and translated version of the Ages and

Stages Questionnaires (ASQ), the Ages and Stages Questionnaires: Thai (ASQ: Thai),,~

in early childcare settings in Northeast Thailand. The ASQ: Thai was used in early

childcare settings, which allowed parents and early childcare staff to work together on

common goals for the child. The research result suggested that the ASQ: Thai

contributed to the awareness of child development by parents and early childcare staff.

Moreover, the results reflected positive outcomes and a basis for future study.

This chapter discusses and interprets of the findings including the choice of

participants, cultural appropriateness, reliability, and utility. The last section focuses on

the implications and limitations of the research.

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Participants

Three categories of participants included children, parents/caregivers, and early

childcare staff/teachers. Children were between 22 and 39 months of age and attended

and received early childhood education services in early childcare centers and elementary

schools in Northeast Thailand. A total of267 children were recruited and were divided

into three age grouping for completing the 24-month, 30-month, and 36-month

questionnaires. There were 54.55% (n = 30) males and 45.45% (n = 25) females at the

24-months interval, 51.96% (n = 59) males and 48.04% (n = 51) females at the 30­

months, and 53.64% (n = 59) males and 46.36% (n = 51) females at the 36-month

questionnaires. There were no clinical reports for disabilities on any child; all children

were in classrooms for typically developing children..

Over 80% completed of ASQ: Thai questionnaires were filled out by either

fathers or mothers (n = 215); and grandparents completed 15% (n = 40) completed.

Grandparents frequently completed the ASQ: Thai because some children were left with

their grandparents while their parents worked in remote areas. The language that

families used with their children was central Thai. However, some families reported that

they used the Lao language with their children. However, the ASQ: Thai did not seem to

cause any difficulty with understanding. Forty percent ofparents/caregivers reported

that they had received bachelor degrees (n = 103), Grade 12 diploma (n = 60), Grade 9

diploma (n = 25); and Grade 4 diploma (n = 25). However, almost half of participants

earned around 1,000 to 6,000 baht or 30-175 U.S. dollars per month. This is a low

income level compared to the government standard income which is about 10,000 baht or

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285 U.S. dollars per month. The income of families who earned less than 6,000 baht may

have come from selling crop products or trading. The families who live in villages

mainly earn their income from these trades. A total of 30% (N = 79) of families earned

more than 6,000 baht; most of these families lived in urban areas.

Early childcare staff and teachers were important participants in this research

study. They helped to distribute research forms to parents and caregivers as well as

recruit children in their classrooms and communities. Moreover, the early childcare staff

and teachers helped to assess children and collect the surveys from parents. About 28.6%

(n = 14) were early childcare staff and 71.40% (n = 35) were pre-service training teachers

in early childhood education. All early childcare staff had earned a bachelor degree. in

early childhood education and a certificate in early childhood education, and had of at

least two years experience working in early childcare settings. The pre-service training

teachers were working on a bachelor degree in early childhood education at the Faculty

of Education, Mahasarakham University, and had been studying for 5 years toward their

degree. All of the preschool teachers were in the fifth year of the program, and had been

training to work in early childcare settings since the third year of their program.

Cultural Appropriateness

Research Question I: Content Validity of the ASQ: Thai

Divergent processes had been under taken to assess the content validity of the ASQ:

Thai, including of the translations and adaptations for Thai cultural and linguistic contexts,

a back translation, the review ofthe translation by a panel of experts, and suggestions for

improvement from parents/caregivers and early childcare staff/teachers.

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In the back translation, an expert, Dr. Wajuppa Tossa, observed that the ASQ: Thai

was adequate in comparison to the original version. She pointed out that the ASQ: Thai

kept the structure of each sentence parallel to the original and had no major concerns and

felt it was appropriate for use in Thai early childhood settings. Further collaboration in the

development of the ASQ: Thai should include professionals who offer services in early

childhood education and special education fields in other settings in Thailand.

For another measure of content validity, a panel of experts pointed out some

concerns about the ASQ: Thai regarding cultural appropriateness. They suggested some

changes in replacing the objects used, some words, and some activities in order to make the

test more appropriate. However, over all, the experts mentioned that the ASQ: Thai was

the best tool to use for screening young children because the ASQ: Thai could be a good

starting tool for screening and improving child development in Northeast Thailand.

The responses from parents' satisfaction surveys were positive. There were three

choices of "Yes," "Sometimes," and "No" in the parent survey form asking about the

understanding and the appropriateness of the ASQ: Thai. All 100% (N =173) of the

parents responded with "Yes" and "Sometimes" choices.

According to the early childcare staff/teachers' responses, the ASQ: Thai appeared

to be culturally appropriate, age appropriate, and easy to understand. Fully 100% (N = 49)

ofthe early childcare staff and teachers gave the answers "Yes" and "Sometimes" on those

topics.

No one respondent answered "No" on the questionnaire. Generally, the answer

"NO" is not typically used in Northeast Thai society. If someone wants to refuse a

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request, he/she rarely says "No." He/she would rather say "sometimes" or "OK." The

interpretation of these cases may show only half acceptance with the satisfaction

associated with using the ASQ: Thai. Providers and parents may be happy with the ASQ:

Thai when they know that the instrument is useful and effective for helping their

children. In this discussion, the content validity observations appeared positive to these

parents and caregivers.

From the results, the translation appeared clear and adequately close to the

original one; the expert panel agreed the ASQ: Thai could be used for screening and the

satisfaction of the parents and early childcare staff and teachers was high. In conclusion,

the ASQ: Thai appeared culturally appropriate for use in early childcare settings.

Reliability

Research Question II: Reliability of the ASQ: Thai

Reliability of the ASQ: Thai is described in terms of internal consistency, test­

retest reliability, and interobserver reliability. Internal consistency analyses included

analyses of correlation and completion of Cronbach's coefficient alpha (Cronbach, 1951).

Internal Consistency. To analyze internal consistency, Cronbach's coefficient

alpha and Pearson correlation analyses were used. According to Cohen (1960), an alpha

of .80 is a strong agreement, .60-.80 is a good agreement, and .40 -.60 is a moderate

agreement. Therefore, Cronbach's coefficient alphas mostly reflected strong agreement;

however, some domains had only moderate agreement, such as on personal-social

domain of the ASQ: Thai, as completed by EC staff, (r = .58). The highest alpha was .89

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for the problem solving domain (parent completed) and the gross motor domain 36­

month interval on the completed by both EC staff and parents.

Pearson product moment correlation coefficients were calculated between the

developmental area and overall scores across the questionnaires. Pearson correlation

coefficients were quite strong for both sets of scores. According to Cohen (1960), these

correlations reflected moderate to good agreement, ranging from 0.40 to 0.60. Scores

between all domains in ASQ: Thais completed by both EC staff and parents/caregivers

were significantly correlated at p > .90.

Test-Retest Reliability. The comparison of test-retest reliability yielded strong

results between questionnaires completed by parents/caregivers and on EC staff the same

child within a 2-month time period. Test-retest information was collected by asking

parents/caregivers and EC staff to assess 58 children across the three age intervals. All

children were randomly selected to receive second tests. Correlations were based on the

response ofparents/caregivers and EC staffs between the two questionnaires and exceeded

90%.

Interobserver Reliability. Interobserver reliability was examined by comparing

children's classifications (i.e. typical, risk) based on questionnaires completed by

parents/caregivers with the classifications (i.e. typical, risk) based on questionnaires

completed by EC staff in the same period of time. Agreement between 49 EC staff and 267

parents/caregivers was quite strong, greater than 76%.

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Differences between the U.S. ASQ and the ASQ: Thai

Research Question III: Differences Between the Scores of Northeast Thai Children of

24-, 30-, and 36-Month ASQ: Thai and Those of U.S. Children on the Same ASQ

Intervals

The range, mean, median, interquartile range, and cutoff scores on the 24-,30-,

and 36-month ASQ: Thai (comparing parents/caregivers and BC staff separately) and

U.S. data sample were compared. Means (M) of the Thai data set and U.S. data set were

somewhat different across intervals and domain. The main differences were in the

standard deviation (SD) units. Due to the large differences in the two sample sets, the SD

of ASQ: Thai was very different from the U.S. SD. Therefore, the cutoff scores of ASQ:

Thai were different from those derived from U.S. population. The cutoff scores of ASQ:

Thai were either much higher or much lower from the U.S .. The reasons would occur

parents and BC staff completed the ASQ: Thai, they gave higher scores to their children.

