Across England, local authorities are working hard to implement their Best Start in Life plans and improve their offers to children and their families. The right data can help them understand where the need is greatest and to make evidence-informed decisions about the services they offer. 

One of the key sources of child development data in England is the Ages and Stages Questionnaire, third edition (ASQ-3). The ASQ-3 measures development in five categories: communication, gross motor skills, fine motor skills, problem-solving and personal-social development. Caregivers answer “yes”, “sometimes”, or “not yet” to a series of questions regarding their child’s development in each category. The scores are then aggregated for each category and scores are compared to standardised cut-off points that indicate whether the child may need further assessment (high risk), monitoring and discussion (some risk), or are on track developmentally. In England, this measure is typically collected by health visitors as part of the statutory two- to two-and-a-half-year check. 

Here are five things local authorities should know about using ASQ-3 data.

The ASQ-3 was designed as a screening tool: a quick test of which children are in greatest need of tailored support. It is intended to function much like a triage nurse in A&E in a hospital by using simple, direct questions to highlight those cases that are in need of immediate attention and help. 

While the ASQ-3 is not perfect in terms of how it captures data and how that data is used in England, it is the most widely administered measure of broad child development before children start school. When it is delivered and used as intended, it can help to identify those specific children who are at risk of not meeting their developmental milestones and would benefit from early intervention and support. It also gives a population estimate of how many children are in need, at risk, or on track to meet development goals. 

Monitoring ASQ-3 levels over time - particularly where local authorities have invested in high-coverage preventative services for families of children under two - can help show whether population-level need is changing and how much need tends to fluctuate in a specific area.

The ASQ-3 can only ever show how a child is doing at one very specific point in time. Where it does flag that a child needs more support, it can’t explain what the underlying causes of that need are.

In A&E, the triage nurse’s assessment tells the hospital which patients are most in need of urgent care but doesn’t fully explain why that person is unwell; a much more detailed consultation with doctors is needed to understand what’s going on and how to make people better. 

In the same way, a broader system of assessment and support is needed alongside ASQ-3 data to understand why children might have particular needs and to more effectively target the causes. 

At a population level - eg, across a local authority - ASQ-3 data alone can’t always show whether a support program or intervention is having an impact. If the program is only offered to a small group of children, these children could make significant developmental gains, but this might be lost in the scale of the data which is collected across the whole area. Some interventions could be targeting outcomes that aren’t measured in the ASQ-3 - such as changes to the home-learning environment or to a parent’s confidence. 

Using the ASQ-3 data in isolation could mean local authorities conclude that an intervention isn’t working, when actually the data is not capable of showing whether it is working or not.

There are consistently higher numbers of children reaching expected levels of development on the ASQ-3 as compared to the Early Years Foundation Stage Profile (EYFSP) completed at the end of reception year, which is sometimes interpreted as a sign that things have gone downhill since children were two and a half. But actually, the two measures are very different and this discrepancy in results shouldn’t be surprising. The ASQ-3 is a short assessment usually completed by children’s carers with their health visitor, whilst the EYFSP is designed to be sensitive to much more nuanced differences in children’s development and is based on a full academic year’s worth of observation and interaction between a child and their teachers. 

As the ASQ-3 won’t necessarily tell local authorities all the children at risk of not reaching GLD, it’s important to consider other opportunities to identify and support those children, such as through early childhood education and care (ECEC) settings. Practitioners in ECEC settings often have an in-depth understanding of children’s learning and the wider family context, which means they are a helpful resource for identifying need and targeting support.

Local authorities should think about whether there are any children who are missing their two to two-and-a-half-year health visiting review or the ASQ-3 assessment. If possible, they should map out the uptake of the review by geography (eg, LSOAs, wards), levels of deprivation (eg, income deprivation affecting children index, IDACI) and population characteristics (eg, ethnicity, English-language status). If this granular data isn’t available, there might be insights that can be gathered from staff and practitioners to help identify areas and causes of need. 

Local authorities should also consider other approaches, such as outreach programmes to increase the accessibility and uptake of the review. They should then ensure that the ASQ-3 data is used to triage families to appropriate pathways of support based on the data and wider knowledge of the family context.

Our Nesta data profiles can help and local authorities may also have access to additional data in their area, such as specific measures of children’s speech, language and communication and data gathered in early childhood and education settings. By using the ASQ-3 as one piece of the data landscape, local authorities can better understand how their Best Start in Life plans are working, target support where it is most needed and help more children to reach their full potential in the early years.