Skip to main content

Cultural Adaptation and Psychometric Validation of the Ages and Stages Questionnaires for use in Georgia

Journal of Child and Family Studies volume 27, pages 739–749 (2018)Cite this article

Abstract

Low- and middle-income countries need simple, technically sound developmental screening tools. The Ages and Stages Questionnaires, 3rd edition (ASQ-3) is widely accepted as a scientifically reliable and valid, user-friendly, and easy-to-learn and administer tool. This study documents the cultural adaptation, validation, and standardization of the Georgian ASQ-3 for children 1–66 months. The parents of 2974 children from one to 66 months completed the Georgian ASQ-3. We compared mean domain scores to the US normative sample, and performed multivariate analyses to detect variables associated with ASQ-3 cutoff scores. Cronbach's alpha values for all age groups varied from 0.643 to 0.824 across areas. We found significant differences in cutoff points between the Georgian ASQ-3 and US reference population in most domains across age groups. Child gender was associated with Communication (B, 0.453; p = 0.01), Fine Motor (B, 0.457; p = 0.01) and Personal–Social (B, 0.576; p = 0.001) with scores for girls more frequently distributed above the cutoff. We found administration of the Georgian ASQ-3 was easy after adaptation. We recommend additional research to investigate sensitivity and specificity and gender differences.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

39,95 €

Price includes VAT (Finland)

References

  • Alvik, A., & Grøholt, B. (2011). Examination of the cut-off scores determined by the Ages and Stages Questionnaire in a population-based sample of 6 month-old Norwegian infants. BMC Pediatrics, 11(1). https://doi.org/10.1186/1471-2431-11-117.

  • Azmitia, M., & Hesser, J. (1993). Why siblings are important agents of cognitive development: A comparison of siblings and peers. Child Development, 64(2), 430–444. https://doi.org/10.1111/j.1467-8624.1993.tb02919.x.

    Article  Google Scholar 

  • Ball, J. (2006). Screening and assessment experiences review in First Nations early childhood programs in British Columbia. British Columbia: First Nations and Inuit Health Branch.

    Google Scholar 

  • Bright Futures Steering Committee, & Medical Home Initiatives for Children with Special Needs Project Advisory Committee. (2006). Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118(1), 405–420.

    Article  Google Scholar 

  • Carneiro, P., Meghir, C., & Parey, M. (2013). Maternal education, home environments, and the development of children and adolescents. Journal of the European Economic Association, 11, 123–160. https://doi.org/10.1111/j.1542-4774.2012.01096.x.

    Article  Google Scholar 

  • Charafeddine, L., Sinno, D., Ammous, F., Yassin, W., Al-Shaar, L., & Mikati, M. A. (2013). Ages and stages questionnaires: Adaptation to an Arabic speaking population and cultural sensitivity. European Journal of Paediatric Neurology, 17(5), 471–478. https://doi.org/10.1016/j.ejpn.2013.03.001.

    Article  PubMed  Google Scholar 

  • D’Aprano, A., Silburn, S., Johnston, V., Robinson, G., Oberklaid, F., & Squires, J. (2016). Adaptation of the ages and stages questionnaire for remote aboriginal Australia. Qualitative Health Research, 26(5), 613–625. https://doi.org/10.1177/1049732314562891.

    Article  PubMed  Google Scholar 

  • Dionne, C., McKinnon, S., Squires, J., & Clifford, J. (2014). Developmental screening in a Canadian First Nation (Mohawk): Psychometric properties and adaptations of ages & stages questionnaires (2nd edition). BMC Pediatrics, 14(1), 23 https://doi.org/10.1186/1471-2431-14-23.

    Article  PubMed  PubMed Central  Google Scholar 

  • Duncan, G. J., Magnuson, K., & Votruba-Drzal, E. (2014). Boosting family income to promote child development. The Future of Children, 24(1), 99–120. https://doi.org/10.1353/foc.2014.000f.

