Because you want the optimal performance from the child, if a child has difficulty understanding English, you should use his or her native language if possible. ASQ-3 measures all developmental domains and is not designed as an measurement of English skills. So, for the 42 month questionnaire, item 1 in Fine Motor measures ability to draw an item: “After your child watches you draw a single circle with a pencil, crayon, or pen, ask him to make a circle like yours.” You should ask the child in their native language to make a circle to ensure that they understand the request. The item is measuring fine motor skills, not whether the child understands the request in English. Giving the child directions or requests in a language other than English does not affect the questionnaire’s validity.