Ages & Stages Questionnaires

Kylie Levin, B.S.

Kent State University
330-958-4654

Results of Initial Evaluation

Name: AP
Date of Birth: July 2013
Chronological Age: 43 months, 19 days
Parents: MP & JP
Date of screening: February 27, 2017

Reason for referral: The Ages & Stages Questionnaire Third Addition (ASQ-3) and
Ages & Stages Questionnaire Social-Emotional: Second Addition (ASQ:SE-2) are
completed through parent interviews to determine if a child is appropriately reaching
developmental milestones in the communication, gross motor, fine motor, problem
solving, personal-social, and social-emotional domains. These areas of development are
further explained in the Current Assessment section below. The purpose of the
questionnaire is to determine what follow-up action is necessary to move the child
towards progression in development. APs parents did not have any major concerns, but
she was assessed for a graduate course assignment.

Background information: AP attends preschool two days a week. She also participates
in swim lessons and soccer. MP and JP reported their work hours are opposite of each
other, as JP is a part time nurse, so they are typically the ones watching AP. The days that
their schedules overlap, APs grandmother watches her. Her parents mentioned that AP
broke her left leg at the age of 2 and had a cast from her thigh down. Her parents reported
AP has a loving and caring personality. Their only concern is that she falls a lot, but she
is great at walking.

Current assessment: The ASQ-3 and ASQ:SE-2 were the two tests used during the
initial evaluation. They were partially administered through APs parents filling out the
questions and through parent interviews through myself. The ASQ-3 measures
communication skills; like talking about what is happening in a picture book, gross motor
skills; larger movements like the ability to walk up stairs or briefly stand on one foot, fine
motor skills; smaller movements like holding a pencil between your fingers and thumb,
problem solving skills; like dressing up and pretending to be someone else, and personal-
social skills; interactions like taking turns with another child or adult. There are six age
appropriate questions listed under each of these domains. The ASQ:SE-2 measures social
emotional skills; like overall happiness or friendliness towards familiar and unfamiliar
people. The ASQ:SE-2 includes a column labeled Check if this is a concern, in which
this is considered when determining future directions. There are three options to choose
from for both questionnaires including, Yes, Sometimes, and No. These two
questionnaires can help us find out where AP has strengths and weaknesses, if any. There
are cutoff scores for each of the evaluated domains. On the ASQ-3, if AP scored below
the cutoff further evaluation or additional support would be recommended. On the
ASQ:SE-2, if AP scored above the cutoff further evaluation or additional support would
be recommended.

Summary of scores:

Domain APs Scores ASQ Cutoff Scores*

Communication 60 27.06
Gross Motor 60 36.27
Fine Motor 60 19.82
Problem Solving 60 28.11
Personal Social 60 31.12
Social Emotional 45 85

AP scored well above the cutoff score in all domains on the ASQ-3. APs development
appears to be on schedule alongside children her age. She scored below the cutoff score
on the ASQ:SE-2, meaning she has no or a low risk of social emotional deficits. APs
social emotional development appears to be on schedule alongside children her age. Her
parents did not show any concerns for her social emotional development.

Overall questions: Based on parent report, AP communicates better than her peers. She
walks, runs, and climbs like other children but falls often. AP appears to enjoy sweets
more than vegetables, but it is not a major concern of her parents.

Recommendations: No further actions are needed at this time. Parents should monitor
APs falls and follow up if needed.

___________________________
Signature & Date

*ASQ-3 scores below the cutoff score indicate further evaluation may be recommended,
ASQ:SE-2 scores above the cutoff score indicate further evaluation may be
recommended.