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Research Article  |   May 2013
Review of Instrument Development and Testing Studies for Children and Youth
Author Affiliations
  • Claudia List Hilton, PhD, MBA, OTR/L, SROT, FAOTA, is Assistant Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO; hiltonc@wusm.wustl.edu. Address correspondence to 12803 Westledge Lane, St. Louis, MO 63131
  • Sophie E. Goloff is Research Assistant, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
  • Ofra Altaras, OT(I), is Research Assistant, Department of Occupational Therapy, University of Haifa, Haifa, Israel
  • Naomi Josman, PhD, OT(I), is Associate Professor, Department of Occupational Therapy, Joint Program, Faculty of Social Welfare and Health Sciences, University of Haifa and Technion, Haifa, Israel
Article Information
Assessment Development and Testing / Evidence-Based Practice / Pediatric Evaluation and Intervention / School-Based Practice / Departments
Research Article   |   May 2013
Review of Instrument Development and Testing Studies for Children and Youth
American Journal of Occupational Therapy, May/June 2013, Vol. 67, e30-e54. doi:10.5014/ajot.2013.007831
American Journal of Occupational Therapy, May/June 2013, Vol. 67, e30-e54. doi:10.5014/ajot.2013.007831
Abstract

We reviewed 12 articles from 2012 that addressed development and testing of instruments for children and youths and American Journal of Occupational Therapy articles from 2009–2013 that addressed 11 activity and participation instruments to determine how well this group of instruments facilitates the generation of evidence sufficient to support practice in accordance with the Centennial Vision. We observed an increase in the number of instrument development and testing studies and in higher level studies and larger cohorts; funding was provided for almost half of the studies, and attention was given to use of blind testing and transition to adult-age assessments. Further development of performance-based activity and participation instruments; instruments that examine biomedical molecular–cellular, biomedical, and environmental mechanisms; and intervention fidelity measures and increased use of blind testing are necessary for occupational therapy to meet the Centennial Vision.

Our goal in this review was to critically appraise articles from 2012 addressing instrument development and testing for children and youths and to review more extensively articles published in the American Journal of Occupational Therapy (AJOT) in the period 2009–2013 that address activity and participation instruments. Doucet and Gutman (2013)  asserted that the strength of our profession is in occupational therapists’ unique ability to thoroughly and comprehensively measure function. They stated further that the ability to evaluate it in a specific, objective, and quantifiable way is not only important to determine progress for reimbursement of services but is also critical for the profession’s survival. Others have added that to address this issue, it is necessary to discard home-grown assessments, which are neither reliable nor valid, and adopt the use of cost- and time-efficient standardized assessments (Radomski & Trombly-Latham, 2008). Attention to instrument development is a crucial step toward providing evidence-based practice that will allow the occupational therapy profession to become a “powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs” (American Occupational Therapy Association [AOTA], 2007, p. 613).
Our objective for this review was to examine how well this group of assessments facilitates the generation of evidence sufficient to support practice in accordance with the Centennial Vision, positioning occupational therapy as an evidence-based and science-driven profession to embrace excellence and sharpen its competitive edge (AOTA, 2007; Clark, 2011). This effort was designed to examine AJOT’s performance in three key areas: (1) guiding practitioners to make evidence-based decisions by disseminating well-designed clinical trials; (2) raising the awareness of practitioners, clients, and third-party payers of science-driven and evidence-based innovations that have the potential to improve participation and quality of life; and (3) ultimately influencing health care decisions for current and future clients. These areas echo AOTA’s Centennial Vision to conduct research geared to influence and support evidence-based decision making and foster innovation in occupational therapy practice (AOTA, 2007).
The International Classification of Functioning, Disability and Health(ICF): Children and Youth Version (World Health Organization [WHO], 2007) describes activity as “the execution of a task or action” (p. 12) and participation as “involvement in a life situation” (p. 12). Participation in purposeful activities is a central aspect of the human experience (Wilcock, 1993). The Occupational Therapy Practice Framework: Domain and Process, 2nd Edition (AOTA, 2008) acknowledges the important connection between participation and health. The importance of participation in the lives of children has been examined in several studies. Law and King (2000)  observed that participation in formal and informal activities is the “context in which children form friendships, develop skills and competencies, express creativity, achieve mental and physical health, and determine meaning and purpose in life” (p. 10). They proposed that by participating in activities, children develop an understanding of society’s expectations and acquire the physical and social skills needed to function and flourish. Moreover, participation in everyday activities plays an important role in a child’s social development and influences long-term mental and physical health (Law et al., 2004). Therefore, measuring the impact of occupational therapy interventions on participation and developing sensitive and psychometrically sound assessment tools to monitor client progress in participation are essential. It is also important that the assessment tools be able to evaluate performance or function to measure the changes in participation (Majnemer, 2009).
The AOTA Children and Youth Ad Hoc Committee (CYAC) identified 11 key areas of research that delineate the focus of the Centennial Vision for the area of children and youth (AOTA, 2006, p. 8):
  1. Basic and applied scientific studies related to skills, processes, and foundations for childhood and adolescent occupations

  2. Factors that contribute to the success or failure of a specific frame of reference

  3. Both qualitative and quantitative methodologies to address multiple facets of the above

  4. Efficacy studies that examine interventions (efficacy, effectiveness, outcomes development)

  5. Theory development and development of conceptual models that promote integration of theory and practice

  6. Empirical studies conducted in context

  7. Translational research providing information on applications to practice, policy development, systems change, and program development

  8. The roles and participation of parents, siblings, and other family members within family-centered services

  9. Longitudinal studies of the participation of children with special needs in their daily lives as they transition through childhood and adolescence into adulthood

  10. Studies that examine factors central to the children, youth, and their families such as finding a friend, participating in community life, and procuring and maintaining jobs

  11. Studies that examine the emotional and social cost of occupational deprivation and occupational injustice for children and youth such as depression, alcohol and substance abuse, and suicide in disenfranchised youth, and what this is costing emotionally to youth and family as well as to society.

These areas advocate the conduct of rigorous research, evidence-based and systemically oriented to respective stakeholders, with the ultimate goal of enhancing treatment efficacy and outcomes. A substantial proportion of occupational therapy practitioners work with children and youth. According to the 2010 AOTA Workforce Study, 21.7% of occupational therapists and 21.4% of occupational therapy assistants currently practice in schools, in addition to the 5.2% of occupational therapists and 1.8% of occupational therapy assistants who are engaged in practice with children and their caregivers in early intervention programs. These practitioners, in particular, could benefit from quality evidence-based research that addresses activity and participation in children and youth and documents the validity and viability of a range of assessments.
Method
We first analyzed the 12 articles addressing instrument development and testing studies related to children and youth published in AJOT in 2012. We identified the research design used in each published study, determined whether the published research had the rigor to provide evidence for practice, and discussed implications for use of this evidence by practitioners, clients, and third-party payers. We used the level-of-evidence hierarchy system developed by the AOTA Evidence-Based Literature Review Project (Lieberman & Scheer, 2002) to classify the reviewed articles. Level I is the highest level of research, encompassing systematic reviews, meta-analyses, and randomized controlled trials. Level II consists of two-group pretest–posttest designs in which control is present and randomization is not (e.g., cohort designs, case control studies). Level III designs include neither control nor randomization but instead use a one-group pretest–posttest design. Level IV includes single-subject designs, descriptive studies, and case series. Level V involves case study or expert opinion studies that are not based on systematic review. Consistent with Hilton and Smith’s (2012)  review of 2011 articles on children and youth, we used a pediatric adaptation of Baum’s (2011)  expanded ICF categories (WHO, 2001) to examine levels of mechanisms in rehabilitation science. See Table 1 for details.
Table 1.
Language of Rehabilitation Science
Language of Rehabilitation Science×
Framework CategoryTerms Used
Biomedical molecular–cellularPlasticityNeurotrophic factors
SynapseNeurotransmitters
NeurogenesisNeuromodulators
Receptor
BiomedicalAttentional controlCerebellar activation
Motor inhibitionMotor control
Anatomical connectivityMetabolism
Pattern recognition
Body function and body structure (ICF)Executive functionAttention
Sensory processingArousal
MoodSleep
Motivational stateIntellectual function
Motor planning and praxisTheory of mind
Language
Functional limitationsGaitMobility
StrengthEndurance
Postural controlPlanning
Grasp and pinchSocial skills
Problem solvingSelf-regulation
Range
Activity (ICF)Stair climbingToileting
StandingWriting
WalkingListening
DressingLearning
Grooming and hygieneCommunication
FeedingSocial interaction
Participation (ICF)EducationReligion and spirituality
Community and social lifeChild care
Recreation, leisure, and playWork and chores
Environment (ICF)Social supportReceptivity
Social capitalAccess to services
Assistive technologyServices, systems, and policies
School and community
Accommodations
Table Footer NoteNote. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001). From “The John Stanley Coulter Memorial Lecture—Fulfilling the Promise: Supporting Participation in Daily Life,” by C. Baum, 2011, Archives of Physical Medicine and Rehabilitation, 92, p. 172. Copyright © 2011 by Elsevier. Used with permission.
Note. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001). From “The John Stanley Coulter Memorial Lecture—Fulfilling the Promise: Supporting Participation in Daily Life,” by C. Baum, 2011, Archives of Physical Medicine and Rehabilitation, 92, p. 172. Copyright © 2011 by Elsevier. Used with permission.×
Table 1.
Language of Rehabilitation Science
Language of Rehabilitation Science×
Framework CategoryTerms Used
Biomedical molecular–cellularPlasticityNeurotrophic factors
SynapseNeurotransmitters
NeurogenesisNeuromodulators
Receptor
BiomedicalAttentional controlCerebellar activation
Motor inhibitionMotor control
Anatomical connectivityMetabolism
Pattern recognition
Body function and body structure (ICF)Executive functionAttention
Sensory processingArousal
MoodSleep
Motivational stateIntellectual function
Motor planning and praxisTheory of mind
Language
Functional limitationsGaitMobility
StrengthEndurance
Postural controlPlanning
Grasp and pinchSocial skills
Problem solvingSelf-regulation
Range
Activity (ICF)Stair climbingToileting
StandingWriting
WalkingListening
DressingLearning
Grooming and hygieneCommunication
FeedingSocial interaction
Participation (ICF)EducationReligion and spirituality
Community and social lifeChild care
Recreation, leisure, and playWork and chores
Environment (ICF)Social supportReceptivity
Social capitalAccess to services
Assistive technologyServices, systems, and policies
School and community
Accommodations
Table Footer NoteNote. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001). From “The John Stanley Coulter Memorial Lecture—Fulfilling the Promise: Supporting Participation in Daily Life,” by C. Baum, 2011, Archives of Physical Medicine and Rehabilitation, 92, p. 172. Copyright © 2011 by Elsevier. Used with permission.
Note. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001). From “The John Stanley Coulter Memorial Lecture—Fulfilling the Promise: Supporting Participation in Daily Life,” by C. Baum, 2011, Archives of Physical Medicine and Rehabilitation, 92, p. 172. Copyright © 2011 by Elsevier. Used with permission.×
×
Our second task in this review was to analyze 11 instrument development and testing studies of activity and participation instruments related to children and youth published in AJOT between 2009 and 2013. For this group, we focused on the instruments themselves. We analyzed frame of reference or theoretical model used to conceptualize development of the instrument, perspective used by the instrument (child, parent or caregiver, teacher, observation or administration), cultural relevance, population addressed by the instrument, purpose, description, test components, and item categories. We discussed practicality (time for completion, cost, training, and use for clinical vs. research purposes) and outcome measures. We compared the psychometric analyses completed on each assessment.
Results
Instrument Development and Testing Studies (2012)
The number of instrument development and testing studies rose from 5 studies in 2011 (Hilton & Smith, 2012) to 12 studies in 2012. (See Table 2 at the end of this article for a detailed analysis.) Among the 12 studies, 7 were Level II and 5 were Level III (Blanche, Bodison, Chang, & Reinoso, 2012; Bourke-Taylor, Law, Howie, & Pallant, 2012; Honaker, Rosello, & Candler, 2012; Ohl et al., 2012; Weiner, Toglia, & Berg, 2012), compared with 2 Level II and 3 Level III studies in 2011. Of the 12 studies in 2012, 1 examined a cohort of <30; 5, between 31 and 100; 5, between 101 and 265; and 1, >2,000. In 2011, 3 of the 5 studies had <30 and none had >400. One 2012 study reported using blinded testing (Brossard-Racine, Mazer, Julien, & Majnemer, 2012). Of the 13 studies, 5 were funded. Three of the instruments were designed for transitional ages of adolescence and young adulthood (Kao, Kramer, Liljenquist, Tian, & Coster, 2012; Saban, Ornoy, Grotto, & Parush, 2012; Weiner et al., 2012), and 2 were designed specifically for that age group. Two of the instruments address parent and family occupations (Bourke-Taylor et al., 2012; Honaker et al., 2012). One of the studies involved blinded testing (Brossard-Racine et al., 2012). No studies involved development of an intervention fidelity measure.
Four of the instrument development and testing studies examined body function or body structure mechanisms (Blanche, Bodison, et al., 2012; Blanche, Reinoso, Chang, & Bodison, 2012; Ohl et al., 2012; Weiner et al., 2012). Three instruments addressed functional limitation mechanisms (Griswold & Townsend, 2012; Saban et al., 2012; Silva & Schalock, 2012). Three instruments addressed activity mechanisms (Bourke-Taylor et al., 2012; Brossard-Racine et al., 2012; Kao et al., 2012). One of these addressed activity for mothers (Bourke-Taylor et al., 2012). Two instruments addressed participation mechanisms (Honaker et al., 2012; McDonald & Vigen, 2012).
Table 2.
Articles on Children and Youth Instrument Development and Testing Studies Published in 2012 in the American Journal of Occupational Therapy
Articles on Children and Youth Instrument Development and Testing Studies Published in 2012 in the American Journal of Occupational Therapy×
Author/YearFundingStudy ObjectivesLevel/Design/ParticipantsPerspective, Purpose, and SubtestsResultsStudy Limitations
Blanche, Bodison, Chang, & Reinoso (2012) NoTo develop a new observational tool to identify proprioceptive processing disorders in children with developmental disabilities and to establish its validity and reliability
  • Level III
  • Participants
  • N = 130 children with known developmental disabilities, convenience sample, ages 2–9 yr
  • Perspective
  • Therapist-administered observation of children during free play
  • Purpose
  • The Comprehensive Observations of Proprioception (COP) is a criterion-based observational tool that was originally constructed to measure two main areas of proprioceptive functions: behavior and sensory–motor abilities.
  • Subtests
  • The COP includes items representing the following areas of performance that are believed to be affected by proprioception: rate and timing of movements, the regulation of muscle force, the regulation of muscle stretch, motor programming, postural control, fluidity of movement, calibration of spatial frame of reference, feedback from the outcome of the motor command, joint stability, conscious estimation of muscle force, orientation of body segments, and body scheme.
The COP’s correlation to existing measures targeting proprioception suggests that well-trained therapists can effectively apply observational measures in their assessment of proprioceptive functions. Exploratory factor analysis suggests that what have traditionally been considered sensory–motor functions can be further differentiated into functions related to postural control, muscle tone and mobility, and motor planning, contributing to the understanding of proprioceptive functions.
  • Data were collected using a convenience sample from one region of the country. The results obtained from this study need to be examined in a larger population.
  • Examiners were not blinded to condition of participants.
Blanche, Reinoso, Chang, & Bodison (2012) NoTo compare performance of children with ASD with that of children with developmental disabilities and matched controls on proprioceptive processing and to elucidate the unique nature of these difficulties
  • Level II
  • Participants
  • N = 86; 32 children with ASD, mean age = 6.3, SD = 1.3; 26 children with other developmental disabilities, mean age = 6.8, SD = 1.9; 28 control, mean age = 6.7, SD = 1.8
  • Perspective
  • Therapist-administered observation of children during free play
  • Purpose
  • The Comprehensive Observations of Proprioception (COP) is a clinical tool consisting of 18 items focusing on motor and behavior regulation aspects of proprioceptive processing in children.
  • Subtests
  • COP items used were as follows:
  • • Decreased muscle tone
  • • Joint hypermobility
  • • Decreased joint alignment
  • • Inefficient ankle strategies
  • • Inadequate weight-shifting patterns
  • • Decreased postural control
  • • Decreased feedback-related motor planning
  • • Decreased feed-forward–related motor planning
  • • Inefficient grading of force
  • • Tiptoeing
  • • Pushing others or objects
  • • Enjoyment while being pulled
  • • Tendency to lean on others
  • • Overactivity
  • • Overpassivity
  • • Crashing, falling, running
Children with ASD presented a distinct pattern of proprioceptive processing difficulties on four COP items when compared with control counterparts and children with developmental disability: difficulty with feedback-related motor planning skills,walking on tiptoes, pushing others or objects, and crashing, falling, and running. Findings suggest that proprioceptive difficulties in children with ASD may contribute to decreased motor planning and postural control and to disruptive behaviors that negatively affect their participation in daily tasks.
  • Further assessment of psychometric properties, clinical utility using the COP in different settings, and meaningful differences in diverse clinical populations are needed.
  • Examiners were not blinded to condition of participants.
Bourke-Taylor, Law, Howie, & Pallant (2012) NoTo describe the development and internal consistency, factor structure, and construct validity of the Health Promoting Activities Scale (HPAS)
  • Level III
  • Participants
  • N = 152 mothers, mean age = 41.7 (SD = 5.4), recruited through disability support networks for parents of school-age children with developmental disabilities living in Victoria, Australia
  • Perspective
  • Mother self-report
  • Purpose
  • The HPAS measures the frequency with which mothers participate in self-selected leisure activities that promote health and well-being.
  • Subtests
  • • Personal health care tasks
  • • Physically active recreational pursuit that you do alone
  • • Physically active recreational pursuit that you do with others
  • • Spiritual or rejuvenating personal time
  • • Social activities with other people who are important and supportive toward you
  • • Time out for yourself
  • • Quiet, physically inactive leisure pursuit that you do alone
  • • Quiet, physically inactive leisure pursuit that you do with others
Initial evaluations indicate that this brief tool is psychometrically sound. This study supports the internal consistency, factor structure, and construct validity of the HPAS.Different sampling methods that provide population-based data and additional verification of medical history are required. Further evaluation of the sensitivity of the HPAS to detect changes in health-promoting behaviors and subjective health over time will indicate whether the HPAS is a valid outcome measure.
Brossard-Racine, Mazer, Julien, & Majnemer (2012) Doctoral fellowship from Fond de Recherche en Santé du Québec, Edith and Richard Strauss Fellowship, studentship from the Stars/Montreal Children’s HospitalTo validate the discriminant ability of the Evaluation Tool of Children’s Handwriting (ETCH) in identifying children in second to third grade with handwriting difficulties and to determine the percentage of change in handwriting scores that is consistently detected by occupational therapists
  • Level II
  • Participants
  • N = 60 (26 children from previous study on children with attention deficit hyperactivity disorder), mean age = 8.1 yr (SD = 0.8 yr)
  • N = 34 occupational therapists; 21% with 1–2 yr experience working with children with handwriting difficulties, 32% with 3–5 yr experience, 47% with >6 yr experience
  • Perspective
  • Occupational therapists completed questionnaires assessing paired samples from a previous study.
  • Purpose
  • The ETCH assesses children’s handwriting skills using tasks similar to those experienced in the classroom. The manuscript version of the ETCH (ETCH–M) examines legibility in children in first through third grade.
  • Subtests
  • Only the total scores for word legibility and letter legibility from the ETCH were used. Occupational therapists were presented with samples of handwriting and asked to complete a questionnaire consisting of two questions: “Looking only at Sample A, does this child need handwriting rehabilitation services?” and “Compare the two samples using a Likert Scale (1 = B is much better than A, 5 = B is much worse than A).”
Total Word Legibility and Total Letter Legibility had excellent accuracy in distinguishing children; 75% total word legibility and 76% total letter legibility discriminated between children with and without handwriting difficulties. Identifying the percentage of change in total word legibility and total letter legibility that clinicians consistently detected resulted in fair levels of accuracy.All samples were previously scored by an independent evaluator who was blind to the child’s identity and timing of testing. Therapists presented with the samples were blind to the child’s identity, condition, time between two evaluations, whether any intervention had occurred between the two samples, and legibility scores obtained for each sample. The level of agreement among occupational therapists in rating clinically meaningful change was low, which could be because they were not previously trained for scoring consistency or because the group was not homogeneous in experience. The question posed could also have been too broad and nonspecific.
Griswold & Townsend (2012) Funding provided by the Hamel Center for Undergraduate ResearchTo examine the sensitivity of the Evaluation of Social Interaction (ESI) as a measure of the overall quality of social interaction for children as they engage in social exchanges in natural contexts with typical social partners
  • Level II
  • Participants
  • N = 46; 23 matched pairs of children including 1 with a disability and 2 without. Participants were 34 boys and 12 girls ranging in age from 2–12 yr (M = 7 yr).
  • Perspective
  • The occupational therapist observes the participants and rates their behavior.
  • Purpose
  • The ESI measures the overall quality of social interaction for children as they engage in social exchanges in a natural context with typical social partners.
  • Subtests
  • The ESI includes 27 skills that relate to initiating and ending a social interaction, producing the social interaction, physically supporting the interaction, shaping the content and maintaining the flow of the interaction, verbally supporting the social interaction, and adapting to problems that might arise during the social interaction.
  • It categorizes social interactions by the intended purpose: gathering information, sharing information, problem solving and decision making, collaborating and producing, acquiring goods and services, and conversing socially and making small talk.
Results suggest that the ESI is able to differentiate the overall quality of social interaction between children with and without a disability on the basis of observing two social exchanges in the natural contexts of school, play, and activities of daily living when interacting with usual social partners. The exception was 3-yr-olds, possibly because they are still very young and have a greater variation in the quality of their social interaction.
  • Sample size was small and lacked demographic diversity. Because each child was observed twice, often in different natural contexts or with different social partners, the researchers questioned whether and how the environment, activity context, and social partners influenced the children’s quality of social interaction.
  • Examiners were not blinded to condition of participants.
Honaker, Rosello, & Candler (2012) NoTo examine the test–retest reliability of Family Looking Into Family Experiences (Family L.I.F.E.) in consistently identifying desired family occupations and perceived efficiency, effectiveness, and satisfaction ratings of those occupations for families with a child with ASD
  • Level III
  • Participants
  • Self-selected convenience sample of 15 families that included a child with an ASD and at least 1 sibling.
  • 13 families were used for test–retest reliability data collection, and 2 were used to initially establish consistency in administration of Family L.I.F.E.
  • Perspective
  • An occupational therapist interviews a primary caregiver.
  • Purpose
  • Family L.I.F.E. engages families and therapists to identify, evaluate, and measure perceived success in unique and relevant family occupations.
  • Subtests
  • The family identifies five desired family occupations and rates perceived efficiency, effectiveness, and satisfaction of those occupations. The instrument includes a demographic section, a time diary of a typical day and typical weekend day to help identify routines and rituals, and eight interview questions that focus on family togetherness, child rearing, and impact on family occupations. The therapist assists the family in identifying 5 key family occupations and limiting factors, which the family then rates on perceived effectiveness, efficiency, and satisfaction using a Likert scale.
  • Results suggest that occupations identified by families using Family L.I.F.E. are stable over time. The ratings of effectiveness and efficiency are also reliable over the period of 1 wk. The findings indicated that satisfaction with performance on the identified occupations is more variable.
  • Occupations identified as more problematic at initial testing held that position on retest, suggesting that these performance scores are stable constructs.
Results of this study were limited to one small diagnostic group, one race, and two regional locations, and all respondents were mothers. Cultural factors were not examined. Results cannot be generalized to the entire population with ASD. Further research is needed to determine consistency across races, cultures, various diagnoses, other single diagnostic categories, and more than one caregiver respondent.
Kao, Kramer, Liljenquist, Tian, & Coster (2012) Funded by grants from the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentTo examine the level of functional performance of children and youths with ASD and co-occurring conditions as measured by 3 domains of the revised Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI–CAT); to compare performance of children and youths with ASD or intellectual and developmental disabilities (IDDs) with that of children and youth without disabilities; and to examine how functional performance varies by age
  • Level II
  • Participants
  • N = 2,463; 108 children with ASD, 150 children with IDDs, 2,205 children without disabilities
  • Perspective
  • Parent-report response questionnaire; data were collected over the Internet.
  • Purpose
  • The PEDI–CAT measures function in infants, children, and youths from birth through age 20 yr.
  • Subtests
  • The PEDI–CAT includes four domains: Daily Activities, Social/Cognitive, Mobility, and Responsibility. Only the Social/Cognitive, Daily Activities, and Responsibility domains were used in this experiment.
  • No relationship was found between diagnosis and children’s level of functioning at age 5 for the PEDI–CAT Social/Cognitive, Daily Activities, and Responsibility domains. Older children with ASD had significantly lower levels of function than children without disabilities on all domains. No significant difference was found in the level of functioning of children with ASD and children with IDDs across all reference ages (5, 10, and 15 yr).
  • These findings suggest that children with ASD and IDDs may demonstrate similar levels of functional performance and task management responsibilities after controlling for age. Both groups demonstrate lower performance than children without disabilities.