Some parents and BC staff may have had biases about their children abilities. They may

think their children could not do such activities which were difficult. Therefore, they

gave children low scores. Another reason is some parents and BC staff may not feel the

test was serious. They may have ignored trying activities with their children. Another

reason that may affect the scores is the size of sample. The differences might be

minimized if the Thai sample was larger and more diverse. The BC staff had more

training on the use of ASQ: Thai, scores might have been different.

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Utility

Research Question N: Utility of the ASQ: Thai

Parents/Caregivers' Time Use and Assistance Needs. Parents and caregivers

were asked to fill out a survey about the amount of time spent on completing the ASQ:

Thai. Forty eight percent parents reported they took about 10-20 minutes. Nearly

38.80% took more than 20 minutes. These numbers demonstrate that the

parents/caregivers spent time reading and understanding each question. Sometimes, they

asked EC staff to help them answer the questions when they could not understand.

Nearly 40% reported they needed help computing the ASQ: Thai. As reported in the

interview, they asked EC staff to help them. About 11 % asked EC staff for help

sometimes. It is clear that about half of the parents needed help in order to assess their

children. Therefore, the collaboration of parents and EC staff should be formally

arranged in an ASQ: Thai system.

Parents/Caregivers' Implementation. Nearly 51 % of parents/caregivers thought

ASQ: Thai helped them to think about their child's development. According to the

interview, they had previously just paid attention to their children's academic skills

related to classroom learning. The ASQ: Thai focused on developmental areas that they

had not previously recognized. Over 42% thought ASQ: Thai was interesting and that

they could see their child's developmental picture more clearly. They could see the

developmental levels where their children should be. Seven percent of the parents

answered that the test was too long and wasted their time. There were no concerns that

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the questionnaire would be overwhelming by giving them too much to do. Overall

parents/caregivers liked the time they spent completing the ASQ: Thai.

EC Staffs Time Use. For EC staff, 38.80% reported they used less than 10

minutes to assess each child, and 38.80% used about 10-20 minutes to complete the

assessment on each child. No one took more than 20 minutes. Furthermore, 71.40%

reported that the ASQ: Thai was not time-consuming.

EC Staffs Implementation. Most of the EC staff reported ASQ: Thai was easy to

implement in early childcare settings. As they suggested, ASQ: Thai could be used with

preschool children when they entered early childcare settings; they learned that the ASQ:

Thai helped them to recognize and track each child's developmental level in the

classroom. EC staff also reported that ASQ: Thai was helpful for developmental

screening and recognition of the developmental delays.

From the interview with parents/caregivers and EC staff, ASQ: Thai represented a

greater understanding and increase in their knowledge and skills related to child

development and the early screening process. Neither group had any previous knowledge

of hands-on screening instruments. When using ASQ: Thai, they gained more knowledge

about child development. Therefore, completing the ASQ: Thai was a way to learn about

child development as well as screen for developmental delays. Both parents/caregivers

and EC staff pointed out that the ASQ: Thai gave them details about child development

and future steps for learning.

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Limitations

There were several limitations to this current research study. These included: 1)

lack of a diverse population, 2) lack of training for conducting the screening assessment,

3) lack oftime for monitoring each assessor, 4) lack of comparative tests for concurrent

findings, and 5) lack of a real understanding by early childhood staff of early

identification in Thailand.

The demographic study showed that half of the parents and caregivers earned

more than 6,000 baht a month, which means they most likely lived in an urban area.

While the researcher tried to recruit the sample from parents/caregivers who lived in

villages or rural areas, most EC staff taught in schools located in a provincial town,

where the majority of parents lived and earned a monthly salary in this urban area.

Training on the use of the ASQ: Thai training took place during a 2-day period,

which was not enough for providing in-depth training in the ASQ assessment process.

Even though the EC staff had 2-4 years in early childhood training, they needed more

training and skills related to knowledge ofEI/ECSE and early identification.

Data collection took about three months in Northeast Thailand. There was no

random sampling. All samples were selected based on EC staff. The EC personnel were

scattered all over Northeast Thailand so it took time to follow up with the EC staff and

parents/caregivers. More time was also needed to make family visits. However, there

was inadequate time for home visits as well as no funding for transportation. This issue

will be considered in the next research project.

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As mentioned, an early identification system in Thailand was not well known nor

well established. Therefore this line research requires much more infrastructure and

training. There are also no assessment tools that have been studied in Thailand that could

served as concurrent validity measures. More investigation is also needed to develop

robust procedures to establish concurrent validity of the ASQ: Thai.

Finally, EI/ECSE is a relatively new field in early childhood education in

Thailand. The EC staffhad been trained only in delivering the core curriculum from the

Ministry of Education. Knowledge about special needs and EI/ECSE service delivery is

not embedded in the training. This lack of knowledge and training issues may have

affected the research results.

Implications

Research

Initial results and findings regarding content and cultural validity of ASQ: Thai

were positive, suggesting an adequate translation and strong agreement from the experts.

For reliability, the findings were significant although the sample population was small.

Completed questionnaires by both parents/caregivers and EC staff were found

significantly correlated, with positive correlations, and strong agreement for test-retest

reliability. In addition, satisfaction surveys reflected high satisfaction from

parents/caregivers and EC staff. Future research on the ASQ needs to be expanded,

looking at young children aged 2 months to 66 months in Northeast Thailand.

For future research, psychometric properties of concurrent validity, sensitivity,

and specificity must be studied. The ASQ: Thai must be compared with another

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assessment instrument or battery of assessment or professional evaluation that has

already been studied and used in Thailand. While there are a couple of instruments

currently used in Thailand, they have no psychometric studies supporting their use. For

sensitivity and specificity studies, children with developmental delays and disabilities

must be included in this research. A diverse, normative sample throughout Thailand

must be included in future research as well. A broad population of Ee staff as well as

parents/caregivers must be recruited in order to get accurate results. The sample for this

current study did not include a diverse population. Therefore, future research must be

based on a larger, more diverse sample.

Practice

Results from this study suggest guidelines future practices for establishing an

early childhood screening system for Thai environment. The following areas are

suggested for concentration.

Suggested Practice for a Thai Screening System. Initially, a system for

developmental and behavioral screening should be field tested and studied and in specific

locales such as urban and rural areas. Any new concept and screening system must be

officially evaluated in order to be implemented in any single Thai area. Therefore, a

regional screening system must be developed and then used in available at early

childhood education settings and service delivery systems and these systems should be

carefully studied and evaluated as they are implemented.

Results from this research should include the following ideas. First, screening

systems must start from legislation and policy from the royal government. The Thai

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royal government must mandate a screening law. Next, the Ministry of Education,

Ministry of Public Health, Ministry of the Interior, and Ministry of Social Development

and Human Security must have regulations for the screening system and enforce the law

so it is widely used and understood in all government agencies. Government agencies

under the supervision of the four ministries will then need to collaborate in order to serve

the people within each area.

Second, an effective screening instrument must be officially planned, adapted,

and implemented. During the planning phase, a screening test will need to be chosen,

adopted, and studied in order to find the most appropriate instrument. The cultural

appropriateness of the screening instrument will need to be studied so that it is

appropriate for children in all cultures in Thailand.

Third, personnel working in the screening system will need to be trained. Centers

must be developed in each province around the country. The center can then recruit early

child development personnel and staff from district public health centers, district and

provincial hospitals, private pediatric clinics, early childhood departments from district

councils, and elementary schools personal to receive training in the screening instrument

and system. During training and implementation, the idea of family involvement needs

to be included. As the screening procedure is a collaborative process between parents

and assessors, screening personnel will be asked to do the screening assessment between

with the family.

Fourth, the screening system including screening tests will need to be distributed

to all official offices who work with young children, such as district public health centers,

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126

hospitals, schools, and special education centers. Each office will need to offer the

developmental screening test for the children who live under the provision of the office

area. The staff will collect data from the test, refer children as needed according to

results, and ask the parents to visit the office again within the following four or six

months in order to be rescreened so that the developmental progress of the child can be

monitored over time.

Fifth, evaluation of the screening system is as critical as the development of the

test. The center staff will need to collect and analyze screening data, including outcomes

for children identified with delays. If parents find their children as at-risk or with

concerns, they must be asked to assist with simple general interventions with the child.

The child who receives a result indicating possible delayed development must be referred

to pediatricians or specialists in hospitals and other institutions for follow-up.

