We value your privacy We use cookies to enhance your browsing experience, serve personalised ads or content, and analyse our traffic. By clicking "Accept All", you consent to our use of cookies. CustomiseReject AllAccept All Powered by [Visit CookieYes website](https://www.cookieyes.com/product/cookie-consent/?ref=cypbcyb&utm_source=cookie-banner&utm_medium=fl-branding) Customise Consent Preferences We use cookies to help you navigate efficiently and perform certain functions. You will find detailed information about all cookies under each consent category below. The cookies that are categorised as "Necessary" are stored on your browser as they are essential for enabling the basic functionalities of the site. ... Show more NecessaryAlways Active Necessary cookies are required to enable the basic features of this site, such as providing secure log-in or adjusting your consent preferences. These cookies do not store any personally identifiable data. - Cookie rc::a - Duration Never Expires - Description This cookie is set by the Google recaptcha service to identify bots to protect the website against malicious spam attacks. - Cookie wpEmojiSettingsSupports - Duration session - Description WordPress sets this cookie when a user interacts with emojis on a WordPress site. It helps determine if the user's browser can display emojis properly. - Cookie rc::c - Duration session - Description This cookie is set by the Google recaptcha service to identify bots to protect the website against malicious spam attacks. - Cookie VISITOR\_PRIVACY\_METADATA - Duration 6 months - Description YouTube sets this cookie to store the user's cookie consent state for the current domain. - Cookie cookieyes-consent - Duration 1 year - Description CookieYes sets this cookie to remember users' consent preferences so that their preferences are respected on subsequent visits to this site. It does not collect or store any personal information about the site visitors. - Cookie wordpress\_test\_cookie - Duration session - Description WordPress sets this cookie to determine whether cookies are enabled on the users' browsers. Functional Functional cookies help perform certain functionalities like sharing the content of the website on social media platforms, collecting feedback, and other third-party features. - Cookie VISITOR\_INFO1\_LIVE - Duration 6 months - Description A cookie set by YouTube to measure bandwidth that determines whether the user gets the new or old player interface. - Cookie yt-remote-connected-devices - Duration Never Expires - Description YouTube sets this cookie to store the user's video preferences using embedded YouTube videos. - Cookie ytidb::LAST\_RESULT\_ENTRY\_KEY - Duration Never Expires - Description The cookie ytidb::LAST\_RESULT\_ENTRY\_KEY is used by YouTube to store the last search result entry that was clicked by the user. This information is used to improve the user experience by providing more relevant search results in the future. - Cookie yt-remote-device-id - Duration Never Expires - Description YouTube sets this cookie to store the user's video preferences using embedded YouTube videos. - Cookie yt-remote-session-name - Duration session - Description The yt-remote-session-name cookie is used by YouTube to store the user's video player preferences using embedded YouTube video. - Cookie yt-remote-fast-check-period - Duration session - Description The yt-remote-fast-check-period cookie is used by YouTube to store the user's video player preferences for embedded YouTube videos. - Cookie yt-remote-session-app - Duration session - Description The yt-remote-session-app cookie is used by YouTube to store user preferences and information about the interface of the embedded YouTube video player. - Cookie yt-remote-cast-available - Duration session - Description The yt-remote-cast-available cookie is used to store the user's preferences regarding whether casting is available on their YouTube video player. - Cookie yt-remote-cast-installed - Duration session - Description The yt-remote-cast-installed cookie is used to store the user's video player preferences using embedded YouTube video. Analytics Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics such as the number of visitors, bounce rate, traffic source, etc. - Cookie \_ga - Duration 1 year 1 month 4 days - Description Google Analytics sets this cookie to calculate visitor, session and campaign data and track site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognise unique visitors. - Cookie \_gid - Duration 1 day - Description Google Analytics sets this cookie to store information on how visitors use a website while also creating an analytics report of the website's performance. Some of the collected data includes the number of visitors, their source, and the pages they visit anonymously. - Cookie \_hjSessionUser\_\* - Duration 1 year - Description Hotjar sets this cookie to ensure data from subsequent visits to the same site is attributed to the same user ID, which persists in the Hotjar User ID, which is unique to that site. - Cookie \_hjSession\_\* - Duration 1 hour - Description - Cookie \_ga\_\* - Duration 1 year 1 month 4 days - Description Google Analytics sets this cookie to store and count page views. - Cookie YSC - Duration session - Description YSC cookie is set by Youtube and is used to track the views of embedded videos on Youtube pages. Performance Performance cookies are