Tests for two year olds?

So, Boybug has his 2-year review with the health visitor next week. I knew it was coming, and was braced for questions about his height and/or weight, maybe a question about his language, movement, social skills.

I was not expecting a 7 page questionnaire!!

Now, at the top of the questionnaire it does say “this is not a test”. But it is a test. Obviously. Totally biased because both the invigilator and marker (both me) are direct blood-relation to the test-subject (poor ol’ Boybug), but a test nonetheless. I don’t have a problem with that, I quite like subjecting the kids to tests in the name of science or just my general curiosity, but I do like to know why and how the test is being conducted.

Ages and Stages?

The questionnaire was accompanied with a very brief letter detailing our review appointment, and with the only details about the questionnaire/test being: “please bring the encolsed questionnaire (filling in what you can) with you”. That and a hyperlink that took me three attempts to type correctly, it’s so long and intricate.

Nil points for communications, dear health visiting teams. In research it really is important that those participating understand what is going on. So far, I have no idea.

I followed the link provided and all I found was this. It’s a questionnaire that’s been used for more than 20 years (further reading tells me this is in the US and the questionnaire I’ve got has been modified for the UK in 2015…so not completely accurate). It’s only going to take me 10-15 minutes, and is a series of “fun” activities. Also, if I’m really sadistic there are 21 of these things I could subject my offspring to between the ages of 1 month to 5 and a half years old.

But what is the questionnaire?

A little more Googling tells me that the Ages and Stages questionnaire was developed by a research group at the Univeristy of Oregon, US. According to their website it has been thoroughly tested, and they present some scientific papers to back it up. Their website is slick, and reminds me of some of the pharmaceutical-backed information sites. It’s not a free service though. They charge $275 for a starter kit, and have obviously negotiated to provide the National Health Service with their services.

And why am I doing it?

I am being asked to do it, because since 2015 every two year old has an “integrated” review, and as part of this local health visiting teams are using these questionnaires. It serves two purposes – on the face of it, it provides a starting point for a conversation with the health visiting team about the child’s progress, provides a way of highlighting strengths and weaknesses, and potentially engages the parents in the review and gives them some insight into key milestones. I’m on board with that. I think the questionnaire probably does the job, though I think this could be done better with a little bit more thought around how they are communicating with parents.

The second reason I’m being asked to do it is interesting.  It enables “public health services to gather population-level information on children’s development”. I presume they will obtain my consent for this at the review itself. Perhaps as it’s anonymised it doesn’t need consent. Maybe I’ll ask. Either way, I only found this out after quite a bit of reading.

Scientific rigour and does it matter?

Now, when I started writing this I thought I was being pedantic. I’m sure the test helps find some children who require additional support that may not already be getting it. Which is great. But with the talk of collating population-level information, some of which will undoubtable inform national policy, all of a sudden I’m wary.

A questionnaire to check development needs to be asking questions that are scientifically sound and give the best idea of how a child is developing. The questionnaire seems to be well researched, and as a novice in the area of child development I’ll take that at face-value.

But, I have some concerns, all around communications really.

  • A report into how the questionnaire has been working in two local areas stated the importance of communication with parents. I think in terms of written communication surrounding the questionnaire, my local team has failed. I would have liked some information on what the questionnaire was used for, short guidance on what the questions were trying to achieve and a clearer message that this is not a test and children are not expected to do all of this (included in the text of the questionnaire but not in the letter).
  • Interview technique is a tricky skill to perfect. I, effectively the rather biased interviewer, have been given little instruction. I am left to interpret the questions how I see fit. “Draw a line, does your child copy you?”. Is the question “can your child draw a line?” if so, yes he can. Or is it “did he draw a line that time? If so, no he didn’t. Or is it “does he copy what you draw?” The answer is sometimes, but not a line this time I did it. That probably doesn’t matter in terms of the individual child, but may make a difference when bias and confounding come into play on a population level. How we interpret questions will be linked to things like our reading age, education level, occupation. All things that will also alter how our children perform on these “questionnaires”.
  • One of the key aims of the questionnaire is to engage parents. I felt engaged for a brief moment. Then I felt annoyed. Without providing me with enough information, the questionnaire is either going to be next to useless on a personal and population level, or else need significant alteration before the data is used. As a tool to start a conversation that is fine. It has got me interested. As a tool to look at a population it means either you take my very flawed questionnaire where I wasn’t sure of the questions, or you allow the Health Visitor to totally override my responses to provide a better picture, but leave me feeling less engaged.

Boybug breaks the test

That’s an exaggeration. He didn’t. But the test, sorry questionnaire, did seem to centre around cooperation. This is not one of Boybug’s strengths. Girlbug would have aced it (if it was a test) in her eagerness to please. Boybug couldn’t care less what I, or anyone else, thinks of his fine motor skills. Here are some examples:

Question: Without giving your child help by pointing or using gestures, ask him to “put the book on the table” and “put the shoe under the table”. Does your child carry out both of these directions correctly?

Answer: No. He put the book on the table. When asked to put something under the table he looked under the table. Then looked at me and said “No, on the table”. Then proceeded to empty the entire contents of the playroom onto the kitchen table. All of it. This test is under “communication”. He understood and communicated. He just didn’t cooperate.

Question: While your child watches, line up four objects like blocks or cars in a row. Does your child copy you?

Answer: No. A previous question asked him to stack seven blocks, so when I line blocks up he says “tower. Artie’s tower” and proceeds to make a tower, find more blocks, make a bigger tower. Find a king to put on top of the tower. Obviously he can line things up. In fact, when I asked him to draw a line as part of this test he lined all the pencils up instead of drawing a line. Side note: For Fucks Sake Boybug!!!

Question: When you point to the figure and ask you child, “what is this” does your child say a word that means person?

Answer: No. He says “words” and “letters”. He thinks I’m pointing to the text of the question as the text wrap around the picture due to poor formatting. I clarify. He says “hand” as that is the exact part of the figure my finger falls. I say “no, the whole thing”. He say “oh…yeah…thing”.

And then finally:

Question: Does your child put on a coat by himself?

Answer: No. It’s August, and so he hasn’t really been wearing one. And even if it was the winter he is a second child so I don’t have time to watch him struggle to get a coat on in an endearing moment of independence. He’s lucky if his hands have been pulled through the armholes as he’s shoved in the buggy for another school run.

Am I just grumpy?

I suspect this is a total over-reaction to a quite benign questionnaire. But in my defence, Boybug was really annoying for the whole thing. And also, I worry that it’s because he’s never been to nursery. No, he would still be annoying, but maybe he would be better at tests. I worry that the reason he couldn’t do a lot of the questions is because I’ve never asked him to do things like that, or phrased it like that. I’m not worried for his development – I’m sure at some point he’ll learn to line up four blocks when asked. But I do wonder what the results of the “population level” data will show.

I hazard a guess that the data will show children that are in childcare do far better on these questionnaires at age two. Which in itself is fine. Childcare is fine, obviously, and often very necessary. But there’s plenty of time for Boybug to learn to put his coat on. Does it always have to be a race? If Boybug could have put is coat on three months earlier if he was at nursery, does that mean it’s the best place for him?

I guess what I’m saying is: lets not make any policy decisions, or sweeping generalised headlines, on these pretty rough tools. Sure, these are useful questions to be asking about an individual two year old to inform a discussion about the child’s capabilities. But I do worry about the validity of then tallying up a score, and putting it alongside demographic data to draw conclusions about different sections of the population.

I look forward to next week’s review. Reading this back I think I am beginning to appreciate where Boybug may have got his uncooperative nature from!






One thought on “Tests for two year olds?

  1. In my experience with the same ‘test’ recently, having done a similar type thing for my eldest 3 years ago in a London borough. I took it more to mean what can he do generally and only put him through the ‘test’ for those questions I didn’t know the answer to. Mainly down to time constraints, but also because I knew with just the handful I did put him through, I would be lucky to get him to cooperate. So this just shows how subjective this questionnaire is. I am quite detailed in my discussions with the health visitor at the review and I felt the way it paned out it was a chance to identify possible areas of support. For example I was offered to get in touch again in 6 months if I feel his speech isn’t progressing so that he can be referred for help if needed. But generally she was not concerned. I noticed there were items on the table to do the ‘test’ I assume if you we unable to complete. But maybe if they pick up any concerns at the review they can repeat to check for any signs of difficulty?
    I agree that this needs to be far more robust to provide any kind of accurate information on the population but it may depend on how many are in the cohort. Discrepancies would surely be ironed out if enough are involved? Is this done nationally?
    Also the original answers aren’t kept they just recorded the scores for each element plus a few other written answers, so a lot may depend on the health visitors carrying them out and if their training to complete them provides consistent scoring.


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