Ability of Ages and Stages Questionaire 3rd Edition to Identify Children in Need of Comprehensive Motor Evaluation

Abstract

PURPOSE: The Ages and Stages Questionnaire Third Edition (ASQ-3) is a widely used screening tool designed to identify children who need comprehensive developmental assessment. Its accuracy for identifying children in need of additional motor assessment has not been determined. The purposes of this study were to establish concurrent validity between ASQ-3 gross motor (GM) and fine motor (FM) scores and their corresponding Peabody Developmental Motor Scales Second Edition (PDMS-2) quotients, and to examine the diagnostic accuracy of the ASQ-3 using the PDMS-2 as a gold standard reference test. MATERIALS/METHODS: This was a secondary analysis of a previous study in which both ASQ-3 and PDMS-2 data were collected, and ASQ-3 data were not analyzed. The sample included 27 children aged 18 to 59 months (mean=41.52 months) with and without known disabilities. The Pearson Correlation Coefficient was used to examine relationships between ASQ-3 GM and FM scores and their corresponding PDMS-2 motor quotients. Diagnostic accuracy was calculated for the ASQ-3 GM and FM scores compared to the PDMS-2 gross motor quotient (GMQ) and fine motor quotient (FMQ). Contingency tables (2x2) were used to calculate sensitivity (SN), specificity (SP), positive and negative predictive values (PPV/NPV), and positive and negative likelihood ratios (PLR/NLR). All values were calculated using one and two standard deviations (1SD/2SD) below the norm as a construct for delay, as eligibility requirements vary across states. RESULTS: There were no significant correlations between ASQ-3 scores and PDMS-2 scores. The ASQ-3 was found to have high SP in identifying children who need further !! !!! iv! motor testing (SP for GM = 0.91; SP for FM = 0.96). ASQ-3 also showed low sensitivity (SN=0) for identifying children in need of further testing for gross and fine motor delay. Predictive values for GM were as follows: PPV at 1 and 2SD = 0, NPV at 1SD = 0.84, NPV at 2SD = 0.92. Predictive values for 1 and 2SD FM were as follows: PPV = 0.5 and NPV = 0.96. Likelihood ratios for GM were as follows: at 1SD PLR = 0, NLR = 1.10; at 2SD PLR = 0, NLR = 1.09. Likelihood ratios for FM were as follows: at 1SD and 2SD PLR = 12.5, NLR = 0.52. CONCLUSION: The ASQ-3 performed best for correctly identifying children in need of further assessment of fine motor skills, since children who scored below the ASQ-3 FM cutoff also scored below norms on the PDMS-2 FMQ. The ASQ-3 demonstrated limited accuracy for identifying children in need of further assessment of gross motor skills, since children who scored below the ASQ-3 GM cutoff scored at or above the mean on the PDMS-2 GMQ. Study limitations included a small and homogenous population with low prevalence of motor delay. Clinicians should carefully consider the purpose of conducting screening and importance of correctly allocating limited resources in deciding whether or not to use the ASQ-3 as a means of identifying children in need of comprehensive motor assessment.