Impairment severity data were not collected, so relationship with adaptive behavior as measured by the PEDI–CAT was not examined. Uneven sample sizes, specifically the smaller diagnostic sample sizes, reduce the power to detect potentially subtle but meaningful differences between diagnostic groups.
McDonald & Vigen (2012) Research grant from California Foundation for Occupational TherapyTo examine the ability of the McDonald Play Inventory (MPI) to reliably and validly measure the play activities and play styles of 7- to 11-yr-old children and to discriminate between the play of neurotypical children and children with known learning and developmental disabilities
  • Level II
  • Participants
  • N = 124 (89 neurotypical children and 35 with disabilities), ages 7–11 yr
  • Perspective
  • Self-report questionnaires given to children; the parent version was given to their parents to establish concurrent validity.
  • Purpose
  • The MPI is a self-report play inventory that measures the types and frequencies of play activities and play styles of 7- to 11-yr-old children.
  • Subtests
  • McDonald Play Activity Inventory (MPAI): Measures child’s perceived frequency of engagement in four mutually exclusive categories: fine motor, gross motor, social group, and solitary.
  • McDonald Play Style Inventory (MPSI): Measures types and frequencies of play behaviors via four subscales: Physical Coordination, Cooperation, Peer Acceptance, and Social Participation.
Inclusion of items in the inventory was supported. The MPAI and MPSI each achieved acceptable internal consistency values. Test–retest reliability was consistent, showing that the MPI is a fairly accurate measurement of the reported play performance over time. Neurotypical children and children with ASD showed a statistically significant difference only on the Social Participation subscale of the MPSI. Children with disabilities reported engaging in play activities with the same frequency as their nondisabled peers but reported differences in perceived style of play. Parents from both groups did not concur with their children’s responses.Limitations include the lack of generalization to children from lower socioeconomic backgrounds and other geographic areas. Possible differences in play style between White and Asian-American children were not analyzed. Further research is needed to gather normative data on children from diverse backgrounds and age ranges to detect similarities and differences in MPI scores among a wider age range of children and their parents.
Ohl et al. (2012) NoTo examine the test–retest reliability and internal consistency of the Sensory Profile (SP) Caregiver Questionnaire
  • Level III
  • Participants
  • N = 55 (primary caregivers of children 36–72 mo old) recruited from preschools and child care centers in New York metropolitan area
  • Perspective
  • Primary caregivers were given questionnaires to complete about their child’s behavior.
  • Purpose
  • The SP provides a standard method for professionals to measure the possible contributions of sensory processing to children’s daily performance patterns.
  • Subtests
  • The SP is organized into three main sections: Sensory Processing, Modulation, and Behavioral and Emotional Responses. Results were divided into sensory section, factor, and quadrant scores (Registration, Seeking, Sensitivity, Avoiding).
  • Analysis at the quadrant level suggests acceptable test–retest reliability and internal consistency, indicating that caregivers’ observations of their children are stable over time.
  • Test–retest and internal consistency analyses revealed higher psychometric indexes across the four quadrants than across the factors and sections, suggesting that a quadrant-level analysis captures children’s sensory processing patterns more consistently than factor- or section-level analyses.
This study was limited by a small sample size of geographic convenience and a lack of demographic information about the study participants. More research is needed to further examine the SP’s test–retest reliability and its utility as an outcome measure. Future studies should include a larger sample with greater demographic representation.
Saban, Ornoy, Grotto, & Parush (2012) NoTo develop the Adolescents and Adults Coordination Questionnaire (AAC–Q), assess its psychometric properties, and establish cutoff scores for use
  • Level II
  • Participants
  • N = 56; 28 adolescents and adults with suspected DCD (M age = 21.18 yr, SD = 4.73) and 28 peers without DCD (mean age = 27.64 yr, SD = 3.75); convenience sample
  • Cutoff scores for suspected DCD were established using data from a sample of 2,379 participants (M age = 20.68 yr)
  • Perspective
  • Self-report questionnaire
  • Purpose
  • The AAC–Q is used to identify DCD in adolescents and adults.
  • Subtests
  • The AAC–Q consists of 12 items representing areas and realms of functions vital to everyday performance of life tasks such as organization skills, spatial and temporal orientation, fine and gross motor function, and writing.
  • This study supports use of the AAC–Q as a standardized, brief, ecologically valid, user-friendly measure to screen for DCD. Sufficient evidence was found of the reliability and validity of the instrument and identified cutoff points indicating suspected DCD.
  • Internal consistency for both samples in this study and test–retest reliability of pilot study were high, implying that the instrument is reliable.
  • Study provided considerable evidence for the validity of the AAC–Q.
Self-report method of attaining information may introduce bias resulting from the mood and truthfulness of the respondent. Use of a convenience sample for the first phase of the study is an additional limitation, as is the fact that no diagnostic tests are available to determine the accuracy of group placement.
Silva & Schalock (2012) Support from Curry Stone Foundation and Northwest Health FoundationTo validate the Sense and Self-Regulation Checklist (SSC), a parent–caregiver measure of comorbid symptoms in autism
  • Level II
  • Participants
  • N = 265 (99 children with ASD; M age = 3.9 yr, SD = 1.2), 28 children with other developmental disabilities (DD; M age = 2.26, SD = 1.4), 138 typically developing children, age 24–72 mo (M age = 3.9, SD = .89)
  • Perspective
  • Primary caregivers were given a form to fill out.
  • Purpose
  • The SSC is a caregiver questionnaire that is divided into items relative to abnormal sensory response to ordinary injurious and noninjurious stimuli and items relative to difficulties reaching early self-regulation milestones.
  • Subtests
  • The SSC is divided into Sensory and Self-Regulatory domains. The Sensory domain includes Touch–Pain, Auditory, Visual, and Taste–Smell. The Self-Regulatory domain includes Sleep, Appetite–Digestion, Self-Soothing, Orienting–Attending, Aggressive Behavior, and Self-Injurious Behavior.
  • Domain, subdomain, and overall scores demonstrated acceptable internal consistency across all three groups.
  • Group differences in total sensory scores, total self-regulatory scores, and total sensory and self-regulatory scores were highly significant.
  • Children with ASD were more multisensorily impaired than children in other groups.
  • Positive and relatively strong relationships between sensory impairment and severity of autism and between self-regulation impairment and severity of autism were seen.
  • Larger samples are needed to achieve acceptable internal consistency in the subdomain scores across groups to satisfactorily control for variability in symptoms—specifically, a larger other DD group to further differentiate children with ASD from children with other conditions.
  • Mental and developmental age data need to be collected and correlated with SSC scores to place the findings in a more clinical context. Collecting more demographic data on the informants answering the SSC would be of interest.
Weiner, Toglia, & Berg (2012) NoTo describe the baseline executive function profile of youths at risk who are participating in a 2-yr return-to-school education program by exploring the relationship between accuracy, time, and strategy use
  • Level III
  • Participants
  • N = 113 male and female high school students, ages 16–21 yr. Participants were enrolled in a charter school for disconnected youth in St. Louis.
  • Perspective
  • The scheduling task was administered to participants by an examiner.
  • Purpose
  • The Weekly Calendar Planning Activity (WCPA) is a performance-based measure of executive function. The examiner keeps track of time, observable strategy use, and adherence to rules of the task while providing distractions at planned intervals throughout the task.
  • Subtests
  • Level 2 of the WCPA was used.
  • The WCPA allows detection of complex task performance, strategy use, self-evaluation of performance, and error patterns, which translate into intervention strategies. The complexity of the task and the broad range of scores suggest that the WCPA may be useful in assessing even subtle executive functioning differences.
  • Relationships were found between number of entered appointments and task time, task time and number of strategies used, and number of strategies used and accuracy of entered appointments.
  • Results cannot be generalized to other populations until testing of a more representative sample of 16- to 21-yr-olds occurs.
  • The socioeconomic and race divide between testers and sample was a limitation, as was the fact that literacy issues may have been present in some of the sample. The students may have had no interest in the task, which could have affected performance.
  • Examiners were not blinded to condition of participants.
Table Footer NoteNote. ASD = autism spectrum disorder; DCD = developmental coordination disorder; M = mean; SD = standard deviation.
Note. ASD = autism spectrum disorder; DCD = developmental coordination disorder; M = mean; SD = standard deviation.×
Table 2.
Articles on Children and Youth Instrument Development and Testing Studies Published in 2012 in the American Journal of Occupational Therapy
Articles on Children and Youth Instrument Development and Testing Studies Published in 2012 in the American Journal of Occupational Therapy×
Author/YearFundingStudy ObjectivesLevel/Design/ParticipantsPerspective, Purpose, and SubtestsResultsStudy Limitations
Blanche, Bodison, Chang, & Reinoso (2012) NoTo develop a new observational tool to identify proprioceptive processing disorders in children with developmental disabilities and to establish its validity and reliability
  • Level III
  • Participants
  • N = 130 children with known developmental disabilities, convenience sample, ages 2–9 yr
  • Perspective
  • Therapist-administered observation of children during free play
  • Purpose
  • The Comprehensive Observations of Proprioception (COP) is a criterion-based observational tool that was originally constructed to measure two main areas of proprioceptive functions: behavior and sensory–motor abilities.
  • Subtests
  • The COP includes items representing the following areas of performance that are believed to be affected by proprioception: rate and timing of movements, the regulation of muscle force, the regulation of muscle stretch, motor programming, postural control, fluidity of movement, calibration of spatial frame of reference, feedback from the outcome of the motor command, joint stability, conscious estimation of muscle force, orientation of body segments, and body scheme.
The COP’s correlation to existing measures targeting proprioception suggests that well-trained therapists can effectively apply observational measures in their assessment of proprioceptive functions. Exploratory factor analysis suggests that what have traditionally been considered sensory–motor functions can be further differentiated into functions related to postural control, muscle tone and mobility, and motor planning, contributing to the understanding of proprioceptive functions.
  • Data were collected using a convenience sample from one region of the country. The results obtained from this study need to be examined in a larger population.
  • Examiners were not blinded to condition of participants.
Blanche, Reinoso, Chang, & Bodison (2012) NoTo compare performance of children with ASD with that of children with developmental disabilities and matched controls on proprioceptive processing and to elucidate the unique nature of these difficulties
  • Level II
  • Participants
  • N = 86; 32 children with ASD, mean age = 6.3, SD = 1.3; 26 children with other developmental disabilities, mean age = 6.8, SD = 1.9; 28 control, mean age = 6.7, SD = 1.8
  • Perspective
  • Therapist-administered observation of children during free play
  • Purpose
  • The Comprehensive Observations of Proprioception (COP) is a clinical tool consisting of 18 items focusing on motor and behavior regulation aspects of proprioceptive processing in children.
  • Subtests
  • COP items used were as follows:
  • • Decreased muscle tone
  • • Joint hypermobility
  • • Decreased joint alignment
  • • Inefficient ankle strategies
  • • Inadequate weight-shifting patterns
  • • Decreased postural control
  • • Decreased feedback-related motor planning
  • • Decreased feed-forward–related motor planning
  • • Inefficient grading of force
  • • Tiptoeing
  • • Pushing others or objects
  • • Enjoyment while being pulled
  • • Tendency to lean on others
  • • Overactivity
  • • Overpassivity
  • • Crashing, falling, running
Children with ASD presented a distinct pattern of proprioceptive processing difficulties on four COP items when compared with control counterparts and children with developmental disability: difficulty with feedback-related motor planning skills,walking on tiptoes, pushing others or objects, and crashing, falling, and running. Findings suggest that proprioceptive difficulties in children with ASD may contribute to decreased motor planning and postural control and to disruptive behaviors that negatively affect their participation in daily tasks.
  • Further assessment of psychometric properties, clinical utility using the COP in different settings, and meaningful differences in diverse clinical populations are needed.
  • Examiners were not blinded to condition of participants.
Bourke-Taylor, Law, Howie, & Pallant (2012) NoTo describe the development and internal consistency, factor structure, and construct validity of the Health Promoting Activities Scale (HPAS)
  • Level III
  • Participants
  • N = 152 mothers, mean age = 41.7 (SD = 5.4), recruited through disability support networks for parents of school-age children with developmental disabilities living in Victoria, Australia
  • Perspective
  • Mother self-report
  • Purpose
  • The HPAS measures the frequency with which mothers participate in self-selected leisure activities that promote health and well-being.
  • Subtests
  • • Personal health care tasks
  • • Physically active recreational pursuit that you do alone
  • • Physically active recreational pursuit that you do with others
  • • Spiritual or rejuvenating personal time
  • • Social activities with other people who are important and supportive toward you
  • • Time out for yourself
  • • Quiet, physically inactive leisure pursuit that you do alone
  • • Quiet, physically inactive leisure pursuit that you do with others
Initial evaluations indicate that this brief tool is psychometrically sound. This study supports the internal consistency, factor structure, and construct validity of the HPAS.Different sampling methods that provide population-based data and additional verification of medical history are required. Further evaluation of the sensitivity of the HPAS to detect changes in health-promoting behaviors and subjective health over time will indicate whether the HPAS is a valid outcome measure.
Brossard-Racine, Mazer, Julien, & Majnemer (2012) Doctoral fellowship from Fond de Recherche en Santé du Québec, Edith and Richard Strauss Fellowship, studentship from the Stars/Montreal Children’s HospitalTo validate the discriminant ability of the Evaluation Tool of Children’s Handwriting (ETCH) in identifying children in second to third grade with handwriting difficulties and to determine the percentage of change in handwriting scores that is consistently detected by occupational therapists
  • Level II
  • Participants
  • N = 60 (26 children from previous study on children with attention deficit hyperactivity disorder), mean age = 8.1 yr (SD = 0.8 yr)
  • N = 34 occupational therapists; 21% with 1–2 yr experience working with children with handwriting difficulties, 32% with 3–5 yr experience, 47% with >6 yr experience
  • Perspective
  • Occupational therapists completed questionnaires assessing paired samples from a previous study.
  • Purpose
  • The ETCH assesses children’s handwriting skills using tasks similar to those experienced in the classroom. The manuscript version of the ETCH (ETCH–M) examines legibility in children in first through third grade.
  • Subtests
  • Only the total scores for word legibility and letter legibility from the ETCH were used. Occupational therapists were presented with samples of handwriting and asked to complete a questionnaire consisting of two questions: “Looking only at Sample A, does this child need handwriting rehabilitation services?” and “Compare the two samples using a Likert Scale (1 = B is much better than A, 5 = B is much worse than A).”
Total Word Legibility and Total Letter Legibility had excellent accuracy in distinguishing children; 75% total word legibility and 76% total letter legibility discriminated between children with and without handwriting difficulties. Identifying the percentage of change in total word legibility and total letter legibility that clinicians consistently detected resulted in fair levels of accuracy.All samples were previously scored by an independent evaluator who was blind to the child’s identity and timing of testing. Therapists presented with the samples were blind to the child’s identity, condition, time between two evaluations, whether any intervention had occurred between the two samples, and legibility scores obtained for each sample. The level of agreement among occupational therapists in rating clinically meaningful change was low, which could be because they were not previously trained for scoring consistency or because the group was not homogeneous in experience. The question posed could also have been too broad and nonspecific.
Griswold & Townsend (2012) Funding provided by the Hamel Center for Undergraduate ResearchTo examine the sensitivity of the Evaluation of Social Interaction (ESI) as a measure of the overall quality of social interaction for children as they engage in social exchanges in natural contexts with typical social partners
  • Level II
  • Participants
  • N = 46; 23 matched pairs of children including 1 with a disability and 2 without. Participants were 34 boys and 12 girls ranging in age from 2–12 yr (M = 7 yr).
  • Perspective
  • The occupational therapist observes the participants and rates their behavior.
  • Purpose
  • The ESI measures the overall quality of social interaction for children as they engage in social exchanges in a natural context with typical social partners.
  • Subtests
  • The ESI includes 27 skills that relate to initiating and ending a social interaction, producing the social interaction, physically supporting the interaction, shaping the content and maintaining the flow of the interaction, verbally supporting the social interaction, and adapting to problems that might arise during the social interaction.
  • It categorizes social interactions by the intended purpose: gathering information, sharing information, problem solving and decision making, collaborating and producing, acquiring goods and services, and conversing socially and making small talk.
Results suggest that the ESI is able to differentiate the overall quality of social interaction between children with and without a disability on the basis of observing two social exchanges in the natural contexts of school, play, and activities of daily living when interacting with usual social partners. The exception was 3-yr-olds, possibly because they are still very young and have a greater variation in the quality of their social interaction.
  • Sample size was small and lacked demographic diversity. Because each child was observed twice, often in different natural contexts or with different social partners, the researchers questioned whether and how the environment, activity context, and social partners influenced the children’s quality of social interaction.
  • Examiners were not blinded to condition of participants.
Honaker, Rosello, & Candler (2012) NoTo examine the test–retest reliability of Family Looking Into Family Experiences (Family L.I.F.E.) in consistently identifying desired family occupations and perceived efficiency, effectiveness, and satisfaction ratings of those occupations for families with a child with ASD
  • Level III
  • Participants
  • Self-selected convenience sample of 15 families that included a child with an ASD and at least 1 sibling.
  • 13 families were used for test–retest reliability data collection, and 2 were used to initially establish consistency in administration of Family L.I.F.E.
  • Perspective
  • An occupational therapist interviews a primary caregiver.
  • Purpose
  • Family L.I.F.E. engages families and therapists to identify, evaluate, and measure perceived success in unique and relevant family occupations.
  • Subtests
  • The family identifies five desired family occupations and rates perceived efficiency, effectiveness, and satisfaction of those occupations. The instrument includes a demographic section, a time diary of a typical day and typical weekend day to help identify routines and rituals, and eight interview questions that focus on family togetherness, child rearing, and impact on family occupations. The therapist assists the family in identifying 5 key family occupations and limiting factors, which the family then rates on perceived effectiveness, efficiency, and satisfaction using a Likert scale.
  • Results suggest that occupations identified by families using Family L.I.F.E. are stable over time. The ratings of effectiveness and efficiency are also reliable over the period of 1 wk. The findings indicated that satisfaction with performance on the identified occupations is more variable.
  • Occupations identified as more problematic at initial testing held that position on retest, suggesting that these performance scores are stable constructs.
Results of this study were limited to one small diagnostic group, one race, and two regional locations, and all respondents were mothers. Cultural factors were not examined. Results cannot be generalized to the entire population with ASD. Further research is needed to determine consistency across races, cultures, various diagnoses, other single diagnostic categories, and more than one caregiver respondent.
Kao, Kramer, Liljenquist, Tian, & Coster (2012) Funded by grants from the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentTo examine the level of functional performance of children and youths with ASD and co-occurring conditions as measured by 3 domains of the revised Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI–CAT); to compare performance of children and youths with ASD or intellectual and developmental disabilities (IDDs) with that of children and youth without disabilities; and to examine how functional performance varies by age
  • Level II
  • Participants
  • N = 2,463; 108 children with ASD, 150 children with IDDs, 2,205 children without disabilities
  • Perspective
  • Parent-report response questionnaire; data were collected over the Internet.
  • Purpose
  • The PEDI–CAT measures function in infants, children, and youths from birth through age 20 yr.
  • Subtests
  • The PEDI–CAT includes four domains: Daily Activities, Social/Cognitive, Mobility, and Responsibility. Only the Social/Cognitive, Daily Activities, and Responsibility domains were used in this experiment.
  • No relationship was found between diagnosis and children’s level of functioning at age 5 for the PEDI–CAT Social/Cognitive, Daily Activities, and Responsibility domains. Older children with ASD had significantly lower levels of function than children without disabilities on all domains. No significant difference was found in the level of functioning of children with ASD and children with IDDs across all reference ages (5, 10, and 15 yr).
  • These findings suggest that children with ASD and IDDs may demonstrate similar levels of functional performance and task management responsibilities after controlling for age. Both groups demonstrate lower performance than children without disabilities.
Impairment severity data were not collected, so relationship with adaptive behavior as measured by the PEDI–CAT was not examined. Uneven sample sizes, specifically the smaller diagnostic sample sizes, reduce the power to detect potentially subtle but meaningful differences between diagnostic groups.
McDonald & Vigen (2012) Research grant from California Foundation for Occupational TherapyTo examine the ability of the McDonald Play Inventory (MPI) to reliably and validly measure the play activities and play styles of 7- to 11-yr-old children and to discriminate between the play of neurotypical children and children with known learning and developmental disabilities
  • Level II
  • Participants
  • N = 124 (89 neurotypical children and 35 with disabilities), ages 7–11 yr
  • Perspective
  • Self-report questionnaires given to children; the parent version was given to their parents to establish concurrent validity.
  • Purpose
  • The MPI is a self-report play inventory that measures the types and frequencies of play activities and play styles of 7- to 11-yr-old children.
  • Subtests
  • McDonald Play Activity Inventory (MPAI): Measures child’s perceived frequency of engagement in four mutually exclusive categories: fine motor, gross motor, social group, and solitary.
  • McDonald Play Style Inventory (MPSI): Measures types and frequencies of play behaviors via four subscales: Physical Coordination, Cooperation, Peer Acceptance, and Social Participation.
Inclusion of items in the inventory was supported. The MPAI and MPSI each achieved acceptable internal consistency values. Test–retest reliability was consistent, showing that the MPI is a fairly accurate measurement of the reported play performance over time. Neurotypical children and children with ASD showed a statistically significant difference only on the Social Participation subscale of the MPSI. Children with disabilities reported engaging in play activities with the same frequency as their nondisabled peers but reported differences in perceived style of play. Parents from both groups did not concur with their children’s responses.Limitations include the lack of generalization to children from lower socioeconomic backgrounds and other geographic areas. Possible differences in play style between White and Asian-American children were not analyzed. Further research is needed to gather normative data on children from diverse backgrounds and age ranges to detect similarities and differences in MPI scores among a wider age range of children and their parents.
Ohl et al. (2012) NoTo examine the test–retest reliability and internal consistency of the Sensory Profile (SP) Caregiver Questionnaire
  • Level III
  • Participants
  • N = 55 (primary caregivers of children 36–72 mo old) recruited from preschools and child care centers in New York metropolitan area
  • Perspective
  • Primary caregivers were given questionnaires to complete about their child’s behavior.
  • Purpose
  • The SP provides a standard method for professionals to measure the possible contributions of sensory processing to children’s daily performance patterns.
  • Subtests
  • The SP is organized into three main sections: Sensory Processing, Modulation, and Behavioral and Emotional Responses. Results were divided into sensory section, factor, and quadrant scores (Registration, Seeking, Sensitivity, Avoiding).
  • Analysis at the quadrant level suggests acceptable test–retest reliability and internal consistency, indicating that caregivers’ observations of their children are stable over time.
  • Test–retest and internal consistency analyses revealed higher psychometric indexes across the four quadrants than across the factors and sections, suggesting that a quadrant-level analysis captures children’s sensory processing patterns more consistently than factor- or section-level analyses.
This study was limited by a small sample size of geographic convenience and a lack of demographic information about the study participants. More research is needed to further examine the SP’s test–retest reliability and its utility as an outcome measure. Future studies should include a larger sample with greater demographic representation.
Saban, Ornoy, Grotto, & Parush (2012) NoTo develop the Adolescents and Adults Coordination Questionnaire (AAC–Q), assess its psychometric properties, and establish cutoff scores for use
  • Level II
  • Participants
  • N = 56; 28 adolescents and adults with suspected DCD (M age = 21.18 yr, SD = 4.73) and 28 peers without DCD (mean age = 27.64 yr, SD = 3.75); convenience sample
  • Cutoff scores for suspected DCD were established using data from a sample of 2,379 participants (M age = 20.68 yr)
  • Perspective
  • Self-report questionnaire
  • Purpose
  • The AAC–Q is used to identify DCD in adolescents and adults.
  • Subtests
  • The AAC–Q consists of 12 items representing areas and realms of functions vital to everyday performance of life tasks such as organization skills, spatial and temporal orientation, fine and gross motor function, and writing.
  • This study supports use of the AAC–Q as a standardized, brief, ecologically valid, user-friendly measure to screen for DCD. Sufficient evidence was found of the reliability and validity of the instrument and identified cutoff points indicating suspected DCD.
  • Internal consistency for both samples in this study and test–retest reliability of pilot study were high, implying that the instrument is reliable.
  • Study provided considerable evidence for the validity of the AAC–Q.
Self-report method of attaining information may introduce bias resulting from the mood and truthfulness of the respondent. Use of a convenience sample for the first phase of the study is an additional limitation, as is the fact that no diagnostic tests are available to determine the accuracy of group placement.
Silva & Schalock (2012) Support from Curry Stone Foundation and Northwest Health FoundationTo validate the Sense and Self-Regulation Checklist (SSC), a parent–caregiver measure of comorbid symptoms in autism
  • Level II
  • Participants
  • N = 265 (99 children with ASD; M age = 3.9 yr, SD = 1.2), 28 children with other developmental disabilities (DD; M age = 2.26, SD = 1.4), 138 typically developing children, age 24–72 mo (M age = 3.9, SD = .89)
  • Perspective
  • Primary caregivers were given a form to fill out.
  • Purpose
  • The SSC is a caregiver questionnaire that is divided into items relative to abnormal sensory response to ordinary injurious and noninjurious stimuli and items relative to difficulties reaching early self-regulation milestones.
