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Research Article  |   September 2014
Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, 2009–2013: A Content, Methodology, and Instrument Design Review
Author Affiliations
  • Ted Brown, PhD, MSc, MPA, OT(C), OTR, is Associate Professor, Undergraduate Course Convener, and Department Postgraduate Coordinator, Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University—Peninsula Campus, Frankston, Victoria 3800, Australia; ted.brown@monash.edu
  • Helen Bourke-Taylor, PhD, MSc, is Senior Lecturer in Occupational Therapy, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Melbourne Campus (St Patrick’s), Victoria, Australia; helen.bourke-taylor@acu.edu.au
Article Information
Assessment Development and Testing / Centennial Vision / Evidence-Based Practice / Pediatric Evaluation and Intervention / School-Based Practice / Departments / Centennial Vision
Research Article   |   September 2014
Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, 2009–2013: A Content, Methodology, and Instrument Design Review
American Journal of Occupational Therapy, September/October 2014, Vol. 68, e154-e216. doi:10.5014/ajot.2014.012237
American Journal of Occupational Therapy, September/October 2014, Vol. 68, e154-e216. doi:10.5014/ajot.2014.012237
Abstract

We extracted 35 articles published between January 2009 and September 2013 in the American Journal of Occupational Therapy (AJOT) that focused on children and youth instrument development and testing, summarized study details and traits of the 37 measures reported in them, and then critiqued the measures. Most of the articles contained Level III evidence (one-group nonrandomized and noncontrolled). The most common types of reliability reported in the articles were internal consistency, test–retest reliability, and interrater reliability; the most frequent types of validity reported were discriminant validity and construct validity. Most pediatric assessment tools were designed for school-age children between ages 5 and 12 yr. The two most common purposes for the assessments were reported as descriptive and discriminative. The continued publication of instruments that measure children and youth participation in meaningful occupations and life roles in home, school, and community environments is recommended.

To commemorate the American Occupational Therapy Association’s (AOTA’s) 100th anniversary in 2017, the AOTA board of directors endorsed the implementation of the Centennial Vision, which was “designed to be a road map for the future of the profession” (AOTA, 2007a, p. 613). The Centennial Vision challenges the field of occupational therapy to generate high-quality evidence documenting its effectiveness and impact in six primary practice areas: (1) productive aging; (2) rehabilitation, disability, and participation; (3) children and youth; (4) work and industry; (5) health and wellness; and (6) mental health (Corcoran, 2007).
Gutman (2008b)  articulated that achieving the goals identified in AOTA’s Centennial Vision would require adhering to five primary research priorities: (1) providing evidence of the efficacy of occupational therapy practice; (2) testing the reliability and validity of occupational therapy assessment instruments; (3) examining the connection between engagement in occupation and health and well-being; (4) using fundamental and basic research to explain how disability experiences affect people’s participation in community life; and (5) asking and answering topical questions that will provide insights for the occupational therapy profession’s ongoing development and evolution. “The sagacity of the Centennial Vision is that it has charged the profession to produce research needed to support the efficacy of practice in all major practice areas” (Gutman, 2008a, p. 501).
In 2006, AOTA’s Children and Youth Ad Hoc Committee generated a list of 11 research areas they deemed important to inform occupational therapy practice with children and youth (AOTA, 2006) and in turn outlined AOTA’s Centennial Vision for pediatric occupational therapy:

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, 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. (AOTA, 2006, p. 8)

Progress Toward Meeting the Centennial Vision: Children and Youth Instrument Development and Testing
The American Journal of Occupational Therapy (AJOT) is a significant vehicle to assist AOTA in achieving the Centennial Vision’s mandate (AOTA, 2007a). To monitor how AJOT is fulfilling this purpose, Sharon A. Gutman, AJOT’s Editor-in-Chief, commissioned several AJOT authors to write a series of review articles that chart the journal’s progress toward achieving the Centennial Vision. Several of these articles have focused on the identified primary practice area of children and youth. Examples of reviews published in AJOT focusing on this practice area include those written by Brown (2010a), Bendixen and Kreider (2011), Hilton and Smith (2012), and Hilton, Goloff, Altaras, and Josman (2013) .
Many of the previous review articles published in AJOT have used the level of evidence hierarchy system developed by the AOTA Evidence-Based Literature Review Project (Lieberman & Scheer, 2002; Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996) to classify articles included in them. Level I involves systematic reviews, meta-analyses, and randomized controlled trials. Level II consists of two-group pretest–posttest designs in which controls are used (e.g., cohort designs, case control studies) and randomization is not. Level III designs involve neither control nor randomization but instead use a one-group pretest–posttest design. Level IV includes single-subject designs, descriptive studies, case series, and case reports. Finally, Level V involves only expert opinion and is not based on any systematic research.
Children and Youth
Brown (2010a)  completed a review and critique of 39 articles published in AJOT in 2008 and 2009 that fell under the practice area of children and youth. He found that the most frequent type of research published was basic research, accounting for 38.5% (n = 15) of all studies published on the topic of child and youth practice issues. Instrument development and testing and effectiveness studies were the next two most frequently noted research approaches, accounting for 25.6% (n = 10) and 20.5% (n = 8), respectively. Quantitative studies were the predominant research paradigm used, with 76.9% (n = 30) of the studies dealing with children and youth. Studies using a qualitative approach accounted for only 12.8% (n = 5), and 10.3% (n = 4) of the studies used a mixed-methods approach. When considering the level of evidence of children and youth studies published in AJOT in 2008–2009, Level III articles were the most common, accounting for 46.2% (n = 18). None of the 39 studies published in the 2008 and 2009 volumes of AJOT that focused on children and youth practice examined the link between health and well-being and occupational engagement.
Bendixen and Kreider (2011)  conducted a systematic review of AJOT articles that focused on the practice category of children and youth published from 2009 to 2010. They used the International Classification of Functioning, Disability and Health (ICF;World Health Organization [WHO], 2001), ICF: Child and Youth Version (ICF–CY;WHO, 2007), and Positive Youth Development (PYD; Catalano, Berglund, Ryan, Lonczak, & Hawkins, 1999) frameworks to monitor how occupational therapy research was tracking toward AOTA’s Centennial Vision goals. They sorted 46 AJOT articles by research type and categorized them into either the ICF–CY or the PYD framework. Of the 46 articles, 12 reported on instrument development and testing, 15 were classified as basic research, 4 were designated as efficacy studies, and 15 involved evaluating the effectiveness of occupational therapy intervention. The ICF–CY breakdown of the variables that the 46 studies focused on was as follows: Body Functions, 31%; Activity, 31%; Participation, 16%; Environment, 12%; and Personal, 10% (Bendixen & Kreider, 2011). “Most of the effectiveness studies reported in AJOT during 2009–2010 focused on activity-based outcomes such as visual–motor integration, motor skill, feeding, and handwriting. As a whole, most treatment effectiveness studies measured clinical and activity-based outcomes of the intervention” (Bendixen & Kreider, 2011, p. 356). The authors concluded that to best meet the Centennial Vision goals, occupational therapists need to “document changes in children’s engagement in everyday life situations and build the evidence of occupational therapy’s efficacy in facilitating participation” (p. 357).
Hilton and Smith (2012)  examined 22 articles published in the 2011 AJOT volume that dealt with the practice area of children and youth. Similar to the approach used by Bendixen and Kreider (2011), Hilton and Smith sorted the articles by type of research (Gutman, 2008b), level of evidence (Lieberman & Scheer, 2002), and the ICF categories expanded by Baum (2011)  to incorporate levels of rehabilitation science.
Of the 22 articles analyzed, 10 were intervention effectiveness studies, 5 were instrument development and testing studies, 6 were basic research studies, and 1 was a professional issues study. “The most common evidence level was Level III (36.4%), followed by Level IV (31.8%), Level II (18.2%), and Level I (13.6%)” (Hilton & Smith, 2012, p. e49). The distribution of ICF rehabilitation levels in the 22 articles was as follows: Body Functions and Structures, 50%; Functional Limitations, 32%; Environment, 23%; Participation, 18%; Activity, 14%; and Biomedical, 5% (Hilton & Smith, 2012). Similar to Bendixen and Kreider’s (2011)  findings for articles published in 2009–2010, Hilton and Smith (2012)  reported that the largest percentage of children and youth articles published in 2011 presented results of intervention effectiveness studies classified as Level III or IV, with the majority focusing on the ICF Body Functions and Structures components. However, they noted that “longitudinal, efficacy, and qualitative studies, as well as studies examining adolescents and the transition to adulthood, were absent from articles in this review and are important areas for future investigation” (Hilton & Smith, 2012, p. e39).
Whitney and Hilton (2013)  analyzed 11 intervention effectiveness studies related to children and youth published in the 2012 AJOT volume using evidence level (Lieberman & Scheer, 2002) and Baum’s (2011)  expanded ICF categories. They also rated the 11 articles on four additional criteria outlined by Reichow, Volkmar, and Cicchetti (2008) : efficacy, effectiveness, comparative effectiveness, and pragmatic methodology. Of the studies, 4 (36.4%) were Level I, 2 (18.2%) were Level II, 3 (27.3%) were Level III, and 2 (18.2%) were Level IV. The studies addressed five of the seven ICF rehabilitation science mechanisms: Body Functions and Structures (n = 3; 27.3%), Functional Limitations (n = 5; 45.5%), Activity (n = 3; 27.3%), Participation (n = 1; 9.1%), and Environment (n = 1; 9.1%). Note that some of the studies fell under more than one of the expanded ICF categories.
Whitney and Hilton (2013)  found that 63% of the studies used pragmatic trial methodology (e.g., assessing treatment in context as it is meant to be delivered), and 1 study dealt with comparative effectiveness. They noted that the 11 studies included in this review “showed improvement in their ability to guide practitioners to make evidence-based decisions by increasing the understanding of the pragmatic relevance of intervention and the extent to which intervention promotes participation in childhood and adolescent occupations” (p. e163).
Instrument Development and Testing
Hilton et al. (2013)  examined two groups of studies published in AJOT: 12 articles from the 2012 AJOT volume that concentrated on both children and youth and instrument development and testing and 11 AJOT articles published during 2009–2013 that reported on instrument development and testing studies with a specific focus on children and youth activity and participation scales. Hilton et al. wanted to investigate whether these instruments facilitated the production of credible evidence that endorsed the Centennial Vision principles. Among the 12 instrument development and testing studies published in 2012, 7 (58.3%) were Level II and 5 (41.7%) were Level III; 11 of the studies were on instruments that were the subject of the studies on child and youth activity and participation scales published from 2009 to 2013:
Hilton et al. (2013)  reported an increase in the number of instrument development and testing studies overall: More than half of the studies involved higher levels of evidence, external funding, and larger sample sizes. They also reported that blinding was a research method feature. Hilton et al. noted that “these findings indicate that the profession is moving in the right direction in instrument development and testing” (p. e34).
Meeting the Centennial Vision for Instrument Development and Testing in the Practice Area of Children and Youth
The occupational therapy profession worldwide seeks to consolidate theoretical underpinnings that explain, justify, validate, and develop existing models as well as to develop psychometrically sound instruments that will measure and substantiate occupational therapy practice. The end goal of achieving an evidence-based profession in occupational therapy is reliant on the development of psychometrically robust instruments, tests, and measures (Brown, 2010b). AOTA’s Centennial Vision itself charges the profession to produce both high-quality research evidence and substantive impact within practice. Consequently, occupational therapists having access to and being conversant with a range of psychometrically vigorous assessment tools and scales is crucial to achieving this aim (Coster, 2006a, 2008).
Assessment tools developed within occupational therapy have four main purposes: descriptive, discriminative, predictive, and evaluative (Brown, 2012; Fawcett, 2007). A tool’s purpose will influence the ensuing need for psychometric development and evaluation. Any research investigating an instrument’s psychometric properties should state the assessment’s purpose to guide potential clinicians or researchers who may want to use the instrument. Descriptive tools provide “information which describes the person’s current functional status, problems, needs and/or circumstances” (Fawcett, 2007, p. 98). Descriptive assessments provide a baseline or way of describing a child’s functional status to plan intervention. Examples of descriptive assessments include the Child Occupational Self Assessment (Keller et al., 2005), Assessment of Life Habits for children (Noreau et al., 2007), Paediatric Activity Card Sort (Mandich, Polatajko, Miller, & Baum, 2004), and the Self-Observation and Report Technique (Rintala et al., 1984).
Discriminative assessments are usually norm based and distinguish between individuals or groups on some characteristic or underlying dimension (Fawcett, 2007). Examples include any norm-based developmental assessment such as the Movement Assessment Battery for Children–Second Edition (Henderson, Sugden, & Barnett, 2007), the Peabody Developmental Motor Scales–Second Edition (Folio & Fewell, 2000), or the Vineland Adaptive Behavior Scales–Second Edition (Sparrow, Cicchetti, & Balla, 2005). Discriminative assessments seek to accurately determine whether a child or youth is within a specified range of typical development or performance. The assessment seeks to discriminate between children who may or may not be presenting with suspected occupational performance challenges. Consequently, the discriminant validity of such assessments becomes an extremely important part of their psychometric evaluation.
Predictive assessments “classify people into pre-defined categories of interest in an attempt to predict an event or functional status in another situation” (Fawcett, 2007, p. 99). An example is the Sensory Profile (Dunn, 1999), which predicts sensory responsiveness in other situations and also categorizes the child accordingly. Moreover, children’s performance on the Beery–Buktenica Developmental Test of Visual–Motor Integration (Beery, Buktenica, & Beery, 2010) in kindergarten has been shown to be predictive of future academic performance in subsequent grades (Kurdek & Sinclair, 2000). The Functional Independence Measure for Children (WeeFIM; Uniform Data System for Medical Rehabilitation, 2006) has also demonstrated the ability to predict future functional outcomes of children with neurological injuries (Msall et al., 1994). Consequently, the predictive validity of assessment tools and scales that are used for this specified purpose is crucial.
The fourth type of purpose is evaluative. Evaluative assessments detect the magnitude of change over time within one person or a group of people after an intervention or event (Fawcett, 2007). Evaluative assessments may be designed with the purpose of measuring changes in performance, competence, or satisfaction over time from the client’s perspective and are known as outcome measures. Examples include the Canadian Occupational Performance Measure (Law et al., 2005) and the Perceived Efficacy and Goal Setting System (Missiuna, Pollock, & Law, 2004). Other tools are designed to detect both development and progress over time, such as the Pediatric Evaluation of Disability Inventory (Haley, Coster, Ludlow, Haltiwanger, & Andrellos, 1992). Consequently, evaluative tests require sound test–retest and interrater reliability before thorough investigations of their responsiveness to change over time. For example, the Melbourne Assessment of Unilateral Upper Limb Function second edition (MAUULF–2; Randall, Johnson, & Reddihough, 2010) had established test–retest, intrarater, and interrater reliability before evaluation of its sensitivity to change over time. With such established properties as an outcome measure, the MAUULF–2 has been used to measure change in the functional status of children after occupational therapy intervention (Wallen, O’Flaherty, & Waugh, 2007) and botulinum toxin A (Rameckers, Duysens, Speth, Vles, & Smits-Engelsman, 2010; Speth, Leffers, Janssen-Potten, & Vles, 2005).
It is important to note that many assessment tools and scales have dual or multiple purposes. The usefulness of an instrument or tool in occupational therapy practice and research increases when it has two or more purposes. Examples include the Movement Assessment Battery for Children–Second Edition, which discriminates between children with and without motor differences and predicts whether a child exhibits the signs of developmental coordination disorder. Therefore, assessment tools with more than one purpose, as well as substantiated and appropriate psychometric evaluation, are the most robust instruments available to both clinicians and researchers in the field. The development of such instruments, scales, and tools is imperative for the future of occupational therapy in the evidence-based health care and education arena.
Finally, given the assessment tool’s purpose, it is important to describe the methods involved in establishing its psychometric body of evidence, namely its reliability and validity. Reliability refers to a test’s ability to collect data on a consistent basis, and validity refers to the available body of evidence indicating how well test items represent the construct they claim to assess. Specific subtypes of reliability include internal consistency, correlations between subscales and total scale score, test–retest reliability, intrarater reliability, interrater reliability, split-half reliability, and alternate-form reliability (Mertler, 2007). Usually, a test needs to have established validity before its reliability can be investigated; however, preliminary reliability scores are frequently reported (e.g., internal consistency, split-half reliability) before formal construct validity evidence is published. In other words, a test’s items can appear to reliably measure a construct without evidence that the items adequately represent the construct being assessed. Subtypes of validity include content validity, criterion-related validity, predictive validity, convergent validity, divergent validity, discriminant validity, and factorial validity (Brown, 2012; Fawcett, 2007).
In this article, we review 35 articles published in AJOT between January 2009 and September 2013 that were in the practice areas of children and youth and instrument development and testing. The purpose of this review was to describe these articles and their level of evidence (Gutman, 2008a). We also critique the specific pediatric assessment instruments cited in these articles, which provide a gauge of how well AJOT is meeting the challenges set forth in AOTA’s Centennial Vision.
Method
The AJOT Editor-in-Chief identified 35 articles published in AJOT between January 2009 and September 2013 that addressed both children and youth and instrument development and testing. We used a content analysis approach to summarize the characteristics of the 35 articles (Table 1).*Table 2 provides specific details about the pediatric instrument being investigated. Table 3 profiles and critiques the pediatric assessment instruments included in the 2009–2013 AJOT articles. Among other details, Table 3 includes the stage of instrument development and evaluation, which we based on DeVellis’s (2003)  10 stages of scale development:
  1. Content domain specification (literature review, interviews with relevant audience, focus group) to ensure existence of construct

  2. Item pool generation or reports on initial development of items

  3. Content validity evaluation (content experts, relevant audiences) to ensure representativeness

  4. Questionnaire development and evaluation and evaluation of scoring

  5. Pilot study questionnaire

  6. Sampling and data collection

  7. Reliability assessment

  8. Validity or dimensionality assessment (factorial, dimensionality, convergent, divergent, discriminant: statistical analysis and statistical evidence of construct)