Finally, all early childhood settings will be part of the screening system. Each

setting will screen every child as part of the enrollment process. If a child is detected as

at-risk or with concerns, the early childhood staff will collaborate with a specialist in

order to monitor and follow the child's progress.

Suggestion Practices for EI/ECSE Personnel Preparation. For a personnel

preparation system for early childhood teachers, the most effective intervention

programs, models, and experimental projects can be used as examples and adapted to the

Thai system. Since Thailand has few EI/ECSE settings, effective examples from abroad

will be essential to use in the beginning. Success stories in Thailand in EI/ECSE can be

presented as models to early childhood educators. Peered-coaching models, both

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127

reciprocal and professional, can be implemented in early childhood personnel preparation

by trained coaches. However, the system will at first need to be a modeling process, with

EI/ECSE staff first observing EI/ECSE programs from abroad and then comparing and

contrasting them with examples from Thailand. Selected staff can be trained initially by

U.S. EI/ECSE personnel. Then, the staff can work as EI/ECSE personnel preparation

trainers.

In order to develop a system, several personnel preparation strategies are

suggested:

1. Train early childhood personnel to use a development screening test in order

to identify preschool age children with disabilities.

2. Set up child development programs that include placements for children with

disabilities.

3. Set up professional education programs with minors and majors in EI/ECSE

in colleges of education.

4. Set up in-service training centers for early childhood educators and early

childcare staff, including centers in rural areas.

5. Recruit visiting scholars from abroad to visit the child development programs

and give observations and constructive coaching as well as trainings to the staff.

6. Publish reports, papers, and works of EI/ECSE Thai professionals.

7. Create an EI/ECSE training and support network, electronically as well as

traditionally.

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128

Application of Best Practices to an EI/ECSE system in Thailand. The Division for

Early Childhood (DEC) has policies and advances in evidence-based practices that

support families and enhance the optimal development of young children who have or are

at risk for developmental delays and disabilities (Sandall et aI., 2005). DEC provides

recommended practices for personnel preparation, which are suitable for early childhood

special educators and early interventionists. DEC-recommended practices can provide a

scaffold for development of the Thai EI/ECSE system.

DEC Recommended Practices highlight the work of both early childhood special

educators and the staff who work and intervene in early childhood settings (Sandall et aI.,

2005). The guidelines of DEC are clear, specific, and readily available to apply in

personnel preparation and intervention. DEC Recommended Practices suggests the

participation of families in the delivery of training services, in increasing the quality of

pre-service and in-service trainings, increasing family-centered practices, and promoting

cultural and linguistic diversity (Sandall et aI., 2005). DEC Recommended Practices

also promote an interdisciplinary and collaborative model with family involvement and

effective training in evidence-based practice. These models could form the basis of an

effective Thai system and could help to organize a personnel preparation system for Thai

early childhood teachers. Because of these important and relevant features, DEC

Recommended Practices have the potential to be adapted to promote culturally competent

approaches for EC personnel and children in Thailand.

Changes in Thailand in the practices ofearly childhood educators and staff must

be implemented. Personnel preparation in early childhood must include provisions for

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129

young children with disabilities. Standards adapted from DEC Recommended Practices

for personnel preparation are the most fitting for early childhood education in Thailand.

Therefore, personnel preparation must include a focus on family involvement,

multicultural and social contexts, learning through play, the uniqueness of each child, and

the child's interests and needs as a basis for intervention for implementation in a Thai

personnel program for several reasons.

Personnel Training. First, as Thailand has diversity in language, religion, and

areas, DEC Recommended Practices will help early childhood educators to recognize

bias in race, culture, and the hierarchical systems in Thai society. Second, guidelines and

recommended practices for early childhood settings can form a comprehensive and

standardized personnel system that can be used throughout the country. Third, these

guidelines will help to promote a new structure for an early chi}dhood education system

in Thailand. For example, collaboration among agencies and personnel can be

encouraged through various practices such as an empowerment model, peer coaching,

and ongoing evaluation of programs. This will help to increase the quality of early

childhood programs by training early childhood education personnel to learn these

strategies. Finally, the DEC guidelines will encourage field experiences that allow early

childhood teachers to experience real situations and be prepared to provide authentic

services using recommended practices for children and families. Early childhood

teachers will have many opportunities to practice implementing recommended practices

in real settings to become competent, highly qualified early childhood educators.

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130

Two strands from DEC Recommended Practices, Family Involvement (Strand PP1) and

Community Participating (Strand PP3), can be adapted and applied effectively in

Thailand. The strand PP1 states: "Family involvement begins early and continues

throughout all aspects of the pre-service program" (p. 78). As a best practice, family

involvement is an ideal that must be adapted to Thai culture. So, this strand can be

adapted to "Family involvement is encouraged to be included in the pre-service program"

(p.78). For PP3, "Community agency and school personnel are involved in the

preparation program," the community agency may not want to work with the personnel

preparation program. Therefore, this strand can be adapted to encourage community

agencies to partner with school personnel and school personnel to encourage the

community agency to get involved in preparation programs; and school personnel will be

encouraged to get involved with the community (Sandall et aI., 2005). In addition, DEC

Recommended Practices highlight the significance of learning activities including the

study of cultural and linguistic diversity. Cultural and linguistic diversity can be

embedded into personnel training programs and may enhance early childhood teachers'

experiences.

Conclusion

The findings from this research study suggest that the ASQ: Thai is appropriate

and can be used in early childcare settings in Thailand. More importantly, the research is

provides a foundation for developing a screening system development in Thailand. The

research points out that a screening system must start with regulation from the central

government. Therefore, the government needs to provide funds and support for this area.

Page 150: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

131

Then, research will need to start at the universities and early childhood development

centers in order to develop an appropriate screening process. Next, personnel training

will need to be undertaken. Early childhood staff in all settings will need to receive

training on screening procedures, on-going follow up and mentoring. Collaboration

across ministries and professionals must take place in order for staff training and system

implementation to be successful. For example, staff from schools must work with staff

from hospitals and public health centers. Significantly, the aims and goals for optimal

child development must be developed and disseminated in early childhood settings and

among staff that will in turn link to the greater screening and intervention system.

Future research on the ASQ: Thai is needed. Governmental agencies must start

working on early identification in order to develop a foundation for EI/ECSE in Thailand.

Increased study of cultural, language, and disability issues must be included.

Collaboration among families, specialists, EC staff, and community members is critical

for this system. With coordinated and integrated training and services, developmental

outcomes for young children in Thailand will be improved.

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132

APPENDIX A

LETTER OF INVITATION: FACULTY OF EDUCATION, MAHASARAKHAM

UNIVERSITY

Page 152: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

133

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Page 153: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

134

UNIVERSITY OF OREGON

College of Education

Assnc. Prof. Dr, PraYlt ErawanDean of Faculty of EducationlVlahasarakhmn UniversityAmphoc lVluang. tVlahasarakh<Ull44(}()(l

(kt()!x~r I J. 200R

;v'l)' mum: is Pmsong Smhong ! am a doctoral candidate at th(~ Early Intervention Pmgnnll.College of Educlltlon. University of Oregon, USA. I'm calling to talk to you about partKipatingin my rn,c<\t'c:h sllHly. I am recently bcgmning my research disserWtion entitled "Evaluating thePSyThornctric Properties and the Utility of the Ages and Stages Qm'stiol1l1<lires: Thai {ASQ:fhai) in Northeast Thailand." The procedures of til{' research arc I) to trllin tcacht'r$ andchlldcarc staf1'to usc the ASQ: Thai. 2, to USt~ th,~ ASQ: Thai to ~cn::cn children age 24 montlbto 36 tIlomhs (2-3 years old), 3) whelp parcn!s and cart'givcrs to lISC the /\SQ: ThaL and 4} tnobserv(~ and interview the ASQ: Thai uscrs,

rIlis study requires various partiCipations. You're eligihle to be in this sHldy hexause YOllrll1stitllk~ could provide rcsmm:es and contacts that will bt~ helpful for IbIS study, To make thisslUdy success, 1 would like to request your kind assistance and cooperation thlm your institutionHl Ihe ibllowing topics:

I. to issue an offkial ktter requesting cooperation from Early Childhood instiwtiollsin nortbeast Thailand.

') to give permission to your s!<lff to attend the workshop of the lise of sCl't'Cninginstrument.to give permission fix assessment staff to give a screening test for the earlychildhood students in your school or ~~cnter.

