Children and Families Policy Research Unit


NIHR Children and Families Policy Research Unit


Measuring child development at the 2-2½ year health review in England

Measuring child development at the 2-2½ year health review in England: available tools, stakeholder priorities and feasibility of implementation


October 2022 – September 2023

Research Team

Dr Jenny Woodman - UCL (project lead), Professor Pasco Fearon and Dr Jo Lysons - University of Cambridge, Professor Sally Kendall - University of Kent, Ms Jennifer Kirman - Oxford Brookes University, Dr Ryc Aquino - University of Newcastle, Ms Hannah Cann - UCL and Southampton City Council 

What we hope to find out

We are investigating tools to measure child development at 2-2½ years. We are assessing how well tools would identify children in need of further support in England, how well they match priorities of policy makers, practitioners and parents and how feasible they might be to implement across England in the universal health review for children aged 2-2½. 

Why are we doing this study

Every child in England should be offered a health review aged 2- 2½ years, as part of the Department for Health and Social Care (DHSC)’s Healthy Child Programme. The Ages & Stages Questionnaire (ASQ; 3rd Edition) is a measure of child development and an adapted British version is used at this health review aged 2- 2½ years.  However, there are known barriers to the ASQ-3 meeting its intended function as a population measure of child development in England. There is variability in way ASQ is used across the country and issues around national collation of data have raised questions about how far we can compare ASQ-3 scores between local areas. Additionally, providers have been calling for a digital version of ASQ.

ASQ is used in England as a tool for collecting data that can monitor trends and disparities in early child development at a population level. However, we know that many local areas in England are using ASQ as a way of deciding which individual children are referred for extra support. As ASQ has not been validated as a screening tool in a UK population, we don’t know how well this approach works to make sure the children who will benefit from extra support are the ones getting referred. 

Why this is important

This study will inform government decisions about the best measure of child development in the health review offered to every child in England at age 2- 2½ years. We will be able to assess how far available tools might be suitable for a population level measure of child development and whether it can also be used to trigger referral pathways for individual children.

What we will do

Rapid review: We will conduct a rapid review of evidence about tools to measure child development across multiple domains in children aged 2-3 years. 

Workshops: We will be conducting 17 focus groups of key stakeholders in order to gain insights into their priorities and needs related to a measure of child development to be used at the 2-2½ year review. We will also gather insights into barriers/facilitators of successfully implementing the ASQ and of collating accurate and complete ASQ data at a local and national level. The 17 focus groups will include parents and carers of preschool children, including parents of children with a disability, fathers and mothers, foster carers and kinship carers. Focus groups for professionals will include: policy colleagues, health visiting teams (across skill mix), commissioners, public health intelligence specialists and social workers.   

The results of the rapid review will be assessed against stakeholder priorities and parameters for successful implementation, to assess which if any tools could be used at the 2-2½ year review.