  • Subtests
  • The SSC is divided into Sensory and Self-Regulatory domains. The Sensory domain includes Touch–Pain, Auditory, Visual, and Taste–Smell. The Self-Regulatory domain includes Sleep, Appetite–Digestion, Self-Soothing, Orienting–Attending, Aggressive Behavior, and Self-Injurious Behavior.
  • Domain, subdomain, and overall scores demonstrated acceptable internal consistency across all three groups.
  • Group differences in total sensory scores, total self-regulatory scores, and total sensory and self-regulatory scores were highly significant.
  • Children with ASD were more multisensorily impaired than children in other groups.
  • Positive and relatively strong relationships between sensory impairment and severity of autism and between self-regulation impairment and severity of autism were seen.
  • Larger samples are needed to achieve acceptable internal consistency in the subdomain scores across groups to satisfactorily control for variability in symptoms—specifically, a larger other DD group to further differentiate children with ASD from children with other conditions.
  • Mental and developmental age data need to be collected and correlated with SSC scores to place the findings in a more clinical context. Collecting more demographic data on the informants answering the SSC would be of interest.
Weiner, Toglia, & Berg (2012) NoTo describe the baseline executive function profile of youths at risk who are participating in a 2-yr return-to-school education program by exploring the relationship between accuracy, time, and strategy use
  • Level III
  • Participants
  • N = 113 male and female high school students, ages 16–21 yr. Participants were enrolled in a charter school for disconnected youth in St. Louis.
  • Perspective
  • The scheduling task was administered to participants by an examiner.
  • Purpose
  • The Weekly Calendar Planning Activity (WCPA) is a performance-based measure of executive function. The examiner keeps track of time, observable strategy use, and adherence to rules of the task while providing distractions at planned intervals throughout the task.
  • Subtests
  • Level 2 of the WCPA was used.
  • The WCPA allows detection of complex task performance, strategy use, self-evaluation of performance, and error patterns, which translate into intervention strategies. The complexity of the task and the broad range of scores suggest that the WCPA may be useful in assessing even subtle executive functioning differences.
  • Relationships were found between number of entered appointments and task time, task time and number of strategies used, and number of strategies used and accuracy of entered appointments.
  • Results cannot be generalized to other populations until testing of a more representative sample of 16- to 21-yr-olds occurs.
  • The socioeconomic and race divide between testers and sample was a limitation, as was the fact that literacy issues may have been present in some of the sample. The students may have had no interest in the task, which could have affected performance.
  • Examiners were not blinded to condition of participants.
Table Footer NoteNote. ASD = autism spectrum disorder; DCD = developmental coordination disorder; M = mean; SD = standard deviation.
Note. ASD = autism spectrum disorder; DCD = developmental coordination disorder; M = mean; SD = standard deviation.×
×
Activity and Participation Instruments (2009–2013)
The 11 activity and participation instruments examine a range of activities from several perspectives. Three are performance based (Brossard-Racine et al., 2012; Josman, Goffer, & Rosenblum, 2010; Munkholm, Berg, Löfgren, & Fisher, 2010). The first, the School Version of the Assessment of Motor and Process Skills (School AMPS; Munkholm et al., 2010), is an observation of various aspects of school functioning and is performed in the classroom during the child’s regular routine. Similarly, the Do-Eat (Josman et al., 2010) evaluates the child’s performance of three activities of daily living (ADLs), instrumental activities of daily living (IADLs), and school activities and can be administered in any convenient environment. The third performance-based instrument, the Evaluation Tool of Children’s Handwriting–Manuscript (ETCH–M; Brossard-Racine et al., 2012), solely evaluates the performance of handwriting tasks. The School Function Assessment (SFA; Hwang & Davies, 2009), although not performance based, is an ecological test in which observation of participation and performance is conducted in the classroom.
The remaining seven tests are questionnaires, five from the child’s perspective and two from caregiver’s, teacher’s, or therapist’s perspective. Among those examining the child’s perspective, the McDonald Play Inventory (MPI; McDonald & Vigen, 2012) focuses solely on play, the Children’s Leisure Assessment Scale (CLASS; Rosenblum, Sachs, & Schreuer, 2010) evaluates leisure participation, the Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC; Potvin et al., 2013) assesses activities outside of school, and the Quality of Life in School Questionnaire (QoLS; Weintraub & Bar-Haim Erez, 2009) focuses on quality of life in school. The Child Occupational Self Assessment (COSA; Kramer et al., 2010) is a self-report questionnaire of competence and values of everyday activities. As mentioned earlier, the remaining two questionnaires are completed by caregivers. Similarly, the purpose of the Revised Pediatric Evaluation of Disability Inventory (PEDI–CAT; Kao et al., 2012) is to measure and understand the functional abilities of children and youth and is completed by the caregiver. The final caregiver questionnaire, the Sensory Experience Questionnaire (SEQ; Little et al., 2011), examines sensory-based observed behaviors.
Seven of the studies addressed cultural relevance, and 5 of those stated that the instruments adequately addressed it (Josman et al., 2010; Kao et al., 2012; Kramer et al., 2010; Munkholm et al., 2010; Rosenblum et al., 2010). See Table 3 at the end of this article for details.
Table 3.
Activity and Participation Instruments (2009–2012)
Activity and Participation Instruments (2009–2012)×
Measure (Author/Year)Frame of Reference and Theoretical ModelCultural RelevanceParticipantsPerspective, Purpose, and DescriptionTest Components and Item CategoriesPracticalityOutcome Measures
Child Occupational Self Assessment (Keller, Kafkes, Basu, Federico, & Kielhofner, 2005; Kramer, Kielhofner, & Smith, 2010)Model of Human Occupation (Kielhofner, 2008) Data were collected in the United States, United Kingdom, Iceland, Germany, and Switzerland and from people of several ethnicities.Children ages 7–17 with conditions such as autism, attention deficit hyperactivity disorder, expressive language delay, cerebral palsy, and intellectual disabilities
  • Perspective
  • Child questionnaire (a version is also available that the therapist can complete with the child)
  • Purpose
  • Self-report of occupational competence and value for everyday activities
  • Description
  • Measures the extent to which children feel they competently meet expectations and responsibilities associated with activities and the relative value of those activities. Also facilitates children’s involvement in the therapy process. The first two versions include visual cues. During performance, the therapist can reduce visual distractions, provide examples, and write on behalf of the child.
  • Test Components
  • 25 items that represent a range of everyday activities
  • Each item is rated using two rating scales: the occupational competence scale and the value scale. Each scale is a 4-stage scale. Higher scores represent better competence or value.
  • There are three means of administration:
  • 1. Standard pen and pencil with visual cues
  • 2. Card sort version
  • 3. Summary form of all items with no visual cues.
  • During administration, the child is guided to pick the category that best describes him or her and told that there is no right or wrong answer.
  • Item Categories
  • Competence and value
PracticalSelf-reports of competence and value
Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (King et al., 2004; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)Person–Environment–Occupation (Law et al., 1996)Not mentioned
  • Children with and without disabilities, 6–18 yr old
  • This study used the assessment with children with high-functioning autism
  • Perspective
  • Child interview. Children can be supported by an adult through adaptation when necessary. The test manual notes that for the factual questions, a parent may answer for the child.
  • Purpose
  • To estimate children’s participation outside of school; primarily a measure of recreational participation (46 out of 55 items)
  • Description
  • A self-rated measure of 55 items. Rating scales are specific to each dimension.
  • Test Components
  • Six dimensions of participation:
  • 1. Diversity (activities in which the child participates)
  • 2. Intensity (frequency of participation)
  • 3. Social aspect
  • 4. Where (the location the activity takes place)
  • 5. Child’s degree of enjoyment
  • 6. Preference (the child’s desire to participate).
  • Item Categories
  • • Recreational
  • • Physical
  • • Social
  • • Skill-based
  • • Self-improvement.
Self-report; short and can be used in many populationsA total score for each one of the 5 dimensions for each category, including scores for formal and informal activities
Children’s Leisure Assessment Scale (Rosenblum, Sachs, & Schreuer, 2010)Not mentionedMulticulturalSchool-age children
  • Perspective
  • Child questionnaire
  • Purpose
  • To measure multidimensional participation in children and adolescents. To document children’s perceptions about their ambitions regarding certain activities and those that they would like to undertake but have not.
  • Description
  • 40 questions examine 4 dimensions: type of activity; frequency; with whom you usually perform the activity; and how much you like it. Reference is also made to activities that the child would like to do.
  • Test Components
  • Quantitative and qualitative evaluation in 6 dimensions of participation: variety, frequency, sociability, performance, and time-consuming and desired activities
  • Activity Categories
  • • Instrumental
  • • Indoor games and sports
  • • Outdoor
  • • Self-enrichment.
Brief; takes about 15 min to complete
  • Variety (no. of activities in which the child was engaged), frequency, sociability, and preference
  • Additional Information
  • Time invested in 5 chosen activities that the child would like to perform
Do-Eat (Josman, Goffer, & Rosenblum, 2010)Ecological—administered in the child’s natural surroundings; based on both top-down and bottom-up approachesTasks are culturally relevantChildren with or at risk for DCD, ages 5–8 yr
  • Perspective
  • Therapist administration and caregiver questionnaire
  • Purpose
  • To evaluate relevant performance areas for children with DCD and to assist in establishing customized goals and objectives for intervention with these children
  • Description
  • The child is asked to perform 3 tasks while the parent completes a questionnaire. Scoring sheet; scores rated on a scale ranging from 1 (unsatisfactory performance) to 5 (very good performance). Cues are provided as needed according to hierarchical principles.
  • Test Components
  • • Prepare a sandwich.
  • • Prepare chocolate milk.
  • • Fill out a certificate of outstanding performance for him- or herself.
  • The parent questionnaire consists of 12 positive statements (e.g., “My child eats and drinks without getting dirty”).
  • Item Categories
  • Performance, sensory–motor skills, executive functions associated with task performance
Easy to obtainOverall task performance score, overall score analyzing sensory–motor skills, and overall score analyzing executive functions associated with task performance. Also provides total score (average of the 3 scores) and total score for the questionnaire.
Evaluation Tool of Children’s Handwriting (Amundson, 1995; Brossard-Racine, Mazer, Julien, & Majnemer, 2012)Ecological modelOnly for Latin alphabetChildren in Grades 1–3 (the study examined children in Grades 2–3)
  • Perspective
  • Therapist evaluation of the child’s product
  • Purpose
  • To examine legibility of handwriting
  • Description
  • The child has 7 different tasks (similar to those experienced in the classroom) to accomplish. Then the therapist scores the child’s performance, referring to legibility of letters, numerals, and words.
  • Test Components
  • • Legibility (specific criteria such as omission, closing, misplacing, reversion, and poor erasure)
  • • Performance time or writing speed
  • Item Categories
  • • Alphabet writing from memory
  • • Numeral writing from memory
  • • Near-point copying
  • • Far-point copying
  • • Dictation of nonwords
  • • Dictation of numbers
  • • Composition of short sentence.
Takes 30 min to administer; two versions: manuscript and cursiveTotal legibility score for letters, numerals, and words
McDonald Play Inventory (McDonald & Vigen, 2012)Not mentionedOne of the limitations of this research includes the lack of generalization to children from lower socioeconomic backgrounds or other geographic areas.7- to 11-yr-old children with neurotypical development and with known learning and developmental disabilities
  • Perspective
  • Child self-report questionnaire
  • Purpose
  • To measure play activities and play styles
  • Description
  • The McDonald Play Activity Inventory measures the child’s perceived frequency of engagement in play; the McDonald Play Style Inventory measures the types and frequencies of play behaviors. In Part 1, the child is asked to rate how frequently he or she participates in the 40 play activities in 4 categories. In Part 2, the child rates 24 play behavior items, 12 neutral play activity items, and 4 “lie” or social desirability items on a 5-point Likert scale.
  • Test Components
  • Play activity frequency and play behavior
  • Item Categories
  • • Fine motor
  • • Gross motor
  • • Social group
  • • Solitary or passive
  • • Physical coordination
  • • Cooperation
  • • Peer acceptance
  • • Social participation.
Can be completed in 15–30 minScores for each of the scales (categories) and two total scores for the two inventories
Quality of Life in School Questionnaire (Weintraub & Bar-Haim Erez, 2009)Client-centered approach, biopsychosocial model (World Health Organization, 2001), Person–Environment–Occupation model (Christiansen, Baum, & Bass-Haugen, 2005; Law et al., 1996)Stated that quality of life (QoL) may be influenced by cultural background and recommended carrying out cross-cultural studiesElementary school students in Grades 3–6
  • Perspective
  • Child questionnaire
  • Purpose
  • To examine children’s perception of their QoL at school
  • Description
  • 36 items; each item is scored on a 4-point scale
  • Test Components
  • • Teacher–student relationship and school activities
  • • Physical environment of the school and the classroom
  • • Negative feelings toward school
  • • Positive feelings toward school.
BriefMean score for each of the 4 categories (factors) and total score
Revised Pediatric Evaluation of Disability Inventory(Haley & Coster, 2010)Not mentionedParticipants were representative of the ethnic distribution of the 2000 U.S. census.Infants, children, and youths from birth to age 20 yr
  • Perspective
  • Caregiver questionnaire
  • Purpose
  • To measure and understand the functional abilities of children and youth with autism spectrum disorders (ASD) and to capture the functional strengths of children with disabilities, including those with ASD
  • Description
  • • 4-point rating scale of daily activities and social–cognitive domains
  • • 5-point rating scale for the responsibility domain
  • Test Components
  • Daily activities (68 items):
  • • Eating and mealtime
  • • Getting dressed
  • • Keeping clean
  • • Home tasks
  • Social–cognitive (60 items):
  • • Interaction
  • • Communication
  • • Everyday cognition
  • • Self-management
  • • Responsibility (51 items):
    • ○ Organization and planning
    • ○ Taking care of daily needs
    • ○ Health management
    • ○ Staying safe.
  • Item Categories
  • 4 domains:
  • • Daily activities
  • • Social–cognitive
  • • Mobility
  • • Responsibility.
Computer-adaptive test
  • Total score (mean) for each domain:
  • • Daily activities
  • • Social–cognitive
  • • Mobility
  • • Responsibility
School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998; Hwang & Davies, 2009)Not mentioned, but consistent with ecological modelNot mentionedElementary school children
  • Perspective
  • Teacher or therapist questionnaire
  • Purpose
  • To measure the wide spectrum of school-related functional tasks associated with the role of an elementary school child and to guide students with special needs
  • Description
  • This study used 18 scales (of 21) with 266 items. Each item is scored on a 4-point rating scale (1 = does not perform, 4 = consistent performance). The scales are hierarchically ordered from easy to difficult.
  • Test Components
  • Nine cognitive–behavioral task scales and 9 physical task scales
  • Item Categories
  • There is a rating scale guide.
  • • Travel
  • • Maintaining and changing position
  • • Recreational movement
  • • Manipulation with movement
  • • Using materials
  • • Setup and cleanup
  • • Eating and drinking
  • • Hygiene
  • • Clothing management
  • • Functional communication
  • • Memory and understanding
  • • Following social conventions
  • • Compliance with adult directives
  • • Task behavior
  • • Positive interaction
  • • Behavior regulation
  • • Personal care
  • • Awareness and safety.
Very detailed; takes time to administerA score for each scale allows therapist or teacher to identify areas of particular limitation or strength and to identify specific functional tasks that are difficult for the student.
School Version of the Assessment of Motor and Process Skills (Fisher, Bryze, Hume, & Griswold, 2007; Munkholm, Berg, Löfgren, & Fisher, 2010)Ecological—the natural classroom setting; performance-basedFree of bias associated with world regionStudents ages 3–17; differentiated between typically developing students and students with disability (at risk, mild, developmental and neurological, cognitive, and psychological and other multiple diagnoses)
  • Perspective
  • Therapist and teacher (interview). Therapist interviews the teacher first and then observes the student in class during normal routines.
  • Purpose
  • To measure the quality of schoolwork task performance as it is observed in the natural classroom setting
  • Description
  • The therapist observes the student while the student completes 2 schoolwork tasks given by the teacher and takes observational notes that he or she later uses to score the quality of performance.
  • Test Components
  • School motor skills:
  • • Body position
  • • Obtaining and holding objects
  • • Moving self and object
  • • Sustaining performance.
  • School process skills:
  • • Sustaining performance
  • • Applying knowledge
  • • Temporal organization
  • • Organizing space and objects
  • • Adapting performance.
  • Item Categories
  • 1. Pen-and-pencil writing tasks
  • 2. Drawing and coloring tasks
  • 3. Cutting and pasting tasks
  • 4. Computer writing tasks
  • 5. Math manipulative tasks.
Assessment requires a computer scoring program
  • Two linear quality-of-performance measures:
  • 1. School motor quality of performance
  • 2. School process quality of performance
Sensory Experiences Questionnaire (Baranek, David, Poe, Stone, & Watson, 2006; Little et al., 2011)Not mentionedNot mentionedYoung children (5–72 mo) with autism and developmental delays
  • Perspective
  • Caregiver questionnaire
  • Purpose
  • To identify sensory processing patterns in the context of daily activities.
  • The items are rated on a 5-point Likert scale (1 = almost never to 5 = almost always)
  • Description
  • Higher scores are indicative of more sensory processing problems. In addition, there are qualitative questions regarding parent compensatory strategies used in response.
  • Test Components
  • 4 scales:
  • 1. Hyperresponsiveness
  • 2. Hyporesponsiveness
  • 3. Social
  • 4. Nonsocial.
  • Item Categories
  • The items reflect 5 sensory domains:
  • 1. Tactile
  • 2. Auditory
  • 3. Visual
  • 4. Vestibular–proprioceptive
  • 5. Gustatory–olfactory.
Brief (10–15 min)4 dimensional subscale scores and a total score
Table Footer NoteNote. DCD = developmental coordination disorder; SD = standard deviation.
Note. DCD = developmental coordination disorder; SD = standard deviation.×
Table 3.
Activity and Participation Instruments (2009–2012)
Activity and Participation Instruments (2009–2012)×
Measure (Author/Year)Frame of Reference and Theoretical ModelCultural RelevanceParticipantsPerspective, Purpose, and DescriptionTest Components and Item CategoriesPracticalityOutcome Measures
Child Occupational Self Assessment (Keller, Kafkes, Basu, Federico, & Kielhofner, 2005; Kramer, Kielhofner, & Smith, 2010)Model of Human Occupation (Kielhofner, 2008) Data were collected in the United States, United Kingdom, Iceland, Germany, and Switzerland and from people of several ethnicities.Children ages 7–17 with conditions such as autism, attention deficit hyperactivity disorder, expressive language delay, cerebral palsy, and intellectual disabilities
  • Perspective
  • Child questionnaire (a version is also available that the therapist can complete with the child)
  • Purpose
  • Self-report of occupational competence and value for everyday activities
  • Description
  • Measures the extent to which children feel they competently meet expectations and responsibilities associated with activities and the relative value of those activities. Also facilitates children’s involvement in the therapy process. The first two versions include visual cues. During performance, the therapist can reduce visual distractions, provide examples, and write on behalf of the child.
  • Test Components
  • 25 items that represent a range of everyday activities
  • Each item is rated using two rating scales: the occupational competence scale and the value scale. Each scale is a 4-stage scale. Higher scores represent better competence or value.
  • There are three means of administration:
  • 1. Standard pen and pencil with visual cues
  • 2. Card sort version
  • 3. Summary form of all items with no visual cues.
  • During administration, the child is guided to pick the category that best describes him or her and told that there is no right or wrong answer.
  • Item Categories
  • Competence and value
PracticalSelf-reports of competence and value
Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (King et al., 2004; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)Person–Environment–Occupation (Law et al., 1996)Not mentioned
  • Children with and without disabilities, 6–18 yr old
  • This study used the assessment with children with high-functioning autism
  • Perspective
  • Child interview. Children can be supported by an adult through adaptation when necessary. The test manual notes that for the factual questions, a parent may answer for the child.
  • Purpose
  • To estimate children’s participation outside of school; primarily a measure of recreational participation (46 out of 55 items)
  • Description
  • A self-rated measure of 55 items. Rating scales are specific to each dimension.
  • Test Components
  • Six dimensions of participation:
  • 1. Diversity (activities in which the child participates)
  • 2. Intensity (frequency of participation)
  • 3. Social aspect
  • 4. Where (the location the activity takes place)
  • 5. Child’s degree of enjoyment
  • 6. Preference (the child’s desire to participate).
  • Item Categories
  • • Recreational
  • • Physical
  • • Social
  • • Skill-based
  • • Self-improvement.
Self-report; short and can be used in many populationsA total score for each one of the 5 dimensions for each category, including scores for formal and informal activities
Children’s Leisure Assessment Scale (Rosenblum, Sachs, & Schreuer, 2010)Not mentionedMulticulturalSchool-age children
  • Perspective
  • Child questionnaire
  • Purpose
  • To measure multidimensional participation in children and adolescents. To document children’s perceptions about their ambitions regarding certain activities and those that they would like to undertake but have not.
  • Description
  • 40 questions examine 4 dimensions: type of activity; frequency; with whom you usually perform the activity; and how much you like it. Reference is also made to activities that the child would like to do.
  • Test Components
  • Quantitative and qualitative evaluation in 6 dimensions of participation: variety, frequency, sociability, performance, and time-consuming and desired activities
  • Activity Categories
  • • Instrumental
  • • Indoor games and sports
  • • Outdoor
  • • Self-enrichment.
Brief; takes about 15 min to complete
  • Variety (no. of activities in which the child was engaged), frequency, sociability, and preference
  • Additional Information
  • Time invested in 5 chosen activities that the child would like to perform
Do-Eat (Josman, Goffer, & Rosenblum, 2010)Ecological—administered in the child’s natural surroundings; based on both top-down and bottom-up approachesTasks are culturally relevantChildren with or at risk for DCD, ages 5–8 yr
  • Perspective
  • Therapist administration and caregiver questionnaire
  • Purpose
  • To evaluate relevant performance areas for children with DCD and to assist in establishing customized goals and objectives for intervention with these children
  • Description
  • The child is asked to perform 3 tasks while the parent completes a questionnaire. Scoring sheet; scores rated on a scale ranging from 1 (unsatisfactory performance) to 5 (very good performance). Cues are provided as needed according to hierarchical principles.
  • Test Components
  • • Prepare a sandwich.
  • • Prepare chocolate milk.
  • • Fill out a certificate of outstanding performance for him- or herself.
  • The parent questionnaire consists of 12 positive statements (e.g., “My child eats and drinks without getting dirty”).
  • Item Categories
  • Performance, sensory–motor skills, executive functions associated with task performance
Easy to obtainOverall task performance score, overall score analyzing sensory–motor skills, and overall score analyzing executive functions associated with task performance. Also provides total score (average of the 3 scores) and total score for the questionnaire.
Evaluation Tool of Children’s Handwriting (Amundson, 1995; Brossard-Racine, Mazer, Julien, & Majnemer, 2012)Ecological modelOnly for Latin alphabetChildren in Grades 1–3 (the study examined children in Grades 2–3)
  • Perspective
  • Therapist evaluation of the child’s product
  • Purpose
  • To examine legibility of handwriting
  • Description
  • The child has 7 different tasks (similar to those experienced in the classroom) to accomplish. Then the therapist scores the child’s performance, referring to legibility of letters, numerals, and words.
  • Test Components
  • • Legibility (specific criteria such as omission, closing, misplacing, reversion, and poor erasure)
  • • Performance time or writing speed
  • Item Categories
  • • Alphabet writing from memory
  • • Numeral writing from memory
  • • Near-point copying
  • • Far-point copying
  • • Dictation of nonwords
  • • Dictation of numbers
  • • Composition of short sentence.
Takes 30 min to administer; two versions: manuscript and cursiveTotal legibility score for letters, numerals, and words
McDonald Play Inventory (McDonald & Vigen, 2012)Not mentionedOne of the limitations of this research includes the lack of generalization to children from lower socioeconomic backgrounds or other geographic areas.7- to 11-yr-old children with neurotypical development and with known learning and developmental disabilities
  • Perspective
  • Child self-report questionnaire
  • Purpose
  • To measure play activities and play styles
  • Description
  • The McDonald Play Activity Inventory measures the child’s perceived frequency of engagement in play; the McDonald Play Style Inventory measures the types and frequencies of play behaviors. In Part 1, the child is asked to rate how frequently he or she participates in the 40 play activities in 4 categories. In Part 2, the child rates 24 play behavior items, 12 neutral play activity items, and 4 “lie” or social desirability items on a 5-point Likert scale.
  • Test Components
  • Play activity frequency and play behavior
  • Item Categories
  • • Fine motor
  • • Gross motor
  • • Social group
  • • Solitary or passive
  • • Physical coordination
  • • Cooperation
  • • Peer acceptance
  • • Social participation.
Can be completed in 15–30 minScores for each of the scales (categories) and two total scores for the two inventories
Quality of Life in School Questionnaire (Weintraub & Bar-Haim Erez, 2009)Client-centered approach, biopsychosocial model (World Health Organization, 2001), Person–Environment–Occupation model (Christiansen, Baum, & Bass-Haugen, 2005; Law et al., 1996)Stated that quality of life (QoL) may be influenced by cultural background and recommended carrying out cross-cultural studiesElementary school students in Grades 3–6
  • Perspective
  • Child questionnaire
  • Purpose
  • To examine children’s perception of their QoL at school
  • Description
  • 36 items; each item is scored on a 4-point scale
  • Test Components
  • • Teacher–student relationship and school activities
  • • Physical environment of the school and the classroom
  • • Negative feelings toward school
  • • Positive feelings toward school.
