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The ASQ-3 (Ages & Stages Questionnaires, Third Edition) is a parent-completed developmental screen for ages 1 to 66 months, scored in five domains against interval-specific cutoffs. Pediatric, family, and early-childhood programs use it at well-child visits and program intakes. Each domain lands above cutoff, in the monitoring zone, or below cutoff, and each zone obligates something different. This page covers how to document ASQ-3 results, with a fictional sample note.
Pediatric and family practices, early intervention and Head Start programs, child care and public health screeners; parents complete it, trained staff score it, the clinician interprets and acts
Pediatricians and family physicians, early-intervention and Part C teams, Head Start and preschool programs, audiology and specialty referrals, payers auditing screening claims, families
4 to 10 chart lines plus the completed summary sheet · parent completion 10 to 15 minutes, scoring 2 to 3 minutes
Parent-completed developmental screen (five domains of six items each, scored against interval-specific cutoffs at 21 age intervals)
9-, 18-, and 30-month well-child screening, EPSDT checkups, Head Start 45-day screens, preterm follow-up, and any visit where surveillance or a parent concern warrants a standardized screen
Published by Brookes (2009 edition current; ASQ-4 in development, undated); recommended by the AAP and named in many state Medicaid manuals, but no US law mandates ASQ-3 by name; no items or cutoffs reproduced
The ASQ-3 (Ages & Stages Questionnaires, Third Edition; Squires and Bricker, Paul H. Brookes Publishing, 2009) is the most widely used parent-completed developmental screen in US pediatric practice. Twenty-one age-interval questionnaires cover children from 1 through 66 months; at each interval a parent answers six questions in each of five domains (communication, gross motor, fine motor, problem solving, personal-social), each response scored as demonstrated, emerging, or not yet, and summed within the domain. Every domain at every interval has its own empirically derived cutoff set at two standard deviations below that domain's mean, plus a monitoring zone between one and two standard deviations below, added in this edition. There is no valid global ASQ-3 total, and the closing Overall section, which gathers parent concerns about hearing, vision, talking, behavior, and possible loss of skills, is deliberately untotaled. A fourth edition is in development with no announced date; ASQ-3 remains the current edition as of August 2026.
The load-bearing facts for documentation are the three-zone structure and the interval rule. A domain result is above cutoff, in the monitoring zone, or at or below cutoff, and each zone obligates something different: below cutoff is a positive screen that triggers referral, the monitoring zone requires an active, dated follow-up plan (it is neither a pass nor an automatic referral, and no published study isolates its predictive value, so its handling rests on publisher guidance), and even five above-cutoff domains do not make a negative screen when the Overall section holds a concern. The interval is selected by the child's exact age in months and days, corrected for prematurity when the child was born three or more weeks early and is under 24 months; the cutoffs were built on corrected ages, so an uncorrected interval choice can turn a true pass into a false positive. The ASQ:SE-2 is a separate social-emotional instrument, not a sixth domain, and a positive ASQ-3 screen leads toward evaluation instruments like those on the Bayley-4 and DAYC-2 pages, inside the framework on the developmental assessment page.
Pediatric and family practices administer the ASQ-3 at the standardized screening ages the American Academy of Pediatrics recommends (9, 18, and 30 months, with autism-specific screening at 18 and 24 months via instruments like the M-CHAT-R/F) and at any visit where surveillance or a parent concern warrants a standardized screen. Medicaid EPSDT programs make it a payer matter: several state manuals name the ASQ-3 among approved instruments and require the chart to show the instrument name, scores, and guidance provided, and Texas requires early-childhood-intervention referral within seven days of identifying a suspected delay. Early intervention, Head Start (which must screen within 45 days of entry), child care, and public health programs run it at scale, including the ASQ-TRAK adaptation in Australian Aboriginal and Torres Strait Islander contexts. Neonatal follow-up clinics use it with corrected ages in preterm cohorts, where a pass is highly reassuring but a positive screen carries a high false-positive rate. The documentation reader is usually downstream: the Part C intake team acting on the referral clock, the audiologist receiving a communication-domain referral, a payer auditing 96110 units, or the next screener judging whether a monitoring-zone domain has repeated. The PSC-17 page covers psychosocial screening in older children; it is not a developmental-domain alternative.
