Structured developmental screening tools are an essential component of developmental monitoring. They facilitate detection of developmental difficulties and access to early intervention. While a recent cross-cultural adaptation of the Ages and Stages Questionnaire (ASQ-3) demonstrated high face validity, there are no developmental screening tools validated for use with remote-dwelling Aboriginal children. The use of culturally inappropriate tools can lead to unreliable results with serious negative consequences. This study aimed to determine the concurrent validity of the adapted ASQ-3 (the ASQ-TRAK), while exploring the challenges of implementing validation studies in remote contexts.
In collaboration with an Aboriginal Medical Service, we aimed to recruit 120 Aboriginal children aged 2–36 months. Child health nurses were trained to administer the ASQ-TRAK during routine well-child checks. A structured developmental assessment, the Bayley Scales of Infant Development 3rd Edition (Bayley-III), was administered within one week by a trained and blinded practitioner. A total of 67 children and their caregivers participated. Scores on the ASQ-TRAK communication, gross motor, fine motor, and problem-solving domains were moderately correlated with the corresponding domains on the Bayley-III (R = .67; R = .49; R = .46; and R = .60, respectively; all p < .001). Developmental delay was defined by a score of ≥2 SD below age-specific norms on any ASQ-TRAK domain and/or a standard score of ≤75 on any Bayley-III domain. Overall, percentage agreement for classification of developmental delay was 90%. The ASQ-TRAK had a sensitivity of 71% and a specificity of 92% for detecting developmental delay. These results are comparable to the sensitivity (86%) and specificity (86%) reported for the ASQ-3.
While early results are promising, they are limited by a small sample size. We faced a number of challenges recruiting the target number of participants, including the time-consuming and imprecise nature of locating eligible families using clinic records, ensuring families understood the research and could provide informed consent, and non-attendance or withdrawal from appointments. These challenges and suggestions for overcoming them will be discussed. Future research will continue to build on the current findings so that the ASQ-TRAK can be used with confidence.