BriefMean score for each of the 4 categories (factors) and total score
Revised Pediatric Evaluation of Disability Inventory(Haley & Coster, 2010)Not mentionedParticipants were representative of the ethnic distribution of the 2000 U.S. census.Infants, children, and youths from birth to age 20 yr
  • Perspective
  • Caregiver questionnaire
  • Purpose
  • To measure and understand the functional abilities of children and youth with autism spectrum disorders (ASD) and to capture the functional strengths of children with disabilities, including those with ASD
  • Description
  • • 4-point rating scale of daily activities and social–cognitive domains
  • • 5-point rating scale for the responsibility domain
  • Test Components
  • Daily activities (68 items):
  • • Eating and mealtime
  • • Getting dressed
  • • Keeping clean
  • • Home tasks
  • Social–cognitive (60 items):
  • • Interaction
  • • Communication
  • • Everyday cognition
  • • Self-management
  • • Responsibility (51 items):
    • ○ Organization and planning
    • ○ Taking care of daily needs
    • ○ Health management
    • ○ Staying safe.
  • Item Categories
  • 4 domains:
  • • Daily activities
  • • Social–cognitive
  • • Mobility
  • • Responsibility.
Computer-adaptive test
  • Total score (mean) for each domain:
  • • Daily activities
  • • Social–cognitive
  • • Mobility
  • • Responsibility
School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998; Hwang & Davies, 2009)Not mentioned, but consistent with ecological modelNot mentionedElementary school children
  • Perspective
  • Teacher or therapist questionnaire
  • Purpose
  • To measure the wide spectrum of school-related functional tasks associated with the role of an elementary school child and to guide students with special needs
  • Description
  • This study used 18 scales (of 21) with 266 items. Each item is scored on a 4-point rating scale (1 = does not perform, 4 = consistent performance). The scales are hierarchically ordered from easy to difficult.
  • Test Components
  • Nine cognitive–behavioral task scales and 9 physical task scales
  • Item Categories
  • There is a rating scale guide.
  • • Travel
  • • Maintaining and changing position
  • • Recreational movement
  • • Manipulation with movement
  • • Using materials
  • • Setup and cleanup
  • • Eating and drinking
  • • Hygiene
  • • Clothing management
  • • Functional communication
  • • Memory and understanding
  • • Following social conventions
  • • Compliance with adult directives
  • • Task behavior
  • • Positive interaction
  • • Behavior regulation
  • • Personal care
  • • Awareness and safety.
Very detailed; takes time to administerA score for each scale allows therapist or teacher to identify areas of particular limitation or strength and to identify specific functional tasks that are difficult for the student.
School Version of the Assessment of Motor and Process Skills (Fisher, Bryze, Hume, & Griswold, 2007; Munkholm, Berg, Löfgren, & Fisher, 2010)Ecological—the natural classroom setting; performance-basedFree of bias associated with world regionStudents ages 3–17; differentiated between typically developing students and students with disability (at risk, mild, developmental and neurological, cognitive, and psychological and other multiple diagnoses)
  • Perspective
  • Therapist and teacher (interview). Therapist interviews the teacher first and then observes the student in class during normal routines.
  • Purpose
  • To measure the quality of schoolwork task performance as it is observed in the natural classroom setting
  • Description
  • The therapist observes the student while the student completes 2 schoolwork tasks given by the teacher and takes observational notes that he or she later uses to score the quality of performance.
  • Test Components
  • School motor skills:
  • • Body position
  • • Obtaining and holding objects
  • • Moving self and object
  • • Sustaining performance.
  • School process skills:
  • • Sustaining performance
  • • Applying knowledge
  • • Temporal organization
  • • Organizing space and objects
  • • Adapting performance.
  • Item Categories
  • 1. Pen-and-pencil writing tasks
  • 2. Drawing and coloring tasks
  • 3. Cutting and pasting tasks
  • 4. Computer writing tasks
  • 5. Math manipulative tasks.
Assessment requires a computer scoring program
  • Two linear quality-of-performance measures:
  • 1. School motor quality of performance
  • 2. School process quality of performance
Sensory Experiences Questionnaire (Baranek, David, Poe, Stone, & Watson, 2006; Little et al., 2011)Not mentionedNot mentionedYoung children (5–72 mo) with autism and developmental delays
  • Perspective
  • Caregiver questionnaire
  • Purpose
  • To identify sensory processing patterns in the context of daily activities.
  • The items are rated on a 5-point Likert scale (1 = almost never to 5 = almost always)
  • Description
  • Higher scores are indicative of more sensory processing problems. In addition, there are qualitative questions regarding parent compensatory strategies used in response.
  • Test Components
  • 4 scales:
  • 1. Hyperresponsiveness
  • 2. Hyporesponsiveness
  • 3. Social
  • 4. Nonsocial.
  • Item Categories
  • The items reflect 5 sensory domains:
  • 1. Tactile
  • 2. Auditory
  • 3. Visual
  • 4. Vestibular–proprioceptive
  • 5. Gustatory–olfactory.
Brief (10–15 min)4 dimensional subscale scores and a total score
Table Footer NoteNote. DCD = developmental coordination disorder; SD = standard deviation.
Note. DCD = developmental coordination disorder; SD = standard deviation.×
×
Analyzing the Tests From the Psychometric Point of View
Munkholm et al. (2010)  evaluated the School AMPS for significant differential item functioning (DIF) and differential test functioning (DTF) and concluded that the instrument is valid when used in different regions of the world. Other studies examining well-established instruments evaluated the CAPE/PAC (Potvin et al., 2013), COSA (Kramer et al., 2010), MPI (McDonald & Vigen, 2012), and SFA (Hwang & Davies, 2009). These four articles reported research regarding the validity of the instruments, whereas test–retest reliability was reported only for the CAPE/PAC and MPI. The Do-Eat (Josman et al., 2010) and CLASS (Rosenblum et al., 2010) were both in the early stages of development with recommendations for further studies with additional populations and age groups. Nevertheless, both studies established reliability and validity. The current studies are the only ones published related to these instruments, other than the Do-Eat manual. Additionally, Weintraub and Bar-Haim Erez (2009)  established the construct validity of the QoLS, yet mentioned no reliability details. In contrast to all of the other studies reviewed, no gender differences were found for the QoLS. Th PEDI–CAT authors described good levels of reliability and validity, although the studies conducted have not yet been published. Both the SEQ (Little et al., 2011) and ETCH–M (Brossard-Racine et al., 2012) are at the initial stages and require further research to establish validity (see Table 4 at the end of this article for more details).
Table 4.
Psychometric Comparison of Activity and Participation Instruments (2009–2012)
Psychometric Comparison of Activity and Participation Instruments (2009–2012)×
InstrumentReliability StudiesValidity StudiesCoding: Scale and Scoring
Child Occupational Self Assessment (Keller, Kafkes, Basu, Federico, & Kielhofner, 2005; Kramer, Kielhofner, & Smith, 2010)Not mentioned
  • Content and Structural Validity
  • An earlier version found 2 and 4 items that had poor fit to the model. This study found only 1 item.
  • Substantive Validity
  • On both scales, >85% of children responded in a consistent manner. Also, as in previous studies, the theoretically meaningful item hierarchies provided further evidence.
  • External Validity
  • Mixed support was found.
Description and visual example
Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC; King et al., 2004; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)
  • Test–Retest Reliability
  • This study, similar to previous studies, found test–retest reliability >.70 except for the social aspect dimension, which was low (r = .196), unlike in previous studies.
  • Reliability was further estimated as parents agreed with the majority of their children’s self-ratings on this assessment.
  • Content Validity (whether the CAPE/PAC was reflective of activities that children with high-functioning autism participate in and thus valid to the population)
  • The 55 activities appeared to cover the recreational activities in which the children with high-functioning autism participate (according to interviews with the children in the study).
Description and visual example
Children’s Leisure Assessment Scale (Rosenblum, Sachs, & Schreuer, 2010)
  • Internal Reliability
  • Cronbach’s αs = .57–.83.
  • Content and Face Validity
  • The questionnaire was reviewed by expert consultants, parents, and children.
  • Construct Validity
  • Construct validity is evident from the gender distinction found in the study and by its 4 domains.
  • Internal Validity
  • α = .71
  • Factor Analysis
  • As a result of factor analysis, 10 activities were eliminated.
Cursory description, no visual or detailed examples
Do-Eat (Josman, Goffer, & Rosenblum, 2010)
  • Internal Consistency
  • αs = .89–.93 for both the Do-Eat (for each of the 3 components) and the parent questionnaire.
  • Interrater Reliability
  • 2 experienced occupational therapists viewed a videotape of a child performing the Do-Eat and rated performance (rs = .92–1.00)
  • Test–Retest Reliability
  • A study is being conducted.
  • Discriminant Validity
  • Recent research found discriminant validity among 3 age groups and both genders of typically developing children.
  • Construct Validity
  • The Do-Eat distinguished between children with developmental coordination disorder and typically developing children, as demonstrated by significant between-groups differences on the Do-Eat (t = 14.09, p < .001, df = 57) and the parent questionnaire (t = 3.64, p < .001, df = 57).
  • Concurrent Validity
  • Significant correlations were found between the Do-Eat and the Movement Assessment Battery for Children final score (r = −.86, p < .001).
  • Content and Face Validity
  • On the basis of interviewing teachers and parents, observing children, and analysis of functional tools, the content was validated by 5 expert consultants and 5 experienced occupational therapists.
  • Future studies are recommended in different ages and populations.
Detailed description, written and visual examples
Evaluation Tool of Children’s Handwriting (ETCH; Amundson, 1995; Brossard-Racine, Mazer, Julien, & Majnemer, 2012)
  • Test–Retest Reliability
  • r = .63 for total legibility, r = .77 for total letter legibility, r = .71 for total word legibility
  • Interrater Reliability
  • ICCs ranged from .42 to .84 for the individual items on the ETCH–Manuscript for children referred to occupational therapy. The current study also found weak interrater reliability (ICC = .19).
  • Content Validity
  • Established in 3 pilot editions.
  • Concurrent Validity
  • This validity has been questioned; one study found that the assessment was not sensitive enough to identify difficulties experienced by the children’s teacher; another unpublished study provided opposite evidence for second-grade children. No cutoff value has been published. According to the occupational therapists in this study, 75% total word legibility and 76% total letter legibility discriminated between children with and without handwriting difficulties (the manual suggest higher cutoff scores).
Cursory description; no visual or detailed examples
McDonald Play Inventory (McDonald & Vigen; 2012)
  • Internal Consistency
  • First pilot research found internal consistency of .87 and .83; in this research, the values were .84 and .79 for the McDonald Play Activity Inventory (MPAI) and the McDonald Play Style Inventory (MPSI), respectively.
  • Test–Retest Reliability
  • .69 for the MPAI and .82 for the MPSI (the original study, in 1992, found similar values).
  • Factor Analysis
  • Moderate to strong correlations (.47–.81) were found between each subscale and total scale score. The intercorrelation between the subscales ranged from low (<.25) to moderate (.50–.71). The intercorrelation between the total inventory scores fell in the moderate range (.49).
  • Construct Validity
  • No statistically significant differences were found by gender or between groups (disabled and nondisabled) on the MPAI total inventory or subscale. Significant differences were reported in the total score of the MPSI (p = .002), cooperation (p = .01), peer acceptance (p = .002), social participation (p = .003), and physical coordination (p = .003).
  • Significant difference on social participation (p = .02) was found in the analyses of the mean differences between children with ASD and neurotypical children. Significant differences were also found between age groups.
  • Concurrent Validity
  • The child’s self-rating was compared with the parent’s rating. Low to moderate correlations were found for some of the subscales.
Detailed description; written example; no visual example
Quality of Life in Schools (Weintraub & Bar-Haim Erez, 2009)Not mentioned
  • Construct Validity
  • Validity was tested in two versions. In the initial version, 3 factors were identified; 2 were divided into 2. At the end, Cronbach’s αs were .717–.853. In the second version, Cronbach’s αs were .68–.91 for the factors and .88 for the total score. Significant medium to high correlation with each of the categories (.51 < r < .69) were found. Post hoc analysis indicated that students in Grade 3 perceived their school quality of life to be significantly better than did students in Grades 4–6 (.00 < r < .01) for all categories and total score. The study found no gender differences, in contrast to other studies.
Detailed description; no visual or detailed examples
Revised Pediatric Evaluation of Disability Inventory (Haley & Coster, 2010)
  • Discriminant Validity
  • An earlier study, not yet published (Dumas et al., 2012), found good discriminant validity. In the social–cognitive domain, significant differences were found between children with ASD and children without disabilities at ages 10 and 15 yr (p < .01). All other differences were not significant. In the responsibility domain, significant differences were found between children with ASD and children without disabilities at ages 10 and 15 yr. Other differences were not significant.
Cursory description; written examples in a table at the end of the article
School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998; Hwang & Davies, 2009)Several studies are mentioned without details.
  • Several studies are mentioned without details. Evidence of reliability and validity in these studies was frequently based on analyses of the summed criterion or raw scores of the scale rather than a scrutiny of individual item rating.
  • Internal Construct Validity
  • Internal validity was supported for 15 of the 18 scales.
  • Construct Validity
  • Of 266 items, 252 met the criterion set for Rasch goodness-of-fit statistics. Three scales were found to be unidimensional, measuring a single construct. The study also found a reliable hierarchical pattern of the assessment.
No description; no visual example; no detailed examples
School Version of the Assessment of Motor and Process Skills (Fisher, Bryze, Hume, & Griswold, 2007; Munkholm, Berg, Löfgren, & Fisher, 2010)Not mentionedThe study evaluated the cross-regional differential item functioning (DIF) to prove its validity. Preliminary results proved its validity for some regions, and the purpose of this study was to extend these results. Minimal DIF was found in 3 school motor items and 1 school process item, but in general all school motor and school process items remained free of DIF: from .33 to −.30 logit (SE = .06–.12 logit) on the School Motor Scale and from .28 to −.31 logit (SE = .05–.07) on the School Process Scale. In addition, the study evaluated whether DIF leads to differential test functioning and proved there is no significant difference in total scores of different regions.Detailed description; detailed written examples
Sensory Experience Questionnaire (Baranek, David, Poe, Stone, & Watson, 2006; Little et al., 2011)
  • Test–Retest Reliability for Total Score
  • ICC = .92 (with differences between different items)
  • Internal Consistency
  • .80 (with differences between different items).
  • Previous studies mentioned with no details.
Authors mention that future research is needed to further validate the questionnaire.Detailed description; written example; no visual example
Table Footer NoteNote. ASD = autism spectrum disorder; ICC = intraclass correlation coefficient; SE = standard error.
Note. ASD = autism spectrum disorder; ICC = intraclass correlation coefficient; SE = standard error.×
Table 4.
Psychometric Comparison of Activity and Participation Instruments (2009–2012)
Psychometric Comparison of Activity and Participation Instruments (2009–2012)×
InstrumentReliability StudiesValidity StudiesCoding: Scale and Scoring
Child Occupational Self Assessment (Keller, Kafkes, Basu, Federico, & Kielhofner, 2005; Kramer, Kielhofner, & Smith, 2010)Not mentioned
  • Content and Structural Validity
  • An earlier version found 2 and 4 items that had poor fit to the model. This study found only 1 item.
  • Substantive Validity
  • On both scales, >85% of children responded in a consistent manner. Also, as in previous studies, the theoretically meaningful item hierarchies provided further evidence.
  • External Validity
  • Mixed support was found.
Description and visual example
Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC; King et al., 2004; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)
  • Test–Retest Reliability
  • This study, similar to previous studies, found test–retest reliability >.70 except for the social aspect dimension, which was low (r = .196), unlike in previous studies.
  • Reliability was further estimated as parents agreed with the majority of their children’s self-ratings on this assessment.
  • Content Validity (whether the CAPE/PAC was reflective of activities that children with high-functioning autism participate in and thus valid to the population)
  • The 55 activities appeared to cover the recreational activities in which the children with high-functioning autism participate (according to interviews with the children in the study).
Description and visual example
Children’s Leisure Assessment Scale (Rosenblum, Sachs, & Schreuer, 2010)
  • Internal Reliability
  • Cronbach’s αs = .57–.83.
  • Content and Face Validity
  • The questionnaire was reviewed by expert consultants, parents, and children.
  • Construct Validity
  • Construct validity is evident from the gender distinction found in the study and by its 4 domains.
  • Internal Validity
  • α = .71
  • Factor Analysis
  • As a result of factor analysis, 10 activities were eliminated.
Cursory description, no visual or detailed examples
Do-Eat (Josman, Goffer, & Rosenblum, 2010)
  • Internal Consistency
  • αs = .89–.93 for both the Do-Eat (for each of the 3 components) and the parent questionnaire.
  • Interrater Reliability
  • 2 experienced occupational therapists viewed a videotape of a child performing the Do-Eat and rated performance (rs = .92–1.00)
  • Test–Retest Reliability
  • A study is being conducted.
  • Discriminant Validity
  • Recent research found discriminant validity among 3 age groups and both genders of typically developing children.
  • Construct Validity
  • The Do-Eat distinguished between children with developmental coordination disorder and typically developing children, as demonstrated by significant between-groups differences on the Do-Eat (t = 14.09, p < .001, df = 57) and the parent questionnaire (t = 3.64, p < .001, df = 57).
  • Concurrent Validity
  • Significant correlations were found between the Do-Eat and the Movement Assessment Battery for Children final score (r = −.86, p < .001).
  • Content and Face Validity
  • On the basis of interviewing teachers and parents, observing children, and analysis of functional tools, the content was validated by 5 expert consultants and 5 experienced occupational therapists.
  • Future studies are recommended in different ages and populations.
Detailed description, written and visual examples
Evaluation Tool of Children’s Handwriting (ETCH; Amundson, 1995; Brossard-Racine, Mazer, Julien, & Majnemer, 2012)
  • Test–Retest Reliability
  • r = .63 for total legibility, r = .77 for total letter legibility, r = .71 for total word legibility
  • Interrater Reliability
  • ICCs ranged from .42 to .84 for the individual items on the ETCH–Manuscript for children referred to occupational therapy. The current study also found weak interrater reliability (ICC = .19).
  • Content Validity
  • Established in 3 pilot editions.
  • Concurrent Validity
  • This validity has been questioned; one study found that the assessment was not sensitive enough to identify difficulties experienced by the children’s teacher; another unpublished study provided opposite evidence for second-grade children. No cutoff value has been published. According to the occupational therapists in this study, 75% total word legibility and 76% total letter legibility discriminated between children with and without handwriting difficulties (the manual suggest higher cutoff scores).
Cursory description; no visual or detailed examples
McDonald Play Inventory (McDonald & Vigen; 2012)
  • Internal Consistency
  • First pilot research found internal consistency of .87 and .83; in this research, the values were .84 and .79 for the McDonald Play Activity Inventory (MPAI) and the McDonald Play Style Inventory (MPSI), respectively.
  • Test–Retest Reliability
  • .69 for the MPAI and .82 for the MPSI (the original study, in 1992, found similar values).
  • Factor Analysis
  • Moderate to strong correlations (.47–.81) were found between each subscale and total scale score. The intercorrelation between the subscales ranged from low (<.25) to moderate (.50–.71). The intercorrelation between the total inventory scores fell in the moderate range (.49).
  • Construct Validity
  • No statistically significant differences were found by gender or between groups (disabled and nondisabled) on the MPAI total inventory or subscale. Significant differences were reported in the total score of the MPSI (p = .002), cooperation (p = .01), peer acceptance (p = .002), social participation (p = .003), and physical coordination (p = .003).
  • Significant difference on social participation (p = .02) was found in the analyses of the mean differences between children with ASD and neurotypical children. Significant differences were also found between age groups.
  • Concurrent Validity
  • The child’s self-rating was compared with the parent’s rating. Low to moderate correlations were found for some of the subscales.
Detailed description; written example; no visual example
Quality of Life in Schools (Weintraub & Bar-Haim Erez, 2009)Not mentioned
  • Construct Validity
  • Validity was tested in two versions. In the initial version, 3 factors were identified; 2 were divided into 2. At the end, Cronbach’s αs were .717–.853. In the second version, Cronbach’s αs were .68–.91 for the factors and .88 for the total score. Significant medium to high correlation with each of the categories (.51 < r < .69) were found. Post hoc analysis indicated that students in Grade 3 perceived their school quality of life to be significantly better than did students in Grades 4–6 (.00 < r < .01) for all categories and total score. The study found no gender differences, in contrast to other studies.
Detailed description; no visual or detailed examples
Revised Pediatric Evaluation of Disability Inventory (Haley & Coster, 2010)
  • Discriminant Validity
  • An earlier study, not yet published (Dumas et al., 2012), found good discriminant validity. In the social–cognitive domain, significant differences were found between children with ASD and children without disabilities at ages 10 and 15 yr (p < .01). All other differences were not significant. In the responsibility domain, significant differences were found between children with ASD and children without disabilities at ages 10 and 15 yr. Other differences were not significant.
Cursory description; written examples in a table at the end of the article
School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998; Hwang & Davies, 2009)Several studies are mentioned without details.
  • Several studies are mentioned without details. Evidence of reliability and validity in these studies was frequently based on analyses of the summed criterion or raw scores of the scale rather than a scrutiny of individual item rating.
  • Internal Construct Validity
  • Internal validity was supported for 15 of the 18 scales.
  • Construct Validity
  • Of 266 items, 252 met the criterion set for Rasch goodness-of-fit statistics. Three scales were found to be unidimensional, measuring a single construct. The study also found a reliable hierarchical pattern of the assessment.
No description; no visual example; no detailed examples
School Version of the Assessment of Motor and Process Skills (Fisher, Bryze, Hume, & Griswold, 2007; Munkholm, Berg, Löfgren, & Fisher, 2010)Not mentionedThe study evaluated the cross-regional differential item functioning (DIF) to prove its validity. Preliminary results proved its validity for some regions, and the purpose of this study was to extend these results. Minimal DIF was found in 3 school motor items and 1 school process item, but in general all school motor and school process items remained free of DIF: from .33 to −.30 logit (SE = .06–.12 logit) on the School Motor Scale and from .28 to −.31 logit (SE = .05–.07) on the School Process Scale. In addition, the study evaluated whether DIF leads to differential test functioning and proved there is no significant difference in total scores of different regions.Detailed description; detailed written examples
Sensory Experience Questionnaire (Baranek, David, Poe, Stone, & Watson, 2006; Little et al., 2011)
  • Test–Retest Reliability for Total Score
  • ICC = .92 (with differences between different items)
  • Internal Consistency
  • .80 (with differences between different items).
  • Previous studies mentioned with no details.
Authors mention that future research is needed to further validate the questionnaire.Detailed description; written example; no visual example
Table Footer NoteNote. ASD = autism spectrum disorder; ICC = intraclass correlation coefficient; SE = standard error.
Note. ASD = autism spectrum disorder; ICC = intraclass correlation coefficient; SE = standard error.×
×
Discussion
Instrument Development and Testing Studies (2012)
The increase in the number of instrument development and testing studies from 5 in 2011 to 12 in 2012 indicates an increase in the priority of measuring function among articles published in AJOT, which reflects adherence to the agenda of increasing the ability of occupational therapists to provide evidence-based decision making, a priority identified in the AOTA Centennial Vision (AOTA, 2007, p. 614). The larger percentage of higher-level studies and larger cohorts in 2012 indicate an increase in the rigor of instrument development and testing studies published in AJOT in 2012. Funding for almost half of the studies shows the promise of “expanded collaboration for success” in the support provided for instrument development (AOTA, 2007, p. 614).
The three instruments designed for the transitional ages of adolescence and young adulthood would be appropriate for the goal of “longitudinal studies of the participation of children with special needs in their daily lives as they transition through childhood and adolescence into adulthood” (AOTA, 2006, p. 8). The two instruments addressing parent and family occupations support the goal of examination of the “roles and participation of parents, siblings, and other family members within family centered services” (AOTA, 2006, p. 8). Not all of the instruments from the 2012 instrument development and testing studies have the potential for blind testing, but among those for which it would be appropriate, it was underused, thus suggesting an area of focus for future improvement.
Intervention fidelity measures examine how well the intervention is delivered as it was intended (Gearing et al., 2011). Consistency in adherence to intervention fidelity is a key element in guiding practitioners to make evidence-based decisions by disseminating well-designed clinical trials and raising practitioners’, clients’, and third-party payers’ awareness of science-driven and evidence-based innovations (AOTA, 2007). Fidelity ensures that measurement of interventions’ effectiveness is consistent; without it, one cannot claim that they are evidence based (Murphy & Gutman, 2012). Fidelity is critical in research examining intervention effectiveness, but developing fidelity assessments for areas of intervention that do not have consistent protocol agreement, such as sensory integration intervention (May-Benson & Koomar, 2010) or client-centered intervention, is also valuable. This area is an important one for future instrument development to address the goals of the Centennial Vision.
