Ages & Stages Questionnaires

At Suburban Pediatrics we believe that early detection of developmental delays and behavioral problems is crucial to better outcomes for children. We use a developmental screening tool called the Ages and Stages Questionnaire (ASQ-3). It allows us to follow your child’s development more closely and provide early intervention should it be needed.

Designed to screen children for developmental delays in the critical 1st 5 years of life

Reliable, accurate and well-studied

Designed for ease of use for parents.

Parents fill out questionnaires at home and bring them to the child’s checkup.

Children can be tested in the comfort of home and at the parents’ convenience.

5 developmental areas: communication, gross motor, fine motor, problem solving & personal-social

Allows parents to observe their children prior to the office visit.
Involving the parents enhances the accuracy of the screening

Because your child's first years of life are so important, we want to help you provide the best start for your child. You've been invited to participate in the Ages & Stages Questionnaires, Third Edition (ASQ-3), to help you keep track of your child's development.

 

We ask that the questionnaire be completed at the 12-, 24- and 36-month periods. You will be asked to answer questions about some things your child can and cannot do. The questionnaire includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills.

 

 

12 months (1 year) .......................................... (PDF)

24 months (2 year) .......................................... (PDF)

36 months (3 year) .......................................... (PDF)

 

 

If you are unable to print from home, Suburban Pediatrics can print and mail/fax you the forms to complete.  There will also be copies available in the office for you to complete before you go into a room. Please arrive 15 minutes early for your appointment if you will be completing at the office.

 

This questionnaire must be completed before your child’s appointment.