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ASQ-3 scores are sensitive to small differences in age in a Peruvian infant population
K C Chong1, V L Zhou1, D Tarazona2
1School of Medicine, University of Rochester, Rochester, NY, USA.
Insights
The Ages and Stages Questionnaires Edition 3 (ASQ-3) may underestimate developmental delays in young children due to age variations. This study found age significantly impacts ASQ-3 scores, suggesting potential underestimation of developmental sensitivity.
Area of Science:
- Developmental Pediatrics
- Child Health Screening
- Public Health Interventions
Background:
- The Ages and Stages Questionnaires Edition 3 (ASQ-3) is a validated tool for screening developmental delays in young children.
- Previous research indicates variability in ASQ-3 scores among children within the same screening interval.
- Understanding age-related score variations is crucial for accurate developmental assessment in diverse populations.
Purpose of the Study:
- To investigate the relationship between chronological age and ASQ-3 scores within specific screening intervals.
- To determine if age subgrouping influences ASQ-3 results in a population of Peruvian infants.
- To assess the impact of age on the sensitivity of ASQ-3 in detecting developmental delays.
Main Methods:
- A cross-sectional study involving 5850 Peruvian infants under two years old participating in the Cuna Más program.
- Infants were administered the appropriate ASQ-3 screening interval and categorized into 2-week age subgroups within each 2-month window.
- Statistical analyses included Fisher's exact test, ANOVA, Bonferroni post hoc tests, and linear regression to assess age-score relationships.
Main Results:
- Age subgroup remained a significant predictor of total ASQ-3 scores, sectional scores, and suspected developmental delays, even after adjusting for socioeconomic and nutritional factors.
- A significant association was found between age subgroups and ASQ-3 scores, with P < 0.001.
- Nearly half (49.6%) of the infants screened positive for suspected delays in one or more developmental areas.
Conclusions:
- Chronological age is a significant factor influencing ASQ-3 scores in young Peruvian children.
- The ASQ-3 may underestimate the developmental sensitivity to minor age differences in this population.
- Further research is needed to refine screening intervals or interpret scores considering precise age.
Objective:
The Ages and Stages Questionnaires Edition 3 (ASQ-3) are a well-validated international screen for developmental delays in young children. However, previous studies demonstrate variable scores between children eligible to take the same ASQ-3 interval. This study aimed to determine a relationship between age and ASQ-3 score for each screening interval.
Methods:
This was a baseline exploratory cross-sectional study of infants under 2 years old evaluated for the Peruvian social programme Cuna Más. Participants were included in Cuna Más if they lived in districts with fewer than 2000 inhabitants or 400 homes, indicating a predominantly rural population. The appropriate ASQ-3 screening interval was administered to each subject. Subjects were divided into four 2-week chronological subgroups based on age within each 2-month screening window and aggregated across all 12 screening intervals. Fisher's exact test, analysis of variance and Bonferonni post hoc test were used to compare differences between age subgroups. Linear regression was performed to assess the relationship between ASQ-3 score and both aggregated and disaggregated age subgroup.
Results:
A total of 5850 Peruvian infants were evaluated in 2013. Mean age was 13 ± 6.6 months, 50.7% were male and mean maternal education was 6.6 ± 4.0 years; 34.8% infants were stunted, 7.8% were underweight, 0.9% were wasted and 2% had age adjusted greater than 35 days for prematurity for ASQ-3 interval assignment. Mean total ASQ-3 was 42.2 ± 8.2. The ASQ-3 allocated 49.6% with suspected delay in one or more developmental areas. Before and after adjusting for wealth quintile, maternal education level, infant nutritional status and prematurity adjustment, age subgroup remained significantly associated with total ASQ-3 score (β = 1.8, CI: 1.7-2.0, P < 0.001), sectional ASQ-3 score (all P < 0.001) and inversely associated with one or more scores indicating suspected developmental delay (P < 0.001).
Conclusions:
The ASQ-3 may underestimate the sensitivity of child development to small differences in age in this population.
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