Instrument development and testing studies examined a wider range of mechanisms in 2012 than in 2011, as defined by the expanded ICF categories to examine levels of rehabilitation science (Baum, 2011), which ranged among body function and body structure, functional limitations, activity, and participation. None examined biomedical molecular–cellular or biomedical mechanisms. Environmental mechanisms were not examined, except for one study that looked at activities of mothers and one that looked at participation of families, which are both aspects of a child’s environment, so these assessments could be used to examine children’s and youths’ environments. These assessments addressing mother and family participation support the AOTA Children and Youth Ad Hoc Committee (CYAC) goal of informing practice in “the roles and participation of parents, siblings, and other family members within family centered services” (AOTA, 2006, p. 8).
Activity and Participation Instruments (2009–2013)
The analysis of activity and participation instruments indicates a recent shift in occupational therapy assessment development. Although for many years pediatric assessments focused on developmental outcomes, looking at motor, cognitive, sensory, behavioral, perceptual, speech, and social–emotional abilities with a focus on identifying delays in these developmental domains, only in the past decade has the focus on performance-based or functional outcomes (Majnemer, 2009) grown. Among the assessments examined in this review, three are performance based, evaluating ADLs and IADLs or school performance. From an ecological validity point of view, the performance-based tests more closely evaluate everyday function than other component-based tests and address the need to thoroughly and comprehensively measure function (Doucet & Gutman, 2013). The examination of DIF and DTF by Munkholm et al. (2010)  supports the Centennial Vision goal of becoming a globally connected and diverse workforce. Examination of cultural relevance is a similarly important aspect of instrument development that has been found to be adequately addressed in 45% of the studies.
Activity and participation assessments are used to document what children actually do in their natural environments and are therefore helpful in developing individualized goals and treatment plans and for monitoring change over time. Activity and participation outcome domains may include walking; feeding; communication; social interaction; recreation, leisure, and play; education; work and chores; and community and social life (Baum, 2011, Table 1). The assessments in this review focus on many of these domains, suggesting their value in supporting the AOTA CYAC goal of informing practice in “basic and applied scientific studies related to skills, processes, and foundations for childhood and adolescent occupations” (AOTA, 2006, p. 8). Recent activity and participation measurement development, as examined in this review of recent AJOT publications, supports movement of the profession toward the Centennial Vision of becoming an evidence-based and science-driven profession. Increasing the focus on developing performance-based instruments is necessary to measure what the child actually does in his or her natural environment and to inform practice and raise practitioners’, clients’, and third-party payers’ awareness of science-driven and evidence-based innovations that have the potential to improve participation and quality of life. Continued development of questionnaire assessments is also valuable to provide different perspectives that will provide client-centered information for “efficacy studies that examine interventions (efficacy, effectiveness, outcomes development)” (AOTA, 2006, p. 8).
Conclusion
Our analysis of 2012 AJOT articles on children and youth instrument development and testing reveals several important steps to support occupational therapy’s Centennial Vision goal of becoming a “powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs” (AOTA, 2007, p. 613). We observed an increase in the number of instrument development and testing studies and in higher-level studies and studies with larger cohorts published in AJOT since 2011. Other positive indicators are funding of almost half of the studies, attention to use of blind testing, and more attention to transition to adult-age assessment. Attention to instruments that examine the other categories of rehabilitation science not addressed in 2012 (i.e., biomedical molecular–cellular, biomedical, and environmental) will further support the Centennial Vision. Inclusion of intervention fidelity measures and increased use of blind testing will also support this goal.
The increased focus on performance-based activity and participation instruments and continued development of questionnaire instruments identified by this review indicate further important forward steps toward addressing the Centennial Vision. Further increase in development of performance-based activity and participation instruments is necessary to further support this goal. Greater attention to examination of cultural relevance, such as DIF and DTF, and other culturally relevant aspects of instruments are important to becoming a globally connected and diverse workforce.
These findings indicate that the profession is moving in the right direction in instrument development and testing. The steps forward that we have observed, along with the suggestions for future instrument development, will help guide practitioners to make evidence-based decisions by disseminating well-designed clinical trials; raise practitioners’, clients’, and third-party payers’ awareness of science-driven and evidence-based innovations that have the potential to improve participation and quality of life; and, ultimately, influence health care decisions for current and future clients.
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*Honaker, D., Rosello, S. S., & Candler, C. (2012). Brief Report—Test–retest reliability of Family L.I.F.E. (Looking Into Family Experiences): An occupation-based assessment. American Journal of Occupational Therapy, 66, 617–620. http://dx.doi.org/10.5014/ajot.2012.004002 [Article] [PubMed]×
*Hwang, J.-L., & Davies, P. L. (2009). Rasch analysis of the School Function Assessment provides additional evidence for the internal validity of the Activity Performance Scales. American Journal of Occupational Therapy, 63, 369–373. http://dx.doi.org/10.5014/ajot.63.3.369 [Article] [PubMed]
*Hwang, J.-L., & Davies, P. L. (2009). Rasch analysis of the School Function Assessment provides additional evidence for the internal validity of the Activity Performance Scales. American Journal of Occupational Therapy, 63, 369–373. http://dx.doi.org/10.5014/ajot.63.3.369 [Article] [PubMed]×
*Josman, N., Goffer, A., & Rosenblum, S. (2010). Development and standardization of a “Do-Eat” activity of daily living performance test for children. American Journal of Occupational Therapy, 64, 47–58. http://dx.doi.org/10.5014/ajot.64.1.47 [Article] [PubMed]
*Josman, N., Goffer, A., & Rosenblum, S. (2010). Development and standardization of a “Do-Eat” activity of daily living performance test for children. American Journal of Occupational Therapy, 64, 47–58. http://dx.doi.org/10.5014/ajot.64.1.47 [Article] [PubMed]×
*Kao, Y., Kramer, J., Liljenquist, K., Tian, F., & Coster, W. (2012). Comparing the functional performance of children and youths with autism, developmental disabilities, and no disability using the revised Pediatric Evaluation of Disability Inventory Item Banks. American Journal of Occupational Therapy, 66, 607–616. http://dx.doi.org/10.5014/ajot.2012.004218 [Article] [PubMed]
*Kao, Y., Kramer, J., Liljenquist, K., Tian, F., & Coster, W. (2012). Comparing the functional performance of children and youths with autism, developmental disabilities, and no disability using the revised Pediatric Evaluation of Disability Inventory Item Banks. American Journal of Occupational Therapy, 66, 607–616. http://dx.doi.org/10.5014/ajot.2012.004218 [Article] [PubMed]×
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*Keller, J., Kafkes, A., Basu, S., Federico, J., & Kielhofner, G. (2005). The Child Occupational Self Assessment (COSA) (Version 2.1). Chicago: University of Illinois, College of Applied Health Sciences, Department of Occupational Therapy, MOHO Clearinghouse.×
Kielhofner, G. (2008). A Model of Human Occupation: Theory and application (4th ed.). Baltimore: Lippincott Williams & Wilkins.
Kielhofner, G. (2008). A Model of Human Occupation: Theory and application (4th ed.). Baltimore: Lippincott Williams & Wilkins.×
*King, G., Law, M., King, S., Hurley, P., Rosenbaum, S. H., Hanna, S., & Young, N. (2004). Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC) manual. San Antonio, TX: Psychological Corporation..
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*Kramer, J. M., Kielhofner, G., & Smith, E. V., Jr. (2010). Validity evidence for the Child Occupational Self Assessment. American Journal of Occupational Therapy, 64, 621–632. http://dx.doi.org/10.5014/ajot.2010.08142 [Article] [PubMed]
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Law, M., & King, G. (2000). Participation! Every child’s goal. Today’s Kids in Motion, 1, 10–12.×
Lieberman, D., & Scheer, J. (2002). AOTA’s Evidence-Based Literature Review Project: An overview. American Journal of Occupational Therapy, 56, 344–349. http://dx.doi.org/10.5014/ajot.56.3.344 [Article] [PubMed]
Lieberman, D., & Scheer, J. (2002). AOTA’s Evidence-Based Literature Review Project: An overview. American Journal of Occupational Therapy, 56, 344–349. http://dx.doi.org/10.5014/ajot.56.3.344 [Article] [PubMed]×
*Little, L. M., Freuler, A. C., Houser, M. B., Guckian, L., Carbine, K., David, F. J., & Baranek, G. T. (2011). Psychometric validation of the Sensory Experiences Questionnaire. American Journal of Occupational Therapy, 65, 207–210. http://dx.doi.org/10.5014/ajot.2011.000844 [Article] [PubMed]
*Little, L. M., Freuler, A. C., Houser, M. B., Guckian, L., Carbine, K., David, F. J., & Baranek, G. T. (2011). Psychometric validation of the Sensory Experiences Questionnaire. American Journal of Occupational Therapy, 65, 207–210. http://dx.doi.org/10.5014/ajot.2011.000844 [Article] [PubMed]×
Majnemer, A. (2009). Focusing on function. Physical and Occupational Therapy in Pediatrics, 29, 219–221. http://dx.doi.org/10.1080/01942630903032392 [Article] [PubMed]
Majnemer, A. (2009). Focusing on function. Physical and Occupational Therapy in Pediatrics, 29, 219–221. http://dx.doi.org/10.1080/01942630903032392 [Article] [PubMed]×
May-Benson, T. A., & Koomar, J. A. (2010). Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children. American Journal of Occupational Therapy, 64, 403–414. http://dx.doi.org/10.5014/ajot.2010.09071 [Article] [PubMed]
May-Benson, T. A., & Koomar, J. A. (2010). Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children. American Journal of Occupational Therapy, 64, 403–414. http://dx.doi.org/10.5014/ajot.2010.09071 [Article] [PubMed]×
*McDonald, A. E., & Vigen, C. (2012). Reliability and validity of the McDonald Play Inventory. American Journal of Occupational Therapy, 66, e52–e60. http://dx.doi.org/10.5014/ajot.2012.002493 [Article] [PubMed]
*McDonald, A. E., & Vigen, C. (2012). Reliability and validity of the McDonald Play Inventory. American Journal of Occupational Therapy, 66, e52–e60. http://dx.doi.org/10.5014/ajot.2012.002493 [Article] [PubMed]×
*Munkholm, M., Berg, B., Löfgren, B., & Fisher, A. G. (2010). Cross-regional validation of the School Version of the Assessment of Motor and Process Skills. American Journal of Occupational Therapy, 64, 768–775. http://dx.doi.org/10.5014/ajot.2010.0904
*Munkholm, M., Berg, B., Löfgren, B., & Fisher, A. G. (2010). Cross-regional validation of the School Version of the Assessment of Motor and Process Skills. American Journal of Occupational Therapy, 64, 768–775. http://dx.doi.org/10.5014/ajot.2010.0904×
Murphy, S. L., & Gutman, S. A. (2012). Intervention fidelity: A necessary aspect of intervention effectiveness studies. American Journal of Occupational Therapy, 66, 387–388. http://dx.doi.org/10.5014/ajot.2010.005405 [Article] [PubMed]
Murphy, S. L., & Gutman, S. A. (2012). Intervention fidelity: A necessary aspect of intervention effectiveness studies. American Journal of Occupational Therapy, 66, 387–388. http://dx.doi.org/10.5014/ajot.2010.005405 [Article] [PubMed]×
*Ohl, A., Butler, C., Carney, C., Jarmel, E., Palmieri, M., Pottheiser, D., & Smith, T. (2012). Brief Report—Test–retest reliability of the Sensory Profile Caregiver Questionnaire. American Journal of Occupational Therapy, 66, 483–487. http://dx.doi.org/10.5014/ajot.2012.003517 [Article] [PubMed]
*Ohl, A., Butler, C., Carney, C., Jarmel, E., Palmieri, M., Pottheiser, D., & Smith, T. (2012). Brief Report—Test–retest reliability of the Sensory Profile Caregiver Questionnaire. American Journal of Occupational Therapy, 66, 483–487. http://dx.doi.org/10.5014/ajot.2012.003517 [Article] [PubMed]×
*Potvin, M.-C., Snider, L., Prelock, P., Kehayia, E., & Wood-Dauphinee, S. (2013). Children's Assessment of Participation and Enjoyment/Preference for Activities of Children: Psychometric Properties in a Population With High-Functioning Autism. American Journal of Occupational Therapy, 67, 209–217. http://dx.doi.org/10.5014/ajot.2013.006288 [Article] [PubMed]
*Potvin, M.-C., Snider, L., Prelock, P., Kehayia, E., & Wood-Dauphinee, S. (2013). Children's Assessment of Participation and Enjoyment/Preference for Activities of Children: Psychometric Properties in a Population With High-Functioning Autism. American Journal of Occupational Therapy, 67, 209–217. http://dx.doi.org/10.5014/ajot.2013.006288 [Article] [PubMed]×
Radomski, M. V., & Trombly Latham, K. (Eds.). (2008). Occupational therapy for physical dysfunction. Philadelphia: Lippincott Williams & Wilkins.
Radomski, M. V., & Trombly Latham, K. (Eds.). (2008). Occupational therapy for physical dysfunction. Philadelphia: Lippincott Williams & Wilkins.×
*Rosenblum, S., Sachs, D., & Schreuer, N. (2010). Reliability and validity of the Children’s Leisure Assessment Scale. American Journal of Occupational Therapy, 64, 633–641. http://dx.doi.org/10.5014/ajot.2010.08173 [Article] [PubMed]
*Rosenblum, S., Sachs, D., & Schreuer, N. (2010). Reliability and validity of the Children’s Leisure Assessment Scale. American Journal of Occupational Therapy, 64, 633–641. http://dx.doi.org/10.5014/ajot.2010.08173 [Article] [PubMed]×
*Saban, M. T., Ornoy, A., Grotto, I., & Parush, S. (2012). Adolescents and Adults Coordination Questionnaire: Development and psychometric properties. American Journal of Occupational Therapy, 66, 406–413. http://dx.doi.org/10.5014/ajot.2012.003251 [Article] [PubMed]
*Saban, M. T., Ornoy, A., Grotto, I., & Parush, S. (2012). Adolescents and Adults Coordination Questionnaire: Development and psychometric properties. American Journal of Occupational Therapy, 66, 406–413. http://dx.doi.org/10.5014/ajot.2012.003251 [Article] [PubMed]×
*Silva, L. M. T., & Schalock, M. (2012). Sense and Self-Regulation Checklist, a measure of comorbid autism symptoms: Initial psychometric evidence. American Journal of Occupational Therapy, 66, 177–186. http://dx.doi.org/10.5014/ajot.2012.001578 [Article] [PubMed]
*Silva, L. M. T., & Schalock, M. (2012). Sense and Self-Regulation Checklist, a measure of comorbid autism symptoms: Initial psychometric evidence. American Journal of Occupational Therapy, 66, 177–186. http://dx.doi.org/10.5014/ajot.2012.001578 [Article] [PubMed]×
*Weiner, N. W., Toglia, J., & Berg, C. (2012). Weekly Calendar Planning Activity (WCPA): A performance-based assessment of executive function piloted with at-risk adolescents. American Journal of Occupational Therapy, 66, 699–708. http://dx.doi.org/10.5014/ajot.2012.004754 [Article] [PubMed]
*Weiner, N. W., Toglia, J., & Berg, C. (2012). Weekly Calendar Planning Activity (WCPA): A performance-based assessment of executive function piloted with at-risk adolescents. American Journal of Occupational Therapy, 66, 699–708. http://dx.doi.org/10.5014/ajot.2012.004754 [Article] [PubMed]×
*Weintraub, N., & Bar-Haim Erez, A. (2009). Quality of Life in School (QoLS) questionnaire: Development and validity. American Journal of Occupational Therapy, 63, 724–731. http://dx.doi.org/10.5014/ajot.63.6.724 [Article] [PubMed]
*Weintraub, N., & Bar-Haim Erez, A. (2009). Quality of Life in School (QoLS) questionnaire: Development and validity. American Journal of Occupational Therapy, 63, 724–731. http://dx.doi.org/10.5014/ajot.63.6.724 [Article] [PubMed]×
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Wilcock, A. A. (1993). A theory of the human need for occupation. Journal of Occupational Science, 1, 17–24. http://dx.doi.org/10.1080/14427591.1993.9686375 [Article] ×
World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.
World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.×
World Health Organization. (2007). International classification of functioning, disability and health: Children and youth version. Geneva: Author.
World Health Organization. (2007). International classification of functioning, disability and health: Children and youth version. Geneva: Author.×
*Indicates studies that were reviewed for this article.
Indicates studies that were reviewed for this article.×
Table 1.
Language of Rehabilitation Science
Language of Rehabilitation Science×
Framework CategoryTerms Used
Biomedical molecular–cellularPlasticityNeurotrophic factors
SynapseNeurotransmitters
NeurogenesisNeuromodulators
Receptor
BiomedicalAttentional controlCerebellar activation
Motor inhibitionMotor control
Anatomical connectivityMetabolism
Pattern recognition
Body function and body structure (ICF)Executive functionAttention
Sensory processingArousal
MoodSleep
Motivational stateIntellectual function
Motor planning and praxisTheory of mind
Language
Functional limitationsGaitMobility
StrengthEndurance
Postural controlPlanning
Grasp and pinchSocial skills
Problem solvingSelf-regulation
Range
Activity (ICF)Stair climbingToileting
StandingWriting
WalkingListening
DressingLearning
Grooming and hygieneCommunication
FeedingSocial interaction
Participation (ICF)EducationReligion and spirituality
Community and social lifeChild care
Recreation, leisure, and playWork and chores
Environment (ICF)Social supportReceptivity
Social capitalAccess to services
Assistive technologyServices, systems, and policies
School and community
Accommodations
Table Footer NoteNote. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001). From “The John Stanley Coulter Memorial Lecture—Fulfilling the Promise: Supporting Participation in Daily Life,” by C. Baum, 2011, Archives of Physical Medicine and Rehabilitation, 92, p. 172. Copyright © 2011 by Elsevier. Used with permission.
Note. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001). From “The John Stanley Coulter Memorial Lecture—Fulfilling the Promise: Supporting Participation in Daily Life,” by C. Baum, 2011, Archives of Physical Medicine and Rehabilitation, 92, p. 172. Copyright © 2011 by Elsevier. Used with permission.×
Table 1.
Language of Rehabilitation Science
Language of Rehabilitation Science×
Framework CategoryTerms Used
Biomedical molecular–cellularPlasticityNeurotrophic factors
SynapseNeurotransmitters
NeurogenesisNeuromodulators
Receptor
BiomedicalAttentional controlCerebellar activation
Motor inhibitionMotor control
Anatomical connectivityMetabolism
Pattern recognition
Body function and body structure (ICF)Executive functionAttention
Sensory processingArousal
MoodSleep
Motivational stateIntellectual function
Motor planning and praxisTheory of mind
Language
Functional limitationsGaitMobility
StrengthEndurance
Postural controlPlanning
Grasp and pinchSocial skills
Problem solvingSelf-regulation
Range
Activity (ICF)Stair climbingToileting
StandingWriting
WalkingListening
DressingLearning
Grooming and hygieneCommunication
FeedingSocial interaction
Participation (ICF)EducationReligion and spirituality
Community and social lifeChild care
Recreation, leisure, and playWork and chores
Environment (ICF)Social supportReceptivity
Social capitalAccess to services
Assistive technologyServices, systems, and policies
School and community
Accommodations
Table Footer NoteNote. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001). From “The John Stanley Coulter Memorial Lecture—Fulfilling the Promise: Supporting Participation in Daily Life,” by C. Baum, 2011, Archives of Physical Medicine and Rehabilitation, 92, p. 172. Copyright © 2011 by Elsevier. Used with permission.
Note. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001). From “The John Stanley Coulter Memorial Lecture—Fulfilling the Promise: Supporting Participation in Daily Life,” by C. Baum, 2011, Archives of Physical Medicine and Rehabilitation, 92, p. 172. Copyright © 2011 by Elsevier. Used with permission.×
×
Table 2.
Articles on Children and Youth Instrument Development and Testing Studies Published in 2012 in the American Journal of Occupational Therapy
Articles on Children and Youth Instrument Development and Testing Studies Published in 2012 in the American Journal of Occupational Therapy×
Author/YearFundingStudy ObjectivesLevel/Design/ParticipantsPerspective, Purpose, and SubtestsResultsStudy Limitations
Blanche, Bodison, Chang, & Reinoso (2012) NoTo develop a new observational tool to identify proprioceptive processing disorders in children with developmental disabilities and to establish its validity and reliability
  • Level III
  • Participants
  • N = 130 children with known developmental disabilities, convenience sample, ages 2–9 yr
  • Perspective
  • Therapist-administered observation of children during free play
  • Purpose
  • The Comprehensive Observations of Proprioception (COP) is a criterion-based observational tool that was originally constructed to measure two main areas of proprioceptive functions: behavior and sensory–motor abilities.
  • Subtests
  • The COP includes items representing the following areas of performance that are believed to be affected by proprioception: rate and timing of movements, the regulation of muscle force, the regulation of muscle stretch, motor programming, postural control, fluidity of movement, calibration of spatial frame of reference, feedback from the outcome of the motor command, joint stability, conscious estimation of muscle force, orientation of body segments, and body scheme.
The COP’s correlation to existing measures targeting proprioception suggests that well-trained therapists can effectively apply observational measures in their assessment of proprioceptive functions. Exploratory factor analysis suggests that what have traditionally been considered sensory–motor functions can be further differentiated into functions related to postural control, muscle tone and mobility, and motor planning, contributing to the understanding of proprioceptive functions.
  • Data were collected using a convenience sample from one region of the country. The results obtained from this study need to be examined in a larger population.
  • Examiners were not blinded to condition of participants.
Blanche, Reinoso, Chang, & Bodison (2012) NoTo compare performance of children with ASD with that of children with developmental disabilities and matched controls on proprioceptive processing and to elucidate the unique nature of these difficulties
  • Level II
  • Participants
  • N = 86; 32 children with ASD, mean age = 6.3, SD = 1.3; 26 children with other developmental disabilities, mean age = 6.8, SD = 1.9; 28 control, mean age = 6.7, SD = 1.8
  • Perspective
  • Therapist-administered observation of children during free play
  • Purpose
  • The Comprehensive Observations of Proprioception (COP) is a clinical tool consisting of 18 items focusing on motor and behavior regulation aspects of proprioceptive processing in children.
  • Subtests
  • COP items used were as follows:
  • • Decreased muscle tone
  • • Joint hypermobility
  • • Decreased joint alignment
  • • Inefficient ankle strategies
  • • Inadequate weight-shifting patterns
  • • Decreased postural control
  • • Decreased feedback-related motor planning
  • • Decreased feed-forward–related motor planning
  • • Inefficient grading of force
  • • Tiptoeing
  • • Pushing others or objects
  • • Enjoyment while being pulled
  • • Tendency to lean on others
  • • Overactivity
  • • Overpassivity
  • • Crashing, falling, running
Children with ASD presented a distinct pattern of proprioceptive processing difficulties on four COP items when compared with control counterparts and children with developmental disability: difficulty with feedback-related motor planning skills,walking on tiptoes, pushing others or objects, and crashing, falling, and running. Findings suggest that proprioceptive difficulties in children with ASD may contribute to decreased motor planning and postural control and to disruptive behaviors that negatively affect their participation in daily tasks.
  • Further assessment of psychometric properties, clinical utility using the COP in different settings, and meaningful differences in diverse clinical populations are needed.
  • Examiners were not blinded to condition of participants.
Bourke-Taylor, Law, Howie, & Pallant (2012) NoTo describe the development and internal consistency, factor structure, and construct validity of the Health Promoting Activities Scale (HPAS)
  • Level III
  • Participants
  • N = 152 mothers, mean age = 41.7 (SD = 5.4), recruited through disability support networks for parents of school-age children with developmental disabilities living in Victoria, Australia
  • Perspective
  • Mother self-report
  • Purpose
  • The HPAS measures the frequency with which mothers participate in self-selected leisure activities that promote health and well-being.
  • Subtests
  • • Personal health care tasks
  • • Physically active recreational pursuit that you do alone
  • • Physically active recreational pursuit that you do with others
  • • Spiritual or rejuvenating personal time
  • • Social activities with other people who are important and supportive toward you
  • • Time out for yourself
  • • Quiet, physically inactive leisure pursuit that you do alone
  • • Quiet, physically inactive leisure pursuit that you do with others
Initial evaluations indicate that this brief tool is psychometrically sound. This study supports the internal consistency, factor structure, and construct validity of the HPAS.Different sampling methods that provide population-based data and additional verification of medical history are required. Further evaluation of the sensitivity of the HPAS to detect changes in health-promoting behaviors and subjective health over time will indicate whether the HPAS is a valid outcome measure.
Brossard-Racine, Mazer, Julien, & Majnemer (2012) Doctoral fellowship from Fond de Recherche en Santé du Québec, Edith and Richard Strauss Fellowship, studentship from the Stars/Montreal Children’s HospitalTo validate the discriminant ability of the Evaluation Tool of Children’s Handwriting (ETCH) in identifying children in second to third grade with handwriting difficulties and to determine the percentage of change in handwriting scores that is consistently detected by occupational therapists
  • Level II
  • Participants
  • N = 60 (26 children from previous study on children with attention deficit hyperactivity disorder), mean age = 8.1 yr (SD = 0.8 yr)
  • N = 34 occupational therapists; 21% with 1–2 yr experience working with children with handwriting difficulties, 32% with 3–5 yr experience, 47% with >6 yr experience
  • Perspective
  • Occupational therapists completed questionnaires assessing paired samples from a previous study.
  • Purpose
  • The ETCH assesses children’s handwriting skills using tasks similar to those experienced in the classroom. The manuscript version of the ETCH (ETCH–M) examines legibility in children in first through third grade.
