Guideline 14

Guideline 14: Infant, Toddler Developmental Screening

Purpose

Administration of a valid screening tool identifies developmental delays early. Early intervention is key to reducing the impact of any delays on the child and their family. Parent-child interaction and attachment can be enhanced when parents better understand the child's developmental status and trajectory.

Process

Administration of a validated screening tool identifies children that are developing on schedule; identifies areas children would benefit from practice/support; and identifies children at risk for developmental delays. Results of screening will inform that: most children are on schedule and doing great; some children will benefit from practice in an area of development; and a few children will need referral for evaluation. Screening does not diagnose delays or disabilities. If a child has known developmental delays, assure Early Intervention and developmental pediatric appointments are in place. Do not continue with developmental screens in the known delayed area unless requested by parent.

Home Visitors in the Babies First! and Nurse-Family Partnership programs are encouraged to use the Ages and Stages Questionnaires (ASQ)-3 and the Ages and Stages Questionnaires (ASQ): Social Emotional (SE)-2 for screening. The screens should be administered at intervals according to the guidelines of the home visiting program and anytime concerns arise. ASQ-3 and ASQ-SE results may be obtained from other providers rather than having the family repeat the screening for the same age.

ASQ-3 is a series of questionnaires for children ages 1 month to 5 ½ years. And is a validated tool that can accurately identify children at risk for developmental delays. There are 21 individual age-based ASQ-3 questionnaires but not all ages need to be administered for each child. The 9-month questionnaire was designed for use in health care settings and is not recommended for use in home visiting. The ASQ:SE-2 is composed of nine questionnaires that can be used with all children from 1 month to 72 months of age.

Introduce the screening tool to families, explain the purpose of the screening, who will have access to the screening information and how the results will be used.
Carefully calculate a child's age at administration in months and days. See ASQ-3 and ASQ:SE-2 User's Guides for detailed guidance. There is an age calculator that the publisher of the ASQ provides at the following website. (https://agesandstages.com/free-resources/asq-calculator/. ) Age adjustments must be made when a child is born more than 3 weeks premature, up to, but not including 24 months

Administer the ASQ-3 and ASQ:SE at intervals 4 months, 6 months, 10 months, 12 months, 18 months, 24 months, and Q 6 months after 24 months. Or, at any time the caregiver has concerns.

The questionnaire is completed by the parent/caregiver. Accuracy is improved when a familiar caregiver reports on observable behaviors in a familiar, comfortable environment over time. The child should be given some time to play with materials and the caregiver should try out the majority of the items. Studies suggest that parents are highly reliable reporters on developmental screening tools. The questionnaires are designed to encourage parent/ caregiver involvement in the screening process. Home Visitors report that completing the ASQ-3/ASQ: SE-2 with parents offers an important opportunity to educate parents about whether their child's development and behavior is similar to that of same-age peers.
Score the questionnaire. Review responses. If there are any missing items, try to obtain answers. If an item is inappropriate, omit the item. Calculate area totals. If any items omitted, calculate new area total (See ASQ-3/ASQ:SE-2 User's Guide for detailed guidance. Your county may need to purchase this resource). Review any parent comments.
Score interpretation and follow-up. Consider culture and family values when interpreting the results. Discuss results with family. If score is above the cutoff: Provide follow-up activities and rescreen according to program schedule. If the score is below the cutoff in the monitoring gray zone: Provide activities to practice skills in specific areas and rescreen in 2 months or sooner. Make community referrals as appropriate if the score is below cutoff the black zone, or in one of more areas.

In consultation with family, provide referral to Early Intervention and share results with the primary care provider. The summary sheet (score form) provides a complete summary of ASQ information, and can be used to share information with other providers. When sharing results with the summary sheet only, the optional individual item response section should be completed.
If a parent expresses concern, regardless of the ASQ result, re-screen and refer if necessary. Follow-up activities may include:

ASQ Play activities found in the Appendix of the ASQ-3 User's Guide. They are in a chart format, and each age interval contains activities across developmental areas.
ASQ Learning Activities are a separate publication. The learning activities contain actions by developmental area. An on-line guide to activities by developmental area may be found here.
ASQ: SE-2 Learning Activities are found in Appendix E of the ASQ-SE2 User's Guide. The Learning Activities include age-by-age handouts and activities to support parents. On-line parent handout activity sheets may be found here.
CDC's Learn the Signs. Act Early Initiative includes a number of resources for professionals (including home visitors) and parents. https://www.cdc.gov/ncbddd/actearly/index.html

Information about how to refer a child to EI/ECSE can be found here.

References:

Assessment of Social Emotional Development and Protective Factors. https://www.aap.org/en/patient-care/early-childhood/early-relational-health/assessment-of-social-emotional-development-and-protective-factors/. Accessed 2/7/2025.