Caregiver rating of early childhood development: Reliability and validity of the ASQ-3 in rural Guatemala

Early Hum Dev. 2021 Oct;161:105453. doi: 10.1016/j.earlhumdev.2021.105453. Epub 2021 Aug 24.


Background: Although performance-based assessment of early childhood development is preferred, there are a number of limitations to this methodology in low resource settings (LRSs). Hence, clinicians and researchers often rely on caregiver report screening tools. The Ages and Stages Questionnaire 3 (ASQ) is one of the most widely used caregiver report measures globally. Adequate psychometric properties have been demonstrated in high income settings, especially when used in older children, high- risk children, or those with severe neurodevelopmental delays. However, its utility is more variable within very young children and for use in LRSs.

Methods: The reliability and validity of the ASQ was determined for children ages 0-5 years living in rural Guatemala. Internal consistency and test-retest reliability were assessed, as well as concurrent and predictive validity. Sensitivity, specificity, positive and negative predictive values related to performance-based developmental assessment (Mullen Scales of Early Learning; MSEL) and growth status (i.e. stunting) were also calculated.

Results: Internal consistency reliability for the ASQ was adequate, except when results were limited by small sample size. Test-retest reliability ranged from low to moderate (r = 0.08-0.43; p < 0.05-0.01). However, there was significant variability in mean scores over time across ASQ domain scores. In terms of validity, the ASQ did not discriminate adequately between children who performed within or below age-expectations on performance-based developmental testing or those with and without stunting.

Conclusions: The ASQ did not demonstrate adequate psychometric properties in rural Guatemala, consistent with concerns documented in other LRSs. These results indicate that existing caregiver report screening measures of early childhood development should be utilized with caution in LRSs, and alternative methods for assessment or in the development and utilization of caregiver report measures should be considered.

Keywords: ASQ-3; Development; Early childhood assessment; Guatemala; Reliability; Validity.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Caregivers*
  • Child
  • Child Development*
  • Child, Preschool
  • Guatemala
  • Humans
  • Infant
  • Infant, Newborn
  • Psychometrics
  • Reproducibility of Results
  • Surveys and Questionnaires