  • Subtests
  • Only the total scores for word legibility and letter legibility from the ETCH were used. Occupational therapists were presented with samples of handwriting and asked to complete a questionnaire consisting of two questions: “Looking only at Sample A, does this child need handwriting rehabilitation services?” and “Compare the two samples using a Likert Scale (1 = B is much better than A, 5 = B is much worse than A).”
Total Word Legibility and Total Letter Legibility had excellent accuracy in distinguishing children; 75% total word legibility and 76% total letter legibility discriminated between children with and without handwriting difficulties. Identifying the percentage of change in total word legibility and total letter legibility that clinicians consistently detected resulted in fair levels of accuracy.All samples were previously scored by an independent evaluator who was blind to the child’s identity and timing of testing. Therapists presented with the samples were blind to the child’s identity, condition, time between two evaluations, whether any intervention had occurred between the two samples, and legibility scores obtained for each sample. The level of agreement among occupational therapists in rating clinically meaningful change was low, which could be because they were not previously trained for scoring consistency or because the group was not homogeneous in experience. The question posed could also have been too broad and nonspecific.
Griswold & Townsend (2012) Funding provided by the Hamel Center for Undergraduate ResearchTo examine the sensitivity of the Evaluation of Social Interaction (ESI) as a measure of the overall quality of social interaction for children as they engage in social exchanges in natural contexts with typical social partners
  • Level II
  • Participants
  • N = 46; 23 matched pairs of children including 1 with a disability and 2 without. Participants were 34 boys and 12 girls ranging in age from 2–12 yr (M = 7 yr).
  • Perspective
  • The occupational therapist observes the participants and rates their behavior.
  • Purpose
  • The ESI measures the overall quality of social interaction for children as they engage in social exchanges in a natural context with typical social partners.
  • Subtests
  • The ESI includes 27 skills that relate to initiating and ending a social interaction, producing the social interaction, physically supporting the interaction, shaping the content and maintaining the flow of the interaction, verbally supporting the social interaction, and adapting to problems that might arise during the social interaction.
  • It categorizes social interactions by the intended purpose: gathering information, sharing information, problem solving and decision making, collaborating and producing, acquiring goods and services, and conversing socially and making small talk.
Results suggest that the ESI is able to differentiate the overall quality of social interaction between children with and without a disability on the basis of observing two social exchanges in the natural contexts of school, play, and activities of daily living when interacting with usual social partners. The exception was 3-yr-olds, possibly because they are still very young and have a greater variation in the quality of their social interaction.
  • Sample size was small and lacked demographic diversity. Because each child was observed twice, often in different natural contexts or with different social partners, the researchers questioned whether and how the environment, activity context, and social partners influenced the children’s quality of social interaction.
  • Examiners were not blinded to condition of participants.
Honaker, Rosello, & Candler (2012) NoTo examine the test–retest reliability of Family Looking Into Family Experiences (Family L.I.F.E.) in consistently identifying desired family occupations and perceived efficiency, effectiveness, and satisfaction ratings of those occupations for families with a child with ASD
  • Level III
  • Participants
  • Self-selected convenience sample of 15 families that included a child with an ASD and at least 1 sibling.
  • 13 families were used for test–retest reliability data collection, and 2 were used to initially establish consistency in administration of Family L.I.F.E.
  • Perspective
  • An occupational therapist interviews a primary caregiver.
  • Purpose
  • Family L.I.F.E. engages families and therapists to identify, evaluate, and measure perceived success in unique and relevant family occupations.
  • Subtests
  • The family identifies five desired family occupations and rates perceived efficiency, effectiveness, and satisfaction of those occupations. The instrument includes a demographic section, a time diary of a typical day and typical weekend day to help identify routines and rituals, and eight interview questions that focus on family togetherness, child rearing, and impact on family occupations. The therapist assists the family in identifying 5 key family occupations and limiting factors, which the family then rates on perceived effectiveness, efficiency, and satisfaction using a Likert scale.
  • Results suggest that occupations identified by families using Family L.I.F.E. are stable over time. The ratings of effectiveness and efficiency are also reliable over the period of 1 wk. The findings indicated that satisfaction with performance on the identified occupations is more variable.
  • Occupations identified as more problematic at initial testing held that position on retest, suggesting that these performance scores are stable constructs.
Results of this study were limited to one small diagnostic group, one race, and two regional locations, and all respondents were mothers. Cultural factors were not examined. Results cannot be generalized to the entire population with ASD. Further research is needed to determine consistency across races, cultures, various diagnoses, other single diagnostic categories, and more than one caregiver respondent.
Kao, Kramer, Liljenquist, Tian, & Coster (2012) Funded by grants from the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentTo examine the level of functional performance of children and youths with ASD and co-occurring conditions as measured by 3 domains of the revised Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI–CAT); to compare performance of children and youths with ASD or intellectual and developmental disabilities (IDDs) with that of children and youth without disabilities; and to examine how functional performance varies by age
  • Level II
  • Participants
  • N = 2,463; 108 children with ASD, 150 children with IDDs, 2,205 children without disabilities
  • Perspective
  • Parent-report response questionnaire; data were collected over the Internet.
  • Purpose
  • The PEDI–CAT measures function in infants, children, and youths from birth through age 20 yr.
  • Subtests
  • The PEDI–CAT includes four domains: Daily Activities, Social/Cognitive, Mobility, and Responsibility. Only the Social/Cognitive, Daily Activities, and Responsibility domains were used in this experiment.
  • No relationship was found between diagnosis and children’s level of functioning at age 5 for the PEDI–CAT Social/Cognitive, Daily Activities, and Responsibility domains. Older children with ASD had significantly lower levels of function than children without disabilities on all domains. No significant difference was found in the level of functioning of children with ASD and children with IDDs across all reference ages (5, 10, and 15 yr).
  • These findings suggest that children with ASD and IDDs may demonstrate similar levels of functional performance and task management responsibilities after controlling for age. Both groups demonstrate lower performance than children without disabilities.
Impairment severity data were not collected, so relationship with adaptive behavior as measured by the PEDI–CAT was not examined. Uneven sample sizes, specifically the smaller diagnostic sample sizes, reduce the power to detect potentially subtle but meaningful differences between diagnostic groups.
McDonald & Vigen (2012) Research grant from California Foundation for Occupational TherapyTo examine the ability of the McDonald Play Inventory (MPI) to reliably and validly measure the play activities and play styles of 7- to 11-yr-old children and to discriminate between the play of neurotypical children and children with known learning and developmental disabilities
  • Level II
  • Participants
  • N = 124 (89 neurotypical children and 35 with disabilities), ages 7–11 yr
  • Perspective
  • Self-report questionnaires given to children; the parent version was given to their parents to establish concurrent validity.
  • Purpose
  • The MPI is a self-report play inventory that measures the types and frequencies of play activities and play styles of 7- to 11-yr-old children.
  • Subtests
  • McDonald Play Activity Inventory (MPAI): Measures child’s perceived frequency of engagement in four mutually exclusive categories: fine motor, gross motor, social group, and solitary.
  • McDonald Play Style Inventory (MPSI): Measures types and frequencies of play behaviors via four subscales: Physical Coordination, Cooperation, Peer Acceptance, and Social Participation.
Inclusion of items in the inventory was supported. The MPAI and MPSI each achieved acceptable internal consistency values. Test–retest reliability was consistent, showing that the MPI is a fairly accurate measurement of the reported play performance over time. Neurotypical children and children with ASD showed a statistically significant difference only on the Social Participation subscale of the MPSI. Children with disabilities reported engaging in play activities with the same frequency as their nondisabled peers but reported differences in perceived style of play. Parents from both groups did not concur with their children’s responses.Limitations include the lack of generalization to children from lower socioeconomic backgrounds and other geographic areas. Possible differences in play style between White and Asian-American children were not analyzed. Further research is needed to gather normative data on children from diverse backgrounds and age ranges to detect similarities and differences in MPI scores among a wider age range of children and their parents.
Ohl et al. (2012) NoTo examine the test–retest reliability and internal consistency of the Sensory Profile (SP) Caregiver Questionnaire
  • Level III
  • Participants
  • N = 55 (primary caregivers of children 36–72 mo old) recruited from preschools and child care centers in New York metropolitan area
  • Perspective
  • Primary caregivers were given questionnaires to complete about their child’s behavior.
  • Purpose
  • The SP provides a standard method for professionals to measure the possible contributions of sensory processing to children’s daily performance patterns.
  • Subtests
  • The SP is organized into three main sections: Sensory Processing, Modulation, and Behavioral and Emotional Responses. Results were divided into sensory section, factor, and quadrant scores (Registration, Seeking, Sensitivity, Avoiding).
  • Analysis at the quadrant level suggests acceptable test–retest reliability and internal consistency, indicating that caregivers’ observations of their children are stable over time.
  • Test–retest and internal consistency analyses revealed higher psychometric indexes across the four quadrants than across the factors and sections, suggesting that a quadrant-level analysis captures children’s sensory processing patterns more consistently than factor- or section-level analyses.
This study was limited by a small sample size of geographic convenience and a lack of demographic information about the study participants. More research is needed to further examine the SP’s test–retest reliability and its utility as an outcome measure. Future studies should include a larger sample with greater demographic representation.
Saban, Ornoy, Grotto, & Parush (2012) NoTo develop the Adolescents and Adults Coordination Questionnaire (AAC–Q), assess its psychometric properties, and establish cutoff scores for use
  • Level II
  • Participants
  • N = 56; 28 adolescents and adults with suspected DCD (M age = 21.18 yr, SD = 4.73) and 28 peers without DCD (mean age = 27.64 yr, SD = 3.75); convenience sample
  • Cutoff scores for suspected DCD were established using data from a sample of 2,379 participants (M age = 20.68 yr)
  • Perspective
  • Self-report questionnaire
  • Purpose
  • The AAC–Q is used to identify DCD in adolescents and adults.
  • Subtests
  • The AAC–Q consists of 12 items representing areas and realms of functions vital to everyday performance of life tasks such as organization skills, spatial and temporal orientation, fine and gross motor function, and writing.
  • This study supports use of the AAC–Q as a standardized, brief, ecologically valid, user-friendly measure to screen for DCD. Sufficient evidence was found of the reliability and validity of the instrument and identified cutoff points indicating suspected DCD.
  • Internal consistency for both samples in this study and test–retest reliability of pilot study were high, implying that the instrument is reliable.
  • Study provided considerable evidence for the validity of the AAC–Q.
Self-report method of attaining information may introduce bias resulting from the mood and truthfulness of the respondent. Use of a convenience sample for the first phase of the study is an additional limitation, as is the fact that no diagnostic tests are available to determine the accuracy of group placement.
Silva & Schalock (2012) Support from Curry Stone Foundation and Northwest Health FoundationTo validate the Sense and Self-Regulation Checklist (SSC), a parent–caregiver measure of comorbid symptoms in autism
  • Level II
  • Participants
  • N = 265 (99 children with ASD; M age = 3.9 yr, SD = 1.2), 28 children with other developmental disabilities (DD; M age = 2.26, SD = 1.4), 138 typically developing children, age 24–72 mo (M age = 3.9, SD = .89)
  • Perspective
  • Primary caregivers were given a form to fill out.
  • Purpose
  • The SSC is a caregiver questionnaire that is divided into items relative to abnormal sensory response to ordinary injurious and noninjurious stimuli and items relative to difficulties reaching early self-regulation milestones.
  • Subtests
  • The SSC is divided into Sensory and Self-Regulatory domains. The Sensory domain includes Touch–Pain, Auditory, Visual, and Taste–Smell. The Self-Regulatory domain includes Sleep, Appetite–Digestion, Self-Soothing, Orienting–Attending, Aggressive Behavior, and Self-Injurious Behavior.
  • Domain, subdomain, and overall scores demonstrated acceptable internal consistency across all three groups.
  • Group differences in total sensory scores, total self-regulatory scores, and total sensory and self-regulatory scores were highly significant.
  • Children with ASD were more multisensorily impaired than children in other groups.
  • Positive and relatively strong relationships between sensory impairment and severity of autism and between self-regulation impairment and severity of autism were seen.
  • Larger samples are needed to achieve acceptable internal consistency in the subdomain scores across groups to satisfactorily control for variability in symptoms—specifically, a larger other DD group to further differentiate children with ASD from children with other conditions.
  • Mental and developmental age data need to be collected and correlated with SSC scores to place the findings in a more clinical context. Collecting more demographic data on the informants answering the SSC would be of interest.
Weiner, Toglia, & Berg (2012) NoTo describe the baseline executive function profile of youths at risk who are participating in a 2-yr return-to-school education program by exploring the relationship between accuracy, time, and strategy use
  • Level III
  • Participants
  • N = 113 male and female high school students, ages 16–21 yr. Participants were enrolled in a charter school for disconnected youth in St. Louis.
  • Perspective
  • The scheduling task was administered to participants by an examiner.
  • Purpose
  • The Weekly Calendar Planning Activity (WCPA) is a performance-based measure of executive function. The examiner keeps track of time, observable strategy use, and adherence to rules of the task while providing distractions at planned intervals throughout the task.
  • Subtests
  • Level 2 of the WCPA was used.
  • The WCPA allows detection of complex task performance, strategy use, self-evaluation of performance, and error patterns, which translate into intervention strategies. The complexity of the task and the broad range of scores suggest that the WCPA may be useful in assessing even subtle executive functioning differences.
  • Relationships were found between number of entered appointments and task time, task time and number of strategies used, and number of strategies used and accuracy of entered appointments.
  • Results cannot be generalized to other populations until testing of a more representative sample of 16- to 21-yr-olds occurs.
  • The socioeconomic and race divide between testers and sample was a limitation, as was the fact that literacy issues may have been present in some of the sample. The students may have had no interest in the task, which could have affected performance.
  • Examiners were not blinded to condition of participants.
Table Footer NoteNote. ASD = autism spectrum disorder; DCD = developmental coordination disorder; M = mean; SD = standard deviation.
Note. ASD = autism spectrum disorder; DCD = developmental coordination disorder; M = mean; SD = standard deviation.×
Table 2.
Articles on Children and Youth Instrument Development and Testing Studies Published in 2012 in the American Journal of Occupational Therapy
Articles on Children and Youth Instrument Development and Testing Studies Published in 2012 in the American Journal of Occupational Therapy×
Author/YearFundingStudy ObjectivesLevel/Design/ParticipantsPerspective, Purpose, and SubtestsResultsStudy Limitations
Blanche, Bodison, Chang, & Reinoso (2012) NoTo develop a new observational tool to identify proprioceptive processing disorders in children with developmental disabilities and to establish its validity and reliability
  • Level III
  • Participants
  • N = 130 children with known developmental disabilities, convenience sample, ages 2–9 yr
  • Perspective
  • Therapist-administered observation of children during free play
  • Purpose
  • The Comprehensive Observations of Proprioception (COP) is a criterion-based observational tool that was originally constructed to measure two main areas of proprioceptive functions: behavior and sensory–motor abilities.
  • Subtests
  • The COP includes items representing the following areas of performance that are believed to be affected by proprioception: rate and timing of movements, the regulation of muscle force, the regulation of muscle stretch, motor programming, postural control, fluidity of movement, calibration of spatial frame of reference, feedback from the outcome of the motor command, joint stability, conscious estimation of muscle force, orientation of body segments, and body scheme.
The COP’s correlation to existing measures targeting proprioception suggests that well-trained therapists can effectively apply observational measures in their assessment of proprioceptive functions. Exploratory factor analysis suggests that what have traditionally been considered sensory–motor functions can be further differentiated into functions related to postural control, muscle tone and mobility, and motor planning, contributing to the understanding of proprioceptive functions.
  • Data were collected using a convenience sample from one region of the country. The results obtained from this study need to be examined in a larger population.
  • Examiners were not blinded to condition of participants.
Blanche, Reinoso, Chang, & Bodison (2012) NoTo compare performance of children with ASD with that of children with developmental disabilities and matched controls on proprioceptive processing and to elucidate the unique nature of these difficulties
  • Level II
  • Participants
  • N = 86; 32 children with ASD, mean age = 6.3, SD = 1.3; 26 children with other developmental disabilities, mean age = 6.8, SD = 1.9; 28 control, mean age = 6.7, SD = 1.8
  • Perspective
  • Therapist-administered observation of children during free play
  • Purpose
  • The Comprehensive Observations of Proprioception (COP) is a clinical tool consisting of 18 items focusing on motor and behavior regulation aspects of proprioceptive processing in children.
  • Subtests
  • COP items used were as follows:
  • • Decreased muscle tone
  • • Joint hypermobility
  • • Decreased joint alignment
  • • Inefficient ankle strategies
  • • Inadequate weight-shifting patterns
  • • Decreased postural control
  • • Decreased feedback-related motor planning
  • • Decreased feed-forward–related motor planning
  • • Inefficient grading of force
  • • Tiptoeing
  • • Pushing others or objects
  • • Enjoyment while being pulled
  • • Tendency to lean on others
  • • Overactivity
  • • Overpassivity
  • • Crashing, falling, running
Children with ASD presented a distinct pattern of proprioceptive processing difficulties on four COP items when compared with control counterparts and children with developmental disability: difficulty with feedback-related motor planning skills,walking on tiptoes, pushing others or objects, and crashing, falling, and running. Findings suggest that proprioceptive difficulties in children with ASD may contribute to decreased motor planning and postural control and to disruptive behaviors that negatively affect their participation in daily tasks.
  • Further assessment of psychometric properties, clinical utility using the COP in different settings, and meaningful differences in diverse clinical populations are needed.
  • Examiners were not blinded to condition of participants.
Bourke-Taylor, Law, Howie, & Pallant (2012) NoTo describe the development and internal consistency, factor structure, and construct validity of the Health Promoting Activities Scale (HPAS)
  • Level III
  • Participants
  • N = 152 mothers, mean age = 41.7 (SD = 5.4), recruited through disability support networks for parents of school-age children with developmental disabilities living in Victoria, Australia
  • Perspective
  • Mother self-report
  • Purpose
  • The HPAS measures the frequency with which mothers participate in self-selected leisure activities that promote health and well-being.
  • Subtests
  • • Personal health care tasks
  • • Physically active recreational pursuit that you do alone
  • • Physically active recreational pursuit that you do with others
  • • Spiritual or rejuvenating personal time
  • • Social activities with other people who are important and supportive toward you
  • • Time out for yourself
  • • Quiet, physically inactive leisure pursuit that you do alone
  • • Quiet, physically inactive leisure pursuit that you do with others
Initial evaluations indicate that this brief tool is psychometrically sound. This study supports the internal consistency, factor structure, and construct validity of the HPAS.Different sampling methods that provide population-based data and additional verification of medical history are required. Further evaluation of the sensitivity of the HPAS to detect changes in health-promoting behaviors and subjective health over time will indicate whether the HPAS is a valid outcome measure.
Brossard-Racine, Mazer, Julien, & Majnemer (2012) Doctoral fellowship from Fond de Recherche en Santé du Québec, Edith and Richard Strauss Fellowship, studentship from the Stars/Montreal Children’s HospitalTo validate the discriminant ability of the Evaluation Tool of Children’s Handwriting (ETCH) in identifying children in second to third grade with handwriting difficulties and to determine the percentage of change in handwriting scores that is consistently detected by occupational therapists
  • Level II
  • Participants
  • N = 60 (26 children from previous study on children with attention deficit hyperactivity disorder), mean age = 8.1 yr (SD = 0.8 yr)
  • N = 34 occupational therapists; 21% with 1–2 yr experience working with children with handwriting difficulties, 32% with 3–5 yr experience, 47% with >6 yr experience
  • Perspective
  • Occupational therapists completed questionnaires assessing paired samples from a previous study.
  • Purpose
  • The ETCH assesses children’s handwriting skills using tasks similar to those experienced in the classroom. The manuscript version of the ETCH (ETCH–M) examines legibility in children in first through third grade.
  • Subtests
  • Only the total scores for word legibility and letter legibility from the ETCH were used. Occupational therapists were presented with samples of handwriting and asked to complete a questionnaire consisting of two questions: “Looking only at Sample A, does this child need handwriting rehabilitation services?” and “Compare the two samples using a Likert Scale (1 = B is much better than A, 5 = B is much worse than A).”
Total Word Legibility and Total Letter Legibility had excellent accuracy in distinguishing children; 75% total word legibility and 76% total letter legibility discriminated between children with and without handwriting difficulties. Identifying the percentage of change in total word legibility and total letter legibility that clinicians consistently detected resulted in fair levels of accuracy.All samples were previously scored by an independent evaluator who was blind to the child’s identity and timing of testing. Therapists presented with the samples were blind to the child’s identity, condition, time between two evaluations, whether any intervention had occurred between the two samples, and legibility scores obtained for each sample. The level of agreement among occupational therapists in rating clinically meaningful change was low, which could be because they were not previously trained for scoring consistency or because the group was not homogeneous in experience. The question posed could also have been too broad and nonspecific.
Griswold & Townsend (2012) Funding provided by the Hamel Center for Undergraduate ResearchTo examine the sensitivity of the Evaluation of Social Interaction (ESI) as a measure of the overall quality of social interaction for children as they engage in social exchanges in natural contexts with typical social partners
  • Level II
  • Participants
  • N = 46; 23 matched pairs of children including 1 with a disability and 2 without. Participants were 34 boys and 12 girls ranging in age from 2–12 yr (M = 7 yr).
  • Perspective
  • The occupational therapist observes the participants and rates their behavior.
  • Purpose
  • The ESI measures the overall quality of social interaction for children as they engage in social exchanges in a natural context with typical social partners.
  • Subtests
  • The ESI includes 27 skills that relate to initiating and ending a social interaction, producing the social interaction, physically supporting the interaction, shaping the content and maintaining the flow of the interaction, verbally supporting the social interaction, and adapting to problems that might arise during the social interaction.
  • It categorizes social interactions by the intended purpose: gathering information, sharing information, problem solving and decision making, collaborating and producing, acquiring goods and services, and conversing socially and making small talk.
Results suggest that the ESI is able to differentiate the overall quality of social interaction between children with and without a disability on the basis of observing two social exchanges in the natural contexts of school, play, and activities of daily living when interacting with usual social partners. The exception was 3-yr-olds, possibly because they are still very young and have a greater variation in the quality of their social interaction.
  • Sample size was small and lacked demographic diversity. Because each child was observed twice, often in different natural contexts or with different social partners, the researchers questioned whether and how the environment, activity context, and social partners influenced the children’s quality of social interaction.
  • Examiners were not blinded to condition of participants.
Honaker, Rosello, & Candler (2012) NoTo examine the test–retest reliability of Family Looking Into Family Experiences (Family L.I.F.E.) in consistently identifying desired family occupations and perceived efficiency, effectiveness, and satisfaction ratings of those occupations for families with a child with ASD
  • Level III
  • Participants
  • Self-selected convenience sample of 15 families that included a child with an ASD and at least 1 sibling.
  • 13 families were used for test–retest reliability data collection, and 2 were used to initially establish consistency in administration of Family L.I.F.E.
  • Perspective
  • An occupational therapist interviews a primary caregiver.
  • Purpose
  • Family L.I.F.E. engages families and therapists to identify, evaluate, and measure perceived success in unique and relevant family occupations.
  • Subtests
  • The family identifies five desired family occupations and rates perceived efficiency, effectiveness, and satisfaction of those occupations. The instrument includes a demographic section, a time diary of a typical day and typical weekend day to help identify routines and rituals, and eight interview questions that focus on family togetherness, child rearing, and impact on family occupations. The therapist assists the family in identifying 5 key family occupations and limiting factors, which the family then rates on perceived effectiveness, efficiency, and satisfaction using a Likert scale.
  • Results suggest that occupations identified by families using Family L.I.F.E. are stable over time. The ratings of effectiveness and efficiency are also reliable over the period of 1 wk. The findings indicated that satisfaction with performance on the identified occupations is more variable.
  • Occupations identified as more problematic at initial testing held that position on retest, suggesting that these performance scores are stable constructs.
Results of this study were limited to one small diagnostic group, one race, and two regional locations, and all respondents were mothers. Cultural factors were not examined. Results cannot be generalized to the entire population with ASD. Further research is needed to determine consistency across races, cultures, various diagnoses, other single diagnostic categories, and more than one caregiver respondent.
Kao, Kramer, Liljenquist, Tian, & Coster (2012) Funded by grants from the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentTo examine the level of functional performance of children and youths with ASD and co-occurring conditions as measured by 3 domains of the revised Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI–CAT); to compare performance of children and youths with ASD or intellectual and developmental disabilities (IDDs) with that of children and youth without disabilities; and to examine how functional performance varies by age
  • Level II
  • Participants
  • N = 2,463; 108 children with ASD, 150 children with IDDs, 2,205 children without disabilities
  • Perspective
  • Parent-report response questionnaire; data were collected over the Internet.
  • Purpose
  • The PEDI–CAT measures function in infants, children, and youths from birth through age 20 yr.
  • Subtests
  • The PEDI–CAT includes four domains: Daily Activities, Social/Cognitive, Mobility, and Responsibility. Only the Social/Cognitive, Daily Activities, and Responsibility domains were used in this experiment.
  • No relationship was found between diagnosis and children’s level of functioning at age 5 for the PEDI–CAT Social/Cognitive, Daily Activities, and Responsibility domains. Older children with ASD had significantly lower levels of function than children without disabilities on all domains. No significant difference was found in the level of functioning of children with ASD and children with IDDs across all reference ages (5, 10, and 15 yr).
