Over the last decade, three series published in the Lancet on child development have increased global awareness of the importance of early brain development and highlighted the critical role nurturing care plays in the first 3 years of a child’s life. Yet, as practitioners and policy makers in low- and middle-income countries increasingly acknowledge the influence early development has on later developmental, educational, and socioeconomic trajectories, there has been less agreement regarding the most appropriate methods and measures for screening and monitoring child development over time.
Jason W. Small
In an article published in Developmental Medicine & Child Neurology, we and our colleagues, Emily Vargas-Barón, PhD, of RISE Institute, Washington, and Kevin P. Marks, MD, of PeaceHealth Medical Group in Eugene, Ore., countered some of the concerns raised about translating and adapting screening measures developed in HICs. In the paper, we documented the translation, cultural adaptation, and implementation of the Ages and Stages Questionnaires (ASQ) in LMICs based on a critical examination of 53 studies published in a variety of peer-reviewed journals.
We used a consensus rating procedure to classify the articles into one of four categories: feasibility study, psychometric study, prevalence study, or research study. In total, we identified 8 feasibility studies, 12 psychometric studies, and 9 prevalence studies. The main objectives of these studies varied by economy and region.
Overall, the review revealed that the ASQ is already being used broadly in a range of countries, cultures, and linguistic contexts. As of 2017, the ASQ has been used in 23 LMICs distributed across all world regions and has been translated into at least 16 languages for use in these countries. Over half of the studies reported that parents filled out the ASQ, a finding that runs contrary to recent misconceptions about the use of developmental screeners in LMICs.
Additionally, we found that adaptation and use of the ASQ in LMICs often followed one of two paths. The first path involved engagement in a systematic translation and adaptation process, collection of evidence to support reliability and validity, completion of prevalence studies, and use in research or practice. This first path resulted in higher rates of parent completion and, in general, closer adherence to the administration procedures recommended by the ASQ development team. In contrast, a second path utilized the ASQ solely for research purposes. This path tended to result in more frequent deviations from recommended procedures for adaptation and translation (for example, on-the-fly translation or administration by assessors) and may be fueling some of the misunderstandings associated with developmental screening in LMICs.
Dr. Hollie Hix-Small