Preliminary Results of the Macedonian-Adapted Version of Ages and Stages Developmental Questionnaires

INTRODUCTION

Early experiences affect the development of the brain and have a direct impact on how children develop their sociability, self-expression, independence, initiative, and social and emotional skills.[123] Once infancy is a crucial time for both physically and mentally in every human's life, measuring the development in young children promotes information that can be used to determine which groups of children are eligible for receiving further assistance and provides the opportunity for children to benefit from early intervention.

Several approaches have been used to assess young children's developmental outcomes and the results of psychometric testing, in general, and screening tools, in specific, accurately reflect children development, when the tool administered has adequate psychometric properties. From this standpoint, psychometric instruments must guarantee their validity and reliability. Validity refers to the accuracy of measurement for a specific purpose and is the extent to which the test measures what it says it measures. Reliability refers the degree to which an assessment instrument produces stable and consistent results each time it is used in the same setting with the same type of subjects.[4]

In spite of that, there is a lack of a screening and early identification system for preschool children in the Republic of Macedonia. Children are often not identified as having disabilities until they are 3 years or older and sometimes, not even until they start school (Dimitrova-Radojichikj, Chichevska-Jovanova, and Rashikj-Canevska, 2016). This situation can be partially explained because in Macedonia, there are only four centers that provide early intervention services and because of the absence of psychometric screening tools: Even if a wide range of screening tools is available to assess child development, before a local adaptation, their use is limited to the population from whom they were developed.[5]

The process of developing, adapting, and implementing screening tools to use with Macedonian children is vital to improve services for young children and help them to reach their full potential. With that said, the purpose of this study is to verify the reliability of the translated and adapted version of Ages and Stages Questionnaires, 3^rd Edition (ASQ-3-M) with data gathered in Republic of Macedonia.

MATERIALS AND METHODS

RESULTS

Of the 210 participants’ approaches to take part in this study, 165 (78.6%) completed the ASQ: 3-M. These results are presented in Table 1, which show the absolute frequency and percentage of each included sociodemographic variable.

Table 1 Reporting of demographic variables

The reliability was estimated by three different ways: Internal consistency with Cronbach's alpha, test-retest reliability by ICC and IRR by Pearson Product-Moment correlation. All results were significant, and the outcomes are reported in Table 2.

Table 2 Reliability results for all 5 dimensions

Cronbach alpha is a test of internal consistency and the higher is the score, the better is the internal consistency. Test-retest provides clinicians with the assurance that the instrument measures the outcome the same way each time it is performed. Better reproducibility, measured by higher ICC, suggests better precision of single measurements, which is a requirement for better tracking of changes in measurement. IRR assess the degree to which different raters/observers give consistent estimates of the same phenomenon.

To decide which of two hypotheses is more likely given an experimental result, one must consider the ratios of their likelihoods. This ratio is called the Bayes Factor (BF), and BF₁₀ reflects the likelihood of H₁ compared to H₀ given a set of data. BF is a continuous measure of evidence and results with values between 1 and 3 are seems as inconclusive, values between 3 and 10 are weak and >10 are generally seem as strong evidence. Results are reported in Table 3.

Table 3 Mean, standard deviation and hypothesis testing

Despite the numerical difference, there were no evidence of a statistically difference between males and females in terms of their abilities. Figure 1 displays the mean scores of all vb ariables of ASQ-3-M for males and females.

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Figure 1

Gender differences (Bayes t-test)

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DISCUSSION

To the best of our knowledge, this is the first study of the Macedonian version of ASQ-3, as well the first to investigate the gender differences in response to it. In terms of cultural and linguistic appropriateness for Macedonian children, some items underwent modifications to ensure words and phrases are semantically similar, with a minimum of wording changes. A similar process of item adaptation happened in other countries, such as Brazil,[7] Chile,[8] and China,[9] which points to the importance of the cross-cultural adaptation of psychological instruments before its implementation.[5]

The internal consistency of the questionnaire ranged between 0.65 and 0.87. These results were higher than studies in Portugal,[19] but were similar to other international studies, such as those conducted in China[9] and in Arabic countries.[20] This outcome indicates that although some items were changed, they retained their concepts and did not lose their original meanings. Test-retest reliability measures the stability of test outcomes over time and was estimated by having parents complete two ASQ-3-M’ on the same child within a 2 weeks’ interval. The ICC between scores of the two ASQ-3-M concludes the stability of the scores of ASQ-3-M. Similar findings were found in other studies.[1021]

The IRR refers to the agreement of test outcomes and was examined using Person Product Moment. The results between parents and kind garden teachers were lower than the original ASQ-3 study,[12] but showed a strong agreement between both parents and teachers. The literature about the agreement between professionals and parents led both results (high and low agreement) and this evidence and this results provides supporting to evidence of the agreement regarding child development.[22]

There were no significant differences between the groups with respect to all scales of ASQ-3-M. However, although these results did not show a statistically significant difference between genders on any of the ASQ-3-M domains, this could be seen as result of having small sample. Variations between men and women development can be found in the literature[12] and in other studies that used ASQ-3 was measurement tool.[2324]

Some limitations are presented in these results. This study included only children at preschool age (36, 48, and 60 months) and only in Skopje. For a valid normative study, a larger sample of at least 100 children at each age interval is needed, stratified on a national Macedonia sample. In addition, only paper questionnaires were used in this study and to truly reach diverse young children; an online system would be preferable, as this would reduce the time and energy needed for data collection in individual kindergarten classrooms throughout the country. However, the impact of the limitations was small, as can be seen in the findings of this study.

These issues aside, as mentioned earlier, the basis of adult health and well-being are built prenatally and during early childhood.[1325] The availability of ASQ: 3-M opens up possibilities for examining child development in diverse cultural groups, as well as for effective cross-cultural comparisons of development.

It was concluded that the Macedonian version of the ASQ-3 questionnaire was successfully translated and adapted, with good internal consistency and reliability, which provide solid support for the use of the scale to measure domains of child development among children in Macedonia. While this study has demonstrated the potential ASQ-3-M, it also being extended in longitudinal and comparative ways.