Psychometric properties of the Brazilian-adapted version of the Ages and Stages Questionnaire in public child daycare centers
Introduction
Developmental neuroscience research indicates that early life experience can have a major impact on cognitive, emotional, behavioral, and social development later in life [1], [2]. Although most of the brain structures in early childhood are already present, they are still extremely immature and thus subjected to a wide range of environmental interactions. These early experiences represent the main underpinning of brain development that determines the strength and function of several neural circuits [3]. Accordingly, social deficits, generally associated with poverty and environmental degradation, might lead to a disruption of normal brain development in children [4].
These findings have important implications for political and economic decisions with regard to public investment in early childhood development programs [5], [6]. The efficiency of these programs for low-income families, such as government-funded child daycare centers, is a dynamic process that depends, among other factors, on continuous evaluation. Assessing the development of children enrolled in public daycare centers represents one aspect of this evaluation process and might contribute to program enhancement and guide policy decisions [7]. The developmental assessment of child daycare centers might also help identify children who might need early intervention. For example, Gleason et al. [8] reported that approximately 10% of children between 1 month and 5 years of age had some kind of serious psychopathology. Moreover, less than 10% of these children were properly identified before they reach school age [9].
Most of the early developmental instruments, such as the Bayley Scales [10], require specialized training and are time-consuming and expensive, which might impose difficulty for a routine examination program in a daycare center. Conversely, some much simpler instruments are less expensive and time-consuming and generally designed to screen for developmental delays. Developmental screening consists of a brief process of evaluating large numbers of children to identify those who might be at high risk for developmental delay and for that reason need further evaluation [11].
The Ages and Stages Questionnaire (ASQ) is a screening instrument used for developmental assessment during the first 5 years of life [12]. The third edition of the ASQ (ASQ-3) comprises a series of 21 questionnaires for infants (2, 4, 6, and 8 months of age), toddlers (9, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, and 33 months of age), and preschoolers (36, 42, 48, 54, and 60 months of age) designed to screen developmental performance in the domains of communication, gross motor skills, fine motor skills, problem solving, and personal–social skills. Each domain has six items, and each item is scored as “yes” (10 points), “sometimes” (5 points), or “not yet” (0 points) [13].
Several reports indicate that the ASQ has well-established psychometric properties in a clinical context, such as test–retest reliability, internal consistency, criterion validity, sensitivity, and specificity [14], [15], [16], [17], [18], [19], [20]. Moreover, the ASQ has been employed as an instrument to assess the impact of Early Head-Start programs and public childcare systems, such as The Florida Infant Mental Health Pilot Program [21], and the five programs developed by the Early Promotion & Intervention Research Consortium [22]. Indeed, the ASQ is the screening instrument that has the most published research in the academic setting [23] and appears to be a reliable instrument to measure infant development in childcare centers [7], [24].
The ASQ has been cross-culturally validated in other languages, such as Portuguese from Portugal [25], Spanish [26], French [27], Dutch [17], Norwegian [28], [29], Danish [30], Chinese [31], Korean [32], and Hindi [33]. However, the ASQ has not yet been translated into Brazilian Portuguese. Therefore, the main purpose of the present work was to translate all of the ASQ-3 questionnaires into Brazilian Portuguese and explore their psychometric characteristics.
This study was also driven by the need to develop a reliable assessment instrument that might be used to help evaluate Brazilian public child daycare programs and allow the screening of children for possible developmental delays. This is an important issue because almost 18% of Brazilian children between 0 and 5 years old attend public daycare centers [34]. In Rio de Janeiro, 26.5% of all children within this age range specifically attend public childcare centers [34]. For that reason, the present work also sought to adapt the ASQ-3 questionnaires to these public institutions and evaluate whether childcare providers are able to administer these questionnaires.
Section snippets
Participants
Data from the present study were collected from children enrolled in all of the 468 public daycare centers in the city of Rio de Janeiro. Children in the age range of 4 to 60 months were distributed according to the 20 age intervals defined by the ASQ. The 2 month questionnaire was not used because public child daycare centers only accept children who are older than 4 months. The project was approved by the PUC-Rio Ethical Committee, Rio de Janeiro, Brazil.
The ASQ-BR
The Brazilian version of the ASQ-3
Descriptive and reliability analysis
A total of 45,640 ASQ-BR questionnaires were included in the analyses. Data from the 4 month questionnaire were excluded because the sample size was too small to enable statistical inferences (n = 10). Data from the 9 and 10 month questionnaires were merged because the items on these two questionnaires are exactly the same. Therefore, a total of 18 ASQ-BR questionnaires were analyzed. Table 1 presents the number of questionnaires answered by each age interval and the percent distribution of boys
Discussion
Currently, no brief and low-cost early developmental screening instruments with psychometric strength have been adapted for Brazilian public daycare centers. Accordingly, the present study represents the first evaluation of the psychometric properties of the Brazilian–Portuguese translation and adaptation of the ASQ-3 for public daycare centers. The results confirmed that the ASQ-BR questionnaires consist of a set of easy and brief instruments that can be completed in a brief period of time.
Conflict of interest
None.
Acknowledgments
The present work was only possible because of the invaluable support of many people. We are deeply grateful to Ricardo Paes e Barros, Mirela Carvalho, Rosana Mendonça, Marcia Gil, Sheila Najberg, Daniel Santos, Eduardo Pádua, and Jane Squires.
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