Sandra Hogan LCMHC TMF 2, Coordinator AGES & STAGES QUESTIONNAIRES: SOCIAL EMOTIONAL (ASQ-SE): A Parent- Completed Child-Monitoring System for Social-Emotional Behaviors A Training sponsored by the Greater Nashua Birth to Six Mental Health Team Sandra Hogan LCMHC TMF 2, Coordinator Edited by Dawn Varney

understand the components of the ASQ-SE system Training Objectives Participants will: understand the components of the ASQ-SE system understand how to utilize the results of an ASQ-SE

What is the ASQ-SE system? Parent-caregiver completed screening tool Series of 8 questionnaires for children ages 3 months to 5 ½ years Written at a 4th-6th grade reading level Accurately identifies children at risk for social-emotional concerns Focuses on 7 areas: self-regulation, compliance, communication, adaptive functioning, autonomy, affect, and interaction with people Available in English, Spanish, Korean, & French

Validity and reliability of the ASQ-SE (2003) Normed on research sample of 3,014 children including Caucasian, African American, Hispanic, Asian/Pacific Islander, Native American, & children with mixed ethnicity 93% validity: agreement during research between parent completed questionnaire and other measurement tools 78% overall sensitivity: ability to correctly identify children with social-emotional disabilities 95% overall specificity: ability to correctly identify children without social-emotional delays 97% satisfaction: parents indicated the questionnaires were easy to understand and appropriate

Uses of ASQ-SE Monitoring all children’s social-emotional development on an ongoing basis Screening a specific child / deciding whether further assessment is needed Helping parents understand their child’s social-emotional development Opening communications between parents and professionals about their child’s progress Targeting interventions

Social Emotional Areas Self-regulation Compliance Communication Adaptive functioning Autonomy Affect Interaction with people

Moves from one activity to the next SELF-REGULATION “Items address the child’s ability or willingness to calm or settle down or adjust to physiological or environmental concerns or stimulation.” (ASQ-SE User’s Guide) Examples: Can calm down Stays with activities Moves from one activity to the next

Follows simple directions / routine Does what you ask COMPLIANCE “Items address the child’s ability or willingness to conform to the direction of others and follow rules.” (ASQ-SE User’s Guide) Examples: Follows simple directions / routine Does what you ask

Listens, turns to look, smiles COMMUNICATION “Items address the child’s ability or willingness to respond to or initiate verbal or nonverbal signals to indicate feelings, affective, or internal states.” (ASQ-SE User’s Guide) Examples: Listens, turns to look, smiles Lets you know/uses words when hungry, sick, tired Uses words for feelings

Hurts self on purpose, stays away from danger ADAPTIVE FUNCTIONING “Items address the child’s success or ability to cope with physiological needs (e.g. sleeping, eating, elimination, safety)” (ASQ-SE User’s Guide) Examples: Has eating problems Hurts self on purpose, stays away from danger Stays dry during day; is toilet trained Sleeps minimum for 24 hour period Interest/knowledge of sex

Checks when exploring; explores new places AUTONOMY “Items address the child’s ability or willingness to self-initiate or respond without guidance (i. e. moving to independence)” (ASQ-SE User’s Guide) Examples: Checks when exploring; explores new places Clings to you more than you expect

Likes to be hugged and cuddled Is interested in things around her AFFECT “Items address the child’s ability or willingness to demonstrate his or her own feelings and empathy for others.” (ASQ-SE User’s Guide) Examples: Likes to be hugged and cuddled Is interested in things around her Seems happy Shows concerns for others’ feelings

INTERACTION WITH PEOPLE “Items address the child’s ability or willingness to respond to or initiate social responses to parents, other adults, and peers.” (ASQ-SE User’s Guide) Examples: Enjoys mealtimes together Plays near; greets; talks to adults Likes to be around other children Other children like to play with your child

Completing ASQ-SE Parents indicate whether child does the behavior most of the time, sometimes, rarely or never, A 4th column permits parents a spot to check if behavior is a concern to them If items are inappropriate for child, omit them Review overall responses, clarify and make notes as needed

Omitted item? No more than 2 questions on the 6-18 month questionnaires and 3 questions on the 24-60 month questionnaires can be omitted and still calculate an average score and total score Average score = total points for items answered / # of items answered Final total score = total points of items + (average score X # of unanswered items)

ASQ-SE Summary Sheet Each age interval has unique summary sheet and cutoff score Add scores from each page of the questionnaire and total the score Determine where score falls with cutoff score If score is above the cutoff, consult with staff and family about next steps Age interval Cutoff Score Child’s ASQ-SE Score 6 months 45 ? 12 months 48 18 months 50 24 months 30 months 57 36 months 59 48 months 70 60 months

Interpretation Consider the following when determining appropriate follow-up: Parent responses to the open-ended questions Setting events and time, behavior at home different or same as at school, known triggers Any developmental concerns Health factors which may affect functioning Family & cultural factors

ASQ-SE score above the cutoff Provide follow-up activities to reinforce skills Address concerns brought up by parents Seek consultation such as PTAN Make referral to pediatrician, referral for mental health assessment & treatment, Family Resource Center, home visiting services, parenting class, etc Re-screen at next appropriate interval

Trends in Head Start Strategies Communication: Encourage words for wants/needs Encourage to express feelings Referral for speech evaluation Interaction with people: Facilitate play/communication Facilitate play with peers Routine-mealtime Compliance: Establish consistency of rules and routine Positive behavioral support techniques

Head Start Strategies Continued Self Regulation Self calming skills Routine and rules Build attention span through structured activities Structure transitions, use warnings, reminders Adaptive Functioning Discuss eating concerns-refer to pediatrician Media literacy-interest in sex Rules specific to safety Discuss sleep patterns Toilet training

Head Start Strategies continued Affect Parent-child activities Autonomy Routine Overall Some goals will address multiple concerns Example: rules and routine offer structure and consistency that allow a child to follow directions, transition, remain calm due to predictability Example: Encourage use of words for needs/wants/feelings may also support decreased tantrums

Head Start Strategies cont. Child Development education can support parents with strategies to interact with their children in a positive way, become in-tune with child’s needs, and prepare for next stages of development Discussion is critical to understand the perspective of the reporter, gather additional information and plan next steps Refer for additional services-pediatrician, mental health services, internal mental health supports, parent education, further assessment, etc.

SUMMARY EARLY, REGULAR SCREENING IS CRITICAL FOR DETECTING SOCIAL-EMOTIONAL CONCERNS PARTNERING WITH PARENTS IS ESSENTIAL EDUCATING PARENTS ABOUT THEIR CHILD’S DEVELOPMENT IS IMPORTANT ASQ-SE CAN ASSIST IN IDENTIFYING CONCERNS EARLY TO MAKE APPROPRIATE REFERRALS

REFERENCES “The ASQ:SE User’s Guide by Jane Squires, Diane Bricker, & Elizabeth Twombly, Brookes Publishing, 2003 www.agesandstages.com