No US, Canadian, or Australian authority prescribes an ASQ-3 note format, and none mandates the instrument by name. What survives review is a record that justifies the interval, states each domain's zone rather than a bare number, treats the monitoring zone as an active category with a dated plan, gives the Overall section its veto power, and separates a positive screen from a diagnosis. Each element below carries the pitfall that most often undermines it.
Interval selection and corrected age. Record the questionnaire interval administered and the age arithmetic that justified it: exact chronological age in months and days, and, for a child born three or more weeks early who is under 24 months, the corrected age that selected the form (with the gestational basis). At 24 months and older, chronological age governs. Pitfall: Choosing the nearest month label or the visit's billing age. The cutoffs were built on corrected ages, and a wrong interval samples the wrong skills against the wrong comparison: the commonest error that flips a true pass into a false positive.
Respondent, language, and completeness. Chart who completed the questionnaire and their relationship, the language of the form actually used, any interpreter or interview assistance, and the completion date. Note whether every domain was scorable: one or two blank items in a domain permit the authorized adjusted score (identified as adjusted); more than two make that domain not scorable. Pitfall: An unscorable domain silently scored, an adjusted score presented as ordinary, or a translated administration charted without the language and assistance that shaped it.
Domain results by zone, not bare sums. State each of the five domains relative to its interval-specific boundary: above cutoff, monitoring zone, or at or below cutoff. Raw sums alone carry no meaning across intervals, and there is no global total; the five-domain profile is the result. Pitfall: "ASQ score 45" or "passed." A sum without its interval and domain is uninterpretable, and pass language erases the zone structure the instrument is built on.
The monitoring-zone plan, dated. For any monitoring-zone domain, document the contextual review (health, opportunity to practice the skill, language, culture), the parent discussion, the targeted activities provided for that domain, and a specific rescreen date or interval. Escalate to referral when a parent or provider is concerned, the same domain has sat in the zone before, several domains cluster low, or regression or clinical findings accompany the result. Pitfall: "Passed; watch fine motor." That entry erases the category, records no intervention, and creates no auditable follow-up commitment, which is exactly what the zone obligates.
The Overall section, in words. Record the Overall section's answers in words: parent concerns about hearing, vision, talking, or behavior, and any reported loss of previously acquired skills. These untotaled items can override a reassuring domain profile; regression in particular is a red flag that acts regardless of scores. Pitfall: "Passed all domains" while the Overall section reports the child does not respond to quiet speech. The section exists to catch what the thirty scored items cannot, and skipping it is the most consequential omission in ASQ charting.
Referrals and the clocks. For a below-cutoff result or an acted-on concern, document the referrals placed and when: early intervention (in the US, Part C child-find rules put a seven-day clock on referral after identification, and a 45-day clock on the evaluation and initial IFSP after referral), audiology for any communication concern, and the medical evaluation with the primary care clinician. Name who owns confirmation. Pitfall: A positive screen that ends at the score, or a referral charted as a diagnosis. The screen identifies suspected delay; eligibility requires a multidisciplinary evaluation that no single procedure, the ASQ-3 included, can constitute.
Interpretation boundary and follow-up. State the result as a screening outcome: a positive screen for possible delay, not a diagnosis; a negative screen that does not rule out emerging concerns, especially milder ones the instrument detects less reliably. Close with the follow-up: the next routine screening age, the dated rescreen for monitored domains, or the referral confirmations pending. Pitfall: "Developmental delay" entered as a finding from a screen, or a declined screen charted (or billed) as completed. Offer, refusal, surveillance continued, and the re-offer plan are what a declined screen documents.
ASQ-3 DOCUMENTATION BLOCK Date: [ ] Setting: [ ] Screener: [ ] Interpreting clinician: [ ] Interval administered: [ ]-month questionnaire Chronological age: [ ] months [ ] days Born early: [N / Y: [ ] weeks] Corrected age (if under 24 months and 3+ weeks early): [ ] months [ ] days (corrected age selected the interval: Y/N) Respondent + relationship: [ ] Language of form: [ ] Interpreter or interview assistance: [ ] Completeness: [all domains scorable / domain [ ] adjusted for [1-2] blank items / domain [ ] NOT scorable (>2 blank)] Domain results (zone, not just sum): Communication: [above cutoff / monitoring zone / below cutoff] Gross motor: [ ] Fine motor: [ ] Problem solving: [ ] Personal-social: [ ] Overall section (in words): [hearing / vision / talking / behavior concerns; any loss of previously acquired skills; parent worries] Monitoring-zone plan (per domain): [contextual review, parent discussion, targeted activities provided, rescreen DATE, escalation criteria] Referrals (below cutoff or acted-on concern): [early intervention (date placed; 7-day clock met), audiology, medical evaluation] Owner: [ ] Interpretation: [positive screen for possible delay, not a diagnosis / negative screen; does not rule out milder or emerging delay] ASQ:SE-2 (separate instrument): [not administered / administered and documented separately] Follow-up: [next routine screening age / rescreen date / referral confirmation] Declined screen: [offered, declined, surveillance continued, re-offer plan; not billed as completed] Clinician signature / credentials: Date:
Free to use and share, no signup. The PDF includes a one-page cheat sheet with element-by-element pitfalls and a pre-sign checklist; the DOCX is the blank documentation block, ready to adapt. Neither reproduces questionnaire items, cutoff values, or summary-sheet layouts.
Scenario: a 9-month well-child visit for a former preterm infant, where corrected age selects the interval and one domain lands in the monitoring zone, documented with the plan the zone obligates. All details are fictional.
Patient: L.M., 9 mo (born 9 weeks early) · Setting: Pediatric primary care, 9-month well-child visit · Clinician: A. Rivera, MD · Note date: 08/20/2026
Screening: ASQ-3 completed today in Spanish by the child's mother without assistance. Chronological age 9 months 4 days; born at 31 weeks, 9 weeks before the due date, so corrected age (6 months 27 days) selected the questionnaire: the 6-month interval, within its administration window. Correction applies until 24 months of chronological age and is documented here so the next screener repeats the arithmetic. All thirty domain items answered; no adjusted scores needed.
Results: Communication, fine motor, problem solving, and personal-social: above their interval-specific cutoffs. Gross motor: in the monitoring zone (between one and two standard deviations below the domain mean for this interval), not below cutoff. Overall section reviewed in words with the mother: no concern about hearing, vision, or use of both hands, no loss of previously acquired skills; she notes he spends most weekdays in a bouncer seat at his grandmother's home with limited floor time.
Monitoring-zone plan: Contextual review suggests limited opportunity to practice trunk and floor skills rather than regression or an accompanying concern, and this is the first screen with any domain in the zone. Discussed with the mother: this result is neither a pass nor a referral; it calls for targeted practice and a scheduled recheck. Floor-time and supported-sitting activities for the gross motor domain were demonstrated and provided in Spanish, and the grandmother will be shown at pickup today. Rescreen scheduled for the last week of October (nine weeks out, appointment booked today), with the interval matched to corrected age at that date. Earlier referral criteria reviewed with the mother: any parent or provider concern, loss of skills, or a second screen with gross motor in the zone will prompt early-intervention referral without waiting.
Interpretation: Screening result, not a diagnosis: four domains above cutoff and one monitoring-zone domain with a plausible opportunity explanation, a reassuring Overall section, and no red flags. In a former preterm infant a reassuring screen at corrected age carries strong negative predictive value, while any future positive result would still need evaluation rather than being read as a diagnosis. Preterm follow-up surveillance continues alongside screening rather than being replaced by it.
Administrative: Completed information summary scanned to the record and results entered in the screening fields (instrument, interval, both ages, domain zones, plan), consistent with our Medicaid program's documentation requirements for developmental screening. One standardized developmental screen completed, scored, and documented this visit. Follow-up owner: Dr. Rivera; front desk to confirm the late-October rescreen appointment before the family leaves.
This sample is fictional and for educational purposes. It does not describe a real patient or record; the ages, results, dates, and details are invented to show documentation structure and are not clinical guidance. No questionnaire items or cutoff values are reproduced.
Writing these after every session? BastionGPT drafts complete notes from bullets, dictation, or a transcript.
Generate a note from bulletsUnited States: the screening duty comes from professional guidance and payer policy, and the referral duty from federal law. The American Academy of Pediatrics recommends developmental surveillance at every well visit, standardized screening at 9, 18, and 30 months, and autism-specific screening at 18 and 24 months (CONVENTION: the AAP recommends, it does not legislate). Medicaid EPSDT makes periodic screening a federal entitlement (LAW) whose instrument choices are state policy: Texas names the ASQ among accepted tools at designated ages and requires early-childhood-intervention referral within seven days of identifying suspected delay in a child under 36 months; Minnesota requires the chart to show the instrument name, the scores, and the guidance provided; North Dakota lists ASQ-3 under 96110 and ASQ:SE-2 separately under 96127 (PAYER POLICY, state by state). Billing follows the same logic: 96110 per completed, scored, documented standardized developmental screen, with same-day multiples and modifiers governed by the specific payer, and behavioral instruments under 96127; a declined screen generates no billable unit. IDEA Part C is the legal frame after a positive screen: primary referral sources, physicians included, must refer within seven days of identification, the lead agency then has 45 days to complete evaluation and the initial IFSP meeting, and no single procedure, an ASQ-3 score included, can be the sole basis of eligibility (LAW). Head Start programs must complete a research-based screen within 45 days of entry (LAW for grantees). The evidence posture is worth one honest sentence in counseling: the USPSTF finds insufficient evidence for universal speech-language screening in asymptomatic children, while the AAP recommends universal standardized screening; both positions are current.
Canada and Australia run different screening architectures, and a defensible chart names the one it sits in. Canadian well-child care is organized around the Rourke Baby Record's surveillance framework, with Ontario funding an enhanced 18-month visit that requires an age-appropriate developmental review (commonly the Rourke plus the Looksee checklist) rather than mandating the ASQ-3 (PAYER POLICY, provincial); the Canadian Task Force on Preventive Health Care recommends against population-based standardized screening of asymptomatic children aged one to four while supporting surveillance and the assessment of identified concerns, a genuine divergence from the US model, so a Canadian ASQ-3 administration is usually concern-triggered and should say so (CONVENTION). Australia's states each run their own child health record and schedule (the NSW Blue Book, Victoria's ten Key Ages and Stages visits, Queensland's Red Book pathways using PEDS), none of which mandates the ASQ-3 universally; the ASQ-TRAK adaptation is used in Aboriginal and Torres Strait Islander contexts, and from November 2026 a Medicare-supported health assessment for 3-year-olds (through existing item families) adds a national touchpoint without prescribing an instrument (CONVENTION and state policy). In every jurisdiction the same two rules hold: the screen identifies, the evaluation determines; and prematurity correction follows the instrument's own rule (three or more weeks early, corrected until 24 months) rather than any local surveillance convention.
