Introducing Standardised Developmental Assessment in Nepal's Cleft Care Programme

Nepal's cleft care programme, based at Kirtipur Hospital in Kathmandu, now provides speech therapy input and basic psychosocial support to children with cleft conditions across the country. However, the team have not previously had access to standardised assessment tools - making it difficult to identify developmental needs consistently, tailor interventions effectively, or build an evidence base for the programme over time.

This project, being run jointly by  Kate le Marechal (Clinical Psychologist working in UK cleft care) and Siobhan McMahon (Specialist Speech and Language Therapist - currently based in Nepal for a year) - seeks to change this by teaching and training the Nepali team to introduce the Ages and Stages Questionnaire (ASQ-3) within the Nepali cleft service. The ASQ-3 is a widely used developmental screening tool that evaluates children’s abilities across five key domains: communication, gross motor skills, fine motor skills, problem solving, and personal-social skills. A Nepali translation of the questionnaire already exists, and the pilot phase of the ASQ project will assess the quality of the translation and consider adapting specific assessment items for cultural appropriateness where needed. The project has been supported by the International Steering Committee and approved for funding.

The licence has been obtained for the English language ASQ-3 questionnaires, the Nepali translations have also been received, and Kate and Siobhan have purchased the materials (the ‘kit’) required to deliver the assessments from Nepal where possible or from the UK. Other resources (such as culturally appropriate story books) will be purchased or created in consultation with the Nepali team. In March, Kate was supported by the International Steering Committee to fly to Kathmandu to spend a week with Siobhan providing introductory teaching and training about the ASQ for the lead Nurse, Speech Therapist and Psychologist.  It was a productive week and culminated in the Nepali team successfully delivering their first ASQ.

Roni, the Speech Therapist, led the assessment with the support of her colleagues - and the family who agreed to take part made it a memorable occasion. Krivrag, a 42-month-old boy born with a cleft palate and currently receiving diagnostic speech therapy, took part with his mum. The assessment revealed just how strong his language and communication skills are, despite the difficulties that he experiences with some of his speech sounds as a result of his cleft - something that clearly came as a source of pride and reassurance to his mother. It was a wonderful illustration of what this tool can offer: not just clinical information, but the opportunity to celebrate a child's strengths and give families positive, meaningful feedback. The session ended with a team debrief and a real sense of excitement about what the ASQ-3 could achieve for children across Nepal.

Siobhan McMahon and Kate Le Marechal

Siobhan (Speech and Language Therapist) and Kate (Psychologist) spent the week together teaching the ASQ Assessment to Nepali colleagues.

Sheshang & Roni

Colleagues working together to learn the ASQ assessment process. Sheshang is a Psychologist at the Kirtipur Hospital and Roni is the Speech and Language Therapist.

Krivrag and Roni

ASQ assessment in progress.

“On behalf of the Speech Therapy Team we would like to express our sincere gratitude for providing us with a colour printer and lamination machine. These resources are extremely valuable for our work. They help us prepare colourful therapy materials, visual aids, assessment tools and laminated worksheets that can be reused during therapy sessions. This has greatly improved the quality of our services and made therapy more engaging and effective for our children. Your support has made a meaningful difference in our daily clinical work. We truly appreciate your kindness and continued support toward our team. Thank you once again for your generosity.”

Roni Pradhan