Published online August 1, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. 457-458 (doi:10.1542/peds.2007-1364)
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LETTER TO THE EDITOR

Should General Pediatricians Not Select the Ages & Stages Questionnaire in Light of the Rydz et al Study?

Kevin Marks, MD
PeaceHealth Medical Group
Eugene, OR 97401

To the Editor.—

Pediatricians might be swayed to not select the Ages & Stages Questionnaire (ASQ) because of the conclusions of the Rydz et al1 study of the 18-month ASQ psychometric properties (sensitivity: 0.67; specificity: 0.39; positive predictive value: 34%; negative predictive value: 71%). Should we accept these results and choose another tool? My opinion is that we should not.

  1. Neither the Battelle Development Inventory nor the English ASQ was well matched to the study's suburban, largely middle-class population from Quebec, Canada. The ASQ was normed on >8000 children from diverse ethnic and socioeconomic backgrounds.2
  2. Rydz et al used only the English ASQ and did not provide the French or Spanish translations.
  3. Nearly all the studied, age-interval ASQs have moderate-to-high sensitivity and specificity. Multiple gold-standard instruments were used when developing the ASQ, including the Bayley scales and revised Gesell at 16 and 20 months.2
  4. Single, 18-month–interval screening leads to hazy conclusions about overall ASQ accuracy and feasibility; there are 19 available intervals. It is akin to a dentist looking at 1 tooth and drawing conclusions about the person's overall dental health.
  5. There were "approximately" 3 months between the administration of the ASQ and the "gold-standard" Battelle. Much can happen in that interval of a toddler's life. ASQ screening can increase parental focus on the child's development and encourage early intervention techniques at home.
  6. Abridged ASQ procedures were used. Parental response was based solely on previous child observations, which is antithetical to the authors' instructions. The ASQ can be completed in the office, but mailing it back should be an acceptable alternative after parents have had a chance to play with their child and observe target behaviors.
  7. There was a suspicious conclusion that 40% (53 of 134) of the children who had returned and completed the ASQ failed at least 1 domain, which brings up selection bias. Were there significant sociodemographic disparities between the 101 participants and the rest of the 532 recruited subjects? Our study concluded that 10% (77 of 770) of the participants who completed ASQ screening failed at least 1 domain.3
  8. Lipkin and Gwynn have already addressed other methodologic flaws with the Rydz et al study.4
  9. Although 92% found the Child Development Inventory "easy or very easy to complete," any busy pediatrician knows that a 300-item, 30- to 50-minute Child Development Inventory designed only for children >15 months of age is not office-friendly.5,6
  10. In my humble opinion, of the 20 screening-tool choices offered by the American Academy of Pediatrics,6 the ASQ has the most optimal blend of validity, reliability, and feasibility.

REFERENCES

  1. Rydz D, Srour M, Oskoui M, et al. Screening for developmental delay in the setting of a community pediatric clinic: a prospective assessment of parent-report questionnaires. Pediatrics. 2006;118(4) . Available at: www.pediatrics.org/cgi/content/full/118/4/e1178
  2. Squires J, Potter L, Bricker D. The ASQ User's Guide for the Ages & Stages Questionnaire: A Parent-Completed, Child-Monitoring System. 2nd ed. Baltimore, MD: Paul H. Brookes; 1999
  3. Hix-Small H, Marks K, Squires J, Nickel R. Impact of implementing developmental screening at 12 and 24 months in a pediatric practice. Pediatrics. 2007;120 :381 –389[Abstract/Free Full Text]
  4. Lipkin PH, Gwynn H. Improving developmental screening: combining parent and pediatrician opinions with standardized questionnaires [letter]. Pediatrics. 2007;119 :655 –656[Free Full Text]
  5. Ireton H. Child Development Inventory Manual. Minneapolis, MN; Behavior Science Systems Inc; 1992
  6. American Academy of Pediatrics, Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics. 2006;118(4):1808–1809]. Pediatrics. 2006;118 :405 –420[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics




This Article
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