4, to help lIl"it,: the parents of 24-36 months ~Illdt'nts 10 participate in thiS study,

If yOll !HIVC any more questions about tllis pro~~ess or if you n~'l.~d to crmtact m~~ aboutparticipation, I m.ty be reached at psaih()ng{(lJl(~w]ail.l:Qll1or at 043·970566, ),'ou (~Ollld

,1lso contact m:y academic advis~)r, Dr. Jane Squires. for more int\.'rm'ltioll, via c-nlailatigl1tiI,;;'..:;!Q£1tm:Qg£m,.§4!J~DJ. Sh\'~ could also be contacted via airmail service ill

Early Intervention Program. 5253, University of Oregon, Eugene,OR97403·52533 USA.

Rt~spccttlllly YOUI'S.

Prasong SaihoflgDoctOral Candidalt:, Ph,D,

Page 154: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

I '

APPENDIXB

LETTER OF INVITATIONS TO SCHOOL DIRECTORS, EC STAFF, AND

PARENTS/CAREGIVERS

135

Page 155: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

136

UNIVERSITY OF OREGON

C()lkgt~of Educ'ltion

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ll,,\~ lmriml i1 Jane Squires, Early Intervention Program. 901 E 18th Avenue. Eugene. OR

97403 T (541) 346-0807 F. (541) 346-5639

OJ HJlh ~ \'1 HI if 1(J rH til

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Page 156: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

UNIVERSITY OF OREGON

CoLiege of Education

137

Dear Pment/Legal Guardian,

Ocloht:r _2001\

My name is Prasong Saihong, I am a doctOntl candidate at the Early Intervention Program.Col1t'ge of Education, University of Oregon, USA, I'm calling to talk to you aboutpankipating in my rc~search study. I <lin recently bcgmning my rl:seardl dissertatwn entitled"[valuating tht, Psychometric Properties and the Utility of the Ages and Stage,Questionnaires: Thai (ASQ: Thail in Northeast Thailand." The procedures oCtIle rcscnt'ch areI) to train teacllt'r~ and chiJdcare slalr to use the ASQ: Thai. 2) to liSt' tht~ ASQ: Thm 10

screen children age 24 months to 36 months (2-3 years old). J) to help parenL,; and caregiversto usc the ASQ: Thai. and 4) to nbs(:rv<,: and jnll~rvicw the ASQ: Thai users,

I would like to invite you to take part and to give your cbild to participate in the study, itshQuid take you less than 30 minutes. You would be asked to complete tbese surveys; the AgesStages Questionniiire: Thai with )lOlir child, the Family Information Survey and the FamilyUtility Survey. Your child will be \;ompleted the ASQ: Thai by hislher teachers.

1f you have any mOrt: questions abotl! Ihis process or jf you need to contact me aboutpartkipatk)n, I may be reached at psaihonl!(il)h()tm,~LC\~m., ()t at 043-910566. Youcould also contact my academic advisor. Dr. Jane Sqnires. fi)rmore mfi)1111ation, viae-mail atisquin;s«(t.llon~gon.e(!.!!-o!. She could also he rontacled via ainllailscrv.lccalEarly Intervention Program. 5253, University of Oregon. Eugene.OH97403·52533 t}SA

Re"pectfully Y<mrs.

Prasong SaihongDoctoral Cmdidatt;, Ph,D,Early Intervention Prognul1

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138

UNIVERSITY OF OREGUN

College of Education

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Ages and Stages Questionnaires: Thai (ASQ: Thai) in Northeast Thailand J'lH'J1)1Ifn11~!'Jril'1~>io'ljti

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Jane Squires Early Intervention Program, 901 E 18th Avenue, Eugene, OR 97403 T. (541) 346­0807 F, (541) 346-5639

(lHIJlI1::: n'H{ lTl!llNlJ)

lfi1ffmJ nl1 flJtymm 1m~o11 tm,hw l'illtnJ ffllj1w~flll~uiu

111fJttlf.Jm~fffHl1mlt:lm1itJ Imt1Y1!.I1fiIJl'Oj~flf.lU

Early Imervcm~on Program'JOT E T8th AV(llue, Eugene. OR 97403 T. (541) 346-0807.1', (541) 346-56J'}

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UNIVERSITY OF OREGON

139

DcaI' Early Childcarl'lSdlOo] Director

()clober . 200S

.:Vly name is Prasong Saihong. I am a doctoral candidate at the Farly Interv~mti()n Program.Colkgc of Edllcati<m. University of O~g()n. USA. I'm calling l() talk to you about participating111 my research study. ! am recently bl~ginningmy research dissertation (ontit!t'd "'Evaluating thePsychometric Properues and the Utility of the Ages and Stages Questionnaires: Thai (ASe):Thai) in Northeast Thailand," The procedUlTs of the rescan:h arc!) to train teachers andchi tdcare staff 10 use the AS<): Thai. 2) to use the i\SQ: Thai 1<) screen chi ttiren age 24 monthsto 36 months (2-3 years old). 3) w hdp par(~nt;; and carcgivcrs 10 usc the ASQ: ThaI. and 4) f()

\)nSd,..e and interVIew th{~ ASQ: Thai llS{~r",

Th1s sIudy req1.llrCS various panicipnlions. You're eligibk tl.) he in this study because yourinstitute could provide resources dUll will be helpful for this study. To make this study stlCCess, Iwould like to request your kind assistance and cooperation fmrn your institution in 11K: followingtopics:

l.

J,

to gIve permissi~m to your staff to anent! thl~ workshop of the use of scrc,~nlng

instrument.to give plCrmission for assesslt1,:rlt swtf 10 give a s{~rlCcning tesl fi)[ the L~arl.'{

childhOi}d student!'> in your school or centert() help illyite th'" par,mts of24-36 months 5tudClltS 10 partiCipate in this study.

if you have ,my rnore que'Stions about tll is process or if you need to contact me aboutpartitoipatiof), I may be n~aehcd:n p\>mJJ9ug@h9!IlH\iL<;mn. or at 043-970566, You couldilL;o contacllny academic advisor, Dr. Jane Sq\lir(~s, fl)r more illfl:mnatiol1, \'Ia e ..rn"ililti;>quircs(dllOregoll.,,~dtt:9L She ('ould also be iXllltIlC!l~d vi<1 airmail servi<:'c atEady Inltc'fvcntlOn Program. 5253. University of OregorL Eugene,OR'J74(~3-:;:!53JUSA

Pn\song Salhol1gDoctoral CandIdate. l)h. DEn!'ly Intervcntion Progl'llm

Early lnterv(~ntion ProgramWIlE IHlh Awm(~. Euf"m'. OR 974(JJ T. {~4 I ) 346..(ll\{) 1 r. i 54! ) 346.. )1>39

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UNIVERSIT'{ OF OREGON

140

~'~!lU

'v'not l'l,llUlb~tT4'1{ (rH~H'~)J fj'i'lll'l\J it')lln·I'J.,.rl"'W·tt)l\ll$(riM·'l,~lJ,}\'.u~rlnHlft'H'h,liJH1:h1tnAulJll'li,"I'tt' lU

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Childhood SIKcial Ldllcation) ')11n,m,,,n1ffm, ,Yhnilll'\tlll";lml~uill (Early Intcl'vention Prograrn.l

'1mn'I!I1\ 1:.i1'Wl «('olkg..: of EduClIti'llI) lJm:)wmrultliJT~h"'fHHJ (Uni'llersity of Oregon) 'tim,. i~(,)Hl\l"1

,:hnlwn;l'-'l' 1:Hru>",\~'1Jlni)!;'l!)'(1t)1\>1h~rf:>l~v,11u"ting the Psyd\omctric Propertks lInd t'he Utility of til.:Ages and Stages QUc,;tiOlUl<lil'es; Thai (ASQ: Thal) in N()rth{~<ISI Thailand

'1J\)J~>i1"trll~l~:rl tt,,\:tllUlt 1.r,'(~'lJ'H·Ufl~"()~nHffilnjn J(~n'lJ~lJ -rudrl'l;'h~t~)nn H! 2-:\ "t"lll )1'~{Hlh.'lnjlh~1nlf'T.}nld~~n

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HIn,i'u.tihl'oil~~'(H,1n'1ifu1.1u.\qo·un·1') ':i il(hi',Joil'} ') t'~ OJ l&")"wi1i)i\r4 !""lltlt'~ ihUfif\ F",'l;;v))";'... ,·.';,,,.>,,.... ,;;;,

hnfflH\ ,\ .Jane SqlliTt~s.Early Intervcntion Program, 901 E 1Sth Avenue, Eugene. OR 9740:~ T.(541 ) :-,H,OS07 F. (541 ) 346.. 5639

