Use of Ages and Stages Questionnaires™ (ASQ) in a Navajo population: Comparison with the U.S. normative dataset.

The study had no gold-standard diagnosis of developmental delay, so estimates of how well the ASQ-3 worked depended on assumptions borrowed from U.S. studies. Changing those assumptions altered the estimates, so the screening accuracy figures are not fixed. Caregivers were interviewed using the ASQ:I, not the usual parent-completed ASQ-3 format, which may change responses. The questionnaire was not translated into Navajo; although staff could explain items, all caregivers chose English. Some items, including mirror-related items, may be culturally less relevant, and missing-item score adjustments were used. Assessments were not evenly distributed across ages because home visits were affected by scheduling and remote infrastructure. The survey was administered once, so it did not test whether caregiver responses were stable over time. The authors suggested possible cultural explanations for lower scores, such as cradle boarding or less use of furniture, but the study did not test these explanations. The sample was limited to Navajo children in this cohort, so results may not apply to all Native American or other populations. Mothers of children without ASQ assessments were slightly younger than mothers of children with assessments, means 25.96 and 27.60, so missing data were not completely random.

Do not read lower ASQ-3 scores as proof that Navajo infants have developmental delays. The ASQ-3 is a screening tool, not a diagnostic test, and the study had no gold standard, so lower scores may reflect cultural differences in item responses, norms, or caregiver interviews.