Reunião para discussão do ASQ-3 (versão em Português)

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Versão em português da apresentação de Jane Squires, uma das autoras do ASQ-3 (sigla para Ages and Stages Questionnaires), método de avaliação infantil desenvolvido nos Estados Unidos e utilizado em mais de 18 países, apresentado pela Secretaria de Assuntos Estratégicos (SAE) promoveu no dia 05 de dezembro de 2011.

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  • Became interested in early intervention—and what we can do to change children’s developmental repertoireWas teacher for 5 and 6 year old—realized that many of these children would never catch up—that their lack of experiences in the preschool years would limit their lifetime outcomes.
  • humanitarian, improved family functioning opportune time--biological
  • Look at outcome data in terms of cost benefits
  • Not only is caregiving environment important but also health of environment—exposure to toxins
  • Reunião para discussão do ASQ-3 (versão em Português)

    1. 1.  Jane Squires, Ph.D. University of Oregon Early Intervention Program jsquires@uoregon.edu Brazilia, Brazil December, 2011 1
    2. 2.  Define and discuss benefits of developmental screening. Describe Ages & Stages Questionnaires. Describe Ages and Stages: Social- Emotional. Discuss and compare screening approaches. 2
    3. 3. Poor environments during earlychildhood can be like shifting thecourse of an ocean liner two degrees atthe beginning of a voyage. Over athousand mile trip (or a 70 year lifespan) you wind up in a different port.Or you may crash into rocky shores. Myers, 2006, American Project 3
    4. 4. 2.53% 5.74% 11.36 %Incidence of children identified as having disability (2009) http://www.ideadata.org 4
    5. 5. Benefits of early, universal screening  Earlier age for receiving services and supports  Improved child and family outcomes  Reduced stress  Cost effective 6
    6. 6. Early childhood programs save money 3 to 1 benefit-cost ratio Better health and academic outcomes $3-9 for every dollar invested 16% annual return • http://epinet.org • http://brookings.edu • http://minneapolisfed.org/ 7
    7. 7. Nonrandom Distribution of Childhood Morbidities Biomedical/Psychiatric Morbidities & Health Care Utilization1 in 5 children are responsible for over ½ W. T. Boycehealth cost, morbidity University of British Columbia
    8. 8.  Cost effective to intervene earlier Less use of community resources Health/mental health Social service School Legal system Large pay off for services for each dollar spent
    9. 9. Participants in programs • Have higher scores on reading and math achievement tests • Better language and cognitive abilities • Improved social emotional development • Better prepared to succeed in elementary school • More likely to pursue secondary education
    10. 10.  Participants in programs • Have less need for special education and other remedial services • Have lower dropout rates and higher graduation rates • Have better health and • Experience less child abuse and neglect These children are less likely to become teenage parents, more likely to be employed as adults, have less rates of drug use, lower rates of delinquency and adult crime, and lower incarceration rates.
    11. 11.  A brief assessment procedure designed to identify children who should receive more intensive diagnosis or evaluation from local early intervention, early childhood special education, health, mental health agencies. Similar in theory to health screenings such as a quick hearing or vision screen. 14
    12. 12. Below Cutoff Near Cutoff Not near cutoffProfessional Continue to monitor (re-screen) & useAssessment curriculum-based assessment toEligible Not Eligible develop learning plans 15
    13. 13.  Informal checklists or tests without psychometric data Expensive professionally administered tests “Islands” of screening No system for referral, follow up 16
    14. 14. Without With Screening Screening Tools ToolsDevelopmental 30% identified 70-80% Palfrey et al, 1994 Disabilities identified Squires et al, 1996Mental Health 20% identified 80-90% Lavigne et al, 1993 Problems identified Sturner, 1991 Courtesy of START 17
    15. 15. Effective screening tests  Parent or caregiver completed  Quick and easy to administer  Low cost  Valid and reliable  Able to be used in a variety of ways 18