('"tnljlh~rf{i{t'f')tnt{lj")

,1"fltTt'111 nnr!j"'-1! H~lYl If\~l ~n l}f) )') ffllH li~itnlH:iHit ~rudtfl\.i~l.l{lJ

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E••r1y Intervention Prognl!\lt)Ol E ISf}) ,;\\'t.~n'H-~+ h.ugt~ne, ()l{ ~)7,"Hn T. {~41. J"~6,,OS07 F c~41} 346~56J9

Page 160: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

UN IVERSrTY OF OREGON

Col lege of Education

141

Dear

October 6. 2008

My name is Prasol1g Saihong. Jam a doctoral candidate at the Early Jntt:rvcntiml Program.College of Education. Unlvcrslry of Oregon, USA. I'm calling to talk to you abollt panicipatlngin my n:~st~arch study. I am n..'cenlly Ik~gil1ning my research diss{~rtatjol1 entitled "Evalu<llin:g tht~

Pi\ychomelric Propcrtle~ and the Ulilily of the Age!; and Stages Questionnaires: Thai IASQ:Thlli) in Nonheast Thailand." The procedures of the research are I) to train teachers andcl1ildcarc ,taff ro lISC the ASQ: Thai. 2) to lise (he ASQ: TlJai to ,(Teen cllildl'cn age 2-3 yCUl)

old., 3) to help parenh and caregi vel'S to use the ASQ: Thai and 4f to observe and interview theASQ: Thai users.

You are invitt'd as a possihle participant beCllUse you pmviding services for chiltlmn who me 2-3yellTs ohl If YOi' Ut'cidc to partidpate ill !hi, Pl'(lj<~l~1. you will do these following htiks:

I. to attend the workshop of the u~e or ~Cft~eflillg in~[rumenL

, to give a screening tel't for the early chi \dhood students in your school or center.3, \0 help inYIte the PUI'Cllts of 22-36 mQnths :;'llldcm~ to parlkip'aic in thb study,

If you have ,llly more questions abollt this process or if you need 10 cnntact m~~ aboutparticipation, lmay be reached at P1'!!jh(mgSifh(,~!P!JljJ,~~9111~ or at 043-970566, You couldalso cI)J1tacII1lY academic ad\'i~or. Dr. Jane Squires. for more inform.tlion, via t~-majl atjsmltn:'5@J!QI,,:gQIL~~j\!, Sh(~ (:ould also be contacted via airmail servitCc atEarly Inlerventitlll Program. 525:1. Univc'rsilv of Oregon, Eugene.

• - 0,;, . ~- ...~ - ",. •

OR9740J,525JJ USA.

Respectfully Yours,

Pra~ong SaihongDnctor;al Candidate, ~~h.D.

Emly lnlen(~n(ioll Program

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UNIVERSITY OF OREGON

142

~lHI~'} lrnn..in:tt.:,{ ,1 Hlll.;:nj' r!ilrfpJ 11l'J-..f11111'frlllntt ~~nti<itlhn; f)uj;:~ihnn41HtNf UH l~hlU n\'tJ

,j!l;it ;'1',) HI 'n)':; \~,rl r!"f WI H) ,i\f!" w;n~;:,Y)lnf)tIl1lP'(m l'! 1"11'1 n;lt)lJ)'ij\1nJihH'rll'.1f1lI~" it, IEarl y

Intt~rvt~ntion/Emty Childhood Sped,11 Educ'llioll) I\l 11)'j~!1I,n1ifimil,:ili'i}l{h11'iln;{f1lj2ldiltEaI'll'

Intcl'vcntlon Program) ';mn6(InTlnmll (CoHt~gc of Education,! mn1mmltJl!!;~i~hmn;ni

(Univcr~ity of On:g~Hll ;,w;;t"'I)'1II'i\'lHihJl)l'\ilmfl:hlin:';lilrt~Yll)1!tI"hnh111\ Evaluating the

P~ydl()m(:lnc PJ\)pcl'lic~ and Ihe UlililY ofth.:' Ages lind SUIgt~~ Qu(~sli(lnllllirc": Thai iASQ:

Thai, in NortiK~a"lThailand .(it) ')l'jlh~:IG\J(!jjHiHllllnd",jH~H'\lHn "il~"j:;Y)1J!;nllli1H"11\1'It)HrH

'IlIili'lillm 'lJr~i1lli1flltj:ilJll),nhl1lJ'l;,ilt1i'lfl'Aii ll!!wiil <ASQ: ThaUl,JiH,)f\t: ltJntllHiltJ,mli'la 1;wii,1'tNHYii

n l'i :)'h§u¥'i~ci~)1thI 1) t)}J1W11"hl lr}.;!lh~:lihl'ltILin/ln-l~H 2) 1$ HnnJ\H1(HnJ~hhJ1::.liJUt~t)tl~ll·)O~I)q 24 ~~fnJ \)-4 J6

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"i\IlIJW 'Ul: hmi'mf ii JaHe Sqlllf(~S, Early Intervenlion Progl'lHll, 901 E J81h Avenue, Eug.::ne.OR 97403 T. (54 j) 346,OR07 F (541) 3465639

(lJimi'l:in,{ ,1"lOh ili')

II'nirlllmf:i\1i!1! 1101'1 'iff) III r;nniir\llTrlh'ltHhnftjl0.mJ~tiTn

lmnitlln nill'ltll'W;1l ,\ 'l\jn lJl' )':It-m H)t,1'lllthllJ

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143

UNIVERSITY OF OREGON

C{)lleg(~ of' Edu(ation

Dear

(ktobt'f 6. 2008

My thime is Pra:\.ong Suihong. I am a doctoral candid..te at the Em'ly Intervention Program.College of Education. Univer~ily of Orl:gon. US/\.. I'm clllling to talk to you llboUIpartkipaflng in my research sludy. I am recently beginning my research diSst~l1illion entitled"Evaluating the Psychmnetric Propel'ties and the Utility of the Ages and SIngesQuestinmlaires: Thai (ASQ: ThaD in Northem.t Thililand," The procedures of tlK: n:st:arch all'

I) to tmin teach(~rs and childc'lre staff to use the ASQ: Thai. 2) to liSt: the ASQ: Th<li toscn~eB children age 2-3 years old. 3} to help parents and caregivers to use the ASQ: TI1ai, and4j to ohserve and imerview the ASQ: Thai users.

You <in: invit",d as a possible pani,:ip.mt b,:ctlusC you providing ,(~rvice~ for children who arc 2­3 Y<?iUS okL If ynu dedde h\ !}ilrlJClpatc ill this project, you will do these following tasks:

I. to aHend ttle workshop of the usc of screening inqrument2. 10 gin: a screening test for the early childhood students in your school or center.., to help invite the parents of 22-)6 months students to participate in this 'lUdy

If you have any Inure questions .tbout this pf(K:e~~ Uf if you need to t:ontacl nwaboutp;uticipation. I nlilY be reached at RS<[email protected]_~!..m. or at 04_~-(70)66. Youcould also coutact my academic advis.oc Dr, .lane Squires. for more infonnillHlIl. via,',mail at isquin~s(ihlOn:goll.edu. She could ;.\Jso be conwctcd via <iinnail scrvicl~

at

Early Intervention Program. 5253. University of Oregon. Eugene.OR97403·52S33 USA.

Pm>,ong Saihongl)oclonll Camlidalc, Ph.D,Ear! y Intervention Program

Page 163: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

APPENDIXC

CONSENT FORMS

144

Page 164: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

145

Graduate Research StudyAudio Consent Fonn

Dear Parents/Early childcare staffs/teachers,

You are invited to take an interview part in a research study conducted by PrasongSaihong from the University of Oregon, Early Intervention Program.. The goal of thestudy is to study the usefulness of the Ages Stages Questionnaire: Thai (ASQ: Thai) toscreen young children's developmental and behavioral areas in Northeast Thailand.You were selected as a possible participant because you are providing services forchildren who are 2-3 years. Before you participate in this study, there are several thingsyou should know.

• Your participation is voluntary. You can choose to participate in this study or not.You are also free to stop your involvement in the project at any time.

• Some of the questions you will be asked are about your personal experience. Youdo not have to answer any questions that make you uncomfortable.

