Document Type


Publication Date




  • Developmental delay is present in approximately 15 percent of children in the United States. 1
  • Less than one fifth of those children receive early intervention before age 3.
  • Screening processes in pediatric settings are insufficient to identify all children with developmental delay.


  • Investigate the level of agreement in typical methods of administration of the 36 month Ages and Stages Questionnaire 3rd ed. (ASQ 3) between parents, CCPs, and student physical therapists (SPTs).


  • 11 children and parents from 2 childcare centers
  • 5 childcare providers (CCPs)
  • 7 student physical therapists (SPTs)


Outcome Measure: 36-Month ASQ-3

  • Standardized developmental screening tool designed to test a wide age range and be administered by various parties
  • Rapid, simple, and cost effective way to monitor a child’s development

Developmental screening was conducted across two testing sessions for each child based on common practices of ASQ-3 administration (Fig. 1).

  • Session 1: Parent scored child’s performance from memory, unless confronted with novel items in which scoring was inferred or administered. SPT was present for questions.
  • Session 2: CCP administered every item and scored the child based on their elicited performance while another SPT scored as an observer.


Inter-rater Agreement:

  • CCPs and SPTs significantly agreed in 4/5 domains
  • No significant agreement between parents/CCPs or parents/SPTs for any domain (Table 1).

Trends in specific domains (Fig. 2):

  • Highly variable across the 5 domains
  • Gross Motor: 73% of parents scored their child’s ability higher than at least one rater from the standardized session by as much as 25 points.
  • Problem Solving: 64% of the parents scored their child as much as 30 points lower than at least one other rater.


  • Inter rater agreement between parents and CCPs or healthcare professionals was limited.

Clinical Relevance

  • Testing condition for parents was not parallel to the condition for other groups
  • Recommend future exploration into interpretation of this screening tool and best use of the ASQ 3 by parents and CCPs to promote their participation.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.