used to understand and analyse the key performance indexes of the website which helps in delivering a better user experience for the visitors. - Cookie \_gat - Duration 1 minute - Description Google Universal Analytics sets this cookie to restrain request rate and thus limit data collection on high-traffic sites. Advertisement Advertisement cookies are used to provide visitors with customised advertisements based on the pages you visited previously and to analyse the effectiveness of the ad campaigns. - Cookie \_\_Secure-YEC - Duration past - Description YouTube sets this cookie to stores the user's video player preferences using embedded YouTube video - Cookie \_\_Secure-YNID - Duration 6 months - Description Google cookie used to protect user security and prevent fraud, especially during the login process. - Cookie \_\_Secure-ROLLOUT\_TOKEN - Duration 6 months - Description YouTube sets this cookie to manage feature rollout and experimentation. It helps Google control which new features or interface changes are shown to users as part of testing and staged rollouts, ensuring consistent experience for a given user during an experiment. Uncategorised Other uncategorised cookies are those that are being analysed and have not been classified into a category as yet. No cookies to display. Reject AllSave My PreferencesAccept All Powered by [Visit CookieYes website](https://www.cookieyes.com/product/cookie-consent/?ref=cypbcyb&utm_source=cookie-banner&utm_medium=sl-branding) # When an ASQ:SE-2 score raises concern ### Next steps and helpful resources When a child scores in the monitoring zone, always work with the parents when considering possible follow-up actions You’ve finished scoring the Ages & Stages Questionnaires **®**: Social-Emotional, Second Edition (ASQ **®**:SE-2) and find the child’s score to be in the monitoring zone or above the cutoff. What’s next? Assuming you’ve already considered any [factors that may have impacted results](https://agesandstages.com/free-resources/articles/factors-consider-interpreting-asq-results/) and ruled out developmental issues, now it’s time to take the appropriate follow-up actions. Parents should be heavily involved in this process, since their concerns—not simply their child’s score—will drive decisions about what to do next and whether referrals are required. ## Handling scores in the monitoring zone Not all behavioral or social-emotional concerns will necessitate further evaluation or mental health services. But it’s important that children who score in the monitoring zone are rescreened and supported. Scores in the monitoring zone suggest there may be follow-up actions that can support the child and family. ASQ:SE-2 developers recommend that you rescreen the child in 2–4 months, and in the meantime, encourage parents to do age-appropriate activities that will support their child’s social-emotional development. Share the social-emotional activity sheets found in the back of the [ASQ:SE-2 User’s Guide](http://products.brookespublishing.com/ASQSE-2-Users-Guide-P851.aspx), or provide these colorful PDFs in [English](https://agesandstages.com/wp-content/uploads/2020/11/asqse2-activities.pdf) or [Spanish](https://agesandstages.com/wp-content/uploads/2020/11/asqse2-activities-spanish.pdf). Both resources include age-specific ideas. If the child is a girl and her score is in the monitoring zone, developers recommend considering a referral for further evaluation. Data collected in the renorming of ASQ:SE-2 indicated that girls’ total scores were significantly lower than boys’ scores. See the [technical report](https://agesandstages.com/asqse-2-technical-appendix/) in the ASQ:SE-2 User’s Guide for more information about gender-specific performance. Just as you would with kids who score above the cutoff, when a child scores in the monitoring zone it’s best to work with his or her parents to consider possible follow-up actions. ## Taking follow-up action _You’ll find a checklist of follow-up actions in the fifth section of the ASQ:SE-2 Information Summary sheet, but we’ve detailed below the ones that pertain specifically to children who have concerning scores. These can also be found in chapter 6 of the [ASQ:SE-2 User’s Guide](http://products.brookespublishing.com/ASQSE-2-Users-Guide-P851.aspx)_ _._ Consider following up with several of these actions, depending on the child’s specific results and what the parents may say about factors that may influence their child’s behavior. - **Share results with the primary health care provider.** Not only is sharing results a screening best practice, it allows the doctor to explore with parents the possibility that problem behaviors are related to medical or health concerns. Be sure to also provide the child’s Information Summary and Item Response sheets, as well as information about ASQ:SE-2 and interpreting scores. _Appendix D of the user’s guide has sample letters you can use, including one for health care providers._ - **Provide parents with educational materials.