• You will be interviewed in person on time 20-30 minutes.• You will be asked your opinion about using the Ages Stages Questionnaire:

Thai.• Your interview sessions will be audio recorded to insure an accurate record of your

comments. All records of the interview will be destroyed after the project iscompleted.

• The answers you provide to the questions are completely confidential. When theresearcher writes up what the researcher learned from your interview, theresearcher will remove your real name to keep your identity private.

• The things you say during the interview will not be discussed with anyone exceptthe researcher advisor and researcher.

If you have any questions regarding this project, you may contact the researcher [email protected], or call me at 043-970566 or e-mail the faculty advisor, Dr. JaneSquires at [email protected] write to her at Early Intervention Program,5253, University of Oregon, Eugene, OR97403-5253 USA.Your signatures indicates that you (a) have read and understand all ofthese points, (b)are willing to participate, (c) understand that your participation is voluntary, (d) canchoose to stop your participation at any time, (e) understand that the interview will beaudio recorded, and (f) have received a copy ofthis fonn.

___I have read this letter and agree to participate in the study.

Signature .Date

Name (please print) _

Page 165: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

146

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'j) I 'j) <V """ d"" rI Cl. <V cld. ~ "'" I cld _~O1'\'11ll'lJil1:Y~1:YU fl!ilIl~lil~ilm:;l'lii 'I'1illilt1t1 [email protected]!L1!.H! l'l'1Ji'I''I'l'l'1'1'1 11Jil ~1il~1ilil1'OlJU'I'11JJfllJl'lJil~ 566-970-043

'I cI d:il 'V ~ I d!'01l1:Y fl11:Y'I'1 .'lJl'1'lI'Ol IilJjsquires@uoregon.@\! 11Jil1:Y~'OIil111J1U'I'1 Early Intervention Program, 5253, University of Oregon,

Eugene, OR97403-52533

USA.

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Page 166: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

Graduate Research StudyConsent Form

Dear Parclll(s)/Lcgal Guardian.

't"Ol! and your child are invited to take parr in a research study conducted by PrasongSaihong from the University of Oregon. Early Intervention Program. USA The goal of the~tudy is to study the usefulness of the Ages SInges Questionnaire: Thai (ASQ: Thai) to screcnyuung children's development'1! and behavioral meas in Nonheast Thailand, Yuu wereselected because you have a child who is 2-3 years old. Your child is selected because helsheIS 2·3 ye3.i~ old. Therefore. I would like. to ask permission hom you to give your childparlicipatl~ ill the study.

if you de,~ide ynu would like to take part and to give ynur child to participate in the study, itshould take you less than 30 minutes, You would be asked 10 complete these surveys: theAges Slage~ Quesliol1naire: Thai with your child, the Family Illfmmation Survey and theFamily Utilily Survey, Your child will be compl(~ted the ASQ: Thai by his/her lcadle.",

The Ages Stages Questionnaire: Thai is a screening tool to identify y()lIng chilch'en fordcvdopmenull ami behavioml issues for referml and intervention. Early interventioTl hasbeen proven by scientific research to benefit young children with development problems,Identifying young children \.\<'jth these issues early would assist in the provision ()f earlyinlcrvt'nlion for Illest.: children in order to prevent further problems.

Benefit- You may not f,~d comforlable filling up a form about yc)ur child but it may helpyou to 1Il1derst.md your child's development and if he/she needs a funher assessment.

Ally information gathered in this study that can he identified with you and your child will remainconfidential and wil! Ix' disclosed only willi your pemli!->sion, Numbers will be assigned toyour materials to prolect your privacy.

You and your child partidpaliol1 are voluntary. Your decision whether 01' not 10

participmc will nOl alTl.'cl the school enrollmeol of Yllur child, If you decide toparticipate, you arc free to "'ithdra"" al any time without affecting the services f()f you.If you have any questions, please fee! free tn e·mail the researcher atpsaihollg@hotm~~il.com. or cal! m{~ al 043·970566 or e·mail the facnlt)! udvisor, Dr. JaneS{luires at [email protected]·or wrilC 10 her at Early Il1lt~rremion Program. 5253,University of Oregon. Eugene, OR97403-52533 USA or e-mail: hum;ln,subicctl'i@()rsa.uon~,.goll.edu,

Y{)ur signaturcs indicates Ihn! you have t't~ad and understand the inf()J'malio)l provided aoovc,that you willingly agree to parlicipate. th.u you may withdraw your consent at <loytime and discontinue participation without penalty, and that you ha~'e rc{:eived a copy ofthis form, If you have question!-> ahout you :~nd/or your child's rights as a researchparticipant, cont<1ct Hum<ln Subjet:ts CompliMce. Riverfront Research Park. Suile 'OS,lIniversily of Oregon. Eugene, OR 974U3-5237.

__ I have read this letter and agree to allow my child 10 participate in fhe study.

I DO NOT give consent for my child (Ilame) to panicipalc in this study

Parent/Legal Guardian Si!~Jll1tuIJe. ,__._.D[ltc ._~

Parellt/Legal Guardian Name (please print) _

147

Page 167: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

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149

Graduate Research StudyConsent Form

Dear Early childcare staffs/teachers,

You ure invited to take purt in a research study conducted by Prasong Saihong from the University of Oregon. EarlyIntervention Program, USA. The goal of the study is to determine and investigate the usefulness of the AgesStages Questionnaire: Thai to screen young children's developmental and behavioral areas in Northeast Thailand.You were selected because you are providing services for children who are 2-3 years old.

If ynu decide you would like to participlltc. the time will be 10 weeks, The research will take place in YIJUr workplace(school. childcare center).

The procedure indudes: Early childeare staff/teachers will attend the workshop of the use of the ASQ: Thai screeninginstrument for 2 day: Early childcare staff/teachers inviting parent<; visiting your childcare center or school to complete

the Ages Stages Questionnaire: Thai Family Infonnation Survey and the Parent Satisfaction Survey. This processshould take less than 30 minutes. You will also be asked to score each child on the ASQ: Thai. After you havecollected the data from all the parents who have agreed to participate in this study, you would be asked to complete theEarly Childcare Staff Utility Survey and E,n-I)' Childcare Stuff Information Survey. It will take approx.imately 5minutes to complete these surveys.

The Ages Stages Questionnaire: Thai is a screening tool to identify young children for developmental andbehavioral issues for referl'a! al\d intervention. Early intervention has been proven by scientific research tobenefit young children with development problems. Identifying young children with these iSSliCS carly wouldassist in the provision of early intervention for these children in order to prevent further problems.

Risk- The potential risk of participating in the study may include loss of confidentiality, psychological risks and socialrisks. [f you are not comfOrtable to gh'e any information in relation to those risks, you can stop this process any time.During the screening process. you mllY have stress dc,lling with parents. Parents may ask to discuss this process ofscreening system. You just let them know that there -,viII be no referral or provided follow-up.

Befle/it- The benefit may indude a better understanding of young: children's development and the screening process.However, this benefit cannot be guaranteed.

Any infonnation gathered in this study lhat can be identified with you will reumin confidential and will be disclosedonly with your permission. Numbers will be assigned to your materials to protect your privacy.

Your participation is vol ulllary , If you decide to participate. you are free to withdraw at any time withoutaffecting the services for you. If you have any questions, please feel free to e-mail the researcher [email protected]. or call me at 043·910506 or e-mail the facult)· advisor. Dr. June Squires atjl"ql!iX!:,~_qtuO!!<&QIUeJ!l!:;,QLwrhe to her at Ear!y Intervention Program, 5253, University of Oregon, Eugene,OR974l)3·5253, USA.

YOUI' signatures indicates that you have read and understand the information provided above, that you

willingly agree to particip'lle. that you may withdraw your consent at any time and discontinueparticipation without penalty, and that you have received a copy of this form. If you have questions about youand/or your child's rights a.s a rcse~rch participant. conhlCt Humun Subjccts Compliance, Riverfront ResearchPark. Suite 105. University of Oregon. Eugene. OR 97403-5237 or e-mail; human [email protected].

____I have re,ld this leiter and agree to participat~ in the study.

Childcare Staff/Teacher Si~;naturle.

