asq-3 scoring and communication, a preschool teacher's guide

asq-3 (ages and stages questionnaires, third edition) is a screener, not a diagnosis. it is a short parent-completed questionnaire that flags children who might benefit from a closer look in five areas: communication, gross motor, fine motor, problem solving, and personal-social. asq:se-2 is a separate tool for social-emotional development.

a screener sorts children into three groups: on track, needs monitoring, needs referral for further evaluation. it does not say a child has a delay. it says the next honest step is either watchful monitoring or a referral to the local part c or part b evaluation team.

the family fills out the form. the teacher scores it, interprets it against the age-specific cutoffs, and communicates the results. every step matters, and the last one, the conversation, is the one most programs rush.

asq-3 has 21 age-specific intervals from 1 month through 66 months. use the interval closest to the child's adjusted age (or actual age if the child was full term). for a child born more than three weeks early who is under 24 months, adjust for prematurity before choosing the interval.

check that the family answered every item and that any 'not yet' or 'sometimes' is a real answer, not a skipped question. a blank item is not a zero. if items were skipped, ask the family before scoring, in the home language, without judgment: sometimes a family skips an item because they were unsure what it meant, not because the child cannot do it.

each area (communication, gross motor, fine motor, problem solving, personal-social) has six items. score each item: yes = 10, sometimes = 5, not yet = 0. add the six item scores for that area to get the area total.

then compare the area total to the two cutoffs printed on the scoring sheet for that age interval: the referral cutoff (about two standard deviations below the mean) and the monitoring cutoff (about one standard deviation below the mean). a total at or below the referral cutoff means refer for further evaluation. a total between the two cutoffs means monitor and rescreen. a total above the monitoring cutoff means the child is on track in that area.

the overall section (behavior, hearing, vision, and any parent concerns) is not scored numerically but must be reviewed. a yes on a concern item can shift the recommendation even when every area is above the monitoring cutoff.

asq:se-2 looks similar but scores in the opposite direction: higher totals suggest more concern, not less. most items are worth 0, 5, or 10, and some items are reverse-scored (marked with an r). a caregiver concern on any item adds five points.

compare the total to the single cutoff for that age interval. a total at or above the cutoff means refer for further social-emotional evaluation. a total in the monitoring zone (just below the cutoff, marked on the scoring sheet) means rescreen in a few months.

the most common scoring error on asq:se-2 is missing a reverse-scored item. read the r marker for every item before adding.

first, double-check the interval and the math. a wrong interval or a missed reverse-scored item can turn 'on track' into 'refer', or the reverse. if the result is close to a cutoff, score the form again on a different day.

second, look at the child in the room. if the form says refer but the child is meeting every one of those milestones during a normal morning, the honest thing to tell the family is what both sources say, not just the number. a screener flags who to look at more carefully; the teacher's own observation is part of that look.

third, plan the conversation in the family's home language. if the teacher and family do not share a language, request an interpreter in advance for any 'monitor' or 'refer' result. never use the child as the interpreter.

open with one true, specific thing about the child (she carried the water pitcher to every table this morning and did not spill). families cannot hear a screening result until they know the teacher sees their child.

then name the tool in plain words: this is a short questionnaire we do with every family, to make sure we are not missing anything. it is not a test the child passes or fails.

share the result for each area, one at a time, in the family's language. use the exact words 'on track', 'a good idea to keep watching', or 'a good idea to have someone else take a closer look'. do not use 'delayed', 'behind', or 'failed'. those words end the conversation.

for a monitor result, name what you will watch, when you will rescreen (usually two to four months), and one thing the family can do at home that supports that area. for a refer result, hand the family a written next step: the name and phone of the local evaluation team, what a free evaluation looks like, and that a referral does not commit the child to services.

close by handing the floor to the family. ask: does this match what you see at home? is there anything you have been wondering about that this did not ask? then write down what they said, in their words, on the same page as the score.

on the form, record the total for each area, the date scored, the interval used, and whether prematurity was adjusted. sign and date. if a rescreen is planned, write the rescreen date on the same page.

in the child's file, add a one-paragraph note: date of the conversation, who was there, the family's home language, what was shared, what the family said, and the agreed next step (rescreen date, referral made, or no action). that paragraph is what protects the child if the family moves programs or if a referral is questioned later.

for programs on head start or state pre-k systems, follow the local timeline for referrals (usually within seven to thirty days of the screening). keep a copy of any signed referral consent in the child's file.

using an interval too old for the child. a four year old scored on the 60 month interval will look 'behind' when they are actually on track. always use the interval closest to the child's adjusted age.

treating asq-3 like asq:se-2 (or the reverse). the scoring direction is opposite. read the top of the form.

burying the referral in the middle of a five-minute pickup chat. any monitor or refer result deserves a scheduled ten to fifteen minute sit-down, in a private space, in the home language.

framing a referral as bad news. a referral is a free second opinion from someone with more tools. that is the sentence to practice out loud before the meeting.

this guide is the long view. the site has shorter tools for the next ten minutes: