• developmental;
  • neonatal surgery;
  • neonatology;
  • surgery


Whilst there have been comparisons of the Ages and Stages Questionnaire (ASQ) with other gold standard developmental assessments, research concerning the free-text comments section of the questionnaire has been limited. The objective of this paper is to assess whether parental concerns expressed in the free-text comments section of the ASQ can accurately predict infant development.


Data from the Development After Infant Surgery study was analysed post hoc. Free-text comments from the ASQ were analysed qualitatively by thematic analysis and quantitatively in comparison to the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Infants who underwent cardiac surgery (97), non-cardiac surgery (131) and no surgery (controls; 166) were analysed.


Parental concern expressed on the ASQ predicted a lower mean BSID-III score when groups were analysed collectively. Medical concern and developmental concern were shown to be predictors of child development, whilst global concerns and behavioural concerns were unrelated to child development. The presence of carer concern was assessed for its value in predicting a BSID-III subscale score less than 8 in all groups. Sensitivity ranged from 22% to 48%, and specificity ranged from 73% to 88%.


Parental concern was found to predict a lower BSID-III when all groups were analysed collectively. Despite this, parental concern as a screening test for developmental delay failed to meet the National Health and Medical Research Council guidelines for adequate psychometric properties. The findings from this study suggest that there is value in attending to the comments written by carers on the ASQ.