Accuracy of parent-reported ages and stages questionnaire in assessing the motor and language skills of preterm infants

Hwarng, G. Y. H., Ereno, I. L., Ho, S. K. Y., Allen, J. C., Moorakonda, R. B., Yeo, C. L.* | JNPM 2021;


BACKGROUND:Parent-completed tools like the Ages and Stages Questionnaire Third Edition (ASQ-3) are important in developmental screening. As a screening tool, a high negative predictive value (NPV) is critical to avoid missing the diagnosis of developmental delay. This study evaluated the NPV and accuracy of the ASQ-3 in assessing the development of preterm infants.

METHODS:Infants born at <32 weeks and/or <1250 grams, presenting to the Neonatal Neurodevelopmental Clinic at the Singapore General Hospital for follow-up from January 2014 to June 2017, at 6, 12, and 18 months corrected age, were included. The ASQ-3 and standardized tests – Peabody Developmental Motor Scale-Second Edition (PDMS-2) and Preschool Language Scale, Fourth Edition UK (PLS-4 UK) – were administered. ASQ-3 gross motor and fine motor scores were compared to PDMS-2 at 6 and 12 months, and ASQ-3 communication scores to PLS-4 UK at 18 months.

RESULTS:At 6 months (n = 145), NPV for gross motor and fine motor were 96.4% (accuracy 80.0%) and 95.4% (accuracy 77.2%) respectively. At 12 months (n = 127), NPV for gross motor and fine motor were 88.9% (accuracy 79.8%) and 82.8% (accuracy 74.0%) respectively. At 18 months (n = 113), NPV for language was 56.9% (accuracy 63.7%).

CONCLUSIONS:The ASQ-3 showed high NPV and accuracy in screening gross motor and fine motor skills at 6 and 12 months, but not in screening language skills at 18 months. Judicious use of the ASQ-3 may allow for more effective utilization of resources.

*Corresponding Author: 

Yeo Cheo Lian, MBBS, M.Med (Paeds), MMEd (Dundee), FAMS, Department of Neonatal and Developmental Medicine, Singapore General Hospital, 20 College Road, Academia, Singapore 169856. Tel.: +65 6321 4597; E-mail: