PC2092: Relationship Between Ages and Stages Questionnaire (ASQ) and Childhood Opportunity Index (COI) in a De-identified Patient Database in San Bernardino and Riverside Counties

Background: The Ages and Stages Questionnaires (ASQ) are standardized tools utilized to screen for delays in child development using age-specific developmental questions. The ASQ covers 5 areas of development: communication, gross motor, fine motor, problem solving and personal social. Higher scores typically indicate more positive developmental outcomes. The Childhood Opportunity Index (COI) gives us a quantifiable measure of the differences in opportunities for children based on where they live. Geographical areas are ranked by nationally-normed COI score that ranges from 1 to 100, with each ranking point containing 1% of children and with 1 being the very lowest ranked neighborhoods. The COI is based on 29 indicators such as availability and quality of early education centers, schools, high school graduation rates, the number of adults with high-skills jobs, poverty, and employment rates. To explore the relationship between ASQ and COI, we analyzed ASQ results at 10, 18, 30, and 36 months of age with the respective patient’s COI based on zip code in San Bernardino and Riverside Counties. We hypothesize that there is a difference in childhood opportunity between those that screen as concern, monitor, and no concern on each category of ASQ.

Methods: We conducted a retrospectively reviewed study of patients that visited pediatric clinics in San Bernardino and Riverside Counties from January 4, 2021 to February 23, 2022. Patients were included if they filled out a valid ASQ and lived in a zip code that had a nationally-normed COI from the COI 2.0 Zip Code Dataset for 2020. The population sizes for each age group were: 36.7% (n=2974) for 10 months, 27.9% (n=2261) for 18 months, 10.8% (n=878) for 30 months, 24.6% (n=1800) for 36 months. Relationships were evaluated using non-parametric median testing and Kruskal-Wallis H Test.

Results: In the de-identified patient database, 8108 patients met the inclusion criteria. COI medians compared across ASQ categories and ages show that those with a result of “concern” tend to have lower COI scores (Table 1). The Kruskal-Wallis H-test shows significant differences in COI for “concern” and “no concern” as patients age, being most notable at 36 months for each of the ASQ categories (Table 2).

Conclusion: This study highlights how COIs are significantly different based on ASQ results as patients age, supporting our hypothesis. This shows that educational, health, environmental, social and economic factors play a significant role in child development as measured by the ASQ. With such well-defined geographical areas provided by the COI, informed efforts can be made to target areas to help prevent developmental gaps from widening. Future research will hope to incorporate Social Determinants of Health data with COIs and ASQs to quantitatively locate at-risk children.