  9. Wider application of scale to new populations

  10. Evaluation of scale’s measurement properties by others than the scale’s authors.

Table 1.
Summary of Articles Describing Development and Testing of Instruments for Children and Youth, Published in the American Journal of Occupational Therapy, January 2009–September 2013
Summary of Articles Describing Development and Testing of Instruments for Children and Youth, Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Author/YearStudy ObjectivesDesign/Participants/Recruitment Strategy/Statistics UsedInstrument/Tool Being InvestigatedMeasurement Characteristics InvestigatedResults
Blanche, Bodison, Chang, & Reinoso (2012) To document the development of the COP, an instrument for identifying proprioceptive processing issues in children
  • Design
  • Prospective scale design over 3 phases: (1) scale construction and content validity, (2) establishment of validity and reliability, and (3) factor analysis
  • Participants
  • 130 children with known developmental disabilities ages 2–9 yr
  • Recruitment
  • Not reported
  • Statistics Used
  • Factor analysis, Pearson’s correlation coefficient, ICC
COP
  • • Interrater reliability
  • • Face validity
  • • Content validity
  • • Construct validity
  • • Criterion validity
  • • Factor analysis
  • Content validity: 18 items were originally derived from the existing literature; 9 OTs who were experts in sensory integration rated the COP items; 4 items were rejected.
  • Construct validity: Children with developmental disabilities had significantly higher total scores and individual item scores on the COP than children without proprioceptive difficulties (ps < .01) except for Item 17 (overly passive; p = .12).
  • Criterion validity: Established through comparison of the COP with the Sensory Processing Measure–Home Form and the Kinesthesia and Standing and Walking Balance subtests of the Sensory Integration and Praxis Test; results indicated that the COP measured 2 distinct influences on proprioception functions: motor performance and sensory seeking.
  • Interrater reliability: Four OTs rated 4 20-min videotapes; total score ICC between the 4 raters was .91, indicating that variation among the raters was minimal.
  • Exploratory factor analysis: Results of the factor analysis revealed 4 factors: Tone and Joint Alignment (Factor 1), Behavioral Manifestations (Factor 2), Postural Motor (Factor 3), and Motor Planning (Factor 4)
Blanche, Reinoso, Chang, & Bodison (2012) To describe the proprioceptive difficulties of children with ASD
  • Design
  • Retrospective group-comparison design
  • Participants
  • 32 children with ASD (no additional motor difficulties), 26 children with developmental disabilities (excluding ASD), 28 typically developing children (matched control)
  • Recruitment
  • De-identified data were collected from a chart review at 2 occupational therapy clinics. The de-identified data of the matched control children were collected in a natural setting.
  • Statistics
  • ANOVA for the 3-group comparison and a post hoc analysis with Tukey-Kramer method for pairwise comparison were applied.
The COP, a scale that measures proprioceptive processing in children by direct observation• Ability of COP to discriminate between groups of participants with known differences (discriminant validity)
  • • Children with ASD present with proprioceptive processing difficulties that are different from those of typically developing children and children with developmental delays.
  • • The 3 groups were significantly different on all 16 of the individual COP items, on the total COP score, and on the 4 COP factors.
  • • Post hoc analysis indicated that children with ASD and developmental disabilities were not significantly different on 4 COP items (feedback-related motor planning, tiptoeing, pushing other or objects, and crashing, falling, and running) and on 2 COP factors (Factor 1, Tone and Joint Alignment, and Factor 3, Postural Control and Grading of Force).
Bourke-Taylor, Law, Howie, & Pallant (2012) To describe the initial development and psychometric evaluation of the HPAS
  • Design
  • Mixed methodology using an initial qualitative study and experts to generate scale items and mail out questionnaire with follow-up phone call to collect data; cross-sectional research design including within-group comparisons
  • Participants
  • 152 mothers of children with developmental disabilities in Victoria, New South Wales, Australia
  • Recruitment
  • Self-selected sampling, including a snowball design (“Recruit a girlfriend”). Inclusion criteria: mother of a school-aged child with a disability
  • Statistics
  • Descriptive, correlations, evaluation of normalcy, factor analysis, and Mann-Whitney U comparisons
The HPAS, which measures the frequency with which mothers caring for a school-age child with a disability participate in self-selected leisure occupations
  • • Construct validity
  • • Discriminant validity
  • • Internal consistency
  • • Factor structure
  • • The HPAS showed good internal consistency (Cronbach’s α = .78).
  • • Construct validity was supported by moderate correlations with subjective maternal mental and general health (Short Form–36, Version 2) and by differentiation in leisure participation among groups of mothers reporting differences in mental health status and sleep interruption.
Brossard-Racine, Mazer, Julien, & Majnemer (2012) To determine ETCH scores for cutoff points to determine children who do and do not require intervention for handwriting issues and to determine the percentage of change for clinical significance
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 34 therapists judged and compared 35 pairs of handwriting samples from 26 children
  • Recruitment
  • Convenience sample of pediatric OTs working in greater Montreal, Quebec
  • OTs were included if they had >1 yr experience working with children with handwriting problems.
  • The handwriting samples were obtained from a group of children involved in a cohort study of school-age children with attention deficit hyperactivity disorder. Children were ages 7–9 yr and routinely used manuscript writing.
  • Statistics
  • ROC analyses, minimal clinically important difference (MCID), descriptive statistics, Shrout-Fleiss reliability ICC
ETCH
  • • Discriminant validity
  • • Interrater reliability
  • Discriminative validity: Word legibility had a crude area under the curve of .86 (95% CI [.84, .88]) and an adjusted area of .96 (95% CI [.95, .97]). Letter legibility had a crude area under the curve of .82 (95% CI [.80, .84]) and an adjusted area of .96 (95% CI = .95, .97).
  • • Interrater reliability between therapists was relatively good (ICC = 5.53).
  • • A difference of 10.0%–12.5% for total word legibility and 6.0%–7.0% for total letter legibility were found as cutoff points for MCID.
  • • For children in Grades 2 and 3, 75.0% total word legibility and 76.0% total letter legibility on the ETCH–Manuscript are suggested as the cutoff values to discriminate between children with handwriting legibility difficulties who should be seen in rehabilitation for evaluation and treatment and those who have no such difficulties.
Brown, Unsworth, & Lyons (2009) To examine the factor structure of 4 visual-motor integration instruments through factor analysis
  • Design
  • Prospective cross-sectional evaluation
  • Participants
  • 400 children ages 5–12 yr in metropolitan Melbourne, Victoria, Australia
  • Recruitment
  • Letters were sent to 955 children in 6 participating state schools.
  • Statistics
  • Factor analysis, descriptive statistics, Cronbach’s α
  • • TVMI
  • • VMI
  • • Test of Visual-Motor Skills–Revised (TVSM–R)
  • • SVMPT
  • • Construct validity
  • • Internal consistency
  • • Cronbach’s αs for the VMI, TVMI, TVMS–R, and SVMPT were all >.80.
  • • VMI displayed a 6-factor structure.
  • • TVMI displayed a 3-factor structure.
  • • TVSM–R displayed a 4-factor structure.
  • • SVMPT displayed a 3-factor structure.
  • • All 4 visual–motor integration instruments exhibited multidimensionality.
Chien, Brown, & McDonald (2010) To assess the interrater and test–retest reliability of the Assessment of Children’s Hand Skills (ACHS)
  • Design
  • Prospective, reliability study
  • Participants
  • 54 children participated in the study; 30 were in the interrater reliability component of the study, and 44 were in the test–retest reliability part of the study.
  • Recruitment
  • A convenience sampling approach was used; of the 54 participants, 30 were typically developing children who were recruited from 1 child care center and 2 preschools in southern metropolitan regions of Melbourne, Victoria, Australia; the remaining 24 children were recruited from 2 special schools if they presented with hand skill difficulties caused by disorders such as ASD, Down syndrome, or developmental delay.
  • Statistics
  • Cronbach’s α, Spearman’s coefficient, weighted κ
ACHS
  • • Interrater reliability
  • • Test–retest reliability
  • • Content validity
  • • The ACHS’s test–retest reliability was satisfactory at the individual item level (.42 < κ > .79) and the total scale level (Spearman’s r = .78, p < .01).
  • • Moderate interrater agreement of the total scale scores was demonstrated (r = .63, p < .01), but individual items exhibited varied interrater agreement.
  • • The ACHS’s content validity was established through an extensive review of the literature, the conceptualization of a hand skill framework on which to base the ACHS skill items, several rounds of review and revision based on expert feedback, and preliminary field testing.
Duff & Goyen (2010) To determine the reliability and validity of the ETCH–Cursive (ETCH-C) using the general scoring criteria
  • Design
  • Cross-sectional, semirandomized reliability and validity study
  • Participants
  • Purposive sampling from randomly selected schools. Participants were 63 typically developing 10- to 12-yr-old children from 10 schools in Sydney, New South Wales, Australia: 33 participants with handwriting difficulties and 30 without.
  • Recruitment
  • Asked teachers in randomly selected schools to identify Grade 5 and 6 students with and without handwriting difficulties.
  • Statistics
  • Descriptive statistics, ICC, ROC, Pearson correlation coefficient, ANOVA, Tukey’s post hoc analysis
ETCH-C, a standardized assessment tool to evaluate cursive handwriting
  • • Interrater reliability
  • • Intrarater reliability
  • • Test–retest reliability
  • • Discriminant validity
  • • Concurrent validity
  • Reliability: ICCs for intrarater reliability ranged from .55 to .80 for the 3 subscales. ICCs for interrater reliability ranged from .57 to .84 for the 3 subscales. ICC test–retest reliability ranged from .24 to .65 for the 3 subscales.
  • Discriminant validity: 3 cutoff scores were determined to differentiate between students with and without handwriting difficulties: total letter score cutoff = 92; total word score cutoff = 85; total number score cutoff = 95.
  • Concurrent validity: ETCH-C total letter score was moderately correlated with the Test of Legible Handwriting (r = .6, p < .001).
Fingerhut (2013) To psychometrically evaluate and continue ongoing development of the LPP tool
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 162 parents or caregivers of children with special needs receiving intervention at a private practice clinic
  • Recruitment
  • Convenience sampling
  • Statistics
  • Descriptive statistics, nonparametric Kruskal–Wallis one-way ANOVA, Spearman rank-order analysis, factor analysis
LPP, a measurement tool to facilitate family-centered pediatric practice
  • • Internal consistency
  • • Test–retest reliability
  • • Construct validity
  • Internal structure: 2-factor solution, resulting in 2 subscales, Satisfaction With Efficiency (Cronbach’s α = .90) and Satisfaction With Effectiveness (Cronbach’s α = .70). Internal consistency for total scale was strong (Cronbach’s α = .90).
  • • Test–retest reliability (r = .89)
  • • Construct validity supported through moderate inverse correlation (r = −.51) between LPP and Parenting Stress Index scores
Gantschnig, Page, Nilsson, & Fisher (2013) To detect differences in ADLs between children with and without disabilities
  • Design
  • Retrospective, involving secondary data analysis of existing database
  • Participants
  • AMPS database used 10,998 4- to 15-yr-old children with and without disabilities from 11 world regions.
  • Recruitment
  • Convenience sampling from existing database
  • Statistics
  • Descriptive statistics, t tests, regression analysis
AMPS, a standardized observational assessment that measures quality of motor processing ability during ADLs
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: Significant main effect for age, β = .139, confidence interval [.129, .149], p < .001, t = 26.187, R2 =.361. Significant differences were found in ADL performance between children with and without disabilities on the basis of motor ability at every age but 4 yr with effect sizes ranging from small to large. Significant differences were found in ADL performance between children with and without disabilities on the basis of processing ability at every age, with effect sizes ranging from moderate to very large. ADL motor and processing scores were significantly higher for typically developing children.
  • Construct validity: The AMPS can detect and measure motor and processing ability differences among children with and without disabilities from age 5 yr, with increasing differences as children age (≤15 yr). Processing ability differences can be detected at age 4 yr.
Griswold & Townsend (2012) To determine the sensitivity of the Evaluation of Social Interaction (ESI) to discriminate between children with and without disability as they engage in social exchanges in a natural context with typical social partners
  • Design
  • Quasi-experimental validity study
  • Participants
  • 46 children (34 boys, 12 girls) between ages 2 and 12 yr, half typically developing and half with a disability
  • Recruitment
  • A letter requesting participation consent was sent to parents of children attending preschool, kindergarten, readiness, 1st-grade, and 2nd-grade classrooms at a local elementary school in the northwestern United States.
  • 23 pairs of age- and gender-matched children with and without a disability were included in the results.
  • Statistics
  • Raw scores converted to log-odd probability units, paired t test
ESI• Discriminant validity to differentiate between children with and without disability• Paired t-test analysis revealed a statistically significant difference, t(22) = −4.065, p = .001, in the quality of social interaction for children with and without a disability, indicating sensitivity to discriminate between groups.
Honaker, Rosello, & Candler (2012) To examine the test–retest reliability and construct validity of the Family L.I.F.E. (Looking Into Family Experiences) and to examine the perceived efficiency, effectiveness, and satisfaction ratings for family occupations
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • Interview of 15 families with a child with ASD (4 girls, 11 boys, between ages 4 and 11 yr 2 mo). Two families eliminated from data collection.
  • Recruitment
  • Participants were a self-selected convenience sample of 15 families from 4 venues.
  • Statistics
  • Wilcoxon signed-rank test, Spearman’s ρ
Family L.I.F.E.
  • • Test–retest reliability
  • • Internal consistency
  • • Internal consistency was good (Cronbach’s α =.9), and test– retest reliability was strong (r = .89).
  • • 92% of the families identified the same occupations as important at test and retest, 1 wk apart.
Hwang & Davies (2009) To examine the internal construct validity of the School Function Assessment (SFA) by examining its unidimensionality and hierarchical structure; the study focused on Part III, known as the Activity Performance Scales.
  • Design
  • Prospective 2-group, nonrandomized, noncontrolled design
  • Participants
  • 64 elementary school children (35 with disabilities, 29 without disabilities) between ages 6 and 15 yr
  • Recruitment
  • Participants were recruited from several school districts in western New York via convenience sampling.
  • Statistics
  • Rasch analysis
SFA
  • • Internal validity
  • • Construct validity
  • • 252 items (of 266) on the Activity Performance Scales met criterion set for Rasch goodness-of-fit statistics.
  • • 15 of 18 of the SFA’s Activity Performance Scales were found to be unidimensional, measuring a single construct.
  • • Item difficulty analysis yielded a hierarchical structure of the Activity Performance Scales similar to the existing layout of the SFA.
Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen (2013) To determine norm scores for the Box and Block Test for children (3–10 yr)
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 215 typically developing Dutch children ages 3–10 yr who were representative on socioeconomic variables and ethnicity
  • Recruitment
  • Convenience sampling; children were recruited through local schools and playgroups
  • Statistics
  • Descriptive statistics, Spearman’s or Pearson’s correlation coefficients, ICCs, t tests
Box and Block test for children (a standardized gross manual dexterity test)
  • • Test–retest reliability
  • • Discriminant validity
  • • Concurrent validity
  • • Construct validity
  • Discriminant validity: No difference between boys and girls or left- and right-handed children within groups of children stratified for age (i.e., 3-year-olds, 4-year-olds). A significant and large effect size was found for children aged 3–8 yr for both the dominant, F(7, 207) = 77.07, p < .001, r = .82, and nondominant hands, F(7, 207) = 77.07, p < .001, r = .85.
  • Test-retest reliability: ICC = .85
  • Concurrent validity: correlations between both dominant- and nondominant-hand Box and Block Test scores and the Movement Assessment Battery for Children–2 manual dexterity subtests were moderate to strong for children ages 3–6 yr and weak to moderate for children ages 7–10 yr.
  • Construct validity: Findings support the use of the Box and Block test as a measure of gross manual dexterity among children ages 3–10 yr.
Josman, Abdallah, & Engel-Yeger (2011) To use the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) to measure cultural and sociodemographic effects on cognitive skills in 2 groups of children
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 226 typically developing children representative of Israeli census: 101 Jewish Israeli children and 125 Muslim Palestinian children
  • Recruitment
  • Convenience sampling from Israeli schools in which OTs trained in the administration of the LOTCA worked
  • Statistics
  • Descriptive statistics, MANOVA between identified groups
LOTCA, a standardized assessment of cognitive ability
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: The LOTCA detected differences between groups of children with known differences in culture, parental education level, years of schooling, and age of the child.
  • Construct validity: The LOTCA’s validity as a tool that measures the cognitive function of young children was supported.
Josman, Goffer, & Rosenblum (2010) To examine reliability and validity of the Do–Eat assessment tool for children with DCD
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 59 children aged 5–6.5 yr (30 diagnosed with DCD as determined by Movement Assessment Battery for Children scores below the 15th percentile)
  • Recruitment
  • Convenience sample of 5- and 6-year-old children; 30 children with a diagnosis of DCD and 29 typically developing children
  • Statistics
  • Descriptive statistics, Mann–Whitney U test, Cronbach’s α, t tests, Pearson correlation coefficients
Do-Eat: Dynamic assessment of child making a sandwich, preparing chocolate milk, and completing a handwriting task in the child’s natural context
  • • Internal consistency
  • • Interrater reliability
  • • Construct validity
  • • Concurrent validity
  • Content and face validity: Process of literature review and expert consultation—5 OTs and 5 expert consultants
  • Interrater reliability: High among 3 blinded occupational therapy assessors (rs = .92).
  • Internal consistency: High for Do-Eat components: performance skills (Cronbach’s α = .93), sensory-motor skill (Cronbach’s α = .90), and executive function (Cronbach’s α = .89).
  • Construct validity: Significant between-groups differences on the Do-Eat, t(57) = 14.09, p < .001, and the Parent Questionnaire, t(57) = 3.64, p < .001.
  • Concurrent validity: Significant correlation (r = −.086, p < .001) between children’s scores on sensory-motor component of the Do-Eat and Movement Assessment Battery for Children final score.
Kao, Kramer, Liljenquist, Tian, & Coster (2012) To compare the functional performance of children and youth with autism, developmental disabilities, and no disability using the revised PEDI–Computer Adaptive Test (PEDI–CAT) item banks
  • Design
  • Cross-sectional, nonrandomized, secondary data analysis, reliability, and validity study
  • Participants
  • Participants were purposively sampled from an existing nationally representative data set (N = 2,205) that included 108 children diagnosed with ASD and 150 children with intellectual and developmental disabilities (IDD). Three age groups were selected from the dataset—5 years, 10 years, and 15 years—although the sample size for each group was not reported.
  • Recruitment
  • Representational sampling of families with 1 or more child younger than age 21 yr and data collected via the Internet
  • Statistics
  • Descriptive statistics, analysis of covariance
PEDI–CAT
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: Social–cognitive domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001), but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age.
  • • Daily activities domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001), but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age.
  • • Responsibility domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001) but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age. The largest difference between children with ASD and typically developing children was found to occur at age 15 yr.
  • Construct validity: This study supports the construct validity of the PEDI–CAT to differentiate between children aged 10 and 15 yr with and without disability. The PEDI–CAT did not differentiate between children with and without disability at age 5 yr. Moreover, no significant differences were found between the scores of children with ASD or IDD on any domain, indicating that the PEDI–CAT is not a disability-specific measure.
Kramer, Kielhofner, & Smith (2010) To determine the construct validity, reliability, and goodness of fit of the Child Occupational Self Assessment (COSA) and other factors (child factors, values, administration time, and application)
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 98 practitioners (OTs and physical therapists) and researchers from a central database completed the COSA on 502 children with disabilities between ages 6 and 17 yr from 5 countries.
  • Recruitment
  • Researchers and clinicians from around the world were contacted through email distribution lists and website announcements and during professional meetings and training and invited to share children’s COSA responses with a central database.
  • Statistics
  • Descriptive statistics of population, demographic information, Rasch Partial Credit model, parametric and nonparametric statistics to obtain validity evidence
COSA, with 2 scales, Occupational Competence and Values
  • • Internal reliability
  • • Item fit
  • • Internal and external validity
  • • Construct validity
  • • Concurrent validity
  • • Most children’s responses to the COSA can be validly interpreted as indicators of occupational competence and value for everyday activities.
  • • The COSA has good construct validity in the following areas: content, structural, and substantive validity as given by item and child fit statistics and unidimensionality evaluation.
  • • Evidence for external validity was mixed, depending on some demographic and assessment administration variables.
  • Item fit: All Occupational Competence items had positive point-biserial correlations ranging from .30 to .53. Children reported the least amount of competence and the most difficulty for self-regulation and cognitive tasks, as well as chores. The item separation index was 6.18, which translates to 8.57 strata; the reliability of item separation was .97.
  • Values items: All items had positive point-biserial correlations ranging from .42 to .61. Children were less likely to indicate value for activities typically regulated and demanded by adults. Values item separation across the continuum was 3.96, which transforms to 5.6 strata; item separation reliability across that continuum was .94.
  • Child fit: Of 502 children who completed the Occupational Competence ratings, 59 did not meet fit requirements (11.75%). All t tests and ANOVAs were nonsignificant using a Bonferroni-adjusted α of .01.
  • Person Fit to Values items: Of 496 children who responded to the Values rating scale, 76 did not meet fit requirements (15.3%).
Kuijper, van der Wilden, Ketelaar, & Gorter (2010) To investigate the relationship between the manual abilities of children with cerebral palsy (as categorized using the Manual Ability Classification System [MACS]) and caregiver assistance using the Self-Care scale of the PEDI and to assess the interrater reliability of the MACS
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 61 Dutch children with cerebral palsy between ages 5 and 14 yr
  • Parental consent was obtained.
  • Recruitment
  • Convenience sampling of children attending specialized schools
  • Statistics
  • Descriptive statistics, Spearman’s rank-order correlation coefficient (ρ), linear weighted κ
MACS, Self-Care domain of the PEDI Part 2, Caregiver Assistance scale• Construct validity
  • • The MACS categories demonstrated sensitivity to different levels of caregiver assistance required for self-care, as measured by the PEDI.
  • • The Spearman rank-order correlation coefficient between the MACS levels (as scored by the therapists) and scores on the PEDI Caregiver Assistance scale for self-care activities were significant (ρ = −.72) at the .01 level (two-tailed), although the use of even nonparametric correlation statistics here is questionable and unorthodox.
  • • The study also drew conclusions about the children’s skill level in self-care, although the researchers did not use the PEDI Part 1, which would allow this assertion.
  • • Weighted κ (with linear weighting) for the interobserver reliability of the MACS between the therapists and physicians was found to be .86 (CI [.78, .94]).
  • • 50 children (82%) were classified at the same MACS level by the therapist and the rehabilitation physician, and the remainder were within 1 level.
Little et al. (2011) To evaluate the psychometric properties (reliability) of the Sensory Experiences Questionnaire (SEQ)
  • Design
  • Prospective, nonrandomized, noncontrolled
  • Participants
  • 358 parents of children ages 6–72 mo belonging to 1 of 3 groups: (1) children with autism, (2) children with developmental delay, or (3) typically developing children
  • The test–retest reliability subsample consisted of 24 caregivers, each of whom completed a 2nd questionnaire within 2–4 wk of the 1st questionnaire.
  • Recruitment
  • Convenience sampling; a letter and SEQ form were distributed to caregivers by a designated contact person at preschools, early intervention programs, day care centers, or diagnostic and evaluation centers throughout rural and metropolitan areas in North Carolina, as well as through a university-based research registry
  • Statistics
  • Cronbach’s α and ICC
SEQ
  • • Internal consistency
  • • Test–retest reliability
  • • Internal consistency was excellent; Cronbach’s α was reported to be .80.
  • • Total score test–retest reliability was excellent (ICC = .92).
  • • Subscale test–retest reliability scores ranged from .68 to .86.
  • • The SEQ can be used as an early tool for identifying sensory patterns in young children with autism and other developmental disabilities.
McDonald & Vigen (2012) To describe the instrument development process of the McDonald Play Inventory (MPI) and examine the MPI’s internal reliability and discriminative validity among both neurotypical children and children with known disabilities
  • Design
  • Prospective, nonrandomized, noncontrolled reliability and validity study
  • Participants
  • 124 children between ages 7 and 11 yr (89 neurotypical, 35 with disabilities); 17 parents participated.
  • Recruitment
  • Convenience sampling; participants drawn from a camp, elementary school, and 2 private practice clinics in the United States; participants recruited over a 1-yr period
  • Statistics
  • For internal consistency, Cronbach’s α; for test–retest reliability, Pearson correlation coefficient; for concurrent validity, Pearson correlation coefficient and paired-sample t tests
MPI, which is made up of 2 parts: (1) McDonald Play Activity Inventory (MPAI) and McDonald Play Style Inventory (MPSI)
  • • Internal consistency
  • • Test–retest reliability
  • • Concurrent validity
  • • Construct validity
  • • The self-report instrument yielded reliable and valid measures of a child’s perceived play performance and discriminated between the play of children with and without disabilities.
  • Item analysis and inter-correlations: Each item was moderately correlated (.27–.75) with the respective subscale score. Moderate to strong correlations (.47–.81) were found between each subscale and total scale score.
  • • Intercorrelations between the subscales ranged from low (<.25) to moderate (.50–.71).
  • • The intercorrelation between the total inventory scores was in the moderate range (.49).
  • Internal consistency: Internal consistency was acceptable—α = .84 for the MPAI and α = .79 for the MPSI.
  • Test–retest reliability: Pearson correlation coefficient for the MPAI was .69; for the MPSI, .82; indicates results were consistent over 1-mo period.
  • Construct validity: No statistically significant differences were found by gender or presence of disability on the self-reported play activities of the MPAI total inventory or subscale scores.
  • Concurrent validity: For parent–child responses, the MPAI showed a low correlation (r = .04) and the MPSI showed a moderate correlation (r = .49).
Mulcahey et al. (2013) To examine the psychometric properties of upper-extremity and activity item pools and to evaluate the item banks and simulated 5-, 10-, and 15-item computer adaptive tests (CATs)
  • Design
  • Multicenter cross-sectional study
  • Participants
  • 200 children with brachial plexus birth palsy between ages 4 and 21 yr; 1-time data collection occurred at the point of care.
  • Recruitment
  • Convenience sampling approach
  • Statistics
  • Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA); DIF through the use of ordinal logistic regression; 1-way ANOVA tests with post hoc comparisons
Pediatric Outcomes Data Collection Instrument (PODCI)
  • • Construct validity
  • • Differential item functioning
  • • Concurrent validity
  • • Discriminative validity
  • • In the EFA of the activity items, the 1st factor explained approximately 55% of the total variance.
  • • In the EFA of the upper-extremity items, the 1st factor explained 58% of the total variance.
  • • Three items showed DIF, 2 upper-extremity items (“My child can use an eraser without tearing paper,” “Using only his/her hands, my child can pull up the tab on a can of soda”) and 1 activity item (“Cleaning the floor with a broom and dustpan”). These items were retained owing to the importance of their content.
  • • Concurrent validity was established with a moderate correlation with the Box and Block Test and the PODCI.
  • • The majority of the PODCI items were able to differentiate participants with a known clinical difference.
Munkholm, Berg, Löfgren, & Fisher (2010) To evaluate whether the School version of AMPS is valid for evaluating students in different world regions
  • Design
  • Cross-sectional retrospective study
  • Participants
  • 984 students ranging in age from 3 to 13 yr from North America, Australia and New Zealand, United Kingdom, and Nordic countries (246 students from each region)
  • Recruitment
  • Participants were selected from the sample of all students ages 3–15 yr located in the School AMPS database.
  • Statistics
  • Many-faceted Rasch analysis
School AMPS
  • • Many-faceted Rasch analyses to generate item difficulty calibrations by region and evaluate for significant DIF and differential test functioning
  • • Construct validity
  • • School AMPS items (walk, moves, endures, and navigates) demonstrated DIF but resulted in no differential test functioning.
  • • The School AMPS can be used to evaluate students’ quality of schoolwork task performances across regions because it is free of geographic bias associated with world region.
Ohl et al. (2012) To examine the test–retest reliability and internal consistency of the Sensory Profile Caregiver Questionnaire
  • Design
  • Prospective, nonrandomized, noncontrolled
  • Participants
  • 55 caregivers of children ranging in age from 36 to 72 mo
  • Recruitment
  • Participants were recruited from 6 nursery schools and child care centers in the New York metropolitan area.
  • Parents of children attending the centers were sent a flyer, then a research pack. Completed assessments were posted back to the researcher in self-addressed stamped envelope. Participation was voluntary.
  • Statistics
  • Descriptive statistics, ICCs, Cronbach’s α
  • Sensory Profile Caregiver
  • Questionnaire
  • • Test–retest reliability
  • • Internal consistency
  • • Test–retest reliability was good across quadrant scores (ICCs = .80–.90) and moderate to good across factor (ICCs = .69–.88) and section scores (ICCs = .50–.87).
  • • Internal consistency was high across quadrant scores (αs = .89–.95) and factor scores (αs = .82–.93) and moderate to high across section scores (αs = .67–.93).
Parham et al. (2011) 
  • To develop a reliable and valid fidelity measure for use in research on the Ayres Sensory Integration (ASI) intervention
  • Research questions:
  • Does the Process section of the Fidelity Measure show acceptable interrater reliability?
  • Does the Process section of the Fidelity Measure have acceptable internal consistency?
  • Does the Process section of the Fidelity Measure demonstrate adequate validity in differentiating ASI from other intervention approaches in occupational therapy?
  • Does the entire Fidelity Measure demonstrate content validity in addressing key elements of ASI intervention?
  • Design
  • Instrument development
  • Participants
  • 14 experts in sensory integration from 6 different countries who completed 6-hr training
  • Content validity was established through 19 experts in sensory integration from 6 different countries.
  • Recruitment
  • Content experts were recruited to assist with the development of the Fidelity Measure.
  • Statistics
  • Interrater reliability, content validity, internal consistency, Cronbach’s α, ICC
Ayres Sensory Integration Fidelity Measure
  • • Interrater reliability
  • • Internal consistency
  • • Content validity
  • • Reliability of the Process section was strong for total fidelity score (ICC = .99, Cronbach’s α = .99) and acceptable for most items.
  • • Total score significantly differentiated ASI from 4 alternative interventions.
  • • Expert ratings indicated strong agreement that items in the Structural and Process sections represent ASI intervention.
Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee (2013) To establish the psychometric properties of the Children’s Assessment of Participation and Enjoyment/Preferences for Activities (CAPE/PAC) related to children with high-functioning autism (HFA)
  • Design
  • Mixed methodology, including qualitative research to evaluate content validity and feasibility of use
  • Participants
  • 30 children with HFA between ages 7 and 13 yr (with IQ >80 or adaptive functioning score >60) and 31 typically developing peers
  • Recruitment
  • Children were recruited through multiple sources (parent support group, therapists, health department) and informal modes.
  • Statistics
  • Descriptive statistics, correlation, Mann–Whitney U test
CAPE/PAC
  • • Content validity
  • • Discriminant validity
  • • Test–retest reliability
  • • CAPE/PAC can be used to assess participation (recreational) among children with HFA.
  • • Content validity was assessed as adequate after qualitative evaluation. Test–retest reliability of overall scores was adequate (r > .7), except the social aspect dimension, which was low (r > .196).
  • • Parents’ agreement with most of their children’s self-ratings on this assessment provided an estimate of interrater reliability (in HFA group, 75% of parents agreed or strongly agreed with their child’s rating on the CAPE, and 50% of parents agreed or strongly agreed with their child’s rating for the PAC).
  • • The CAPE/PAC has adequate discriminant validity and test–retest reliability and is able to discriminate between children with and without HFA. Therefore, results suggest that the CAPE/PAC is applicable for use with children with HFA.
Rosenblum, Sachs, & Schreuer (2010) To examine the internal consistency and construct validity of the Children’s Leisure Assessment Scale (CLASS)
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 249 children and adolescents in Israel (114 boys, 135 girls)
  • Recruitment
  • Stratified snowball sampling
  • Inclusion criteria: typically developing public school students
  • Statistics
  • Descriptive statistics, Cronbach’s α, factor analysis, MANOVA, t tests
CLASS; measures multidimensional participation in children’s and adolescents’ leisure activities
  • • Internal consistency
  • • Face validity
  • • Content validity
  • • Construct validity
  • • Discriminant validity
  • Face and content validity: Original assessment reviewed by 5 expert consultants and 5 experienced pediatric OTs.
  • Internal consistency: Leisure factors (instrumental indoor activities, outdoor activities, self-enriched activities, games and sports activities) showed acceptable levels of internal reliability (Cronbach’s α ranged from .57 to .83).
  • Construct validity: Discriminant validity based on gender; girls participated in significantly more activities than the boys (65% and 56%, respectively), with greater frequency and with greater preference for self-enrichment and instrumental indoor activities. Boys participated in significantly more games and sports activities.
Saban, Ornoy, Grotto, & Parush (2012) To describe the development of the Adolescents and Adults Coordination Questionnaire (AAC–Q) and describe its psychometric properties
  • Design
  • Prospective, randomized, instrument development study
  • Participants
  • Convenience sampling of (1) 28 adolescents and young adults diagnosed with DCD (between ages 16 and 35 yr) in Israel and (2) 28 age- and gender-matched participants who had no diagnosis of DCD and who had never been referred or treated for motor coordination problems in Israel
  • Random sampling of 2,379 participants ages 19–25 yr from Israel Military Service
  • Recruitment
  • The DCD group was recruited by contacting professionals who worked with adults. The control group was recruited through advertisements in the university setting and workplace.
  • Statistics
  • Descriptive statistics, independent-sample t tests, construct validity, Cronbach’s α, Pearson’s correlation coefficients
AAC–Q
  • • Content validity
  • • Construct validity
  • • Internal consistency
  • • Test–retest reliability
  • Content reliability: 12 AAC–Q items had >95% interrater agreement from 8 OTs.
  • Internal consistency: High; Cronbach’s α = .88
  • Test–retest reliability: r = .94, p < .001
  • Construct validity: Independent-sample t tests revealed significant differences between participants with and without DCD, t(27) = 9.37, p < .001. A high significant correlation was found between the scores of the 2 scales (r = .973, p < .05), indicating that although separate, the scales assess the same construct. Resulted in removal of the Degree or Intensity scale from the AAC–Q.
Silva & Schalock (2012) To validate the Sense and Self-Regulation Checklist (SSC), a parent–caregiver measure of sensory and self-regulatory responses of children with autism in everyday life
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 265 children < age 6 yr with typical development (n = 138), autism (n = 99), or other developmental delay (DD; n = 28); the informants were the children’s caregivers.
  • Recruitment
  • Convenience sampling for all groups. Children with autism and DD had already been involved in other studies with researchers. They were recruited from 6 regional early childhood special education programs across Oregon.
  • Parents of typically developing children were recruited through 1 child care center, 3 mother support groups, and 1 toddler drop-in play center in Oregon.
  • Statistics
  • Descriptive statistics of participants, χ2 test, Pearson correlation coefficient, multiple regression, Cronbach’s α, ANOVA, post hoc tests
SSC
  • • Internal consistency
  • • Test–retest reliability
  • • Discriminant validity
  • Internal consistency: Overall scores were acceptable. Cronbach’s α = .87 for children with ASD, .89 for typically developing kids, and .85 for children with other DD. In the sensory domain, α = .81 for children with ASD, .80 for typically developing children, and .58 for children with other DD. In the self-regulation domain, α = .79 for children with ASD, .86 for typically developing children, and .83 for children with other DD.
  • Test–retest reliability: After 4-mo follow-up, sensory impairment test–retest coefficient = .595, self-regulation = .831, and overall score = .677.
  • • 2 new findings discriminated autism from other groups: (1) multifocal tactile sensory impairment, characterized by hyporeactivity to injurious stimuli and hyperreactivity to noninjurious stimuli, F(2, 262) = 86.8, p < .001, and (2) global self-regulatory delay, F(2, 262) = 122, p < .001.
  • • The SSC reports a prevalence of sensory and self-regulatory findings approaching 100% (96% and 98%, respectively) in the autism group, raising the possibility that sensory and self-regulatory difficulties represent a core part of autism.
Spirtos, O’Mahony, & Malone (2011) To further examine the interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function (MAUULF)
  • Design
  • Cross-sectional, nonrandomized reliability study
  • Participants
  • 3 OTs who independently scored 34 videotaped assessments of 11 children with hemiplegic cerebral palsy ages 6 yr 1 mo–14 yr 5 mo.
  • All therapists had used the MAUULF in clinical practice and had a 3-hr training session.
  • Recruitment
  • Convenience sample of 3 experienced OTs with honors degrees in occupational therapy who were working in the same center for children and adults with physical disabilities
  • Written informed consent was obtained from the parents of the children for blind scoring of their child’s assessments as
  • part of a larger study.
  • Statistics
  • Descriptive statistics, ICCs, confidence intervals
MAUULF• Interrater reliability
  • Total scores: The correlation between raters was high for the total score (ICC = .961).
  • Test components: The highest correlation between raters was found for fluency (ICC = .902), followed by range of movement (ICC = .866), and the lowest correlation was found for quality of movement (ICC = .683).
  • Individual test item scores: The ICCs varied and ranged from .368 to .899.
Taylor, Lee, Kramer, Shirashi, & Kielhofner (2011) To conduct a psychometric examination (reliability, sensitivity, and validity) of the Occupational Self Assessment (OSA) by focusing on an adolescent population
  • Design
  • Prospective scale evaluation study
  • Participants
  • 296 adolescents between ages 12 and 18 yr with recent diagnosis of acute mononucleosis
  • Follow-up sample was 31 participants who did not consider themselves fully recovered and 59 matched control participants who did consider themselves fully recovered from mono at 12 mo after initial enrollment and after the acute phase. Two matched controls were identified for each participant with persistent fatigue.
  • Recruitment
  • Participants were recruited from schools, hospitals, outpatient clinics, and private physician practices in Chicago.
  • Statistics
  • Item Response Theory; Rasch Rating Scale Model
OSA
  • • Test–retest reliability
  • • Sensitivity
  • • Construct validity
  • • Concurrent validity
  • • OSA items coalesced to capture the intended constructs; the rating scales functioned as intended.
  • • >90% of participants were validly measured.
  • • Demonstrated adequate sensitivity and stability (test–retest reliability) over time.
  • • OSA measure of competence was moderately associated with infectious symptoms, fatigue severity, health status, and stress, and the measure of values was not.
  • • Adolescents who had not recovered from mononucleosis after 12 mo reported lower competence scores yet attached the same value or importance to occupational participation as adolescents who had recovered.
Toglia & Berg (2013) 
  • To compare abilities and strategy use of a group of at-risk youth, ages 16–21 yr, with a community sample of high school students using the WCPA and to investigate the discriminative validity of the WCPA
  • Design
  • Quasi-experimental 2-group comparison, cross-sectional research
  • Participants
  • 113 at-risk youth from an alternative high school and 49 youth from community high schools from a midwestern U.S. city
  • Recruitment
  • A representative sample of gender, race, age, and educational backgrounds were sought using convenience sampling and stratified sampling methods.
  • Statistics
  • Descriptive statistics, Pearson χ2 with Fisher’s exact test significance and t-test comparisons
WCPA, a performance measure of everyday executive function• Discriminative validity: 2 participant groups with known differences compared on their performance on the WCPA
  • t-test comparison between the 2 groups, with Bonferroni correction of p = .004 (.05/12) to avoid a Type I error; WCPA scores revealed significant differences between the 2 participant groups with the exception of total time (p = .91), planning time (p = .97), and rules followed (p = .03).
  • • The WCPA was able to differentiate between 2 groups of participants with known differences; the community group was more likely to follow rules, enter appointments accurately, self-report errors, and use a greater number of strategies than the at-risk youth group.
  • • Comparison of the at-risk and community youth participant groups provides support for the WCPA’s discriminative validity.
Tsai, Lin, Liao, & Hsieh (2009) To examine the reliability of Motor-Free Visual Perception Test–Revised (MVPT–R) and Test of Visual–Perceptual Skills–Revised (TVPS–R)
  • Design
  • Prospective reliability study
  • Participants
  • 52 children (31 boys, 21 girls; age range = 5 yr 5 mo–8 yr 9 mo)
  • Recruitment
  • Convenience sampling was used for children in regular kindergarten and special education classrooms in Taipei, Taiwan.
  • Inclusion criteria: Diagnosis of cerebral palsy, ages 5–8, ability to follow general oral instructions
  • Exclusion criteria: Child could not follow the instructions of the MVPT–R and TVPS–R, poor visual acuity as indicated by Teller Acuity Cards
  • Statistics
  • Descriptive statistics, ICCs, smallest real differences, Cronbach’s α, standard error of measurement
MVPT–R, TVPS –R
  • • Test–rest reliability
  • • Interrater reliability
  • • Internal consistency
  • Test-retest reliability: MVPT–R total score was excellent (ICC = .96); TVPS–R total score was also excellent (ICC = .97); TVPS–R subscale scores were high (ICCs = .76–.92).
  • Interrater reliability: MVPT–R interrater agreement was excellent (ICC = .92); TVPS–R interrater agreement was excellent (ICC = .93); TVPS–R subscale score was high (ICCs = .74–.89) except for the visual sequential memory subscale (ICC = .63).
  • Internal consistency: MVPT–R, Cronbach’s α = .87; TVPS–R, Cronbach’s α = .98; TVPS–R subscale Cronbach’s αs were high (.87–.94).
Vanvuchelen, Roeyers, & De Weerdt (2011) To examine the interrater and test–retest reliability of the Preschool Imitation and Praxis Scale (PIPS)
  • Design
  • Prospective, instrument reliability study
  • Participants
  • 119 typically developing preschool children (69 girls, 50 boys) between ages 1.5 and 4.9 yr were sampled from day care centers and regular preschools in Flanders, Belgium.
  • Recruitment
  • Stratified random sampling was used.
  • Inclusion criteria: Children not born preterm and had no known physical or mental handicap
  • Statistics
  • Descriptive statistics, Cohen’s weighted κs, ICCs, smallest detectable difference, Pearson product–moment correlation coefficient
PIPS
  • • Intrarater reliability
  • • Interrater reliability
  • • Test–rest reliability
  • • The intrarater reliability of the PIPS total score was high (ICC = .996).
  • • The interrater reliability of the PIPS total score was high (ICC = .995).
  • • Test–retest reliability was high (r = .93) for the association scores between 56 children assessed with a time interval of 1 wk.
Weiner, Toglia, & Berg (2012) To evaluate initial psychometric properties of the WCPA, to describe the baseline executive functioning profile of at-risk youth, and to investigate relationship between accuracy, time, strategy use, error patterns, and self-evaluation of performance
  • Participants
  • 113 at-risk youth (53 girls, 60 boys) between ages 16 and 21 yr from an alternative high school. 9 did not participate; however, details are not provided about the remaining 104.
  • Recruitment
  • Participants were enrolled at a school for high-risk youth in the midwestern United States.
  • Statistics
  • Descriptive statistics, Pearson correlation coefficient
WCPA, a performance measure of everyday executive function
  • • Interrater reliability
  • • Interitem correlations
  • • Clinically useful tool for measuring executive functioning among youth.
  • • Interrater reliability for 2 trained scorers was high (ICC = .99) for total accuracy scores.
  • • On average, participants spent 15.9 min on the WCPA, made 7.9 errors, and followed 4.0 of 5 possible rules. No ceiling effect was observed in overall accuracy. Participants used a mean of 3.1 strategies (standard deviation = 1.9) while completing the WCPA.
  • • Participants who used more strategies spent more time planning and completing the task and were more accurate.
  • • The assessment allows evaluation of complex task performance, strategy use, self-evaluation of performance, and error patterns, which guide interventions.
Weintraub & Bar-Haim Erez (2009) To describe the development and initial evaluation of the construct validity of the Quality of Life in School (QoLS) questionnaire
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 353 elementary school students (180 boys, 173 girls) in 3rd–6th grade from 8 general education schools in Israel
  • Recruitment
  • Purposive sampling in identified schools and parents approached for permission to include their typically developing child
  • Inclusion criteria: In Grades 3–6, no neurological symptoms, no physical disability, not receiving special education services
  • Statistics
  • Cronbach’s α, Pearson correlation coefficients, 2-way ANOVA, MANOVA (between gender and age), ANOVA, factor analysis
QoLS–Version 2
  • • Comprehensive description of development and initial evaluation of QoLS–Version 2
  • • Construct validity
  • • Internal consistency
  • • Factor structure
  • • Discriminant validity
  • • Factor analysis identified 4 categories within questionnaire: (1) teacher–student relationship and school activity (Cronbach’s α = .91), (2) physical environment (Cronbach’s α = .82), (3) negative feelings (Cronbach’s α = .90), and (4) positive feelings (Cronbach’s α = .68).
  • Internal consistency: Total questionnaire Cronbach’s α = .88.
  • • Total QoLS score had significant medium to high correlation with each category (.51 < r < .69).
  • • Discriminant validity in process to evaluate use of this tool with students with disabilities was not reported in this article.
  • • QoLS may assist clinicians and educators in evaluating students’ school quality of life from a multidimensional perspective, pending application to students with disabilities.
Table Footer NoteNote. ADLs = activities of daily living; AMPS = Assessment of Motor and Process Skills; ANOVA = analysis of variance; ASD = autism spectrum disorder; CI = confidence interval; COP = Comprehensive Observations of Proprioception; DCD = developmental coordination disorder; DIF = differential item functioning; ETCH = Evaluation Tool of Children’s Handwriting; HPAS = Health Promoting Activities Scale; ICC = intraclass correlation coefficient; LPP = Life Participation for Parents; MANOVA = multivariate analysis of variance; OT = occupational therapist; PEDI = Pediatric Evaluation of Disability Inventory; ROC = receiver operating characteristic; SVMPT = Slosson Visual–Motor Performance Test–Revised; TVMI = Test of Visual–Motor Integration; VMI = Developmental Test of Visual–Motor Integration; WCPA = Weekly Calendar Planning Activity.
Note. ADLs = activities of daily living; AMPS = Assessment of Motor and Process Skills; ANOVA = analysis of variance; ASD = autism spectrum disorder; CI = confidence interval; COP = Comprehensive Observations of Proprioception; DCD = developmental coordination disorder; DIF = differential item functioning; ETCH = Evaluation Tool of Children’s Handwriting; HPAS = Health Promoting Activities Scale; ICC = intraclass correlation coefficient; LPP = Life Participation for Parents; MANOVA = multivariate analysis of variance; OT = occupational therapist; PEDI = Pediatric Evaluation of Disability Inventory; ROC = receiver operating characteristic; SVMPT = Slosson Visual–Motor Performance Test–Revised; TVMI = Test of Visual–Motor Integration; VMI = Developmental Test of Visual–Motor Integration; WCPA = Weekly Calendar Planning Activity.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 1). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 1). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
Table 1.
Summary of Articles Describing Development and Testing of Instruments for Children and Youth, Published in the American Journal of Occupational Therapy, January 2009–September 2013
Summary of Articles Describing Development and Testing of Instruments for Children and Youth, Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Author/YearStudy ObjectivesDesign/Participants/Recruitment Strategy/Statistics UsedInstrument/Tool Being InvestigatedMeasurement Characteristics InvestigatedResults
Blanche, Bodison, Chang, & Reinoso (2012) To document the development of the COP, an instrument for identifying proprioceptive processing issues in children
  • Design
  • Prospective scale design over 3 phases: (1) scale construction and content validity, (2) establishment of validity and reliability, and (3) factor analysis
  • Participants
  • 130 children with known developmental disabilities ages 2–9 yr
  • Recruitment
  • Not reported
  • Statistics Used
  • Factor analysis, Pearson’s correlation coefficient, ICC
COP
  • • Interrater reliability
  • • Face validity
  • • Content validity
  • • Construct validity
  • • Criterion validity
  • • Factor analysis
  • Content validity: 18 items were originally derived from the existing literature; 9 OTs who were experts in sensory integration rated the COP items; 4 items were rejected.
  • Construct validity: Children with developmental disabilities had significantly higher total scores and individual item scores on the COP than children without proprioceptive difficulties (ps < .01) except for Item 17 (overly passive; p = .12).
  • Criterion validity: Established through comparison of the COP with the Sensory Processing Measure–Home Form and the Kinesthesia and Standing and Walking Balance subtests of the Sensory Integration and Praxis Test; results indicated that the COP measured 2 distinct influences on proprioception functions: motor performance and sensory seeking.
  • Interrater reliability: Four OTs rated 4 20-min videotapes; total score ICC between the 4 raters was .91, indicating that variation among the raters was minimal.
  • Exploratory factor analysis: Results of the factor analysis revealed 4 factors: Tone and Joint Alignment (Factor 1), Behavioral Manifestations (Factor 2), Postural Motor (Factor 3), and Motor Planning (Factor 4)
Blanche, Reinoso, Chang, & Bodison (2012) To describe the proprioceptive difficulties of children with ASD
  • Design
  • Retrospective group-comparison design
  • Participants
  • 32 children with ASD (no additional motor difficulties), 26 children with developmental disabilities (excluding ASD), 28 typically developing children (matched control)
  • Recruitment
  • De-identified data were collected from a chart review at 2 occupational therapy clinics. The de-identified data of the matched control children were collected in a natural setting.
  • Statistics
  • ANOVA for the 3-group comparison and a post hoc analysis with Tukey-Kramer method for pairwise comparison were applied.
The COP, a scale that measures proprioceptive processing in children by direct observation• Ability of COP to discriminate between groups of participants with known differences (discriminant validity)
  • • Children with ASD present with proprioceptive processing difficulties that are different from those of typically developing children and children with developmental delays.
  • • The 3 groups were significantly different on all 16 of the individual COP items, on the total COP score, and on the 4 COP factors.
  • • Post hoc analysis indicated that children with ASD and developmental disabilities were not significantly different on 4 COP items (feedback-related motor planning, tiptoeing, pushing other or objects, and crashing, falling, and running) and on 2 COP factors (Factor 1, Tone and Joint Alignment, and Factor 3, Postural Control and Grading of Force).
Bourke-Taylor, Law, Howie, & Pallant (2012) To describe the initial development and psychometric evaluation of the HPAS
  • Design
  • Mixed methodology using an initial qualitative study and experts to generate scale items and mail out questionnaire with follow-up phone call to collect data; cross-sectional research design including within-group comparisons
  • Participants
  • 152 mothers of children with developmental disabilities in Victoria, New South Wales, Australia
  • Recruitment
  • Self-selected sampling, including a snowball design (“Recruit a girlfriend”). Inclusion criteria: mother of a school-aged child with a disability
  • Statistics
  • Descriptive, correlations, evaluation of normalcy, factor analysis, and Mann-Whitney U comparisons
The HPAS, which measures the frequency with which mothers caring for a school-age child with a disability participate in self-selected leisure occupations
  • • Construct validity
  • • Discriminant validity
  • • Internal consistency
  • • Factor structure
  • • The HPAS showed good internal consistency (Cronbach’s α = .78).
  • • Construct validity was supported by moderate correlations with subjective maternal mental and general health (Short Form–36, Version 2) and by differentiation in leisure participation among groups of mothers reporting differences in mental health status and sleep interruption.
Brossard-Racine, Mazer, Julien, & Majnemer (2012) To determine ETCH scores for cutoff points to determine children who do and do not require intervention for handwriting issues and to determine the percentage of change for clinical significance
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 34 therapists judged and compared 35 pairs of handwriting samples from 26 children
  • Recruitment
  • Convenience sample of pediatric OTs working in greater Montreal, Quebec
  • OTs were included if they had >1 yr experience working with children with handwriting problems.
  • The handwriting samples were obtained from a group of children involved in a cohort study of school-age children with attention deficit hyperactivity disorder. Children were ages 7–9 yr and routinely used manuscript writing.
  • Statistics
  • ROC analyses, minimal clinically important difference (MCID), descriptive statistics, Shrout-Fleiss reliability ICC
ETCH
  • • Discriminant validity
  • • Interrater reliability
  • Discriminative validity: Word legibility had a crude area under the curve of .86 (95% CI [.84, .88]) and an adjusted area of .96 (95% CI [.95, .97]). Letter legibility had a crude area under the curve of .82 (95% CI [.80, .84]) and an adjusted area of .96 (95% CI = .95, .97).
  • • Interrater reliability between therapists was relatively good (ICC = 5.53).
  • • A difference of 10.0%–12.5% for total word legibility and 6.0%–7.0% for total letter legibility were found as cutoff points for MCID.
  • • For children in Grades 2 and 3, 75.0% total word legibility and 76.0% total letter legibility on the ETCH–Manuscript are suggested as the cutoff values to discriminate between children with handwriting legibility difficulties who should be seen in rehabilitation for evaluation and treatment and those who have no such difficulties.
Brown, Unsworth, & Lyons (2009) To examine the factor structure of 4 visual-motor integration instruments through factor analysis
  • Design
  • Prospective cross-sectional evaluation
  • Participants
  • 400 children ages 5–12 yr in metropolitan Melbourne, Victoria, Australia
  • Recruitment
  • Letters were sent to 955 children in 6 participating state schools.
  • Statistics
  • Factor analysis, descriptive statistics, Cronbach’s α
  • • TVMI
  • • VMI
  • • Test of Visual-Motor Skills–Revised (TVSM–R)
  • • SVMPT
  • • Construct validity
  • • Internal consistency
  • • Cronbach’s αs for the VMI, TVMI, TVMS–R, and SVMPT were all >.80.
  • • VMI displayed a 6-factor structure.
  • • TVMI displayed a 3-factor structure.
  • • TVSM–R displayed a 4-factor structure.
  • • SVMPT displayed a 3-factor structure.
  • • All 4 visual–motor integration instruments exhibited multidimensionality.
Chien, Brown, & McDonald (2010) To assess the interrater and test–retest reliability of the Assessment of Children’s Hand Skills (ACHS)
  • Design
  • Prospective, reliability study
  • Participants
  • 54 children participated in the study; 30 were in the interrater reliability component of the study, and 44 were in the test–retest reliability part of the study.
  • Recruitment
  • A convenience sampling approach was used; of the 54 participants, 30 were typically developing children who were recruited from 1 child care center and 2 preschools in southern metropolitan regions of Melbourne, Victoria, Australia; the remaining 24 children were recruited from 2 special schools if they presented with hand skill difficulties caused by disorders such as ASD, Down syndrome, or developmental delay.
  • Statistics
  • Cronbach’s α, Spearman’s coefficient, weighted κ
ACHS
  • • Interrater reliability
  • • Test–retest reliability
  • • Content validity
  • • The ACHS’s test–retest reliability was satisfactory at the individual item level (.42 < κ > .79) and the total scale level (Spearman’s r = .78, p < .01).
  • • Moderate interrater agreement of the total scale scores was demonstrated (r = .63, p < .01), but individual items exhibited varied interrater agreement.
  • • The ACHS’s content validity was established through an extensive review of the literature, the conceptualization of a hand skill framework on which to base the ACHS skill items, several rounds of review and revision based on expert feedback, and preliminary field testing.
Duff & Goyen (2010) To determine the reliability and validity of the ETCH–Cursive (ETCH-C) using the general scoring criteria
  • Design
  • Cross-sectional, semirandomized reliability and validity study
  • Participants
  • Purposive sampling from randomly selected schools. Participants were 63 typically developing 10- to 12-yr-old children from 10 schools in Sydney, New South Wales, Australia: 33 participants with handwriting difficulties and 30 without.
  • Recruitment
  • Asked teachers in randomly selected schools to identify Grade 5 and 6 students with and without handwriting difficulties.
  • Statistics
  • Descriptive statistics, ICC, ROC, Pearson correlation coefficient, ANOVA, Tukey’s post hoc analysis
ETCH-C, a standardized assessment tool to evaluate cursive handwriting
  • • Interrater reliability
  • • Intrarater reliability
  • • Test–retest reliability
  • • Discriminant validity
  • • Concurrent validity
  • Reliability: ICCs for intrarater reliability ranged from .55 to .80 for the 3 subscales. ICCs for interrater reliability ranged from .57 to .84 for the 3 subscales. ICC test–retest reliability ranged from .24 to .65 for the 3 subscales.
  • Discriminant validity: 3 cutoff scores were determined to differentiate between students with and without handwriting difficulties: total letter score cutoff = 92; total word score cutoff = 85; total number score cutoff = 95.
  • Concurrent validity: ETCH-C total letter score was moderately correlated with the Test of Legible Handwriting (r = .6, p < .001).
Fingerhut (2013) To psychometrically evaluate and continue ongoing development of the LPP tool
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 162 parents or caregivers of children with special needs receiving intervention at a private practice clinic
  • Recruitment
  • Convenience sampling
  • Statistics
  • Descriptive statistics, nonparametric Kruskal–Wallis one-way ANOVA, Spearman rank-order analysis, factor analysis
LPP, a measurement tool to facilitate family-centered pediatric practice
  • • Internal consistency
  • • Test–retest reliability
  • • Construct validity
  • Internal structure: 2-factor solution, resulting in 2 subscales, Satisfaction With Efficiency (Cronbach’s α = .90) and Satisfaction With Effectiveness (Cronbach’s α = .70). Internal consistency for total scale was strong (Cronbach’s α = .90).
  • • Test–retest reliability (r = .89)
  • • Construct validity supported through moderate inverse correlation (r = −.51) between LPP and Parenting Stress Index scores
Gantschnig, Page, Nilsson, & Fisher (2013) To detect differences in ADLs between children with and without disabilities
  • Design
  • Retrospective, involving secondary data analysis of existing database
  • Participants
  • AMPS database used 10,998 4- to 15-yr-old children with and without disabilities from 11 world regions.
  • Recruitment
  • Convenience sampling from existing database
  • Statistics
  • Descriptive statistics, t tests, regression analysis
AMPS, a standardized observational assessment that measures quality of motor processing ability during ADLs
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: Significant main effect for age, β = .139, confidence interval [.129, .149], p < .001, t = 26.187, R2 =.361. Significant differences were found in ADL performance between children with and without disabilities on the basis of motor ability at every age but 4 yr with effect sizes ranging from small to large. Significant differences were found in ADL performance between children with and without disabilities on the basis of processing ability at every age, with effect sizes ranging from moderate to very large. ADL motor and processing scores were significantly higher for typically developing children.
  • Construct validity: The AMPS can detect and measure motor and processing ability differences among children with and without disabilities from age 5 yr, with increasing differences as children age (≤15 yr). Processing ability differences can be detected at age 4 yr.
Griswold & Townsend (2012) To determine the sensitivity of the Evaluation of Social Interaction (ESI) to discriminate between children with and without disability as they engage in social exchanges in a natural context with typical social partners
  • Design
  • Quasi-experimental validity study
  • Participants
  • 46 children (34 boys, 12 girls) between ages 2 and 12 yr, half typically developing and half with a disability
  • Recruitment
  • A letter requesting participation consent was sent to parents of children attending preschool, kindergarten, readiness, 1st-grade, and 2nd-grade classrooms at a local elementary school in the northwestern United States.
  • 23 pairs of age- and gender-matched children with and without a disability were included in the results.
  • Statistics
  • Raw scores converted to log-odd probability units, paired t test
ESI• Discriminant validity to differentiate between children with and without disability• Paired t-test analysis revealed a statistically significant difference, t(22) = −4.065, p = .001, in the quality of social interaction for children with and without a disability, indicating sensitivity to discriminate between groups.
Honaker, Rosello, & Candler (2012) To examine the test–retest reliability and construct validity of the Family L.I.F.E. (Looking Into Family Experiences) and to examine the perceived efficiency, effectiveness, and satisfaction ratings for family occupations
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • Interview of 15 families with a child with ASD (4 girls, 11 boys, between ages 4 and 11 yr 2 mo). Two families eliminated from data collection.
  • Recruitment
  • Participants were a self-selected convenience sample of 15 families from 4 venues.
  • Statistics
  • Wilcoxon signed-rank test, Spearman’s ρ
Family L.I.F.E.
  • • Test–retest reliability
  • • Internal consistency
  • • Internal consistency was good (Cronbach’s α =.9), and test– retest reliability was strong (r = .89).
  • • 92% of the families identified the same occupations as important at test and retest, 1 wk apart.
Hwang & Davies (2009) To examine the internal construct validity of the School Function Assessment (SFA) by examining its unidimensionality and hierarchical structure; the study focused on Part III, known as the Activity Performance Scales.
  • Design
  • Prospective 2-group, nonrandomized, noncontrolled design
  • Participants
  • 64 elementary school children (35 with disabilities, 29 without disabilities) between ages 6 and 15 yr
  • Recruitment
  • Participants were recruited from several school districts in western New York via convenience sampling.
  • Statistics
  • Rasch analysis
SFA
  • • Internal validity
  • • Construct validity
  • • 252 items (of 266) on the Activity Performance Scales met criterion set for Rasch goodness-of-fit statistics.
  • • 15 of 18 of the SFA’s Activity Performance Scales were found to be unidimensional, measuring a single construct.
  • • Item difficulty analysis yielded a hierarchical structure of the Activity Performance Scales similar to the existing layout of the SFA.
Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen (2013) To determine norm scores for the Box and Block Test for children (3–10 yr)
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 215 typically developing Dutch children ages 3–10 yr who were representative on socioeconomic variables and ethnicity
  • Recruitment
  • Convenience sampling; children were recruited through local schools and playgroups
  • Statistics
  • Descriptive statistics, Spearman’s or Pearson’s correlation coefficients, ICCs, t tests
Box and Block test for children (a standardized gross manual dexterity test)
  • • Test–retest reliability
  • • Discriminant validity
  • • Concurrent validity
  • • Construct validity
  • Discriminant validity: No difference between boys and girls or left- and right-handed children within groups of children stratified for age (i.e., 3-year-olds, 4-year-olds). A significant and large effect size was found for children aged 3–8 yr for both the dominant, F(7, 207) = 77.07, p < .001, r = .82, and nondominant hands, F(7, 207) = 77.07, p < .001, r = .85.
  • Test-retest reliability: ICC = .85
  • Concurrent validity: correlations between both dominant- and nondominant-hand Box and Block Test scores and the Movement Assessment Battery for Children–2 manual dexterity subtests were moderate to strong for children ages 3–6 yr and weak to moderate for children ages 7–10 yr.
  • Construct validity: Findings support the use of the Box and Block test as a measure of gross manual dexterity among children ages 3–10 yr.
Josman, Abdallah, & Engel-Yeger (2011) To use the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) to measure cultural and sociodemographic effects on cognitive skills in 2 groups of children
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 226 typically developing children representative of Israeli census: 101 Jewish Israeli children and 125 Muslim Palestinian children
  • Recruitment
  • Convenience sampling from Israeli schools in which OTs trained in the administration of the LOTCA worked
  • Statistics
  • Descriptive statistics, MANOVA between identified groups
LOTCA, a standardized assessment of cognitive ability
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: The LOTCA detected differences between groups of children with known differences in culture, parental education level, years of schooling, and age of the child.
  • Construct validity: The LOTCA’s validity as a tool that measures the cognitive function of young children was supported.
Josman, Goffer, & Rosenblum (2010) To examine reliability and validity of the Do–Eat assessment tool for children with DCD