  • These findings suggest that children with ASD and IDDs may demonstrate similar levels of functional performance and task management responsibilities after controlling for age. Both groups demonstrate lower performance than children without disabilities.
Impairment severity data were not collected, so relationship with adaptive behavior as measured by the PEDI–CAT was not examined. Uneven sample sizes, specifically the smaller diagnostic sample sizes, reduce the power to detect potentially subtle but meaningful differences between diagnostic groups.
McDonald & Vigen (2012) Research grant from California Foundation for Occupational TherapyTo examine the ability of the McDonald Play Inventory (MPI) to reliably and validly measure the play activities and play styles of 7- to 11-yr-old children and to discriminate between the play of neurotypical children and children with known learning and developmental disabilities
  • Level II
  • Participants
  • N = 124 (89 neurotypical children and 35 with disabilities), ages 7–11 yr
  • Perspective
  • Self-report questionnaires given to children; the parent version was given to their parents to establish concurrent validity.
  • Purpose
  • The MPI is a self-report play inventory that measures the types and frequencies of play activities and play styles of 7- to 11-yr-old children.
  • Subtests
  • McDonald Play Activity Inventory (MPAI): Measures child’s perceived frequency of engagement in four mutually exclusive categories: fine motor, gross motor, social group, and solitary.
  • McDonald Play Style Inventory (MPSI): Measures types and frequencies of play behaviors via four subscales: Physical Coordination, Cooperation, Peer Acceptance, and Social Participation.
Inclusion of items in the inventory was supported. The MPAI and MPSI each achieved acceptable internal consistency values. Test–retest reliability was consistent, showing that the MPI is a fairly accurate measurement of the reported play performance over time. Neurotypical children and children with ASD showed a statistically significant difference only on the Social Participation subscale of the MPSI. Children with disabilities reported engaging in play activities with the same frequency as their nondisabled peers but reported differences in perceived style of play. Parents from both groups did not concur with their children’s responses.Limitations include the lack of generalization to children from lower socioeconomic backgrounds and other geographic areas. Possible differences in play style between White and Asian-American children were not analyzed. Further research is needed to gather normative data on children from diverse backgrounds and age ranges to detect similarities and differences in MPI scores among a wider age range of children and their parents.
Ohl et al. (2012) NoTo examine the test–retest reliability and internal consistency of the Sensory Profile (SP) Caregiver Questionnaire
  • Level III
  • Participants
  • N = 55 (primary caregivers of children 36–72 mo old) recruited from preschools and child care centers in New York metropolitan area
  • Perspective
  • Primary caregivers were given questionnaires to complete about their child’s behavior.
  • Purpose
  • The SP provides a standard method for professionals to measure the possible contributions of sensory processing to children’s daily performance patterns.
  • Subtests
  • The SP is organized into three main sections: Sensory Processing, Modulation, and Behavioral and Emotional Responses. Results were divided into sensory section, factor, and quadrant scores (Registration, Seeking, Sensitivity, Avoiding).
  • Analysis at the quadrant level suggests acceptable test–retest reliability and internal consistency, indicating that caregivers’ observations of their children are stable over time.
  • Test–retest and internal consistency analyses revealed higher psychometric indexes across the four quadrants than across the factors and sections, suggesting that a quadrant-level analysis captures children’s sensory processing patterns more consistently than factor- or section-level analyses.
This study was limited by a small sample size of geographic convenience and a lack of demographic information about the study participants. More research is needed to further examine the SP’s test–retest reliability and its utility as an outcome measure. Future studies should include a larger sample with greater demographic representation.
Saban, Ornoy, Grotto, & Parush (2012) NoTo develop the Adolescents and Adults Coordination Questionnaire (AAC–Q), assess its psychometric properties, and establish cutoff scores for use
  • Level II
  • Participants
  • N = 56; 28 adolescents and adults with suspected DCD (M age = 21.18 yr, SD = 4.73) and 28 peers without DCD (mean age = 27.64 yr, SD = 3.75); convenience sample
  • Cutoff scores for suspected DCD were established using data from a sample of 2,379 participants (M age = 20.68 yr)
  • Perspective
  • Self-report questionnaire
  • Purpose
  • The AAC–Q is used to identify DCD in adolescents and adults.
  • Subtests
  • The AAC–Q consists of 12 items representing areas and realms of functions vital to everyday performance of life tasks such as organization skills, spatial and temporal orientation, fine and gross motor function, and writing.
  • This study supports use of the AAC–Q as a standardized, brief, ecologically valid, user-friendly measure to screen for DCD. Sufficient evidence was found of the reliability and validity of the instrument and identified cutoff points indicating suspected DCD.
  • Internal consistency for both samples in this study and test–retest reliability of pilot study were high, implying that the instrument is reliable.
  • Study provided considerable evidence for the validity of the AAC–Q.
Self-report method of attaining information may introduce bias resulting from the mood and truthfulness of the respondent. Use of a convenience sample for the first phase of the study is an additional limitation, as is the fact that no diagnostic tests are available to determine the accuracy of group placement.
Silva & Schalock (2012) Support from Curry Stone Foundation and Northwest Health FoundationTo validate the Sense and Self-Regulation Checklist (SSC), a parent–caregiver measure of comorbid symptoms in autism
  • Level II
  • Participants
  • N = 265 (99 children with ASD; M age = 3.9 yr, SD = 1.2), 28 children with other developmental disabilities (DD; M age = 2.26, SD = 1.4), 138 typically developing children, age 24–72 mo (M age = 3.9, SD = .89)
  • Perspective
  • Primary caregivers were given a form to fill out.
  • Purpose
  • The SSC is a caregiver questionnaire that is divided into items relative to abnormal sensory response to ordinary injurious and noninjurious stimuli and items relative to difficulties reaching early self-regulation milestones.
  • Subtests
  • The SSC is divided into Sensory and Self-Regulatory domains. The Sensory domain includes Touch–Pain, Auditory, Visual, and Taste–Smell. The Self-Regulatory domain includes Sleep, Appetite–Digestion, Self-Soothing, Orienting–Attending, Aggressive Behavior, and Self-Injurious Behavior.
  • Domain, subdomain, and overall scores demonstrated acceptable internal consistency across all three groups.
  • Group differences in total sensory scores, total self-regulatory scores, and total sensory and self-regulatory scores were highly significant.
  • Children with ASD were more multisensorily impaired than children in other groups.
  • Positive and relatively strong relationships between sensory impairment and severity of autism and between self-regulation impairment and severity of autism were seen.
  • Larger samples are needed to achieve acceptable internal consistency in the subdomain scores across groups to satisfactorily control for variability in symptoms—specifically, a larger other DD group to further differentiate children with ASD from children with other conditions.
  • Mental and developmental age data need to be collected and correlated with SSC scores to place the findings in a more clinical context. Collecting more demographic data on the informants answering the SSC would be of interest.
Weiner, Toglia, & Berg (2012) NoTo describe the baseline executive function profile of youths at risk who are participating in a 2-yr return-to-school education program by exploring the relationship between accuracy, time, and strategy use
  • Level III
  • Participants
  • N = 113 male and female high school students, ages 16–21 yr. Participants were enrolled in a charter school for disconnected youth in St. Louis.
  • Perspective
  • The scheduling task was administered to participants by an examiner.
  • Purpose
  • The Weekly Calendar Planning Activity (WCPA) is a performance-based measure of executive function. The examiner keeps track of time, observable strategy use, and adherence to rules of the task while providing distractions at planned intervals throughout the task.
  • Subtests
  • Level 2 of the WCPA was used.
  • The WCPA allows detection of complex task performance, strategy use, self-evaluation of performance, and error patterns, which translate into intervention strategies. The complexity of the task and the broad range of scores suggest that the WCPA may be useful in assessing even subtle executive functioning differences.
  • Relationships were found between number of entered appointments and task time, task time and number of strategies used, and number of strategies used and accuracy of entered appointments.
  • Results cannot be generalized to other populations until testing of a more representative sample of 16- to 21-yr-olds occurs.
  • The socioeconomic and race divide between testers and sample was a limitation, as was the fact that literacy issues may have been present in some of the sample. The students may have had no interest in the task, which could have affected performance.
  • Examiners were not blinded to condition of participants.
Table Footer NoteNote. ASD = autism spectrum disorder; DCD = developmental coordination disorder; M = mean; SD = standard deviation.
Note. ASD = autism spectrum disorder; DCD = developmental coordination disorder; M = mean; SD = standard deviation.×
×
Table 3.
Activity and Participation Instruments (2009–2012)
Activity and Participation Instruments (2009–2012)×
Measure (Author/Year)Frame of Reference and Theoretical ModelCultural RelevanceParticipantsPerspective, Purpose, and DescriptionTest Components and Item CategoriesPracticalityOutcome Measures
Child Occupational Self Assessment (Keller, Kafkes, Basu, Federico, & Kielhofner, 2005; Kramer, Kielhofner, & Smith, 2010)Model of Human Occupation (Kielhofner, 2008) Data were collected in the United States, United Kingdom, Iceland, Germany, and Switzerland and from people of several ethnicities.Children ages 7–17 with conditions such as autism, attention deficit hyperactivity disorder, expressive language delay, cerebral palsy, and intellectual disabilities
  • Perspective
  • Child questionnaire (a version is also available that the therapist can complete with the child)
  • Purpose
  • Self-report of occupational competence and value for everyday activities
  • Description
  • Measures the extent to which children feel they competently meet expectations and responsibilities associated with activities and the relative value of those activities. Also facilitates children’s involvement in the therapy process. The first two versions include visual cues. During performance, the therapist can reduce visual distractions, provide examples, and write on behalf of the child.
  • Test Components
  • 25 items that represent a range of everyday activities
  • Each item is rated using two rating scales: the occupational competence scale and the value scale. Each scale is a 4-stage scale. Higher scores represent better competence or value.
  • There are three means of administration:
  • 1. Standard pen and pencil with visual cues
  • 2. Card sort version
  • 3. Summary form of all items with no visual cues.
  • During administration, the child is guided to pick the category that best describes him or her and told that there is no right or wrong answer.
  • Item Categories
  • Competence and value
PracticalSelf-reports of competence and value
Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (King et al., 2004; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)Person–Environment–Occupation (Law et al., 1996)Not mentioned
  • Children with and without disabilities, 6–18 yr old
  • This study used the assessment with children with high-functioning autism
  • Perspective
  • Child interview. Children can be supported by an adult through adaptation when necessary. The test manual notes that for the factual questions, a parent may answer for the child.
  • Purpose
  • To estimate children’s participation outside of school; primarily a measure of recreational participation (46 out of 55 items)
  • Description
  • A self-rated measure of 55 items. Rating scales are specific to each dimension.
  • Test Components
  • Six dimensions of participation:
  • 1. Diversity (activities in which the child participates)
  • 2. Intensity (frequency of participation)
  • 3. Social aspect
  • 4. Where (the location the activity takes place)
  • 5. Child’s degree of enjoyment
  • 6. Preference (the child’s desire to participate).
  • Item Categories
  • • Recreational
  • • Physical
  • • Social
  • • Skill-based
  • • Self-improvement.
Self-report; short and can be used in many populationsA total score for each one of the 5 dimensions for each category, including scores for formal and informal activities
Children’s Leisure Assessment Scale (Rosenblum, Sachs, & Schreuer, 2010)Not mentionedMulticulturalSchool-age children
  • Perspective
  • Child questionnaire
  • Purpose
  • To measure multidimensional participation in children and adolescents. To document children’s perceptions about their ambitions regarding certain activities and those that they would like to undertake but have not.
  • Description
  • 40 questions examine 4 dimensions: type of activity; frequency; with whom you usually perform the activity; and how much you like it. Reference is also made to activities that the child would like to do.
  • Test Components
  • Quantitative and qualitative evaluation in 6 dimensions of participation: variety, frequency, sociability, performance, and time-consuming and desired activities
  • Activity Categories
  • • Instrumental
  • • Indoor games and sports
  • • Outdoor
  • • Self-enrichment.
Brief; takes about 15 min to complete
  • Variety (no. of activities in which the child was engaged), frequency, sociability, and preference
  • Additional Information
  • Time invested in 5 chosen activities that the child would like to perform
Do-Eat (Josman, Goffer, & Rosenblum, 2010)Ecological—administered in the child’s natural surroundings; based on both top-down and bottom-up approachesTasks are culturally relevantChildren with or at risk for DCD, ages 5–8 yr
  • Perspective
  • Therapist administration and caregiver questionnaire
  • Purpose
  • To evaluate relevant performance areas for children with DCD and to assist in establishing customized goals and objectives for intervention with these children
  • Description
  • The child is asked to perform 3 tasks while the parent completes a questionnaire. Scoring sheet; scores rated on a scale ranging from 1 (unsatisfactory performance) to 5 (very good performance). Cues are provided as needed according to hierarchical principles.
  • Test Components
  • • Prepare a sandwich.
  • • Prepare chocolate milk.
  • • Fill out a certificate of outstanding performance for him- or herself.
  • The parent questionnaire consists of 12 positive statements (e.g., “My child eats and drinks without getting dirty”).
  • Item Categories
  • Performance, sensory–motor skills, executive functions associated with task performance
Easy to obtainOverall task performance score, overall score analyzing sensory–motor skills, and overall score analyzing executive functions associated with task performance. Also provides total score (average of the 3 scores) and total score for the questionnaire.
Evaluation Tool of Children’s Handwriting (Amundson, 1995; Brossard-Racine, Mazer, Julien, & Majnemer, 2012)Ecological modelOnly for Latin alphabetChildren in Grades 1–3 (the study examined children in Grades 2–3)
  • Perspective
  • Therapist evaluation of the child’s product
  • Purpose
  • To examine legibility of handwriting
  • Description
  • The child has 7 different tasks (similar to those experienced in the classroom) to accomplish. Then the therapist scores the child’s performance, referring to legibility of letters, numerals, and words.
  • Test Components
  • • Legibility (specific criteria such as omission, closing, misplacing, reversion, and poor erasure)
  • • Performance time or writing speed
  • Item Categories
  • • Alphabet writing from memory
  • • Numeral writing from memory
  • • Near-point copying
  • • Far-point copying
  • • Dictation of nonwords
  • • Dictation of numbers
  • • Composition of short sentence.
Takes 30 min to administer; two versions: manuscript and cursiveTotal legibility score for letters, numerals, and words
McDonald Play Inventory (McDonald & Vigen, 2012)Not mentionedOne of the limitations of this research includes the lack of generalization to children from lower socioeconomic backgrounds or other geographic areas.7- to 11-yr-old children with neurotypical development and with known learning and developmental disabilities
  • Perspective
  • Child self-report questionnaire
  • Purpose
  • To measure play activities and play styles
  • Description
  • The McDonald Play Activity Inventory measures the child’s perceived frequency of engagement in play; the McDonald Play Style Inventory measures the types and frequencies of play behaviors. In Part 1, the child is asked to rate how frequently he or she participates in the 40 play activities in 4 categories. In Part 2, the child rates 24 play behavior items, 12 neutral play activity items, and 4 “lie” or social desirability items on a 5-point Likert scale.
  • Test Components
  • Play activity frequency and play behavior
  • Item Categories
  • • Fine motor
  • • Gross motor
  • • Social group
  • • Solitary or passive
  • • Physical coordination
  • • Cooperation
  • • Peer acceptance
  • • Social participation.
Can be completed in 15–30 minScores for each of the scales (categories) and two total scores for the two inventories
Quality of Life in School Questionnaire (Weintraub & Bar-Haim Erez, 2009)Client-centered approach, biopsychosocial model (World Health Organization, 2001), Person–Environment–Occupation model (Christiansen, Baum, & Bass-Haugen, 2005; Law et al., 1996)Stated that quality of life (QoL) may be influenced by cultural background and recommended carrying out cross-cultural studiesElementary school students in Grades 3–6
  • Perspective
  • Child questionnaire
  • Purpose
  • To examine children’s perception of their QoL at school
  • Description
  • 36 items; each item is scored on a 4-point scale
  • Test Components
  • • Teacher–student relationship and school activities
  • • Physical environment of the school and the classroom
  • • Negative feelings toward school
  • • Positive feelings toward school.
BriefMean score for each of the 4 categories (factors) and total score
Revised Pediatric Evaluation of Disability Inventory(Haley & Coster, 2010)Not mentionedParticipants were representative of the ethnic distribution of the 2000 U.S. census.Infants, children, and youths from birth to age 20 yr
  • Perspective
  • Caregiver questionnaire
  • Purpose
  • To measure and understand the functional abilities of children and youth with autism spectrum disorders (ASD) and to capture the functional strengths of children with disabilities, including those with ASD
  • Description
  • • 4-point rating scale of daily activities and social–cognitive domains
  • • 5-point rating scale for the responsibility domain
  • Test Components
  • Daily activities (68 items):
  • • Eating and mealtime
  • • Getting dressed
  • • Keeping clean
  • • Home tasks
  • Social–cognitive (60 items):
  • • Interaction
  • • Communication
  • • Everyday cognition
  • • Self-management
  • • Responsibility (51 items):
    • ○ Organization and planning
    • ○ Taking care of daily needs
    • ○ Health management
    • ○ Staying safe.
  • Item Categories
  • 4 domains:
  • • Daily activities
  • • Social–cognitive
  • • Mobility
  • • Responsibility.
Computer-adaptive test
  • Total score (mean) for each domain:
  • • Daily activities
  • • Social–cognitive
  • • Mobility
  • • Responsibility
School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998; Hwang & Davies, 2009)Not mentioned, but consistent with ecological modelNot mentionedElementary school children
  • Perspective
  • Teacher or therapist questionnaire
  • Purpose
  • To measure the wide spectrum of school-related functional tasks associated with the role of an elementary school child and to guide students with special needs
  • Description
  • This study used 18 scales (of 21) with 266 items. Each item is scored on a 4-point rating scale (1 = does not perform, 4 = consistent performance). The scales are hierarchically ordered from easy to difficult.
  • Test Components
  • Nine cognitive–behavioral task scales and 9 physical task scales
  • Item Categories
  • There is a rating scale guide.
  • • Travel
  • • Maintaining and changing position
  • • Recreational movement
  • • Manipulation with movement
  • • Using materials
  • • Setup and cleanup
  • • Eating and drinking
  • • Hygiene
  • • Clothing management
  • • Functional communication
  • • Memory and understanding
  • • Following social conventions
  • • Compliance with adult directives
  • • Task behavior
  • • Positive interaction
  • • Behavior regulation
  • • Personal care
  • • Awareness and safety.
Very detailed; takes time to administerA score for each scale allows therapist or teacher to identify areas of particular limitation or strength and to identify specific functional tasks that are difficult for the student.
School Version of the Assessment of Motor and Process Skills (Fisher, Bryze, Hume, & Griswold, 2007; Munkholm, Berg, Löfgren, & Fisher, 2010)Ecological—the natural classroom setting; performance-basedFree of bias associated with world regionStudents ages 3–17; differentiated between typically developing students and students with disability (at risk, mild, developmental and neurological, cognitive, and psychological and other multiple diagnoses)
  • Perspective
  • Therapist and teacher (interview). Therapist interviews the teacher first and then observes the student in class during normal routines.
  • Purpose
  • To measure the quality of schoolwork task performance as it is observed in the natural classroom setting
  • Description
  • The therapist observes the student while the student completes 2 schoolwork tasks given by the teacher and takes observational notes that he or she later uses to score the quality of performance.
  • Test Components
  • School motor skills:
  • • Body position
  • • Obtaining and holding objects
  • • Moving self and object
  • • Sustaining performance.
  • School process skills:
  • • Sustaining performance
  • • Applying knowledge
  • • Temporal organization
  • • Organizing space and objects
  • • Adapting performance.
  • Item Categories
  • 1. Pen-and-pencil writing tasks
  • 2. Drawing and coloring tasks
  • 3. Cutting and pasting tasks
  • 4. Computer writing tasks
  • 5. Math manipulative tasks.
Assessment requires a computer scoring program
  • Two linear quality-of-performance measures:
  • 1. School motor quality of performance
  • 2. School process quality of performance
Sensory Experiences Questionnaire (Baranek, David, Poe, Stone, & Watson, 2006; Little et al., 2011)Not mentionedNot mentionedYoung children (5–72 mo) with autism and developmental delays
  • Perspective
  • Caregiver questionnaire
  • Purpose
  • To identify sensory processing patterns in the context of daily activities.
  • The items are rated on a 5-point Likert scale (1 = almost never to 5 = almost always)
  • Description
  • Higher scores are indicative of more sensory processing problems. In addition, there are qualitative questions regarding parent compensatory strategies used in response.
  • Test Components
  • 4 scales:
  • 1. Hyperresponsiveness
  • 2. Hyporesponsiveness
  • 3. Social
  • 4. Nonsocial.
  • Item Categories
  • The items reflect 5 sensory domains:
  • 1. Tactile
  • 2. Auditory
  • 3. Visual
  • 4. Vestibular–proprioceptive
  • 5. Gustatory–olfactory.
Brief (10–15 min)4 dimensional subscale scores and a total score
Table Footer NoteNote. DCD = developmental coordination disorder; SD = standard deviation.
Note. DCD = developmental coordination disorder; SD = standard deviation.×
Table 3.
Activity and Participation Instruments (2009–2012)
Activity and Participation Instruments (2009–2012)×
Measure (Author/Year)Frame of Reference and Theoretical ModelCultural RelevanceParticipantsPerspective, Purpose, and DescriptionTest Components and Item CategoriesPracticalityOutcome Measures
Child Occupational Self Assessment (Keller, Kafkes, Basu, Federico, & Kielhofner, 2005; Kramer, Kielhofner, & Smith, 2010)Model of Human Occupation (Kielhofner, 2008) Data were collected in the United States, United Kingdom, Iceland, Germany, and Switzerland and from people of several ethnicities.Children ages 7–17 with conditions such as autism, attention deficit hyperactivity disorder, expressive language delay, cerebral palsy, and intellectual disabilities
  • Perspective
  • Child questionnaire (a version is also available that the therapist can complete with the child)
  • Purpose
  • Self-report of occupational competence and value for everyday activities
  • Description
  • Measures the extent to which children feel they competently meet expectations and responsibilities associated with activities and the relative value of those activities. Also facilitates children’s involvement in the therapy process. The first two versions include visual cues. During performance, the therapist can reduce visual distractions, provide examples, and write on behalf of the child.
  • Test Components
  • 25 items that represent a range of everyday activities
  • Each item is rated using two rating scales: the occupational competence scale and the value scale. Each scale is a 4-stage scale. Higher scores represent better competence or value.
  • There are three means of administration:
  • 1. Standard pen and pencil with visual cues
  • 2. Card sort version
  • 3. Summary form of all items with no visual cues.
  • During administration, the child is guided to pick the category that best describes him or her and told that there is no right or wrong answer.
  • Item Categories
  • Competence and value
PracticalSelf-reports of competence and value
Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (King et al., 2004; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)Person–Environment–Occupation (Law et al., 1996)Not mentioned
  • Children with and without disabilities, 6–18 yr old
  • This study used the assessment with children with high-functioning autism
  • Perspective
  • Child interview. Children can be supported by an adult through adaptation when necessary. The test manual notes that for the factual questions, a parent may answer for the child.
  • Purpose
  • To estimate children’s participation outside of school; primarily a measure of recreational participation (46 out of 55 items)
  • Description
  • A self-rated measure of 55 items. Rating scales are specific to each dimension.
  • Test Components
  • Six dimensions of participation:
  • 1. Diversity (activities in which the child participates)
  • 2. Intensity (frequency of participation)
  • 3. Social aspect
  • 4. Where (the location the activity takes place)
  • 5. Child’s degree of enjoyment
  • 6. Preference (the child’s desire to participate).
  • Item Categories
  • • Recreational
  • • Physical
  • • Social
  • • Skill-based
  • • Self-improvement.
Self-report; short and can be used in many populationsA total score for each one of the 5 dimensions for each category, including scores for formal and informal activities
Children’s Leisure Assessment Scale (Rosenblum, Sachs, & Schreuer, 2010)Not mentionedMulticulturalSchool-age children
  • Perspective
  • Child questionnaire
  • Purpose
  • To measure multidimensional participation in children and adolescents. To document children’s perceptions about their ambitions regarding certain activities and those that they would like to undertake but have not.
  • Description
  • 40 questions examine 4 dimensions: type of activity; frequency; with whom you usually perform the activity; and how much you like it. Reference is also made to activities that the child would like to do.
  • Test Components
  • Quantitative and qualitative evaluation in 6 dimensions of participation: variety, frequency, sociability, performance, and time-consuming and desired activities
  • Activity Categories
  • • Instrumental
  • • Indoor games and sports
  • • Outdoor
  • • Self-enrichment.
Brief; takes about 15 min to complete
  • Variety (no. of activities in which the child was engaged), frequency, sociability, and preference
  • Additional Information
  • Time invested in 5 chosen activities that the child would like to perform
Do-Eat (Josman, Goffer, & Rosenblum, 2010)Ecological—administered in the child’s natural surroundings; based on both top-down and bottom-up approachesTasks are culturally relevantChildren with or at risk for DCD, ages 5–8 yr
  • Perspective
  • Therapist administration and caregiver questionnaire
  • Purpose
  • To evaluate relevant performance areas for children with DCD and to assist in establishing customized goals and objectives for intervention with these children
  • Description
  • The child is asked to perform 3 tasks while the parent completes a questionnaire. Scoring sheet; scores rated on a scale ranging from 1 (unsatisfactory performance) to 5 (very good performance). Cues are provided as needed according to hierarchical principles.