    16. 16.  Validity Reliability Adequate normative population Cultural sensitivity Comprehensiveness Attractiveness to children
    17. 17. Professionally-administeredParent-completedInformation on screening tools  http://www.dbpeds.org/  http://www.fpnotebook.com  http://www.cimh.org  Individual publishers
    18. 18.  Battelle Developmental Inventory Screen, 2nd (http://www.assess.nelson.com) Bayley Scales of Infant Development Screen, 3rd (http://harcourtassessment.com) Brigance Screens (http://www.curriculumassociates.com) Denver II (http://www.denverii.com/DenverII.html) Early Screening Inventory (www.pearsonearlylearning.com)
    19. 19.  Pediatric Evaluation of Developmental Status PEDS--Glascoe • www.pedstest.com MacArthur Communicative Development Inventory--Fenson et al. Minnesota Child Development Inventories • http://www.childdevrev.com/cdi.html Ages & Stages Questionnaires • http://www.brookespublishing.com • http://agesandstages.com
    20. 20. “the science of examining the strange behaviors of children in a strange situation with strange adults for the briefest possible periods of time” (Bronfenbrenner, 1979)
    21. 21. Parents are reservoirs of rich information about their childrenParental involvement reduces costScreening structures observations, reports and communications about child development
    22. 22. Screening may become a teaching tool for parents and teaching staffInformation/communication can be useful for primary health care providers and communication based rehabilitation centerEffective and efficient method of early identification
    23. 23.  As accurate as formal measures for identifying cognitive delay (Glascoe, 1989, 1990; Pulsifer, 1994) As accurate as formal measures for identifying language delay (Tomblin, 1987) As accurate as formal measures for identifying symptoms of ADHD and school related problems (Mulhern, 1994) More accurate than Denver for predicting school-age learning problems (Diamond, 1987)
    24. 24. Accuracy of parent report Dinnebeil & Rule (1994)  23 studies  High reliability in parent report Area specific studies  Cognitive (Glascoe, 1999)  Communication (Ring and Fenson, 2000)  Attention deficit and school related problems (Mulhern, 1994)  Gross motor (Bodnarchuk & Eaton, 2004) 29
    25. 25. Parent, caregiver report Low cost, economical Often know child best Natural environment for child Accurate, if based on current, observable behavior 30
    26. 26. Agreement between parent-completed ASQ andprofessionally administered standardized assessment: Low income parents .85 (N = 54) (below federal poverty level) Middle income parents .89 (N = 42) No statistical significance between groupsSquires, Potter, & Bricker, (1998) Early Childhood Research Quarterly,13, 2, 345- 354.
    27. 27.  Parents/caregiverscan provide rich information about child across settings Parent involvement reduces cost • 3-10 times less Screening structures observations, reports, communications about child development
    28. 28. Cost EffectiveParent-completed assessments range between $1.25-10 per assessment (U.S. interview/mail models)Professionally-administered cost 3- 10 times more (Chan & Taylor, 1998; Dobrez Lo Sasso, Holl et al., 2001; Glascoe, Foster, & Wolraich, 1997)
    29. 29.  24 month olds, 52 infants/mothers Bayley administered by psychologist Communication and personal social— moderately correlated .55 Gross motor & motor .46 Sensitivity = 100% Specificity = 87% Recommended, as cost effective Gollenberg, Lynch et al., 2010 34
    30. 30.  Identify children at risk for developmental delays Series of questionnaires for children ages 1 month to 5 ½ Parent- or caregiver-completed screening tool that encourages parental/ caregiver involvement 35
    31. 31.  ASQ initiated in 1980 at University of Oregon by Diane Bricker and colleagues. Authors reviewed standardized tests, literature. ASQ skills selected were:  Easily observed or elicited by parents in home. Adopted by pediatric, child care, early intervention, child welfare programs for early identification Most widely tool by pediatricians (70%) 36
    32. 32.  Follow-up of medically at risk infants Developmental screening for infants/toddlers living in poverty, other risk conditions Universal screening Translated, used internationally 37
    33. 33. ASQ Communication Gross motor Fine motor Problem solving Personal-social 38
    34. 34. 39
    35. 35. 40