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 59 children aged 5–6.5 yr (30 diagnosed with DCD as determined by Movement Assessment Battery for Children scores below the 15th percentile)
  • Recruitment
  • Convenience sample of 5- and 6-year-old children; 30 children with a diagnosis of DCD and 29 typically developing children
  • Statistics
  • Descriptive statistics, Mann–Whitney U test, Cronbach’s α, t tests, Pearson correlation coefficients
Do-Eat: Dynamic assessment of child making a sandwich, preparing chocolate milk, and completing a handwriting task in the child’s natural context
  • • Internal consistency
  • • Interrater reliability
  • • Construct validity
  • • Concurrent validity
  • Content and face validity: Process of literature review and expert consultation—5 OTs and 5 expert consultants
  • Interrater reliability: High among 3 blinded occupational therapy assessors (rs = .92).
  • Internal consistency: High for Do-Eat components: performance skills (Cronbach’s α = .93), sensory-motor skill (Cronbach’s α = .90), and executive function (Cronbach’s α = .89).
  • Construct validity: Significant between-groups differences on the Do-Eat, t(57) = 14.09, p < .001, and the Parent Questionnaire, t(57) = 3.64, p < .001.
  • Concurrent validity: Significant correlation (r = −.086, p < .001) between children’s scores on sensory-motor component of the Do-Eat and Movement Assessment Battery for Children final score.
Kao, Kramer, Liljenquist, Tian, & Coster (2012) To compare the functional performance of children and youth with autism, developmental disabilities, and no disability using the revised PEDI–Computer Adaptive Test (PEDI–CAT) item banks
  • Design
  • Cross-sectional, nonrandomized, secondary data analysis, reliability, and validity study
  • Participants
  • Participants were purposively sampled from an existing nationally representative data set (N = 2,205) that included 108 children diagnosed with ASD and 150 children with intellectual and developmental disabilities (IDD). Three age groups were selected from the dataset—5 years, 10 years, and 15 years—although the sample size for each group was not reported.
  • Recruitment
  • Representational sampling of families with 1 or more child younger than age 21 yr and data collected via the Internet
  • Statistics
  • Descriptive statistics, analysis of covariance
PEDI–CAT
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: Social–cognitive domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001), but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age.
  • • Daily activities domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001), but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age.
  • • Responsibility domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001) but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age. The largest difference between children with ASD and typically developing children was found to occur at age 15 yr.
  • Construct validity: This study supports the construct validity of the PEDI–CAT to differentiate between children aged 10 and 15 yr with and without disability. The PEDI–CAT did not differentiate between children with and without disability at age 5 yr. Moreover, no significant differences were found between the scores of children with ASD or IDD on any domain, indicating that the PEDI–CAT is not a disability-specific measure.
Kramer, Kielhofner, & Smith (2010) To determine the construct validity, reliability, and goodness of fit of the Child Occupational Self Assessment (COSA) and other factors (child factors, values, administration time, and application)
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 98 practitioners (OTs and physical therapists) and researchers from a central database completed the COSA on 502 children with disabilities between ages 6 and 17 yr from 5 countries.
  • Recruitment
  • Researchers and clinicians from around the world were contacted through email distribution lists and website announcements and during professional meetings and training and invited to share children’s COSA responses with a central database.
  • Statistics
  • Descriptive statistics of population, demographic information, Rasch Partial Credit model, parametric and nonparametric statistics to obtain validity evidence
COSA, with 2 scales, Occupational Competence and Values
  • • Internal reliability
  • • Item fit
  • • Internal and external validity
  • • Construct validity
  • • Concurrent validity
  • • Most children’s responses to the COSA can be validly interpreted as indicators of occupational competence and value for everyday activities.
  • • The COSA has good construct validity in the following areas: content, structural, and substantive validity as given by item and child fit statistics and unidimensionality evaluation.
  • • Evidence for external validity was mixed, depending on some demographic and assessment administration variables.
  • Item fit: All Occupational Competence items had positive point-biserial correlations ranging from .30 to .53. Children reported the least amount of competence and the most difficulty for self-regulation and cognitive tasks, as well as chores. The item separation index was 6.18, which translates to 8.57 strata; the reliability of item separation was .97.
  • Values items: All items had positive point-biserial correlations ranging from .42 to .61. Children were less likely to indicate value for activities typically regulated and demanded by adults. Values item separation across the continuum was 3.96, which transforms to 5.6 strata; item separation reliability across that continuum was .94.
  • Child fit: Of 502 children who completed the Occupational Competence ratings, 59 did not meet fit requirements (11.75%). All t tests and ANOVAs were nonsignificant using a Bonferroni-adjusted α of .01.
  • Person Fit to Values items: Of 496 children who responded to the Values rating scale, 76 did not meet fit requirements (15.3%).
Kuijper, van der Wilden, Ketelaar, & Gorter (2010) To investigate the relationship between the manual abilities of children with cerebral palsy (as categorized using the Manual Ability Classification System [MACS]) and caregiver assistance using the Self-Care scale of the PEDI and to assess the interrater reliability of the MACS
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 61 Dutch children with cerebral palsy between ages 5 and 14 yr
  • Parental consent was obtained.
  • Recruitment
  • Convenience sampling of children attending specialized schools
  • Statistics
  • Descriptive statistics, Spearman’s rank-order correlation coefficient (ρ), linear weighted κ
MACS, Self-Care domain of the PEDI Part 2, Caregiver Assistance scale• Construct validity
  • • The MACS categories demonstrated sensitivity to different levels of caregiver assistance required for self-care, as measured by the PEDI.
  • • The Spearman rank-order correlation coefficient between the MACS levels (as scored by the therapists) and scores on the PEDI Caregiver Assistance scale for self-care activities were significant (ρ = −.72) at the .01 level (two-tailed), although the use of even nonparametric correlation statistics here is questionable and unorthodox.
  • • The study also drew conclusions about the children’s skill level in self-care, although the researchers did not use the PEDI Part 1, which would allow this assertion.
  • • Weighted κ (with linear weighting) for the interobserver reliability of the MACS between the therapists and physicians was found to be .86 (CI [.78, .94]).
  • • 50 children (82%) were classified at the same MACS level by the therapist and the rehabilitation physician, and the remainder were within 1 level.
Little et al. (2011) To evaluate the psychometric properties (reliability) of the Sensory Experiences Questionnaire (SEQ)
  • Design
  • Prospective, nonrandomized, noncontrolled
  • Participants
  • 358 parents of children ages 6–72 mo belonging to 1 of 3 groups: (1) children with autism, (2) children with developmental delay, or (3) typically developing children
  • The test–retest reliability subsample consisted of 24 caregivers, each of whom completed a 2nd questionnaire within 2–4 wk of the 1st questionnaire.
  • Recruitment
  • Convenience sampling; a letter and SEQ form were distributed to caregivers by a designated contact person at preschools, early intervention programs, day care centers, or diagnostic and evaluation centers throughout rural and metropolitan areas in North Carolina, as well as through a university-based research registry
  • Statistics
  • Cronbach’s α and ICC
SEQ
  • • Internal consistency
  • • Test–retest reliability
  • • Internal consistency was excellent; Cronbach’s α was reported to be .80.
  • • Total score test–retest reliability was excellent (ICC = .92).
  • • Subscale test–retest reliability scores ranged from .68 to .86.
  • • The SEQ can be used as an early tool for identifying sensory patterns in young children with autism and other developmental disabilities.
McDonald & Vigen (2012) To describe the instrument development process of the McDonald Play Inventory (MPI) and examine the MPI’s internal reliability and discriminative validity among both neurotypical children and children with known disabilities
  • Design
  • Prospective, nonrandomized, noncontrolled reliability and validity study
  • Participants
  • 124 children between ages 7 and 11 yr (89 neurotypical, 35 with disabilities); 17 parents participated.
  • Recruitment
  • Convenience sampling; participants drawn from a camp, elementary school, and 2 private practice clinics in the United States; participants recruited over a 1-yr period
  • Statistics
  • For internal consistency, Cronbach’s α; for test–retest reliability, Pearson correlation coefficient; for concurrent validity, Pearson correlation coefficient and paired-sample t tests
MPI, which is made up of 2 parts: (1) McDonald Play Activity Inventory (MPAI) and McDonald Play Style Inventory (MPSI)
  • • Internal consistency
  • • Test–retest reliability
  • • Concurrent validity
  • • Construct validity
  • • The self-report instrument yielded reliable and valid measures of a child’s perceived play performance and discriminated between the play of children with and without disabilities.
  • Item analysis and inter-correlations: Each item was moderately correlated (.27–.75) with the respective subscale score. Moderate to strong correlations (.47–.81) were found between each subscale and total scale score.
  • • Intercorrelations between the subscales ranged from low (<.25) to moderate (.50–.71).
  • • The intercorrelation between the total inventory scores was in the moderate range (.49).
  • Internal consistency: Internal consistency was acceptable—α = .84 for the MPAI and α = .79 for the MPSI.
  • Test–retest reliability: Pearson correlation coefficient for the MPAI was .69; for the MPSI, .82; indicates results were consistent over 1-mo period.
  • Construct validity: No statistically significant differences were found by gender or presence of disability on the self-reported play activities of the MPAI total inventory or subscale scores.
  • Concurrent validity: For parent–child responses, the MPAI showed a low correlation (r = .04) and the MPSI showed a moderate correlation (r = .49).
Mulcahey et al. (2013) To examine the psychometric properties of upper-extremity and activity item pools and to evaluate the item banks and simulated 5-, 10-, and 15-item computer adaptive tests (CATs)
  • Design
  • Multicenter cross-sectional study
  • Participants
  • 200 children with brachial plexus birth palsy between ages 4 and 21 yr; 1-time data collection occurred at the point of care.
  • Recruitment
  • Convenience sampling approach
  • Statistics
  • Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA); DIF through the use of ordinal logistic regression; 1-way ANOVA tests with post hoc comparisons
Pediatric Outcomes Data Collection Instrument (PODCI)
  • • Construct validity
  • • Differential item functioning
  • • Concurrent validity
  • • Discriminative validity
  • • In the EFA of the activity items, the 1st factor explained approximately 55% of the total variance.
  • • In the EFA of the upper-extremity items, the 1st factor explained 58% of the total variance.
  • • Three items showed DIF, 2 upper-extremity items (“My child can use an eraser without tearing paper,” “Using only his/her hands, my child can pull up the tab on a can of soda”) and 1 activity item (“Cleaning the floor with a broom and dustpan”). These items were retained owing to the importance of their content.
  • • Concurrent validity was established with a moderate correlation with the Box and Block Test and the PODCI.
  • • The majority of the PODCI items were able to differentiate participants with a known clinical difference.
Munkholm, Berg, Löfgren, & Fisher (2010) To evaluate whether the School version of AMPS is valid for evaluating students in different world regions
  • Design
  • Cross-sectional retrospective study
  • Participants
  • 984 students ranging in age from 3 to 13 yr from North America, Australia and New Zealand, United Kingdom, and Nordic countries (246 students from each region)
  • Recruitment
  • Participants were selected from the sample of all students ages 3–15 yr located in the School AMPS database.
  • Statistics
  • Many-faceted Rasch analysis
School AMPS
  • • Many-faceted Rasch analyses to generate item difficulty calibrations by region and evaluate for significant DIF and differential test functioning
  • • Construct validity
  • • School AMPS items (walk, moves, endures, and navigates) demonstrated DIF but resulted in no differential test functioning.
  • • The School AMPS can be used to evaluate students’ quality of schoolwork task performances across regions because it is free of geographic bias associated with world region.
Ohl et al. (2012) To examine the test–retest reliability and internal consistency of the Sensory Profile Caregiver Questionnaire
  • Design
  • Prospective, nonrandomized, noncontrolled
  • Participants
  • 55 caregivers of children ranging in age from 36 to 72 mo
  • Recruitment
  • Participants were recruited from 6 nursery schools and child care centers in the New York metropolitan area.
  • Parents of children attending the centers were sent a flyer, then a research pack. Completed assessments were posted back to the researcher in self-addressed stamped envelope. Participation was voluntary.
  • Statistics
  • Descriptive statistics, ICCs, Cronbach’s α
  • Sensory Profile Caregiver
  • Questionnaire
  • • Test–retest reliability
  • • Internal consistency
  • • Test–retest reliability was good across quadrant scores (ICCs = .80–.90) and moderate to good across factor (ICCs = .69–.88) and section scores (ICCs = .50–.87).
  • • Internal consistency was high across quadrant scores (αs = .89–.95) and factor scores (αs = .82–.93) and moderate to high across section scores (αs = .67–.93).
Parham et al. (2011) 
  • To develop a reliable and valid fidelity measure for use in research on the Ayres Sensory Integration (ASI) intervention
  • Research questions:
  • Does the Process section of the Fidelity Measure show acceptable interrater reliability?
  • Does the Process section of the Fidelity Measure have acceptable internal consistency?
  • Does the Process section of the Fidelity Measure demonstrate adequate validity in differentiating ASI from other intervention approaches in occupational therapy?
  • Does the entire Fidelity Measure demonstrate content validity in addressing key elements of ASI intervention?
  • Design
  • Instrument development
  • Participants
  • 14 experts in sensory integration from 6 different countries who completed 6-hr training
  • Content validity was established through 19 experts in sensory integration from 6 different countries.
  • Recruitment
  • Content experts were recruited to assist with the development of the Fidelity Measure.
  • Statistics
  • Interrater reliability, content validity, internal consistency, Cronbach’s α, ICC
Ayres Sensory Integration Fidelity Measure
  • • Interrater reliability
  • • Internal consistency
  • • Content validity
  • • Reliability of the Process section was strong for total fidelity score (ICC = .99, Cronbach’s α = .99) and acceptable for most items.
  • • Total score significantly differentiated ASI from 4 alternative interventions.
  • • Expert ratings indicated strong agreement that items in the Structural and Process sections represent ASI intervention.
Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee (2013) To establish the psychometric properties of the Children’s Assessment of Participation and Enjoyment/Preferences for Activities (CAPE/PAC) related to children with high-functioning autism (HFA)
  • Design
  • Mixed methodology, including qualitative research to evaluate content validity and feasibility of use
  • Participants
  • 30 children with HFA between ages 7 and 13 yr (with IQ >80 or adaptive functioning score >60) and 31 typically developing peers
  • Recruitment
  • Children were recruited through multiple sources (parent support group, therapists, health department) and informal modes.
  • Statistics
  • Descriptive statistics, correlation, Mann–Whitney U test
CAPE/PAC
  • • Content validity
  • • Discriminant validity
  • • Test–retest reliability
  • • CAPE/PAC can be used to assess participation (recreational) among children with HFA.
  • • Content validity was assessed as adequate after qualitative evaluation. Test–retest reliability of overall scores was adequate (r > .7), except the social aspect dimension, which was low (r > .196).
  • • Parents’ agreement with most of their children’s self-ratings on this assessment provided an estimate of interrater reliability (in HFA group, 75% of parents agreed or strongly agreed with their child’s rating on the CAPE, and 50% of parents agreed or strongly agreed with their child’s rating for the PAC).
  • • The CAPE/PAC has adequate discriminant validity and test–retest reliability and is able to discriminate between children with and without HFA. Therefore, results suggest that the CAPE/PAC is applicable for use with children with HFA.
Rosenblum, Sachs, & Schreuer (2010) To examine the internal consistency and construct validity of the Children’s Leisure Assessment Scale (CLASS)
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 249 children and adolescents in Israel (114 boys, 135 girls)
  • Recruitment
  • Stratified snowball sampling
  • Inclusion criteria: typically developing public school students
  • Statistics
  • Descriptive statistics, Cronbach’s α, factor analysis, MANOVA, t tests
CLASS; measures multidimensional participation in children’s and adolescents’ leisure activities
  • • Internal consistency
  • • Face validity
  • • Content validity
  • • Construct validity
  • • Discriminant validity
  • Face and content validity: Original assessment reviewed by 5 expert consultants and 5 experienced pediatric OTs.
  • Internal consistency: Leisure factors (instrumental indoor activities, outdoor activities, self-enriched activities, games and sports activities) showed acceptable levels of internal reliability (Cronbach’s α ranged from .57 to .83).
  • Construct validity: Discriminant validity based on gender; girls participated in significantly more activities than the boys (65% and 56%, respectively), with greater frequency and with greater preference for self-enrichment and instrumental indoor activities. Boys participated in significantly more games and sports activities.
Saban, Ornoy, Grotto, & Parush (2012) To describe the development of the Adolescents and Adults Coordination Questionnaire (AAC–Q) and describe its psychometric properties
  • Design
  • Prospective, randomized, instrument development study
  • Participants
  • Convenience sampling of (1) 28 adolescents and young adults diagnosed with DCD (between ages 16 and 35 yr) in Israel and (2) 28 age- and gender-matched participants who had no diagnosis of DCD and who had never been referred or treated for motor coordination problems in Israel
  • Random sampling of 2,379 participants ages 19–25 yr from Israel Military Service
  • Recruitment
  • The DCD group was recruited by contacting professionals who worked with adults. The control group was recruited through advertisements in the university setting and workplace.
  • Statistics
  • Descriptive statistics, independent-sample t tests, construct validity, Cronbach’s α, Pearson’s correlation coefficients
AAC–Q
  • • Content validity
  • • Construct validity
  • • Internal consistency
  • • Test–retest reliability
  • Content reliability: 12 AAC–Q items had >95% interrater agreement from 8 OTs.
  • Internal consistency: High; Cronbach’s α = .88
  • Test–retest reliability: r = .94, p < .001
  • Construct validity: Independent-sample t tests revealed significant differences between participants with and without DCD, t(27) = 9.37, p < .001. A high significant correlation was found between the scores of the 2 scales (r = .973, p < .05), indicating that although separate, the scales assess the same construct. Resulted in removal of the Degree or Intensity scale from the AAC–Q.
Silva & Schalock (2012) To validate the Sense and Self-Regulation Checklist (SSC), a parent–caregiver measure of sensory and self-regulatory responses of children with autism in everyday life
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 265 children < age 6 yr with typical development (n = 138), autism (n = 99), or other developmental delay (DD; n = 28); the informants were the children’s caregivers.
  • Recruitment
  • Convenience sampling for all groups. Children with autism and DD had already been involved in other studies with researchers. They were recruited from 6 regional early childhood special education programs across Oregon.
  • Parents of typically developing children were recruited through 1 child care center, 3 mother support groups, and 1 toddler drop-in play center in Oregon.
  • Statistics
  • Descriptive statistics of participants, χ2 test, Pearson correlation coefficient, multiple regression, Cronbach’s α, ANOVA, post hoc tests
SSC
  • • Internal consistency
  • • Test–retest reliability
  • • Discriminant validity
  • Internal consistency: Overall scores were acceptable. Cronbach’s α = .87 for children with ASD, .89 for typically developing kids, and .85 for children with other DD. In the sensory domain, α = .81 for children with ASD, .80 for typically developing children, and .58 for children with other DD. In the self-regulation domain, α = .79 for children with ASD, .86 for typically developing children, and .83 for children with other DD.
  • Test–retest reliability: After 4-mo follow-up, sensory impairment test–retest coefficient = .595, self-regulation = .831, and overall score = .677.
  • • 2 new findings discriminated autism from other groups: (1) multifocal tactile sensory impairment, characterized by hyporeactivity to injurious stimuli and hyperreactivity to noninjurious stimuli, F(2, 262) = 86.8, p < .001, and (2) global self-regulatory delay, F(2, 262) = 122, p < .001.
  • • The SSC reports a prevalence of sensory and self-regulatory findings approaching 100% (96% and 98%, respectively) in the autism group, raising the possibility that sensory and self-regulatory difficulties represent a core part of autism.
Spirtos, O’Mahony, & Malone (2011) To further examine the interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function (MAUULF)
  • Design
  • Cross-sectional, nonrandomized reliability study
  • Participants
  • 3 OTs who independently scored 34 videotaped assessments of 11 children with hemiplegic cerebral palsy ages 6 yr 1 mo–14 yr 5 mo.
  • All therapists had used the MAUULF in clinical practice and had a 3-hr training session.
  • Recruitment
  • Convenience sample of 3 experienced OTs with honors degrees in occupational therapy who were working in the same center for children and adults with physical disabilities
  • Written informed consent was obtained from the parents of the children for blind scoring of their child’s assessments as
  • part of a larger study.
  • Statistics
  • Descriptive statistics, ICCs, confidence intervals
MAUULF• Interrater reliability
  • Total scores: The correlation between raters was high for the total score (ICC = .961).
  • Test components: The highest correlation between raters was found for fluency (ICC = .902), followed by range of movement (ICC = .866), and the lowest correlation was found for quality of movement (ICC = .683).
  • Individual test item scores: The ICCs varied and ranged from .368 to .899.
Taylor, Lee, Kramer, Shirashi, & Kielhofner (2011) To conduct a psychometric examination (reliability, sensitivity, and validity) of the Occupational Self Assessment (OSA) by focusing on an adolescent population
  • Design
  • Prospective scale evaluation study
  • Participants
  • 296 adolescents between ages 12 and 18 yr with recent diagnosis of acute mononucleosis
  • Follow-up sample was 31 participants who did not consider themselves fully recovered and 59 matched control participants who did consider themselves fully recovered from mono at 12 mo after initial enrollment and after the acute phase. Two matched controls were identified for each participant with persistent fatigue.
  • Recruitment
  • Participants were recruited from schools, hospitals, outpatient clinics, and private physician practices in Chicago.
  • Statistics
  • Item Response Theory; Rasch Rating Scale Model
OSA
  • • Test–retest reliability
  • • Sensitivity
  • • Construct validity
  • • Concurrent validity
  • • OSA items coalesced to capture the intended constructs; the rating scales functioned as intended.
  • • >90% of participants were validly measured.
  • • Demonstrated adequate sensitivity and stability (test–retest reliability) over time.
  • • OSA measure of competence was moderately associated with infectious symptoms, fatigue severity, health status, and stress, and the measure of values was not.
  • • Adolescents who had not recovered from mononucleosis after 12 mo reported lower competence scores yet attached the same value or importance to occupational participation as adolescents who had recovered.
Toglia & Berg (2013) 
  • To compare abilities and strategy use of a group of at-risk youth, ages 16–21 yr, with a community sample of high school students using the WCPA and to investigate the discriminative validity of the WCPA
  • Design
  • Quasi-experimental 2-group comparison, cross-sectional research
  • Participants
  • 113 at-risk youth from an alternative high school and 49 youth from community high schools from a midwestern U.S. city
  • Recruitment
  • A representative sample of gender, race, age, and educational backgrounds were sought using convenience sampling and stratified sampling methods.
  • Statistics
  • Descriptive statistics, Pearson χ2 with Fisher’s exact test significance and t-test comparisons
WCPA, a performance measure of everyday executive function• Discriminative validity: 2 participant groups with known differences compared on their performance on the WCPA
  • t-test comparison between the 2 groups, with Bonferroni correction of p = .004 (.05/12) to avoid a Type I error; WCPA scores revealed significant differences between the 2 participant groups with the exception of total time (p = .91), planning time (p = .97), and rules followed (p = .03).
  • • The WCPA was able to differentiate between 2 groups of participants with known differences; the community group was more likely to follow rules, enter appointments accurately, self-report errors, and use a greater number of strategies than the at-risk youth group.
  • • Comparison of the at-risk and community youth participant groups provides support for the WCPA’s discriminative validity.
Tsai, Lin, Liao, & Hsieh (2009) To examine the reliability of Motor-Free Visual Perception Test–Revised (MVPT–R) and Test of Visual–Perceptual Skills–Revised (TVPS–R)
  • Design
  • Prospective reliability study
  • Participants
  • 52 children (31 boys, 21 girls; age range = 5 yr 5 mo–8 yr 9 mo)
  • Recruitment
  • Convenience sampling was used for children in regular kindergarten and special education classrooms in Taipei, Taiwan.
  • Inclusion criteria: Diagnosis of cerebral palsy, ages 5–8, ability to follow general oral instructions
  • Exclusion criteria: Child could not follow the instructions of the MVPT–R and TVPS–R, poor visual acuity as indicated by Teller Acuity Cards
  • Statistics
  • Descriptive statistics, ICCs, smallest real differences, Cronbach’s α, standard error of measurement
MVPT–R, TVPS –R
  • • Test–rest reliability
  • • Interrater reliability
  • • Internal consistency
  • Test-retest reliability: MVPT–R total score was excellent (ICC = .96); TVPS–R total score was also excellent (ICC = .97); TVPS–R subscale scores were high (ICCs = .76–.92).
  • Interrater reliability: MVPT–R interrater agreement was excellent (ICC = .92); TVPS–R interrater agreement was excellent (ICC = .93); TVPS–R subscale score was high (ICCs = .74–.89) except for the visual sequential memory subscale (ICC = .63).
  • Internal consistency: MVPT–R, Cronbach’s α = .87; TVPS–R, Cronbach’s α = .98; TVPS–R subscale Cronbach’s αs were high (.87–.94).
Vanvuchelen, Roeyers, & De Weerdt (2011) To examine the interrater and test–retest reliability of the Preschool Imitation and Praxis Scale (PIPS)
  • Design
  • Prospective, instrument reliability study
  • Participants
  • 119 typically developing preschool children (69 girls, 50 boys) between ages 1.5 and 4.9 yr were sampled from day care centers and regular preschools in Flanders, Belgium.
  • Recruitment
  • Stratified random sampling was used.
  • Inclusion criteria: Children not born preterm and had no known physical or mental handicap
  • Statistics
  • Descriptive statistics, Cohen’s weighted κs, ICCs, smallest detectable difference, Pearson product–moment correlation coefficient
PIPS
  • • Intrarater reliability
  • • Interrater reliability
  • • Test–rest reliability
  • • The intrarater reliability of the PIPS total score was high (ICC = .996).
  • • The interrater reliability of the PIPS total score was high (ICC = .995).
  • • Test–retest reliability was high (r = .93) for the association scores between 56 children assessed with a time interval of 1 wk.
Weiner, Toglia, & Berg (2012) To evaluate initial psychometric properties of the WCPA, to describe the baseline executive functioning profile of at-risk youth, and to investigate relationship between accuracy, time, strategy use, error patterns, and self-evaluation of performance
  • Participants
  • 113 at-risk youth (53 girls, 60 boys) between ages 16 and 21 yr from an alternative high school. 9 did not participate; however, details are not provided about the remaining 104.
  • Recruitment
  • Participants were enrolled at a school for high-risk youth in the midwestern United States.
  • Statistics
  • Descriptive statistics, Pearson correlation coefficient
WCPA, a performance measure of everyday executive function
  • • Interrater reliability
  • • Interitem correlations
  • • Clinically useful tool for measuring executive functioning among youth.
  • • Interrater reliability for 2 trained scorers was high (ICC = .99) for total accuracy scores.
  • • On average, participants spent 15.9 min on the WCPA, made 7.9 errors, and followed 4.0 of 5 possible rules. No ceiling effect was observed in overall accuracy. Participants used a mean of 3.1 strategies (standard deviation = 1.9) while completing the WCPA.
  • • Participants who used more strategies spent more time planning and completing the task and were more accurate.
  • • The assessment allows evaluation of complex task performance, strategy use, self-evaluation of performance, and error patterns, which guide interventions.
Weintraub & Bar-Haim Erez (2009) To describe the development and initial evaluation of the construct validity of the Quality of Life in School (QoLS) questionnaire
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 353 elementary school students (180 boys, 173 girls) in 3rd–6th grade from 8 general education schools in Israel
  • Recruitment
  • Purposive sampling in identified schools and parents approached for permission to include their typically developing child
  • Inclusion criteria: In Grades 3–6, no neurological symptoms, no physical disability, not receiving special education services
  • Statistics
  • Cronbach’s α, Pearson correlation coefficients, 2-way ANOVA, MANOVA (between gender and age), ANOVA, factor analysis
QoLS–Version 2
  • • Comprehensive description of development and initial evaluation of QoLS–Version 2
  • • Construct validity
  • • Internal consistency
  • • Factor structure
  • • Discriminant validity
  • • Factor analysis identified 4 categories within questionnaire: (1) teacher–student relationship and school activity (Cronbach’s α = .91), (2) physical environment (Cronbach’s α = .82), (3) negative feelings (Cronbach’s α = .90), and (4) positive feelings (Cronbach’s α = .68).
  • Internal consistency: Total questionnaire Cronbach’s α = .88.
  • • Total QoLS score had significant medium to high correlation with each category (.51 < r < .69).
  • • Discriminant validity in process to evaluate use of this tool with students with disabilities was not reported in this article.
  • • QoLS may assist clinicians and educators in evaluating students’ school quality of life from a multidimensional perspective, pending application to students with disabilities.
Table Footer NoteNote. ADLs = activities of daily living; AMPS = Assessment of Motor and Process Skills; ANOVA = analysis of variance; ASD = autism spectrum disorder; CI = confidence interval; COP = Comprehensive Observations of Proprioception; DCD = developmental coordination disorder; DIF = differential item functioning; ETCH = Evaluation Tool of Children’s Handwriting; HPAS = Health Promoting Activities Scale; ICC = intraclass correlation coefficient; LPP = Life Participation for Parents; MANOVA = multivariate analysis of variance; OT = occupational therapist; PEDI = Pediatric Evaluation of Disability Inventory; ROC = receiver operating characteristic; SVMPT = Slosson Visual–Motor Performance Test–Revised; TVMI = Test of Visual–Motor Integration; VMI = Developmental Test of Visual–Motor Integration; WCPA = Weekly Calendar Planning Activity.
Note. ADLs = activities of daily living; AMPS = Assessment of Motor and Process Skills; ANOVA = analysis of variance; ASD = autism spectrum disorder; CI = confidence interval; COP = Comprehensive Observations of Proprioception; DCD = developmental coordination disorder; DIF = differential item functioning; ETCH = Evaluation Tool of Children’s Handwriting; HPAS = Health Promoting Activities Scale; ICC = intraclass correlation coefficient; LPP = Life Participation for Parents; MANOVA = multivariate analysis of variance; OT = occupational therapist; PEDI = Pediatric Evaluation of Disability Inventory; ROC = receiver operating characteristic; SVMPT = Slosson Visual–Motor Performance Test–Revised; TVMI = Test of Visual–Motor Integration; VMI = Developmental Test of Visual–Motor Integration; WCPA = Weekly Calendar Planning Activity.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 1). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 1). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
×
Table 2.
Summary of Instruments for Children and Youth Described in Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013
Summary of Instruments for Children and Youth Described in Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Instrument (Article)Frame of Reference/Theoretical or Practice ModelPopulation/Group; Perspective; Purpose, Use, or Intent of InstrumentDescription of InstrumentAdministration and Scoring Time RequiredSubscales or Item CategoriesResources and Equipment RequiredScores and Results Obtained
Adolescents and Adults Coordination Questionnaire (AAC–Q; Saban, Ornoy, Grotto, & Parush, 2012) Motor Control and ICF, Body Functions and Structures
  • Population: Adolescents and young adults between ages 16 and 35.
  • Perspective: Self-report.
  • Purpose: To identify and investigate DCD in adolescents and adults age ≤35 yr; the AAC–Q can enable a greater understanding of how DCD influences participation and function in daily life activities, information that may guide the development of more effective intervention programs for this group.
  • Consists of 12 items, which include basic and instrumental activities of daily living, organizational skills, spatial and temporal orientation, activities requiring fine motor function, activities requiring gross motor function, and writing.
  • • Respondents are asked to respond using a 5-point Likert frequency scale.
  • • Takes <10 min to complete.
  • • Final score ranges from 12 to 60, with lower scores indicating better motor coordination function.
  • • Single composite score is calculated.
  • • Questionnaire
  • • Pen or pencil
Total score ranges from 12 to 60.
Assessment of Children’s Hand Skills (ACHS; Chien, Brown & McDonald, 2010)Ecological and top-down assessment
  • Population: Children ages 2–12 yr.
  • Perspective: Observation based; professional scores performance on the basis of specific criteria.
  • Purpose: To evaluate how effectively children use their hands when engaged in meaningful occupations and to analyze and rate children’s actual hand skill performance in their relevant environments.
Assesses children’s hand use in naturalistic settings via observational rating scale.
  • • The ACHS research version consists of 20 hand skill items rated on a 6-point rating scale.
  • • A score of 6 indicates very effective hand skill performance, whereas a score of 1 indicates very ineffective hand skill performance.
Children’s hand skills are divided into 6 distinct categories: manual gesture, body-contact hand skills, adaptive skilled hand use, arm–hand use, bimanual use, and general activities.
  • • Assessment booklet
  • • Naturalistic environment
  • • Pencil
Composite scores and subscale scores for the 6 hand skill categories are generated.
Assessment of Motor and Process Skills (AMPS; Gantschnig, Page, Nilsson, & Fisher, 2013)
  • Model of Human Occupation and occupational performance
  • Population: Children with typical development or mild disabilities ages 4–15 yr.
  • Perspective: Therapist or clinician administered and scored.
  • Purpose: To differentiate and measure the motor and processing skills of children with and without disabilities during ADL tasks.
Internationally standardized observational assessment of activities of daily living in which the child is rated on 16 motor and 20 processing ADL items.Takes approximately 1 hr to administer.Computer-generated results
  • • Test manual
  • • Scoring sheets
Scores for motor and processing skills
Ayres Sensory Integration (ASI) Fidelity Measure (Parham et al., 2011)Sensory integration theory
  • Population: Not applicable.
  • Perspective: Third-party raters, who complete Fidelity Measure to investigate whether service provided on the basis of sensory integration principles aligns with theoretical principles.
  • Purpose: To document whether interventions carried out are in accordance with the essential procedural aspects of ASI intervention, to monitor replicable ASI intervention delivery in research such as randomized clinical trials, and to differentiate between ASI and other types of intervention.
  • • Addresses the key structural and process elements of ASI intervention.
  • • Parts 1–4 measure the structural elements.
  • • Part 5 measures therapist adherence to 10 process elements (e.g., tailors activity to present just-right challenge).
  • • Scoring involves subjectivity.
  • • Scored on a 4-point Likert scale.
  • • A total Fidelity score of 100 equals a perfect match to ASI intervention strategies.
  • • Total Fidelity score of 80 was designated as the tentative cutpoint for determining whether an observed intervention session adhered to ASI therapeutic principles.
Total summed raw score
  • • Training
  • • Pen
Total Fidelity score
Box and Block Test (Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen, 2013)Biomedical framework; ICF: Body Structure and Function and Activity
  • Population: Children ages 3–10 yr with differences in hand function.
  • Perspective: Child completes timed test; therapist- or clinician-administered and scored on the basis of specific criteria.
  • Purpose: To provide performance score on normed standardized test of gross manual dexterity.
Standardized and specifically measured set of boxes that fit inside each other.Time to administer varies—longer for younger children (≤30 min)Raw scores converted to standard scores. Each is hand scored separately.
  • • Box with partition
  • • Blocks
  • • Timer
  • • Scoring forms
Standard scores
Child Occupational Self Assessment (COSA; Kramer, Kielhofner, & Smith, 2010)Model of Human Occupation
  • Population: Children with disabilities ages 6–17 yr.
  • Perspective: Self-report (child-friendly rating scale).
  • Purpose: Self-report of occupational competence and value for everyday activities designed to involve children in identifying goals and assessing outcomes; measures the extent to which children feel they competently meet expectations and responsibilities associated with activities and the relative value of those activities.
Consists of a series of 25 items that represent a range of everyday activities that most children encounter at home, at school, and in their communities.
  • • Can be administered in 1 of 3 ways: (1) standard paper-and-pencil format that provides different visual cues for each rating category description, (2) card-sort version that places each item on a separate card and each rating category (and visual cue) on a larger rating card, and (3) summary form that presents all items and rating categories in a matrix format without visual cues.
  • • Takes approximately 30 min to complete.
  • • Each item is rated using two 4-point rating scales: Occupational Competence scale and Values scale.
COSA rating scale converted to 1–4 for data entry and delivered to database for analysis (in the study described). Use by clinicians, including scoring, not described.
  • • Assessment
  • • Manual
  • • Training in administration
List of activities that the child feels less competent doing but for which he or she indicates high importance; these activities can be addressed in therapy.
Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)PEO model and ICF
  • Population: Children with and without disability ages 6–18 yr.
  • Perspective: Self-report of child’s perception; can include third-party parent assistance.
  • Purpose: Self-rated measure that estimates a child’s participation outside of school; children complete the assessment independently or supported by an adult through adaptations.
  • Booklet and score sheet format for self-selection of response that most represents child’s perspective
• 30–60 min to administer and score
  • • Consists of 55 items related to participation (46 of these are recreational)
  • • Provides information about 5 dimensions of participation: intensity, social aspect, location, child’s degree of enjoyment in the activity, and preference
  • • Pen
  • • Assessment
  • • Manual
Raw scores within dimensions
Occupational Therapy Practice Framework (2nd ed.; AOTA, 2008), occupational performance
  • Population: Children and adolescents.
  • Perspective: Self-report.
  • Purpose: To measure multidimensional participation in children’s and adolescents’ leisure activities; designed to document children’s perceptions about their time investment in leisure activities and their ambitions regarding certain activities that they would like to undertake but have not for a variety of reasons.
Consists of 30 items under 4 factors: (1) instrumental indoor activities, (2) outdoor activities, (3) self-enriched activities, and (4) games and sports activities, which relate to 6 dimensions of leisure participation: variety, frequency, sociability, preference, time consumption, and desired activities.
  • The dimensions of participation are scored:
  • Variety: sum score of participation in activities (0 = not doing the activity at all, 1= doing the activity)
  • Frequency: measured on a 4-point Likert-type scale (1 = once in a few months, 2 = once a month, 3 = twice a week, and 4 = every day)
  • Sociability: defined by who performed the activity with the child, rated on a 4-point Likert-type scale (1 = alone, 2 = with a relative, 3 = with one friend, and 4 = with friends)
  • Preference: rated on a 10-point scale ranging from 1 (do not like at all) to 10 (like very much)
• Consists of 30 items under 4 factors: (1) instrumental indoor activities, (2) outdoor activities, (3) self-enriched activities, and (4) games and sports activities.
  • • Manual
  • • Assessment
  • • Scoring sheet
  • • Pen
Allows evaluation of leisure activities among typically developing children and adolescents.
Proprioception and sensory integration theory, motor control, ICF
  • Population: Children age ≥2 yr with suspected proprioceptive processing difficulties.
  • Perspective: Observational assessment; the COP guides clinical observations and helps the clinician identify adequate performance and deviation from typical parameters using defined criteria; professional scores performance on the basis of specific criteria.
  • Purpose: To measure proprioceptive processing in children.
  • • Contains 18 items focusing on motor and behavior regulation aspects of proprioceptive processing in children.
  • • Measures 4 factors: (1) tone and joint alignment, (2) behavior manifestations, (3) postural motor, and (4) motor planning.
  • • Can be used in a variety of contexts, such as the home, clinic, and school.
Takes 15 min to administer; therapist observes child and rates the COP items.Measures 4 factors: (1) tone and joint alignment, (2) behavior manifestations, (3) postural motor, and (4) motor planning.Copy of scale and place to observe childTotal COP score plus 4 factor scores
Developmental Test of Visual–Motor Integration (VMI; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 2–17 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Visual–motor screening tool to identify children who are experiencing difficulty coordinating visual perception and motor movements; has 2 supplement standardized tests: VMI Visual Perception and VMI Motor Coordination. Can be administered individually or in a group.
Consists of 27 geometric forms to be copied and organized in developmental sequence.• Administration takes approximately 15 min, and scoring time is approximately 10 min.Total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Do-Eat (Josman, Goffer, & Rosenblum, 2010)Ecological practice model, PEO model, Occupational Therapy Practice Framework (2nd ed.)
  • Population: Children with DCD.
  • Perspective: Therapist observation and parent or third-party questionnaire.
  • Purpose: To evaluate daily task performance abilities among children with DCD; assists with establishing customized goals and objectives for intervention.
  • Ecologically valid assessment; focuses on food preparation, drawing, writing, and cutting.
  • • Child is asked to perform 3 tasks: (1) Make a sandwich, (2) prepare chocolate milk, and (3) fill out a certificate of outstanding performance for him- or herself.
  • • See Appendix 1 of article for assessment.
  • • Accompanying parental questionnaire consists of 12 positive statements.
  • Assessment is administered in natural surroundings (e.g., kindergarten, family kitchen).
  • • Scoring is sum totaled.
  • • Throughout performance, child receives score for performing the task, analysis score for sensory–motor skills, and analysis score for executive functioning.
  • • Test scores range from 1 (unsatisfactory performance) to 5 (very good performance).
  • • Accompanying parental questionnaire scored on scale ranging from 1 (never) to 5 (always).
  • • Overall task performance score is calculated.
  • • Overall score analyzing sensory–motor skills and executive functioning.
  • • Test includes summary score sheets including scores discussed in preceding bullets and parental questionnaire score.
  • • Score for performing the task
  • • Analysis score for sensory–motor skills
  • • Analysis score for executive functioning
  • • Parental questionnaire score
  • • Assessment
  • • Manual
  • • Ingredients for tasks
  • • Certificate that child fills out
  • • Score card
  • • Overall task performance score
  • • Overall score analyzing sensory–motor skills and overall score analyzing executive functioning
  • • Summary test score sheets including scores in previous bullet and parental questionnaire score
Evaluation of Social Interaction (ESI; Griswold & Townsend, 2012)Model of Human Occupation
  • Population: Children ages 2–12 yr with and without a disability.
  • Perspective: Performance-based assessment gained through observation (verbal and nonverbal behaviors); professional scores performance on the basis of specific criteria.
  • Purpose: To assess the quality of social interaction in children as a baseline to measure change in social interaction performance; enables occupational therapist to plan interventions to address specific social interaction skill deficits for children during activities in natural contexts.
  • Social interaction performance is scored on 27 skills that relate to initiating and ending a social interaction, producing the interaction, physically supporting the interaction, shaping the content and maintaining the flow of the interaction, verbally supporting the interaction, and adapting to problems that might arise during the interaction.
  • • 27 skills are scored on 4-point criterion-referenced rating scale.
  • • Scores are placed in ESI software, which generates a measure of the quality of social interaction.
  • • Social interactions are categorized by their intended purpose.
  • • Categories: gathering information, sharing information, problem solving or decision making, collaborating or producing, acquiring goods and services, conversing socially or making small talk
Natural environment to observe child (school, home, kindergarten, park, etc.)
  • • Measure of the quality of social interaction (objective measure): baseline to measure change in social interaction performance
  • • Raw scores converted to logits
Evaluation Tool of Children’s Handwriting (ETCH; Brossard-Racine, Mazer, Julien, & Majnemer, 2012; Duff & Goyen, 2010)PEO model, occupational performance, and Occupational Therapy Practice Framework (2nd ed.)
  • Population: School-age children.
  • Perspective: Professional scores performance on the basis of specific criteria.
  • Purpose: Standardized measure that assesses a range of handwriting tasks similar to those experienced in the classroom setting; designed to identify and characterize handwriting difficulties in young school-age children.
  • • The ETCH is available in both manuscript and cursive versions.
  • • The Manuscript version of the ETCH (ETCH–M) targets children in Grades 1–3 and examines legibility through 7 different tasks: alphabet, writing from memory (upper- and lowercase), numeral writing from memory, near-point copying, far-point copying, dictation of non-words and numbers, and composition of a short sentence.
  • • Takes approximately 30 min to administer.
  • • Letters, numerals, and words are judged for legibility using a list of specific criteria such as omission, closing, misplacing, reversion, and poor erasure.
  • • The percentage of legibility is determined for each task by counting the legible letters, numerals, or words and dividing by the total number of letters, numerals, or words required.
  • • The percentages from each task are then averaged to provide a total legibility score for letters, numerals, and words.
  • • Performance time or writing speed is measured in seconds for the alphabet and numeral writing tasks and in letters per minute for the copying and composition tasks.
Sum total
  • • Assessment
  • • Manual
  • • Pen or pencil
  • • Total legibility score (for word and letter)
  • • Performance time and writing speed score
Family L.I.F.E. (Looking Into Family Experiences; Honaker, Rosello, & Candler, 2012)
  • Occupational adaptation practice model and Occupational Therapy Practice Framework (2nd ed.)
  • Population: Families with a child with autism spectrum disorder.
  • Perspective: Self-report by family.
  • Purpose: Occupation-based assessment that engages families and therapists in a collaborative partnership to identify unique and relevant family occupations, evaluate these occupations, and measure perceived success in these occupations.
  • • Assessment includes demographic section and a time diary of a typical weekday and a typical weekend day (helps to identify routines and rituals).
  • • 8 interview questions focus on family togetherness, child rearing, and impact on family occupations.
  • • Likert scale is used to rate each occupation on perceived effectiveness, efficiency, and satisfaction.
  • • The sum of the scores is tallied for each factor and divided by the number of occupations to achieve a separate overall score.
Sum total to give overall score
  • • Assessment
  • • Manual
Overall score
Health Promoting Activities Scale (HPAS; Bourke-Taylor, Law, Howie, & Pallant, 2012)PEO model, ecological practice model
  • Population: Initially developed for mothers of children with a disability.
  • Perspective: Self-report instrument.
  • Purpose: To measure the frequency of participation in healthy occupations that are associated with mental health and well-being.
  • • 8 items with activity key for participants to consider their self-selected occupations
  • • Response items are rated on a 7-point scale ranging from daily to never.
Sum totalSingle composite scoreFreely available brief scaleTotal score
Life Participation for Parents (Fingerhut, 2013)Occupational adaptation practice model, family-centered practice
  • Population: Parents of children with a disability.
  • Perspective: Self-report of parent.
  • Purpose: To facilitate family-centered pediatric practice by measuring the ability of parents to participate in life occupations while raising a child with special needs.
Contains 22 questions asking parents about their ability to participate.
  • • The questions are answered on a 5-point Likert scale ranging from strongly agree to strongly disagree, with a lower score indicating less satisfaction with occupational participation.
  • • Reverse scoring of positively worded questions
Total Stress score and subscale scores: Satisfaction With Efficiency and Satisfaction With Effectiveness
  • • Assessment
  • • Pen
Scores sum totaled: overall and 2 subscales
Manual Ability Classification System (Kuijper, van der Wilden, Ketelaar, & Gorter, 2010)ICF: Body Structures and Functions and Activity
  • Population: Children ages 5–14 yr with cerebral palsy (CP).
  • Perspective: Third party—either parent or professional who knows the child’s performance.
  • Purpose: Classification system with 5 levels pertaining to defined use of the hands by children with CP.
  • The classification system has a decision tree to guide the scorer (occupational therapist or physician). Focuses on the way children with CP use both of their hands when handling objects in daily age-appropriate activities.
  • • Has 5 classification system levels: (1) Handles objects easily and successfully; (2) handles most objects with somewhat reduced quality and speed of achievement; (3) handles objects with difficulty, needs help to prepare or modify activities; (4) handles a limited selection of easily managed objects in adapted situations; and (5) does not handle objects and has severely limited ability to perform even simple actions.
  • • The scale is ordinal, and the distances between levels are not considered equal.
Hand use is classified at 1 of the 5 levels by skilled observer.Obtain classification score for 1 of 5 levels.
  • • Manual and score sheets can be downloaded from http://www.macs.nu/
  • • Available in multiple languages.
  • • The assessment requires no special training for occupational therapists and physicians.
Obtain classification score for 1 of 5 levels regarding hand function for children with CP
  • McDonald Play Inventory
  • (MPI): McDonald Play Activity Inventory (MPAI) and McDonald Play Style Inventory (MPSI; McDonald & Vigen, 2012)
PEO and Occupational Performance models
  • Population: Children ages 7–11 yr.
  • Perspective: Self-report (child) or third party, and including parental report.
  • Purpose: Two-part child self-rated scale of play.
  • • Made up of 2 parts: (1) the MPAI, which measures the child’s perceived frequency of engagement in 4 categories that form 4 subscales (Fine Motor, Gross Motor, Social Group, Solitary), and (2) the MPSI, which measures the types and frequency of play behaviors (affective component) in 4 domains: physical coordination, cooperation, peer acceptance, and social participation.
  • • MPSI consists of 24 play behavior items (6 items in each category), 12 neutral play activity items, and 4 “lie” or social desirability items.
  • • MPAI: Rate the frequency of participation in activity on 5-point Likert-scale (never, about once or twice a year, about once or twice a month, about once or twice a week, or almost every day).
  • • MPSI: Rate responses on 5-point Likert scale (never, hardly ever, sometimes, a lot, and always)
  • • Administration time: 15 min without assistance, 20–30 min with assistance
MPI is composed of two parts: MPAI and MPSI.
  • • Assessment
  • • Manual
  • • Pen
  • • Total score
  • • Subscale scores
ICF: Body Structures and Functions and Activity
  • Population: Children with neurological impairments ages 5–15 yr.
  • Perspective: Performance based or third party.
  • Purpose: Criterion-referenced assessment to measure quality of upper-limb movement in children with a neurological impairment; measures 1 hand at a time. Widely used to examine the effectiveness of specific interventions.
  • • Contains 16 items that examine the child’s performance on tasks.
  • • Individual items are scored under 4 categories: (1) range of movement, (2) target accuracy, (3) fluency, and (4) quality of movement.
  • • Individual items are scored under 4 categories.
  • • Each item is scored on a scale of either 0–3 or 0–4 (the manual provides a detailed description of what is required for each score).
Total raw scores are converted to percentages.
  • • Training session for scoring, although skill level of trainer is unknown
  • • Manual
  • • Total percentage score
  • • Designed to evaluate change over time
Motor-Free Visual Perception Test–Revised (MVPT–R; Tsai, Lin, Liao, & Hsieh, 2009)Perceptual–motor theory
  • Population: Children ages 4–12 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess children’s visual–perceptual strengths and weaknesses.
  • Consists of 40 items divided into spatial relationships, visual memory, visual discrimination, figure ground, and visual closure.
  • • Total score ranges from 0 to 40 points.
  • • Items are either right or wrong.
  • • The whole scale is administered to candidate.
One total summed score is calculated.
  • • Answer sheet
  • • Test manual
  • • Book of item plates
  • • Total raw scale score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Occupational Self Assessment (OSA; Taylor, Lee, Kramer, Shirashi, & Kielhofner, 2011)Model of Human Occupation
  • Population: Can be used with adolescents and adults.
  • Perspective: Self-report.
  • Purpose: Client-centered evaluation tool that measures clients’ perceptions of their own competence and the value they assign to occupations.
Clients rate their competence in and importance of everyday activities for 21 items; the client chooses 4 items that he or she would like to change.Takes approximately 30 min to complete and 15 min to score.Scores are calculated for 21 questions and 2 subscales, Competence and Values.
  • • Scoring sheets
  • • Pencil
• Summary scores for items; also provides scores for 2 subscales, Competence and Values
Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI–CAT; Kao, Kramer, Liljenquist, Tian, & Coster, 2012)ICF
  • Population: Children and young people with a disability through age 21 yr.
  • Perspective: Judgment-based, standardized instrument using parental reports or structured interview with professional who knows the child.
  • Purpose: To evaluate the child’s capability in the social–cognitive, daily activities, mobility, and responsibility domains.
  • • Consists of the following domains: daily activities (68 items), social-cognitive (60 items), and responsibility (51 items).
  • • Also measures environmental supports and modifications that the child needs to complete activities.
Sum total; raw scores are transformed into scaled scores for each domain.Raw scores that are transformed into scaled scoresComputer databaseScaled scores provide an indication of a child’s performance on relatively easy to relatively difficult items in a particular domain.
Pediatric Outcomes Data Collection Instrument (PODCI; Mulcahey et al., 2013)
  • Functional outcome measurement; ICF : Body Structures and Functions and Activity
  • Population: Children and adolescents ages 4–21 yr.
  • Perspective: Therapist or clinician administered and scored; professional scores performance on the basis of specific criteria.
  • Purpose: To provide an outcome measure for the upper-extremity and activity items of the PODCI when applied to brachial plexus injury.
The PODCI consists of 52 final Upper Extremity items and 34 Activity items.Takes approximately 1 hr to administer.
  • Scales include upper extremity and physical function, transfer and basic mobility, sports/physical function, pain/comfort, treatment expectations, happiness, satisfaction with symptoms, and global functioning.
  • • Computer
  • • Computer adaptive test program
  • • Scale items that the CAT runs through with respondent
Scores for the Upper Extremity and Activity subscales
Preschool Imitation and Praxis Scale (PIPS; Vanvuchelen, Roeyers, & De Weerdt, 2011)
  • Play theory, Occupational Performance of Children model, and PEO practice models
  • Population: Preschool children ages 1–5 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess the accuracy of bodily procedural imitation performance in young children
  • • Consists of 10 task categories (6 gestural, 3 procedural, and 1 facial) and 30 PIPS tasks.
  • • Performance is scored on a 3- or 5-point scale.
  • • Sum total
  • • Final PIPS score is a reflection of the accuracy of the child’s imitation performance.
  • • Administration takes 10–20 min.
The 30 tasks are divided into 10 task categories.
  • • PIPS manual
  • • PIPS assessment
  • • Pen to score
  • • Items in assessment: toy bear, wooden block, toy animal with lamp in it, box, cup, doll, toy car, bed, blanket
Total score
Quality of Life in School Version 2 (QoLS; Weintraub & Bar-Haim Erez, 2009)Biopsychosocial model and PEO model
  • Population: School-age children.
  • Perspective: Self-report.
  • Purpose: Self-rated measure evaluating student’s school quality of life from a multidimensional perspective.
Consists of 36 items divided into 4 categories: (1) teacher–student relationship and school activities (12 items), (2) physical environment of school and classroom (11 items), (3) negative feelings toward school (8 items), and (4) positive feelings toward school (5 items).Gain score for each category and total school36 items divided into 4 categories
  • • Training in assessment administration
  • • Assessment
  • • Manual
  • • Pen
Raw score for each category and total score
School Function Assessment (SFA; Hwang & Davies, 2009)Ecological assessment, functional assessment, application of Rasch measurement model
  • Population: School-age children.
  • Perspective: Third party; teacher observes the student and provides ratings on the basis of observation.
  • Purpose: Criterion-referenced assessment that measures a wide spectrum of school-related functional tasks associated with the role of elementary school child; guides program planning for students with special needs.
Consists of 18 scales made up of 266 items.Scored on a 4-point rating scale (1 = does not perform, 4 = consistent performance)Activity Performance scale consists of 18 scales made up of 266 items
  • • Manual
  • • Assessment
  • • Pen
Total score
School Version of the Assessment of Motor and Process Skills (School AMPS; Munkholm, Berg, Löfgren, & Fisher, 2010)Model of Human Occupation
  • Population: Children ages 3–13 yr attending an educational program or school.
  • Perspective: Third party; discussion with teacher and performance-based observation of child completing 2 tasks in an education or classroom context; professional scores performance on the basis of specific criteria.
  • Purpose: Functional assessment for measuring the quality of schoolwork task performance as it is observed in the natural classroom setting.
Consists of 26 schoolwork tasks plus 16 school motor and 20 school process skill items. Tasks range from simple to complex: pen-writing tasks, pencil-writing tasks, drawing, coloring tasks, cutting and pasting tasks, computer writing tasks, math, and manipulative tasks.
  • • Therapist unobtrusively observes students in their natural classroom environment.
  • • Therapist scores the quality of observed performance using the scoring criteria for the 16 school motor and 20 school process skill items on a 4-point rating scale.
• 2 linear graphs represent the quality of schoolwork performance measures: (1) school motor quality of performance and (2) school process quality of performance.
  • • Formal training in administration
  • • Paper, pen
  • • Computer and program
  • • Manual
Two schoolwork performance measures: (1) school motor quality of performance and (2) school process quality of performance
Sense and Self-Regulation Checklist (SSRC; Silva & Schalock, 2012)Behavioral self-regulation and sensory processing paradigm
  • Population: Children age <6 yr with developmental delay.
  • Perspective: Third party— parent or caregiver.
  • Purpose: To identify areas of sensory and self-regulation difficulty to assess the child’s response to treatment.
  • • Measures 2 domains: sensory difficulties and self-regulation.
  • • Sensory difficulties domain has 6 subdomains: touch–pain, auditory, visual, taste–smell, hyperreactive to noninjurious stimuli, and hyporeactive to noninjurious stimuli (additional category created: abnormal touch–pain).
  • • Self-regulation domain has 6 categories: sleep, appetite–digestion, self-soothing, orientation–attention, aggressive behavior, and self-injurious behavior.
• Scored on a 4-point rating scale: 0 (never), 1 (rarely), 2 (sometimes), and 3 (often)Sum totalCaregivers must have elementary school education and read English, Spanish, or Chinese.Two domain scores (1 for sensory and 1 for self-regulation)
Sensory Experiences Questionnaire (SEQ; Little et al., 2011)Sensory processing model
  • Population: Children ages 7–72 mo with suspected autism and related developmental disorders.
  • Perspective: Parent or caregiver report.
  • Purpose: Brief caregiver questionnaire for young children with suspected autism and developmental delays; used to identify sensory processing patterns (hypo- and hyperresponsiveness) in the context of daily activities. It is designed to be used as a supplement to diagnostic and developmental assessments.
  • • Brief (10–15 min) caregiver report
  • • Yields 4 dimensional subscale scores as well as a total score.
  • • Items reflect 5 sensory domains: tactile, auditory, visual, vestibular–proprioceptive, and gustatory–olfactory.
  • • Contains qualitative questions regarding parent compensatory strategies used in response to the sensory processing problems experienced by the child.
  • • Takes 10–15 min to complete.
  • • Caregiver responses are based on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always).
  • • Higher scores indicate more sensory processing problems.
Total score and 4 subscale scores (hyperresponsiveness, hyporesponsiveness, social, and nonsocial)
  • • Assessment form
  • • Pen
Raw total score and 4 subscale scores
Sensory Profile Caregiver Questionnaire (SPCQ; Ohl et al., 2012)Dunn’s Model of Sensory Processing
  • Population: Children ages 3–12 yr.
  • Perspective: Third party: parent report or caregiver questionnaire.
  • Purpose: To provide information about children’s tendencies to respond to stimuli and which sensory systems are likely contributing or creating barriers to functional performance.
  • Sensory Profile contains >125 items organized into 3 sections: (1) sensory processing, which contains 6 item categories that measure children’s responses to information taken in through the sensory systems; (2) modulation, which contains 5 item categories that measure children’s ability to monitor and regulate information to generate an appropriate response to the situation; and (3) behavioral and emotional responses, which contains 3 item categories that measure children’s emotional and behavioral responses to sensory experiences.
  • • Need manual for scoring guidelines.
  • • Caregivers record the frequency with which their child displays each item behavior on a 5-point Likert scale (1 = always, 2 = frequently, 3 = occasionally, 4 = seldom, 5 = never).
  • • Responses are totaled on a Summary Score Sheet that yields 2 scores: section score and factor score.
  • • Section score, which provides a visual summary of children’s sensory processing, modulation, and behavioral and emotional response abilities
  • • Factor score, which captures children’s responses to sensory experiences on the basis of not solely their sensory systems but also other aspects of sensory processing
  • • Quadrant score, which measures the degree to which children miss, obtain, detect, or are bothered by sensory input
  • • Manual
  • • Assessment sheets
  • • Summary score
  • • Sheet
  • • Pen
Section, factor, and quadrant scores
Slosson Visual Motor Performance Test (SVMPT; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 4–18 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Screening tool to identify people with visual–motor perceptual problems in which hand–eye coordination is involved; measures a person’s ability to interpret and translate visually perceived geometric patterns.
Consists of 14 geometric figures; each is copied 3 times.Administration takes approximately 20 min, and scoring time is approximately 10 min.One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual–Motor Integration (TVMI; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 4–17 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Standardized norm-referenced test of visual–motor integration; used to document presence and degree of visual–motor difficulties in children.
  • • Consists of 30 geometric figures.
  • • Uses a copying format whereby children copy figure into designated space.
Administration takes approximately 20 min, and scoring time is approximately 10 min.One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual-Motor Skills–Revised (TVMS–R; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 3–13 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Assesses children’s ability to translate, with their hands, what they visually perceive to gain an understanding of the children’s strengths and weaknesses in visual–motor integration abilities.
  • • Consists of 23 geometric figures.
  • • Uses a copying format whereby children copy figure into designated space.
  • • Administration takes approximately 20 min, and scoring time is approximately 10 min.
  • • When scoring, it allows therapist to categorize a child’s visual–motor errors and accuracies.
One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual–Perceptual Skills–Revised (TVPS–R; Tsai, Lin, Liao, & Hsieh, 2009)Perceptual–motor theory
  • Population: Children ages 4–12 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess children’s visual–perceptual strengths and weaknesses.
  • • Consists of 112 items grouped into 7 subscales.
  • • Total score ranges from 0 to 112 points, and subscale scores range from 0 to 16 points.
Sum total
  • 7 subscale scores are calculated: visual discrimination, visual memory, visual–spatial relationships, visual form constancy, visual sequential memory, visual figure–ground, and visual closure.
  • • Answer sheet
  • • Test manual
  • • Book of item plates
  • • Total raw score and subscale scores
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Weekly Calendar Planning Activity (WCPA; Toglia & Berg, 2013; Weiner, Toglia, & Berg, 2012)Cognitive–behavioral and ecological practice models
  • Population: Adolescents and adults age 16 and older.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To measure everyday executive function skills of adolescents and adults.
  • • 18 appointments are presented in a randomly ordered list.
  • • The participant is required to enter the appointments into a 1-wk schedule while recognizing and managing conflicts and adhering to 5 written rules.
  • • The rules include ( 1) leave Wednesday free, (2) do not cross out appointments once they are entered, (3) inform the examiner when it is a specified time, (4) do not respond to distracting questions from the examiner, and (5) inform the examiner when finished.
  • • Strategies used during the task are recorded on a list of 16 preidentified strategies.
  • • Strategies used during the task are recorded on a list of 16 preidentified strategies.
  • • Scores calculated include total accuracy of appointment placement on the calendar, errors made in appointment placement, planning time and total task time, number of rules followed, and type of strategies used.
  • • Total accuracy of appointment placement on the calendar
  • • Total errors made in appointment placement
  • • Self-report errors
  • • Inaccuracy errors