Childcare Staff/Teacher Name (please prillt) _

Page 169: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

150

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Page 170: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

APPENDIXD

THE ASQ: THAI PROTOCOLS

151

Page 171: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

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Page 190: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

APPENDIXE

THE ASQ: THAI, ENGLISH BACK-TRANSLATION

171

Page 191: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

172

Example ofthe ASQ: Thai, English Back-Translation

u.s. version

InstructionOn the following pages are questions aboutactivities children do. Your child mayhave already done some of the activitiesdescribed here, and there may be someyour child has not begun doing yet. Foreach item, please check the box that tellswhether your child is doing the activityregularly, sometimes.

Important Points to Remember:D Be sure to try each activity with

your child before checking a box.D Try to make completing this

questionnaire a game that is fun foryou and your child.

D Make sure your child is rested, fed,and ready to play.

D Please return this questionnaire byD If you have any questions or

concerns about your child or aboutthis

D questionnaire, please call:D Look forward to filling out another.

24 month COMMUNICATION

Be sure to try each activity with your child.

1. Without showing her first, does yourchild point to the correct picture whenyou say, "Show me the kitty" or ask,"Where is the dog?" (She needs to

Thai version

The following questions are aboutactivities children do. Your child mayhave already been able to do some ofthe activities, and may not be able tobegin doing some yet. For eachquestion, please check the box thattells whether your child can do theactivity regularly, sometimes, or notyet.Important Points to Pay Attention to:

D Before checking the box, please makesure that you try each activity withyour child

D Try to find ways to make the filling inof this questionnaire a fun game foryou and your child.

D You have to check the see whetheryour child is well rested, sufficientlyeaten, and ready to play.

D Please send back this questionnaireby...

D If you have questions or concernsabout your child's development andabout the this evaluation form, pleasecontact the researcher at the followingphone number..

D There will be another questionnaire;please specify the date that you wishto forward to fill out anotherquestionnaire. Date Month .Year

COMMUNICATION DEVELOPMENT

Please have your child try theactivities according to the followingquestions.

1. Can your child point to the correctpicture, without your hint, when

Page 192: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

.-------------------- -- ----- -

173

...

identify only one picture correctly.)2. Does your child imitate a two-word

sentence? For example, when you saya two-word phrase, such as "Mamaeat," "Daddy play," "Go home," or"What's this?" does your child say bothwords back to you? (Check "yes" evenifhis words are difficult to understand.)

3. Without giving her clues by pointing orusing gestures, can your child carry outat least three of these kinds ofdirections?a. "Put the toy on the table."b. "Close the door."c. "Bring me a towel."d. "Find your coat."e. "Take my hand."f. "Get your book."

4. If you point to a picture of a ball (kitty,cup, hat, etc.) and ask your child,"What is this?" does your childcorrectly name at least one picture?

5. Does your child say two or three wordsthat represent different ideas together,such as "See dog," "Mommy comehome," or "Kitty gone"? (Don't countword combinations that express oneidea, such as "Bye-bye," "All gone,""All right," and "What's that?")

Please give an example of your child'sword combinations:

6. Does your child correctly use at leasttwo words like "me," "I," "mine," and"you"?

24 Month: Gross Motor

you say, "Where is the dog?" or"Which is the picture of a kitten?"

2. Can your child repeat a two-wordsentence? For example, "Eat rice,""take trip," "Go home," or"What's this?" Can your childrepeat both words?

3. Can your child follow three of thefollowing directions without yourhints neither by pointing orgesturing?a. "Put the toy on the table."b. "Close the door."c. "Please bring me a towel."d. "Show me your blouse

(shirt)? "e. "Hold Mama's and Papa's

hands."f. "Go bring your book here."

4. When you point to a picture of aball (a kitty, a cup, a hat, etc.) andask your child, "What is this?"can your child tell the name of atleast one picture correctly?

5. Can your child say combinationsof two or three words of differentmeanings together, such as "Seedog," "Mama comes home," or"Kitty gone"? (The combinationsof two words with the samemeanings do not count, such as"Bye-bye," "All gone," "Allright," and "What's that?")Pleasegive an example of wordscombinations spoken by yourchild.

6. Can your child use at least twopronouns and possessive pronounscorrectly? For example, "me," "I,""mine," and "you."

Gross Motor

1. Does your child walk down stairs if you 1. Can your child walk down stairs when

Page 193: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

hold onto one of his hands? (You canlook for this at a store, on a playground,or at home.)

2. When you show her how to kick a largeball, does your child try to kick the ballby moving her leg forward or bywalking into it? (If your child alreadykicks a ball, check "yes" for this item.)

3. Does your child walk either up or downat least two steps by himself? You canlook for this at a store, on a playground,or at home. (Check "yes" even ifheholds onto the wall or railing.)

4. Does your child run fairly well,stopping herself without bumping intothings or falling?

5. Does your child jump with both feetleaving the floor at the same time?

6. Without holding onto anything forsupport, does your child kick a ball byswinging his leg forward?

30 Month: Fine Motor

1. Does your child use a turning motionwith her hand while trying to turndoorknobs, wind toys, twist tops, orscrew lids on and off jars?

2. After he watches you draw a line fromthe top of the paper to the bottom witha pencil, crayon, or pen, asks your childto make a line like yours. Do not letyour child trace your line. Does yourchild copy you by drawing a single linein a vertical direction?

3. Does your child thread a shoelacethrough either a bead or eyelet of ashoe?

4. After she watches you draw a line fromone side of the paper to the other side,asks your child to make a line like

174

you hold one of his hands? (You canobserve this at a store, on aplayground, or at home.)

2. When you kick a ball to show yourchild how to kick a ball, can your childkick the ball by kicking her legforward or by walking toward the ball?(If your child is able to kick a ball,check "yes" for this question.)

3. Can your child walk either up or downat least two steps by him/her self? Youcan observe this at a store, on aplayground, or at home. (Check "yes"even if s/he holds onto the rail or thewall.)

4. Can your child run quite well, and cans/he stop without bumping into thingsor falling?

5. Can your child jump with both feet offthe floor at the same time? (Look at thepicture.)

6. Can your child kick a ball by kickinghis or her leg forward without holdingon anything?

Fine Motor

1. Can your child tum his or her wristwhen trying to tum doorknobs, windtoys, twist tops, or screw lids on andoff bottles?

2. After your child watches you draw aline from the top to the bottom of thepaper with a pencil, crayon, or pen,asks your child to draw a line likeyours. Do not let your child trace yourline. Can your child do it?

3. Can your child thread beads with astring or tie a shoelace?

4. After your child watches you draw aline from one left to right on a piece ofpaper, asks your child to draw a linelike yours. Do not let your child traceyour line. Can your child draw a line

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175

yours. Do not let your child trace your from left to right horizontally?line. Does your child copy you by 5. After your child watches you draw onedrawing a single line in a horizontal circle, asks your child to draw a circledirection? like yours. Do not let him trace your

5. After he watches you draw a single circle. Can your child draw a circlecircle, asks your child to make a circle like what you have shown your child?like yours. Do not let him trace your 6. Can your child open a book page bycircle. Does your child copy you by page?drawing a circle?

6. Does your child tum pages in a book,one page at a time?

30 Month: Problem Solving Intellectual Development

1. When looking in the mirror, ask, 1. When looking in the mirror, ask,"Where is ?" (Dse your child's "Where is ?" (Dse yourname.) Does your child point to her child's name.) Can your child point toimage in the mirror? her picture in the mirror?

2. If your child wants something he 2. When your child wants something s/hecannot reach, does he find a chair or cannot reach, does s/he find a chair orbox to stand on to reach it? box to stand on to reach it?

3. While your child watches, line up four 3. While your child watches, line up fourobjects like blocks or cars in a row. objects such as blocks or cars in a row.Does your child copy or imitate you Can your child imitate you in lining upand line up four objects in a row? (You four objects in a row? (You can alsocan also use spools of thread, small use thread spools, small boxes, orboxes, or other toys.) other toys for this activity.)

4. When you point to the figure and ask 4. When you point to the figure and askyour child, "What is this?" does your your child, "What is this?" can yourchild say a word that means a person? child say a word meaning a person?Responses like "snowman," "boy," The correct answers may be "robot,""man," "girl," and "Daddy" are correct. "boy," "man," "girl," and "Daddy."Please write your child's response here: Please write your child's answer here:

5. When you say, "Say seven three," does 5:. When you say, "Say seven three," canyour child repeat just the two numbers your child repeat the two numbers inin the correct order? Do not repeat the the same order? Do not use the samenumbers. If necessary, try another pair set of numbers. Ifnecessary, you mayof numbers and say, "Say eight two." use another pair of numbers and say,Your child must repeat just one series "Say eight two." When your child canof two numbers for you to answer "yes" repeat one of the series of twoto this question. numbers, you can answer "yes" for this

6. After she draws a "picture," even a question.simple scribble, does your child tell you 6. After your child draws a "picture,"what she drew? You may say, "Tell me even if you cannot tell what it is, doesabout your picture," or ask, "What is your child tell you what s/he draws?

