The Ages and Stages Questionnaire - Talking about raising Aboriginal Kids (ASQ-TRAK) developmental screening tool for Australian Aboriginal children. Determining the reliability and face validity of the ASQ-TRAK and exploring the characteristics of developmental delay in Aboriginal children in urban, regional and remote areas of South Australia.

The study will be using a new developmental screening tool (the ASQ-TRAK) to observe the characteristics of normal childhood development and any deviation from normal childhood development in a cohort of Australian Aboriginal children. Each child is likely to be observed on one occasion only however as the trial will be conducted over a 12 month period it is possible that a child may be observed on 2 or 3 occasions over this time. The ASQ-TRAK is a developmental screening tool that was developed in consultation with Aboriginal communities in the Northern Territory in Australia. It is based on the Ages and Stages Questionnaire 3 (ASQ-3) which is a widely used developmental screening tool that has been validated in the United States and demonstrated feasibility and acceptability across a number of different cultures and language groups. Whilst the ASQ-3 has been validated in the United States it has not been validated for use in Australian Aboriginal people. To date, no developmental screening tool exists that has been validated for use for Aboriginal people. The ASQ-TRAK tool was modified from the existing ASQ-3 as part of a pHD project completed by Dr Anita D'Aprano. The project involved taking the ASQ-3 and having meetings and interviews with community representatives (of 2 remote Indigenous communities in the Northern Territory), early childhood experts and linguists as to how the tool could be changed to be more culturally appropriate and relevant for Aboriginal people. Questions were changed to be more culturally relevant and the English used was altered to be simpler and easier to understand. The ASQ-TRAK was then translated into the languages of the 2 communities where the initial study was undertaken and each question was illustrated to help with understanding the question. The observation for study participants consists of a number of questions, tasks and games that the child undertakes. The tool is designed so that the question, task or game is administered by the parent or caregiver with support from the worker. The tool consists of five domains; communication, fine motor, gross motor, problem solving and personal-social. These domains are assessed in a variety of ways and may include observing how the child talks or communicates, asking the child to stack blocks or draw a picture, observing how a child moves or asking them to jump or catch a ball, observing how a small child may work to retrieve an object out of reach or an older child about concepts such as "big" and "small" and asking a parent about the ways in which a child plays or interacts with people. After each observation the parent or guardian will be asked to complete a questionnaire in order to evaluate what the parents think about the tools usefulness, acceptability and whether it is felt to be culturally appropriate and respectful. A child may be observed more than once for a number of reasons. Aboriginal children who present to Child and Family Health Services (CaFHS) at any of 4 locations will be approached regarding the study. For the children presenting to the urban and regional sites (but not the remote site) each family will be asked firstly if they consent to take part and then if they would be willing to have the screen re-administered within a 2 week period. The repeat screen could be administered by the same or a different staff member as determined by staff availability. This information will be used to determine intra and inter-observer reliability for the tool. Also, as the trial will run over a 12 month period the same child may be observed at different points of time (and therefore with a different age group questionnaire). I. For example it is routine for CaFHS to encourage parents to present for developmental screening at 6 months of age and at 18 months of age. Therefore a child who, by chance, is 6 months of age at the commencement of the study would be quite likely to be observed on 2 occasions. It is possible that a child for whom there are greater developmental concerns would be offered a developmental screen more frequently and therefore be observed on 3 or more occasions. Any child or family who refuses consent for the trial will be offered developmental screening using the ASQ-3 as is consistent with existing guidelines. The assessments will be performed by a small group of workers who have been trained in how to use the tool, via a 2 day workshop and a practical, workplace based assessment. These workers will either be nurses or Aboriginal health workers with CaFHS. Each observation is likely to take around 45 mins with an extra 10 minutes required in order to complete the parent feedback questionnaire. The assessments are observational in nature however the results of the assessments will be used to guide whether further evaluation of development is required, this would be via referral to a paediatrician or allied health practitioners such as speech pathologists or occupational therapists as is appropriate. Earlier studies of the ASQ-TRAK showed high face validity and the tool was considered to be culturally acceptable and relevant to Aboriginal parents, Aboriginal Health Workers and early childhood development experts in the Northern Territory.