Utility of the Ages and Stages Questionnaire to Identify Developmental Delay in Children Aged 12 to 60 Months

Abstract

ImportanceThe Ages and Stages Questionnaire (ASQ) is a commonly used developmental screening tool, but its utility is debated.ObjectivesTo conduct a a systematic review and meta-analysis to evaluate ASQ’s utility as a screening or diagnostic tool to identify developmental delay in children aged 12-60 months.Data SourcesMedline, EMBASE, CINAHL, PsycINFO, and Mednar were searched from inception until December 2021.Study SelectionStudies meeting both criteria were included. ASQ was performed at age 12 to 60 months or where the median age at ASQ was at least 12 months and formal developmental assessments were done within 2 months of ASQ.Data Extraction and SynthesisTrue positive, false positive, false negative, and true negatives from individual studies were extracted. Meta-analysis was conducted with Stata version 16.1. Risk of bias was assessed using the QUADAS-2 tool. Certainty of evidence (COE) was assessed using GRADE guidelines.Main Outcomes and MeasuresAbility of ASQ scores more than 2 SDs below the mean in more than 1 domain (ASQ-2SD) to identify any developmental delay or severe delay. Based on generally accepted interpretation of likelihood ratio (LR) values, a positive LR (PLR) more than 5 and a negative LR (NLR) of 0.2 or less were considered necessary to rule in or rule out developmental delay, respectively, with at least moderate probability.ResultsInitial search yielded 5777 citations of which 43 were included in the review. Of them, 36 were included in the meta-analysis. The pooled sensitivity, specificity, PLR, and NLR are as follows: ASQ-2SD to predict any delay in 1 or more domain (n = 16), 0.77 (95% CI, 0.64-0.86), 0.81 (95% CI, 0.75-0.86), 4.10 (95% CI, 3.17-5.30), and 0.28 (95% CI, 0.18-0.44); ASQ-2SD to predict severe delay in 1 or more domain (n = 15), 0.84 (95% CI, 0.75-0.90), 0.77 (95% CI, 0.71-0.82), 3.72 (95% CI, 2.98-4.64), and 0.20 (95% CI, 0.13-0.32); ASQ-2SD motor domain to predict motor delay (n = 7), 0.41 (95% CI, 0.26-0.57), 0.94 (95% CI, 0.87-0.97), 6.5 (95% CI, 3.8-11.1), and 0.63 (95% CI, 0.50-0.81); and ASQ-2SD cognitive domain to predict cognitive delay (n = 2), 0.44 (95% CI, 0.24-0.65), 0.93 (95% CI, 0.81-0.95), 6.4 (95% CI, 2.4-16.8), and 0.61 (95% CI, 0.43-0.86). The COE was low/very low.Conclusions and RelevanceIf a child aged 12 to 60 months passes all ASQ domains, there is a moderate probability that they do not have severe developmental delay (low COE). If a child aged 12-60 months fails the motor or cognitive domain of ASQ, there is a moderate probability that they have some motor or cognitive delay, respectively (very low COE).Trial RegistrationPROSPERO (CRD42021268543).

Classification Performance of the Ages and Stages Questionnaire: Influence of Maternal Education Level

“…One prospective study considered the ASQ-3 equivalent to the Bayley-III at 2 years of CA to detect moderate to severe neurodevelopmental impairment [ 24 ]. A recent meta-analysis including 36 studies concluded that the ASQ-3 performance to identify developmental delay in children aged between 12 and 60 months was moderate, with a pooled sensitivity of 0.77 (95% CI, 0.64–0.86), a pooled specificity of 0.81 (95% CI, 0.75–0.86), a pooled positive likelihood ratio of 4.10 (95% CI, 3.17–5.30), and a pooled negative likelihood ratio of 0.28 (95% CI, 0.18–0.44) [ 25 ].…”

Socioemotional Development of Infants and Toddlers During the COVID-19 Pandemic

“…Each domain score places a participant in a category: (1) low risk, (2) monitor (scores 1 or more and less than 2 SDs from the mean), and (3) refer (scores more than 2 SDs from the mean) . The ASQ-3 has demonstrated good psychometric properties . The 10- and 18-month ASQ-3 assessments have a 30-day before and after validity window, for example, the 18-month assessment may be administered to a child from age 17 months and 0 days to 18 months and 30 days.…”

Assessment of Neurodevelopment in Infants With and Without Exposure to Asymptomatic or Mild Maternal SARS-CoV-2 Infection During Pregnancy

“…Similar null results on the ASQ-3 among infants with prenatal exposure to maternal SARS-CoV-2 infection have been reported from other geographical regions, including Kuwait and China; however, it should be noted that both the COMBO Initiative and other research groups have found slightly lower parent-reported developmental scores in infants born during the pandemic compared with those born before the pandemic. To date, the cumulative available data have relied on parent-reported measures such as the ASQ-3, which has only moderate sensitivity and specificity for estimating actual neurodevelopmental delays . Furthermore, parent-reported measures of infant development might be at greater risk of biased perception during a global pandemic due to parental stress and reduced parental exposure to other children and typical infant developmental trajectories.…”

“…To date, the cumulative available data have relied on parent-reported measures such as the ASQ-3, which has only moderate sensitivity and specificity for estimating actual neurodevelopmental delays. 21 Furthermore, parent-reported measures of infant development might be at greater risk of biased perception during a global pandemic due to parental stress and reduced parental exposure to other children and typical infant developmental trajectories. It is therefore important to use standardized observational measures to assess associations between maternal SARS-CoV-2 infection status during pregnancy and neurodevelopmental outcomes.…”