    Article  PubMed  Google Scholar 

  • Elbers, J., Macnab, A., McLeod, E., & Gagnon, F. (2008). The ages and stages questionnaires: Feasibility of use as a screening tool for children in Canada. Canadian Journal of Rural Medicine, 13(1), 9–14.

    PubMed  Google Scholar 

  • Filgueiras, A., Pires, P., Maissonette, S., & Landeira-Fernandez, J. (2013). Psychometric properties of the Brazilian-adapted version of the ages and stages questionnaire in public child daycare centers. Early Human Development, 89(8), 561–576. https://doi.org/10.1016/j.earlhumdev.2013.02.005.

    Article  PubMed  Google Scholar 

  • GeoStat.Ge. (n.d.). http://www.geostat.ge/index.php?action=page&p_id=1181&lang=eng Accessed 7 Dec 2016.

  • Guevara, J. P., Gerdes, M., Localio, R., Huang, Y. V., Pinto-Martin, J., Minkovitz, C. S., et al. (2013). Effectiveness of developmental screening in an urban setting. Pediatrics, 131(1), 30–37. https://doi.org/10.1542/peds.2012-0765.

    Article  PubMed  Google Scholar 

  • Guralnick, M. J. (2004). Effectiveness of early intervention for vulnerable children: A developmental perspective. In M. A. Feldman (Ed.), Early intervention: The essential readings (pp. 9–50). Malden, MA: Blackwell.

    Google Scholar 

  • Guralnick, M. J. (1997). Second-generation research in the field of early intervention. The Effectiveness of Early Intervention (pp. 3–20). Baltimore, MD: Paul H. Brookes Publishing Co.

    Google Scholar 

  • Heckman, J. J. (2013). Giving kids a fair chance. Cambridge, Mass.: MIT Press.

    Google Scholar 

  • Heo, K. H., Squires, J., & Yovanoff, P. (2008). Cross-cultural adaptation of a pre-school screening instrument: Comparison of Korean and US populations. Journal of Intellectual Disability Research, 52(3), 195–206. https://doi.org/10.1111/j.1365-2788.2007.01000.x.

    Article  PubMed  Google Scholar 

  • Hix-Small, H., Marks, K., Squires, J., & Nickel, R. (2007). Impact of implementing developmental screening at 12 and 24 months in a pediatric practice. Pediatrics, 120(2), 381–389. https://doi.org/10.1542/peds.2006-3583.

    Article  PubMed  Google Scholar 

  • Janson, H., & Squires, J. (2004). Parent-completed developmental screening in a Norwegian population sample: A comparison with US normative data. Acta Paediatrica, 93(11), 1525–1529. https://doi.org/10.1080/08035250410033051.

    Article  PubMed  Google Scholar 

  • Jee, S. H., Szilagyi, M., Ovenshire, C., Norton, A., Conn, A.-M., Blumkin, A., & Szilagyi, P. G. (2010). Improved detection of developmental delays among young children in foster care. Pediatrics, 125(2), 282–289. https://doi.org/10.1542/peds.2009-0229.

    Article  PubMed  Google Scholar 

  • Juneja, M., Mohanty, M., Jain, R., & Ramji, S. (2012). Ages and stages questionnaire as a screening tool for developmental delay in Indian children. Indian Pediatrics, 49(6), 457–461.

    Article  PubMed  Google Scholar 

  • Kapci, E. G., Kucuker, S., & Uslu, R. I. (2010). How applicable are Ages and Stages Questionnaires for use with Turkish children? Topics in Early Childhood Special Education, 30(3), 176–188. https://doi.org/10.1177/0271121410373149.

    Article  Google Scholar 

  • Kerstjens, J. M., Bos, A. F., ten Vergert, E. M. J., de Meer, G., Butcher, P. R., & Reijneveld, S. A. (2009). Support for the global feasibility of the ages and stages questionnaire as developmental screener. Early Human Development, 85(7), 443–447. https://doi.org/10.1016/j.earlhumdev.2009.03.001.

