Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States.
Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States.
Early Hum Dev. 2021 Oct;161:105453. doi: 10.1016/j.earlhumdev.2021.105453. Epub 2021 Aug 24.
Although performance-based assessment of early childhood development is preferred, there are a number of limitations to this methodology in low resource settings (LRSs). Hence, clinicians and researchers often rely on caregiver report screening tools. The Ages and Stages Questionnaire 3 (ASQ) is one of the most widely used caregiver report measures globally. Adequate psychometric properties have been demonstrated in high income settings, especially when used in older children, high- risk children, or those with severe neurodevelopmental delays. However, its utility is more variable within very young children and for use in LRSs.
The reliability and validity of the ASQ was determined for children ages 0-5 years living in rural Guatemala. Internal consistency and test-retest reliability were assessed, as well as concurrent and predictive validity. Sensitivity, specificity, positive and negative predictive values related to performance-based developmental assessment (Mullen Scales of Early Learning; MSEL) and growth status (i.e. stunting) were also calculated.
Internal consistency reliability for the ASQ was adequate, except when results were limited by small sample size. Test-retest reliability ranged from low to moderate (r = 0.08-0.43; p < 0.05-0.01). However, there was significant variability in mean scores over time across ASQ domain scores. In terms of validity, the ASQ did not discriminate adequately between children who performed within or below age-expectations on performance-based developmental testing or those with and without stunting.
The ASQ did not demonstrate adequate psychometric properties in rural Guatemala, consistent with concerns documented in other LRSs. These results indicate that existing caregiver report screening measures of early childhood development should be utilized with caution in LRSs, and alternative methods for assessment or in the development and utilization of caregiver report measures should be considered.
虽然基于表现的儿童早期发展评估受到青睐，但在资源匮乏环境下（LRSs），这种方法存在诸多局限性。因此，临床医生和研究人员通常依赖于照顾者报告筛查工具。年龄与阶段问卷 3（ASQ）是全球使用最广泛的照顾者报告评估工具之一。在高收入环境中，已充分证明其具有良好的心理测量特性，尤其是在用于年龄较大的儿童、高风险儿童或有严重神经发育迟缓的儿童时。然而，在非常年幼的儿童和在资源匮乏环境下，其应用效果更为多变。
我们确定了生活在危地马拉农村地区的 0-5 岁儿童使用 ASQ 的信度和效度。评估了内部一致性和重测信度，以及同时性和预测效度。还计算了与基于表现的发育评估（Mullen 早期学习量表；MSEL）和生长状况（即发育迟缓）相关的灵敏度、特异性、阳性和阴性预测值。
除了因样本量小而限制结果的情况外，ASQ 的内部一致性可靠性尚可。重测信度范围从低到中等（r=0.08-0.43；p<0.05-0.01）。然而，在时间上，ASQ 各领域得分的平均得分存在显著差异。就有效性而言，ASQ 无法充分区分在基于表现的发育测试中表现出年龄预期内或低于年龄预期的儿童，以及有或无发育迟缓的儿童。
ASQ 在危地马拉农村地区的心理测量特性并不理想，这与在其他资源匮乏环境中记录的问题一致。这些结果表明，在资源匮乏环境下，应谨慎使用现有的儿童早期发育照顾者报告筛查工具，并且应考虑替代评估方法或照顾者报告工具的开发和使用。
