{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:03:33Z","timestamp":1784527413603,"version":"3.55.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000812","name":"European Central Bank","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000812","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"\n Background<\/jats:title>\n Early developmental screening relies heavily on U.S.-standardized normative benchmarks, raising questions about cross-cultural stability and the relative influence of biological vs. contextual factors during infancy. This study examined Ages and Stages Questionnaire (ASQ-3) outcomes at six months in a Bulgarian infant cohort in comparison with established U.S. norms.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this cross-sectional study, 155 infants (six months chronological or corrected age) were assessed using the ASQ-3 during routine pediatric visits. One-sample\n t<\/jats:italic>\n -tests were used to compare domain scores with U.S. normative means. Effect sizes (Cohen's d), 95% confidence intervals, and\n post hoc<\/jats:italic>\n power sensitivity analyses were calculated. Secondary analyses evaluated the effects of birth weight, gestational age, and sex.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Cross-cultural comparisons showed statistically significant differences in Gross Motor (\n d<\/jats:italic>\n \u2009=\u2009\u22120.28) and Problem Solving (\n d<\/jats:italic>\n \u2009=\u20090.30); however, all effect sizes were small (|d|\u2009\u2264\u20090.30), with no moderate or large deviations observed. In contrast, infants with birth weight &lt;2,500\u2005g demonstrated moderate-to-large effects across multiple domains (\n d<\/jats:italic>\n \u2009=\u2009\u22120.63 to \u22120.88), particularly in Gross Motor and Personal-Social functioning. Differences related to gestational age were not clinically meaningful after correction for age. A small female advantage was observed in Communication (\n d<\/jats:italic>\n \u2009=\u20090.37).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n ASQ-3 outcomes at six months suggest a high degree of cross-cultural similarity in this Southeastern European infant cohort. Variability in developmental outcomes in the present cohort appeared more strongly associated with biological risk factors than with cross-cultural contextual variation during early infancy. These findings support the use of ASQ-3 in the Bulgarian clinical context and highlight the importance of integrating perinatal risk factors into early developmental surveillance.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fped.2026.1836394","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:34:26Z","timestamp":1784525666000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["ASQ-3 developmental outcomes at six months in a Bulgarian infant cohort: a cross-cultural comparison with U.S. norms"],"prefix":"10.3389","volume":"14","author":[{"given":"Tatyana","family":"Itova","sequence":"first","affiliation":[{"name":"Department of Public Health and Health Care, University of Ruse","place":["Ruse, 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