Contents lists available at ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev The psychometric properties of the Ages and Stages Questionnaires-3 in Arabic Cross-sectional observational study Lama Charafeddine a, ⁎ , Alia Dani a , Lina Kurdahi Badr b,c , Durriyah Sinno a , Hani Tamim d,e , Joanne Khoury a , Fatima Nasser a , Maha Makki e a Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut (AUB), Beirut, Lebanon b Azusa Pacific University, Azusa, CA, United States c School of Nursing, American University of Beirut, Beirut, Lebanon d Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon e Clinical Research Institute, American University of Beirut Medical Center, Lebanon ARTICLE INFO Keywords: A-ASQ-3 Screening tools Developmental screening Validation Adaptation ABSTRACT Background: Screening for developmental delay is recommended for pediatricians, yet validated screening tools in Arabic are scarce. Aims: Assess the reliability, validity, sensitivity and specificity of the Arabic ASQ-3 in detecting developmental delays in children aged 4–33 months. Study design: Cross-sectional observational study. Subjects: A sample of 491 children from all Lebanese governorates from five age groups (4, 10, 18, 27 and 33 months). Outcome measures: Internal consistency using Cronbach's alpha (Cα), convergent construct validity using Pearson Correlation Coefficient (CC) comparing ASQ-3 in Arabic (A-ASQ-3) to Bayley scale for infant devel- opment (BSID-III) scores were computed. A subset sample (n = 35) underwent assessment with BSID-III for convergent validity, and sensitivity and specificity. A-ASQ-3 scores were compared to the US mean cutoff scores. Results: Subjects' mean age was 17.75 ± 10.6 months. Cα was 0.85; Pearson CC showed positive moderate correlation between A-ASQ-3 gross and fine motor scores and BSID-III composite motor scores (r = 0.42, p = 0.002; r = 0.39, p = 0.004, respectively); and positive moderate correlation between A-ASQ-3 problem solving and BSID-III cognitive scores (r = 0.43, p = 0.001). A-ASQ-3 had 100% sensitivity and 50% specificity for cognitive scores; 60% sensitivity and 70% specificity for motor scores. Conclusion: A-ASQ-3 has adequate reliability and validity for the tested age groups. It is plausible that this would hold true for the rest of the questionnaires. Further testing is needed to make the five clusters more aligned with the US sample scores and to improve the sensitivity and specificity. 1. Introduction In the most recent United Nation reports, enhancing child devel- opment was a top priority that addresses seven indicators of the sus- tainable developmental goals (SDGs) [1]. In low-to-middle income countries, an estimated 200 million children under the age of five, are not reaching their developmental potential due to poverty, poor health, and inadequate medical and developmental care [2]. Children who do not achieve their potential are at increased risk of becoming un- employed parents, transferring this non-productivity to subsequent generations [2]. Therefore, addressing child development early is cru- cial to prevent delay and to allow children to reach their full potential, which aligns with the American Academy of Pediatrics [3] re- commendation of early screening to identify delays and appropriate interventions, with parental education and support [4]. Important factors contributing to late detection of developmental delays in our region include the lack of early screening and the dearth of validated screening tools in Arabic. Most screening tools are devel- oped and validated for English speaking children living in high-income, Western societies with adequate health care and prevention services. https://doi.org/10.1016/j.earlhumdev.2019.06.010 Received 16 May 2019; Received in revised form 25 June 2019; Accepted 25 June 2019 ⁎ Corresponding author at: Department of Pediatrics and Adolescent Medicine, Lebanon. E-mail address: lc12@aub.edu.lb (L. Charafeddine). Early Human Development 136 (2019) 33–38 0378-3782/ © 2019 Elsevier B.V. All rights reserved. T