  • Test Components
  • • Prepare a sandwich.
  • • Prepare chocolate milk.
  • • Fill out a certificate of outstanding performance for him- or herself.
  • The parent questionnaire consists of 12 positive statements (e.g., “My child eats and drinks without getting dirty”).
  • Item Categories
  • Performance, sensory–motor skills, executive functions associated with task performance
Easy to obtainOverall task performance score, overall score analyzing sensory–motor skills, and overall score analyzing executive functions associated with task performance. Also provides total score (average of the 3 scores) and total score for the questionnaire.
Evaluation Tool of Children’s Handwriting (Amundson, 1995; Brossard-Racine, Mazer, Julien, & Majnemer, 2012)Ecological modelOnly for Latin alphabetChildren in Grades 1–3 (the study examined children in Grades 2–3)
  • Perspective
  • Therapist evaluation of the child’s product
  • Purpose
  • To examine legibility of handwriting
  • Description
  • The child has 7 different tasks (similar to those experienced in the classroom) to accomplish. Then the therapist scores the child’s performance, referring to legibility of letters, numerals, and words.
  • Test Components
  • • Legibility (specific criteria such as omission, closing, misplacing, reversion, and poor erasure)
  • • Performance time or writing speed
  • Item Categories
  • • Alphabet writing from memory
  • • Numeral writing from memory
  • • Near-point copying
  • • Far-point copying
  • • Dictation of nonwords
  • • Dictation of numbers
  • • Composition of short sentence.
Takes 30 min to administer; two versions: manuscript and cursiveTotal legibility score for letters, numerals, and words
McDonald Play Inventory (McDonald & Vigen, 2012)Not mentionedOne of the limitations of this research includes the lack of generalization to children from lower socioeconomic backgrounds or other geographic areas.7- to 11-yr-old children with neurotypical development and with known learning and developmental disabilities
  • Perspective
  • Child self-report questionnaire
  • Purpose
  • To measure play activities and play styles
  • Description
  • The McDonald Play Activity Inventory measures the child’s perceived frequency of engagement in play; the McDonald Play Style Inventory measures the types and frequencies of play behaviors. In Part 1, the child is asked to rate how frequently he or she participates in the 40 play activities in 4 categories. In Part 2, the child rates 24 play behavior items, 12 neutral play activity items, and 4 “lie” or social desirability items on a 5-point Likert scale.
  • Test Components
  • Play activity frequency and play behavior
  • Item Categories
  • • Fine motor
  • • Gross motor
  • • Social group
  • • Solitary or passive
  • • Physical coordination
  • • Cooperation
  • • Peer acceptance
  • • Social participation.
Can be completed in 15–30 minScores for each of the scales (categories) and two total scores for the two inventories
Quality of Life in School Questionnaire (Weintraub & Bar-Haim Erez, 2009)Client-centered approach, biopsychosocial model (World Health Organization, 2001), Person–Environment–Occupation model (Christiansen, Baum, & Bass-Haugen, 2005; Law et al., 1996)Stated that quality of life (QoL) may be influenced by cultural background and recommended carrying out cross-cultural studiesElementary school students in Grades 3–6
  • Perspective
  • Child questionnaire
  • Purpose
  • To examine children’s perception of their QoL at school
  • Description
  • 36 items; each item is scored on a 4-point scale
  • Test Components
  • • Teacher–student relationship and school activities
  • • Physical environment of the school and the classroom
  • • Negative feelings toward school
  • • Positive feelings toward school.
BriefMean score for each of the 4 categories (factors) and total score
Revised Pediatric Evaluation of Disability Inventory(Haley & Coster, 2010)Not mentionedParticipants were representative of the ethnic distribution of the 2000 U.S. census.Infants, children, and youths from birth to age 20 yr
  • Perspective
  • Caregiver questionnaire
  • Purpose
  • To measure and understand the functional abilities of children and youth with autism spectrum disorders (ASD) and to capture the functional strengths of children with disabilities, including those with ASD
  • Description
  • • 4-point rating scale of daily activities and social–cognitive domains
  • • 5-point rating scale for the responsibility domain
  • Test Components
  • Daily activities (68 items):
  • • Eating and mealtime
  • • Getting dressed
  • • Keeping clean
  • • Home tasks
  • Social–cognitive (60 items):
  • • Interaction
  • • Communication
  • • Everyday cognition
  • • Self-management
  • • Responsibility (51 items):
    • ○ Organization and planning
    • ○ Taking care of daily needs
    • ○ Health management
    • ○ Staying safe.
  • Item Categories
  • 4 domains:
  • • Daily activities
  • • Social–cognitive
  • • Mobility
  • • Responsibility.
Computer-adaptive test
  • Total score (mean) for each domain:
  • • Daily activities
  • • Social–cognitive
  • • Mobility
  • • Responsibility
School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998; Hwang & Davies, 2009)Not mentioned, but consistent with ecological modelNot mentionedElementary school children
  • Perspective
  • Teacher or therapist questionnaire
  • Purpose
  • To measure the wide spectrum of school-related functional tasks associated with the role of an elementary school child and to guide students with special needs
  • Description
  • This study used 18 scales (of 21) with 266 items. Each item is scored on a 4-point rating scale (1 = does not perform, 4 = consistent performance). The scales are hierarchically ordered from easy to difficult.
  • Test Components
  • Nine cognitive–behavioral task scales and 9 physical task scales
  • Item Categories
  • There is a rating scale guide.
  • • Travel
  • • Maintaining and changing position
  • • Recreational movement
  • • Manipulation with movement
  • • Using materials
  • • Setup and cleanup
  • • Eating and drinking
  • • Hygiene
  • • Clothing management
  • • Functional communication
  • • Memory and understanding
  • • Following social conventions
  • • Compliance with adult directives
  • • Task behavior
  • • Positive interaction
  • • Behavior regulation
  • • Personal care
  • • Awareness and safety.
Very detailed; takes time to administerA score for each scale allows therapist or teacher to identify areas of particular limitation or strength and to identify specific functional tasks that are difficult for the student.
School Version of the Assessment of Motor and Process Skills (Fisher, Bryze, Hume, & Griswold, 2007; Munkholm, Berg, Löfgren, & Fisher, 2010)Ecological—the natural classroom setting; performance-basedFree of bias associated with world regionStudents ages 3–17; differentiated between typically developing students and students with disability (at risk, mild, developmental and neurological, cognitive, and psychological and other multiple diagnoses)
  • Perspective
  • Therapist and teacher (interview). Therapist interviews the teacher first and then observes the student in class during normal routines.
  • Purpose
  • To measure the quality of schoolwork task performance as it is observed in the natural classroom setting
  • Description
  • The therapist observes the student while the student completes 2 schoolwork tasks given by the teacher and takes observational notes that he or she later uses to score the quality of performance.
  • Test Components
  • School motor skills:
  • • Body position
  • • Obtaining and holding objects
  • • Moving self and object
  • • Sustaining performance.
  • School process skills:
  • • Sustaining performance
  • • Applying knowledge
  • • Temporal organization
  • • Organizing space and objects
  • • Adapting performance.
  • Item Categories
  • 1. Pen-and-pencil writing tasks
  • 2. Drawing and coloring tasks
  • 3. Cutting and pasting tasks
  • 4. Computer writing tasks
  • 5. Math manipulative tasks.
Assessment requires a computer scoring program
  • Two linear quality-of-performance measures:
  • 1. School motor quality of performance
  • 2. School process quality of performance
Sensory Experiences Questionnaire (Baranek, David, Poe, Stone, & Watson, 2006; Little et al., 2011)Not mentionedNot mentionedYoung children (5–72 mo) with autism and developmental delays
  • Perspective
  • Caregiver questionnaire
  • Purpose
  • To identify sensory processing patterns in the context of daily activities.
  • The items are rated on a 5-point Likert scale (1 = almost never to 5 = almost always)
  • Description
  • Higher scores are indicative of more sensory processing problems. In addition, there are qualitative questions regarding parent compensatory strategies used in response.
  • Test Components
  • 4 scales:
  • 1. Hyperresponsiveness
  • 2. Hyporesponsiveness
  • 3. Social
  • 4. Nonsocial.
  • Item Categories
  • The items reflect 5 sensory domains:
  • 1. Tactile
  • 2. Auditory
  • 3. Visual
  • 4. Vestibular–proprioceptive
  • 5. Gustatory–olfactory.
Brief (10–15 min)4 dimensional subscale scores and a total score
Table Footer NoteNote. DCD = developmental coordination disorder; SD = standard deviation.
Note. DCD = developmental coordination disorder; SD = standard deviation.×
×
Table 4.
Psychometric Comparison of Activity and Participation Instruments (2009–2012)
Psychometric Comparison of Activity and Participation Instruments (2009–2012)×
InstrumentReliability StudiesValidity StudiesCoding: Scale and Scoring
Child Occupational Self Assessment (Keller, Kafkes, Basu, Federico, & Kielhofner, 2005; Kramer, Kielhofner, & Smith, 2010)Not mentioned
  • Content and Structural Validity
  • An earlier version found 2 and 4 items that had poor fit to the model. This study found only 1 item.
  • Substantive Validity
  • On both scales, >85% of children responded in a consistent manner. Also, as in previous studies, the theoretically meaningful item hierarchies provided further evidence.
  • External Validity
  • Mixed support was found.
Description and visual example
Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC; King et al., 2004; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)
  • Test–Retest Reliability
  • This study, similar to previous studies, found test–retest reliability >.70 except for the social aspect dimension, which was low (r = .196), unlike in previous studies.
  • Reliability was further estimated as parents agreed with the majority of their children’s self-ratings on this assessment.
  • Content Validity (whether the CAPE/PAC was reflective of activities that children with high-functioning autism participate in and thus valid to the population)
  • The 55 activities appeared to cover the recreational activities in which the children with high-functioning autism participate (according to interviews with the children in the study).
Description and visual example
Children’s Leisure Assessment Scale (Rosenblum, Sachs, & Schreuer, 2010)
  • Internal Reliability
  • Cronbach’s αs = .57–.83.
  • Content and Face Validity
  • The questionnaire was reviewed by expert consultants, parents, and children.
  • Construct Validity
  • Construct validity is evident from the gender distinction found in the study and by its 4 domains.
  • Internal Validity
  • α = .71
  • Factor Analysis
  • As a result of factor analysis, 10 activities were eliminated.
Cursory description, no visual or detailed examples
Do-Eat (Josman, Goffer, & Rosenblum, 2010)
  • Internal Consistency
  • αs = .89–.93 for both the Do-Eat (for each of the 3 components) and the parent questionnaire.
  • Interrater Reliability
  • 2 experienced occupational therapists viewed a videotape of a child performing the Do-Eat and rated performance (rs = .92–1.00)
  • Test–Retest Reliability
  • A study is being conducted.
  • Discriminant Validity
  • Recent research found discriminant validity among 3 age groups and both genders of typically developing children.
  • Construct Validity
  • The Do-Eat distinguished between children with developmental coordination disorder and typically developing children, as demonstrated by significant between-groups differences on the Do-Eat (t = 14.09, p < .001, df = 57) and the parent questionnaire (t = 3.64, p < .001, df = 57).
  • Concurrent Validity
  • Significant correlations were found between the Do-Eat and the Movement Assessment Battery for Children final score (r = −.86, p < .001).
  • Content and Face Validity
  • On the basis of interviewing teachers and parents, observing children, and analysis of functional tools, the content was validated by 5 expert consultants and 5 experienced occupational therapists.
  • Future studies are recommended in different ages and populations.
Detailed description, written and visual examples
Evaluation Tool of Children’s Handwriting (ETCH; Amundson, 1995; Brossard-Racine, Mazer, Julien, & Majnemer, 2012)
  • Test–Retest Reliability
  • r = .63 for total legibility, r = .77 for total letter legibility, r = .71 for total word legibility
  • Interrater Reliability
  • ICCs ranged from .42 to .84 for the individual items on the ETCH–Manuscript for children referred to occupational therapy. The current study also found weak interrater reliability (ICC = .19).
  • Content Validity
  • Established in 3 pilot editions.
  • Concurrent Validity
  • This validity has been questioned; one study found that the assessment was not sensitive enough to identify difficulties experienced by the children’s teacher; another unpublished study provided opposite evidence for second-grade children. No cutoff value has been published. According to the occupational therapists in this study, 75% total word legibility and 76% total letter legibility discriminated between children with and without handwriting difficulties (the manual suggest higher cutoff scores).
Cursory description; no visual or detailed examples
McDonald Play Inventory (McDonald & Vigen; 2012)
  • Internal Consistency
  • First pilot research found internal consistency of .87 and .83; in this research, the values were .84 and .79 for the McDonald Play Activity Inventory (MPAI) and the McDonald Play Style Inventory (MPSI), respectively.
  • Test–Retest Reliability
  • .69 for the MPAI and .82 for the MPSI (the original study, in 1992, found similar values).
  • Factor Analysis
  • Moderate to strong correlations (.47–.81) were found between each subscale and total scale score. The intercorrelation between the subscales ranged from low (<.25) to moderate (.50–.71). The intercorrelation between the total inventory scores fell in the moderate range (.49).
  • Construct Validity
  • No statistically significant differences were found by gender or between groups (disabled and nondisabled) on the MPAI total inventory or subscale. Significant differences were reported in the total score of the MPSI (p = .002), cooperation (p = .01), peer acceptance (p = .002), social participation (p = .003), and physical coordination (p = .003).
  • Significant difference on social participation (p = .02) was found in the analyses of the mean differences between children with ASD and neurotypical children. Significant differences were also found between age groups.
  • Concurrent Validity
  • The child’s self-rating was compared with the parent’s rating. Low to moderate correlations were found for some of the subscales.
Detailed description; written example; no visual example
Quality of Life in Schools (Weintraub & Bar-Haim Erez, 2009)Not mentioned
  • Construct Validity
  • Validity was tested in two versions. In the initial version, 3 factors were identified; 2 were divided into 2. At the end, Cronbach’s αs were .717–.853. In the second version, Cronbach’s αs were .68–.91 for the factors and .88 for the total score. Significant medium to high correlation with each of the categories (.51 < r < .69) were found. Post hoc analysis indicated that students in Grade 3 perceived their school quality of life to be significantly better than did students in Grades 4–6 (.00 < r < .01) for all categories and total score. The study found no gender differences, in contrast to other studies.
Detailed description; no visual or detailed examples
Revised Pediatric Evaluation of Disability Inventory (Haley & Coster, 2010)
  • Discriminant Validity
  • An earlier study, not yet published (Dumas et al., 2012), found good discriminant validity. In the social–cognitive domain, significant differences were found between children with ASD and children without disabilities at ages 10 and 15 yr (p < .01). All other differences were not significant. In the responsibility domain, significant differences were found between children with ASD and children without disabilities at ages 10 and 15 yr. Other differences were not significant.
Cursory description; written examples in a table at the end of the article
School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998; Hwang & Davies, 2009)Several studies are mentioned without details.
  • Several studies are mentioned without details. Evidence of reliability and validity in these studies was frequently based on analyses of the summed criterion or raw scores of the scale rather than a scrutiny of individual item rating.
  • Internal Construct Validity
  • Internal validity was supported for 15 of the 18 scales.
  • Construct Validity
  • Of 266 items, 252 met the criterion set for Rasch goodness-of-fit statistics. Three scales were found to be unidimensional, measuring a single construct. The study also found a reliable hierarchical pattern of the assessment.
No description; no visual example; no detailed examples
School Version of the Assessment of Motor and Process Skills (Fisher, Bryze, Hume, & Griswold, 2007; Munkholm, Berg, Löfgren, & Fisher, 2010)Not mentionedThe study evaluated the cross-regional differential item functioning (DIF) to prove its validity. Preliminary results proved its validity for some regions, and the purpose of this study was to extend these results. Minimal DIF was found in 3 school motor items and 1 school process item, but in general all school motor and school process items remained free of DIF: from .33 to −.30 logit (SE = .06–.12 logit) on the School Motor Scale and from .28 to −.31 logit (SE = .05–.07) on the School Process Scale. In addition, the study evaluated whether DIF leads to differential test functioning and proved there is no significant difference in total scores of different regions.Detailed description; detailed written examples
Sensory Experience Questionnaire (Baranek, David, Poe, Stone, & Watson, 2006; Little et al., 2011)
  • Test–Retest Reliability for Total Score
  • ICC = .92 (with differences between different items)
  • Internal Consistency
  • .80 (with differences between different items).
  • Previous studies mentioned with no details.
Authors mention that future research is needed to further validate the questionnaire.Detailed description; written example; no visual example
Table Footer NoteNote. ASD = autism spectrum disorder; ICC = intraclass correlation coefficient; SE = standard error.
Note. ASD = autism spectrum disorder; ICC = intraclass correlation coefficient; SE = standard error.×
Table 4.
Psychometric Comparison of Activity and Participation Instruments (2009–2012)
Psychometric Comparison of Activity and Participation Instruments (2009–2012)×
InstrumentReliability StudiesValidity StudiesCoding: Scale and Scoring
Child Occupational Self Assessment (Keller, Kafkes, Basu, Federico, & Kielhofner, 2005; Kramer, Kielhofner, & Smith, 2010)Not mentioned
  • Content and Structural Validity
  • An earlier version found 2 and 4 items that had poor fit to the model. This study found only 1 item.
  • Substantive Validity
  • On both scales, >85% of children responded in a consistent manner. Also, as in previous studies, the theoretically meaningful item hierarchies provided further evidence.
  • External Validity
  • Mixed support was found.
Description and visual example
Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children (CAPE/PAC; King et al., 2004; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)
  • Test–Retest Reliability
  • This study, similar to previous studies, found test–retest reliability >.70 except for the social aspect dimension, which was low (r = .196), unlike in previous studies.
  • Reliability was further estimated as parents agreed with the majority of their children’s self-ratings on this assessment.
  • Content Validity (whether the CAPE/PAC was reflective of activities that children with high-functioning autism participate in and thus valid to the population)
  • The 55 activities appeared to cover the recreational activities in which the children with high-functioning autism participate (according to interviews with the children in the study).
Description and visual example
Children’s Leisure Assessment Scale (Rosenblum, Sachs, & Schreuer, 2010)
  • Internal Reliability
  • Cronbach’s αs = .57–.83.
  • Content and Face Validity
  • The questionnaire was reviewed by expert consultants, parents, and children.
  • Construct Validity
  • Construct validity is evident from the gender distinction found in the study and by its 4 domains.
  • Internal Validity
  • α = .71
  • Factor Analysis
  • As a result of factor analysis, 10 activities were eliminated.
Cursory description, no visual or detailed examples
Do-Eat (Josman, Goffer, & Rosenblum, 2010)
  • Internal Consistency
  • αs = .89–.93 for both the Do-Eat (for each of the 3 components) and the parent questionnaire.
  • Interrater Reliability
  • 2 experienced occupational therapists viewed a videotape of a child performing the Do-Eat and rated performance (rs = .92–1.00)
  • Test–Retest Reliability
  • A study is being conducted.
  • Discriminant Validity
  • Recent research found discriminant validity among 3 age groups and both genders of typically developing children.
  • Construct Validity
  • The Do-Eat distinguished between children with developmental coordination disorder and typically developing children, as demonstrated by significant between-groups differences on the Do-Eat (t = 14.09, p < .001, df = 57) and the parent questionnaire (t = 3.64, p < .001, df = 57).
  • Concurrent Validity
  • Significant correlations were found between the Do-Eat and the Movement Assessment Battery for Children final score (r = −.86, p < .001).
  • Content and Face Validity
  • On the basis of interviewing teachers and parents, observing children, and analysis of functional tools, the content was validated by 5 expert consultants and 5 experienced occupational therapists.
  • Future studies are recommended in different ages and populations.
Detailed description, written and visual examples
Evaluation Tool of Children’s Handwriting (ETCH; Amundson, 1995; Brossard-Racine, Mazer, Julien, & Majnemer, 2012)
  • Test–Retest Reliability
  • r = .63 for total legibility, r = .77 for total letter legibility, r = .71 for total word legibility
  • Interrater Reliability
  • ICCs ranged from .42 to .84 for the individual items on the ETCH–Manuscript for children referred to occupational therapy. The current study also found weak interrater reliability (ICC = .19).
  • Content Validity
  • Established in 3 pilot editions.
  • Concurrent Validity
  • This validity has been questioned; one study found that the assessment was not sensitive enough to identify difficulties experienced by the children’s teacher; another unpublished study provided opposite evidence for second-grade children. No cutoff value has been published. According to the occupational therapists in this study, 75% total word legibility and 76% total letter legibility discriminated between children with and without handwriting difficulties (the manual suggest higher cutoff scores).
Cursory description; no visual or detailed examples
McDonald Play Inventory (McDonald & Vigen; 2012)
  • Internal Consistency
  • First pilot research found internal consistency of .87 and .83; in this research, the values were .84 and .79 for the McDonald Play Activity Inventory (MPAI) and the McDonald Play Style Inventory (MPSI), respectively.
  • Test–Retest Reliability
  • .69 for the MPAI and .82 for the MPSI (the original study, in 1992, found similar values).
  • Factor Analysis
  • Moderate to strong correlations (.47–.81) were found between each subscale and total scale score. The intercorrelation between the subscales ranged from low (<.25) to moderate (.50–.71). The intercorrelation between the total inventory scores fell in the moderate range (.49).
  • Construct Validity
  • No statistically significant differences were found by gender or between groups (disabled and nondisabled) on the MPAI total inventory or subscale. Significant differences were reported in the total score of the MPSI (p = .002), cooperation (p = .01), peer acceptance (p = .002), social participation (p = .003), and physical coordination (p = .003).
  • Significant difference on social participation (p = .02) was found in the analyses of the mean differences between children with ASD and neurotypical children. Significant differences were also found between age groups.
  • Concurrent Validity
  • The child’s self-rating was compared with the parent’s rating. Low to moderate correlations were found for some of the subscales.
Detailed description; written example; no visual example
Quality of Life in Schools (Weintraub & Bar-Haim Erez, 2009)Not mentioned
  • Construct Validity
  • Validity was tested in two versions. In the initial version, 3 factors were identified; 2 were divided into 2. At the end, Cronbach’s αs were .717–.853. In the second version, Cronbach’s αs were .68–.91 for the factors and .88 for the total score. Significant medium to high correlation with each of the categories (.51 < r < .69) were found. Post hoc analysis indicated that students in Grade 3 perceived their school quality of life to be significantly better than did students in Grades 4–6 (.00 < r < .01) for all categories and total score. The study found no gender differences, in contrast to other studies.
Detailed description; no visual or detailed examples
Revised Pediatric Evaluation of Disability Inventory (Haley & Coster, 2010)
  • Discriminant Validity
  • An earlier study, not yet published (Dumas et al., 2012), found good discriminant validity. In the social–cognitive domain, significant differences were found between children with ASD and children without disabilities at ages 10 and 15 yr (p < .01). All other differences were not significant. In the responsibility domain, significant differences were found between children with ASD and children without disabilities at ages 10 and 15 yr. Other differences were not significant.
Cursory description; written examples in a table at the end of the article
School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998; Hwang & Davies, 2009)Several studies are mentioned without details.
  • Several studies are mentioned without details. Evidence of reliability and validity in these studies was frequently based on analyses of the summed criterion or raw scores of the scale rather than a scrutiny of individual item rating.
  • Internal Construct Validity
  • Internal validity was supported for 15 of the 18 scales.
  • Construct Validity
  • Of 266 items, 252 met the criterion set for Rasch goodness-of-fit statistics. Three scales were found to be unidimensional, measuring a single construct. The study also found a reliable hierarchical pattern of the assessment.
No description; no visual example; no detailed examples
School Version of the Assessment of Motor and Process Skills (Fisher, Bryze, Hume, & Griswold, 2007; Munkholm, Berg, Löfgren, & Fisher, 2010)Not mentionedThe study evaluated the cross-regional differential item functioning (DIF) to prove its validity. Preliminary results proved its validity for some regions, and the purpose of this study was to extend these results. Minimal DIF was found in 3 school motor items and 1 school process item, but in general all school motor and school process items remained free of DIF: from .33 to −.30 logit (SE = .06–.12 logit) on the School Motor Scale and from .28 to −.31 logit (SE = .05–.07) on the School Process Scale. In addition, the study evaluated whether DIF leads to differential test functioning and proved there is no significant difference in total scores of different regions.Detailed description; detailed written examples
Sensory Experience Questionnaire (Baranek, David, Poe, Stone, & Watson, 2006; Little et al., 2011)
  • Test–Retest Reliability for Total Score
  • ICC = .92 (with differences between different items)
  • Internal Consistency
  • .80 (with differences between different items).
  • Previous studies mentioned with no details.
Authors mention that future research is needed to further validate the questionnaire.Detailed description; written example; no visual example
Table Footer NoteNote. ASD = autism spectrum disorder; ICC = intraclass correlation coefficient; SE = standard error.
Note. ASD = autism spectrum disorder; ICC = intraclass correlation coefficient; SE = standard error.×
×