  • • Repetition errors
  • • Planning time
  • • Total task time
  • • Number of rules followed
  • • Number of strategies used
  • • Type of strategies used
  • • Paper
  • • Pencil
  • • WCPA pro forma
  • • WCPA test manual
  • • WCPA test booklet
  • • Table, chair, and quiet room for test taker
  • • Total accuracy of appointment placement on the calendar
  • • Total errors made in appointment placement
  • • Self-report errors
  • • Inaccuracy errors
  • • Repetition errors
  • • Planning time
  • • Total task time
  • • Number of rules followed
  • • Number of strategies used
  • • Type of strategies used
Table Footer NoteNote. DCD = developmental coordination disorder; ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2007); PEO = Person–Environment–Occupation model.
Note. DCD = developmental coordination disorder; ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2007); PEO = Person–Environment–Occupation model.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 2). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 2). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
Table 2.
Summary of Instruments for Children and Youth Described in Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013
Summary of Instruments for Children and Youth Described in Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Instrument (Article)Frame of Reference/Theoretical or Practice ModelPopulation/Group; Perspective; Purpose, Use, or Intent of InstrumentDescription of InstrumentAdministration and Scoring Time RequiredSubscales or Item CategoriesResources and Equipment RequiredScores and Results Obtained
Adolescents and Adults Coordination Questionnaire (AAC–Q; Saban, Ornoy, Grotto, & Parush, 2012) Motor Control and ICF, Body Functions and Structures
  • Population: Adolescents and young adults between ages 16 and 35.
  • Perspective: Self-report.
  • Purpose: To identify and investigate DCD in adolescents and adults age ≤35 yr; the AAC–Q can enable a greater understanding of how DCD influences participation and function in daily life activities, information that may guide the development of more effective intervention programs for this group.
  • Consists of 12 items, which include basic and instrumental activities of daily living, organizational skills, spatial and temporal orientation, activities requiring fine motor function, activities requiring gross motor function, and writing.
  • • Respondents are asked to respond using a 5-point Likert frequency scale.
  • • Takes <10 min to complete.
  • • Final score ranges from 12 to 60, with lower scores indicating better motor coordination function.
  • • Single composite score is calculated.
  • • Questionnaire
  • • Pen or pencil
Total score ranges from 12 to 60.
Assessment of Children’s Hand Skills (ACHS; Chien, Brown & McDonald, 2010)Ecological and top-down assessment
  • Population: Children ages 2–12 yr.
  • Perspective: Observation based; professional scores performance on the basis of specific criteria.
  • Purpose: To evaluate how effectively children use their hands when engaged in meaningful occupations and to analyze and rate children’s actual hand skill performance in their relevant environments.
Assesses children’s hand use in naturalistic settings via observational rating scale.
  • • The ACHS research version consists of 20 hand skill items rated on a 6-point rating scale.
  • • A score of 6 indicates very effective hand skill performance, whereas a score of 1 indicates very ineffective hand skill performance.
Children’s hand skills are divided into 6 distinct categories: manual gesture, body-contact hand skills, adaptive skilled hand use, arm–hand use, bimanual use, and general activities.
  • • Assessment booklet
  • • Naturalistic environment
  • • Pencil
Composite scores and subscale scores for the 6 hand skill categories are generated.
Assessment of Motor and Process Skills (AMPS; Gantschnig, Page, Nilsson, & Fisher, 2013)
  • Model of Human Occupation and occupational performance
  • Population: Children with typical development or mild disabilities ages 4–15 yr.
  • Perspective: Therapist or clinician administered and scored.
  • Purpose: To differentiate and measure the motor and processing skills of children with and without disabilities during ADL tasks.
Internationally standardized observational assessment of activities of daily living in which the child is rated on 16 motor and 20 processing ADL items.Takes approximately 1 hr to administer.Computer-generated results
  • • Test manual
  • • Scoring sheets
Scores for motor and processing skills
Ayres Sensory Integration (ASI) Fidelity Measure (Parham et al., 2011)Sensory integration theory
  • Population: Not applicable.
  • Perspective: Third-party raters, who complete Fidelity Measure to investigate whether service provided on the basis of sensory integration principles aligns with theoretical principles.
  • Purpose: To document whether interventions carried out are in accordance with the essential procedural aspects of ASI intervention, to monitor replicable ASI intervention delivery in research such as randomized clinical trials, and to differentiate between ASI and other types of intervention.
  • • Addresses the key structural and process elements of ASI intervention.
  • • Parts 1–4 measure the structural elements.
  • • Part 5 measures therapist adherence to 10 process elements (e.g., tailors activity to present just-right challenge).
  • • Scoring involves subjectivity.
  • • Scored on a 4-point Likert scale.
  • • A total Fidelity score of 100 equals a perfect match to ASI intervention strategies.
  • • Total Fidelity score of 80 was designated as the tentative cutpoint for determining whether an observed intervention session adhered to ASI therapeutic principles.
Total summed raw score
  • • Training
  • • Pen
Total Fidelity score
Box and Block Test (Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen, 2013)Biomedical framework; ICF: Body Structure and Function and Activity
  • Population: Children ages 3–10 yr with differences in hand function.
  • Perspective: Child completes timed test; therapist- or clinician-administered and scored on the basis of specific criteria.
  • Purpose: To provide performance score on normed standardized test of gross manual dexterity.
Standardized and specifically measured set of boxes that fit inside each other.Time to administer varies—longer for younger children (≤30 min)Raw scores converted to standard scores. Each is hand scored separately.
  • • Box with partition
  • • Blocks
  • • Timer
  • • Scoring forms
Standard scores
Child Occupational Self Assessment (COSA; Kramer, Kielhofner, & Smith, 2010)Model of Human Occupation
  • Population: Children with disabilities ages 6–17 yr.
  • Perspective: Self-report (child-friendly rating scale).
  • Purpose: Self-report of occupational competence and value for everyday activities designed to involve children in identifying goals and assessing outcomes; measures the extent to which children feel they competently meet expectations and responsibilities associated with activities and the relative value of those activities.
Consists of a series of 25 items that represent a range of everyday activities that most children encounter at home, at school, and in their communities.
  • • Can be administered in 1 of 3 ways: (1) standard paper-and-pencil format that provides different visual cues for each rating category description, (2) card-sort version that places each item on a separate card and each rating category (and visual cue) on a larger rating card, and (3) summary form that presents all items and rating categories in a matrix format without visual cues.
  • • Takes approximately 30 min to complete.
  • • Each item is rated using two 4-point rating scales: Occupational Competence scale and Values scale.
COSA rating scale converted to 1–4 for data entry and delivered to database for analysis (in the study described). Use by clinicians, including scoring, not described.
  • • Assessment
  • • Manual
  • • Training in administration
List of activities that the child feels less competent doing but for which he or she indicates high importance; these activities can be addressed in therapy.
Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)PEO model and ICF
  • Population: Children with and without disability ages 6–18 yr.
  • Perspective: Self-report of child’s perception; can include third-party parent assistance.
  • Purpose: Self-rated measure that estimates a child’s participation outside of school; children complete the assessment independently or supported by an adult through adaptations.
  • Booklet and score sheet format for self-selection of response that most represents child’s perspective
• 30–60 min to administer and score
  • • Consists of 55 items related to participation (46 of these are recreational)
  • • Provides information about 5 dimensions of participation: intensity, social aspect, location, child’s degree of enjoyment in the activity, and preference
  • • Pen
  • • Assessment
  • • Manual
Raw scores within dimensions
Occupational Therapy Practice Framework (2nd ed.; AOTA, 2008), occupational performance
  • Population: Children and adolescents.
  • Perspective: Self-report.
  • Purpose: To measure multidimensional participation in children’s and adolescents’ leisure activities; designed to document children’s perceptions about their time investment in leisure activities and their ambitions regarding certain activities that they would like to undertake but have not for a variety of reasons.
Consists of 30 items under 4 factors: (1) instrumental indoor activities, (2) outdoor activities, (3) self-enriched activities, and (4) games and sports activities, which relate to 6 dimensions of leisure participation: variety, frequency, sociability, preference, time consumption, and desired activities.
  • The dimensions of participation are scored:
  • Variety: sum score of participation in activities (0 = not doing the activity at all, 1= doing the activity)
  • Frequency: measured on a 4-point Likert-type scale (1 = once in a few months, 2 = once a month, 3 = twice a week, and 4 = every day)
  • Sociability: defined by who performed the activity with the child, rated on a 4-point Likert-type scale (1 = alone, 2 = with a relative, 3 = with one friend, and 4 = with friends)
  • Preference: rated on a 10-point scale ranging from 1 (do not like at all) to 10 (like very much)
• Consists of 30 items under 4 factors: (1) instrumental indoor activities, (2) outdoor activities, (3) self-enriched activities, and (4) games and sports activities.
  • • Manual
  • • Assessment
  • • Scoring sheet
  • • Pen
Allows evaluation of leisure activities among typically developing children and adolescents.
Proprioception and sensory integration theory, motor control, ICF
  • Population: Children age ≥2 yr with suspected proprioceptive processing difficulties.
  • Perspective: Observational assessment; the COP guides clinical observations and helps the clinician identify adequate performance and deviation from typical parameters using defined criteria; professional scores performance on the basis of specific criteria.
  • Purpose: To measure proprioceptive processing in children.
  • • Contains 18 items focusing on motor and behavior regulation aspects of proprioceptive processing in children.
  • • Measures 4 factors: (1) tone and joint alignment, (2) behavior manifestations, (3) postural motor, and (4) motor planning.
  • • Can be used in a variety of contexts, such as the home, clinic, and school.
Takes 15 min to administer; therapist observes child and rates the COP items.Measures 4 factors: (1) tone and joint alignment, (2) behavior manifestations, (3) postural motor, and (4) motor planning.Copy of scale and place to observe childTotal COP score plus 4 factor scores
Developmental Test of Visual–Motor Integration (VMI; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 2–17 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Visual–motor screening tool to identify children who are experiencing difficulty coordinating visual perception and motor movements; has 2 supplement standardized tests: VMI Visual Perception and VMI Motor Coordination. Can be administered individually or in a group.
Consists of 27 geometric forms to be copied and organized in developmental sequence.• Administration takes approximately 15 min, and scoring time is approximately 10 min.Total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Do-Eat (Josman, Goffer, & Rosenblum, 2010)Ecological practice model, PEO model, Occupational Therapy Practice Framework (2nd ed.)
  • Population: Children with DCD.
  • Perspective: Therapist observation and parent or third-party questionnaire.
  • Purpose: To evaluate daily task performance abilities among children with DCD; assists with establishing customized goals and objectives for intervention.
  • Ecologically valid assessment; focuses on food preparation, drawing, writing, and cutting.
  • • Child is asked to perform 3 tasks: (1) Make a sandwich, (2) prepare chocolate milk, and (3) fill out a certificate of outstanding performance for him- or herself.
  • • See Appendix 1 of article for assessment.
  • • Accompanying parental questionnaire consists of 12 positive statements.
  • Assessment is administered in natural surroundings (e.g., kindergarten, family kitchen).
  • • Scoring is sum totaled.
  • • Throughout performance, child receives score for performing the task, analysis score for sensory–motor skills, and analysis score for executive functioning.
  • • Test scores range from 1 (unsatisfactory performance) to 5 (very good performance).
  • • Accompanying parental questionnaire scored on scale ranging from 1 (never) to 5 (always).
  • • Overall task performance score is calculated.
  • • Overall score analyzing sensory–motor skills and executive functioning.
  • • Test includes summary score sheets including scores discussed in preceding bullets and parental questionnaire score.
  • • Score for performing the task
  • • Analysis score for sensory–motor skills
  • • Analysis score for executive functioning
  • • Parental questionnaire score
  • • Assessment
  • • Manual
  • • Ingredients for tasks
  • • Certificate that child fills out
  • • Score card
  • • Overall task performance score
  • • Overall score analyzing sensory–motor skills and overall score analyzing executive functioning
  • • Summary test score sheets including scores in previous bullet and parental questionnaire score
Evaluation of Social Interaction (ESI; Griswold & Townsend, 2012)Model of Human Occupation
  • Population: Children ages 2–12 yr with and without a disability.
  • Perspective: Performance-based assessment gained through observation (verbal and nonverbal behaviors); professional scores performance on the basis of specific criteria.
  • Purpose: To assess the quality of social interaction in children as a baseline to measure change in social interaction performance; enables occupational therapist to plan interventions to address specific social interaction skill deficits for children during activities in natural contexts.
  • Social interaction performance is scored on 27 skills that relate to initiating and ending a social interaction, producing the interaction, physically supporting the interaction, shaping the content and maintaining the flow of the interaction, verbally supporting the interaction, and adapting to problems that might arise during the interaction.
  • • 27 skills are scored on 4-point criterion-referenced rating scale.
  • • Scores are placed in ESI software, which generates a measure of the quality of social interaction.
  • • Social interactions are categorized by their intended purpose.
  • • Categories: gathering information, sharing information, problem solving or decision making, collaborating or producing, acquiring goods and services, conversing socially or making small talk
Natural environment to observe child (school, home, kindergarten, park, etc.)
  • • Measure of the quality of social interaction (objective measure): baseline to measure change in social interaction performance
  • • Raw scores converted to logits
Evaluation Tool of Children’s Handwriting (ETCH; Brossard-Racine, Mazer, Julien, & Majnemer, 2012; Duff & Goyen, 2010)PEO model, occupational performance, and Occupational Therapy Practice Framework (2nd ed.)
  • Population: School-age children.
  • Perspective: Professional scores performance on the basis of specific criteria.
  • Purpose: Standardized measure that assesses a range of handwriting tasks similar to those experienced in the classroom setting; designed to identify and characterize handwriting difficulties in young school-age children.
  • • The ETCH is available in both manuscript and cursive versions.
  • • The Manuscript version of the ETCH (ETCH–M) targets children in Grades 1–3 and examines legibility through 7 different tasks: alphabet, writing from memory (upper- and lowercase), numeral writing from memory, near-point copying, far-point copying, dictation of non-words and numbers, and composition of a short sentence.
  • • Takes approximately 30 min to administer.
  • • Letters, numerals, and words are judged for legibility using a list of specific criteria such as omission, closing, misplacing, reversion, and poor erasure.
  • • The percentage of legibility is determined for each task by counting the legible letters, numerals, or words and dividing by the total number of letters, numerals, or words required.
  • • The percentages from each task are then averaged to provide a total legibility score for letters, numerals, and words.
  • • Performance time or writing speed is measured in seconds for the alphabet and numeral writing tasks and in letters per minute for the copying and composition tasks.
Sum total
  • • Assessment
  • • Manual
  • • Pen or pencil
  • • Total legibility score (for word and letter)
  • • Performance time and writing speed score
Family L.I.F.E. (Looking Into Family Experiences; Honaker, Rosello, & Candler, 2012)
  • Occupational adaptation practice model and Occupational Therapy Practice Framework (2nd ed.)
  • Population: Families with a child with autism spectrum disorder.
  • Perspective: Self-report by family.
  • Purpose: Occupation-based assessment that engages families and therapists in a collaborative partnership to identify unique and relevant family occupations, evaluate these occupations, and measure perceived success in these occupations.
  • • Assessment includes demographic section and a time diary of a typical weekday and a typical weekend day (helps to identify routines and rituals).
  • • 8 interview questions focus on family togetherness, child rearing, and impact on family occupations.
  • • Likert scale is used to rate each occupation on perceived effectiveness, efficiency, and satisfaction.
  • • The sum of the scores is tallied for each factor and divided by the number of occupations to achieve a separate overall score.
Sum total to give overall score
  • • Assessment
  • • Manual
Overall score
Health Promoting Activities Scale (HPAS; Bourke-Taylor, Law, Howie, & Pallant, 2012)PEO model, ecological practice model
  • Population: Initially developed for mothers of children with a disability.
  • Perspective: Self-report instrument.
  • Purpose: To measure the frequency of participation in healthy occupations that are associated with mental health and well-being.
  • • 8 items with activity key for participants to consider their self-selected occupations
  • • Response items are rated on a 7-point scale ranging from daily to never.
Sum totalSingle composite scoreFreely available brief scaleTotal score
Life Participation for Parents (Fingerhut, 2013)Occupational adaptation practice model, family-centered practice
  • Population: Parents of children with a disability.
  • Perspective: Self-report of parent.
  • Purpose: To facilitate family-centered pediatric practice by measuring the ability of parents to participate in life occupations while raising a child with special needs.
Contains 22 questions asking parents about their ability to participate.
  • • The questions are answered on a 5-point Likert scale ranging from strongly agree to strongly disagree, with a lower score indicating less satisfaction with occupational participation.
  • • Reverse scoring of positively worded questions
Total Stress score and subscale scores: Satisfaction With Efficiency and Satisfaction With Effectiveness
  • • Assessment
  • • Pen
Scores sum totaled: overall and 2 subscales
Manual Ability Classification System (Kuijper, van der Wilden, Ketelaar, & Gorter, 2010)ICF: Body Structures and Functions and Activity
  • Population: Children ages 5–14 yr with cerebral palsy (CP).
  • Perspective: Third party—either parent or professional who knows the child’s performance.
  • Purpose: Classification system with 5 levels pertaining to defined use of the hands by children with CP.
  • The classification system has a decision tree to guide the scorer (occupational therapist or physician). Focuses on the way children with CP use both of their hands when handling objects in daily age-appropriate activities.
  • • Has 5 classification system levels: (1) Handles objects easily and successfully; (2) handles most objects with somewhat reduced quality and speed of achievement; (3) handles objects with difficulty, needs help to prepare or modify activities; (4) handles a limited selection of easily managed objects in adapted situations; and (5) does not handle objects and has severely limited ability to perform even simple actions.
  • • The scale is ordinal, and the distances between levels are not considered equal.
Hand use is classified at 1 of the 5 levels by skilled observer.Obtain classification score for 1 of 5 levels.
  • • Manual and score sheets can be downloaded from http://www.macs.nu/
  • • Available in multiple languages.
  • • The assessment requires no special training for occupational therapists and physicians.
Obtain classification score for 1 of 5 levels regarding hand function for children with CP
  • McDonald Play Inventory
  • (MPI): McDonald Play Activity Inventory (MPAI) and McDonald Play Style Inventory (MPSI; McDonald & Vigen, 2012)
PEO and Occupational Performance models
  • Population: Children ages 7–11 yr.
  • Perspective: Self-report (child) or third party, and including parental report.
  • Purpose: Two-part child self-rated scale of play.
  • • Made up of 2 parts: (1) the MPAI, which measures the child’s perceived frequency of engagement in 4 categories that form 4 subscales (Fine Motor, Gross Motor, Social Group, Solitary), and (2) the MPSI, which measures the types and frequency of play behaviors (affective component) in 4 domains: physical coordination, cooperation, peer acceptance, and social participation.
  • • MPSI consists of 24 play behavior items (6 items in each category), 12 neutral play activity items, and 4 “lie” or social desirability items.
  • • MPAI: Rate the frequency of participation in activity on 5-point Likert-scale (never, about once or twice a year, about once or twice a month, about once or twice a week, or almost every day).
  • • MPSI: Rate responses on 5-point Likert scale (never, hardly ever, sometimes, a lot, and always)
  • • Administration time: 15 min without assistance, 20–30 min with assistance
MPI is composed of two parts: MPAI and MPSI.
  • • Assessment
  • • Manual
  • • Pen
  • • Total score
  • • Subscale scores
ICF: Body Structures and Functions and Activity
  • Population: Children with neurological impairments ages 5–15 yr.
  • Perspective: Performance based or third party.
  • Purpose: Criterion-referenced assessment to measure quality of upper-limb movement in children with a neurological impairment; measures 1 hand at a time. Widely used to examine the effectiveness of specific interventions.
  • • Contains 16 items that examine the child’s performance on tasks.
  • • Individual items are scored under 4 categories: (1) range of movement, (2) target accuracy, (3) fluency, and (4) quality of movement.
  • • Individual items are scored under 4 categories.
  • • Each item is scored on a scale of either 0–3 or 0–4 (the manual provides a detailed description of what is required for each score).
Total raw scores are converted to percentages.
  • • Training session for scoring, although skill level of trainer is unknown
  • • Manual
  • • Total percentage score
  • • Designed to evaluate change over time
Motor-Free Visual Perception Test–Revised (MVPT–R; Tsai, Lin, Liao, & Hsieh, 2009)Perceptual–motor theory
  • Population: Children ages 4–12 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess children’s visual–perceptual strengths and weaknesses.
  • Consists of 40 items divided into spatial relationships, visual memory, visual discrimination, figure ground, and visual closure.
  • • Total score ranges from 0 to 40 points.
  • • Items are either right or wrong.
  • • The whole scale is administered to candidate.
One total summed score is calculated.
  • • Answer sheet
  • • Test manual
  • • Book of item plates
  • • Total raw scale score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Occupational Self Assessment (OSA; Taylor, Lee, Kramer, Shirashi, & Kielhofner, 2011)Model of Human Occupation
  • Population: Can be used with adolescents and adults.
  • Perspective: Self-report.
  • Purpose: Client-centered evaluation tool that measures clients’ perceptions of their own competence and the value they assign to occupations.
Clients rate their competence in and importance of everyday activities for 21 items; the client chooses 4 items that he or she would like to change.Takes approximately 30 min to complete and 15 min to score.Scores are calculated for 21 questions and 2 subscales, Competence and Values.
  • • Scoring sheets
  • • Pencil
• Summary scores for items; also provides scores for 2 subscales, Competence and Values
Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI–CAT; Kao, Kramer, Liljenquist, Tian, & Coster, 2012)ICF
  • Population: Children and young people with a disability through age 21 yr.
  • Perspective: Judgment-based, standardized instrument using parental reports or structured interview with professional who knows the child.
  • Purpose: To evaluate the child’s capability in the social–cognitive, daily activities, mobility, and responsibility domains.
  • • Consists of the following domains: daily activities (68 items), social-cognitive (60 items), and responsibility (51 items).
  • • Also measures environmental supports and modifications that the child needs to complete activities.
Sum total; raw scores are transformed into scaled scores for each domain.Raw scores that are transformed into scaled scoresComputer databaseScaled scores provide an indication of a child’s performance on relatively easy to relatively difficult items in a particular domain.
Pediatric Outcomes Data Collection Instrument (PODCI; Mulcahey et al., 2013)
  • Functional outcome measurement; ICF : Body Structures and Functions and Activity
  • Population: Children and adolescents ages 4–21 yr.
  • Perspective: Therapist or clinician administered and scored; professional scores performance on the basis of specific criteria.
  • Purpose: To provide an outcome measure for the upper-extremity and activity items of the PODCI when applied to brachial plexus injury.
The PODCI consists of 52 final Upper Extremity items and 34 Activity items.Takes approximately 1 hr to administer.
  • Scales include upper extremity and physical function, transfer and basic mobility, sports/physical function, pain/comfort, treatment expectations, happiness, satisfaction with symptoms, and global functioning.
  • • Computer
  • • Computer adaptive test program
  • • Scale items that the CAT runs through with respondent
Scores for the Upper Extremity and Activity subscales
Preschool Imitation and Praxis Scale (PIPS; Vanvuchelen, Roeyers, & De Weerdt, 2011)
  • Play theory, Occupational Performance of Children model, and PEO practice models
  • Population: Preschool children ages 1–5 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess the accuracy of bodily procedural imitation performance in young children
  • • Consists of 10 task categories (6 gestural, 3 procedural, and 1 facial) and 30 PIPS tasks.
  • • Performance is scored on a 3- or 5-point scale.
  • • Sum total
  • • Final PIPS score is a reflection of the accuracy of the child’s imitation performance.
  • • Administration takes 10–20 min.
The 30 tasks are divided into 10 task categories.
  • • PIPS manual
  • • PIPS assessment
  • • Pen to score
  • • Items in assessment: toy bear, wooden block, toy animal with lamp in it, box, cup, doll, toy car, bed, blanket
Total score
Quality of Life in School Version 2 (QoLS; Weintraub & Bar-Haim Erez, 2009)Biopsychosocial model and PEO model
  • Population: School-age children.
  • Perspective: Self-report.
  • Purpose: Self-rated measure evaluating student’s school quality of life from a multidimensional perspective.
Consists of 36 items divided into 4 categories: (1) teacher–student relationship and school activities (12 items), (2) physical environment of school and classroom (11 items), (3) negative feelings toward school (8 items), and (4) positive feelings toward school (5 items).Gain score for each category and total school36 items divided into 4 categories
  • • Training in assessment administration
  • • Assessment
  • • Manual
  • • Pen
Raw score for each category and total score
School Function Assessment (SFA; Hwang & Davies, 2009)Ecological assessment, functional assessment, application of Rasch measurement model
  • Population: School-age children.
  • Perspective: Third party; teacher observes the student and provides ratings on the basis of observation.
  • Purpose: Criterion-referenced assessment that measures a wide spectrum of school-related functional tasks associated with the role of elementary school child; guides program planning for students with special needs.
Consists of 18 scales made up of 266 items.Scored on a 4-point rating scale (1 = does not perform, 4 = consistent performance)Activity Performance scale consists of 18 scales made up of 266 items
  • • Manual
  • • Assessment
  • • Pen
Total score
School Version of the Assessment of Motor and Process Skills (School AMPS; Munkholm, Berg, Löfgren, & Fisher, 2010)Model of Human Occupation
  • Population: Children ages 3–13 yr attending an educational program or school.
  • Perspective: Third party; discussion with teacher and performance-based observation of child completing 2 tasks in an education or classroom context; professional scores performance on the basis of specific criteria.
  • Purpose: Functional assessment for measuring the quality of schoolwork task performance as it is observed in the natural classroom setting.
Consists of 26 schoolwork tasks plus 16 school motor and 20 school process skill items. Tasks range from simple to complex: pen-writing tasks, pencil-writing tasks, drawing, coloring tasks, cutting and pasting tasks, computer writing tasks, math, and manipulative tasks.
  • • Therapist unobtrusively observes students in their natural classroom environment.
  • • Therapist scores the quality of observed performance using the scoring criteria for the 16 school motor and 20 school process skill items on a 4-point rating scale.
• 2 linear graphs represent the quality of schoolwork performance measures: (1) school motor quality of performance and (2) school process quality of performance.
  • • Formal training in administration
  • • Paper, pen
  • • Computer and program
  • • Manual
Two schoolwork performance measures: (1) school motor quality of performance and (2) school process quality of performance
Sense and Self-Regulation Checklist (SSRC; Silva & Schalock, 2012)Behavioral self-regulation and sensory processing paradigm
  • Population: Children age <6 yr with developmental delay.
  • Perspective: Third party— parent or caregiver.
  • Purpose: To identify areas of sensory and self-regulation difficulty to assess the child’s response to treatment.
  • • Measures 2 domains: sensory difficulties and self-regulation.
  • • Sensory difficulties domain has 6 subdomains: touch–pain, auditory, visual, taste–smell, hyperreactive to noninjurious stimuli, and hyporeactive to noninjurious stimuli (additional category created: abnormal touch–pain).
  • • Self-regulation domain has 6 categories: sleep, appetite–digestion, self-soothing, orientation–attention, aggressive behavior, and self-injurious behavior.
• Scored on a 4-point rating scale: 0 (never), 1 (rarely), 2 (sometimes), and 3 (often)Sum totalCaregivers must have elementary school education and read English, Spanish, or Chinese.Two domain scores (1 for sensory and 1 for self-regulation)
Sensory Experiences Questionnaire (SEQ; Little et al., 2011)Sensory processing model
  • Population: Children ages 7–72 mo with suspected autism and related developmental disorders.
  • Perspective: Parent or caregiver report.
  • Purpose: Brief caregiver questionnaire for young children with suspected autism and developmental delays; used to identify sensory processing patterns (hypo- and hyperresponsiveness) in the context of daily activities. It is designed to be used as a supplement to diagnostic and developmental assessments.
  • • Brief (10–15 min) caregiver report
  • • Yields 4 dimensional subscale scores as well as a total score.
  • • Items reflect 5 sensory domains: tactile, auditory, visual, vestibular–proprioceptive, and gustatory–olfactory.
  • • Contains qualitative questions regarding parent compensatory strategies used in response to the sensory processing problems experienced by the child.
  • • Takes 10–15 min to complete.
  • • Caregiver responses are based on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always).
  • • Higher scores indicate more sensory processing problems.
Total score and 4 subscale scores (hyperresponsiveness, hyporesponsiveness, social, and nonsocial)
  • • Assessment form
  • • Pen
Raw total score and 4 subscale scores
Sensory Profile Caregiver Questionnaire (SPCQ; Ohl et al., 2012)Dunn’s Model of Sensory Processing
  • Population: Children ages 3–12 yr.
  • Perspective: Third party: parent report or caregiver questionnaire.
  • Purpose: To provide information about children’s tendencies to respond to stimuli and which sensory systems are likely contributing or creating barriers to functional performance.
  • Sensory Profile contains >125 items organized into 3 sections: (1) sensory processing, which contains 6 item categories that measure children’s responses to information taken in through the sensory systems; (2) modulation, which contains 5 item categories that measure children’s ability to monitor and regulate information to generate an appropriate response to the situation; and (3) behavioral and emotional responses, which contains 3 item categories that measure children’s emotional and behavioral responses to sensory experiences.
  • • Need manual for scoring guidelines.
  • • Caregivers record the frequency with which their child displays each item behavior on a 5-point Likert scale (1 = always, 2 = frequently, 3 = occasionally, 4 = seldom, 5 = never).
  • • Responses are totaled on a Summary Score Sheet that yields 2 scores: section score and factor score.
  • • Section score, which provides a visual summary of children’s sensory processing, modulation, and behavioral and emotional response abilities
  • • Factor score, which captures children’s responses to sensory experiences on the basis of not solely their sensory systems but also other aspects of sensory processing
  • • Quadrant score, which measures the degree to which children miss, obtain, detect, or are bothered by sensory input
  • • Manual
  • • Assessment sheets
  • • Summary score
  • • Sheet
  • • Pen
Section, factor, and quadrant scores
Slosson Visual Motor Performance Test (SVMPT; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 4–18 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Screening tool to identify people with visual–motor perceptual problems in which hand–eye coordination is involved; measures a person’s ability to interpret and translate visually perceived geometric patterns.
Consists of 14 geometric figures; each is copied 3 times.Administration takes approximately 20 min, and scoring time is approximately 10 min.One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual–Motor Integration (TVMI; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 4–17 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Standardized norm-referenced test of visual–motor integration; used to document presence and degree of visual–motor difficulties in children.
  • • Consists of 30 geometric figures.
  • • Uses a copying format whereby children copy figure into designated space.
Administration takes approximately 20 min, and scoring time is approximately 10 min.One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual-Motor Skills–Revised (TVMS–R; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 3–13 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Assesses children’s ability to translate, with their hands, what they visually perceive to gain an understanding of the children’s strengths and weaknesses in visual–motor integration abilities.
  • • Consists of 23 geometric figures.
  • • Uses a copying format whereby children copy figure into designated space.
  • • Administration takes approximately 20 min, and scoring time is approximately 10 min.
  • • When scoring, it allows therapist to categorize a child’s visual–motor errors and accuracies.
One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual–Perceptual Skills–Revised (TVPS–R; Tsai, Lin, Liao, & Hsieh, 2009)Perceptual–motor theory
  • Population: Children ages 4–12 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess children’s visual–perceptual strengths and weaknesses.
  • • Consists of 112 items grouped into 7 subscales.
  • • Total score ranges from 0 to 112 points, and subscale scores range from 0 to 16 points.
Sum total
  • 7 subscale scores are calculated: visual discrimination, visual memory, visual–spatial relationships, visual form constancy, visual sequential memory, visual figure–ground, and visual closure.
  • • Answer sheet
  • • Test manual
  • • Book of item plates
  • • Total raw score and subscale scores
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Weekly Calendar Planning Activity (WCPA; Toglia & Berg, 2013; Weiner, Toglia, & Berg, 2012)Cognitive–behavioral and ecological practice models
  • Population: Adolescents and adults age 16 and older.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To measure everyday executive function skills of adolescents and adults.
  • • 18 appointments are presented in a randomly ordered list.
  • • The participant is required to enter the appointments into a 1-wk schedule while recognizing and managing conflicts and adhering to 5 written rules.
  • • The rules include ( 1) leave Wednesday free, (2) do not cross out appointments once they are entered, (3) inform the examiner when it is a specified time, (4) do not respond to distracting questions from the examiner, and (5) inform the examiner when finished.
  • • Strategies used during the task are recorded on a list of 16 preidentified strategies.
  • • Strategies used during the task are recorded on a list of 16 preidentified strategies.
  • • Scores calculated include total accuracy of appointment placement on the calendar, errors made in appointment placement, planning time and total task time, number of rules followed, and type of strategies used.
  • • Total accuracy of appointment placement on the calendar
  • • Total errors made in appointment placement
  • • Self-report errors
  • • Inaccuracy errors
  • • Repetition errors
  • • Planning time
  • • Total task time
  • • Number of rules followed
  • • Number of strategies used
  • • Type of strategies used
  • • Paper
  • • Pencil
  • • WCPA pro forma
  • • WCPA test manual
  • • WCPA test booklet
  • • Table, chair, and quiet room for test taker
  • • Total accuracy of appointment placement on the calendar
  • • Total errors made in appointment placement
  • • Self-report errors
  • • Inaccuracy errors
  • • Repetition errors
  • • Planning time
  • • Total task time
  • • Number of rules followed
  • • Number of strategies used
  • • Type of strategies used
Table Footer NoteNote. DCD = developmental coordination disorder; ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2007); PEO = Person–Environment–Occupation model.
Note. DCD = developmental coordination disorder; ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2007); PEO = Person–Environment–Occupation model.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 2). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 2). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
×
Table 3.
Critique of Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013
Critique of Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Instrument and AuthorPurpose of Instrument and PracticalityLevel of Evidence and Stage of Instrument DevelopmentRelevance to Occupational Therapy PracticeRelevance to Occupational Therapy TheoryRelevance to Occupational Therapy ResearchLimitations of StudyStrengths of Study
Adolescents and Adults Coordination Questionnaire (AAC–Q; Saban, Ornoy, Grotto, & Parush, 2012)
  • Purpose: Descriptive and discriminative
  • Practicality: Self-report 12-item scale; very easy to administer and score
  • Level III
  • Stage 7: reliability assessment
Can assist as an initial screening tool for adolescents and adults suspected of having DCD.Scale can be used to assess theoretical assumptions of motor control theory and other related constructs.
  • • Can be used to investigate the prevalence of DCD in the adult population.
  • • Can be used to evaluate the effectiveness of interventions targeted at adults with DCD.
  • • Study completed in 1 geographic area so there may be bias in the results.
  • • Authors did not include copy of the scale in the published article.
  • • No construct validity regarding whether scale items load on a single DCD factor was reported.
  • • Preliminary psychometric properties of scale look promising.
  • • Provision of cutoff scores is helpful for clinical applications.
  • • Is brief, user friendly, and ecologically valid.
Assessment of Children’s Hand Skills (ACHS; Chien, Brown, & McDonald, 2010)
  • Purpose: Descriptive, discriminative, predictive, and potential for evaluative
  • Practicality: Have to purchase test booklets and manual; have to receive specialist training to administer and score instrument; need well-honed observation skills to be able to score instrument
  • Level III
  • Stage 7: reliability assessment
  • • Can be used to assess a comprehensive range of hand skills for use with different populations of children.
  • • Could be used as an outcome measure after a round of intervention has been provided.
  • • Uses naturalistic observation and fits with an occupation-centered assessment approach to provide occupational therapists with information about children’s hand skill performance in meaningful occupations that are completed in daily contexts.
  • • Is a top-down assessment tool that provides information about children’s activity performance.
Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Requires specialized training to administer and score.
  • • Not commercially available; have to contact author directly.
  • • Only preliminary psychometric data have been reported by its author; no external researchers have evaluated the instrument.
  • • Uses naturalistic observation and fits with an occupation-centered assessment approach to generate information about children’s hand skill assessment performance in meaningful occupations that are completed in daily contexts.
  • • Strong preliminary psychometric evidence about construct validity of instrument using Rasch analysis approach
Assessment of Motor and Process Skills (AMPS; Gantschnig, Page, Nilsson, & Fisher, 2013)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Specific qualification required to administer the AMPS with children for clinical or research purposes
  • Level III
  • Stages 8 and 10: reliability and validity study
Standardized assessment of motor and processing skills during functional tasks; provides clinical information about areas for goals and service direction.Good tool to investigate underpinnings of MOHO and for occupational performance when a child has motor or processing differences.May be very useful in research, particularly retrospective data analysis that investigates relationships between underlying skills and performance.Continued psychometric evaluation needed to determine sensitivity to change over time.Large centrally held AMPS database offers the possibility of numerous knowledge translation research opportunities.
Ayres Sensory Integration (ASI) Fidelity Measure (Parham et al., 2011)
  • Purpose: Discriminative and predictive
  • Practicality: Requires experienced and expert individual to rate features of therapy session to get accurate measures of fidelity to ASI principles covered
  • Level IV
  • Stage 3: content validity evaluation
Adherence to the ASI Fidelity Measure’s structural and process elements will increase the likelihood that interventions labeled ASI and provided by qualified therapists are faithful to ASI principles not only in research but also in education and practice.
  • The Fidelity Measure provides an international standard by which to determine
  • whether an intervention represents ASI, which ensures that the ASI model is applied correctly.
  • The Fidelity Measure provides an international standard by which to determine
  • whether an intervention represents ASI.
  • • Did not field test the ASI Fidelity Measure with novice clinicians.
  • • Did not investigate the construct validity of the ASI Fidelity Measure.
  • • Very experienced expert panel was engaged to establish the content validity of the ASI Fidelity Measure.
  • • Expert panel had international representation, which decreases risk of geographic bias.
Box and Block Test (Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen, 2013)
  • Purpose: Discriminative
  • Practicality: Requires manual and specific boxes, blocks, and scoring sheet; little training necessary
  • Level III
  • Stages 7 and 8: reliability and validity study
Standardized assessment of gross dominant and nondominant hand function that may easily be used for pretest–posttest.May be useful to investigate underpinnings of biomechanical model.May be used to investigate efficacy of biomedical or occupational therapy interventions and measure outcomes on 1 or both upper extremities.Continued psychometric evaluation needed to determine sensitivity to change over time.Norm-referenced, easily administered hand function tool that does relate to real-life functional hand use.
Child Occupational Self Assessment (COSA; Kramer, Kielhofner, & Smith, 2010)
  • Purpose: Descriptive and evaluative
  • Practicality: Can be administered in 1 of 3 ways: standard pencil and paper, card sort, and matrix format
  • Level III
  • Stages 7 and 8: reliability and validity study
  • • Child-centered and child-reported tool that measures extent to which child is meeting expectations and responsibilities in daily activities and the importance of those activities.
  • • Directs clinical intervention by identifying important activities that might be prioritized in therapy.
Sound tool that may be used in research that investigates underpinnings of MOHO or any PEO model.May be used to investigate efficacy of occupational therapy interventions from clients’ perspectives.
  • • Extend validity and reliability studies to include randomized sampling and standardized administration of the measure when data are collected from across cultures and world regions. Further validity studies might include and analyze data from the perspective of other child and environmental variables.
  • • Also requires evaluation of responsiveness to change.
MOHO-based assessment tool that measures child’s subjective experience of occupation in a psychometrically sound way for clinical or research purposes.
Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Child rates the intensity (frequency), social aspect, location, enjoyment, and preference for leisure and recreational pursuits. Easy to administer and score.
  • Level III
  • Stages 8 and 10: evaluation of the scale’s measurement properties by other than the scale’s authors
Very relevant to practice; provides child’s perspective about participation in home and community contexts.Useful in studies investigating theoretical underpinnings of occupational therapy theory (e.g., Canadian Model of Occupational Performance and Engagement, ICF).May be used as client-centered outcome measure.Continued psychometric evaluation needed to determine sensitivity to change over time.Good reliability and validity evidence reported.
Children’s Leisure Assessment Scale (CLASS; Rosenblum, Sachs, & Schreuer, 2010) 
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Easily administered tool to measure participation in leisure activities among children ages 10–18 yr.
  • Level III
  • Stages 7 and 8: reliability and validity study
May be used clinically to determine a leisure activity preference for young children without disability.May be useful to investigate relationship between childhood occupations and any PEO model.May be useful in research about childhood occupations, participation, and other child-related factors.Requires further evaluation to determine discriminant validity for children with and without disability, as well as sensitivity to change over time.Offers very descriptive preference and participation profile of children’s leisure preferences.
Comprehensive Observations of Proprioception (COP; Blanche, Bodison, Chang, & Reinoso, 2012)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Relatively easy to obtain and administer; takes 15 min of observing child in a naturalistic environment
  • Level III
  • Stage 8: validity and dimensionality assessment
Can be used to assess children’s proprioceptive processing skills.Derived from literature based on sensory integration.Could be used to evaluate the effectiveness of occupational therapy intervention programs or could be used to describe clinical features of children with suspected developmental delay or motor skill problems.
  • • Still in early stages of psychometric development and validation.
  • • No normative scores are available.
  • • Has not been evaluated or applied in studies by others than Blanche, Bodison, et al. (2012) .
  • • Blanche, Bodison, et al. have documented the phases and components of the development of the COP.
  • • Preliminary evidence of COP’s interrater reliability, face validity, content validity, construct validity, criterion validity, and factor structure has been reported.
Developmental Test of Visual–Motor Integration (VMI; Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Have to purchase test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs or to establish the visual–motor baseline skills of certain diagnostic groups of clients.
  • • Does not provide information about children’s occupational performance.
  • • Test booklets and manual have to be purchased, creating cost issue.
  • • Well established, with strong psychometric characteristics
  • • Test has been widely used.
  • • Large standardization group on which normative scores are based
Do-Eat (Josman, Goffer, & Rosenblum, 2010)
  • Purpose: Descriptive, discriminative, and predictive
  • Practicality: Child is required to participate in 3 tasks, with appropriate equipment and environment needed: making sandwich, making chocolate milk, and handwriting.
  • Level III
  • Stages 7 and 8: reliability and validity study
Offers capability to measure the functional abilities of children with DCD; also assists in goal development.Good tool to investigate underpinnings of functional skills and performance.Good application for research purposesContinued psychometric evaluation needed to determine sensitivity to change over time.Psychometrically and theoretically sound tool specific to children with DCD
Evaluation of Social Interaction (ESI; Griswold & Townsend, 2012)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: The evaluator (occupational therapist) observes the child as he or she engages in desired relevant activities in natural context with usual social partners.
  • Level III
  • Stage 8: validity assessment
  • • Clinically useful way to measure children’s social interactions in natural settings.
  • • Provides standardized way to measure differences in social interaction and measure change over time.
Can be used to evaluate underpinnings of social interactions and participation.Useful for occupational therapy research to evaluate underpinnings of social interactions and participation and for efficacy studies evaluating occupational therapy interventions.Test–retest and interrater reliability studies needed for pediatric population; sensitivity to change over time needs evaluation before validation as outcome measure.Good reliability and validity for pediatric population.
Evaluation Tool of Children’s Handwriting (ETCH; Brossard-Racine, Mazer, Julien, & Majnemer, 2012; Duff & Goyen, 2010)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: The evaluator observes and then rates a child’s handwriting using 1 of 2 handwriting versions: manuscript and cursive. Provides standardized before-and-after measure of handwriting competency.
  • Level III
  • Stages 8 and 10: validity assessment
Highly useful in pediatric occupational therapy practice in school and clinic settings.Specific handwriting legibility and functionality for children in elementary school.Can be used to evaluate the effectiveness of a handwriting intervention program or to differentiate between typical and atypical handwriting—determine need and eligibility for services.
  • • Requires sensitivity to change over time and randomized sampling.
  • • Might be used in efficacy studies to investigate efficacy and efficiency of occupational therapy interventions that aim to improve handwriting.
Good reliability and validity evidence reported.
Family L.I.F.E. (Looking Into Family Experiences; Honaker, Rosello, & Candler, 2012)
  • Purpose: Descriptive and discriminative
  • Practicality: Requires manual and therapist–family collaboration to identify 5 key family occupations and limiting factors
  • Level III
  • Stage 7: reliability assessment
Engages families and therapists in a collaborative partnership and promotes family-centered practice.Tool may be useful to evaluate the tenets of occupational adaptation or family-centered practice models.Useful research tool to identify subjective family issues pre- and postintervention.Further psychometric evaluation required for validation and reliability.Emphasizes clinical and research consideration of a very important factor in the support system available to a child with a disability: the family.
Health Promoting Activities Scale (HPAS; Bourke-Taylor, Law, Howie, & Pallant, 2012)
  • Level III
  • Stage 8: validity and dimensionality assessment
May be used in clinical practice in numerous contexts working with caregivers.Provides evidence about the associations among participation in meaningful self-selected leisure pursuits, mental health, and well-being.
  • • Psychometrically sound scale with low response burden that measures the person’s perspective.
  • • May be used as an outcome measure because scoring relates to the frequency of participation.
Initial study did not include secondary validation of diagnosis of mental health condition; did not include test–retest reliability or tests of sensitivity to change over time.Psychometrically sound at initial stages of development; novel measurement of complex and meaningful human occupation.
Life Participation for Parents (Fingerhut, 2013)
  • Purpose: Descriptive and evaluative
  • Practicality: Families with a child with a disability complete paper questionnaire about family occupations.
  • Level III
  • Stages 7 and 8: reliability and validity study
Clinically useful to facilitate family-centered service delivery; allows focus on strategies to improve satisfaction with occupational participationGood tool to investigate and evaluate family-centered practice, other theoretical frameworks (ICF, PEO, ecological approach)Useful tool for subjective family status when there is a child with a disability in the family.Continued psychometric evaluation needed to determine sensitivity to change over time.Psychometrically sound family-centered tool that could be used easily in both clinical practice and theory.
Loewenstein Occupational Therapy Cognitive Assessment (LOTCA; Josman, Abdallah, & Engel-Yeger, 2011)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Requires standardized kit and score sheets
  • Level III
  • Stages 8 and 10: evaluation of scale’s measurement properties by those other than authors
Clinical application for occupational therapists may include school readiness or use in other settings to determine eligibility or areas for interventions. May have feasibility as screening tool for school entry.May be useful to investigate relationships between cognition and occupational performance in daily occupations; supports numerous theoretical concepts in occupational therapy.May be used to investigate efficacy of occupational therapy interventions, although sensitivity to change has not been established among children.Further research is needed to establish validity in relation to cross-cultural studies, other child and sociodemographic factors, and actual functional performance in childhood occupation. Requires longitudinal predictive studies. Also, sensitivity to change across time requires investigation if to be used as an outcome measure.Standardized assessment of cognition for young children with capacity to differentiate among children with and without readiness to enter school and early school performance and other issues.
Manual Ability Classification System (MACS; Kuijper, van der Wilden, Ketelaar, & Gorter, 2010)
  • Purpose: Descriptive, discriminative, and predictive
  • Practicality: Involves therapists observing hand skills use and using decision-making tree to classify hand function. The manual is freely available.
  • Level III
  • Stages 8 and 10: validity study
Excellent clinical application to promote communication among children, families, and professionals and provides observational measure of hand function that may result in functional goal setting.May be used to investigate theoretical underpinnings of occupational therapy theory that uses a PEO approach.Application to research is good. Provides researchers with easily rated manual classification system alongside the widely used Gross Motor Function Classification System and more recent Communication Function Classification System.
  • • This particular study used correlational analysis for an ordinal classification scale and the PEDI caregiver scales (Part 2) rather than the PEDI functional skills scale (Part 1).
  • • The conclusion that the MACS is related to the performance of daily self-care skills is inappropriately drawn because PEDI Part 1 was not used in the study. Therefore, findings must be interpreted with caution.
The MACS has good reliability and validity and provides a functional classification to facilitate communication among people with cerebral palsy, families, and professionals.
McDonald Play Inventory (McDonald & Vigen, 2012)
  • Descriptive, discriminative, and evaluative
  • Practicality: Child self-report scale that requires minimal resources
  • Level III
  • Stages 7 and 8: reliability and validity assessment
Can be used to assess children presenting with play-related problems.Provides evidence about children’s self-reported perceptions about their play and play style.Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Convenience sample
  • • Limited psychometric data have been published about the scale.
  • • Assesses an important area of children’s occupational performance.
  • • Accesses children’s perspectives about their play.
  • • Promising psychometric data about the scale have been reported.
Melbourne Assessment of Unilateral Upper Limb Function (MAUULF; Spirtos, O’Mahony, & Malone, 2011)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Standardized kit required, as well as some informal training and preparation for administration and scoring.
  • Level III
  • Stages 7 and 10: evaluation of scale’s measurement properties by those other than authors
Standardized assessment of quality of functional movement for 1 upper extremity.Good tool for rigorous evaluation of quality of upper-limb movement for biomedical interventions as well as occupational therapy interventions.Useful for pre– and post–upper-extremity evaluation for various interventions for children with hemiplegia.Detailed training and instructions needed for clinicians to learn how reliably administer and score the MAUULF.Psychometrically sound upper-extremity test that precisely measures functional arm and hand movement.
Motor-Free Visual Perception Test–Revised (MVPT–R; Tsai, Lin, Liao, & Hsieh, 2009)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Fairly straightforward to administer and score
  • Level III
  • Stages 7 and 10: reliability assessment
Can be used to establish the baseline of a child’s visual–perceptual skills.Can be used to investigate the underpinnings of perceptual–motor theory.Can be used to establish the effectiveness of an intervention program or explore the links between visual–perceptual skills and children’s occupational performance.
  • • Small sample size.
  • • Data gathered in 1 geographic location.
  • • No link to occupational performance of children made.
  • • Answer sheets, test plate book, and test manual have to be purchased, creating cost issue.
  • • Provides evidence of the reliability properties of the MVPT–R.
  • • Is evidence of use of scale in a cross-cultural context.
Occupational Self Assessment (OSA; Taylor, Lee, Kramer, Shirashi, & Kielhofner, 2011)
  • Purpose: Descriptive and discriminative
  • Practicality: Self-report scale on which participants are asked to answer or rate 21 statements; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity assessment
Can be used with a variety of client groups, including those with mental health issues or physical disabilities or older adults.Derived from constructs related to the MOHO.Can be used to evaluate the intervention programs; can be used to operationalize constructs from the MOHO and can provide empirical evidence about the MOHO.
  • • Data were gathered from 1 geographical area.
  • • Convenience sampling was used.
  • • Good sample size to minimize chance of Type I error.
  • • Use of Item Response Theory provides further evidence of the scale’s construct validity.
Pediatric Outcomes Data Collection Instrument (Mulcahey et al., 2013)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Outcome measure designed for children with brachial plexus injury that is administered via computer adaptive test
  • Level III
  • Stages 7 and 8: reliability and validity assessment
Can be used to assess the upper-extremity function of children presenting with brachial plexus injuries.Provides evidence about the upper-extremity function of children presenting with brachial plexus injuries.Could be used to evaluate the effectiveness of occupational therapy intervention programs or as an outcome measure.Limited psychometric data reported.This study provides preliminary psychometric results of application to children with brachial plexus injuries.
PEDI–Computer Adaptive Test (Kao, Kramer, Liljenquist, Tian, & Coster, 2012)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Measures caregiver’s or parent’s estimation of the functional abilities of child with disabilities
  • Level II
  • Stage 7 and 8: reliability and validity study
Offers capability to measure the functional abilities of children with disabilities via computerized data collection. Clinical application and availability are not described in the articles.Excellent tool to investigate participation in daily occupations of children with disabilities in 4 main areas: daily activities, social-cognitive, mobility, and responsibility.Good application for research because data collection is computerized and convenient for participants who are parents.Application to clinical practice and scoring interpretation unknown—not described in article.Psychometrically and theoretically sound computerized instrument.
Preschool Imitation and Praxis Scale (PIPS; Vanvuchelen, Roeyers, & De Weerdt, 2011)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Have to observe child completing motor skill activities and rate his or her performance
  • Level III
  • Stage 7: reliability assessment
May assist clinicians in evaluating and reevaluating preschoolers’ imitation ability.Can be used to investigate the underpinnings of motor development or sensory processing.Can be used to evaluate the effectiveness of an intervention program or could be used to investigate whether certain diagnostic groups present with distinct motor skill difficulties.
  • • No validity evidence reported.
  • • Does not provide much information on the occupational performance of children.
Promising preliminary reliability evidence is reported.
Quality of Life in School (QoLS) Version 2 (Weintraub & Bar-Haim Erez, 2009)
  • Purpose: Descriptive
  • Practicality: Child rates how true statements are about his or her school-related QoL; easy to administer and score
  • Level III
  • Stage 8: very early validation study
Provides a tool to evaluate typically developing students’ perceptions of school-related QoL. May have immediate application to students with psychosocial challenges.May be used to investigate theoretical underpinnings of the relationship between occupation and QoL.May be used in research to explore aspects of school performance, subjective student school-related QoL, and other cultural or environmental factors.
  • • Requires further reliability and validity studies to ensure that the tool discriminates between children who do and do not enjoy, participate well, or academically achieve in school.
  • • Needs to be validated for children with disability.
The tool has a well-documented explanation of its psychometric development that contributes to the user’s confidence and actual rigor of the tool.
School Function Assessment (Hwang & Davies, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Requires specialized skills to administer, score, and interpret; based on interview with person who knows how child functions in school environment
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s activity performance in a school environment.Is a top-down assessment tool that provides information about children’s activity participation.
  • • Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Could provide a baseline for children’s school-related occupations.
  • • Requires specialized training to administer and score.
  • • Is quite time consuming to administer and score.
  • • Scale booklet and manual have to be purchased, creating cost issue.
  • • Well established with strong psychometric characteristics.
  • • Test has been widely used.
  • • Very compatible with an occupation-focused perspective on service provision.
School Version of the Assessment of Motor and Process Skills (Munkholm, Berg, Löfgren, & Fisher, 2010)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Valid and clinically useful tool for measuring the quality of schoolwork task performance as it is observed in the natural classroom setting
  • Level III
  • Stages 8 and 10: validity assessment
Can be used to assess children’s motor and process skills in a classroom environment.
  • • Is a MOHO-based tool.
  • • Builds a body of knowledge about motor and process skills.
Could be used to evaluate the effectiveness of occupational therapy intervention programs or as an outcome measure.Requires completion of a 5-day course in which raters are trained and calibrated; some potential users may not be able to afford the course tuition fees.
  • • Well-validated and standardized scale
  • • Strong evidence of dimensionality
  • • Assesses children’s motor and process skills in a naturalistic environment.
  • • Test users have to complete extensive training course and become calibrated before using instrument independently.
Sense and Self-Regulation Checklist (Silva & Schalock, 2012)
  • Purpose: Descriptive, discriminative, and predictive
  • Practicality: Easily administered and scored parent–caregiver measure
  • Level III
  • Stages 7 and 8: reliability and validity study
May have some application to clinical occupational therapy practice based on a biopsychosocial or biomedical framework; limited application to other types of clinical occupational therapy practice.May be used in research to further investigate the relationships within a biomedical framework.May be used in research to further investigate the relationship among sensory processing, behavior, and self-regulation among children with autism spectrum disorder.Further validation research required to demonstrate application to clinical occupational therapy use.Promising initial psychometric properties, although further validity studies might include and analyze data from the perspective of other child and environmental variables.
Sensory Experiences Questionnaire (SEQ; Little et al., 2011)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Sensory processing
  • Level III
  • Stage 7: reliability assessment
Can be used to assess children presenting with sensory processing issues.Provides evidence about sensory processing issues; could provide support for Dunn’s Sensory Processing Model.Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Limited psychometric data have been published on the SEQ.
  • • Participants for reliability study were recruited from 1 geographic region.
Brief parent-report scale, minimum respondent burden
Sensory Profile Caregiver Questionnaire (Ohl et al., 2012)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Parent-report scale; time consuming to score and interpret
  • Level III
  • Stages 8 and 10: validity assessment
Can be used to assess children’s sensory processing skills.Provides evidence about children’s sensory processing and potential contributions and how this could affect their occupational performance in daily contexts.Could be used to evaluate the effectiveness of occupational therapy intervention programs or as an outcome measure.
  • • Many items to answer.
  • • Limited validity data available.
  • • Scale booklet and manual have to be purchased, creating cost issue.
  • • Comprehensive coverage of sensory processing issues in a classroom context.
  • • Asks for parent and teacher feedback.
  • • Based on practice model.
Slosson Visual–Motor Performance Test (Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Have to purchase test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Does not provide information about children’s occupational performance.
  • • Not widely used by therapists.
  • • Limited psychometric data published about test by external authors.
  • • Scale booklet and manual have to be purchased, creating cost issue.
Preliminary evidence of reliability and validity reported by test authors in test manual is promising.
Test of Visual–Motor Integration (TVMI; Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Requires purchase of test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs or to establish the visual–motor baseline skills of certain diagnostic groups of clients.
  • • Does not provide information about children’s occupational performance.
  • • Not widely used by therapists.
  • • Limited psychometric data published about test by external authors.
Preliminary evidence of reliability and validity reported by test authors in test manual is promising.
Test of Visual–Motor Skills–Revised (TVMS–R; Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Requires purchase of test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs or to establish the visual–motor baseline skills of certain diagnostic groups of clients.
  • • Does not provide information about children’s occupational performance.
  • • Limited psychometric data published about test by external authors.
  • • Scale booklet and manual have to be purchased, creating cost issue.
Preliminary evidence of reliability and validity reported by test authors in test manual is promising.
Test of Visual–Perceptual Skills–Revised (TVPS–R; Tsai, Lin, Liao, & Hsieh, 2009)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Fairly straightforward to administer and score
  • Level III
  • Stages 7 and 10: reliability assessment
Can be used to establish the baseline of a child’s visual–perceptual skills.Can be used to investigate the underpinnings of perceptual motor theory.Can be used to establish the effectiveness of an intervention program or explore the links between visual–perceptual skills and children’s occupational performance.
  • • Small sample size
  • • Data gathered in 1 geographic location.
  • • No link to occupational performance of children made.
  • • Answer sheets, test plate book, and test manual have to be purchased, creating cost issue.
  • • Provides evidence of the reliability properties of the TVPS–R.
  • • Provides evidence for use of scale in a cross-cultural context.
Weekly Calendar Planning Activity (WCPA; Toglia & Berg, 2013; Weiner, Toglia, & Berg, 2012)
  • Purpose: Descriptive and discriminative
  • Practicality: Relatively easy to obtain and administer; relatively inexpensive to use
  • Level III
  • Stage 8: validity and dimensionality assessment
  • • Can be used to assess clients’ executive functioning.