Licensing and accuracy both reward precision. The ASQ-3 is a licensed instrument, not a free form: a purchased master set permits paper reproduction for that purchasing site only (each branch needs its own set), electronic reproduction is prohibited outright, building questionnaire content into an EHR or portal requires a separately priced license from the publisher's rights department, and posting or scoring the questionnaires on any website, free or not, password-protected or not, is unauthorized, which is why the third-party ASQ calculators that rank in search results should not be treated as authoritative or linked from clinical materials. What a practice may freely do is scan completed summary sheets and enter results into record fields, use the publisher's ASQ Online system for sanctioned digital administration, and bill usual screening reimbursement. On accuracy, the honest frame is high specificity with modest sensitivity for milder delay: the publisher's aggregate figures (sensitivity 86 percent, specificity 86 percent) sit above the best pooled independent estimate (about 0.77 and 0.81, with very low certainty in domain-level analyses), and a large primary-care study found sensitivity for any delay as low as 35 percent in younger children and 24 percent in older ones at specificity near 90 percent, with no competing screener superior overall. In preterm follow-up the pattern inverts usefully: at 24 months corrected age a pass carried 100 percent negative predictive value in a very-preterm cohort, while positive screens over-identify, and lower caregiver education measurably reduces classification accuracy, all of which belongs in interpretation rather than in a disclaimer. The Ages & Stages Questionnaires and ASQ are registered trademarks of Paul H. Brookes Publishing Co., Inc. BastionGPT is not affiliated with, or endorsed by, the publisher. This page reproduces no test items, stimuli, norms, or scoring materials.
The numbers behind these errors are specific. In the largest independent primary-care study, ASQ-3 sensitivity for any delay was 35.2 percent in children up to 42 months and 23.5 percent in older children, at specificity near 90 percent; the 2022 meta-analysis pooled 0.77 sensitivity and 0.81 specificity overall but about 0.41 sensitivity for motor delay; in very preterm children at 24 months corrected age a pass carried 100 percent negative predictive value; and the publisher's own technical data rest some interval estimates on as few as 19 cases. The BastionGPT Clinical Advisory Board sees the same errors most often in ASQ-3 documentation reviews:
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By domain, against interval-specific boundaries, never as one number. The parent answers six questions in each of five domains (communication, gross motor, fine motor, problem solving, personal-social); responses of demonstrated, emerging, and not yet convert to descending point values and sum within the domain. Each domain total then reads against its own interval's empirically derived cutoff (two standard deviations below that domain's mean) and monitoring zone (one to two standard deviations below), producing one of three results: above cutoff, monitoring zone, or at or below cutoff. There is no valid global ASQ-3 total, and the closing Overall section, which asks about hearing, vision, talking, behavior, and loss of skills, is deliberately untotaled but can change the action regardless of the domain profile. A defensible note therefore reports five zones plus the Overall answers, not a sum.
An active, documented plan; it is neither a pass nor an automatic referral. The publisher's guidance for a domain between one and two standard deviations below the mean is to review context (health, fatigue, opportunity to practice the skill, language, culture, blank items), discuss the result with the parent, provide targeted activities for that domain, and set a specific rescreen date, commonly within about one to four months. Referral instead of rescreening is appropriate when a parent or provider is concerned, the same domain has landed in the zone before, several domains cluster low, or regression or clinical findings accompany the result, and some state programs referral-trigger at broader thresholds. Two honesty points belong in the record's logic: no published study isolates the zone's predictive value, so its handling rests on publisher guidance, and "passed, watch" is the chart entry that erases all of it.
It selects the questionnaire, not just a footnote. For a child born three or more weeks before the due date, subtract the weeks of prematurity from chronological age and use that corrected age, in months and days, to choose the interval, up until 24 months of chronological age; from age two, use chronological age for everyone. The rule is instrument-specific and consequential because the normative cutoffs were developed using corrected ages for preterm children: screening a former 31-week infant on the chronological 9-month form instead of the corrected-age interval compares the child against the wrong group and is the commonest way a true pass becomes a false monitoring-zone or below-cutoff result. The defensible chart shows both ages, the gestational basis, and the statement that corrected age selected the form, so the next screener can repeat the arithmetic.
Both have fixed rules. Blank items: a domain with one or two missing responses can be scored with the authorized adjustment (the completed items' average assigned to the blanks) and must be identified as adjusted in the record; a domain with more than two missing responses is not scorable and is charted that way, never as a zero, a pass, or a referral. Wrong interval: a questionnaire completed outside its authorized age window (wrong form sent home, corrected age not applied) does not produce a valid result in any zone; recalculate the age, administer the correct interval, and note that the earlier form was not interpretable, rather than transposing its numbers, because both the sampled skills and the cutoff structure differ between intervals. Each domain has only six items, so a single blank removes a sixth of that domain's data, which is why the rules are strict.
