Utility of the Ages and Stages Questionnaire to Identify Developmental Delay in Children Aged 12 to 60 Months A Systematic Review and Meta-analysis

Saravanan Muthusamy, Deepika Wagh, Jason Tan, Max Bulsara, Shripada Rao

Research output: Contribution to journalReview articlepeer-review

3 Citations (Scopus)


IMPORTANCE The Ages and Stages Questionnaire (ASQ) is a commonly used developmental screening tool, but its utility is debated. OBJECTIVES To conduct a a systematic review and meta-analysis to evaluate ASQ's utility as a screening or diagnostic tool to identify developmental delay in children aged 12-60 months. DATA SOURCES Medline, EMBASE, CINAHL, PsycINFO, and Mednar were searched from inception until December 2021.STUDY SELECTION Studies meeting both criteria were included. ASQ was performed at age 12 to 60 months or where the median age at ASQ was at least 12 months and formal developmental assessments were done within 2 months of ASQ.DATA EXTRACTION AND SYNTHESIS True positive, false positive, false negative, and true negatives from individual studies were extracted. Meta-analysis was conducted with Stata version 16.1. Risk of bias was assessed using the QUADAS-2 tool. Certainty of evidence (COE) was assessed using GRADE guidelines. MAIN OUTCOMES AND MEASURES Ability of ASQ scores more than 2 SDs below the mean in more than 1 domain (ASQ-25D) to identify any developmental delay or severe delay. Based on generally accepted interpretation of likelihood ratio (LR) values, a positive LR (PLR) more than 5 and a negative LR (NLR) of 0.2 or less were considered necessary to rule in or rule out developmental delay, respectively, with at least moderate probability. RESULTS Initial search yielded 5777 citations of which 43 were included in the review. Of them, 36 were included in the meta-analysis. The pooled sensitivity, specificity, PLR. and NLR are as follows: ASQ-25D to predict any delay in 1 or more domain (n = 16), 0.77 (95% CI, 0.64-0.86), 0.81(95% CI, 0.75-0.86). 4.10 (95% CI, 3.17-5.30), and 0.28 (95% CI, 0.18-0.44); ASQ-250 to predict severe delay in 1 or more domain (n = 15), 0.84 (95% CI, 0.75-0.90), 0.77 (95% CI, 0.71-0.82), 3.72 (95% CI, 2.98-4.64), and 0.20 (95% CI, 0.13-0.32); ASQ-2SD motor domain to predict motor delay (n = 7), 0.41(95% CI, 0.26-0.57), 0.94 (95% CI, 0.87-0.97), 6.5 (95% CI, 3.8-11.1), and 0.63 (95% CI, 0.50-0.81); and ASQ-2SD cognitive domain to predict cognitive delay (n = 2), 0.44 (95% CI, 0.24-0.65), 0.93 (95% CI, 0.81-0.95), 6.4 (95% CI, 2.4-16.8), and 0.61(95% CI, 0.43-0.86). The COE was low/very low. CONCLUSIONS AND RELEVANCE If a child aged 12 to 60 months passes all ASQ domains, there is a moderate probability that they do not have severe developmental delay (low COE). If a child aged 12-60 months fails the motor or cognitive domain of ASQ, there is a moderate probability that they have some motor or cognitive delay, respectively (very low COE).
Original languageEnglish
Pages (from-to)980-989
Number of pages10
JournalJAMA Pediatrics
Issue number10
Early online date29 Aug 2022
Publication statusPublished - Oct 2022


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