  • • Could be used to evaluate the effectiveness of an intervention program for research purposes.
Could be used to contribute to theories of cognitive functioning or executive functioning remediation practice models.Could be used to evaluate the effectiveness of intervention programs that target clients’ executive function skills.Convenience sampling; recruitment of participants from 1 geographic location, which limits the generalizability of the findings; large sample size difference between the 2 participant groups.Strength of the WCPA is that it is an ecological assessment that involves the completion of an everyday task (i.e., entering appointments into a weekly schedule).
Table Footer NoteNote. Level I = systematic reviews, meta-analyses, and randomized controlled trials; Level II = two-group nonrandomized pretest–posttest designs (e.g., cohort designs, case control studies); Level III = one-group nonrandomized, noncontrolled trials; Level IV = single-subject designs, descriptive studies, and case series; Level V = expert opinion, case study, not based on systematic research methods. DCD = developmental coordination disorder; ICF = International Classification of Function, Disability and Health; MOHO = Model of Human Occupation; PEDI = Pediatric Evaluation of Disability Inventory; PEO = Person–Environment–Occupation model; QoL = quality of life.
Note. Level I = systematic reviews, meta-analyses, and randomized controlled trials; Level II = two-group nonrandomized pretest–posttest designs (e.g., cohort designs, case control studies); Level III = one-group nonrandomized, noncontrolled trials; Level IV = single-subject designs, descriptive studies, and case series; Level V = expert opinion, case study, not based on systematic research methods. DCD = developmental coordination disorder; ICF = International Classification of Function, Disability and Health; MOHO = Model of Human Occupation; PEDI = Pediatric Evaluation of Disability Inventory; PEO = Person–Environment–Occupation model; QoL = quality of life.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 3). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 3). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
Table 3.
Critique of Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013
Critique of Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Instrument and AuthorPurpose of Instrument and PracticalityLevel of Evidence and Stage of Instrument DevelopmentRelevance to Occupational Therapy PracticeRelevance to Occupational Therapy TheoryRelevance to Occupational Therapy ResearchLimitations of StudyStrengths of Study
Adolescents and Adults Coordination Questionnaire (AAC–Q; Saban, Ornoy, Grotto, & Parush, 2012)
  • Purpose: Descriptive and discriminative
  • Practicality: Self-report 12-item scale; very easy to administer and score
  • Level III
  • Stage 7: reliability assessment
Can assist as an initial screening tool for adolescents and adults suspected of having DCD.Scale can be used to assess theoretical assumptions of motor control theory and other related constructs.
  • • Can be used to investigate the prevalence of DCD in the adult population.
  • • Can be used to evaluate the effectiveness of interventions targeted at adults with DCD.
  • • Study completed in 1 geographic area so there may be bias in the results.
  • • Authors did not include copy of the scale in the published article.
  • • No construct validity regarding whether scale items load on a single DCD factor was reported.
  • • Preliminary psychometric properties of scale look promising.
  • • Provision of cutoff scores is helpful for clinical applications.
  • • Is brief, user friendly, and ecologically valid.
Assessment of Children’s Hand Skills (ACHS; Chien, Brown, & McDonald, 2010)
  • Purpose: Descriptive, discriminative, predictive, and potential for evaluative
  • Practicality: Have to purchase test booklets and manual; have to receive specialist training to administer and score instrument; need well-honed observation skills to be able to score instrument
  • Level III
  • Stage 7: reliability assessment
  • • Can be used to assess a comprehensive range of hand skills for use with different populations of children.
  • • Could be used as an outcome measure after a round of intervention has been provided.
  • • Uses naturalistic observation and fits with an occupation-centered assessment approach to provide occupational therapists with information about children’s hand skill performance in meaningful occupations that are completed in daily contexts.
  • • Is a top-down assessment tool that provides information about children’s activity performance.
Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Requires specialized training to administer and score.
  • • Not commercially available; have to contact author directly.
  • • Only preliminary psychometric data have been reported by its author; no external researchers have evaluated the instrument.
  • • Uses naturalistic observation and fits with an occupation-centered assessment approach to generate information about children’s hand skill assessment performance in meaningful occupations that are completed in daily contexts.
  • • Strong preliminary psychometric evidence about construct validity of instrument using Rasch analysis approach
Assessment of Motor and Process Skills (AMPS; Gantschnig, Page, Nilsson, & Fisher, 2013)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Specific qualification required to administer the AMPS with children for clinical or research purposes
  • Level III
  • Stages 8 and 10: reliability and validity study
Standardized assessment of motor and processing skills during functional tasks; provides clinical information about areas for goals and service direction.Good tool to investigate underpinnings of MOHO and for occupational performance when a child has motor or processing differences.May be very useful in research, particularly retrospective data analysis that investigates relationships between underlying skills and performance.Continued psychometric evaluation needed to determine sensitivity to change over time.Large centrally held AMPS database offers the possibility of numerous knowledge translation research opportunities.
Ayres Sensory Integration (ASI) Fidelity Measure (Parham et al., 2011)
  • Purpose: Discriminative and predictive
  • Practicality: Requires experienced and expert individual to rate features of therapy session to get accurate measures of fidelity to ASI principles covered
  • Level IV
  • Stage 3: content validity evaluation
Adherence to the ASI Fidelity Measure’s structural and process elements will increase the likelihood that interventions labeled ASI and provided by qualified therapists are faithful to ASI principles not only in research but also in education and practice.
  • The Fidelity Measure provides an international standard by which to determine
  • whether an intervention represents ASI, which ensures that the ASI model is applied correctly.
  • The Fidelity Measure provides an international standard by which to determine
  • whether an intervention represents ASI.
  • • Did not field test the ASI Fidelity Measure with novice clinicians.
  • • Did not investigate the construct validity of the ASI Fidelity Measure.
  • • Very experienced expert panel was engaged to establish the content validity of the ASI Fidelity Measure.
  • • Expert panel had international representation, which decreases risk of geographic bias.
Box and Block Test (Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen, 2013)
  • Purpose: Discriminative
  • Practicality: Requires manual and specific boxes, blocks, and scoring sheet; little training necessary
  • Level III
  • Stages 7 and 8: reliability and validity study
Standardized assessment of gross dominant and nondominant hand function that may easily be used for pretest–posttest.May be useful to investigate underpinnings of biomechanical model.May be used to investigate efficacy of biomedical or occupational therapy interventions and measure outcomes on 1 or both upper extremities.Continued psychometric evaluation needed to determine sensitivity to change over time.Norm-referenced, easily administered hand function tool that does relate to real-life functional hand use.
Child Occupational Self Assessment (COSA; Kramer, Kielhofner, & Smith, 2010)
  • Purpose: Descriptive and evaluative
  • Practicality: Can be administered in 1 of 3 ways: standard pencil and paper, card sort, and matrix format
  • Level III
  • Stages 7 and 8: reliability and validity study
  • • Child-centered and child-reported tool that measures extent to which child is meeting expectations and responsibilities in daily activities and the importance of those activities.
  • • Directs clinical intervention by identifying important activities that might be prioritized in therapy.
Sound tool that may be used in research that investigates underpinnings of MOHO or any PEO model.May be used to investigate efficacy of occupational therapy interventions from clients’ perspectives.
  • • Extend validity and reliability studies to include randomized sampling and standardized administration of the measure when data are collected from across cultures and world regions. Further validity studies might include and analyze data from the perspective of other child and environmental variables.
  • • Also requires evaluation of responsiveness to change.
MOHO-based assessment tool that measures child’s subjective experience of occupation in a psychometrically sound way for clinical or research purposes.
Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Child rates the intensity (frequency), social aspect, location, enjoyment, and preference for leisure and recreational pursuits. Easy to administer and score.
  • Level III
  • Stages 8 and 10: evaluation of the scale’s measurement properties by other than the scale’s authors
Very relevant to practice; provides child’s perspective about participation in home and community contexts.Useful in studies investigating theoretical underpinnings of occupational therapy theory (e.g., Canadian Model of Occupational Performance and Engagement, ICF).May be used as client-centered outcome measure.Continued psychometric evaluation needed to determine sensitivity to change over time.Good reliability and validity evidence reported.
Children’s Leisure Assessment Scale (CLASS; Rosenblum, Sachs, & Schreuer, 2010) 
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Easily administered tool to measure participation in leisure activities among children ages 10–18 yr.
  • Level III
  • Stages 7 and 8: reliability and validity study
May be used clinically to determine a leisure activity preference for young children without disability.May be useful to investigate relationship between childhood occupations and any PEO model.May be useful in research about childhood occupations, participation, and other child-related factors.Requires further evaluation to determine discriminant validity for children with and without disability, as well as sensitivity to change over time.Offers very descriptive preference and participation profile of children’s leisure preferences.
Comprehensive Observations of Proprioception (COP; Blanche, Bodison, Chang, & Reinoso, 2012)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Relatively easy to obtain and administer; takes 15 min of observing child in a naturalistic environment
  • Level III
  • Stage 8: validity and dimensionality assessment
Can be used to assess children’s proprioceptive processing skills.Derived from literature based on sensory integration.Could be used to evaluate the effectiveness of occupational therapy intervention programs or could be used to describe clinical features of children with suspected developmental delay or motor skill problems.
  • • Still in early stages of psychometric development and validation.
  • • No normative scores are available.
  • • Has not been evaluated or applied in studies by others than Blanche, Bodison, et al. (2012) .
  • • Blanche, Bodison, et al. have documented the phases and components of the development of the COP.
  • • Preliminary evidence of COP’s interrater reliability, face validity, content validity, construct validity, criterion validity, and factor structure has been reported.
Developmental Test of Visual–Motor Integration (VMI; Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Have to purchase test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs or to establish the visual–motor baseline skills of certain diagnostic groups of clients.
  • • Does not provide information about children’s occupational performance.
  • • Test booklets and manual have to be purchased, creating cost issue.
  • • Well established, with strong psychometric characteristics
  • • Test has been widely used.
  • • Large standardization group on which normative scores are based
Do-Eat (Josman, Goffer, & Rosenblum, 2010)
  • Purpose: Descriptive, discriminative, and predictive
  • Practicality: Child is required to participate in 3 tasks, with appropriate equipment and environment needed: making sandwich, making chocolate milk, and handwriting.
  • Level III
  • Stages 7 and 8: reliability and validity study
Offers capability to measure the functional abilities of children with DCD; also assists in goal development.Good tool to investigate underpinnings of functional skills and performance.Good application for research purposesContinued psychometric evaluation needed to determine sensitivity to change over time.Psychometrically and theoretically sound tool specific to children with DCD
Evaluation of Social Interaction (ESI; Griswold & Townsend, 2012)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: The evaluator (occupational therapist) observes the child as he or she engages in desired relevant activities in natural context with usual social partners.
  • Level III
  • Stage 8: validity assessment
  • • Clinically useful way to measure children’s social interactions in natural settings.
  • • Provides standardized way to measure differences in social interaction and measure change over time.
Can be used to evaluate underpinnings of social interactions and participation.Useful for occupational therapy research to evaluate underpinnings of social interactions and participation and for efficacy studies evaluating occupational therapy interventions.Test–retest and interrater reliability studies needed for pediatric population; sensitivity to change over time needs evaluation before validation as outcome measure.Good reliability and validity for pediatric population.
Evaluation Tool of Children’s Handwriting (ETCH; Brossard-Racine, Mazer, Julien, & Majnemer, 2012; Duff & Goyen, 2010)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: The evaluator observes and then rates a child’s handwriting using 1 of 2 handwriting versions: manuscript and cursive. Provides standardized before-and-after measure of handwriting competency.
  • Level III
  • Stages 8 and 10: validity assessment
Highly useful in pediatric occupational therapy practice in school and clinic settings.Specific handwriting legibility and functionality for children in elementary school.Can be used to evaluate the effectiveness of a handwriting intervention program or to differentiate between typical and atypical handwriting—determine need and eligibility for services.
  • • Requires sensitivity to change over time and randomized sampling.
  • • Might be used in efficacy studies to investigate efficacy and efficiency of occupational therapy interventions that aim to improve handwriting.
Good reliability and validity evidence reported.
Family L.I.F.E. (Looking Into Family Experiences; Honaker, Rosello, & Candler, 2012)
  • Purpose: Descriptive and discriminative
  • Practicality: Requires manual and therapist–family collaboration to identify 5 key family occupations and limiting factors
  • Level III
  • Stage 7: reliability assessment
Engages families and therapists in a collaborative partnership and promotes family-centered practice.Tool may be useful to evaluate the tenets of occupational adaptation or family-centered practice models.Useful research tool to identify subjective family issues pre- and postintervention.Further psychometric evaluation required for validation and reliability.Emphasizes clinical and research consideration of a very important factor in the support system available to a child with a disability: the family.
Health Promoting Activities Scale (HPAS; Bourke-Taylor, Law, Howie, & Pallant, 2012)
  • Level III
  • Stage 8: validity and dimensionality assessment
May be used in clinical practice in numerous contexts working with caregivers.Provides evidence about the associations among participation in meaningful self-selected leisure pursuits, mental health, and well-being.
  • • Psychometrically sound scale with low response burden that measures the person’s perspective.
  • • May be used as an outcome measure because scoring relates to the frequency of participation.
Initial study did not include secondary validation of diagnosis of mental health condition; did not include test–retest reliability or tests of sensitivity to change over time.Psychometrically sound at initial stages of development; novel measurement of complex and meaningful human occupation.
Life Participation for Parents (Fingerhut, 2013)
  • Purpose: Descriptive and evaluative
  • Practicality: Families with a child with a disability complete paper questionnaire about family occupations.
  • Level III
  • Stages 7 and 8: reliability and validity study
Clinically useful to facilitate family-centered service delivery; allows focus on strategies to improve satisfaction with occupational participationGood tool to investigate and evaluate family-centered practice, other theoretical frameworks (ICF, PEO, ecological approach)Useful tool for subjective family status when there is a child with a disability in the family.Continued psychometric evaluation needed to determine sensitivity to change over time.Psychometrically sound family-centered tool that could be used easily in both clinical practice and theory.
Loewenstein Occupational Therapy Cognitive Assessment (LOTCA; Josman, Abdallah, & Engel-Yeger, 2011)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Requires standardized kit and score sheets
  • Level III
  • Stages 8 and 10: evaluation of scale’s measurement properties by those other than authors
Clinical application for occupational therapists may include school readiness or use in other settings to determine eligibility or areas for interventions. May have feasibility as screening tool for school entry.May be useful to investigate relationships between cognition and occupational performance in daily occupations; supports numerous theoretical concepts in occupational therapy.May be used to investigate efficacy of occupational therapy interventions, although sensitivity to change has not been established among children.Further research is needed to establish validity in relation to cross-cultural studies, other child and sociodemographic factors, and actual functional performance in childhood occupation. Requires longitudinal predictive studies. Also, sensitivity to change across time requires investigation if to be used as an outcome measure.Standardized assessment of cognition for young children with capacity to differentiate among children with and without readiness to enter school and early school performance and other issues.
Manual Ability Classification System (MACS; Kuijper, van der Wilden, Ketelaar, & Gorter, 2010)
  • Purpose: Descriptive, discriminative, and predictive
  • Practicality: Involves therapists observing hand skills use and using decision-making tree to classify hand function. The manual is freely available.
  • Level III
  • Stages 8 and 10: validity study
Excellent clinical application to promote communication among children, families, and professionals and provides observational measure of hand function that may result in functional goal setting.May be used to investigate theoretical underpinnings of occupational therapy theory that uses a PEO approach.Application to research is good. Provides researchers with easily rated manual classification system alongside the widely used Gross Motor Function Classification System and more recent Communication Function Classification System.
  • • This particular study used correlational analysis for an ordinal classification scale and the PEDI caregiver scales (Part 2) rather than the PEDI functional skills scale (Part 1).
  • • The conclusion that the MACS is related to the performance of daily self-care skills is inappropriately drawn because PEDI Part 1 was not used in the study. Therefore, findings must be interpreted with caution.
The MACS has good reliability and validity and provides a functional classification to facilitate communication among people with cerebral palsy, families, and professionals.
McDonald Play Inventory (McDonald & Vigen, 2012)
  • Descriptive, discriminative, and evaluative
  • Practicality: Child self-report scale that requires minimal resources
  • Level III
  • Stages 7 and 8: reliability and validity assessment
Can be used to assess children presenting with play-related problems.Provides evidence about children’s self-reported perceptions about their play and play style.Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Convenience sample
  • • Limited psychometric data have been published about the scale.
  • • Assesses an important area of children’s occupational performance.
  • • Accesses children’s perspectives about their play.
  • • Promising psychometric data about the scale have been reported.
Melbourne Assessment of Unilateral Upper Limb Function (MAUULF; Spirtos, O’Mahony, & Malone, 2011)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Standardized kit required, as well as some informal training and preparation for administration and scoring.
  • Level III
  • Stages 7 and 10: evaluation of scale’s measurement properties by those other than authors
Standardized assessment of quality of functional movement for 1 upper extremity.Good tool for rigorous evaluation of quality of upper-limb movement for biomedical interventions as well as occupational therapy interventions.Useful for pre– and post–upper-extremity evaluation for various interventions for children with hemiplegia.Detailed training and instructions needed for clinicians to learn how reliably administer and score the MAUULF.Psychometrically sound upper-extremity test that precisely measures functional arm and hand movement.
Motor-Free Visual Perception Test–Revised (MVPT–R; Tsai, Lin, Liao, & Hsieh, 2009)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Fairly straightforward to administer and score
  • Level III
  • Stages 7 and 10: reliability assessment
Can be used to establish the baseline of a child’s visual–perceptual skills.Can be used to investigate the underpinnings of perceptual–motor theory.Can be used to establish the effectiveness of an intervention program or explore the links between visual–perceptual skills and children’s occupational performance.
  • • Small sample size.
  • • Data gathered in 1 geographic location.
  • • No link to occupational performance of children made.
  • • Answer sheets, test plate book, and test manual have to be purchased, creating cost issue.
  • • Provides evidence of the reliability properties of the MVPT–R.
  • • Is evidence of use of scale in a cross-cultural context.
Occupational Self Assessment (OSA; Taylor, Lee, Kramer, Shirashi, & Kielhofner, 2011)
  • Purpose: Descriptive and discriminative
  • Practicality: Self-report scale on which participants are asked to answer or rate 21 statements; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity assessment
Can be used with a variety of client groups, including those with mental health issues or physical disabilities or older adults.Derived from constructs related to the MOHO.Can be used to evaluate the intervention programs; can be used to operationalize constructs from the MOHO and can provide empirical evidence about the MOHO.
  • • Data were gathered from 1 geographical area.
  • • Convenience sampling was used.
  • • Good sample size to minimize chance of Type I error.
  • • Use of Item Response Theory provides further evidence of the scale’s construct validity.
Pediatric Outcomes Data Collection Instrument (Mulcahey et al., 2013)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Outcome measure designed for children with brachial plexus injury that is administered via computer adaptive test
  • Level III
  • Stages 7 and 8: reliability and validity assessment
Can be used to assess the upper-extremity function of children presenting with brachial plexus injuries.Provides evidence about the upper-extremity function of children presenting with brachial plexus injuries.Could be used to evaluate the effectiveness of occupational therapy intervention programs or as an outcome measure.Limited psychometric data reported.This study provides preliminary psychometric results of application to children with brachial plexus injuries.
PEDI–Computer Adaptive Test (Kao, Kramer, Liljenquist, Tian, & Coster, 2012)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Measures caregiver’s or parent’s estimation of the functional abilities of child with disabilities
  • Level II
  • Stage 7 and 8: reliability and validity study
Offers capability to measure the functional abilities of children with disabilities via computerized data collection. Clinical application and availability are not described in the articles.Excellent tool to investigate participation in daily occupations of children with disabilities in 4 main areas: daily activities, social-cognitive, mobility, and responsibility.Good application for research because data collection is computerized and convenient for participants who are parents.Application to clinical practice and scoring interpretation unknown—not described in article.Psychometrically and theoretically sound computerized instrument.
Preschool Imitation and Praxis Scale (PIPS; Vanvuchelen, Roeyers, & De Weerdt, 2011)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Have to observe child completing motor skill activities and rate his or her performance
  • Level III
  • Stage 7: reliability assessment
May assist clinicians in evaluating and reevaluating preschoolers’ imitation ability.Can be used to investigate the underpinnings of motor development or sensory processing.Can be used to evaluate the effectiveness of an intervention program or could be used to investigate whether certain diagnostic groups present with distinct motor skill difficulties.
  • • No validity evidence reported.
  • • Does not provide much information on the occupational performance of children.
Promising preliminary reliability evidence is reported.
Quality of Life in School (QoLS) Version 2 (Weintraub & Bar-Haim Erez, 2009)
  • Purpose: Descriptive
  • Practicality: Child rates how true statements are about his or her school-related QoL; easy to administer and score
  • Level III
  • Stage 8: very early validation study
Provides a tool to evaluate typically developing students’ perceptions of school-related QoL. May have immediate application to students with psychosocial challenges.May be used to investigate theoretical underpinnings of the relationship between occupation and QoL.May be used in research to explore aspects of school performance, subjective student school-related QoL, and other cultural or environmental factors.
  • • Requires further reliability and validity studies to ensure that the tool discriminates between children who do and do not enjoy, participate well, or academically achieve in school.
  • • Needs to be validated for children with disability.
The tool has a well-documented explanation of its psychometric development that contributes to the user’s confidence and actual rigor of the tool.
School Function Assessment (Hwang & Davies, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Requires specialized skills to administer, score, and interpret; based on interview with person who knows how child functions in school environment
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s activity performance in a school environment.Is a top-down assessment tool that provides information about children’s activity participation.
  • • Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Could provide a baseline for children’s school-related occupations.
  • • Requires specialized training to administer and score.
  • • Is quite time consuming to administer and score.
  • • Scale booklet and manual have to be purchased, creating cost issue.
  • • Well established with strong psychometric characteristics.
  • • Test has been widely used.
  • • Very compatible with an occupation-focused perspective on service provision.
School Version of the Assessment of Motor and Process Skills (Munkholm, Berg, Löfgren, & Fisher, 2010)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Valid and clinically useful tool for measuring the quality of schoolwork task performance as it is observed in the natural classroom setting
  • Level III
  • Stages 8 and 10: validity assessment
Can be used to assess children’s motor and process skills in a classroom environment.
  • • Is a MOHO-based tool.
  • • Builds a body of knowledge about motor and process skills.
Could be used to evaluate the effectiveness of occupational therapy intervention programs or as an outcome measure.Requires completion of a 5-day course in which raters are trained and calibrated; some potential users may not be able to afford the course tuition fees.
  • • Well-validated and standardized scale
  • • Strong evidence of dimensionality
  • • Assesses children’s motor and process skills in a naturalistic environment.
  • • Test users have to complete extensive training course and become calibrated before using instrument independently.
Sense and Self-Regulation Checklist (Silva & Schalock, 2012)
  • Purpose: Descriptive, discriminative, and predictive
  • Practicality: Easily administered and scored parent–caregiver measure
  • Level III
  • Stages 7 and 8: reliability and validity study
May have some application to clinical occupational therapy practice based on a biopsychosocial or biomedical framework; limited application to other types of clinical occupational therapy practice.May be used in research to further investigate the relationships within a biomedical framework.May be used in research to further investigate the relationship among sensory processing, behavior, and self-regulation among children with autism spectrum disorder.Further validation research required to demonstrate application to clinical occupational therapy use.Promising initial psychometric properties, although further validity studies might include and analyze data from the perspective of other child and environmental variables.
Sensory Experiences Questionnaire (SEQ; Little et al., 2011)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Sensory processing
  • Level III
  • Stage 7: reliability assessment
Can be used to assess children presenting with sensory processing issues.Provides evidence about sensory processing issues; could provide support for Dunn’s Sensory Processing Model.Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Limited psychometric data have been published on the SEQ.
  • • Participants for reliability study were recruited from 1 geographic region.
Brief parent-report scale, minimum respondent burden
Sensory Profile Caregiver Questionnaire (Ohl et al., 2012)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Parent-report scale; time consuming to score and interpret
  • Level III
  • Stages 8 and 10: validity assessment
Can be used to assess children’s sensory processing skills.Provides evidence about children’s sensory processing and potential contributions and how this could affect their occupational performance in daily contexts.Could be used to evaluate the effectiveness of occupational therapy intervention programs or as an outcome measure.
  • • Many items to answer.
  • • Limited validity data available.
  • • Scale booklet and manual have to be purchased, creating cost issue.
  • • Comprehensive coverage of sensory processing issues in a classroom context.
  • • Asks for parent and teacher feedback.
  • • Based on practice model.
Slosson Visual–Motor Performance Test (Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Have to purchase test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Does not provide information about children’s occupational performance.
  • • Not widely used by therapists.
  • • Limited psychometric data published about test by external authors.
  • • Scale booklet and manual have to be purchased, creating cost issue.
Preliminary evidence of reliability and validity reported by test authors in test manual is promising.
Test of Visual–Motor Integration (TVMI; Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Requires purchase of test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs or to establish the visual–motor baseline skills of certain diagnostic groups of clients.
  • • Does not provide information about children’s occupational performance.
  • • Not widely used by therapists.
  • • Limited psychometric data published about test by external authors.
Preliminary evidence of reliability and validity reported by test authors in test manual is promising.
Test of Visual–Motor Skills–Revised (TVMS–R; Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Requires purchase of test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs or to establish the visual–motor baseline skills of certain diagnostic groups of clients.
  • • Does not provide information about children’s occupational performance.
  • • Limited psychometric data published about test by external authors.
  • • Scale booklet and manual have to be purchased, creating cost issue.
Preliminary evidence of reliability and validity reported by test authors in test manual is promising.
Test of Visual–Perceptual Skills–Revised (TVPS–R; Tsai, Lin, Liao, & Hsieh, 2009)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Fairly straightforward to administer and score
  • Level III
  • Stages 7 and 10: reliability assessment
Can be used to establish the baseline of a child’s visual–perceptual skills.Can be used to investigate the underpinnings of perceptual motor theory.Can be used to establish the effectiveness of an intervention program or explore the links between visual–perceptual skills and children’s occupational performance.
  • • Small sample size
  • • Data gathered in 1 geographic location.
  • • No link to occupational performance of children made.
  • • Answer sheets, test plate book, and test manual have to be purchased, creating cost issue.
  • • Provides evidence of the reliability properties of the TVPS–R.
  • • Provides evidence for use of scale in a cross-cultural context.
Weekly Calendar Planning Activity (WCPA; Toglia & Berg, 2013; Weiner, Toglia, & Berg, 2012)
  • Purpose: Descriptive and discriminative
  • Practicality: Relatively easy to obtain and administer; relatively inexpensive to use
  • Level III
  • Stage 8: validity and dimensionality assessment
  • • Can be used to assess clients’ executive functioning.
  • • Could be used to evaluate the effectiveness of an intervention program for research purposes.
Could be used to contribute to theories of cognitive functioning or executive functioning remediation practice models.Could be used to evaluate the effectiveness of intervention programs that target clients’ executive function skills.Convenience sampling; recruitment of participants from 1 geographic location, which limits the generalizability of the findings; large sample size difference between the 2 participant groups.Strength of the WCPA is that it is an ecological assessment that involves the completion of an everyday task (i.e., entering appointments into a weekly schedule).
Table Footer NoteNote. Level I = systematic reviews, meta-analyses, and randomized controlled trials; Level II = two-group nonrandomized pretest–posttest designs (e.g., cohort designs, case control studies); Level III = one-group nonrandomized, noncontrolled trials; Level IV = single-subject designs, descriptive studies, and case series; Level V = expert opinion, case study, not based on systematic research methods. DCD = developmental coordination disorder; ICF = International Classification of Function, Disability and Health; MOHO = Model of Human Occupation; PEDI = Pediatric Evaluation of Disability Inventory; PEO = Person–Environment–Occupation model; QoL = quality of life.
Note. Level I = systematic reviews, meta-analyses, and randomized controlled trials; Level II = two-group nonrandomized pretest–posttest designs (e.g., cohort designs, case control studies); Level III = one-group nonrandomized, noncontrolled trials; Level IV = single-subject designs, descriptive studies, and case series; Level V = expert opinion, case study, not based on systematic research methods. DCD = developmental coordination disorder; ICF = International Classification of Function, Disability and Health; MOHO = Model of Human Occupation; PEDI = Pediatric Evaluation of Disability Inventory; PEO = Person–Environment–Occupation model; QoL = quality of life.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 3). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 3). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
×
We classified each study according to the level of evidence hierarchy system used by the AOTA Evidence-Based Literature Review Project (Lieberman & Scheer, 2002).
The Person–Environment–Occupation (PEO) model is a prominent occupational therapy model that drives client-centered practice and explains a person’s performance as the dynamic interaction among these three components (Law & Baum, 2005; Law et al., 1996). The person characteristics include physical, cognitive, affective, and other characteristics and capabilities. Environmental aspects are the social, cultural, physical, and institutional environment around the person, and occupations are classified as self-care, productivity, or leisure and play. The PEO model concepts operationalized in the occupational therapy assessment tools are listed in Table 4.
Table 4.
Classification of Instruments in the Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013, by Practice Model
Classification of Instruments in the Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013, by Practice Model×
PEO
ICF
InstrumentPersonEnvironmentOccupationBody Functions and StructuresPersonal FactorsEnvironmental FactorsActivityParticipation
Adolescents and Adults Coordination Questionnaire
Assessment of Children’s Hand Skills
Assessment of Motor and Process Skills
Ayres Sensory Integration Fidelity Measure
Box and Block Test
Child Occupational Self Assessment
Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children
Children’s Leisure Assessment Scale
Comprehensive Observations of Proprioception
Developmental Test of Visual–Motor Integration
Do–Eat
Evaluation of Social Interaction
Evaluation Tool of Children’s Handwriting
Family L.I.F.E. (Looking Into Family Experiences)
Health Promoting Activities Scale
Life Participation for Parents
Manual Ability Classification System
McDonald Play Inventory
Melbourne Assessment of Unilateral Upper Limb Function
Motor-Free Visual Perception Test–Revised
Occupational Self Assessment
Pediatric Evaluation of Disability Inventory–Computer Adaptive Test
Pediatric Outcomes Data Collection Instrument
Preschool Imitation and Praxis Scale
Quality of Life in School Version 2
School Function Assessment
School Version of the Assessment of Motor and Process Skills
Sense and Self-Regulation Checklist
Sensory Experiences Questionnaire
Sensory Profile Caregiver Questionnaire
Slosson Visual–Motor Performance Test
Test of Visual–Motor Integration
Test of Visual–Motor Skills–Revised
Test of Visual–Perceptual Skills–Revised
Weekly Calendar Planning Activity
Table Footer NoteNote. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001, 2007); PEO = Person–Environment–Occupation model (Law et al., 1996).
Note. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001, 2007); PEO = Person–Environment–Occupation model (Law et al., 1996).×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 4). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 4). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
Table 4.
Classification of Instruments in the Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013, by Practice Model
Classification of Instruments in the Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013, by Practice Model×
PEO
ICF
InstrumentPersonEnvironmentOccupationBody Functions and StructuresPersonal FactorsEnvironmental FactorsActivityParticipation
Adolescents and Adults Coordination Questionnaire
Assessment of Children’s Hand Skills
Assessment of Motor and Process Skills
Ayres Sensory Integration Fidelity Measure
Box and Block Test
Child Occupational Self Assessment
Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children
Children’s Leisure Assessment Scale
Comprehensive Observations of Proprioception
Developmental Test of Visual–Motor Integration
Do–Eat
Evaluation of Social Interaction
Evaluation Tool of Children’s Handwriting
Family L.I.F.E. (Looking Into Family Experiences)
Health Promoting Activities Scale
Life Participation for Parents
Manual Ability Classification System
McDonald Play Inventory
Melbourne Assessment of Unilateral Upper Limb Function
Motor-Free Visual Perception Test–Revised
Occupational Self Assessment
Pediatric Evaluation of Disability Inventory–Computer Adaptive Test
Pediatric Outcomes Data Collection Instrument
Preschool Imitation and Praxis Scale
Quality of Life in School Version 2
School Function Assessment
School Version of the Assessment of Motor and Process Skills
Sense and Self-Regulation Checklist
Sensory Experiences Questionnaire
Sensory Profile Caregiver Questionnaire
Slosson Visual–Motor Performance Test
Test of Visual–Motor Integration
Test of Visual–Motor Skills–Revised
Test of Visual–Perceptual Skills–Revised
Weekly Calendar Planning Activity
Table Footer NoteNote. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001, 2007); PEO = Person–Environment–Occupation model (Law et al., 1996).
Note. ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2001, 2007); PEO = Person–Environment–Occupation model (Law et al., 1996).×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 4). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 4). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
×
The ICF provides an international framework that transcends professional boundaries, cultures, and countries. The ICF acknowledges and conceptualizes the influence of environmental (human and physical) and personal (i.e., characteristics and background of the person’s life such as age, gender, education level, socioeconomic status) factors on the health, capabilities, and capacity of the person to engage in activities and participate in opportunities available in his or her home and community (WHO, 2001). Environmental factors such as physical and human resources and personal factors such as age, gender, culture, and the person’s values, interests, life roles, habits, and self-efficacy provide a highly influential backdrop that affects what a person does and how a person interacts with the world around him or her. The ICF has had a significant impact on the development of assessment tools within and outside the field of occupational therapy. We used the ICF to categorize the assessment tools from the 35 AJOT articles (see Table 4).
To summarize, the assessment tools for children and youth included in the 35 AJOT articles published between January 2009 and September 2013 are summarized in Table 2, critiqued in Table 3, and classified using the PEO model and ICF framework in Table 4.
Results
We reviewed 35 journal articles that addressed some aspect of the psychometric development of 37 occupational therapy assessment tools or classification scales.
Two articles reported information about the Weekly Calendar Planning Activity (Toglia & Berg, 2013; Weiner, Toglia & Berg, 2012). Two articles were also published about the Comprehension Observations of Proprioception (Blanche, Bodison, Chang & Reinoso, 2012; Blanche, Reinoso, Chang, & Bodison, 2012). Similarly, the Evaluation Tool of Children's Handwriting was the subject of two articles (Brossard-Racine, Mazer, Julien & Majnemer, 2012; Duff & Goyen, 2010). Brown, Unsworth, and Lyons (2009)  reported details of four visual–motor integration tests: Test of Visual–Motor Integration, Developmental Test of Visual–Motor Integration, Test of Visual–Motor Skills–Revised, and Slosson Visual-Motor Performance Test (SVMPT). Tsai, Lin, Liao, and Hsieh (2009)  published an article about two visual perceptual tests: the Motor-Free Visual Perception Test–Revised and Test of Visual–Perceptual Skills–Revised. Kuijper, van der Wilden, Ketelaar, and Gorter (2010)  reported about the Manual Ability Classification System and the Pediatric Evaluation of Disability Inventory (PEDI) while Kao, Karamer, Liljenquist, Tian, and Coster (2012)  reported about a newer version of the PEDI referred to as the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI–CAT). However, only the PEDI–CAT was reported about in detail. This accounted for the difference between the number of published articles reported in Table 1 and the number of published tests described in Tables 24.
All tools were developed and evaluated by occupational therapists, except for the Manual Ability Classification System (Eliasson et al., 2010, discussed in Kuijper, van der Wilden, Ketelaar, & Gorter, 2010), which was evaluated by physicians. The research projects described in the articles were international (see Table 1): American (18 articles, 51.4%), Israeli (6 articles, 17.1%), Australian (5 articles, 14.3%), Finnish (1 article, 2.9%), Swedish (2 articles, 5.7%), Taiwanese (1 article, 2.9%), Belgian (1 article, 2.9%), and Canadian (1 article, 2.9%). The life stage of the participants varied, with the majority of participants falling into the following age ranges: preschool (≤4 yr; 5 articles, 14.3%), school age (5–14 yr; 22 articles, 62.9%), and youth (15–18 yr; 4 articles, 11.4%). Three studies (8.6%) were dedicated to families, and 1 study (2.9%) involved only therapists.
From January 2009 to September 2013, AJOT published articles outlining the initial measurement properties of nine new scales: the Health Promoting Activities Scale (Bourke-Taylor, Law, Howie, & Pallant, 2012), Adolescents and Adults Coordination Questionnaire (Saban, Ornoy, Grotto, & Parush, 2012), Quality of Life in School (Weintraub & Bar-Haim Erez, 2009), Children’s Leisure Assessment Scale (Rosenblum et al., 2010), McDonald Play Inventory (McDonald & Vigen, 2012), Sense and Self-Regulation Checklist (Silva & Schalock, 2012), Comprehensive Observations of Proprioception (Blanche et al., 2012), Do–Eat (Josman, Goffer, & Rosenblum, 2010), and Life Participation for Parents (Fingerhut, 2013).
The majority of studies described evaluation of the instrument’s reliability, validity, or both (see Table 1). A total of 19 (54.3%) articles dealt with both the reliability and the validity of an instrument, whereas 7 studies focused only on its reliability and 9 focused only on its validity. The specific subtypes of reliability assessed were internal consistency (n = 15), test–retest reliability (n = 15), intrarater reliability (n = 2), and interrater reliability (n = 10). The types of validity assessed were face validity (n = 2), content validity (n = 6), criterion-related validity (n = 1), discriminant validity (n = 15), construct validity (n = 19), concurrent validity (n = 7), and factorial validity (n = 4). No longitudinal studies investigated predictive validity. Only 1 study reported details of an instrument’s responsiveness to change (sensitivity) over time. All articles provided advancement of the psychometric properties of the instruments and measures on which they reported. Two articles were primarily authored by physicians (Kuijper et al., 2010; Silva & Schalock, 2012), and the others were all authored by occupational therapists (n = 33).
Thirty-five assessments are described in Table 2. The assessments are based on a variety of practice models, theories, and frameworks, with some instruments incorporating more than one: cognitive–behavioral (n = 2), occupational performance (n = 6), ecological (n = 6), PEO (n = 6), play (n = 2), perceptual–motor (n = 6), Model of Human Occupation (MOHO; n = 5), motor control (n = 2), sensory processing (n = 3), ICF (n = 8), biopsychosocial (n = 1), the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; AOTA, 2008; n = 4), occupational adaptation (n = 2), sensory integration (n = 2), and biomechanical (n = 1).
In terms of client age groups, 18 scales are aimed at children from birth to age 4, 28 are designed for children between ages 5 and 12, 10 are meant for use with adolescents between ages 13 and 17, and 5 are designed for clients age 18 and older. Note that some of the scales covered more than one age group. For example, the Adolescents and Adults Coordination Questionnaire can be used with adolescents and adults, and the Assessment of Children’s Hand Skills can be used with children ages 3–12. The scores for the assessments are derived from a variety of perspectives: Eight scales are self-report, 10 are third party (usually completed by parents or caregivers who know the child or adolescent), and 22 are based on professionals rating the client’s performance on the basis of a set of criteria. Some instruments use a combination of third-party input and professional ratings.
Regarding DeVellis’s (2003)  stages of scale development, we noted the following combinations: Stage 8 validity studies, n = 5; Stage 7 reliability studies, n = 5; both Stage 7 and 8, n = 10. One study was Stage 3 (content validity evaluation), and 3 studies were both Stages 7 and 10 (reliability studies) completed by those other than the scale developers. Thirteen studies were Stage 8 and 10 validity evaluations completed by researchers other than the original scale authors. No studies investigated responsiveness to change over time or changes in ratings over time to detect sensitivity.
No studies contributed Level I evidence. Thirty-three articles described studies at Level III (one-group nonrandomized and noncontrolled), 1 study was Level II (two-group nonrandomized), and 1 study was Level IV (single-subject or descriptive study; see Table 3). The purposes of most assessments were clearly multifaceted, with only 2 assessments seemingly designed to meet only one purpose. Twenty-nine assessments were clearly under development as descriptive measures, 32 tools were being developed as discriminative measures, 21 tools were being designed as predictive measures, and 27 tools were clearly under development as evaluative measures.
As shown in Table 4, we classified the tests and measures under the components of the PEO model and the ICF (i.e., Body Functions and Structures, Personal Factors, Environmental Factors, Activity, and Participation). Under the PEO model classification, 34 (91.9%) of the tests and measures included the Person, 12 (32.4%) included the Environment, and 19 (51.4%) included the Occupation. The ICF components were distributed as follows: Body Functions and Structures, n = 25 (67.6%); Personal Factors, n = 8 (21.6%); Environmental Factors, n = 10 (27.0%); Activity, n = 18 (48.6%); and Participation, n = 12 (32.4%).
Discussion
As evidenced by this review, considerable research activity has occurred within the field of occupational therapy to develop and evaluate tests and measures related to children and adolescents. In line with previous commentary, the occupational therapy profession remains committed to child- and youth-focused studies (Brown, Rodger, & Brown, 2005; Case-Smith, 2007; Gutman, 2008b). Before the period of time selected for this current review, Gutman (2008b)  reported that instrument development and testing was a common research approach used in a large proportion (26%) of the studies published in AJOT in 2008 and 2009. Moreover, the current review concurs with results from other articles published in AJOT focusing on the children and youth practice area (Brown, 2010a; Bendixen & Kreider, 2011; Hilton & Smith, 2012; Hilton et al., 2013).
Characteristics of Children and Youth Instrument Development and Testing Articles
As noted in the Results section, the majority of the children and youth instrument development and testing articles (48.6%) were completed in the United States. However, researchers from several other countries also published articles dealing with pediatric assessment tools, including Israel (6 articles, 17.1%), Australia (5 articles, 14.3%), and Sweden (2 articles, 5.7%), thus demonstrating that AJOT has both a domestic and an international scope in articles about assessment tools aimed at children and adolescents.
The majority of pediatric assessment tools were designed for children between ages 5 and 12 (80.0%), and fewer were aimed at children ages birth–4 (51.4%) or youth ages 13–17 (28.6%). Several instruments were designed for use by more than one age group. For example, the Occupational Self Assessment can be used with adolescents and adults, and the School Version of the Assessment of Motor and Process Skills, Developmental Test of Visual–Motor Integration, and Evaluation of Social Interaction can be used with preschool-age and school-age children. Although identified as a priority in the Centennial Vision, youth have received substantially less attention in the sphere of scale and instrument development. The findings of this review suggest that future directions might emphasize instrument development for youth who receive occupational therapy services.
Three instruments focused on the perspective of families (Family L.I.F.E. [Looking Into Family Experiences], Life Participation for Parents, and the Health Promoting Activities Scale). AOTA has previously recognized the importance of caregivers and families in the lives of people with disabilities (AOTA, 2007b). The Children and Youth Ad Hoc Committee (AOTA, 2006) identified the need for research that would inform occupational therapy practice to address the roles, occupations, and participation of parents, siblings, and families of children and youth with disabilities. The findings of the current review suggest that, with only 3 published studies addressing instruments in this area of occupational therapy research and practice, further attention is indicated to successfully achieve AOTA’s Centennial Vision.
Of the 35 articles published in AJOT from January 2009 to September 2013, 10 reported the initial measurement properties of 9 new scales. Four of the 9 scales (McDonald Play Inventory, Sense and Self-Regulation Checklist, Comprehensive Observations of Proprioception, and Life Participation for Parents) were by U.S. authors, and 5 were generated by international authors: 4 from Israel (Adolescents and Adults Coordination Questionnaire, Quality of Life in School, Children’s Leisure Assessment Scale, and Do–Eat) and 1 from Australia (Health Promoting Activities Scale).
Practice Models, Theories, and Frameworks on Which Children and Youth Assessment Tools Are Based
The pediatric assessment tools included in the AJOT articles are based on a number of different practice models, theories, and frameworks. The most frequent ones were occupational performance (17.1%), ecological (17.1%), PEO (17.1%), perceptual–motor (17.1%), Model of Human Occupation (14.3%), ICF (23.0%), and the Occupational Therapy Practice Framework (11.4%). Several of the assessment tools were based on more than one practice model or theory, and several did not explicitly state on which practice theory they were based; thus, it had to be inferred.
Stage of Instrument Development and Level of Evidence of Children and Youth Assessment Tools
The extent of psychometric evaluation that an instrument has undergone contributes substantially to clinicians’ and researchers’ confidence in its utility (Fawcett, 2007). We used DeVellis’s (2003)  stages of instrument development to evaluate how rigorous and advanced studies were in the psychometric evaluation of their measurement properties. Of the studies, 54.2% (n = 19) reported details on both the reliability and the validity of pediatric tests and measures, whereas 20.0% (n = 7) focused solely on instrument reliability and 25.7% (n = 9) focused solely on instrument validity. Given that 10 articles published the initial measurement properties of 9 new pediatric assessment tools, it is not surprising that more than half of the articles reported both reliability and validity data. The most common combined stages of instrument evaluation reported by external authors were Stages 8 (validity) and 10 (evaluation of scale’s measurement properties by other than the scale’s authors; 37.1%). It is commendable that Stages 8 and 10 were most frequently reported, because it provides evidence that researchers other than the original test authors are critically evaluating the validity of pediatric instruments used by occupational therapists. This evaluation contributes to the overall body of psychometric knowledge about these assessments.
Reliability studies indicate the degree of consistency or repeatability that a test’s scores achieve between Time 1 and Time 2. Researchers often report several subtypes of reliability. The most common types of reliability reported in the AJOT articles were internal consistency (42.9%, n = 15), test–retest reliability (42.9%, n = 15), and interrater reliability (28.6%, n = 10). No information was reported about split-half reliability or alternate-form reliability of the 37 instruments.
Evaluations of validity indicate how well a test measures the ability, trait, or construct it purports to measure. The most common types of validity reported in the AJOT articles were discriminant validity (48.6%, n = 17) and construct validity (54.3%, n = 19). Other less frequently reported types included face validity (5.7%, n = 2), content validity (17.1%, n = 6), criterion-related validity (2.9%, n = 1), concurrent validity (20.0%, n = 7), and factorial validity (11.4%, n = 4). None of the studies were longitudinal studies that involved investigating the instrument’s predictive validity.
Although all articles provided advancement in the psychometric data for the instruments and measures they reported on, further studies are needed at the later stages of an instrument’s psychometric development, namely evaluation of scoring and constructs within the assessment tools using advanced statistical techniques such as Rasch analysis or structural equation modeling. Evaluation of instruments and wider application to similar, different, or contrasting populations from scale developers and other unrelated researchers are needed. Only 1 study (3%) reported details of an instrument’s responsiveness to change (sensitivity) over time, and no studies investigated changes in ratings over time to detect test sensitivity.
Many of the assessments reported in the 35 articles were designed to meet more than one purpose. For example, 29 assessments were clearly designed as descriptive measures, 32 were developed as discriminative measures, 21 could be used as predictive measures, and 27 were potential evaluative measures. None of the articles provided comprehensive and definitive evidence that the assessment was entirely capable of measuring a characteristic or issue for the purpose for which it was intended. Rather, all articles provided substantial evidence that the tools were contributing to a growing body of evidence supporting their psychometric properties.
No studies contributed Level I evidence. Only 1 study was Level II (two-group nonrandomized), and 1 study was Level IV (single-subject or descriptive study). Most of the articles on pediatric assessment tool articles (94.3%) were at Level III (one-group nonrandomized and noncontrolled).
In sum, analysis of the type of instruments under development, stage of psychometric evaluation, and level of evidence illuminates future directions for occupational therapy researchers who are involved in ongoing development of psychometrically sound and clinically useful tools. First, the type of instrument is an important issue in the ongoing psychometric evaluation of a tool, as well as of its clinical utility. Ensuing evaluation of a tool must systematically confirm the purpose for which it was developed. Considering that 21 (56.8%) of the instruments appeared to be under development for predictive purposes and 27 (73.0%) were under development for evaluative purposes, relatively few studies investigated aspects of the instruments that would confirm their utility for these purposes. Worldwide, occupational therapy must defend and substantiate the need, impact, and efficacy of its interventions; therefore, psychometrically robust predictive and evaluative instruments are urgently needed.
Second, existing instruments require ongoing and higher stage evaluation to provide evidence of their measurement properties. Studies that complete evaluation at Stages 7–10 are important and are featured in the articles published in AJOT in this review period. However, ongoing evaluation is needed and might be published in future issues of AJOT. Finally, in addition to ongoing psychometric evaluation of instruments is the need for more rigorous research designs that produce higher levels of evidence. Considering that the highest level of evidence in the 35 articles was Level II (Kao, Kramer, Liljenquist, Tian, & Coster, 2012), researchers in the field would be well advised to consider research designs that contribute to higher level evidence and publications. Such studies are more likely to require larger cohorts and funding levels.
PEO and ICF Classification of Children and Youth Assessment Tools
The tests and measures reported in the 35 articles were classified under the components of one practice model, the PEO model, and one practice framework, the ICF. Under the PEO model, 97.1% (n = 34) of the tools included the Person, 34.3% (n = 12) involved the Environment, and 54.3% (n = 19) included the Occupation. In other words, nearly all the pediatric assessments published in AJOT included aspects of the person from the PEO model.
The ICF components were distributed as follows: Body Functions and Structures, 71.4% (n = 25); Personal Factors, 22.9% (n = 8); Environmental Factors, 25.7% (n = 9); Activity, 51.4% (n = 18); and Participation, 31.4% (n = 11). By far the most common component of the ICF that was assessed with the pediatric instruments was Body Functions and Structures, with Activity also being assessed by more than 50% of the instruments. These findings suggest that the majority of instruments currently published in AJOT and under development for use with children continue to focus on traditional reductionist approaches to assessment involving components of children’s body functions and structures (as defined by the ICF).
In their review of 46 child- and youth-oriented articles published in AJOT during 2009–2010, Bendixen and Kreider (2011)  found that the distribution of the articles over the ICF domains were as follows: Body Functions and Structures, 31%; Personal Factors, 10%; Environmental Factors, 12%; Activity, 31%; and Participation, 16%. Of the 46 articles in the Bendixen and Kreider article, 12 focused on children and youth instrument development and testing. These 12 articles were classified in the following ICF categories: Body Functions and Structures, 25%; Personal Factors, 0%; Activity, 17%; and Participation, 58%. Bendixen and Kreider noted that “the higher levels of testing and development of Participation-level measures implies facilitation of the much-needed measurement of occupational performance in real-world life situations” (p. 356).
Similar to other reviews of AJOT publications, we found that although substantial attention was paid to PEO or ICF concepts of Activity and Occupation, a particular paucity of instruments under development and review were operationalized to evaluate either Participation or Environment. Participation has long been an important aspect of the assessment and intervention process for children with disabilities and other occupational therapy clients (King et al., 2003; Law, 2002). Growing evidence has supported the importance and influence of Environmental Factors, rather than issues around Body Functions and Structures, with regard to the Participation of children and youth in life situations at home, at school, and in the community (Coster et al., 2013; Fauconnier et al., 2009; Heah, Case, McGuire, & Law, 2007; Law et al., 2004).
In response to evidence suggesting that children and youth with disabilities require interventions aimed at altering environmental and contextual factors, occupational therapy as a profession has commenced developing instruments that assess and measure participation (such as the Participation and Environment Measure for Children and Youth; Coster et al., 2012, 2013) or an aspect of environmental support that enables participation (such as the Assistance to Participate Scale; Bourke-Taylor, Law, Howie, & Pallant, 2009; Bourke-Taylor & Pallant, 2013). The challenges of developing instruments that measure participation, involvement, enjoyment, and performance of children and youth with disabilities have been described (Coster, 2006b; Coster & Khetani, 2008) and continue to be discussed inside and outside of the profession (Granlund, 2013; King, 2013; Raghavendra, 2013). Finally, given that the AOTA Child and Youth Ad Hoc Committee (AOTA, 2006) highlighted the importance of research investigating the participation or consequences of lack of participation for children and youth in 4 of its 11 targeted areas, we recommend future support for the development and evaluation of measures of participation in future AJOT issues.
Limitations
Limitations of this review include that the classification of the 35 articles includes both subjective and objective judgment on our part. We did complete our ratings independently and then compared them to minimize influencing each other. Differences of opinion were negotiated between us until we reached a consensus.
We evaluated 37 instruments from the perspective of the information provided in the 35 articles. We did not otherwise confirm facts and data because the aim of this article was to summarize, synthesize, and comment on the research published in AJOT to date. Therefore, the descriptions of some instruments may have limitations and minor errors because we did not review the original test manuals, nor did we conduct a literature search to locate, peruse, and evaluate research published in other journals or manuals. Consequently, clinicians and researchers using this article to determine the current status of development of individual tools are encouraged to perform literature searches for up-to-date subsequent studies and contact the authors of the instrument. Researchers and clinicians are also advised to liaise with and consult colleagues about the clinical utility and practicalities of different instruments in their work setting and for their client group.
Recommendations for Occupational Therapy Practitioners
Occupational therapy practitioners who work with children and youth have both the need and the professional responsibility to access psychometrically vigorous tests, measures, and instruments. As Brown (2009)  asserted, “If we [occupational therapists] are using assessment tools that do not have strong psychometric properties, then the test results that we use to inform our clinical reasoning and intervention planning are not sound or valid either” (p. 519). Practitioners need access to a variety of tools depending on the client group (specific disability, age group, ethnicity, etc.), individual therapists’ points of reference (MOHO, PEO, perceptual–motor, the Framework, cognitive–behavioral, etc.), and the practice setting (early intervention, school, private practice, rehabilitation setting, youth-oriented service, mental health community service for children and adolescents, etc.). This review demonstrates that a diverse set of assessment tools to address practitioners’ needs is being developed and evaluated.
AJOT has published studies that demonstrate the ongoing development of a substantial number of occupational therapy–specific assessment tools. Clinicians may feel confident that researchers and clinicians are working in collaboration to increase the number of psychometrically valid, reliable, sensitive, descriptive, discriminative, predictive, and evaluative tools. However, clinicians have the responsibility to use instruments for the purposes for which they are intended and to understand what validity and reliability studies have been completed and what still needs to be completed. For example, it is imperative that a test designed to be descriptive and discriminatory be used for such purposes and not as an evaluative or predictive test. Researchers and clinicians alike need adequate knowledge of assessment tools to critically evaluate research such as the AJOT articles included in this review. Moreover, clinicians might be encouraged to become involved in research or collaborate with researchers in the field to promote development of tests and measures that are clinically useful, practical, responsive, reliable, and valid.
Recommendations for Researchers
Researchers in the field of occupational therapy might be commended for taking charge of a discipline-specific instrument development and classification system (e.g., Manual Ability Classification System). The results of this review indicate that more work remains to be done, specifically in the areas of providing more rigorous evaluation of tools to obtain higher levels of evidence and evaluating existing tools in the field to provide reliability and validity studies that are conducted by experts other than the authors. Similarly, wider application of the tools and instruments to other populations (e.g., age, diagnosis, disability) is essential to inform practitioners about their clinical utility among other children and youth.
Other recommendations were described in the discussion and include the need for continued development of instruments that will measure salient aspects of the environment as well as operationalizing and measuring participation for children and youth who receive occupational therapy services. Within the profession, a need also exists for further development of self-report or rated scales that are implicitly client centered and for outcome measures that are otherwise described as evaluative scales or instruments. Moreover, we suggest that occupational therapy researchers use the ICF–CY (WHO, 2007) as a point of reference when developing new assessment tools because it more specifically focuses on the participation and function of children and adolescents than the initial version of the ICF.
Summary and Conclusion
We extracted and summarized 35 articles published in AJOT between January 2009 and September 2013 that focused on the Centennial Vision categories of both children and youth and instrument development and testing. The articles addressed some aspect of the psychometric development of 37 occupational therapy assessments or classification scales.
The majority of the articles contained Level III evidence. The most common types of reliability reported in the articles were internal consistency, test–retest reliability, and interrater reliability, and the most common types of validity reported were discriminant validity and construct validity. Most of pediatric assessment tools were designed for children between ages 5 and 12. The practice models and theories that the pediatric assessment tools were most frequently based on were occupational performance, ecological, PEO, perceptual–motor, MOHO, ICF, and the Framework. Many of the assessments were designed to meet more than one purpose; however, the two most common purposes were descriptive and discriminative.
We recommend seven preferences for future research articles addressing the Centennial Vision: (1) increased instrument development addressing younger children, youth, and families; (2) more rigorous research designs to contribute stronger research evidence; (3) increased client-centered or self- or proxy report measures; (4) higher level evaluation of instruments, including longitudinal studies, to address predictive and evaluative instrument properties; (5) international collaborations to further develop instruments; (6) consolidation and expansion of instruments that serve to address frameworks or models; and (7) emphasis on the publication of instruments that target measurement of the participation of children and youth in meaningful occupations and life roles in home, school, and community environments.
The occupational therapy profession is responsible for providing effective and best practice, value for money, and valuable services to all occupational therapy clients. In the context of children and youth, the client may be the child or youth, the family, the school, the community, the agency, or any other natural environment in which the child or youth participates in his or her daily occupations. AOTA’s (2006)  Children and Youth Ad Hoc Committee targeted 11 areas for research development, and all of them rely on the development and evaluation of psychometrically sound measurement instruments.
As described by Moyers (2010), harm is more than actually causing injury. Harm also results when “our clients receive ineffective intervention or intervention not as effective as an alternative method in improving occupational performance and participation in daily life” (p. 457). It has been more than a decade since Cusick (2001)  encouraged occupational therapists to reflect,