No: it is a positive screen, and the chart should show what it starts rather than what it concludes. In the US the referral machinery is legal: physicians and other primary referral sources must refer a child with a suspected disability to early intervention as soon as possible and within seven days of identification, and the Part C lead agency then has 45 days from referral to complete the multidisciplinary evaluation and initial IFSP meeting; eligibility requires multiple procedures and sources, and no single instrument, the ASQ-3 included, can be the sole criterion. A below-cutoff communication domain also warrants a concurrent medical workup, audiology first, because hearing loss is the reversible cause the screen cannot see. Defensible language: "positive developmental screen; Part C and audiology referrals placed today; medical and developmental evaluation arranged," never "ASQ shows developmental delay."
No. The ASQ:SE-2 (Ages & Stages Questionnaires: Social-Emotional, Second Edition, 2015) is a separate instrument with a different architecture: one questionnaire score rather than five domains, cutoffs built on a different statistical basis, and the opposite direction, since higher ASQ:SE-2 scores indicate concern. The ASQ-3's personal-social domain samples related territory but is not a social-emotional screen, so "ASQ-3 social-emotional domain passed" is a documentation error, and the two instruments' results are never combined into one profile or total. Billing separates them the same way: developmental screening instruments under 96110 and behavioral or emotional instruments under 96127, each requiring its own completed, scored, documented administration; several state Medicaid manuals list the two instruments under exactly those separate codes.
Results yes, content no, and the calculators are unauthorized. The purchased master set licenses paper reproduction for that purchasing site only (each branch buys its own), prohibits electronic reproduction outright, and bars revenue-generating reproduction; practices may freely scan completed summary sheets and key results into EHR fields, but building the questionnaire itself into an EHR or portal requires a separately priced license from the publisher's rights department, and the sanctioned digital administration channel is the publisher's own ASQ Online system with its Family Access add-on. The publisher states the questionnaires may not be posted on any website, even password-protected, and a free tool gets no exemption, so the third-party ASQ calculators ranking in search results are not authorized scoring sources and do not belong in clinical materials or patient instructions.
Better at ruling out than ruling in, and the note should use it that way. The publisher's aggregate figures are sensitivity 86.1 percent and specificity 85.6 percent, but they mask weaker age bands and some interval estimates built on under 20 cases. The best pooled independent estimate is about 0.77 sensitivity and 0.81 specificity for any delay, dropping to roughly 0.41 for motor and 0.44 for cognitive-language analyses with very low certainty, and the largest US primary-care comparison found sensitivity for any delay of 35 percent in younger and 24 percent in older children at specificity near 90, with no competing screener (PEDS, SWYC) superior overall. Preterm follow-up inverts the frame: at 24 months corrected age a pass carried 100 percent negative predictive value in a very-preterm cohort, while positives over-identify, and lower caregiver education measurably reduces classification accuracy. Practical reading: trust a negative screen but never let it silence a concern, and treat every positive as a referral trigger, not a finding.
Yes. Give it the facts (interval, chronological and corrected ages with the gestational basis, respondent and language, domain zones, Overall answers, and your plan) and it drafts the documentation block: interval arithmetic shown, five zones stated, the monitoring-zone plan with targeted activities, a rescreen date, and escalation criteria, and the referral entries with the Part C clock language, ready for your review. It can also cross-check a finished note for a monitoring-zone result charted as passed, a missing corrected-age calculation, an unaddressed Overall concern, or diagnosis language a screen cannot support. BastionGPT is HIPAA-compliant with a signed BAA on every plan, and your data is never used to train models.
The instrument facts and compliance claims on this page trace to these sources, last verified August 2026:
Educational content, not legal or billing advice. Sample notes are fictional. Follow your organization's policies and your board, payer, and jurisdiction requirements.