Measuring child development

The Department of Health is introducing an outcome measure of child development at age 2 to 2 and a half, to be included in the public health outcomes framework from April 2015. The Ages & Stages Questionnaires (ASQ-3), a parent-completed tool, will be used to generate data for the indicator. All health visiting teams are therefore asked to use ASQ-3 as part of Healthy Child Programme (HCP) health and development reviews at age 2 - 2 and a half from April 2015.

The use of ASQ-3 will help to inform discussion about a child's development between parents and professionals, as well as to generate data for the outcome measure. Parents answer a series of questions about their child covering five domains of development:

  1. communication and language
  2. fine motor skills
  3. gross motor skills
  4. problem-solving
  5. personal-social.

Scores are given for each domain, based on parents' responses and the health visitor's clinical judgement, with children identified as either on schedule, requiring monitoring or needing further assessment. The outcomes of ASQ assessments may therefore be mentioned in referrals to GPs and other services. Health visiting teams are also likely to refer to ASQ assessments in their Personal Child Health Record (PCHR) entries on the two year review. It is important to emphasise that ASQ-3 is being introduced as part of HCP health and development reviews and that health visiting teams are expected to take into account a range of factors, including a child's ASQ-3 scores, when making referrals to wider services.


The decision to use ASQ-3 took account of the findings of research commissioned by the Department of Health, looking into measures of child development that were suitable for use as part of health reviews at age 2 - 2 and a half and to generate data for a population measure. There were 35 measures of child development identified, with the strengths and weaknesses of 13 measures considered in detail. Further research into the acceptability of ASQ-3 among parents and health professionals was published in November 2014. Both parents and professionals were broadly positive about ASQ-3 commenting that it provides useful information about a child's development and helps parents and health professionals to work in partnership. The research identified a lack of consistency in the use of ASQ-3 across different areas, particularly with regards to scoring, recording and referral. These have been addressed in training recently developed by Health Education England, working in partnership with e-learning for healthcare, the Department of Health and researchers at the University of Hertfordshire.


The e-learning tool is designed to support health visiting teams using ASQ-3 as part of Healthy Child Programme reviews at age 2 - 2 and a half. The training is available on the e-learning for healthcare website and is accessible to the wider early years workforce as well as health professionals. The training incorporates video clips from real-life two year reviews and covers the practicalities of using the ASQ-3, including which questionnaire to use, scoring and managing conversations with parents.

British English adaption of ASQ-3

The Department of Health is working with the US publishers of ASQ-3 to develop a British English adaption of ASQ-3. A set of British English ASQ-3 materials, funded by the Department of Health, will be sent to each health visiting provider in England shortly. Changes to the British English adaptation are minimal and designed to address linguistic and cultural issues identified in research by parents and health professionals.

Data collection

Data for the outcome measure will be collected via the Children and Young People's Health Services (CYPHS) data set, being developed by the Health and Social Care Information Centre. The outcome measure will report on the percentage of children recorded as 'on schedule' in the 5 domains of development covered in ASQ-3. Reporting on children's development at age two at local and national level will help to assess the impact of services for new-borns to two years olds and to inform commissioning for services for children age two and beyond.

For further information, please contact


UCL Institute of Child Health, Measures of Child Development: A Review.

UCL Institute of Child Health, Population Measure of Child Development.

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