    36. 36. 21 Questionnaire intervals: • 2*, 4, 6, 8, 9*, 10, 12, 14, 16, 18, 20, 22, 24 • 27, 30, 33, 36 (spaced 3 months apart) • 42, 48, 54, 60 (spaced 6 months apart) *New intervals included in ASQ-3 system 41
    37. 37.  5 developmental areas (e.g., Communication) 6 questions in each area Questions are in hierarchical order Questions #5 and #6 are average skills for children of that age interval  (i.e., a 12 month skill for a 12 month child). Response options: Yes, Sometimes, Not Yet Written at 4th to 5th grade reading level 42
    38. 38.  Un-Scored Section Looks at quality of skills (e.g., speech)  Example: “Does your baby use both hand equally well?”  “No” response indicates possible cerebral palsy. Important to follow up. Parent concerns very predictive. Any concerns or questionable responses require follow-up 43
    39. 39.  Not yet = 0 points Sometimes = 5 points Yes = 10 points Domain scores are totaled and compared to cutoff points 44
    40. 40. 45
    41. 41.  Alternative administration methods for individuals from different cultural backgrounds. Alternative materials for individuals from different cultural backgrounds. Normative sample includes diverse populations. Scoring permits omission of inappropriate items. 46
    42. 42.  ASQ companion tool Focused on social emotional, behavioral, self regulation competencies 48
    43. 43.  6, 12, 18, 24, 30, 36, 48 & 60 month intervals 3-6 month administration window on either side 4th to 5th grade reading level Competence and problem behaviors targeted From 19 items (6-month interval) to 33 items (60-month interval)
    44. 44. Behavioral DefinitionAreas Ability/willingness to calm, settle, or adjust toSelf-Regulation physiological or environmental conditionsCompliance Ability/willingness to conform to the direction of others and follow rulesCommunication Verbal/nonverbal signals that indicate feelings, affect, internal statesAdaptive Ability/success in coping with physiological needsAutonomy Ability/willingness to establish independenceAffect Ability/willingness to demonstrate feelings and empathy for othersInteraction with Ability/willingness to respond or initiatePeople social responses with caregivers, adults,peers.
    45. 45. Open-ended questions  Questions related to eating, sleeping, toileting.  All intervals include question “Is there anything that worries you about your baby (child)? If so, please explain.”  Tell me what you enjoy most about your baby (child)?
    46. 46.  Scoring Options Points  Most of the time 0 or 10  Sometimes 5  Never or Hardly Ever 0 or 10  Is this a concern? Yes= 5 Scores are totaled and compared with empirically- derived cutoff points. High scores indicative of problems
    47. 47.  Does your baby laugh or smile at you and other family members?  (z)Most of the time (v) Sometimes (x) Rarely or never Does your baby like to be picked up and held? (z)Most of the time (v) Sometimes (x) Rarely or never
    48. 48.  Does your child destroy or damage things on purpose? Does your child hurt himself on purpose? Does your child play alongside other children? Most of time Sometimes Rarely/Never
    49. 49. ASQ-3 N Sens.% Spec.%2-12 mo. 108 84.6 91.314-24 mo. 78 89.2 77.927-36 mo. 90 85.9 85.742-60 mo. 103 82.5 92.1Normative sample = 18,572
    50. 50.  Overall (2-60 months)  Sensitivity: 86.1%  Specificity: 85.6%  Percent agreement: 85.8%  Under-identified: 6.0%  Over-identified: 8.1%  Test retest reliability: 92% 56
    51. 51.  Validity Reliability Utility Conducted between 1995- 2001 Sample of 3014
    52. 52. N Cutoff Sens Spec % Agree6 71 45 78.6 98.2 94.012 85 48 71.4 97.2 93.018 99 50 75.0 96.6 93.924 152 50 70.8 93.0 89.530 115 57 80.0 89.5 87.836 179 59 77.8 93.0 89.948 174 70 76.9 94.6 92.060 171 70 84.6 95.8 94.0Overall 78.0 94.5 91.8Test-retest reliability = 94%Utility = parents said easy to understand, appropriate, helped think about child’s behavior
    53. 53.  Developmental screening Monitoring course of development Caregiver/teacher tool Prevention—target low areas General overview of development of classroom Research 59
    54. 54.  Identify children with potential delays in development  5-18% may have scores below cutoff points Monitoring  Follow-along screening  9, 18, 24, 36, 48 months (pediatric guidelines)  Make sure development on course 60
    55. 55.  334 children 12-60 months ASQ and PEDS and Bayley, Wechsler, or Vineland PEDS = .74 sensitivity, .64 specificity ASQ = .82 sensitivity, .78 specificity Limbos & Joyce, 2011, Dev & Behavioral Peds 61
