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      Cross-Cultural Adaptation, Validation and Standardization of Ages and Stages Questionnaire (ASQ) in Iranian Children

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          Abstract

          Background

          To provide the validated and standardized form of the Persian version of the Ages and Stages Questionnaires as an appropriate developmental screening tool for evaluation of Iranian children’s development.

          Methods:

          This was a cross-sectional study. Translation and back-translation, content validity determination, cultural and lingual modifications, pilot study on 100 parents and inter-rater reliability determinations were performed, respectively. The national and final stage was carried out 11000, 4–60 month-old children in selected cities throughout the country in order to determine the validity, standard deviation, reliability, sensitivity, specificity, and mean scores points of the test.

          Results:

          The reliability, determined by cronbach’s alpha ranged from 0.76 to 0.86 and the inter-rater reliability was 0.93. The validity determined by factor analysis was satisfactory. The mean scores of Iranian children were identified and compared with those of the normative sample as well as with three other populations of children. The developmental status of Iranian children was higher in the communication, problem-solving and personal-social domains, especially under the age of 24 months, after which their developmental status seems to deteriorate, especially in the motor domains.

          Conclusion:

          The Persian version of the ASQ has appropriate validity and reliability for screening developmental disorders in Iran.

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          Most cited references26

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          Screening for speech and language delay in preschool children: systematic evidence review for the US Preventive Services Task Force.

          PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Published in the public domain by the American Academy of Pediatrics. Speech and language development is a useful indicator of a child's overall development and cognitive ability and is related to school success. Identification of children at risk for developmental delay or related problems may lead to intervention services and family assistance at a young age, when the chances for improvement are best. However, optimal methods for screening for speech and language delay have not been identified, and screening is practiced inconsistently in primary care. We sought to evaluate the strengths and limits of evidence about the effectiveness of screening and interventions for speech and language delay in preschool-aged children to determine the balance of benefits and adverse effects of routine screening in primary care for the development of guidelines by the US Preventive Services Task Force. The target population includes all children up to 5 years old without previously known conditions associated with speech and language delay, such as hearing and neurologic impairments. Studies were identified from Medline, PsycINFO, and CINAHL databases (1966 to November 19, 2004), systematic reviews, reference lists, and experts. The evidence review included only English-language, published articles that are available through libraries. Only randomized, controlled trials were considered for examining the effectiveness of interventions. Outcome measures were considered if they were obtained at any time or age after screening and/or intervention as long as the initial assessment occurred while the child was or =2 screening techniques in 1 population, and comparisons of a single screening technique across different populations are lacking. Fourteen good- and fair-quality randomized, controlled trials of interventions reported significantly improved speech and language outcomes compared with control groups. Improvement was demonstrated in several domains including articulation, phonology, expressive language, receptive language, lexical acquisition, and syntax among children in all age groups studied and across multiple therapeutic settings. Improvement in other functional outcomes such as socialization skills, self-esteem, and improved play themes were demonstrated in some, but not all, of the 4 studies that measured them. In general, studies of interventions were small and heterogeneous, may be subject to plateau effects, and reported short-term outcomes based on various instruments and measures. As a result, long-term outcomes are not known, interventions could not be compared directly, and generalizability is questionable. Use of risk factors to guide selective screening is not supported by studies. Several aspects of screening have been inadequately studied to determine optimal methods, including which instrument to use, the age at which to screen, and which interval is most useful. Trials of interventions demonstrate improvement in some outcome measures, but conclusions and generalizability are limited. Data are not available addressing other key issues including the effectiveness of screening in primary care settings, role of enhanced surveillance by primary care physicians before referral for diagnostic evaluation, non-speech and language and long-term benefits of interventions, and adverse effects of screening and interventions.
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            Screening for developmental and behavioral problems.

            Early detection of developmental and behavioral/mental health problems is greatly facilitated when quality instruments are deployed. This article describes how to identify accurate measures and presents standards for screening tests. Included is a table delineating accurate tools for primary care: typically those relying on information from parents (e.g., PEDS, ASQ, PSC, etc.) as well as measures useful in settings where providers have more time and skill at eliciting behaviors from children (e.g., Brigance screens). Screening measures should be used in the context of developmental surveillance; the longitudinal process of incorporating professional observations into decision-making about children's developmental needs. (c) 2005 Wiley-Liss, Inc.
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              Support for the global feasibility of the Ages and Stages Questionnaire as developmental screener.

              To investigate the psychometric properties of the Dutch version of the 48 months Ages and Stages Questionnaire (D_ASQ_48). Prospective cohort study of a community-based sample of children born in 2002 and 2003 whose parents filled out the D_ASQ_48 and a questionnaire on school status at 60 months. The ASQ was translated into Dutch and back-translated into English by three independent translators. Well Child Centers covering 25% of the Netherlands. Parents of 1510 preterm and 562 term children born in 2002-2003 attending routine Well Child visits at age 45-50 months. Reliability, validity and mean population scores for D_ASQ_48 compared to other countries. Mean population scores for the D_ASQ_48 were mostly similar to those in the USA, Norway and Korea. Exceptions (effect sizes of difference >0.5) were problem solving (USA) and fine motor (Korea). Reliability was good for the total score (Cronbach alpha 0.79) and acceptable for all domains (0.61-0.74). As expected, infants born at gestational age <32 weeks, children from low income families, of low educated mothers, and boys were more likely to fail on several domains (odds ratios, OR ranging from 1.5 to 4.9). The only unexpected association concerned children from one-parent families. Sensitivity to predict special education at five years of age was 89% and specificity 80%. The good psychometric properties of the Dutch ASQ_48 and the small differences when compared to other countries support its usefulness in the early detection of developmental problems amongst children worldwide.

                Author and article information

                Journal
                Iran J Public Health
                Iran. J. Public Health
                IJPH
                Iranian Journal of Public Health
                Tehran University of Medical Sciences
                2251-6085
                2251-6093
                2013
                1 May 2013
                : 42
                : 5
                : 522-528
                Affiliations
                [1 ]Pediatric Neurorehabilitation Research Center, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran
                [2 ]Dept. of Psychology, Karaj Branch, Islamic Azad University (IAU), Alborz, Iran
                [3 ]Ministry of Health and Medical Education, Family and Public Health Office, Tehran, Iran
                Author notes
                [* ]Corresponding Author: Tel: +98 021 22180099 Email: fisajedi@ 123456yahoo.com
                Article
                ijph-42-522
                3684462
                23802111
                63f47255-029f-4fb8-beb2-46790f4fa4ef
                Copyright © Iranian Public Health Association & Tehran University of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 25 November 2012
                : 19 February 2013
                Categories
                Original Article

                Public health
                screening tools,developmental delay,standardization,child,validity
                Public health
                screening tools, developmental delay, standardization, child, validity

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