Am I doing the right thing, in the right way, with the right person, at the right time, in the right place, for the right result and am I the right person to be doing this . . . and is it at the right cost? (p. 103)

Instrumentation permits evaluation that guides intervention, substantiates the conceptual models that underpin the profession, and provides objective measurement of the efficacy and effectiveness of occupational therapy interventions and services. Further development and evaluation of stellar occupation-focused, participation-based tests, measures, and instruments is imperative to the future of the profession.
*All tables appear at the end of this article, after the references.
All tables appear at the end of this article, after the references.×
Indicates studies that were reviewed for this article.
Indicates studies that were reviewed for this article.×
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†Mulcahey, M. J., Merenda, L., Tian, F., Kozin, S., James, M., Gogola, G., & Ni, P. (2013). Computer adaptive test approach to the assessment of children and youth with brachial plexus birth palsy. American Journal of Occupational Therapy, 67, 524–533. http://dx.doi.org/10.5014/ajot.2013.008037 [Article] [PubMed]
†Mulcahey, M. J., Merenda, L., Tian, F., Kozin, S., James, M., Gogola, G., & Ni, P. (2013). Computer adaptive test approach to the assessment of children and youth with brachial plexus birth palsy. American Journal of Occupational Therapy, 67, 524–533. http://dx.doi.org/10.5014/ajot.2013.008037 [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.2010.09041 [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.2010.09041 [Article] [PubMed]×
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†Ohl, A. M., Butler, C., Carney, C., Jarmel, E., Palmieri, M., Pottheiser, D., & Smith, T. (2012). 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. M., Butler, C., Carney, C., Jarmel, E., Palmieri, M., Pottheiser, D., & Smith, T. (2012). 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]×
†Parham, L. D., Roley, S. S., May-Benson, T. A., Koomar, J., Brett-Green, B., Burke, J. P., … Schaaf, R. C. (2011). Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration intervention. American Journal of Occupational Therapy, 65, 133–142. http://dx.doi.org/10.5014/ajot.2011.000745 [Article] [PubMed]
†Parham, L. D., Roley, S. S., May-Benson, T. A., Koomar, J., Brett-Green, B., Burke, J. P., … Schaaf, R. C. (2011). Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration intervention. American Journal of Occupational Therapy, 65, 133–142. http://dx.doi.org/10.5014/ajot.2011.000745 [Article] [PubMed]×
†Potvin, M., Snider, L. M., Prelock, P. A., Kehayia, E., & Wood-Dauphinee, S. (2013). Psychometrics of the Children’s Assessment of Participation and Enjoyment for those 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., Snider, L. M., Prelock, P. A., Kehayia, E., & Wood-Dauphinee, S. (2013). Psychometrics of the Children’s Assessment of Participation and Enjoyment for those with high functioning autism. American Journal of Occupational Therapy, 67, 209–217. http://dx.doi.org/10.5014/ajot.2013.006288 [Article] [PubMed]×
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Rameckers, E. A., Duysens, J., Speth, L. A., Vles, H. J., & Smits-Engelsman, B. C. (2010). Effect of addition of botulinum toxin-A to standardized therapy for dynamic manual skills measured with kinematic aiming tasks in children with spastic hemiplegia. Journal of Rehabilitation Medicine, 42, 332–338. [Article] [PubMed]×
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Rintala, D. H., Uttermohlen, D. M., Buck, E. L., Hanover, D., Alexander, J. L., & Norris-Baker, C. (1984). Self-Observation and Report Technique: Description and clinical applications. Functional assessment in rehabilitation, Baltimore: Paul H. Brookes 205–221.×
†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]×
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†Silva, L. M., & Schalock, M. (2012). Sensory and Self-Regulation Checklist: Initial psychometric evidence and findings. American Journal of Occupational Therapy, 66, 177–186. http://dx.doi.org/10.5014/ajot.2012.001578 [Article] [PubMed]
†Silva, L. M., & Schalock, M. (2012). Sensory and Self-Regulation Checklist: Initial psychometric evidence and findings. American Journal of Occupational Therapy, 66, 177–186. http://dx.doi.org/10.5014/ajot.2012.001578 [Article] [PubMed]×
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Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). The Vineland Adaptive Behavior Scales. 2nd ed. Circle Pines, MN: American Guidance Service.×
Speth, L. A., Leffers, P., Janssen-Potten, Y. J., & Vles, J. S. (2005). Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: A randomized trial in children receiving intensive therapy. Developmental Medicine and Child Neurology, 47, 468–473. http://dx.doi.org/10.1017/S0012162205000903 [Article] [PubMed]
Speth, L. A., Leffers, P., Janssen-Potten, Y. J., & Vles, J. S. (2005). Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: A randomized trial in children receiving intensive therapy. Developmental Medicine and Child Neurology, 47, 468–473. http://dx.doi.org/10.1017/S0012162205000903 [Article] [PubMed]×
†Spirtos, M., O’Mahony, P., & Malone, J. (2011). Interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function for children with hemiplegic cerebral palsy. American Journal of Occupational Therapy, 65, 378–383. http://dx.doi.org/10.5014/ajot.2011.001222 [Article] [PubMed]
†Spirtos, M., O’Mahony, P., & Malone, J. (2011). Interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function for children with hemiplegic cerebral palsy. American Journal of Occupational Therapy, 65, 378–383. http://dx.doi.org/10.5014/ajot.2011.001222 [Article] [PubMed]×
†Taylor, R., Lee, S. W., Kramer, J., Shirashi, Y., & Kielhofner, G. (2011). A psychometric study of the Occupational Self Assessment with post-infectious adolescents. American Journal of Occupational Therapy, 65, e20–e28. http://dx.doi.org/10.5014/ajot.2011.000778 [Article] [PubMed]
†Taylor, R., Lee, S. W., Kramer, J., Shirashi, Y., & Kielhofner, G. (2011). A psychometric study of the Occupational Self Assessment with post-infectious adolescents. American Journal of Occupational Therapy, 65, e20–e28. http://dx.doi.org/10.5014/ajot.2011.000778 [Article] [PubMed]×
†Toglia, J., & Berg, C. (2013). Performance-based measure of executive function: Comparison of community and at-risk youth. American Journal of Occupational Therapy, 67, 515–523. http://dx.doi.org/10.5014/ajot.2013.008482 [Article] [PubMed]
†Toglia, J., & Berg, C. (2013). Performance-based measure of executive function: Comparison of community and at-risk youth. American Journal of Occupational Therapy, 67, 515–523. http://dx.doi.org/10.5014/ajot.2013.008482 [Article] [PubMed]×
†Tsai, L.-T., Lin, K.-C., Liao, H.-F., & Hsieh, C.-L. (2009). Reliability of two visual–perceptual tests for children with cerebral palsy. American Journal of Occupational Therapy, 63, 473–480. http://dx.doi.org/10.5014/ajot.63.4.473 [Article] [PubMed]
†Tsai, L.-T., Lin, K.-C., Liao, H.-F., & Hsieh, C.-L. (2009). Reliability of two visual–perceptual tests for children with cerebral palsy. American Journal of Occupational Therapy, 63, 473–480. http://dx.doi.org/10.5014/ajot.63.4.473 [Article] [PubMed]×
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Uniform Data System for Medical Rehabilitation. (2006). WeeFIM II system clinical guide, Version 6.0. Amherst, NY: Author.×
†Vanvuchelen, M., Roeyers, H., & De Weerdt, W. (2011). Objectivity and stability of the Preschool Imitation and Praxis Scale. American Journal of Occupational Therapy, 65, 569–577. http://dx.doi.org/10.5014/ajot.2010.ajot00000414 [Article] [PubMed]
†Vanvuchelen, M., Roeyers, H., & De Weerdt, W. (2011). Objectivity and stability of the Preschool Imitation and Praxis Scale. American Journal of Occupational Therapy, 65, 569–577. http://dx.doi.org/10.5014/ajot.2010.ajot00000414 [Article] [PubMed]×
Wallen, M., O’Flaherty, S. J., & Waugh, M. C. (2007). Functional outcomes of intramuscular botulinum toxin type a and occupational therapy in the upper limbs of children with cerebral palsy: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 88, 1–10. http://dx.doi.org/10.1016/j.apmr.2006.10.017 [Article] [PubMed]
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†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. (2007). Quality of Life at School (QoLS) Questionnaire.Unpublished measure, School of Occupational Therapy of Hadassah and the Hebrew University, Jerusalem, Israel
Weintraub, N., & Bar-Haim Erez, A. (2007). Quality of Life at School (QoLS) Questionnaire.Unpublished measure, School of Occupational Therapy of Hadassah and the Hebrew University, Jerusalem, Israel×
†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]×
Whitney, R., & Hilton, C. L. (2013). Centennial Vision—Intervention effectiveness for children and youth. American Journal of Occupational Therapy, 67, e154–e165. [Article] [PubMed]
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World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.×
World Health Organization. (2007). International classification of functioning, disability and health: Child and youth version. Geneva: Author.
World Health Organization. (2007). International classification of functioning, disability and health: Child and youth version. Geneva: Author.×
Table 1.
Summary of Articles Describing Development and Testing of Instruments for Children and Youth, Published in the American Journal of Occupational Therapy, January 2009–September 2013
Summary of Articles Describing Development and Testing of Instruments for Children and Youth, Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Author/YearStudy ObjectivesDesign/Participants/Recruitment Strategy/Statistics UsedInstrument/Tool Being InvestigatedMeasurement Characteristics InvestigatedResults
Blanche, Bodison, Chang, & Reinoso (2012) To document the development of the COP, an instrument for identifying proprioceptive processing issues in children
  • Design
  • Prospective scale design over 3 phases: (1) scale construction and content validity, (2) establishment of validity and reliability, and (3) factor analysis
  • Participants
  • 130 children with known developmental disabilities ages 2–9 yr
  • Recruitment
  • Not reported
  • Statistics Used
  • Factor analysis, Pearson’s correlation coefficient, ICC
COP
  • • Interrater reliability
  • • Face validity
  • • Content validity
  • • Construct validity
  • • Criterion validity
  • • Factor analysis
  • Content validity: 18 items were originally derived from the existing literature; 9 OTs who were experts in sensory integration rated the COP items; 4 items were rejected.
  • Construct validity: Children with developmental disabilities had significantly higher total scores and individual item scores on the COP than children without proprioceptive difficulties (ps < .01) except for Item 17 (overly passive; p = .12).
  • Criterion validity: Established through comparison of the COP with the Sensory Processing Measure–Home Form and the Kinesthesia and Standing and Walking Balance subtests of the Sensory Integration and Praxis Test; results indicated that the COP measured 2 distinct influences on proprioception functions: motor performance and sensory seeking.
  • Interrater reliability: Four OTs rated 4 20-min videotapes; total score ICC between the 4 raters was .91, indicating that variation among the raters was minimal.
  • Exploratory factor analysis: Results of the factor analysis revealed 4 factors: Tone and Joint Alignment (Factor 1), Behavioral Manifestations (Factor 2), Postural Motor (Factor 3), and Motor Planning (Factor 4)
Blanche, Reinoso, Chang, & Bodison (2012) To describe the proprioceptive difficulties of children with ASD
  • Design
  • Retrospective group-comparison design
  • Participants
  • 32 children with ASD (no additional motor difficulties), 26 children with developmental disabilities (excluding ASD), 28 typically developing children (matched control)
  • Recruitment
  • De-identified data were collected from a chart review at 2 occupational therapy clinics. The de-identified data of the matched control children were collected in a natural setting.
  • Statistics
  • ANOVA for the 3-group comparison and a post hoc analysis with Tukey-Kramer method for pairwise comparison were applied.
The COP, a scale that measures proprioceptive processing in children by direct observation• Ability of COP to discriminate between groups of participants with known differences (discriminant validity)
  • • Children with ASD present with proprioceptive processing difficulties that are different from those of typically developing children and children with developmental delays.
  • • The 3 groups were significantly different on all 16 of the individual COP items, on the total COP score, and on the 4 COP factors.
  • • Post hoc analysis indicated that children with ASD and developmental disabilities were not significantly different on 4 COP items (feedback-related motor planning, tiptoeing, pushing other or objects, and crashing, falling, and running) and on 2 COP factors (Factor 1, Tone and Joint Alignment, and Factor 3, Postural Control and Grading of Force).
Bourke-Taylor, Law, Howie, & Pallant (2012) To describe the initial development and psychometric evaluation of the HPAS
  • Design
  • Mixed methodology using an initial qualitative study and experts to generate scale items and mail out questionnaire with follow-up phone call to collect data; cross-sectional research design including within-group comparisons
  • Participants
  • 152 mothers of children with developmental disabilities in Victoria, New South Wales, Australia
  • Recruitment
  • Self-selected sampling, including a snowball design (“Recruit a girlfriend”). Inclusion criteria: mother of a school-aged child with a disability
  • Statistics
  • Descriptive, correlations, evaluation of normalcy, factor analysis, and Mann-Whitney U comparisons
The HPAS, which measures the frequency with which mothers caring for a school-age child with a disability participate in self-selected leisure occupations
  • • Construct validity
  • • Discriminant validity
  • • Internal consistency
  • • Factor structure
  • • The HPAS showed good internal consistency (Cronbach’s α = .78).
  • • Construct validity was supported by moderate correlations with subjective maternal mental and general health (Short Form–36, Version 2) and by differentiation in leisure participation among groups of mothers reporting differences in mental health status and sleep interruption.
Brossard-Racine, Mazer, Julien, & Majnemer (2012) To determine ETCH scores for cutoff points to determine children who do and do not require intervention for handwriting issues and to determine the percentage of change for clinical significance
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 34 therapists judged and compared 35 pairs of handwriting samples from 26 children
  • Recruitment
  • Convenience sample of pediatric OTs working in greater Montreal, Quebec
  • OTs were included if they had >1 yr experience working with children with handwriting problems.
  • The handwriting samples were obtained from a group of children involved in a cohort study of school-age children with attention deficit hyperactivity disorder. Children were ages 7–9 yr and routinely used manuscript writing.
  • Statistics
  • ROC analyses, minimal clinically important difference (MCID), descriptive statistics, Shrout-Fleiss reliability ICC
ETCH
  • • Discriminant validity
  • • Interrater reliability
  • Discriminative validity: Word legibility had a crude area under the curve of .86 (95% CI [.84, .88]) and an adjusted area of .96 (95% CI [.95, .97]). Letter legibility had a crude area under the curve of .82 (95% CI [.80, .84]) and an adjusted area of .96 (95% CI = .95, .97).
  • • Interrater reliability between therapists was relatively good (ICC = 5.53).
  • • A difference of 10.0%–12.5% for total word legibility and 6.0%–7.0% for total letter legibility were found as cutoff points for MCID.
  • • For children in Grades 2 and 3, 75.0% total word legibility and 76.0% total letter legibility on the ETCH–Manuscript are suggested as the cutoff values to discriminate between children with handwriting legibility difficulties who should be seen in rehabilitation for evaluation and treatment and those who have no such difficulties.
Brown, Unsworth, & Lyons (2009) To examine the factor structure of 4 visual-motor integration instruments through factor analysis
  • Design
  • Prospective cross-sectional evaluation
  • Participants
  • 400 children ages 5–12 yr in metropolitan Melbourne, Victoria, Australia
  • Recruitment
  • Letters were sent to 955 children in 6 participating state schools.
  • Statistics
  • Factor analysis, descriptive statistics, Cronbach’s α
  • • TVMI
  • • VMI
  • • Test of Visual-Motor Skills–Revised (TVSM–R)
  • • SVMPT
  • • Construct validity
  • • Internal consistency
  • • Cronbach’s αs for the VMI, TVMI, TVMS–R, and SVMPT were all >.80.
  • • VMI displayed a 6-factor structure.
  • • TVMI displayed a 3-factor structure.
  • • TVSM–R displayed a 4-factor structure.
  • • SVMPT displayed a 3-factor structure.
  • • All 4 visual–motor integration instruments exhibited multidimensionality.
Chien, Brown, & McDonald (2010) To assess the interrater and test–retest reliability of the Assessment of Children’s Hand Skills (ACHS)
  • Design
  • Prospective, reliability study
  • Participants
  • 54 children participated in the study; 30 were in the interrater reliability component of the study, and 44 were in the test–retest reliability part of the study.
  • Recruitment
  • A convenience sampling approach was used; of the 54 participants, 30 were typically developing children who were recruited from 1 child care center and 2 preschools in southern metropolitan regions of Melbourne, Victoria, Australia; the remaining 24 children were recruited from 2 special schools if they presented with hand skill difficulties caused by disorders such as ASD, Down syndrome, or developmental delay.
  • Statistics
  • Cronbach’s α, Spearman’s coefficient, weighted κ
ACHS
  • • Interrater reliability
  • • Test–retest reliability
  • • Content validity
  • • The ACHS’s test–retest reliability was satisfactory at the individual item level (.42 < κ > .79) and the total scale level (Spearman’s r = .78, p < .01).
  • • Moderate interrater agreement of the total scale scores was demonstrated (r = .63, p < .01), but individual items exhibited varied interrater agreement.
  • • The ACHS’s content validity was established through an extensive review of the literature, the conceptualization of a hand skill framework on which to base the ACHS skill items, several rounds of review and revision based on expert feedback, and preliminary field testing.
Duff & Goyen (2010) To determine the reliability and validity of the ETCH–Cursive (ETCH-C) using the general scoring criteria
  • Design
  • Cross-sectional, semirandomized reliability and validity study
  • Participants
  • Purposive sampling from randomly selected schools. Participants were 63 typically developing 10- to 12-yr-old children from 10 schools in Sydney, New South Wales, Australia: 33 participants with handwriting difficulties and 30 without.
  • Recruitment
  • Asked teachers in randomly selected schools to identify Grade 5 and 6 students with and without handwriting difficulties.
  • Statistics
  • Descriptive statistics, ICC, ROC, Pearson correlation coefficient, ANOVA, Tukey’s post hoc analysis
ETCH-C, a standardized assessment tool to evaluate cursive handwriting
  • • Interrater reliability
  • • Intrarater reliability
  • • Test–retest reliability
  • • Discriminant validity
  • • Concurrent validity
  • Reliability: ICCs for intrarater reliability ranged from .55 to .80 for the 3 subscales. ICCs for interrater reliability ranged from .57 to .84 for the 3 subscales. ICC test–retest reliability ranged from .24 to .65 for the 3 subscales.
  • Discriminant validity: 3 cutoff scores were determined to differentiate between students with and without handwriting difficulties: total letter score cutoff = 92; total word score cutoff = 85; total number score cutoff = 95.
  • Concurrent validity: ETCH-C total letter score was moderately correlated with the Test of Legible Handwriting (r = .6, p < .001).
Fingerhut (2013) To psychometrically evaluate and continue ongoing development of the LPP tool
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 162 parents or caregivers of children with special needs receiving intervention at a private practice clinic
  • Recruitment
  • Convenience sampling
  • Statistics
  • Descriptive statistics, nonparametric Kruskal–Wallis one-way ANOVA, Spearman rank-order analysis, factor analysis
LPP, a measurement tool to facilitate family-centered pediatric practice
  • • Internal consistency
  • • Test–retest reliability
  • • Construct validity
  • Internal structure: 2-factor solution, resulting in 2 subscales, Satisfaction With Efficiency (Cronbach’s α = .90) and Satisfaction With Effectiveness (Cronbach’s α = .70). Internal consistency for total scale was strong (Cronbach’s α = .90).
  • • Test–retest reliability (r = .89)
  • • Construct validity supported through moderate inverse correlation (r = −.51) between LPP and Parenting Stress Index scores
Gantschnig, Page, Nilsson, & Fisher (2013) To detect differences in ADLs between children with and without disabilities
  • Design
  • Retrospective, involving secondary data analysis of existing database
  • Participants
  • AMPS database used 10,998 4- to 15-yr-old children with and without disabilities from 11 world regions.
  • Recruitment
  • Convenience sampling from existing database
  • Statistics
  • Descriptive statistics, t tests, regression analysis
AMPS, a standardized observational assessment that measures quality of motor processing ability during ADLs
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: Significant main effect for age, β = .139, confidence interval [.129, .149], p < .001, t = 26.187, R2 =.361. Significant differences were found in ADL performance between children with and without disabilities on the basis of motor ability at every age but 4 yr with effect sizes ranging from small to large. Significant differences were found in ADL performance between children with and without disabilities on the basis of processing ability at every age, with effect sizes ranging from moderate to very large. ADL motor and processing scores were significantly higher for typically developing children.
  • Construct validity: The AMPS can detect and measure motor and processing ability differences among children with and without disabilities from age 5 yr, with increasing differences as children age (≤15 yr). Processing ability differences can be detected at age 4 yr.
Griswold & Townsend (2012) To determine the sensitivity of the Evaluation of Social Interaction (ESI) to discriminate between children with and without disability as they engage in social exchanges in a natural context with typical social partners
  • Design
  • Quasi-experimental validity study
  • Participants
  • 46 children (34 boys, 12 girls) between ages 2 and 12 yr, half typically developing and half with a disability
  • Recruitment
  • A letter requesting participation consent was sent to parents of children attending preschool, kindergarten, readiness, 1st-grade, and 2nd-grade classrooms at a local elementary school in the northwestern United States.
  • 23 pairs of age- and gender-matched children with and without a disability were included in the results.
  • Statistics
  • Raw scores converted to log-odd probability units, paired t test
ESI• Discriminant validity to differentiate between children with and without disability• Paired t-test analysis revealed a statistically significant difference, t(22) = −4.065, p = .001, in the quality of social interaction for children with and without a disability, indicating sensitivity to discriminate between groups.
Honaker, Rosello, & Candler (2012) To examine the test–retest reliability and construct validity of the Family L.I.F.E. (Looking Into Family Experiences) and to examine the perceived efficiency, effectiveness, and satisfaction ratings for family occupations
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • Interview of 15 families with a child with ASD (4 girls, 11 boys, between ages 4 and 11 yr 2 mo). Two families eliminated from data collection.
  • Recruitment
  • Participants were a self-selected convenience sample of 15 families from 4 venues.
  • Statistics
  • Wilcoxon signed-rank test, Spearman’s ρ
Family L.I.F.E.
  • • Test–retest reliability
  • • Internal consistency
  • • Internal consistency was good (Cronbach’s α =.9), and test– retest reliability was strong (r = .89).
  • • 92% of the families identified the same occupations as important at test and retest, 1 wk apart.
Hwang & Davies (2009) To examine the internal construct validity of the School Function Assessment (SFA) by examining its unidimensionality and hierarchical structure; the study focused on Part III, known as the Activity Performance Scales.
  • Design
  • Prospective 2-group, nonrandomized, noncontrolled design
  • Participants
  • 64 elementary school children (35 with disabilities, 29 without disabilities) between ages 6 and 15 yr
  • Recruitment
  • Participants were recruited from several school districts in western New York via convenience sampling.
  • Statistics
  • Rasch analysis
SFA
  • • Internal validity
  • • Construct validity
  • • 252 items (of 266) on the Activity Performance Scales met criterion set for Rasch goodness-of-fit statistics.
  • • 15 of 18 of the SFA’s Activity Performance Scales were found to be unidimensional, measuring a single construct.
  • • Item difficulty analysis yielded a hierarchical structure of the Activity Performance Scales similar to the existing layout of the SFA.
Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen (2013) To determine norm scores for the Box and Block Test for children (3–10 yr)
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 215 typically developing Dutch children ages 3–10 yr who were representative on socioeconomic variables and ethnicity
  • Recruitment
  • Convenience sampling; children were recruited through local schools and playgroups
  • Statistics
  • Descriptive statistics, Spearman’s or Pearson’s correlation coefficients, ICCs, t tests
Box and Block test for children (a standardized gross manual dexterity test)
  • • Test–retest reliability
  • • Discriminant validity
  • • Concurrent validity
  • • Construct validity
  • Discriminant validity: No difference between boys and girls or left- and right-handed children within groups of children stratified for age (i.e., 3-year-olds, 4-year-olds). A significant and large effect size was found for children aged 3–8 yr for both the dominant, F(7, 207) = 77.07, p < .001, r = .82, and nondominant hands, F(7, 207) = 77.07, p < .001, r = .85.
  • Test-retest reliability: ICC = .85
  • Concurrent validity: correlations between both dominant- and nondominant-hand Box and Block Test scores and the Movement Assessment Battery for Children–2 manual dexterity subtests were moderate to strong for children ages 3–6 yr and weak to moderate for children ages 7–10 yr.
  • Construct validity: Findings support the use of the Box and Block test as a measure of gross manual dexterity among children ages 3–10 yr.
Josman, Abdallah, & Engel-Yeger (2011) To use the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) to measure cultural and sociodemographic effects on cognitive skills in 2 groups of children
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 226 typically developing children representative of Israeli census: 101 Jewish Israeli children and 125 Muslim Palestinian children
  • Recruitment
  • Convenience sampling from Israeli schools in which OTs trained in the administration of the LOTCA worked
  • Statistics
  • Descriptive statistics, MANOVA between identified groups
LOTCA, a standardized assessment of cognitive ability
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: The LOTCA detected differences between groups of children with known differences in culture, parental education level, years of schooling, and age of the child.
  • Construct validity: The LOTCA’s validity as a tool that measures the cognitive function of young children was supported.
Josman, Goffer, & Rosenblum (2010) To examine reliability and validity of the Do–Eat assessment tool for children with DCD
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 59 children aged 5–6.5 yr (30 diagnosed with DCD as determined by Movement Assessment Battery for Children scores below the 15th percentile)
  • Recruitment
  • Convenience sample of 5- and 6-year-old children; 30 children with a diagnosis of DCD and 29 typically developing children
  • Statistics
  • Descriptive statistics, Mann–Whitney U test, Cronbach’s α, t tests, Pearson correlation coefficients
Do-Eat: Dynamic assessment of child making a sandwich, preparing chocolate milk, and completing a handwriting task in the child’s natural context
  • • Internal consistency
  • • Interrater reliability
  • • Construct validity
  • • Concurrent validity
  • Content and face validity: Process of literature review and expert consultation—5 OTs and 5 expert consultants
  • Interrater reliability: High among 3 blinded occupational therapy assessors (rs = .92).
  • Internal consistency: High for Do-Eat components: performance skills (Cronbach’s α = .93), sensory-motor skill (Cronbach’s α = .90), and executive function (Cronbach’s α = .89).
  • Construct validity: Significant between-groups differences on the Do-Eat, t(57) = 14.09, p < .001, and the Parent Questionnaire, t(57) = 3.64, p < .001.
  • Concurrent validity: Significant correlation (r = −.086, p < .001) between children’s scores on sensory-motor component of the Do-Eat and Movement Assessment Battery for Children final score.
Kao, Kramer, Liljenquist, Tian, & Coster (2012) To compare the functional performance of children and youth with autism, developmental disabilities, and no disability using the revised PEDI–Computer Adaptive Test (PEDI–CAT) item banks
  • Design
  • Cross-sectional, nonrandomized, secondary data analysis, reliability, and validity study
  • Participants
  • Participants were purposively sampled from an existing nationally representative data set (N = 2,205) that included 108 children diagnosed with ASD and 150 children with intellectual and developmental disabilities (IDD). Three age groups were selected from the dataset—5 years, 10 years, and 15 years—although the sample size for each group was not reported.
  • Recruitment
  • Representational sampling of families with 1 or more child younger than age 21 yr and data collected via the Internet
  • Statistics
  • Descriptive statistics, analysis of covariance
PEDI–CAT
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: Social–cognitive domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001), but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age.
  • • Daily activities domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001), but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age.
  • • Responsibility domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001) but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age. The largest difference between children with ASD and typically developing children was found to occur at age 15 yr.
  • Construct validity: This study supports the construct validity of the PEDI–CAT to differentiate between children aged 10 and 15 yr with and without disability. The PEDI–CAT did not differentiate between children with and without disability at age 5 yr. Moreover, no significant differences were found between the scores of children with ASD or IDD on any domain, indicating that the PEDI–CAT is not a disability-specific measure.
Kramer, Kielhofner, & Smith (2010) To determine the construct validity, reliability, and goodness of fit of the Child Occupational Self Assessment (COSA) and other factors (child factors, values, administration time, and application)
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 98 practitioners (OTs and physical therapists) and researchers from a central database completed the COSA on 502 children with disabilities between ages 6 and 17 yr from 5 countries.
  • Recruitment
  • Researchers and clinicians from around the world were contacted through email distribution lists and website announcements and during professional meetings and training and invited to share children’s COSA responses with a central database.
  • Statistics
  • Descriptive statistics of population, demographic information, Rasch Partial Credit model, parametric and nonparametric statistics to obtain validity evidence
COSA, with 2 scales, Occupational Competence and Values
  • • Internal reliability
  • • Item fit
  • • Internal and external validity
  • • Construct validity
  • • Concurrent validity
  • • Most children’s responses to the COSA can be validly interpreted as indicators of occupational competence and value for everyday activities.
  • • The COSA has good construct validity in the following areas: content, structural, and substantive validity as given by item and child fit statistics and unidimensionality evaluation.
  • • Evidence for external validity was mixed, depending on some demographic and assessment administration variables.
  • Item fit: All Occupational Competence items had positive point-biserial correlations ranging from .30 to .53. Children reported the least amount of competence and the most difficulty for self-regulation and cognitive tasks, as well as chores. The item separation index was 6.18, which translates to 8.57 strata; the reliability of item separation was .97.
  • Values items: All items had positive point-biserial correlations ranging from .42 to .61. Children were less likely to indicate value for activities typically regulated and demanded by adults. Values item separation across the continuum was 3.96, which transforms to 5.6 strata; item separation reliability across that continuum was .94.
  • Child fit: Of 502 children who completed the Occupational Competence ratings, 59 did not meet fit requirements (11.75%). All t tests and ANOVAs were nonsignificant using a Bonferroni-adjusted α of .01.
  • Person Fit to Values items: Of 496 children who responded to the Values rating scale, 76 did not meet fit requirements (15.3%).
Kuijper, van der Wilden, Ketelaar, & Gorter (2010) To investigate the relationship between the manual abilities of children with cerebral palsy (as categorized using the Manual Ability Classification System [MACS]) and caregiver assistance using the Self-Care scale of the PEDI and to assess the interrater reliability of the MACS
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 61 Dutch children with cerebral palsy between ages 5 and 14 yr
  • Parental consent was obtained.
  • Recruitment
  • Convenience sampling of children attending specialized schools
  • Statistics
  • Descriptive statistics, Spearman’s rank-order correlation coefficient (ρ), linear weighted κ
MACS, Self-Care domain of the PEDI Part 2, Caregiver Assistance scale• Construct validity
  • • The MACS categories demonstrated sensitivity to different levels of caregiver assistance required for self-care, as measured by the PEDI.
  • • The Spearman rank-order correlation coefficient between the MACS levels (as scored by the therapists) and scores on the PEDI Caregiver Assistance scale for self-care activities were significant (ρ = −.72) at the .01 level (two-tailed), although the use of even nonparametric correlation statistics here is questionable and unorthodox.
  • • The study also drew conclusions about the children’s skill level in self-care, although the researchers did not use the PEDI Part 1, which would allow this assertion.
  • • Weighted κ (with linear weighting) for the interobserver reliability of the MACS between the therapists and physicians was found to be .86 (CI [.78, .94]).
  • • 50 children (82%) were classified at the same MACS level by the therapist and the rehabilitation physician, and the remainder were within 1 level.
Little et al. (2011) To evaluate the psychometric properties (reliability) of the Sensory Experiences Questionnaire (SEQ)
  • Design
  • Prospective, nonrandomized, noncontrolled
  • Participants
  • 358 parents of children ages 6–72 mo belonging to 1 of 3 groups: (1) children with autism, (2) children with developmental delay, or (3) typically developing children
  • The test–retest reliability subsample consisted of 24 caregivers, each of whom completed a 2nd questionnaire within 2–4 wk of the 1st questionnaire.
  • Recruitment
  • Convenience sampling; a letter and SEQ form were distributed to caregivers by a designated contact person at preschools, early intervention programs, day care centers, or diagnostic and evaluation centers throughout rural and metropolitan areas in North Carolina, as well as through a university-based research registry
  • Statistics
  • Cronbach’s α and ICC
SEQ
  • • Internal consistency
  • • Test–retest reliability
  • • Internal consistency was excellent; Cronbach’s α was reported to be .80.
  • • Total score test–retest reliability was excellent (ICC = .92).
  • • Subscale test–retest reliability scores ranged from .68 to .86.
  • • The SEQ can be used as an early tool for identifying sensory patterns in young children with autism and other developmental disabilities.
McDonald & Vigen (2012) To describe the instrument development process of the McDonald Play Inventory (MPI) and examine the MPI’s internal reliability and discriminative validity among both neurotypical children and children with known disabilities
  • Design
  • Prospective, nonrandomized, noncontrolled reliability and validity study
  • Participants
  • 124 children between ages 7 and 11 yr (89 neurotypical, 35 with disabilities); 17 parents participated.
  • Recruitment
  • Convenience sampling; participants drawn from a camp, elementary school, and 2 private practice clinics in the United States; participants recruited over a 1-yr period
  • Statistics
  • For internal consistency, Cronbach’s α; for test–retest reliability, Pearson correlation coefficient; for concurrent validity, Pearson correlation coefficient and paired-sample t tests
MPI, which is made up of 2 parts: (1) McDonald Play Activity Inventory (MPAI) and McDonald Play Style Inventory (MPSI)
  • • Internal consistency
  • • Test–retest reliability
  • • Concurrent validity
  • • Construct validity
  • • The self-report instrument yielded reliable and valid measures of a child’s perceived play performance and discriminated between the play of children with and without disabilities.
  • Item analysis and inter-correlations: Each item was moderately correlated (.27–.75) with the respective subscale score. Moderate to strong correlations (.47–.81) were found between each subscale and total scale score.
  • • Intercorrelations between the subscales ranged from low (<.25) to moderate (.50–.71).
  • • The intercorrelation between the total inventory scores was in the moderate range (.49).
  • Internal consistency: Internal consistency was acceptable—α = .84 for the MPAI and α = .79 for the MPSI.
  • Test–retest reliability: Pearson correlation coefficient for the MPAI was .69; for the MPSI, .82; indicates results were consistent over 1-mo period.
  • Construct validity: No statistically significant differences were found by gender or presence of disability on the self-reported play activities of the MPAI total inventory or subscale scores.
  • Concurrent validity: For parent–child responses, the MPAI showed a low correlation (r = .04) and the MPSI showed a moderate correlation (r = .49).
Mulcahey et al. (2013) To examine the psychometric properties of upper-extremity and activity item pools and to evaluate the item banks and simulated 5-, 10-, and 15-item computer adaptive tests (CATs)
  • Design
  • Multicenter cross-sectional study
  • Participants
  • 200 children with brachial plexus birth palsy between ages 4 and 21 yr; 1-time data collection occurred at the point of care.
  • Recruitment
  • Convenience sampling approach
  • Statistics
  • Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA); DIF through the use of ordinal logistic regression; 1-way ANOVA tests with post hoc comparisons
Pediatric Outcomes Data Collection Instrument (PODCI)
  • • Construct validity
  • • Differential item functioning
  • • Concurrent validity
  • • Discriminative validity
  • • In the EFA of the activity items, the 1st factor explained approximately 55% of the total variance.
  • • In the EFA of the upper-extremity items, the 1st factor explained 58% of the total variance.
  • • Three items showed DIF, 2 upper-extremity items (“My child can use an eraser without tearing paper,” “Using only his/her hands, my child can pull up the tab on a can of soda”) and 1 activity item (“Cleaning the floor with a broom and dustpan”). These items were retained owing to the importance of their content.
  • • Concurrent validity was established with a moderate correlation with the Box and Block Test and the PODCI.
  • • The majority of the PODCI items were able to differentiate participants with a known clinical difference.
Munkholm, Berg, Löfgren, & Fisher (2010) To evaluate whether the School version of AMPS is valid for evaluating students in different world regions
  • Design
  • Cross-sectional retrospective study
  • Participants
  • 984 students ranging in age from 3 to 13 yr from North America, Australia and New Zealand, United Kingdom, and Nordic countries (246 students from each region)
  • Recruitment
  • Participants were selected from the sample of all students ages 3–15 yr located in the School AMPS database.
  • Statistics
  • Many-faceted Rasch analysis
School AMPS
  • • Many-faceted Rasch analyses to generate item difficulty calibrations by region and evaluate for significant DIF and differential test functioning
  • • Construct validity
  • • School AMPS items (walk, moves, endures, and navigates) demonstrated DIF but resulted in no differential test functioning.
  • • The School AMPS can be used to evaluate students’ quality of schoolwork task performances across regions because it is free of geographic bias associated with world region.
Ohl et al. (2012) To examine the test–retest reliability and internal consistency of the Sensory Profile Caregiver Questionnaire
  • Design
  • Prospective, nonrandomized, noncontrolled
  • Participants
  • 55 caregivers of children ranging in age from 36 to 72 mo
  • Recruitment
  • Participants were recruited from 6 nursery schools and child care centers in the New York metropolitan area.
  • Parents of children attending the centers were sent a flyer, then a research pack. Completed assessments were posted back to the researcher in self-addressed stamped envelope. Participation was voluntary.
  • Statistics
  • Descriptive statistics, ICCs, Cronbach’s α
  • Sensory Profile Caregiver
  • Questionnaire
  • • Test–retest reliability
  • • Internal consistency
  • • Test–retest reliability was good across quadrant scores (ICCs = .80–.90) and moderate to good across factor (ICCs = .69–.88) and section scores (ICCs = .50–.87).
  • • Internal consistency was high across quadrant scores (αs = .89–.95) and factor scores (αs = .82–.93) and moderate to high across section scores (αs = .67–.93).
Parham et al. (2011) 
  • To develop a reliable and valid fidelity measure for use in research on the Ayres Sensory Integration (ASI) intervention
  • Research questions:
  • Does the Process section of the Fidelity Measure show acceptable interrater reliability?
  • Does the Process section of the Fidelity Measure have acceptable internal consistency?
  • Does the Process section of the Fidelity Measure demonstrate adequate validity in differentiating ASI from other intervention approaches in occupational therapy?
  • Does the entire Fidelity Measure demonstrate content validity in addressing key elements of ASI intervention?
  • Design
  • Instrument development
  • Participants
  • 14 experts in sensory integration from 6 different countries who completed 6-hr training
  • Content validity was established through 19 experts in sensory integration from 6 different countries.
  • Recruitment
  • Content experts were recruited to assist with the development of the Fidelity Measure.
  • Statistics
  • Interrater reliability, content validity, internal consistency, Cronbach’s α, ICC
Ayres Sensory Integration Fidelity Measure
  • • Interrater reliability
  • • Internal consistency
  • • Content validity
  • • Reliability of the Process section was strong for total fidelity score (ICC = .99, Cronbach’s α = .99) and acceptable for most items.
  • • Total score significantly differentiated ASI from 4 alternative interventions.
  • • Expert ratings indicated strong agreement that items in the Structural and Process sections represent ASI intervention.
Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee (2013) To establish the psychometric properties of the Children’s Assessment of Participation and Enjoyment/Preferences for Activities (CAPE/PAC) related to children with high-functioning autism (HFA)
  • Design
  • Mixed methodology, including qualitative research to evaluate content validity and feasibility of use
  • Participants
  • 30 children with HFA between ages 7 and 13 yr (with IQ >80 or adaptive functioning score >60) and 31 typically developing peers
  • Recruitment
  • Children were recruited through multiple sources (parent support group, therapists, health department) and informal modes.
  • Statistics
  • Descriptive statistics, correlation, Mann–Whitney U test
CAPE/PAC
  • • Content validity
  • • Discriminant validity
  • • Test–retest reliability
  • • CAPE/PAC can be used to assess participation (recreational) among children with HFA.
  • • Content validity was assessed as adequate after qualitative evaluation. Test–retest reliability of overall scores was adequate (r > .7), except the social aspect dimension, which was low (r > .196).
  • • Parents’ agreement with most of their children’s self-ratings on this assessment provided an estimate of interrater reliability (in HFA group, 75% of parents agreed or strongly agreed with their child’s rating on the CAPE, and 50% of parents agreed or strongly agreed with their child’s rating for the PAC).
  • • The CAPE/PAC has adequate discriminant validity and test–retest reliability and is able to discriminate between children with and without HFA. Therefore, results suggest that the CAPE/PAC is applicable for use with children with HFA.
Rosenblum, Sachs, & Schreuer (2010) To examine the internal consistency and construct validity of the Children’s Leisure Assessment Scale (CLASS)
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 249 children and adolescents in Israel (114 boys, 135 girls)
  • Recruitment
  • Stratified snowball sampling
  • Inclusion criteria: typically developing public school students
  • Statistics
  • Descriptive statistics, Cronbach’s α, factor analysis, MANOVA, t tests
CLASS; measures multidimensional participation in children’s and adolescents’ leisure activities
  • • Internal consistency
  • • Face validity
  • • Content validity
  • • Construct validity
  • • Discriminant validity
  • Face and content validity: Original assessment reviewed by 5 expert consultants and 5 experienced pediatric OTs.
  • Internal consistency: Leisure factors (instrumental indoor activities, outdoor activities, self-enriched activities, games and sports activities) showed acceptable levels of internal reliability (Cronbach’s α ranged from .57 to .83).
  • Construct validity: Discriminant validity based on gender; girls participated in significantly more activities than the boys (65% and 56%, respectively), with greater frequency and with greater preference for self-enrichment and instrumental indoor activities. Boys participated in significantly more games and sports activities.
Saban, Ornoy, Grotto, & Parush (2012) To describe the development of the Adolescents and Adults Coordination Questionnaire (AAC–Q) and describe its psychometric properties
  • Design
  • Prospective, randomized, instrument development study
  • Participants
  • Convenience sampling of (1) 28 adolescents and young adults diagnosed with DCD (between ages 16 and 35 yr) in Israel and (2) 28 age- and gender-matched participants who had no diagnosis of DCD and who had never been referred or treated for motor coordination problems in Israel
  • Random sampling of 2,379 participants ages 19–25 yr from Israel Military Service
  • Recruitment
  • The DCD group was recruited by contacting professionals who worked with adults. The control group was recruited through advertisements in the university setting and workplace.
  • Statistics
  • Descriptive statistics, independent-sample t tests, construct validity, Cronbach’s α, Pearson’s correlation coefficients
AAC–Q
  • • Content validity
  • • Construct validity
  • • Internal consistency
  • • Test–retest reliability
  • Content reliability: 12 AAC–Q items had >95% interrater agreement from 8 OTs.
  • Internal consistency: High; Cronbach’s α = .88
  • Test–retest reliability: r = .94, p < .001
  • Construct validity: Independent-sample t tests revealed significant differences between participants with and without DCD, t(27) = 9.37, p < .001. A high significant correlation was found between the scores of the 2 scales (r = .973, p < .05), indicating that although separate, the scales assess the same construct. Resulted in removal of the Degree or Intensity scale from the AAC–Q.
Silva & Schalock (2012) To validate the Sense and Self-Regulation Checklist (SSC), a parent–caregiver measure of sensory and self-regulatory responses of children with autism in everyday life
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 265 children < age 6 yr with typical development (n = 138), autism (n = 99), or other developmental delay (DD; n = 28); the informants were the children’s caregivers.
  • Recruitment
  • Convenience sampling for all groups. Children with autism and DD had already been involved in other studies with researchers. They were recruited from 6 regional early childhood special education programs across Oregon.
  • Parents of typically developing children were recruited through 1 child care center, 3 mother support groups, and 1 toddler drop-in play center in Oregon.
  • Statistics
  • Descriptive statistics of participants, χ2 test, Pearson correlation coefficient, multiple regression, Cronbach’s α, ANOVA, post hoc tests
SSC
  • • Internal consistency
  • • Test–retest reliability
  • • Discriminant validity
  • Internal consistency: Overall scores were acceptable. Cronbach’s α = .87 for children with ASD, .89 for typically developing kids, and .85 for children with other DD. In the sensory domain, α = .81 for children with ASD, .80 for typically developing children, and .58 for children with other DD. In the self-regulation domain, α = .79 for children with ASD, .86 for typically developing children, and .83 for children with other DD.
  • Test–retest reliability: After 4-mo follow-up, sensory impairment test–retest coefficient = .595, self-regulation = .831, and overall score = .677.
  • • 2 new findings discriminated autism from other groups: (1) multifocal tactile sensory impairment, characterized by hyporeactivity to injurious stimuli and hyperreactivity to noninjurious stimuli, F(2, 262) = 86.8, p < .001, and (2) global self-regulatory delay, F(2, 262) = 122, p < .001.
  • • The SSC reports a prevalence of sensory and self-regulatory findings approaching 100% (96% and 98%, respectively) in the autism group, raising the possibility that sensory and self-regulatory difficulties represent a core part of autism.
Spirtos, O’Mahony, & Malone (2011) To further examine the interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function (MAUULF)
  • Design
  • Cross-sectional, nonrandomized reliability study
  • Participants
  • 3 OTs who independently scored 34 videotaped assessments of 11 children with hemiplegic cerebral palsy ages 6 yr 1 mo–14 yr 5 mo.
  • All therapists had used the MAUULF in clinical practice and had a 3-hr training session.
  • Recruitment
  • Convenience sample of 3 experienced OTs with honors degrees in occupational therapy who were working in the same center for children and adults with physical disabilities
  • Written informed consent was obtained from the parents of the children for blind scoring of their child’s assessments as
  • part of a larger study.
  • Statistics
  • Descriptive statistics, ICCs, confidence intervals
MAUULF• Interrater reliability
  • Total scores: The correlation between raters was high for the total score (ICC = .961).
  • Test components: The highest correlation between raters was found for fluency (ICC = .902), followed by range of movement (ICC = .866), and the lowest correlation was found for quality of movement (ICC = .683).
  • Individual test item scores: The ICCs varied and ranged from .368 to .899.
Taylor, Lee, Kramer, Shirashi, & Kielhofner (2011) To conduct a psychometric examination (reliability, sensitivity, and validity) of the Occupational Self Assessment (OSA) by focusing on an adolescent population
  • Design
  • Prospective scale evaluation study
  • Participants
  • 296 adolescents between ages 12 and 18 yr with recent diagnosis of acute mononucleosis
  • Follow-up sample was 31 participants who did not consider themselves fully recovered and 59 matched control participants who did consider themselves fully recovered from mono at 12 mo after initial enrollment and after the acute phase. Two matched controls were identified for each participant with persistent fatigue.
  • Recruitment
  • Participants were recruited from schools, hospitals, outpatient clinics, and private physician practices in Chicago.
  • Statistics
  • Item Response Theory; Rasch Rating Scale Model
OSA
  • • Test–retest reliability
  • • Sensitivity
  • • Construct validity
  • • Concurrent validity
  • • OSA items coalesced to capture the intended constructs; the rating scales functioned as intended.
  • • >90% of participants were validly measured.
  • • Demonstrated adequate sensitivity and stability (test–retest reliability) over time.
  • • OSA measure of competence was moderately associated with infectious symptoms, fatigue severity, health status, and stress, and the measure of values was not.
  • • Adolescents who had not recovered from mononucleosis after 12 mo reported lower competence scores yet attached the same value or importance to occupational participation as adolescents who had recovered.
Toglia & Berg (2013) 
  • To compare abilities and strategy use of a group of at-risk youth, ages 16–21 yr, with a community sample of high school students using the WCPA and to investigate the discriminative validity of the WCPA
  • Design
  • Quasi-experimental 2-group comparison, cross-sectional research
  • Participants
  • 113 at-risk youth from an alternative high school and 49 youth from community high schools from a midwestern U.S. city
  • Recruitment
  • A representative sample of gender, race, age, and educational backgrounds were sought using convenience sampling and stratified sampling methods.
  • Statistics
  • Descriptive statistics, Pearson χ2 with Fisher’s exact test significance and t-test comparisons
WCPA, a performance measure of everyday executive function• Discriminative validity: 2 participant groups with known differences compared on their performance on the WCPA
  • t-test comparison between the 2 groups, with Bonferroni correction of p = .004 (.05/12) to avoid a Type I error; WCPA scores revealed significant differences between the 2 participant groups with the exception of total time (p = .91), planning time (p = .97), and rules followed (p = .03).
  • • The WCPA was able to differentiate between 2 groups of participants with known differences; the community group was more likely to follow rules, enter appointments accurately, self-report errors, and use a greater number of strategies than the at-risk youth group.
  • • Comparison of the at-risk and community youth participant groups provides support for the WCPA’s discriminative validity.
Tsai, Lin, Liao, & Hsieh (2009) To examine the reliability of Motor-Free Visual Perception Test–Revised (MVPT–R) and Test of Visual–Perceptual Skills–Revised (TVPS–R)
  • Design
  • Prospective reliability study
  • Participants
  • 52 children (31 boys, 21 girls; age range = 5 yr 5 mo–8 yr 9 mo)
  • Recruitment
  • Convenience sampling was used for children in regular kindergarten and special education classrooms in Taipei, Taiwan.
  • Inclusion criteria: Diagnosis of cerebral palsy, ages 5–8, ability to follow general oral instructions
  • Exclusion criteria: Child could not follow the instructions of the MVPT–R and TVPS–R, poor visual acuity as indicated by Teller Acuity Cards
  • Statistics
  • Descriptive statistics, ICCs, smallest real differences, Cronbach’s α, standard error of measurement
MVPT–R, TVPS –R
  • • Test–rest reliability
  • • Interrater reliability
  • • Internal consistency
  • Test-retest reliability: MVPT–R total score was excellent (ICC = .96); TVPS–R total score was also excellent (ICC = .97); TVPS–R subscale scores were high (ICCs = .76–.92).
  • Interrater reliability: MVPT–R interrater agreement was excellent (ICC = .92); TVPS–R interrater agreement was excellent (ICC = .93); TVPS–R subscale score was high (ICCs = .74–.89) except for the visual sequential memory subscale (ICC = .63).
  • Internal consistency: MVPT–R, Cronbach’s α = .87; TVPS–R, Cronbach’s α = .98; TVPS–R subscale Cronbach’s αs were high (.87–.94).
Vanvuchelen, Roeyers, & De Weerdt (2011) To examine the interrater and test–retest reliability of the Preschool Imitation and Praxis Scale (PIPS)
  • Design
  • Prospective, instrument reliability study
  • Participants
  • 119 typically developing preschool children (69 girls, 50 boys) between ages 1.5 and 4.9 yr were sampled from day care centers and regular preschools in Flanders, Belgium.
  • Recruitment
  • Stratified random sampling was used.
  • Inclusion criteria: Children not born preterm and had no known physical or mental handicap
  • Statistics
  • Descriptive statistics, Cohen’s weighted κs, ICCs, smallest detectable difference, Pearson product–moment correlation coefficient
PIPS
  • • Intrarater reliability
  • • Interrater reliability
  • • Test–rest reliability
  • • The intrarater reliability of the PIPS total score was high (ICC = .996).
  • • The interrater reliability of the PIPS total score was high (ICC = .995).
  • • Test–retest reliability was high (r = .93) for the association scores between 56 children assessed with a time interval of 1 wk.
Weiner, Toglia, & Berg (2012) To evaluate initial psychometric properties of the WCPA, to describe the baseline executive functioning profile of at-risk youth, and to investigate relationship between accuracy, time, strategy use, error patterns, and self-evaluation of performance
  • Participants
  • 113 at-risk youth (53 girls, 60 boys) between ages 16 and 21 yr from an alternative high school. 9 did not participate; however, details are not provided about the remaining 104.
  • Recruitment
  • Participants were enrolled at a school for high-risk youth in the midwestern United States.
  • Statistics
  • Descriptive statistics, Pearson correlation coefficient
WCPA, a performance measure of everyday executive function
  • • Interrater reliability
  • • Interitem correlations
  • • Clinically useful tool for measuring executive functioning among youth.
  • • Interrater reliability for 2 trained scorers was high (ICC = .99) for total accuracy scores.
  • • On average, participants spent 15.9 min on the WCPA, made 7.9 errors, and followed 4.0 of 5 possible rules. No ceiling effect was observed in overall accuracy. Participants used a mean of 3.1 strategies (standard deviation = 1.9) while completing the WCPA.
  • • Participants who used more strategies spent more time planning and completing the task and were more accurate.
  • • The assessment allows evaluation of complex task performance, strategy use, self-evaluation of performance, and error patterns, which guide interventions.
Weintraub & Bar-Haim Erez (2009) To describe the development and initial evaluation of the construct validity of the Quality of Life in School (QoLS) questionnaire
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 353 elementary school students (180 boys, 173 girls) in 3rd–6th grade from 8 general education schools in Israel
  • Recruitment
  • Purposive sampling in identified schools and parents approached for permission to include their typically developing child
  • Inclusion criteria: In Grades 3–6, no neurological symptoms, no physical disability, not receiving special education services
  • Statistics
  • Cronbach’s α, Pearson correlation coefficients, 2-way ANOVA, MANOVA (between gender and age), ANOVA, factor analysis
QoLS–Version 2
  • • Comprehensive description of development and initial evaluation of QoLS–Version 2
  • • Construct validity
  • • Internal consistency
  • • Factor structure
  • • Discriminant validity
  • • Factor analysis identified 4 categories within questionnaire: (1) teacher–student relationship and school activity (Cronbach’s α = .91), (2) physical environment (Cronbach’s α = .82), (3) negative feelings (Cronbach’s α = .90), and (4) positive feelings (Cronbach’s α = .68).
  • Internal consistency: Total questionnaire Cronbach’s α = .88.
  • • Total QoLS score had significant medium to high correlation with each category (.51 < r < .69).
  • • Discriminant validity in process to evaluate use of this tool with students with disabilities was not reported in this article.
  • • QoLS may assist clinicians and educators in evaluating students’ school quality of life from a multidimensional perspective, pending application to students with disabilities.
Table Footer NoteNote. ADLs = activities of daily living; AMPS = Assessment of Motor and Process Skills; ANOVA = analysis of variance; ASD = autism spectrum disorder; CI = confidence interval; COP = Comprehensive Observations of Proprioception; DCD = developmental coordination disorder; DIF = differential item functioning; ETCH = Evaluation Tool of Children’s Handwriting; HPAS = Health Promoting Activities Scale; ICC = intraclass correlation coefficient; LPP = Life Participation for Parents; MANOVA = multivariate analysis of variance; OT = occupational therapist; PEDI = Pediatric Evaluation of Disability Inventory; ROC = receiver operating characteristic; SVMPT = Slosson Visual–Motor Performance Test–Revised; TVMI = Test of Visual–Motor Integration; VMI = Developmental Test of Visual–Motor Integration; WCPA = Weekly Calendar Planning Activity.
