There are several instances where a professional may decide to refer a child after completion of ASQ-3. For the 5 developmental areas covered by ASQ-3, the tool uses cutoff scores to determine whether a child should be referred. The cutoff scores were developed through a standardization process and are set at 2 standard deviations below the mean. A child may need referral if his score is below the cutoff score in one of the 5 domains. A professional should also consider referral if answers to the Overall questions indicate concern, such as the items related to hearing, vision, or speech. And, in some cases, a professional may want to refer a child based on scores in the monitoring zone (gray area) for multiple developmental areas.