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Diagnostic accuracy of Ages and Stages Questionnaire, Third Edition to identify abnormal or delayed gross motor
Marcella T Danks1, Peter H Gray2, Elizabeth M Hurrion2,3
1School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia.
Insights
The Ages and Stages Questionnaire, Third Edition (ASQ-3) shows poor sensitivity for identifying motor delays in high-risk infants at 4 months. Its accuracy improves for older infants when using the "Monitor" cutoff for abnormal motor development.
Area of Science:
- Neonatal development
- Pediatric motor assessment
- Developmental screening tools
Background:
- Infants born extremely preterm (<28 weeks gestation) or with very low birth weight (<1000g) are at high risk for motor impairments.
- Early identification of motor delays is crucial for timely intervention and improved outcomes.
- The Ages and Stages Questionnaire, Third Edition (ASQ-3) is a widely used parent-completed screening tool.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the ASQ-3 for identifying abnormal or delayed gross motor development in high-risk infants.
- To compare ASQ-3 performance at 4, 8, and 12 months corrected age.
Main Methods:
- A prospective cohort study involving 191 high-risk infants.
- The ASQ-3 was used as the index test.
- The Alberta Infant Motor Scale (AIMS) served as the reference standard for motor development assessment.
- Assessments were conducted at 4, 8, and 12 months corrected age.
Main Results:
- The ASQ-3 demonstrated poor sensitivity for detecting abnormal motor development at 4 months corrected age.
- Using the 'Monitor' cutoff on the ASQ-3 improved sensitivity and specificity for identifying abnormal motor development in infants at 8 and 12 months.
- The ASQ-3 consistently showed low sensitivity in identifying motor delay at all assessed time points.
Conclusions:
- The ASQ-3 is not sufficiently sensitive for early detection (4 months) of motor abnormalities or delays in high-risk infants.
- The ASQ-3's utility for identifying abnormal motor development increases with age when the 'Monitor' cutoff is applied.
- Clinical motor assessments remain essential for high-risk infants, especially during early infancy, to ensure accurate diagnosis and management.
Aim:
To investigate the diagnostic accuracy of parent-completed Ages and Stages Questionnaire, Third Edition (ASQ-3) to identify abnormal or delayed gross motor development in infants born less than 1000 g or less than 28 weeks gestation.
Methods:
Prospective cohort study of high-risk infants comparing ASQ-3 as the index test with concurrent score on Alberta Infant Motor Scale (AIMS) as the reference standard, at 4-, 8- and 12-month corrected (post-term) age. Reference standard positivity cut-offs were 'Abnormal motor development' (AIMS Clinical Range) and 'Motor delay' (AIMS score >1 SD below mean, not captured in Clinical Range).
Results:
Participating infants (n = 191) had mean gestational age (95% confidence interval (CI)) 26.8 weeks (26.6-27.1) and mean birthweight (95% CI) 870 g (844-896). AIMS rated 51%, 31% and 23% of infants as having 'Abnormal motor development' and 12%, 28% and 13% with 'Motor delay', at 4, 8 and 12 months, respectively. Diagnostic accuracy of ASQ-3 to identify abnormal motor development was acceptable for older infants only if 'Monitor' cut-off was used: sensitivity (95% CI) 33% (23-44), 86% (73-95) and 80% (63-92) and specificity (95% CI) 84% (74-92), 76% (66-84), and 76% (67-83) at 4, 8 and 12 months, respectively. ASQ-3 sensitivity to identify motor delay was low.
Conclusions:
ASQ-3 has poor sensitivity to identify abnormal or delayed motor development at 4 months. Using the 'Monitor' cut-off improves the diagnostic accuracy of ASQ-3 for identification of older infants with abnormal motor development who are at high risk of motor disability. However, ASQ-3 has poor sensitivity to identify motor delay. Clinical motor assessment of high-risk infants is recommended, particularly in early infancy.
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