** Make sure the parents know that they can help address problem behaviors or possible social-emotional delays at home, whether or not they plan to refer for an evaluation. Provide them with resources. Activity ideas are plentiful, between the activity sheets in the back of the ASQ:SE-2 User’s Guide and the [free activity sheets](https://agesandstages.com/free-resources/resources/#/products=3&topic=45&type=6) available online. The Internet is an endless source of information of topics that may arise during screening, like toileting or sleeping. National organizations like [ZERO TO THREE](https://www.zerotothree.org/) and the [American Academy of Pediatrics](https://www.healthychildren.org/) provide excellent parenting resources. _See Appendix F of the user’s guide for an extensive list._ - **Provide information about parenting classes or support groups.** Maintain an up-to-date list of community resources, for example classes about behavioral management or supporting foster children who have experienced trauma. If a parent or caregiver requests a recommendation, you’ll be prepared. - **Have another caregiver complete ASQ:SE-2.** While children’s behavior tends to vary with the setting, children with serious mental health or social-emotional delays will generally exhibit more consistent behaviors, regardless of where they are or who is caring for them. Gathering multiple perspectives will provide more information to help determine appropriate follow-up. This is also a helpful tool when working with parents with mental illness or who seem to mistrust the process. - **Refer families to early intervention/early childhood special education (EI/ECSE) providers.** Under the Individuals with Disabilities Education Act (IDEA), Part C and Part B programs have rules that allow for children with areas of concern or suspected social-emotional delays to be assessed and provided appropriate services. Particularly when a child is above the cutoff, they should be referred to an EI/ECSE provider. Depending on your state, eligibility requirements may be too strict due to limited funding and availability of children’s mental health resources, but it’s important to try referring. Some states do a good job outlining how, when, and what services to pursue: [Massachusetts is a good example.](http://www.mass.gov/eohhs/docs/dmh/publications/cbhi-ecmh-guide.pdf) Does your state have a resource like this? If so, keep it on hand and share it with parents. And if the child does not meet eligibility criteria, recommend a community-based program like Head Start. - **Refer for social-emotional, behavioral health, or mental health evaluation.** Talk to local mental health providers to determine which ones can evaluate social-emotional development in very young children. - **Follow up about items of concern.** If a parent expresses a concern during the screening, make sure you talk to them about it. Sometimes parents worry about a behavior but it turns out to be age appropriate so the concern is alleviated. Other concerns may require more follow-up and support from program staff, to help parents understand the behavior and strategize ways to address it. - **Be creative when making referrals.** Creativity may be especially necessary when a child is ineligible for state-funded programs, or does not qualify for certain services. Consider all the possible community agencies that provide concrete support services to families, as well as those that provide parenting support or early childhood services, such as Early Head Start or Head Start. ## Using SEAM when a child does not qualify for services Even if a child does not qualify for services, continued monitoring of and informal intervention for concerning behaviors is strongly recommended. In addition to incorporating [parent–child activities](https://agesandstages.com/free-resources/resources/#/products=3&topic=45&type=6) and providing parents with other helpful resources, there’s a tool that simplifies ongoing assessment and social-emotional skill development, even for providers with no mental health or behavioral intervention training. The [Social-Emotional Assessment/Evaluation Measure (SEAM™)](https://agesandstages.com/products-pricing/seam/) is a curriculum-based assessment tool from the same developers as ASQ:SE-2, and can be used to identify goals and objectives and track progress for children who score in the monitoring zone or referral area, but do not qualify for services. SEAM is ideal for programs that have an ongoing relationship with the child, like a child care center or home visiting program. To learn more about SEAM, [watch a webinar](https://www.youtube.com/watch?v=zlp68FHK67Y) and [view sample forms](https://agesandstages.com/free-resources/resources/#/products=5&type=32). ## Additional resources Chapter 6 of the ASQ:SE-2 User’s Guide goes into detail about communicating scores with families and determining appropriate follow-up. Appendix F of the ASQ:SE-2 User’s Guide has a list of publications and organization websites that offer guidance and tools for children and families. _Originally published: February 2017_ [Download a print-friendly PDF](https://agesandstages.com/wp-content/uploads/2017/02/When-an-ASQSE-2-score-raises-concern-1.pdf) - #### What ASQ Users are Saying “What I love about the ASQ is that it allows our staff to catch delays quickly and allows us to get our clients the early intervention programs that they sometimes need. **In many cases \[ASQ\] helps us catch children up before they start kindergarten, therefore providing children with the start that they deserve.**” Sharon Gee, Supervisor, Healthy Families Niagara - [Previous](https://agesandstages.com/free-resources/articles/asqse-2-score-raises-concern/#) - [Next](https://agesandstages.com/free-resources/articles/asqse-2-score-raises-concern/#)