    Article  PubMed  Google Scholar 

  • Kyerematen, V., Hamb, A., Oberhelman, R. A., Cabrera, L., Bernabe-Ortiz, A., & Berry, S. J. (2014). Exploratory application of the ages and stages (ASQ) child development screening test in a low-income Peruvian shantytown population, 4(1). https://doi.org/10.1136/bmjopen-2013-004132

  • Maneesriwongul, W., & Dixon, J. K. (2004). Instrument translation process: A methods review. Journal of Advanced Nursing, 48(2), 175–186. https://doi.org/10.1111/j.1365-2648.2004.03185.x.

    Article  PubMed  Google Scholar 

  • McAlister, A. R., & Peterson, C. C. (2013). Siblings, theory of mind, and executive functioning in children aged 3-6 years: New longitudinal evidence. Child Development, 84(4), 1442–1458. https://doi.org/10.1111/cdev.12043.

    Article  PubMed  Google Scholar 

  • McKnight, S. (2014). Implementing the Ages and Stages questionnaire in health visiting practice. Community Practitioner, 87(11), 28–32.

    PubMed  Google Scholar 

  • Radecki, L., Sand-Loud, N., O’Connor, K. G., Sharp, S., & Olson, L. M. (2011). Trends in the use of standardized tools for developmental screening in early childhood: 2002–2009. Pediatrics, 128(1), 14–19.

    Article  PubMed  Google Scholar 

  • Ramey, C. T., & Ramey, S. L. (2006). Early learning and school readiness: Can early intervention make a difference? In N. F. Watt, C. C. Ayoub, R. H. Bradley, J. E. Puma & W. A. Lebeouf (Eds.), The Crisis in Youth Mental Health: Critical Issues and Effective Programs (pp. 291–317). Westport, CT: Praeger Press.

    Google Scholar 

  • Richter, J., & Janson, H. (2007). A validation study of the Norwegian version of the ages and stages questionnaires. Acta Paediatrica, 96(5), 748–752. https://doi.org/10.1111/j.1651-2227.2007.00246.x.

    Article  PubMed  Google Scholar 

  • Rydz, D., Srour, M., Oskoui, M., Marget, N., Shiller, M., Birnbaum, R., et al. (2006). Screening for developmental delay in the setting of a community pediatric clinic: a prospective assessment of parent-report questionnaires. Pediatrics, 118(4), 1178–1186. https://doi.org/10.1542/peds.2006-0466.

    Article  Google Scholar 

  • San Antonio, M. C., Fenick, A. M., Shabanova, V., Leventhal, J. M., & Weitzman, C. C. (2014). Developmental screening using the ages and stages questionnaire: standardized versus real-world conditions. Infants & Young Children, 27(2), 111–119. https://doi.org/10.1097/IYC.0000000000000005.

    Article  Google Scholar 

  • Schjølberg, S., Eadie, P., Zachrisson, H. D., Oyen, A.-S., & Prior, M. (2011). Predicting language development at age 18 months: Data from the Norwegian mother and child cohort study. Journal of Developmental and Behavioral Pediatrics, 32(5), 375–383. https://doi.org/10.1097/DBP.0b013e31821bd1dd.

    Article  PubMed  Google Scholar 

  • Schqnhaut, B. L., & Armijo, R. I. (2014). Applicability of the ages & stages questionnaires (ASQ) as a developmental screening tool for psychomotor delay. Revista Chilena De Pediatria, 85(1), 12–21. https://doi.org/10.4067/S0370-41062014000100002.

    Article  Google Scholar 

  • Simpson, S., D’Aprano, A., Tayler, C., Toon Khoo, S., & Highfold, R. (2016). Validation of a culturally adapted developmental screening tool for Australian aboriginal children: Early findings and next steps. Early Human Development, 103, 91–95. https://doi.org/10.1016/j.earlhumdev.2016.08.005.

    Article  PubMed  Google Scholar 

  • Skellern, C. Y., Rogers, Y., & O’Callaghan, M. J. (2001). A parent-completed developmental questionnaire: Follow up of ex-premature infants. Journal of Paediatrics and Child Health, 37(2), 125–129.