    56. 56.  Flower growing region ASQ administered to children as well as growth measurement, blood test Children 24-61 months residing in high- exposure communities scored significantly lower on gross motor skills compared to low exposure group Handal, Lozoff, Breilh, & Harlow, 2007 62
    57. 57. 50 45 40 35Percent delay 30 25 20 15 Community C 10 Communities A and B 5 0
    58. 58.  Minnesota--statewide  Large Hmong and Somali populations ASQ:SE on small PDAs, paper www.patienttools.org Screened 10,000 children Extremely low cost—start up was most High satisfaction by programs and parents Identified between 5-28% of children Foundationforsuccess.org
    59. 59.  Currently on line and paper versions Over 10,000 on-line questionnaires completed. http://asq.uoregon.edu Initial “DIF” Analysis conducted  Few differences found between on-line versus paper completed ASQ’s.  Differential item functioning = 45/500 items 65
    60. 60.  Provides feedback on general development of individual children Allows monitoring of classroom, school Can target skills or areas that are in need of practice Prevent further delays Can compare curriculum with needs in classroom 66
    61. 61.  Prevention Intervention ASQ User’s Guide activities ASQ Learning Activities (available in Spanish) Beautiful Beginnings (Raikes & Whitmer) 67
    62. 62.  Put toys on a sofa or sturdy table so that your baby can practice standing while playing with the toys. Find a big box that your baby can crawl in and out of. Stay close by and talk to your baby about what she is doing. “You went in! Now you are out!” Read baby books or colorful magazines by pointing and telling your baby what is in the picture. Let baby pat pictures. (8-12 months) 68
    63. 63.  Galicia, Spain 2-step process Parents complete PEDS Preschool teachers complete ASQ Focus curriculum on children’s needs Provide follow-up to individual children with low scores Refer children with very low scores to specialist Monitor through ASQ 69
    64. 64.  Retrospective study on children diagnosed with ASD who had ASQ data N = 58; 81% < 3 years 100% identified  96.6% failed communication  86.2% failed personal-social  81.0% failed problem solving 100% of parents identified concerns High sensitivity in identifying ASD 70
    65. 65. Follow-up study (magnesium sulfate)Latin American, Africa, India (125 centers in 19 countries)Completed ASQ interview in homes and community based health and rehabilitation centers2600 children screened by ASQ78% sensitivity, 79% specificityChildren whose mothers received magnesium sulfate during birth had improved outcomes (Duley at al., under review)
    66. 66.  12 and 24 months 20 pediatric practitioners 76% agreement between ASQ and pediatrician estimate of development (OK, at risk) Pediatricians referred mostly for communication, gross motor delays Referrals for further assessment increased 224% in one year 72
    67. 67.  ASQ in the office or mail it from home 30 minutes of training for staff Resource staff scored the ASQ forms Itemized cost = $1.61 - $2.43 per patient. Cost varied on the mail-back option and practitioner f/u decisions Reception, Nurse, Doctor all said:  “The ASQ is a fun and very important part of this well- child visit. Please fill it out. If you don’t have time, take it home and mail it in.”
    68. 68. Control and screening year referrals
    69. 69. 75
    70. 70. ASQ-3 and ASQ:SE Parent, caregiver-completed tools Low cost, effective Flexible administration Provides common platform for multiple agencies serving young children and families Follow up activities on “not yet” skills using activity based intervention 76
    71. 71.  Kiosk in office with toy kit Mail to home and bring in at visit (or email back) Complete first one at office, mail remainder to home Home visiting--nurses, social workers, child welfare Child care settings
    72. 72. Universal screening systems Identification of delays Better outcomes for children/families Requirements of system  Valid, reliable, culturally relevant measures  Low cost methods  Coordinated systems for follow-up and referral 78
    73. 73. Universal screening systems Effective systems identify children at risk for developmental delays Benefits in terms of economic savings and investment in future Technology offers creative and unique solutions Use of videoconferencing, embedded video, web-based screening involving multiple agencies 79
    74. 74. 80

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