ASQ-SE-2 Questionnaire Cover Letter

Dear Parent/Caregiver:

Thank you for participating in our child screening/monitoring program. Enclosed

is a questionnaire from the Ages & Stages Questionnaires®: Social-Emotional,

Second Edition (ASQ:SE-2™), which is a screening tool that will provide a quick

check of your child’s social-emotional development. This questionnaire asks

questions about your child’s behaviors and social-emotional growth. The

information you supply will help reveal your child’s strengths, uncover any areas of

concern, and determine if there are community resources or services that may be

useful for your child or your family. If completing this questionnaire brings up any

questions or concerns, we can talk about information and resources that can help.

We’d like to ask you first to fill out the enclosed family information sheet, which

helps us be sure we have the most up-to-date information possible. Please keep

these tips and directions in mind while completing ASQ:SE-2.

Tips for completing ASQ:SE-2:

Caregivers who know the child well and spend more than 15–20 hours per

week with the child should complete ASQ:SE-2.

Answer based on what you know about your child’s behavior.

Answer questions based on your child’s usual behavior, not behavior when

your child is sick, very tired, or hungry.

Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ:SE-2™), Squires, Bricker & Twombly.

Ages & Stages Questionnaires® is a registered trademark and ASQ:SE-2™ is a trademark of Paul H. Brookes Publishing Co., Inc.

www.agesandstages.com | 1-800-638-3775 |

Directions for completing ASQ:SE-2:

1. Please read each question carefully and check the response that best

describes your child’s behavior:

• Often or always: My child performs this behavior often or always.

• Sometimes: My child sometimes performs this behavior (not

consistently).

• Rarely or never: My child rarely performs this behavior or has never

performed the behavior.

2. Concerns: Check the circle to the right of a question if the behavior is a

concern.

3. Some questions have blank spaces for you to provide examples of your

child’s behavior. Please be sure to explain your response(s).

4. The Overall section at the end of the questionnaire asks open-ended

questions about your child’s behaviors. Answer questions by marking yes

or no and provide an explanation for your responses.

Please be sure to send back the questionnaire within 2 weeks. Please contact me

if you have any questions or concerns.

Sincerely,

Ages & Stages Questionnaires®: Social-Emotional, Second Edition (ASQ:SE-2™), Squires, Bricker & Twombly.

Ages & Stages Questionnaires® is a registered trademark and ASQ:SE-2™ is a trademark of Paul H. Brookes Publishing Co., Inc.