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Developmental Screening Using the Ages and Stages Questionnaire: Standardized Versus Real-World Conditions

San Antonio, Marianne C. DO; Fenick, Ada M. MD; Shabanova, Veronika MPH; Leventhal, John M. MD; Weitzman, Carol C. MD

doi: 10.1097/IYC.0000000000000005
Original Research/Study

Developmental screens are often used in nonstandardized conditions, such as pediatric waiting rooms, despite validation under standardized conditions. We examined the reproducibility of the Ages and Stages Questionnaire (ASQ), a developmental screening instrument commonly used in pediatric practices, under standardized versus nonstandardized conditions in an underserved population. English- or Spanish-speaking parents of 18- or 30-month-old children completed the ASQ in the waiting room and then were randomized to repeat the ASQ in waiting room (W-W) or standardized (W-S) conditions. We calculated ASQ fail rates and intraclass correlation coefficient, a measure of reliability, for each of the 5 domains of the ASQ. We hypothesized that intraclass correlation coefficients in the W-W condition would demonstrate greater reliability than in the W-S condition. A total of 131 parents were randomized (66 W-W, 65 W-S). Parents were mostly minority. Of the entire sample, 25.8% failed the first ASQ screen completed in the waiting room before randomization. There was no statistically significant difference in fail rates between study arms on the first or second screen. Intraclass correlation coefficient for W-W in the 5 domains ranged from 0.66 to 0.95, and for W-S from 0.73 to 0.92. There were no statistically significant differences between intraclass correlation coefficients in W-W versus W-S in any domain. In an underserved population, 25.8% of children failed the ASQ. The ASQ, when completed in the waiting room, is reliable compared with standardized conditions, indicating that the ASQ can be used to screen children for developmental delay in the waiting room of pediatric practices.

Division of Developmental Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware (Dr San Antonio); Department of Pediatrics (Drs Fenick and Leventhal) and Division of Developmental Behavioral Pediatrics, Department of Pediatrics (Dr Weitzman), Yale School of Medicine, New Haven, Connecticut; and Yale Center for Analytical Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut (Ms Shabanova).

Correspondence: Marianne C. San Antonio, DO, Division of Developmental Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803 (

Funding sources are as follows: Academic Pediatric Association Young Investigator Award/The Commonwealth Fund to Dr San Antonio, and Maternal Child Health Bureau Training Grant T77MC00024 to Dr Weitzman. For Ms Shabanova, this publication was made possible by CTSA Grant Number UL1 RR024139 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH road map for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

The authors thank research assistants Jonathan Alverio, Kelsy Greenwald, Janine Martire, Carolina Trombetta, Uchenna Ubozoh, and Yale Primary Care Center Nursing and Administrative Staff.

The authors declare no conflict of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.