1. 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

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Omitted item?
No more than 2 questions on the 6-18 month questionnaires and 3 questions on the 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)

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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.

23. 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

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