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176

this?" to prompt her. To encourage your child, you may say,"Tell me about your picture," or ask,"What is this?"

36 Month: Personal Social Personal and Social Development

1. Does your child use a spoon to feed 1. Can your child use a spoon to eat evenherself with little spilling? when s/he spills some food?

2. Does your child push a little shopping 2. Can your child push a little cartcart, stroller, or wagon, steering it (something with wheels) aroundaround objects and backing out of something and then back out from acorners ifhe cannot turn? corner when s/he cannot turn?

3. When she is looking in a mirror and 3. When your child is looking in a mirroryou ask, "Who is in the mirror?" does and you ask, "Who is in the mirror?"your child say either "Me" or her own can your child say either "Me" or hername? own name?

4. Can your child put on a coat, jacket, or 4. Can your child put on a clothing byshirt by himself? him or herself?

5. Using these exact words, ask your 5. When you ask your child, "Are you achild, "Are you a girl or a boy?" Does girl or a boy?" Can your child answeryour child answer correctly? correctly?

6. Does your child take turns by waiting 6. Does your child take turns in playingwhile another child or adult takes a with toys when someone else isturn? playing?

Overall section Other information

1. Do you think your child hears well? If 1. Do you think your child can hear well?no, explain: If no, explain:

2. Do you think your child talks like other 2. Do you think your child talks like othertoddlers her age? If no, explain: toddlers her age? If no, explain:

3. Can you understand most of what your 3. Do you think your child can use bothchild says? If no, explain: hands well? Ifno, explain:

4. Do you think your child walks, runs, 4. When you help your child to stand, areand climbs like other toddlers his age? his/her feet fully placed on the floor theIf no, explain: entire time If no, explain:

5. Does either parent have a family history 5. Does either parent have a family historyof childhood deafness or hearing of deafness or hearing problems as aimpairment? If yes, explain: child? If no, explain: \

6. Do you have any concerns about your 6. Do you have concerns about yourchild's vision If yes, explain: child's eyesight? If yes, explain:

7. Has your child had any medical 7. Has your child had any medicalproblems in the last several months? If problems in the last two months? If yes,yes, explain: explain:

8. Does anything about your child worry 8. Do you have any concerns about youryou? If yes, explain: child? YES 0 NO 0 If yes, explain:

Page 196: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

APPENDIXF

SURVEYS

177

Page 197: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

ASQ:Thai

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Page 198: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

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Page 199: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

180

Graduate Research StudyThe ASQ: Thai: Parent Information Survey

Instructions: Please complete this survey after filling out a questionnaire on your child.Child's information

1. Child's sex: M / F2. Child's date of birth:

---

3. Where do you take your child to receive early childhood services?

4. Does anything about your child's behavior or development worry you?

5. Your relationship to your child: _6. Who do live in your family? _

Parents' information1. Language:

D Thai

D Lao

D Khmer

D Chinese

D Vietnamese

D Other .2. Ethic:

D Thai

IJ Lao

D Khmer

D Chinese

D Vietnamese

D Other ..3. Education level:

D Graduate degree

D Degree

D Diploma

IJ High school-Mathayom 6

D Secondary school-Mathayom 3

D Primary school-Pratom 6

D Other .4. Age:

IJ >25

Page 200: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

D 25-30

10 31-35

10 36-40

D 41-45

10 46-50D 51-55IJ Above 55

5. Family monthly income:

10 >1,000 baht

D 1,000-3000 baht

D 3,000-6,000 baht

10 6,000-10,000 baht

D 10,000-15,000 baht

10 15,000-20,000 baht

D 20,000-25,000 baht

10 25,000-30,000 baht

10 Above 30,000 baht

D Other .6. Income source:

IJ Selling agricultural products

D Trading

10 Monthly earning

D Other .

181

Page 201: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

182

ASQ: Thai

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Page 202: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

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Page 203: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

Graduate Research StudyThe ASQ: Thai

Early Childcare Staff Information SurveyInstructions: Please complete this survey.Early Childcare Staff' information

1. Language:

o Thai

o Lao

o Khmer

IJ Chinese

o Vietnamese

IJ Other .2. Ethic:

o Thai

IJ Lao

o Khmer

IJ Chinese

o Vietnamese

o Other ..

3. Education level:

IJ Graduate degree

0 Degree

0 Diploma

0 High school-Mathayom 6

IJ Secondary school-Mathayom 34. Degree in early childhood: Yes No5. Degree/Diploma/Certificate:6. Age:

0 >25

0 25-30

0 31-35

0 36-40

0 41-45

0 46-50

0 51-55

0 Above 557. Monthly income:

184

Page 204: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

o >1,000 baht

IJ 1,000-3000 baht

o 3,000-6,000 baht

IJ 6,000-10,000 baht

o 10,000-15,000 bahto 15,000-20,000 baht

o 20,000-25,000 baht

o 25,000-30,000 baht

o Above 30,000 baht

o Other .8. How long have you been working for early childhood services?

o > 1 year

IJ 1-2 years

o 2-3 years

o 3-4 years

o Above 4 years

185

Page 205: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

The ASQ: Thai

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Page 206: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

187

Graduate Research StudyThe ASQ: Thai

Family Utility SurveyInstructions: Please complete this survey after filling out a questionnaire on your child.

1. How long did it take you to complete the ASQ: Thai questionnaire?

o Less than 10 minutes

o 10-20 minutes

IJ 20-30 minutes

o More than 30 minutes

2. Did you need help in completing the questionnaire?

DYes, I asked a few questions to clarify some points

IJ Yes, I needed help all throughout the process

o No, the questionnaire is very clear

3. It was easy to understand the questions:

DYes

o Sometimes

IJ No

4. The questions were appropriate for my child's age:

DYes

o Sometimes

iJ No

5. The questionnaire (please check all thatapply):

o Was interesting

o Helped me think about my child's development

IJ Tool too long

o Was a waste of time

o Didn't tell me much

6. How would you change this questionnaire to make it better?

Page 207: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

188

The ASQ: Thai

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Page 208: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

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189

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190

Graduate Research StudyThe ASQ: Thai

Early Childcare Staff Utility SurveyInstructions: Please complete this survey after you complete the data collection.

1. Are you a:

D teacher

DEarly childcare staff

D Nurse

D Sub-district public health center staff

D Doctor

D Other .

2. Do you hear about any screening tools before this research?

DYes

D Sometimes

D No

3. Was the tool easy to implement?

DYes

D Sometimes

D No

4. The implementation of the tool is time consuming:

DYes

D Sometimes

D No

5. Did your personnel need to assist parents in completing the questionnaire?

D No, most parents could complete the questionnaire by themselves

DYes, a personnel was needed to answer a few questions

DYes, a personnel needed to provide assistance all throughout the process

6. How confident are you with the results ofthe screening tool?

D Very confident

D Somewhat confident

D Not confident at all

7. The questions were appropriate for the children's age:

DYes

D Sometimes

10 No

8. The language was clear and easy to understand:

DYes

Page 210: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

D Sometimes

D No

9. The questions were culturally appropriate:

DYesD Sometimes

D No10. If applicable, please write the number of questions that you think are not

culturally appropriate and give a brief explanation:Domain: Age interval: __ Months Question number:

Comment:

Domain: Age interval: __ Months Question number:

Comment:

Domain: Age interval: __ Months Question number:

Comment:

Domain: Age interval: __ Months Question number:-------

Comment:

Domain: Age interval: __ Months Question number:

Comment:

11. Do you think that this questionnaire is helpful for screening?

IJ Yes

D Sometimes

IJ No12. Did you leam anything about child by completing the ASQ: Thai?

DYes

D Sometimes

D No13. Would you consider using this questionnaire in the future?

DYes

D Sometimes

191

Page 211: EVALUATING RELIABILITY AND USE OF THE AGES AND STAGES

IJ No

14. How would you change this questionnaire to make it better?

192

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193

BIBIOGRAPHY

Amorvivat, S. (1990). Thai ways ofchild rearing practices: an ethnographic study.Bangkok: Chulalongkom University.

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