    Article  PubMed  Google Scholar 

  • Squires, J. (Ed.) (2009). ASQ-3 User’s Guide. Baltimore, MD: Paul H. Brookes Pub.

    Google Scholar 

  • Squires, J., Bricker, D. D., Twombly, E., & Potter, L. (2009). Ages & Stages Questionnaires: A parent-completed child monitoring system (3rd ed.). Baltimore, MD: Paul H. Brookes.

    Google Scholar 

  • Vameghi, R., Sajedi, F., Kraskian Mojembari, A., Habiollahi, A., Lornezhad, H. R., & Delavar, B. (2013). Cross-cultural adaptation, validation and standardization of ages and stages questionnaire (ASQ) in Iranian children. Iranian Journal of Public Health, 42(5), 522–528.

    PubMed  PubMed Central  Google Scholar 

  • Velikonja, T., Edbrooke-Childs, J., Calderon, A., Sleed, M., Brown, A., & Deighton, J. (2016). The psychometric properties of the ages & stages questionnaires for ages 2–2.5: A systematic review. Child: Care, Health and Development, 43(1), 1–17. https://doi.org/10.1111/cch.12397.

    Google Scholar 

  • World Health Organization. (2012). Developmental difficulties in early childhood: Prevention, early identification, assessment, and intervention in low-and middle-income countries. Geneva: World Health Organization.

    Google Scholar 

Download references

Acknowledgements

We are grateful for the contribution of Prof. Rudolf Korinthenberg for his valuable comments and feedback. We also thank Kimberley Murphy for facilitating work with Paul H. Brookes Publishing and reviewing the back-translation of questionnaires. We also acknowledge the sincere cooperation of regional team leaders: Nino Gogatishvili, Nino Kavrelishvili, Nino Tarkhnishvili, Tamar Bakhtadze and Ketevan Gabriadze, who contributed to this study.

Author Contributions

M.Z., M.G., and N.T.: conceptualized, designed, and executed the study. They drafted the initial manuscript, and reviewed and revised the manuscript. T.E.: contributed to the recruitment of the participants and data collection. G.L.: assisted with the data analyses, and writing the initial and revised manuscript. T.C.: contributed to the conceptualization, design, and drafting of the initial and revised manuscript. H.H.S.: conceptualized and designed the study, assisted with the data analyses, and collaborated in the initial writing of the draft manuscript and editing of the final manuscript. All authors approved the final submitted manuscript.

Author information

Authors and Affiliations

  1. Ilia State University, Tbilisi, Georgia

    Medea Zirakashvili

  2. Mental Health Center, Tbilisi, Georgia

    Medea Zirakashvili & Maia Gabunia

  3. Iashvili Children’s Hospital, Tbilisi, Georgia

    Nana Tatishvili

  4. Institute of Neurology and Neuropsychology, Tbilisi, Georgia

    Tamar Ediberidze & Giorgi Lomidze

  5. National Center for Disease Control and Public Health, Tbilisi, Georgia

    Tamar Chachava

  6. Portland State University, Portland, OR, USA

    Hollie Hix-Small

Authors
  1. Medea Zirakashvili
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maia Gabunia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nana Tatishvili
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tamar Ediberidze
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giorgi Lomidze
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tamar Chachava
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hollie Hix-Small
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maia Gabunia.

Ethics declarations

Compliance with Ethical Standards

The Georgian National Centers for Disease Control and Prevention Internal Review Board reviewed and approved the study protocol, questionnaires and consent form. All study procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zirakashvili, M., Gabunia, M., Tatishvili, N. et al. Cultural Adaptation and Psychometric Validation of the Ages and Stages Questionnaires for use in Georgia. J Child Fam Stud 27, 739–749 (2018). https://doi.org/10.1007/s10826-017-0917-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-017-0917-z

Keywords

  • ASQ-3
  • Children
  • Developmental screening
  • Developmental disabilities
  • Low- and middle-income countries