Note. ADLs = activities of daily living; AMPS = Assessment of Motor and Process Skills; ANOVA = analysis of variance; ASD = autism spectrum disorder; CI = confidence interval; COP = Comprehensive Observations of Proprioception; DCD = developmental coordination disorder; DIF = differential item functioning; ETCH = Evaluation Tool of Children’s Handwriting; HPAS = Health Promoting Activities Scale; ICC = intraclass correlation coefficient; LPP = Life Participation for Parents; MANOVA = multivariate analysis of variance; OT = occupational therapist; PEDI = Pediatric Evaluation of Disability Inventory; ROC = receiver operating characteristic; SVMPT = Slosson Visual–Motor Performance Test–Revised; TVMI = Test of Visual–Motor Integration; VMI = Developmental Test of Visual–Motor Integration; WCPA = Weekly Calendar Planning Activity.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 1). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 1). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
Table 1.
Summary of Articles Describing Development and Testing of Instruments for Children and Youth, Published in the American Journal of Occupational Therapy, January 2009–September 2013
Summary of Articles Describing Development and Testing of Instruments for Children and Youth, Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Author/YearStudy ObjectivesDesign/Participants/Recruitment Strategy/Statistics UsedInstrument/Tool Being InvestigatedMeasurement Characteristics InvestigatedResults
Blanche, Bodison, Chang, & Reinoso (2012) To document the development of the COP, an instrument for identifying proprioceptive processing issues in children
  • Design
  • Prospective scale design over 3 phases: (1) scale construction and content validity, (2) establishment of validity and reliability, and (3) factor analysis
  • Participants
  • 130 children with known developmental disabilities ages 2–9 yr
  • Recruitment
  • Not reported
  • Statistics Used
  • Factor analysis, Pearson’s correlation coefficient, ICC
COP
  • • Interrater reliability
  • • Face validity
  • • Content validity
  • • Construct validity
  • • Criterion validity
  • • Factor analysis
  • Content validity: 18 items were originally derived from the existing literature; 9 OTs who were experts in sensory integration rated the COP items; 4 items were rejected.
  • Construct validity: Children with developmental disabilities had significantly higher total scores and individual item scores on the COP than children without proprioceptive difficulties (ps < .01) except for Item 17 (overly passive; p = .12).
  • Criterion validity: Established through comparison of the COP with the Sensory Processing Measure–Home Form and the Kinesthesia and Standing and Walking Balance subtests of the Sensory Integration and Praxis Test; results indicated that the COP measured 2 distinct influences on proprioception functions: motor performance and sensory seeking.
  • Interrater reliability: Four OTs rated 4 20-min videotapes; total score ICC between the 4 raters was .91, indicating that variation among the raters was minimal.
  • Exploratory factor analysis: Results of the factor analysis revealed 4 factors: Tone and Joint Alignment (Factor 1), Behavioral Manifestations (Factor 2), Postural Motor (Factor 3), and Motor Planning (Factor 4)
Blanche, Reinoso, Chang, & Bodison (2012) To describe the proprioceptive difficulties of children with ASD
  • Design
  • Retrospective group-comparison design
  • Participants
  • 32 children with ASD (no additional motor difficulties), 26 children with developmental disabilities (excluding ASD), 28 typically developing children (matched control)
  • Recruitment
  • De-identified data were collected from a chart review at 2 occupational therapy clinics. The de-identified data of the matched control children were collected in a natural setting.
  • Statistics
  • ANOVA for the 3-group comparison and a post hoc analysis with Tukey-Kramer method for pairwise comparison were applied.
The COP, a scale that measures proprioceptive processing in children by direct observation• Ability of COP to discriminate between groups of participants with known differences (discriminant validity)
  • • Children with ASD present with proprioceptive processing difficulties that are different from those of typically developing children and children with developmental delays.
  • • The 3 groups were significantly different on all 16 of the individual COP items, on the total COP score, and on the 4 COP factors.
  • • Post hoc analysis indicated that children with ASD and developmental disabilities were not significantly different on 4 COP items (feedback-related motor planning, tiptoeing, pushing other or objects, and crashing, falling, and running) and on 2 COP factors (Factor 1, Tone and Joint Alignment, and Factor 3, Postural Control and Grading of Force).
Bourke-Taylor, Law, Howie, & Pallant (2012) To describe the initial development and psychometric evaluation of the HPAS
  • Design
  • Mixed methodology using an initial qualitative study and experts to generate scale items and mail out questionnaire with follow-up phone call to collect data; cross-sectional research design including within-group comparisons
  • Participants
  • 152 mothers of children with developmental disabilities in Victoria, New South Wales, Australia
  • Recruitment
  • Self-selected sampling, including a snowball design (“Recruit a girlfriend”). Inclusion criteria: mother of a school-aged child with a disability
  • Statistics
  • Descriptive, correlations, evaluation of normalcy, factor analysis, and Mann-Whitney U comparisons
The HPAS, which measures the frequency with which mothers caring for a school-age child with a disability participate in self-selected leisure occupations
  • • Construct validity
  • • Discriminant validity
  • • Internal consistency
  • • Factor structure
  • • The HPAS showed good internal consistency (Cronbach’s α = .78).
  • • Construct validity was supported by moderate correlations with subjective maternal mental and general health (Short Form–36, Version 2) and by differentiation in leisure participation among groups of mothers reporting differences in mental health status and sleep interruption.
Brossard-Racine, Mazer, Julien, & Majnemer (2012) To determine ETCH scores for cutoff points to determine children who do and do not require intervention for handwriting issues and to determine the percentage of change for clinical significance
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 34 therapists judged and compared 35 pairs of handwriting samples from 26 children
  • Recruitment
  • Convenience sample of pediatric OTs working in greater Montreal, Quebec
  • OTs were included if they had >1 yr experience working with children with handwriting problems.
  • The handwriting samples were obtained from a group of children involved in a cohort study of school-age children with attention deficit hyperactivity disorder. Children were ages 7–9 yr and routinely used manuscript writing.
  • Statistics
  • ROC analyses, minimal clinically important difference (MCID), descriptive statistics, Shrout-Fleiss reliability ICC
ETCH
  • • Discriminant validity
  • • Interrater reliability
  • Discriminative validity: Word legibility had a crude area under the curve of .86 (95% CI [.84, .88]) and an adjusted area of .96 (95% CI [.95, .97]). Letter legibility had a crude area under the curve of .82 (95% CI [.80, .84]) and an adjusted area of .96 (95% CI = .95, .97).
  • • Interrater reliability between therapists was relatively good (ICC = 5.53).
  • • A difference of 10.0%–12.5% for total word legibility and 6.0%–7.0% for total letter legibility were found as cutoff points for MCID.
  • • For children in Grades 2 and 3, 75.0% total word legibility and 76.0% total letter legibility on the ETCH–Manuscript are suggested as the cutoff values to discriminate between children with handwriting legibility difficulties who should be seen in rehabilitation for evaluation and treatment and those who have no such difficulties.
Brown, Unsworth, & Lyons (2009) To examine the factor structure of 4 visual-motor integration instruments through factor analysis
  • Design
  • Prospective cross-sectional evaluation
  • Participants
  • 400 children ages 5–12 yr in metropolitan Melbourne, Victoria, Australia
  • Recruitment
  • Letters were sent to 955 children in 6 participating state schools.
  • Statistics
  • Factor analysis, descriptive statistics, Cronbach’s α
  • • TVMI
  • • VMI
  • • Test of Visual-Motor Skills–Revised (TVSM–R)
  • • SVMPT
  • • Construct validity
  • • Internal consistency
  • • Cronbach’s αs for the VMI, TVMI, TVMS–R, and SVMPT were all >.80.
  • • VMI displayed a 6-factor structure.
  • • TVMI displayed a 3-factor structure.
  • • TVSM–R displayed a 4-factor structure.
  • • SVMPT displayed a 3-factor structure.
  • • All 4 visual–motor integration instruments exhibited multidimensionality.
Chien, Brown, & McDonald (2010) To assess the interrater and test–retest reliability of the Assessment of Children’s Hand Skills (ACHS)
  • Design
  • Prospective, reliability study
  • Participants
  • 54 children participated in the study; 30 were in the interrater reliability component of the study, and 44 were in the test–retest reliability part of the study.
  • Recruitment
  • A convenience sampling approach was used; of the 54 participants, 30 were typically developing children who were recruited from 1 child care center and 2 preschools in southern metropolitan regions of Melbourne, Victoria, Australia; the remaining 24 children were recruited from 2 special schools if they presented with hand skill difficulties caused by disorders such as ASD, Down syndrome, or developmental delay.
  • Statistics
  • Cronbach’s α, Spearman’s coefficient, weighted κ
ACHS
  • • Interrater reliability
  • • Test–retest reliability
  • • Content validity
  • • The ACHS’s test–retest reliability was satisfactory at the individual item level (.42 < κ > .79) and the total scale level (Spearman’s r = .78, p < .01).
  • • Moderate interrater agreement of the total scale scores was demonstrated (r = .63, p < .01), but individual items exhibited varied interrater agreement.
  • • The ACHS’s content validity was established through an extensive review of the literature, the conceptualization of a hand skill framework on which to base the ACHS skill items, several rounds of review and revision based on expert feedback, and preliminary field testing.
Duff & Goyen (2010) To determine the reliability and validity of the ETCH–Cursive (ETCH-C) using the general scoring criteria
  • Design
  • Cross-sectional, semirandomized reliability and validity study
  • Participants
  • Purposive sampling from randomly selected schools. Participants were 63 typically developing 10- to 12-yr-old children from 10 schools in Sydney, New South Wales, Australia: 33 participants with handwriting difficulties and 30 without.
  • Recruitment
  • Asked teachers in randomly selected schools to identify Grade 5 and 6 students with and without handwriting difficulties.
  • Statistics
  • Descriptive statistics, ICC, ROC, Pearson correlation coefficient, ANOVA, Tukey’s post hoc analysis
ETCH-C, a standardized assessment tool to evaluate cursive handwriting
  • • Interrater reliability
  • • Intrarater reliability
  • • Test–retest reliability
  • • Discriminant validity
  • • Concurrent validity
  • Reliability: ICCs for intrarater reliability ranged from .55 to .80 for the 3 subscales. ICCs for interrater reliability ranged from .57 to .84 for the 3 subscales. ICC test–retest reliability ranged from .24 to .65 for the 3 subscales.
  • Discriminant validity: 3 cutoff scores were determined to differentiate between students with and without handwriting difficulties: total letter score cutoff = 92; total word score cutoff = 85; total number score cutoff = 95.
  • Concurrent validity: ETCH-C total letter score was moderately correlated with the Test of Legible Handwriting (r = .6, p < .001).
Fingerhut (2013) To psychometrically evaluate and continue ongoing development of the LPP tool
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 162 parents or caregivers of children with special needs receiving intervention at a private practice clinic
  • Recruitment
  • Convenience sampling
  • Statistics
  • Descriptive statistics, nonparametric Kruskal–Wallis one-way ANOVA, Spearman rank-order analysis, factor analysis
LPP, a measurement tool to facilitate family-centered pediatric practice
  • • Internal consistency
  • • Test–retest reliability
  • • Construct validity
  • Internal structure: 2-factor solution, resulting in 2 subscales, Satisfaction With Efficiency (Cronbach’s α = .90) and Satisfaction With Effectiveness (Cronbach’s α = .70). Internal consistency for total scale was strong (Cronbach’s α = .90).
  • • Test–retest reliability (r = .89)
  • • Construct validity supported through moderate inverse correlation (r = −.51) between LPP and Parenting Stress Index scores
Gantschnig, Page, Nilsson, & Fisher (2013) To detect differences in ADLs between children with and without disabilities
  • Design
  • Retrospective, involving secondary data analysis of existing database
  • Participants
  • AMPS database used 10,998 4- to 15-yr-old children with and without disabilities from 11 world regions.
  • Recruitment
  • Convenience sampling from existing database
  • Statistics
  • Descriptive statistics, t tests, regression analysis
AMPS, a standardized observational assessment that measures quality of motor processing ability during ADLs
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: Significant main effect for age, β = .139, confidence interval [.129, .149], p < .001, t = 26.187, R2 =.361. Significant differences were found in ADL performance between children with and without disabilities on the basis of motor ability at every age but 4 yr with effect sizes ranging from small to large. Significant differences were found in ADL performance between children with and without disabilities on the basis of processing ability at every age, with effect sizes ranging from moderate to very large. ADL motor and processing scores were significantly higher for typically developing children.
  • Construct validity: The AMPS can detect and measure motor and processing ability differences among children with and without disabilities from age 5 yr, with increasing differences as children age (≤15 yr). Processing ability differences can be detected at age 4 yr.
Griswold & Townsend (2012) To determine the sensitivity of the Evaluation of Social Interaction (ESI) to discriminate between children with and without disability as they engage in social exchanges in a natural context with typical social partners
  • Design
  • Quasi-experimental validity study
  • Participants
  • 46 children (34 boys, 12 girls) between ages 2 and 12 yr, half typically developing and half with a disability
  • Recruitment
  • A letter requesting participation consent was sent to parents of children attending preschool, kindergarten, readiness, 1st-grade, and 2nd-grade classrooms at a local elementary school in the northwestern United States.
  • 23 pairs of age- and gender-matched children with and without a disability were included in the results.
  • Statistics
  • Raw scores converted to log-odd probability units, paired t test
ESI• Discriminant validity to differentiate between children with and without disability• Paired t-test analysis revealed a statistically significant difference, t(22) = −4.065, p = .001, in the quality of social interaction for children with and without a disability, indicating sensitivity to discriminate between groups.
Honaker, Rosello, & Candler (2012) To examine the test–retest reliability and construct validity of the Family L.I.F.E. (Looking Into Family Experiences) and to examine the perceived efficiency, effectiveness, and satisfaction ratings for family occupations
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • Interview of 15 families with a child with ASD (4 girls, 11 boys, between ages 4 and 11 yr 2 mo). Two families eliminated from data collection.
  • Recruitment
  • Participants were a self-selected convenience sample of 15 families from 4 venues.
  • Statistics
  • Wilcoxon signed-rank test, Spearman’s ρ
Family L.I.F.E.
  • • Test–retest reliability
  • • Internal consistency
  • • Internal consistency was good (Cronbach’s α =.9), and test– retest reliability was strong (r = .89).
  • • 92% of the families identified the same occupations as important at test and retest, 1 wk apart.
Hwang & Davies (2009) To examine the internal construct validity of the School Function Assessment (SFA) by examining its unidimensionality and hierarchical structure; the study focused on Part III, known as the Activity Performance Scales.
  • Design
  • Prospective 2-group, nonrandomized, noncontrolled design
  • Participants
  • 64 elementary school children (35 with disabilities, 29 without disabilities) between ages 6 and 15 yr
  • Recruitment
  • Participants were recruited from several school districts in western New York via convenience sampling.
  • Statistics
  • Rasch analysis
SFA
  • • Internal validity
  • • Construct validity
  • • 252 items (of 266) on the Activity Performance Scales met criterion set for Rasch goodness-of-fit statistics.
  • • 15 of 18 of the SFA’s Activity Performance Scales were found to be unidimensional, measuring a single construct.
  • • Item difficulty analysis yielded a hierarchical structure of the Activity Performance Scales similar to the existing layout of the SFA.
Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen (2013) To determine norm scores for the Box and Block Test for children (3–10 yr)
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 215 typically developing Dutch children ages 3–10 yr who were representative on socioeconomic variables and ethnicity
  • Recruitment
  • Convenience sampling; children were recruited through local schools and playgroups
  • Statistics
  • Descriptive statistics, Spearman’s or Pearson’s correlation coefficients, ICCs, t tests
Box and Block test for children (a standardized gross manual dexterity test)
  • • Test–retest reliability
  • • Discriminant validity
  • • Concurrent validity
  • • Construct validity
  • Discriminant validity: No difference between boys and girls or left- and right-handed children within groups of children stratified for age (i.e., 3-year-olds, 4-year-olds). A significant and large effect size was found for children aged 3–8 yr for both the dominant, F(7, 207) = 77.07, p < .001, r = .82, and nondominant hands, F(7, 207) = 77.07, p < .001, r = .85.
  • Test-retest reliability: ICC = .85
  • Concurrent validity: correlations between both dominant- and nondominant-hand Box and Block Test scores and the Movement Assessment Battery for Children–2 manual dexterity subtests were moderate to strong for children ages 3–6 yr and weak to moderate for children ages 7–10 yr.
  • Construct validity: Findings support the use of the Box and Block test as a measure of gross manual dexterity among children ages 3–10 yr.
Josman, Abdallah, & Engel-Yeger (2011) To use the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) to measure cultural and sociodemographic effects on cognitive skills in 2 groups of children
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 226 typically developing children representative of Israeli census: 101 Jewish Israeli children and 125 Muslim Palestinian children
  • Recruitment
  • Convenience sampling from Israeli schools in which OTs trained in the administration of the LOTCA worked
  • Statistics
  • Descriptive statistics, MANOVA between identified groups
LOTCA, a standardized assessment of cognitive ability
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: The LOTCA detected differences between groups of children with known differences in culture, parental education level, years of schooling, and age of the child.
  • Construct validity: The LOTCA’s validity as a tool that measures the cognitive function of young children was supported.
Josman, Goffer, & Rosenblum (2010) To examine reliability and validity of the Do–Eat assessment tool for children with DCD
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 59 children aged 5–6.5 yr (30 diagnosed with DCD as determined by Movement Assessment Battery for Children scores below the 15th percentile)
  • Recruitment
  • Convenience sample of 5- and 6-year-old children; 30 children with a diagnosis of DCD and 29 typically developing children
  • Statistics
  • Descriptive statistics, Mann–Whitney U test, Cronbach’s α, t tests, Pearson correlation coefficients
Do-Eat: Dynamic assessment of child making a sandwich, preparing chocolate milk, and completing a handwriting task in the child’s natural context
  • • Internal consistency
  • • Interrater reliability
  • • Construct validity
  • • Concurrent validity
  • Content and face validity: Process of literature review and expert consultation—5 OTs and 5 expert consultants
  • Interrater reliability: High among 3 blinded occupational therapy assessors (rs = .92).
  • Internal consistency: High for Do-Eat components: performance skills (Cronbach’s α = .93), sensory-motor skill (Cronbach’s α = .90), and executive function (Cronbach’s α = .89).
  • Construct validity: Significant between-groups differences on the Do-Eat, t(57) = 14.09, p < .001, and the Parent Questionnaire, t(57) = 3.64, p < .001.
  • Concurrent validity: Significant correlation (r = −.086, p < .001) between children’s scores on sensory-motor component of the Do-Eat and Movement Assessment Battery for Children final score.
Kao, Kramer, Liljenquist, Tian, & Coster (2012) To compare the functional performance of children and youth with autism, developmental disabilities, and no disability using the revised PEDI–Computer Adaptive Test (PEDI–CAT) item banks
  • Design
  • Cross-sectional, nonrandomized, secondary data analysis, reliability, and validity study
  • Participants
  • Participants were purposively sampled from an existing nationally representative data set (N = 2,205) that included 108 children diagnosed with ASD and 150 children with intellectual and developmental disabilities (IDD). Three age groups were selected from the dataset—5 years, 10 years, and 15 years—although the sample size for each group was not reported.
  • Recruitment
  • Representational sampling of families with 1 or more child younger than age 21 yr and data collected via the Internet
  • Statistics
  • Descriptive statistics, analysis of covariance
PEDI–CAT
  • • Discriminant validity
  • • Construct validity
  • Discriminant validity: Social–cognitive domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001), but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age.
  • • Daily activities domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001), but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age.
  • • Responsibility domain differentiated between children with and without disabilities at ages 10 and 15 yr (p < .001) but not at age 5 yr. No significant differences were found between scores of children with ASD or IDD at any age. The largest difference between children with ASD and typically developing children was found to occur at age 15 yr.
  • Construct validity: This study supports the construct validity of the PEDI–CAT to differentiate between children aged 10 and 15 yr with and without disability. The PEDI–CAT did not differentiate between children with and without disability at age 5 yr. Moreover, no significant differences were found between the scores of children with ASD or IDD on any domain, indicating that the PEDI–CAT is not a disability-specific measure.
Kramer, Kielhofner, & Smith (2010) To determine the construct validity, reliability, and goodness of fit of the Child Occupational Self Assessment (COSA) and other factors (child factors, values, administration time, and application)
  • Design
  • Cross-sectional, nonrandomized reliability and validity study
  • Participants
  • 98 practitioners (OTs and physical therapists) and researchers from a central database completed the COSA on 502 children with disabilities between ages 6 and 17 yr from 5 countries.
  • Recruitment
  • Researchers and clinicians from around the world were contacted through email distribution lists and website announcements and during professional meetings and training and invited to share children’s COSA responses with a central database.
  • Statistics
  • Descriptive statistics of population, demographic information, Rasch Partial Credit model, parametric and nonparametric statistics to obtain validity evidence
COSA, with 2 scales, Occupational Competence and Values
  • • Internal reliability
  • • Item fit
  • • Internal and external validity
  • • Construct validity
  • • Concurrent validity
  • • Most children’s responses to the COSA can be validly interpreted as indicators of occupational competence and value for everyday activities.
  • • The COSA has good construct validity in the following areas: content, structural, and substantive validity as given by item and child fit statistics and unidimensionality evaluation.
  • • Evidence for external validity was mixed, depending on some demographic and assessment administration variables.
  • Item fit: All Occupational Competence items had positive point-biserial correlations ranging from .30 to .53. Children reported the least amount of competence and the most difficulty for self-regulation and cognitive tasks, as well as chores. The item separation index was 6.18, which translates to 8.57 strata; the reliability of item separation was .97.
  • Values items: All items had positive point-biserial correlations ranging from .42 to .61. Children were less likely to indicate value for activities typically regulated and demanded by adults. Values item separation across the continuum was 3.96, which transforms to 5.6 strata; item separation reliability across that continuum was .94.
  • Child fit: Of 502 children who completed the Occupational Competence ratings, 59 did not meet fit requirements (11.75%). All t tests and ANOVAs were nonsignificant using a Bonferroni-adjusted α of .01.
  • Person Fit to Values items: Of 496 children who responded to the Values rating scale, 76 did not meet fit requirements (15.3%).
Kuijper, van der Wilden, Ketelaar, & Gorter (2010) To investigate the relationship between the manual abilities of children with cerebral palsy (as categorized using the Manual Ability Classification System [MACS]) and caregiver assistance using the Self-Care scale of the PEDI and to assess the interrater reliability of the MACS
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 61 Dutch children with cerebral palsy between ages 5 and 14 yr
  • Parental consent was obtained.
  • Recruitment
  • Convenience sampling of children attending specialized schools
  • Statistics
  • Descriptive statistics, Spearman’s rank-order correlation coefficient (ρ), linear weighted κ
MACS, Self-Care domain of the PEDI Part 2, Caregiver Assistance scale• Construct validity
  • • The MACS categories demonstrated sensitivity to different levels of caregiver assistance required for self-care, as measured by the PEDI.
  • • The Spearman rank-order correlation coefficient between the MACS levels (as scored by the therapists) and scores on the PEDI Caregiver Assistance scale for self-care activities were significant (ρ = −.72) at the .01 level (two-tailed), although the use of even nonparametric correlation statistics here is questionable and unorthodox.
  • • The study also drew conclusions about the children’s skill level in self-care, although the researchers did not use the PEDI Part 1, which would allow this assertion.
  • • Weighted κ (with linear weighting) for the interobserver reliability of the MACS between the therapists and physicians was found to be .86 (CI [.78, .94]).
  • • 50 children (82%) were classified at the same MACS level by the therapist and the rehabilitation physician, and the remainder were within 1 level.
Little et al. (2011) To evaluate the psychometric properties (reliability) of the Sensory Experiences Questionnaire (SEQ)
  • Design
  • Prospective, nonrandomized, noncontrolled
  • Participants
  • 358 parents of children ages 6–72 mo belonging to 1 of 3 groups: (1) children with autism, (2) children with developmental delay, or (3) typically developing children
  • The test–retest reliability subsample consisted of 24 caregivers, each of whom completed a 2nd questionnaire within 2–4 wk of the 1st questionnaire.
  • Recruitment
  • Convenience sampling; a letter and SEQ form were distributed to caregivers by a designated contact person at preschools, early intervention programs, day care centers, or diagnostic and evaluation centers throughout rural and metropolitan areas in North Carolina, as well as through a university-based research registry
  • Statistics
  • Cronbach’s α and ICC
SEQ
  • • Internal consistency
  • • Test–retest reliability
  • • Internal consistency was excellent; Cronbach’s α was reported to be .80.
  • • Total score test–retest reliability was excellent (ICC = .92).
  • • Subscale test–retest reliability scores ranged from .68 to .86.
  • • The SEQ can be used as an early tool for identifying sensory patterns in young children with autism and other developmental disabilities.
McDonald & Vigen (2012) To describe the instrument development process of the McDonald Play Inventory (MPI) and examine the MPI’s internal reliability and discriminative validity among both neurotypical children and children with known disabilities
  • Design
  • Prospective, nonrandomized, noncontrolled reliability and validity study
  • Participants
  • 124 children between ages 7 and 11 yr (89 neurotypical, 35 with disabilities); 17 parents participated.
  • Recruitment
  • Convenience sampling; participants drawn from a camp, elementary school, and 2 private practice clinics in the United States; participants recruited over a 1-yr period
  • Statistics
  • For internal consistency, Cronbach’s α; for test–retest reliability, Pearson correlation coefficient; for concurrent validity, Pearson correlation coefficient and paired-sample t tests
MPI, which is made up of 2 parts: (1) McDonald Play Activity Inventory (MPAI) and McDonald Play Style Inventory (MPSI)
  • • Internal consistency
  • • Test–retest reliability
  • • Concurrent validity
  • • Construct validity
  • • The self-report instrument yielded reliable and valid measures of a child’s perceived play performance and discriminated between the play of children with and without disabilities.
  • Item analysis and inter-correlations: Each item was moderately correlated (.27–.75) with the respective subscale score. Moderate to strong correlations (.47–.81) were found between each subscale and total scale score.
  • • Intercorrelations between the subscales ranged from low (<.25) to moderate (.50–.71).
  • • The intercorrelation between the total inventory scores was in the moderate range (.49).
  • Internal consistency: Internal consistency was acceptable—α = .84 for the MPAI and α = .79 for the MPSI.
  • Test–retest reliability: Pearson correlation coefficient for the MPAI was .69; for the MPSI, .82; indicates results were consistent over 1-mo period.
  • Construct validity: No statistically significant differences were found by gender or presence of disability on the self-reported play activities of the MPAI total inventory or subscale scores.
  • Concurrent validity: For parent–child responses, the MPAI showed a low correlation (r = .04) and the MPSI showed a moderate correlation (r = .49).
Mulcahey et al. (2013) To examine the psychometric properties of upper-extremity and activity item pools and to evaluate the item banks and simulated 5-, 10-, and 15-item computer adaptive tests (CATs)
  • Design
  • Multicenter cross-sectional study
  • Participants
  • 200 children with brachial plexus birth palsy between ages 4 and 21 yr; 1-time data collection occurred at the point of care.
  • Recruitment
  • Convenience sampling approach
  • Statistics
  • Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA); DIF through the use of ordinal logistic regression; 1-way ANOVA tests with post hoc comparisons
Pediatric Outcomes Data Collection Instrument (PODCI)
  • • Construct validity
  • • Differential item functioning
  • • Concurrent validity
  • • Discriminative validity
  • • In the EFA of the activity items, the 1st factor explained approximately 55% of the total variance.
  • • In the EFA of the upper-extremity items, the 1st factor explained 58% of the total variance.
  • • Three items showed DIF, 2 upper-extremity items (“My child can use an eraser without tearing paper,” “Using only his/her hands, my child can pull up the tab on a can of soda”) and 1 activity item (“Cleaning the floor with a broom and dustpan”). These items were retained owing to the importance of their content.
  • • Concurrent validity was established with a moderate correlation with the Box and Block Test and the PODCI.
  • • The majority of the PODCI items were able to differentiate participants with a known clinical difference.
Munkholm, Berg, Löfgren, & Fisher (2010) To evaluate whether the School version of AMPS is valid for evaluating students in different world regions
  • Design
  • Cross-sectional retrospective study
  • Participants
  • 984 students ranging in age from 3 to 13 yr from North America, Australia and New Zealand, United Kingdom, and Nordic countries (246 students from each region)
  • Recruitment
  • Participants were selected from the sample of all students ages 3–15 yr located in the School AMPS database.
  • Statistics
  • Many-faceted Rasch analysis
School AMPS
  • • Many-faceted Rasch analyses to generate item difficulty calibrations by region and evaluate for significant DIF and differential test functioning
  • • Construct validity
  • • School AMPS items (walk, moves, endures, and navigates) demonstrated DIF but resulted in no differential test functioning.
  • • The School AMPS can be used to evaluate students’ quality of schoolwork task performances across regions because it is free of geographic bias associated with world region.
Ohl et al. (2012) To examine the test–retest reliability and internal consistency of the Sensory Profile Caregiver Questionnaire
  • Design
  • Prospective, nonrandomized, noncontrolled
  • Participants
  • 55 caregivers of children ranging in age from 36 to 72 mo
  • Recruitment
  • Participants were recruited from 6 nursery schools and child care centers in the New York metropolitan area.
  • Parents of children attending the centers were sent a flyer, then a research pack. Completed assessments were posted back to the researcher in self-addressed stamped envelope. Participation was voluntary.
  • Statistics
  • Descriptive statistics, ICCs, Cronbach’s α
  • Sensory Profile Caregiver
  • Questionnaire
  • • Test–retest reliability
  • • Internal consistency
  • • Test–retest reliability was good across quadrant scores (ICCs = .80–.90) and moderate to good across factor (ICCs = .69–.88) and section scores (ICCs = .50–.87).
  • • Internal consistency was high across quadrant scores (αs = .89–.95) and factor scores (αs = .82–.93) and moderate to high across section scores (αs = .67–.93).
Parham et al. (2011) 
  • To develop a reliable and valid fidelity measure for use in research on the Ayres Sensory Integration (ASI) intervention
  • Research questions:
  • Does the Process section of the Fidelity Measure show acceptable interrater reliability?
  • Does the Process section of the Fidelity Measure have acceptable internal consistency?
  • Does the Process section of the Fidelity Measure demonstrate adequate validity in differentiating ASI from other intervention approaches in occupational therapy?
  • Does the entire Fidelity Measure demonstrate content validity in addressing key elements of ASI intervention?
  • Design
  • Instrument development
  • Participants
  • 14 experts in sensory integration from 6 different countries who completed 6-hr training
  • Content validity was established through 19 experts in sensory integration from 6 different countries.
  • Recruitment
  • Content experts were recruited to assist with the development of the Fidelity Measure.
  • Statistics
  • Interrater reliability, content validity, internal consistency, Cronbach’s α, ICC
Ayres Sensory Integration Fidelity Measure
  • • Interrater reliability
  • • Internal consistency
  • • Content validity
  • • Reliability of the Process section was strong for total fidelity score (ICC = .99, Cronbach’s α = .99) and acceptable for most items.
  • • Total score significantly differentiated ASI from 4 alternative interventions.
  • • Expert ratings indicated strong agreement that items in the Structural and Process sections represent ASI intervention.
Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee (2013) To establish the psychometric properties of the Children’s Assessment of Participation and Enjoyment/Preferences for Activities (CAPE/PAC) related to children with high-functioning autism (HFA)
  • Design
  • Mixed methodology, including qualitative research to evaluate content validity and feasibility of use
  • Participants
  • 30 children with HFA between ages 7 and 13 yr (with IQ >80 or adaptive functioning score >60) and 31 typically developing peers
  • Recruitment
  • Children were recruited through multiple sources (parent support group, therapists, health department) and informal modes.
  • Statistics
  • Descriptive statistics, correlation, Mann–Whitney U test
CAPE/PAC
  • • Content validity
  • • Discriminant validity
  • • Test–retest reliability
  • • CAPE/PAC can be used to assess participation (recreational) among children with HFA.
  • • Content validity was assessed as adequate after qualitative evaluation. Test–retest reliability of overall scores was adequate (r > .7), except the social aspect dimension, which was low (r > .196).
  • • Parents’ agreement with most of their children’s self-ratings on this assessment provided an estimate of interrater reliability (in HFA group, 75% of parents agreed or strongly agreed with their child’s rating on the CAPE, and 50% of parents agreed or strongly agreed with their child’s rating for the PAC).
  • • The CAPE/PAC has adequate discriminant validity and test–retest reliability and is able to discriminate between children with and without HFA. Therefore, results suggest that the CAPE/PAC is applicable for use with children with HFA.
Rosenblum, Sachs, & Schreuer (2010) To examine the internal consistency and construct validity of the Children’s Leisure Assessment Scale (CLASS)
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 249 children and adolescents in Israel (114 boys, 135 girls)
  • Recruitment
  • Stratified snowball sampling
  • Inclusion criteria: typically developing public school students
  • Statistics
  • Descriptive statistics, Cronbach’s α, factor analysis, MANOVA, t tests
CLASS; measures multidimensional participation in children’s and adolescents’ leisure activities
  • • Internal consistency
  • • Face validity
  • • Content validity
  • • Construct validity
  • • Discriminant validity
  • Face and content validity: Original assessment reviewed by 5 expert consultants and 5 experienced pediatric OTs.
  • Internal consistency: Leisure factors (instrumental indoor activities, outdoor activities, self-enriched activities, games and sports activities) showed acceptable levels of internal reliability (Cronbach’s α ranged from .57 to .83).
  • Construct validity: Discriminant validity based on gender; girls participated in significantly more activities than the boys (65% and 56%, respectively), with greater frequency and with greater preference for self-enrichment and instrumental indoor activities. Boys participated in significantly more games and sports activities.
Saban, Ornoy, Grotto, & Parush (2012) To describe the development of the Adolescents and Adults Coordination Questionnaire (AAC–Q) and describe its psychometric properties
  • Design
  • Prospective, randomized, instrument development study
  • Participants
  • Convenience sampling of (1) 28 adolescents and young adults diagnosed with DCD (between ages 16 and 35 yr) in Israel and (2) 28 age- and gender-matched participants who had no diagnosis of DCD and who had never been referred or treated for motor coordination problems in Israel
  • Random sampling of 2,379 participants ages 19–25 yr from Israel Military Service
  • Recruitment
  • The DCD group was recruited by contacting professionals who worked with adults. The control group was recruited through advertisements in the university setting and workplace.
  • Statistics
  • Descriptive statistics, independent-sample t tests, construct validity, Cronbach’s α, Pearson’s correlation coefficients
AAC–Q
  • • Content validity
  • • Construct validity
  • • Internal consistency
  • • Test–retest reliability
  • Content reliability: 12 AAC–Q items had >95% interrater agreement from 8 OTs.
  • Internal consistency: High; Cronbach’s α = .88
  • Test–retest reliability: r = .94, p < .001
  • Construct validity: Independent-sample t tests revealed significant differences between participants with and without DCD, t(27) = 9.37, p < .001. A high significant correlation was found between the scores of the 2 scales (r = .973, p < .05), indicating that although separate, the scales assess the same construct. Resulted in removal of the Degree or Intensity scale from the AAC–Q.
Silva & Schalock (2012) To validate the Sense and Self-Regulation Checklist (SSC), a parent–caregiver measure of sensory and self-regulatory responses of children with autism in everyday life
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 265 children < age 6 yr with typical development (n = 138), autism (n = 99), or other developmental delay (DD; n = 28); the informants were the children’s caregivers.
  • Recruitment
  • Convenience sampling for all groups. Children with autism and DD had already been involved in other studies with researchers. They were recruited from 6 regional early childhood special education programs across Oregon.
  • Parents of typically developing children were recruited through 1 child care center, 3 mother support groups, and 1 toddler drop-in play center in Oregon.
  • Statistics
  • Descriptive statistics of participants, χ2 test, Pearson correlation coefficient, multiple regression, Cronbach’s α, ANOVA, post hoc tests
SSC
  • • Internal consistency
  • • Test–retest reliability
  • • Discriminant validity
  • Internal consistency: Overall scores were acceptable. Cronbach’s α = .87 for children with ASD, .89 for typically developing kids, and .85 for children with other DD. In the sensory domain, α = .81 for children with ASD, .80 for typically developing children, and .58 for children with other DD. In the self-regulation domain, α = .79 for children with ASD, .86 for typically developing children, and .83 for children with other DD.
  • Test–retest reliability: After 4-mo follow-up, sensory impairment test–retest coefficient = .595, self-regulation = .831, and overall score = .677.
  • • 2 new findings discriminated autism from other groups: (1) multifocal tactile sensory impairment, characterized by hyporeactivity to injurious stimuli and hyperreactivity to noninjurious stimuli, F(2, 262) = 86.8, p < .001, and (2) global self-regulatory delay, F(2, 262) = 122, p < .001.
  • • The SSC reports a prevalence of sensory and self-regulatory findings approaching 100% (96% and 98%, respectively) in the autism group, raising the possibility that sensory and self-regulatory difficulties represent a core part of autism.
Spirtos, O’Mahony, & Malone (2011) To further examine the interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function (MAUULF)
  • Design
  • Cross-sectional, nonrandomized reliability study
  • Participants
  • 3 OTs who independently scored 34 videotaped assessments of 11 children with hemiplegic cerebral palsy ages 6 yr 1 mo–14 yr 5 mo.
  • All therapists had used the MAUULF in clinical practice and had a 3-hr training session.
  • Recruitment
  • Convenience sample of 3 experienced OTs with honors degrees in occupational therapy who were working in the same center for children and adults with physical disabilities
  • Written informed consent was obtained from the parents of the children for blind scoring of their child’s assessments as
  • part of a larger study.
  • Statistics
  • Descriptive statistics, ICCs, confidence intervals
MAUULF• Interrater reliability
  • Total scores: The correlation between raters was high for the total score (ICC = .961).
  • Test components: The highest correlation between raters was found for fluency (ICC = .902), followed by range of movement (ICC = .866), and the lowest correlation was found for quality of movement (ICC = .683).
  • Individual test item scores: The ICCs varied and ranged from .368 to .899.
Taylor, Lee, Kramer, Shirashi, & Kielhofner (2011) To conduct a psychometric examination (reliability, sensitivity, and validity) of the Occupational Self Assessment (OSA) by focusing on an adolescent population
  • Design
  • Prospective scale evaluation study
  • Participants
  • 296 adolescents between ages 12 and 18 yr with recent diagnosis of acute mononucleosis
  • Follow-up sample was 31 participants who did not consider themselves fully recovered and 59 matched control participants who did consider themselves fully recovered from mono at 12 mo after initial enrollment and after the acute phase. Two matched controls were identified for each participant with persistent fatigue.
  • Recruitment
  • Participants were recruited from schools, hospitals, outpatient clinics, and private physician practices in Chicago.
  • Statistics
  • Item Response Theory; Rasch Rating Scale Model
OSA
  • • Test–retest reliability
  • • Sensitivity
  • • Construct validity
  • • Concurrent validity
  • • OSA items coalesced to capture the intended constructs; the rating scales functioned as intended.
  • • >90% of participants were validly measured.
  • • Demonstrated adequate sensitivity and stability (test–retest reliability) over time.
  • • OSA measure of competence was moderately associated with infectious symptoms, fatigue severity, health status, and stress, and the measure of values was not.
  • • Adolescents who had not recovered from mononucleosis after 12 mo reported lower competence scores yet attached the same value or importance to occupational participation as adolescents who had recovered.
Toglia & Berg (2013) 
  • To compare abilities and strategy use of a group of at-risk youth, ages 16–21 yr, with a community sample of high school students using the WCPA and to investigate the discriminative validity of the WCPA
  • Design
  • Quasi-experimental 2-group comparison, cross-sectional research
  • Participants
  • 113 at-risk youth from an alternative high school and 49 youth from community high schools from a midwestern U.S. city
  • Recruitment
  • A representative sample of gender, race, age, and educational backgrounds were sought using convenience sampling and stratified sampling methods.
  • Statistics
  • Descriptive statistics, Pearson χ2 with Fisher’s exact test significance and t-test comparisons
WCPA, a performance measure of everyday executive function• Discriminative validity: 2 participant groups with known differences compared on their performance on the WCPA
  • t-test comparison between the 2 groups, with Bonferroni correction of p = .004 (.05/12) to avoid a Type I error; WCPA scores revealed significant differences between the 2 participant groups with the exception of total time (p = .91), planning time (p = .97), and rules followed (p = .03).
  • • The WCPA was able to differentiate between 2 groups of participants with known differences; the community group was more likely to follow rules, enter appointments accurately, self-report errors, and use a greater number of strategies than the at-risk youth group.
  • • Comparison of the at-risk and community youth participant groups provides support for the WCPA’s discriminative validity.
Tsai, Lin, Liao, & Hsieh (2009) To examine the reliability of Motor-Free Visual Perception Test–Revised (MVPT–R) and Test of Visual–Perceptual Skills–Revised (TVPS–R)
  • Design
  • Prospective reliability study
  • Participants
  • 52 children (31 boys, 21 girls; age range = 5 yr 5 mo–8 yr 9 mo)
  • Recruitment
  • Convenience sampling was used for children in regular kindergarten and special education classrooms in Taipei, Taiwan.
  • Inclusion criteria: Diagnosis of cerebral palsy, ages 5–8, ability to follow general oral instructions
  • Exclusion criteria: Child could not follow the instructions of the MVPT–R and TVPS–R, poor visual acuity as indicated by Teller Acuity Cards
  • Statistics
  • Descriptive statistics, ICCs, smallest real differences, Cronbach’s α, standard error of measurement
MVPT–R, TVPS –R
  • • Test–rest reliability
  • • Interrater reliability
  • • Internal consistency
  • Test-retest reliability: MVPT–R total score was excellent (ICC = .96); TVPS–R total score was also excellent (ICC = .97); TVPS–R subscale scores were high (ICCs = .76–.92).
  • Interrater reliability: MVPT–R interrater agreement was excellent (ICC = .92); TVPS–R interrater agreement was excellent (ICC = .93); TVPS–R subscale score was high (ICCs = .74–.89) except for the visual sequential memory subscale (ICC = .63).
  • Internal consistency: MVPT–R, Cronbach’s α = .87; TVPS–R, Cronbach’s α = .98; TVPS–R subscale Cronbach’s αs were high (.87–.94).
Vanvuchelen, Roeyers, & De Weerdt (2011) To examine the interrater and test–retest reliability of the Preschool Imitation and Praxis Scale (PIPS)
  • Design
  • Prospective, instrument reliability study
  • Participants
  • 119 typically developing preschool children (69 girls, 50 boys) between ages 1.5 and 4.9 yr were sampled from day care centers and regular preschools in Flanders, Belgium.
  • Recruitment
  • Stratified random sampling was used.
  • Inclusion criteria: Children not born preterm and had no known physical or mental handicap
  • Statistics
  • Descriptive statistics, Cohen’s weighted κs, ICCs, smallest detectable difference, Pearson product–moment correlation coefficient
PIPS
  • • Intrarater reliability
  • • Interrater reliability
  • • Test–rest reliability
  • • The intrarater reliability of the PIPS total score was high (ICC = .996).
  • • The interrater reliability of the PIPS total score was high (ICC = .995).
  • • Test–retest reliability was high (r = .93) for the association scores between 56 children assessed with a time interval of 1 wk.
Weiner, Toglia, & Berg (2012) To evaluate initial psychometric properties of the WCPA, to describe the baseline executive functioning profile of at-risk youth, and to investigate relationship between accuracy, time, strategy use, error patterns, and self-evaluation of performance
  • Participants
  • 113 at-risk youth (53 girls, 60 boys) between ages 16 and 21 yr from an alternative high school. 9 did not participate; however, details are not provided about the remaining 104.
  • Recruitment
  • Participants were enrolled at a school for high-risk youth in the midwestern United States.
  • Statistics
  • Descriptive statistics, Pearson correlation coefficient
WCPA, a performance measure of everyday executive function
  • • Interrater reliability
  • • Interitem correlations
  • • Clinically useful tool for measuring executive functioning among youth.
  • • Interrater reliability for 2 trained scorers was high (ICC = .99) for total accuracy scores.
  • • On average, participants spent 15.9 min on the WCPA, made 7.9 errors, and followed 4.0 of 5 possible rules. No ceiling effect was observed in overall accuracy. Participants used a mean of 3.1 strategies (standard deviation = 1.9) while completing the WCPA.
  • • Participants who used more strategies spent more time planning and completing the task and were more accurate.
  • • The assessment allows evaluation of complex task performance, strategy use, self-evaluation of performance, and error patterns, which guide interventions.
Weintraub & Bar-Haim Erez (2009) To describe the development and initial evaluation of the construct validity of the Quality of Life in School (QoLS) questionnaire
  • Design
  • Cross-sectional, nonrandomized, reliability and validity study
  • Participants
  • 353 elementary school students (180 boys, 173 girls) in 3rd–6th grade from 8 general education schools in Israel
  • Recruitment
  • Purposive sampling in identified schools and parents approached for permission to include their typically developing child
  • Inclusion criteria: In Grades 3–6, no neurological symptoms, no physical disability, not receiving special education services
  • Statistics
  • Cronbach’s α, Pearson correlation coefficients, 2-way ANOVA, MANOVA (between gender and age), ANOVA, factor analysis
QoLS–Version 2
  • • Comprehensive description of development and initial evaluation of QoLS–Version 2
  • • Construct validity
  • • Internal consistency
  • • Factor structure
  • • Discriminant validity
  • • Factor analysis identified 4 categories within questionnaire: (1) teacher–student relationship and school activity (Cronbach’s α = .91), (2) physical environment (Cronbach’s α = .82), (3) negative feelings (Cronbach’s α = .90), and (4) positive feelings (Cronbach’s α = .68).
  • Internal consistency: Total questionnaire Cronbach’s α = .88.
  • • Total QoLS score had significant medium to high correlation with each category (.51 < r < .69).
  • • Discriminant validity in process to evaluate use of this tool with students with disabilities was not reported in this article.
  • • QoLS may assist clinicians and educators in evaluating students’ school quality of life from a multidimensional perspective, pending application to students with disabilities.
Table Footer NoteNote. ADLs = activities of daily living; AMPS = Assessment of Motor and Process Skills; ANOVA = analysis of variance; ASD = autism spectrum disorder; CI = confidence interval; COP = Comprehensive Observations of Proprioception; DCD = developmental coordination disorder; DIF = differential item functioning; ETCH = Evaluation Tool of Children’s Handwriting; HPAS = Health Promoting Activities Scale; ICC = intraclass correlation coefficient; LPP = Life Participation for Parents; MANOVA = multivariate analysis of variance; OT = occupational therapist; PEDI = Pediatric Evaluation of Disability Inventory; ROC = receiver operating characteristic; SVMPT = Slosson Visual–Motor Performance Test–Revised; TVMI = Test of Visual–Motor Integration; VMI = Developmental Test of Visual–Motor Integration; WCPA = Weekly Calendar Planning Activity.
Note. ADLs = activities of daily living; AMPS = Assessment of Motor and Process Skills; ANOVA = analysis of variance; ASD = autism spectrum disorder; CI = confidence interval; COP = Comprehensive Observations of Proprioception; DCD = developmental coordination disorder; DIF = differential item functioning; ETCH = Evaluation Tool of Children’s Handwriting; HPAS = Health Promoting Activities Scale; ICC = intraclass correlation coefficient; LPP = Life Participation for Parents; MANOVA = multivariate analysis of variance; OT = occupational therapist; PEDI = Pediatric Evaluation of Disability Inventory; ROC = receiver operating characteristic; SVMPT = Slosson Visual–Motor Performance Test–Revised; TVMI = Test of Visual–Motor Integration; VMI = Developmental Test of Visual–Motor Integration; WCPA = Weekly Calendar Planning Activity.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 1). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 1). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
×
Table 2.
Summary of Instruments for Children and Youth Described in Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013
Summary of Instruments for Children and Youth Described in Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Instrument (Article)Frame of Reference/Theoretical or Practice ModelPopulation/Group; Perspective; Purpose, Use, or Intent of InstrumentDescription of InstrumentAdministration and Scoring Time RequiredSubscales or Item CategoriesResources and Equipment RequiredScores and Results Obtained
Adolescents and Adults Coordination Questionnaire (AAC–Q; Saban, Ornoy, Grotto, & Parush, 2012) Motor Control and ICF, Body Functions and Structures
  • Population: Adolescents and young adults between ages 16 and 35.
  • Perspective: Self-report.
  • Purpose: To identify and investigate DCD in adolescents and adults age ≤35 yr; the AAC–Q can enable a greater understanding of how DCD influences participation and function in daily life activities, information that may guide the development of more effective intervention programs for this group.
  • Consists of 12 items, which include basic and instrumental activities of daily living, organizational skills, spatial and temporal orientation, activities requiring fine motor function, activities requiring gross motor function, and writing.
  • • Respondents are asked to respond using a 5-point Likert frequency scale.
  • • Takes <10 min to complete.
  • • Final score ranges from 12 to 60, with lower scores indicating better motor coordination function.
  • • Single composite score is calculated.
  • • Questionnaire
  • • Pen or pencil
Total score ranges from 12 to 60.
Assessment of Children’s Hand Skills (ACHS; Chien, Brown & McDonald, 2010)Ecological and top-down assessment
  • Population: Children ages 2–12 yr.
  • Perspective: Observation based; professional scores performance on the basis of specific criteria.
  • Purpose: To evaluate how effectively children use their hands when engaged in meaningful occupations and to analyze and rate children’s actual hand skill performance in their relevant environments.
Assesses children’s hand use in naturalistic settings via observational rating scale.
  • • The ACHS research version consists of 20 hand skill items rated on a 6-point rating scale.
  • • A score of 6 indicates very effective hand skill performance, whereas a score of 1 indicates very ineffective hand skill performance.
Children’s hand skills are divided into 6 distinct categories: manual gesture, body-contact hand skills, adaptive skilled hand use, arm–hand use, bimanual use, and general activities.
  • • Assessment booklet
  • • Naturalistic environment
  • • Pencil
Composite scores and subscale scores for the 6 hand skill categories are generated.
Assessment of Motor and Process Skills (AMPS; Gantschnig, Page, Nilsson, & Fisher, 2013)
  • Model of Human Occupation and occupational performance
  • Population: Children with typical development or mild disabilities ages 4–15 yr.
  • Perspective: Therapist or clinician administered and scored.
  • Purpose: To differentiate and measure the motor and processing skills of children with and without disabilities during ADL tasks.
Internationally standardized observational assessment of activities of daily living in which the child is rated on 16 motor and 20 processing ADL items.Takes approximately 1 hr to administer.Computer-generated results
  • • Test manual
  • • Scoring sheets
Scores for motor and processing skills
Ayres Sensory Integration (ASI) Fidelity Measure (Parham et al., 2011)Sensory integration theory
  • Population: Not applicable.
  • Perspective: Third-party raters, who complete Fidelity Measure to investigate whether service provided on the basis of sensory integration principles aligns with theoretical principles.
  • Purpose: To document whether interventions carried out are in accordance with the essential procedural aspects of ASI intervention, to monitor replicable ASI intervention delivery in research such as randomized clinical trials, and to differentiate between ASI and other types of intervention.
  • • Addresses the key structural and process elements of ASI intervention.
  • • Parts 1–4 measure the structural elements.
  • • Part 5 measures therapist adherence to 10 process elements (e.g., tailors activity to present just-right challenge).
  • • Scoring involves subjectivity.
  • • Scored on a 4-point Likert scale.
  • • A total Fidelity score of 100 equals a perfect match to ASI intervention strategies.
  • • Total Fidelity score of 80 was designated as the tentative cutpoint for determining whether an observed intervention session adhered to ASI therapeutic principles.
Total summed raw score
  • • Training
  • • Pen
Total Fidelity score
Box and Block Test (Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen, 2013)Biomedical framework; ICF: Body Structure and Function and Activity
  • Population: Children ages 3–10 yr with differences in hand function.
  • Perspective: Child completes timed test; therapist- or clinician-administered and scored on the basis of specific criteria.
  • Purpose: To provide performance score on normed standardized test of gross manual dexterity.
Standardized and specifically measured set of boxes that fit inside each other.Time to administer varies—longer for younger children (≤30 min)Raw scores converted to standard scores. Each is hand scored separately.
  • • Box with partition
  • • Blocks
  • • Timer
  • • Scoring forms
Standard scores
Child Occupational Self Assessment (COSA; Kramer, Kielhofner, & Smith, 2010)Model of Human Occupation
  • Population: Children with disabilities ages 6–17 yr.
  • Perspective: Self-report (child-friendly rating scale).
  • Purpose: Self-report of occupational competence and value for everyday activities designed to involve children in identifying goals and assessing outcomes; measures the extent to which children feel they competently meet expectations and responsibilities associated with activities and the relative value of those activities.
Consists of a series of 25 items that represent a range of everyday activities that most children encounter at home, at school, and in their communities.
  • • Can be administered in 1 of 3 ways: (1) standard paper-and-pencil format that provides different visual cues for each rating category description, (2) card-sort version that places each item on a separate card and each rating category (and visual cue) on a larger rating card, and (3) summary form that presents all items and rating categories in a matrix format without visual cues.
  • • Takes approximately 30 min to complete.
  • • Each item is rated using two 4-point rating scales: Occupational Competence scale and Values scale.
COSA rating scale converted to 1–4 for data entry and delivered to database for analysis (in the study described). Use by clinicians, including scoring, not described.
  • • Assessment
  • • Manual
  • • Training in administration
List of activities that the child feels less competent doing but for which he or she indicates high importance; these activities can be addressed in therapy.
Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)PEO model and ICF
  • Population: Children with and without disability ages 6–18 yr.
  • Perspective: Self-report of child’s perception; can include third-party parent assistance.
  • Purpose: Self-rated measure that estimates a child’s participation outside of school; children complete the assessment independently or supported by an adult through adaptations.
  • Booklet and score sheet format for self-selection of response that most represents child’s perspective
• 30–60 min to administer and score
  • • Consists of 55 items related to participation (46 of these are recreational)
  • • Provides information about 5 dimensions of participation: intensity, social aspect, location, child’s degree of enjoyment in the activity, and preference
  • • Pen
  • • Assessment
  • • Manual
Raw scores within dimensions
Occupational Therapy Practice Framework (2nd ed.; AOTA, 2008), occupational performance
  • Population: Children and adolescents.
  • Perspective: Self-report.
  • Purpose: To measure multidimensional participation in children’s and adolescents’ leisure activities; designed to document children’s perceptions about their time investment in leisure activities and their ambitions regarding certain activities that they would like to undertake but have not for a variety of reasons.
Consists of 30 items under 4 factors: (1) instrumental indoor activities, (2) outdoor activities, (3) self-enriched activities, and (4) games and sports activities, which relate to 6 dimensions of leisure participation: variety, frequency, sociability, preference, time consumption, and desired activities.
  • The dimensions of participation are scored:
  • Variety: sum score of participation in activities (0 = not doing the activity at all, 1= doing the activity)
  • Frequency: measured on a 4-point Likert-type scale (1 = once in a few months, 2 = once a month, 3 = twice a week, and 4 = every day)
  • Sociability: defined by who performed the activity with the child, rated on a 4-point Likert-type scale (1 = alone, 2 = with a relative, 3 = with one friend, and 4 = with friends)
  • Preference: rated on a 10-point scale ranging from 1 (do not like at all) to 10 (like very much)
• Consists of 30 items under 4 factors: (1) instrumental indoor activities, (2) outdoor activities, (3) self-enriched activities, and (4) games and sports activities.
  • • Manual
  • • Assessment
  • • Scoring sheet
  • • Pen
Allows evaluation of leisure activities among typically developing children and adolescents.
Proprioception and sensory integration theory, motor control, ICF
  • Population: Children age ≥2 yr with suspected proprioceptive processing difficulties.
  • Perspective: Observational assessment; the COP guides clinical observations and helps the clinician identify adequate performance and deviation from typical parameters using defined criteria; professional scores performance on the basis of specific criteria.
  • Purpose: To measure proprioceptive processing in children.
  • • Contains 18 items focusing on motor and behavior regulation aspects of proprioceptive processing in children.
  • • Measures 4 factors: (1) tone and joint alignment, (2) behavior manifestations, (3) postural motor, and (4) motor planning.
  • • Can be used in a variety of contexts, such as the home, clinic, and school.
Takes 15 min to administer; therapist observes child and rates the COP items.Measures 4 factors: (1) tone and joint alignment, (2) behavior manifestations, (3) postural motor, and (4) motor planning.Copy of scale and place to observe childTotal COP score plus 4 factor scores
Developmental Test of Visual–Motor Integration (VMI; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 2–17 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Visual–motor screening tool to identify children who are experiencing difficulty coordinating visual perception and motor movements; has 2 supplement standardized tests: VMI Visual Perception and VMI Motor Coordination. Can be administered individually or in a group.
Consists of 27 geometric forms to be copied and organized in developmental sequence.• Administration takes approximately 15 min, and scoring time is approximately 10 min.Total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Do-Eat (Josman, Goffer, & Rosenblum, 2010)Ecological practice model, PEO model, Occupational Therapy Practice Framework (2nd ed.)
  • Population: Children with DCD.
  • Perspective: Therapist observation and parent or third-party questionnaire.
  • Purpose: To evaluate daily task performance abilities among children with DCD; assists with establishing customized goals and objectives for intervention.
  • Ecologically valid assessment; focuses on food preparation, drawing, writing, and cutting.
  • • Child is asked to perform 3 tasks: (1) Make a sandwich, (2) prepare chocolate milk, and (3) fill out a certificate of outstanding performance for him- or herself.
  • • See Appendix 1 of article for assessment.
  • • Accompanying parental questionnaire consists of 12 positive statements.
  • Assessment is administered in natural surroundings (e.g., kindergarten, family kitchen).
  • • Scoring is sum totaled.
  • • Throughout performance, child receives score for performing the task, analysis score for sensory–motor skills, and analysis score for executive functioning.
  • • Test scores range from 1 (unsatisfactory performance) to 5 (very good performance).
  • • Accompanying parental questionnaire scored on scale ranging from 1 (never) to 5 (always).
  • • Overall task performance score is calculated.
  • • Overall score analyzing sensory–motor skills and executive functioning.
  • • Test includes summary score sheets including scores discussed in preceding bullets and parental questionnaire score.
  • • Score for performing the task
  • • Analysis score for sensory–motor skills
  • • Analysis score for executive functioning
  • • Parental questionnaire score
  • • Assessment
  • • Manual
  • • Ingredients for tasks
  • • Certificate that child fills out
  • • Score card
  • • Overall task performance score
  • • Overall score analyzing sensory–motor skills and overall score analyzing executive functioning
  • • Summary test score sheets including scores in previous bullet and parental questionnaire score
Evaluation of Social Interaction (ESI; Griswold & Townsend, 2012)Model of Human Occupation
  • Population: Children ages 2–12 yr with and without a disability.
  • Perspective: Performance-based assessment gained through observation (verbal and nonverbal behaviors); professional scores performance on the basis of specific criteria.
  • Purpose: To assess the quality of social interaction in children as a baseline to measure change in social interaction performance; enables occupational therapist to plan interventions to address specific social interaction skill deficits for children during activities in natural contexts.
  • Social interaction performance is scored on 27 skills that relate to initiating and ending a social interaction, producing the interaction, physically supporting the interaction, shaping the content and maintaining the flow of the interaction, verbally supporting the interaction, and adapting to problems that might arise during the interaction.
  • • 27 skills are scored on 4-point criterion-referenced rating scale.
  • • Scores are placed in ESI software, which generates a measure of the quality of social interaction.
  • • Social interactions are categorized by their intended purpose.
  • • Categories: gathering information, sharing information, problem solving or decision making, collaborating or producing, acquiring goods and services, conversing socially or making small talk
Natural environment to observe child (school, home, kindergarten, park, etc.)
  • • Measure of the quality of social interaction (objective measure): baseline to measure change in social interaction performance
  • • Raw scores converted to logits
Evaluation Tool of Children’s Handwriting (ETCH; Brossard-Racine, Mazer, Julien, & Majnemer, 2012; Duff & Goyen, 2010)PEO model, occupational performance, and Occupational Therapy Practice Framework (2nd ed.)
  • Population: School-age children.
  • Perspective: Professional scores performance on the basis of specific criteria.
  • Purpose: Standardized measure that assesses a range of handwriting tasks similar to those experienced in the classroom setting; designed to identify and characterize handwriting difficulties in young school-age children.
  • • The ETCH is available in both manuscript and cursive versions.
  • • The Manuscript version of the ETCH (ETCH–M) targets children in Grades 1–3 and examines legibility through 7 different tasks: alphabet, writing from memory (upper- and lowercase), numeral writing from memory, near-point copying, far-point copying, dictation of non-words and numbers, and composition of a short sentence.
  • • Takes approximately 30 min to administer.
  • • Letters, numerals, and words are judged for legibility using a list of specific criteria such as omission, closing, misplacing, reversion, and poor erasure.
  • • The percentage of legibility is determined for each task by counting the legible letters, numerals, or words and dividing by the total number of letters, numerals, or words required.
  • • The percentages from each task are then averaged to provide a total legibility score for letters, numerals, and words.
  • • Performance time or writing speed is measured in seconds for the alphabet and numeral writing tasks and in letters per minute for the copying and composition tasks.
Sum total
  • • Assessment
  • • Manual
  • • Pen or pencil
  • • Total legibility score (for word and letter)
  • • Performance time and writing speed score
Family L.I.F.E. (Looking Into Family Experiences; Honaker, Rosello, & Candler, 2012)
  • Occupational adaptation practice model and Occupational Therapy Practice Framework (2nd ed.)
  • Population: Families with a child with autism spectrum disorder.
  • Perspective: Self-report by family.
  • Purpose: Occupation-based assessment that engages families and therapists in a collaborative partnership to identify unique and relevant family occupations, evaluate these occupations, and measure perceived success in these occupations.
  • • Assessment includes demographic section and a time diary of a typical weekday and a typical weekend day (helps to identify routines and rituals).
  • • 8 interview questions focus on family togetherness, child rearing, and impact on family occupations.
  • • Likert scale is used to rate each occupation on perceived effectiveness, efficiency, and satisfaction.
  • • The sum of the scores is tallied for each factor and divided by the number of occupations to achieve a separate overall score.
Sum total to give overall score
  • • Assessment
  • • Manual
Overall score
Health Promoting Activities Scale (HPAS; Bourke-Taylor, Law, Howie, & Pallant, 2012)PEO model, ecological practice model
  • Population: Initially developed for mothers of children with a disability.
  • Perspective: Self-report instrument.
  • Purpose: To measure the frequency of participation in healthy occupations that are associated with mental health and well-being.
  • • 8 items with activity key for participants to consider their self-selected occupations
  • • Response items are rated on a 7-point scale ranging from daily to never.
Sum totalSingle composite scoreFreely available brief scaleTotal score
Life Participation for Parents (Fingerhut, 2013)Occupational adaptation practice model, family-centered practice
  • Population: Parents of children with a disability.
  • Perspective: Self-report of parent.
  • Purpose: To facilitate family-centered pediatric practice by measuring the ability of parents to participate in life occupations while raising a child with special needs.
Contains 22 questions asking parents about their ability to participate.
  • • The questions are answered on a 5-point Likert scale ranging from strongly agree to strongly disagree, with a lower score indicating less satisfaction with occupational participation.
  • • Reverse scoring of positively worded questions
Total Stress score and subscale scores: Satisfaction With Efficiency and Satisfaction With Effectiveness
  • • Assessment
  • • Pen
Scores sum totaled: overall and 2 subscales
Manual Ability Classification System (Kuijper, van der Wilden, Ketelaar, & Gorter, 2010)ICF: Body Structures and Functions and Activity
  • Population: Children ages 5–14 yr with cerebral palsy (CP).
  • Perspective: Third party—either parent or professional who knows the child’s performance.
  • Purpose: Classification system with 5 levels pertaining to defined use of the hands by children with CP.
  • The classification system has a decision tree to guide the scorer (occupational therapist or physician). Focuses on the way children with CP use both of their hands when handling objects in daily age-appropriate activities.
  • • Has 5 classification system levels: (1) Handles objects easily and successfully; (2) handles most objects with somewhat reduced quality and speed of achievement; (3) handles objects with difficulty, needs help to prepare or modify activities; (4) handles a limited selection of easily managed objects in adapted situations; and (5) does not handle objects and has severely limited ability to perform even simple actions.
  • • The scale is ordinal, and the distances between levels are not considered equal.
Hand use is classified at 1 of the 5 levels by skilled observer.Obtain classification score for 1 of 5 levels.
  • • Manual and score sheets can be downloaded from http://www.macs.nu/
  • • Available in multiple languages.
  • • The assessment requires no special training for occupational therapists and physicians.
Obtain classification score for 1 of 5 levels regarding hand function for children with CP
  • McDonald Play Inventory
  • (MPI): McDonald Play Activity Inventory (MPAI) and McDonald Play Style Inventory (MPSI; McDonald & Vigen, 2012)
PEO and Occupational Performance models
  • Population: Children ages 7–11 yr.
  • Perspective: Self-report (child) or third party, and including parental report.
  • Purpose: Two-part child self-rated scale of play.
  • • Made up of 2 parts: (1) the MPAI, which measures the child’s perceived frequency of engagement in 4 categories that form 4 subscales (Fine Motor, Gross Motor, Social Group, Solitary), and (2) the MPSI, which measures the types and frequency of play behaviors (affective component) in 4 domains: physical coordination, cooperation, peer acceptance, and social participation.
  • • MPSI consists of 24 play behavior items (6 items in each category), 12 neutral play activity items, and 4 “lie” or social desirability items.
  • • MPAI: Rate the frequency of participation in activity on 5-point Likert-scale (never, about once or twice a year, about once or twice a month, about once or twice a week, or almost every day).
  • • MPSI: Rate responses on 5-point Likert scale (never, hardly ever, sometimes, a lot, and always)
  • • Administration time: 15 min without assistance, 20–30 min with assistance
MPI is composed of two parts: MPAI and MPSI.
  • • Assessment
  • • Manual
  • • Pen
  • • Total score
  • • Subscale scores
ICF: Body Structures and Functions and Activity
  • Population: Children with neurological impairments ages 5–15 yr.
  • Perspective: Performance based or third party.
  • Purpose: Criterion-referenced assessment to measure quality of upper-limb movement in children with a neurological impairment; measures 1 hand at a time. Widely used to examine the effectiveness of specific interventions.
  • • Contains 16 items that examine the child’s performance on tasks.
  • • Individual items are scored under 4 categories: (1) range of movement, (2) target accuracy, (3) fluency, and (4) quality of movement.
  • • Individual items are scored under 4 categories.
  • • Each item is scored on a scale of either 0–3 or 0–4 (the manual provides a detailed description of what is required for each score).
Total raw scores are converted to percentages.
  • • Training session for scoring, although skill level of trainer is unknown
  • • Manual
  • • Total percentage score
  • • Designed to evaluate change over time
Motor-Free Visual Perception Test–Revised (MVPT–R; Tsai, Lin, Liao, & Hsieh, 2009)Perceptual–motor theory
  • Population: Children ages 4–12 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess children’s visual–perceptual strengths and weaknesses.
  • Consists of 40 items divided into spatial relationships, visual memory, visual discrimination, figure ground, and visual closure.
  • • Total score ranges from 0 to 40 points.
  • • Items are either right or wrong.
  • • The whole scale is administered to candidate.
One total summed score is calculated.
  • • Answer sheet
  • • Test manual
  • • Book of item plates
  • • Total raw scale score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Occupational Self Assessment (OSA; Taylor, Lee, Kramer, Shirashi, & Kielhofner, 2011)Model of Human Occupation
  • Population: Can be used with adolescents and adults.
  • Perspective: Self-report.
  • Purpose: Client-centered evaluation tool that measures clients’ perceptions of their own competence and the value they assign to occupations.
Clients rate their competence in and importance of everyday activities for 21 items; the client chooses 4 items that he or she would like to change.Takes approximately 30 min to complete and 15 min to score.Scores are calculated for 21 questions and 2 subscales, Competence and Values.
  • • Scoring sheets
  • • Pencil
• Summary scores for items; also provides scores for 2 subscales, Competence and Values
Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI–CAT; Kao, Kramer, Liljenquist, Tian, & Coster, 2012)ICF
  • Population: Children and young people with a disability through age 21 yr.
  • Perspective: Judgment-based, standardized instrument using parental reports or structured interview with professional who knows the child.
  • Purpose: To evaluate the child’s capability in the social–cognitive, daily activities, mobility, and responsibility domains.
  • • Consists of the following domains: daily activities (68 items), social-cognitive (60 items), and responsibility (51 items).
  • • Also measures environmental supports and modifications that the child needs to complete activities.
Sum total; raw scores are transformed into scaled scores for each domain.Raw scores that are transformed into scaled scoresComputer databaseScaled scores provide an indication of a child’s performance on relatively easy to relatively difficult items in a particular domain.
Pediatric Outcomes Data Collection Instrument (PODCI; Mulcahey et al., 2013)
  • Functional outcome measurement; ICF : Body Structures and Functions and Activity
  • Population: Children and adolescents ages 4–21 yr.
  • Perspective: Therapist or clinician administered and scored; professional scores performance on the basis of specific criteria.
  • Purpose: To provide an outcome measure for the upper-extremity and activity items of the PODCI when applied to brachial plexus injury.
The PODCI consists of 52 final Upper Extremity items and 34 Activity items.Takes approximately 1 hr to administer.
  • Scales include upper extremity and physical function, transfer and basic mobility, sports/physical function, pain/comfort, treatment expectations, happiness, satisfaction with symptoms, and global functioning.
  • • Computer
  • • Computer adaptive test program
  • • Scale items that the CAT runs through with respondent
Scores for the Upper Extremity and Activity subscales
Preschool Imitation and Praxis Scale (PIPS; Vanvuchelen, Roeyers, & De Weerdt, 2011)
  • Play theory, Occupational Performance of Children model, and PEO practice models
  • Population: Preschool children ages 1–5 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess the accuracy of bodily procedural imitation performance in young children
  • • Consists of 10 task categories (6 gestural, 3 procedural, and 1 facial) and 30 PIPS tasks.
  • • Performance is scored on a 3- or 5-point scale.
  • • Sum total
  • • Final PIPS score is a reflection of the accuracy of the child’s imitation performance.
  • • Administration takes 10–20 min.
The 30 tasks are divided into 10 task categories.
  • • PIPS manual
  • • PIPS assessment
  • • Pen to score
  • • Items in assessment: toy bear, wooden block, toy animal with lamp in it, box, cup, doll, toy car, bed, blanket
Total score
Quality of Life in School Version 2 (QoLS; Weintraub & Bar-Haim Erez, 2009)Biopsychosocial model and PEO model
  • Population: School-age children.
  • Perspective: Self-report.
  • Purpose: Self-rated measure evaluating student’s school quality of life from a multidimensional perspective.
Consists of 36 items divided into 4 categories: (1) teacher–student relationship and school activities (12 items), (2) physical environment of school and classroom (11 items), (3) negative feelings toward school (8 items), and (4) positive feelings toward school (5 items).Gain score for each category and total school36 items divided into 4 categories
  • • Training in assessment administration
  • • Assessment
  • • Manual
  • • Pen
Raw score for each category and total score
School Function Assessment (SFA; Hwang & Davies, 2009)Ecological assessment, functional assessment, application of Rasch measurement model
  • Population: School-age children.
  • Perspective: Third party; teacher observes the student and provides ratings on the basis of observation.
  • Purpose: Criterion-referenced assessment that measures a wide spectrum of school-related functional tasks associated with the role of elementary school child; guides program planning for students with special needs.
Consists of 18 scales made up of 266 items.Scored on a 4-point rating scale (1 = does not perform, 4 = consistent performance)Activity Performance scale consists of 18 scales made up of 266 items
  • • Manual
  • • Assessment
  • • Pen
Total score
School Version of the Assessment of Motor and Process Skills (School AMPS; Munkholm, Berg, Löfgren, & Fisher, 2010)Model of Human Occupation
  • Population: Children ages 3–13 yr attending an educational program or school.
  • Perspective: Third party; discussion with teacher and performance-based observation of child completing 2 tasks in an education or classroom context; professional scores performance on the basis of specific criteria.
  • Purpose: Functional assessment for measuring the quality of schoolwork task performance as it is observed in the natural classroom setting.
Consists of 26 schoolwork tasks plus 16 school motor and 20 school process skill items. Tasks range from simple to complex: pen-writing tasks, pencil-writing tasks, drawing, coloring tasks, cutting and pasting tasks, computer writing tasks, math, and manipulative tasks.
  • • Therapist unobtrusively observes students in their natural classroom environment.
  • • Therapist scores the quality of observed performance using the scoring criteria for the 16 school motor and 20 school process skill items on a 4-point rating scale.
• 2 linear graphs represent the quality of schoolwork performance measures: (1) school motor quality of performance and (2) school process quality of performance.
  • • Formal training in administration
  • • Paper, pen
  • • Computer and program
  • • Manual
Two schoolwork performance measures: (1) school motor quality of performance and (2) school process quality of performance
Sense and Self-Regulation Checklist (SSRC; Silva & Schalock, 2012)Behavioral self-regulation and sensory processing paradigm
  • Population: Children age <6 yr with developmental delay.
  • Perspective: Third party— parent or caregiver.
  • Purpose: To identify areas of sensory and self-regulation difficulty to assess the child’s response to treatment.
  • • Measures 2 domains: sensory difficulties and self-regulation.
  • • Sensory difficulties domain has 6 subdomains: touch–pain, auditory, visual, taste–smell, hyperreactive to noninjurious stimuli, and hyporeactive to noninjurious stimuli (additional category created: abnormal touch–pain).
  • • Self-regulation domain has 6 categories: sleep, appetite–digestion, self-soothing, orientation–attention, aggressive behavior, and self-injurious behavior.
• Scored on a 4-point rating scale: 0 (never), 1 (rarely), 2 (sometimes), and 3 (often)Sum totalCaregivers must have elementary school education and read English, Spanish, or Chinese.Two domain scores (1 for sensory and 1 for self-regulation)
Sensory Experiences Questionnaire (SEQ; Little et al., 2011)Sensory processing model
  • Population: Children ages 7–72 mo with suspected autism and related developmental disorders.
  • Perspective: Parent or caregiver report.
  • Purpose: Brief caregiver questionnaire for young children with suspected autism and developmental delays; used to identify sensory processing patterns (hypo- and hyperresponsiveness) in the context of daily activities. It is designed to be used as a supplement to diagnostic and developmental assessments.
  • • Brief (10–15 min) caregiver report
  • • Yields 4 dimensional subscale scores as well as a total score.
  • • Items reflect 5 sensory domains: tactile, auditory, visual, vestibular–proprioceptive, and gustatory–olfactory.
  • • Contains qualitative questions regarding parent compensatory strategies used in response to the sensory processing problems experienced by the child.
  • • Takes 10–15 min to complete.
  • • Caregiver responses are based on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always).
  • • Higher scores indicate more sensory processing problems.
Total score and 4 subscale scores (hyperresponsiveness, hyporesponsiveness, social, and nonsocial)
  • • Assessment form
  • • Pen
Raw total score and 4 subscale scores
Sensory Profile Caregiver Questionnaire (SPCQ; Ohl et al., 2012)Dunn’s Model of Sensory Processing
  • Population: Children ages 3–12 yr.
  • Perspective: Third party: parent report or caregiver questionnaire.
  • Purpose: To provide information about children’s tendencies to respond to stimuli and which sensory systems are likely contributing or creating barriers to functional performance.
  • Sensory Profile contains >125 items organized into 3 sections: (1) sensory processing, which contains 6 item categories that measure children’s responses to information taken in through the sensory systems; (2) modulation, which contains 5 item categories that measure children’s ability to monitor and regulate information to generate an appropriate response to the situation; and (3) behavioral and emotional responses, which contains 3 item categories that measure children’s emotional and behavioral responses to sensory experiences.
  • • Need manual for scoring guidelines.
  • • Caregivers record the frequency with which their child displays each item behavior on a 5-point Likert scale (1 = always, 2 = frequently, 3 = occasionally, 4 = seldom, 5 = never).
  • • Responses are totaled on a Summary Score Sheet that yields 2 scores: section score and factor score.
  • • Section score, which provides a visual summary of children’s sensory processing, modulation, and behavioral and emotional response abilities
  • • Factor score, which captures children’s responses to sensory experiences on the basis of not solely their sensory systems but also other aspects of sensory processing
  • • Quadrant score, which measures the degree to which children miss, obtain, detect, or are bothered by sensory input
  • • Manual
  • • Assessment sheets
  • • Summary score
  • • Sheet
  • • Pen
Section, factor, and quadrant scores
Slosson Visual Motor Performance Test (SVMPT; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 4–18 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Screening tool to identify people with visual–motor perceptual problems in which hand–eye coordination is involved; measures a person’s ability to interpret and translate visually perceived geometric patterns.
Consists of 14 geometric figures; each is copied 3 times.Administration takes approximately 20 min, and scoring time is approximately 10 min.One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual–Motor Integration (TVMI; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 4–17 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Standardized norm-referenced test of visual–motor integration; used to document presence and degree of visual–motor difficulties in children.
  • • Consists of 30 geometric figures.
  • • Uses a copying format whereby children copy figure into designated space.
Administration takes approximately 20 min, and scoring time is approximately 10 min.One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual-Motor Skills–Revised (TVMS–R; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 3–13 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Assesses children’s ability to translate, with their hands, what they visually perceive to gain an understanding of the children’s strengths and weaknesses in visual–motor integration abilities.
  • • Consists of 23 geometric figures.
  • • Uses a copying format whereby children copy figure into designated space.
  • • Administration takes approximately 20 min, and scoring time is approximately 10 min.
  • • When scoring, it allows therapist to categorize a child’s visual–motor errors and accuracies.
One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual–Perceptual Skills–Revised (TVPS–R; Tsai, Lin, Liao, & Hsieh, 2009)Perceptual–motor theory
  • Population: Children ages 4–12 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess children’s visual–perceptual strengths and weaknesses.
  • • Consists of 112 items grouped into 7 subscales.
  • • Total score ranges from 0 to 112 points, and subscale scores range from 0 to 16 points.
Sum total
  • 7 subscale scores are calculated: visual discrimination, visual memory, visual–spatial relationships, visual form constancy, visual sequential memory, visual figure–ground, and visual closure.
  • • Answer sheet
  • • Test manual
  • • Book of item plates
  • • Total raw score and subscale scores
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Weekly Calendar Planning Activity (WCPA; Toglia & Berg, 2013; Weiner, Toglia, & Berg, 2012)Cognitive–behavioral and ecological practice models
  • Population: Adolescents and adults age 16 and older.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To measure everyday executive function skills of adolescents and adults.
  • • 18 appointments are presented in a randomly ordered list.
  • • The participant is required to enter the appointments into a 1-wk schedule while recognizing and managing conflicts and adhering to 5 written rules.
  • • The rules include ( 1) leave Wednesday free, (2) do not cross out appointments once they are entered, (3) inform the examiner when it is a specified time, (4) do not respond to distracting questions from the examiner, and (5) inform the examiner when finished.
  • • Strategies used during the task are recorded on a list of 16 preidentified strategies.
  • • Strategies used during the task are recorded on a list of 16 preidentified strategies.
  • • Scores calculated include total accuracy of appointment placement on the calendar, errors made in appointment placement, planning time and total task time, number of rules followed, and type of strategies used.
  • • Total accuracy of appointment placement on the calendar
  • • Total errors made in appointment placement
  • • Self-report errors
  • • Inaccuracy errors
  • • Repetition errors
  • • Planning time
  • • Total task time
  • • Number of rules followed
  • • Number of strategies used
  • • Type of strategies used
  • • Paper
  • • Pencil
  • • WCPA pro forma
  • • WCPA test manual
  • • WCPA test booklet
  • • Table, chair, and quiet room for test taker
  • • Total accuracy of appointment placement on the calendar
  • • Total errors made in appointment placement
  • • Self-report errors
  • • Inaccuracy errors
  • • Repetition errors
  • • Planning time
  • • Total task time
  • • Number of rules followed
  • • Number of strategies used
  • • Type of strategies used
Table Footer NoteNote. DCD = developmental coordination disorder; ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2007); PEO = Person–Environment–Occupation model.
Note. DCD = developmental coordination disorder; ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2007); PEO = Person–Environment–Occupation model.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 2). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 2). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
Table 2.
Summary of Instruments for Children and Youth Described in Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013
Summary of Instruments for Children and Youth Described in Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Instrument (Article)Frame of Reference/Theoretical or Practice ModelPopulation/Group; Perspective; Purpose, Use, or Intent of InstrumentDescription of InstrumentAdministration and Scoring Time RequiredSubscales or Item CategoriesResources and Equipment RequiredScores and Results Obtained
Adolescents and Adults Coordination Questionnaire (AAC–Q; Saban, Ornoy, Grotto, & Parush, 2012) Motor Control and ICF, Body Functions and Structures
  • Population: Adolescents and young adults between ages 16 and 35.
  • Perspective: Self-report.
  • Purpose: To identify and investigate DCD in adolescents and adults age ≤35 yr; the AAC–Q can enable a greater understanding of how DCD influences participation and function in daily life activities, information that may guide the development of more effective intervention programs for this group.
  • Consists of 12 items, which include basic and instrumental activities of daily living, organizational skills, spatial and temporal orientation, activities requiring fine motor function, activities requiring gross motor function, and writing.
  • • Respondents are asked to respond using a 5-point Likert frequency scale.
  • • Takes <10 min to complete.
  • • Final score ranges from 12 to 60, with lower scores indicating better motor coordination function.
  • • Single composite score is calculated.
  • • Questionnaire
  • • Pen or pencil
Total score ranges from 12 to 60.
Assessment of Children’s Hand Skills (ACHS; Chien, Brown & McDonald, 2010)Ecological and top-down assessment
  • Population: Children ages 2–12 yr.
  • Perspective: Observation based; professional scores performance on the basis of specific criteria.
  • Purpose: To evaluate how effectively children use their hands when engaged in meaningful occupations and to analyze and rate children’s actual hand skill performance in their relevant environments.
Assesses children’s hand use in naturalistic settings via observational rating scale.
  • • The ACHS research version consists of 20 hand skill items rated on a 6-point rating scale.
  • • A score of 6 indicates very effective hand skill performance, whereas a score of 1 indicates very ineffective hand skill performance.
Children’s hand skills are divided into 6 distinct categories: manual gesture, body-contact hand skills, adaptive skilled hand use, arm–hand use, bimanual use, and general activities.
  • • Assessment booklet
  • • Naturalistic environment
  • • Pencil
Composite scores and subscale scores for the 6 hand skill categories are generated.
Assessment of Motor and Process Skills (AMPS; Gantschnig, Page, Nilsson, & Fisher, 2013)
  • Model of Human Occupation and occupational performance
  • Population: Children with typical development or mild disabilities ages 4–15 yr.
  • Perspective: Therapist or clinician administered and scored.
  • Purpose: To differentiate and measure the motor and processing skills of children with and without disabilities during ADL tasks.
Internationally standardized observational assessment of activities of daily living in which the child is rated on 16 motor and 20 processing ADL items.Takes approximately 1 hr to administer.Computer-generated results
  • • Test manual
  • • Scoring sheets
Scores for motor and processing skills
Ayres Sensory Integration (ASI) Fidelity Measure (Parham et al., 2011)Sensory integration theory
  • Population: Not applicable.
  • Perspective: Third-party raters, who complete Fidelity Measure to investigate whether service provided on the basis of sensory integration principles aligns with theoretical principles.
  • Purpose: To document whether interventions carried out are in accordance with the essential procedural aspects of ASI intervention, to monitor replicable ASI intervention delivery in research such as randomized clinical trials, and to differentiate between ASI and other types of intervention.
  • • Addresses the key structural and process elements of ASI intervention.
  • • Parts 1–4 measure the structural elements.
  • • Part 5 measures therapist adherence to 10 process elements (e.g., tailors activity to present just-right challenge).
  • • Scoring involves subjectivity.
  • • Scored on a 4-point Likert scale.
  • • A total Fidelity score of 100 equals a perfect match to ASI intervention strategies.
  • • Total Fidelity score of 80 was designated as the tentative cutpoint for determining whether an observed intervention session adhered to ASI therapeutic principles.
Total summed raw score
  • • Training
  • • Pen
Total Fidelity score
Box and Block Test (Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen, 2013)Biomedical framework; ICF: Body Structure and Function and Activity
  • Population: Children ages 3–10 yr with differences in hand function.
  • Perspective: Child completes timed test; therapist- or clinician-administered and scored on the basis of specific criteria.
  • Purpose: To provide performance score on normed standardized test of gross manual dexterity.
Standardized and specifically measured set of boxes that fit inside each other.Time to administer varies—longer for younger children (≤30 min)Raw scores converted to standard scores. Each is hand scored separately.
  • • Box with partition
  • • Blocks
  • • Timer
  • • Scoring forms
Standard scores
Child Occupational Self Assessment (COSA; Kramer, Kielhofner, & Smith, 2010)Model of Human Occupation
  • Population: Children with disabilities ages 6–17 yr.
  • Perspective: Self-report (child-friendly rating scale).
  • Purpose: Self-report of occupational competence and value for everyday activities designed to involve children in identifying goals and assessing outcomes; measures the extent to which children feel they competently meet expectations and responsibilities associated with activities and the relative value of those activities.
Consists of a series of 25 items that represent a range of everyday activities that most children encounter at home, at school, and in their communities.
  • • Can be administered in 1 of 3 ways: (1) standard paper-and-pencil format that provides different visual cues for each rating category description, (2) card-sort version that places each item on a separate card and each rating category (and visual cue) on a larger rating card, and (3) summary form that presents all items and rating categories in a matrix format without visual cues.
  • • Takes approximately 30 min to complete.
  • • Each item is rated using two 4-point rating scales: Occupational Competence scale and Values scale.
COSA rating scale converted to 1–4 for data entry and delivered to database for analysis (in the study described). Use by clinicians, including scoring, not described.
  • • Assessment
  • • Manual
  • • Training in administration
List of activities that the child feels less competent doing but for which he or she indicates high importance; these activities can be addressed in therapy.
Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)PEO model and ICF
  • Population: Children with and without disability ages 6–18 yr.
  • Perspective: Self-report of child’s perception; can include third-party parent assistance.
  • Purpose: Self-rated measure that estimates a child’s participation outside of school; children complete the assessment independently or supported by an adult through adaptations.
  • Booklet and score sheet format for self-selection of response that most represents child’s perspective
• 30–60 min to administer and score
  • • Consists of 55 items related to participation (46 of these are recreational)
  • • Provides information about 5 dimensions of participation: intensity, social aspect, location, child’s degree of enjoyment in the activity, and preference
  • • Pen
  • • Assessment
  • • Manual
Raw scores within dimensions
Occupational Therapy Practice Framework (2nd ed.; AOTA, 2008), occupational performance
  • Population: Children and adolescents.
  • Perspective: Self-report.
  • Purpose: To measure multidimensional participation in children’s and adolescents’ leisure activities; designed to document children’s perceptions about their time investment in leisure activities and their ambitions regarding certain activities that they would like to undertake but have not for a variety of reasons.
Consists of 30 items under 4 factors: (1) instrumental indoor activities, (2) outdoor activities, (3) self-enriched activities, and (4) games and sports activities, which relate to 6 dimensions of leisure participation: variety, frequency, sociability, preference, time consumption, and desired activities.
  • The dimensions of participation are scored:
  • Variety: sum score of participation in activities (0 = not doing the activity at all, 1= doing the activity)
  • Frequency: measured on a 4-point Likert-type scale (1 = once in a few months, 2 = once a month, 3 = twice a week, and 4 = every day)
  • Sociability: defined by who performed the activity with the child, rated on a 4-point Likert-type scale (1 = alone, 2 = with a relative, 3 = with one friend, and 4 = with friends)
  • Preference: rated on a 10-point scale ranging from 1 (do not like at all) to 10 (like very much)
• Consists of 30 items under 4 factors: (1) instrumental indoor activities, (2) outdoor activities, (3) self-enriched activities, and (4) games and sports activities.
  • • Manual
  • • Assessment
  • • Scoring sheet
  • • Pen
Allows evaluation of leisure activities among typically developing children and adolescents.
Proprioception and sensory integration theory, motor control, ICF
  • Population: Children age ≥2 yr with suspected proprioceptive processing difficulties.
  • Perspective: Observational assessment; the COP guides clinical observations and helps the clinician identify adequate performance and deviation from typical parameters using defined criteria; professional scores performance on the basis of specific criteria.
  • Purpose: To measure proprioceptive processing in children.
  • • Contains 18 items focusing on motor and behavior regulation aspects of proprioceptive processing in children.
  • • Measures 4 factors: (1) tone and joint alignment, (2) behavior manifestations, (3) postural motor, and (4) motor planning.
  • • Can be used in a variety of contexts, such as the home, clinic, and school.
Takes 15 min to administer; therapist observes child and rates the COP items.Measures 4 factors: (1) tone and joint alignment, (2) behavior manifestations, (3) postural motor, and (4) motor planning.Copy of scale and place to observe childTotal COP score plus 4 factor scores
Developmental Test of Visual–Motor Integration (VMI; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 2–17 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Visual–motor screening tool to identify children who are experiencing difficulty coordinating visual perception and motor movements; has 2 supplement standardized tests: VMI Visual Perception and VMI Motor Coordination. Can be administered individually or in a group.
Consists of 27 geometric forms to be copied and organized in developmental sequence.• Administration takes approximately 15 min, and scoring time is approximately 10 min.Total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Do-Eat (Josman, Goffer, & Rosenblum, 2010)Ecological practice model, PEO model, Occupational Therapy Practice Framework (2nd ed.)
  • Population: Children with DCD.
  • Perspective: Therapist observation and parent or third-party questionnaire.
  • Purpose: To evaluate daily task performance abilities among children with DCD; assists with establishing customized goals and objectives for intervention.
  • Ecologically valid assessment; focuses on food preparation, drawing, writing, and cutting.
  • • Child is asked to perform 3 tasks: (1) Make a sandwich, (2) prepare chocolate milk, and (3) fill out a certificate of outstanding performance for him- or herself.
  • • See Appendix 1 of article for assessment.
  • • Accompanying parental questionnaire consists of 12 positive statements.
  • Assessment is administered in natural surroundings (e.g., kindergarten, family kitchen).
  • • Scoring is sum totaled.
  • • Throughout performance, child receives score for performing the task, analysis score for sensory–motor skills, and analysis score for executive functioning.
  • • Test scores range from 1 (unsatisfactory performance) to 5 (very good performance).
  • • Accompanying parental questionnaire scored on scale ranging from 1 (never) to 5 (always).
  • • Overall task performance score is calculated.
  • • Overall score analyzing sensory–motor skills and executive functioning.
  • • Test includes summary score sheets including scores discussed in preceding bullets and parental questionnaire score.
  • • Score for performing the task
  • • Analysis score for sensory–motor skills
  • • Analysis score for executive functioning
  • • Parental questionnaire score
  • • Assessment
  • • Manual
  • • Ingredients for tasks
  • • Certificate that child fills out
  • • Score card
  • • Overall task performance score
  • • Overall score analyzing sensory–motor skills and overall score analyzing executive functioning
  • • Summary test score sheets including scores in previous bullet and parental questionnaire score
Evaluation of Social Interaction (ESI; Griswold & Townsend, 2012)Model of Human Occupation
  • Population: Children ages 2–12 yr with and without a disability.
  • Perspective: Performance-based assessment gained through observation (verbal and nonverbal behaviors); professional scores performance on the basis of specific criteria.
  • Purpose: To assess the quality of social interaction in children as a baseline to measure change in social interaction performance; enables occupational therapist to plan interventions to address specific social interaction skill deficits for children during activities in natural contexts.
  • Social interaction performance is scored on 27 skills that relate to initiating and ending a social interaction, producing the interaction, physically supporting the interaction, shaping the content and maintaining the flow of the interaction, verbally supporting the interaction, and adapting to problems that might arise during the interaction.
  • • 27 skills are scored on 4-point criterion-referenced rating scale.
  • • Scores are placed in ESI software, which generates a measure of the quality of social interaction.
  • • Social interactions are categorized by their intended purpose.
  • • Categories: gathering information, sharing information, problem solving or decision making, collaborating or producing, acquiring goods and services, conversing socially or making small talk
Natural environment to observe child (school, home, kindergarten, park, etc.)
  • • Measure of the quality of social interaction (objective measure): baseline to measure change in social interaction performance
  • • Raw scores converted to logits
Evaluation Tool of Children’s Handwriting (ETCH; Brossard-Racine, Mazer, Julien, & Majnemer, 2012; Duff & Goyen, 2010)PEO model, occupational performance, and Occupational Therapy Practice Framework (2nd ed.)
  • Population: School-age children.
  • Perspective: Professional scores performance on the basis of specific criteria.
  • Purpose: Standardized measure that assesses a range of handwriting tasks similar to those experienced in the classroom setting; designed to identify and characterize handwriting difficulties in young school-age children.
  • • The ETCH is available in both manuscript and cursive versions.
  • • The Manuscript version of the ETCH (ETCH–M) targets children in Grades 1–3 and examines legibility through 7 different tasks: alphabet, writing from memory (upper- and lowercase), numeral writing from memory, near-point copying, far-point copying, dictation of non-words and numbers, and composition of a short sentence.
  • • Takes approximately 30 min to administer.
  • • Letters, numerals, and words are judged for legibility using a list of specific criteria such as omission, closing, misplacing, reversion, and poor erasure.
  • • The percentage of legibility is determined for each task by counting the legible letters, numerals, or words and dividing by the total number of letters, numerals, or words required.
  • • The percentages from each task are then averaged to provide a total legibility score for letters, numerals, and words.
  • • Performance time or writing speed is measured in seconds for the alphabet and numeral writing tasks and in letters per minute for the copying and composition tasks.
Sum total
  • • Assessment
  • • Manual
  • • Pen or pencil
  • • Total legibility score (for word and letter)
  • • Performance time and writing speed score
Family L.I.F.E. (Looking Into Family Experiences; Honaker, Rosello, & Candler, 2012)
  • Occupational adaptation practice model and Occupational Therapy Practice Framework (2nd ed.)
  • Population: Families with a child with autism spectrum disorder.
  • Perspective: Self-report by family.
  • Purpose: Occupation-based assessment that engages families and therapists in a collaborative partnership to identify unique and relevant family occupations, evaluate these occupations, and measure perceived success in these occupations.
  • • Assessment includes demographic section and a time diary of a typical weekday and a typical weekend day (helps to identify routines and rituals).
  • • 8 interview questions focus on family togetherness, child rearing, and impact on family occupations.
  • • Likert scale is used to rate each occupation on perceived effectiveness, efficiency, and satisfaction.
  • • The sum of the scores is tallied for each factor and divided by the number of occupations to achieve a separate overall score.
Sum total to give overall score
  • • Assessment
  • • Manual
Overall score
Health Promoting Activities Scale (HPAS; Bourke-Taylor, Law, Howie, & Pallant, 2012)PEO model, ecological practice model
  • Population: Initially developed for mothers of children with a disability.
  • Perspective: Self-report instrument.
  • Purpose: To measure the frequency of participation in healthy occupations that are associated with mental health and well-being.
  • • 8 items with activity key for participants to consider their self-selected occupations
  • • Response items are rated on a 7-point scale ranging from daily to never.
Sum totalSingle composite scoreFreely available brief scaleTotal score
Life Participation for Parents (Fingerhut, 2013)Occupational adaptation practice model, family-centered practice
  • Population: Parents of children with a disability.
  • Perspective: Self-report of parent.
  • Purpose: To facilitate family-centered pediatric practice by measuring the ability of parents to participate in life occupations while raising a child with special needs.
Contains 22 questions asking parents about their ability to participate.
  • • The questions are answered on a 5-point Likert scale ranging from strongly agree to strongly disagree, with a lower score indicating less satisfaction with occupational participation.
  • • Reverse scoring of positively worded questions
Total Stress score and subscale scores: Satisfaction With Efficiency and Satisfaction With Effectiveness
  • • Assessment
  • • Pen
Scores sum totaled: overall and 2 subscales
Manual Ability Classification System (Kuijper, van der Wilden, Ketelaar, & Gorter, 2010)ICF: Body Structures and Functions and Activity
  • Population: Children ages 5–14 yr with cerebral palsy (CP).
  • Perspective: Third party—either parent or professional who knows the child’s performance.
  • Purpose: Classification system with 5 levels pertaining to defined use of the hands by children with CP.
  • The classification system has a decision tree to guide the scorer (occupational therapist or physician). Focuses on the way children with CP use both of their hands when handling objects in daily age-appropriate activities.
  • • Has 5 classification system levels: (1) Handles objects easily and successfully; (2) handles most objects with somewhat reduced quality and speed of achievement; (3) handles objects with difficulty, needs help to prepare or modify activities; (4) handles a limited selection of easily managed objects in adapted situations; and (5) does not handle objects and has severely limited ability to perform even simple actions.
  • • The scale is ordinal, and the distances between levels are not considered equal.
Hand use is classified at 1 of the 5 levels by skilled observer.Obtain classification score for 1 of 5 levels.
  • • Manual and score sheets can be downloaded from http://www.macs.nu/
  • • Available in multiple languages.
  • • The assessment requires no special training for occupational therapists and physicians.
Obtain classification score for 1 of 5 levels regarding hand function for children with CP
  • McDonald Play Inventory
  • (MPI): McDonald Play Activity Inventory (MPAI) and McDonald Play Style Inventory (MPSI; McDonald & Vigen, 2012)
PEO and Occupational Performance models
  • Population: Children ages 7–11 yr.
  • Perspective: Self-report (child) or third party, and including parental report.
  • Purpose: Two-part child self-rated scale of play.
  • • Made up of 2 parts: (1) the MPAI, which measures the child’s perceived frequency of engagement in 4 categories that form 4 subscales (Fine Motor, Gross Motor, Social Group, Solitary), and (2) the MPSI, which measures the types and frequency of play behaviors (affective component) in 4 domains: physical coordination, cooperation, peer acceptance, and social participation.
  • • MPSI consists of 24 play behavior items (6 items in each category), 12 neutral play activity items, and 4 “lie” or social desirability items.
  • • MPAI: Rate the frequency of participation in activity on 5-point Likert-scale (never, about once or twice a year, about once or twice a month, about once or twice a week, or almost every day).
  • • MPSI: Rate responses on 5-point Likert scale (never, hardly ever, sometimes, a lot, and always)
  • • Administration time: 15 min without assistance, 20–30 min with assistance
MPI is composed of two parts: MPAI and MPSI.
  • • Assessment
  • • Manual
  • • Pen
  • • Total score
  • • Subscale scores
ICF: Body Structures and Functions and Activity
  • Population: Children with neurological impairments ages 5–15 yr.
  • Perspective: Performance based or third party.
  • Purpose: Criterion-referenced assessment to measure quality of upper-limb movement in children with a neurological impairment; measures 1 hand at a time. Widely used to examine the effectiveness of specific interventions.
  • • Contains 16 items that examine the child’s performance on tasks.
  • • Individual items are scored under 4 categories: (1) range of movement, (2) target accuracy, (3) fluency, and (4) quality of movement.
  • • Individual items are scored under 4 categories.
  • • Each item is scored on a scale of either 0–3 or 0–4 (the manual provides a detailed description of what is required for each score).
Total raw scores are converted to percentages.
  • • Training session for scoring, although skill level of trainer is unknown
  • • Manual
  • • Total percentage score
  • • Designed to evaluate change over time
Motor-Free Visual Perception Test–Revised (MVPT–R; Tsai, Lin, Liao, & Hsieh, 2009)Perceptual–motor theory
  • Population: Children ages 4–12 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess children’s visual–perceptual strengths and weaknesses.
  • Consists of 40 items divided into spatial relationships, visual memory, visual discrimination, figure ground, and visual closure.
  • • Total score ranges from 0 to 40 points.
  • • Items are either right or wrong.
  • • The whole scale is administered to candidate.
One total summed score is calculated.
  • • Answer sheet
  • • Test manual
  • • Book of item plates
  • • Total raw scale score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Occupational Self Assessment (OSA; Taylor, Lee, Kramer, Shirashi, & Kielhofner, 2011)Model of Human Occupation
  • Population: Can be used with adolescents and adults.
  • Perspective: Self-report.
  • Purpose: Client-centered evaluation tool that measures clients’ perceptions of their own competence and the value they assign to occupations.
Clients rate their competence in and importance of everyday activities for 21 items; the client chooses 4 items that he or she would like to change.Takes approximately 30 min to complete and 15 min to score.Scores are calculated for 21 questions and 2 subscales, Competence and Values.
  • • Scoring sheets
  • • Pencil
• Summary scores for items; also provides scores for 2 subscales, Competence and Values
Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI–CAT; Kao, Kramer, Liljenquist, Tian, & Coster, 2012)ICF
  • Population: Children and young people with a disability through age 21 yr.
  • Perspective: Judgment-based, standardized instrument using parental reports or structured interview with professional who knows the child.
  • Purpose: To evaluate the child’s capability in the social–cognitive, daily activities, mobility, and responsibility domains.
  • • Consists of the following domains: daily activities (68 items), social-cognitive (60 items), and responsibility (51 items).
  • • Also measures environmental supports and modifications that the child needs to complete activities.
Sum total; raw scores are transformed into scaled scores for each domain.Raw scores that are transformed into scaled scoresComputer databaseScaled scores provide an indication of a child’s performance on relatively easy to relatively difficult items in a particular domain.
Pediatric Outcomes Data Collection Instrument (PODCI; Mulcahey et al., 2013)
  • Functional outcome measurement; ICF : Body Structures and Functions and Activity
  • Population: Children and adolescents ages 4–21 yr.
  • Perspective: Therapist or clinician administered and scored; professional scores performance on the basis of specific criteria.
  • Purpose: To provide an outcome measure for the upper-extremity and activity items of the PODCI when applied to brachial plexus injury.
The PODCI consists of 52 final Upper Extremity items and 34 Activity items.Takes approximately 1 hr to administer.
  • Scales include upper extremity and physical function, transfer and basic mobility, sports/physical function, pain/comfort, treatment expectations, happiness, satisfaction with symptoms, and global functioning.
  • • Computer
  • • Computer adaptive test program
  • • Scale items that the CAT runs through with respondent
Scores for the Upper Extremity and Activity subscales
Preschool Imitation and Praxis Scale (PIPS; Vanvuchelen, Roeyers, & De Weerdt, 2011)
  • Play theory, Occupational Performance of Children model, and PEO practice models
  • Population: Preschool children ages 1–5 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess the accuracy of bodily procedural imitation performance in young children
  • • Consists of 10 task categories (6 gestural, 3 procedural, and 1 facial) and 30 PIPS tasks.
  • • Performance is scored on a 3- or 5-point scale.
  • • Sum total
  • • Final PIPS score is a reflection of the accuracy of the child’s imitation performance.
  • • Administration takes 10–20 min.
The 30 tasks are divided into 10 task categories.
  • • PIPS manual
  • • PIPS assessment
  • • Pen to score
  • • Items in assessment: toy bear, wooden block, toy animal with lamp in it, box, cup, doll, toy car, bed, blanket
Total score
Quality of Life in School Version 2 (QoLS; Weintraub & Bar-Haim Erez, 2009)Biopsychosocial model and PEO model
  • Population: School-age children.
  • Perspective: Self-report.
  • Purpose: Self-rated measure evaluating student’s school quality of life from a multidimensional perspective.
Consists of 36 items divided into 4 categories: (1) teacher–student relationship and school activities (12 items), (2) physical environment of school and classroom (11 items), (3) negative feelings toward school (8 items), and (4) positive feelings toward school (5 items).Gain score for each category and total school36 items divided into 4 categories
  • • Training in assessment administration
  • • Assessment
  • • Manual
  • • Pen
Raw score for each category and total score
School Function Assessment (SFA; Hwang & Davies, 2009)Ecological assessment, functional assessment, application of Rasch measurement model
  • Population: School-age children.
  • Perspective: Third party; teacher observes the student and provides ratings on the basis of observation.
  • Purpose: Criterion-referenced assessment that measures a wide spectrum of school-related functional tasks associated with the role of elementary school child; guides program planning for students with special needs.
Consists of 18 scales made up of 266 items.Scored on a 4-point rating scale (1 = does not perform, 4 = consistent performance)Activity Performance scale consists of 18 scales made up of 266 items
  • • Manual
  • • Assessment
  • • Pen
Total score
School Version of the Assessment of Motor and Process Skills (School AMPS; Munkholm, Berg, Löfgren, & Fisher, 2010)Model of Human Occupation
  • Population: Children ages 3–13 yr attending an educational program or school.
  • Perspective: Third party; discussion with teacher and performance-based observation of child completing 2 tasks in an education or classroom context; professional scores performance on the basis of specific criteria.
  • Purpose: Functional assessment for measuring the quality of schoolwork task performance as it is observed in the natural classroom setting.
Consists of 26 schoolwork tasks plus 16 school motor and 20 school process skill items. Tasks range from simple to complex: pen-writing tasks, pencil-writing tasks, drawing, coloring tasks, cutting and pasting tasks, computer writing tasks, math, and manipulative tasks.
  • • Therapist unobtrusively observes students in their natural classroom environment.
  • • Therapist scores the quality of observed performance using the scoring criteria for the 16 school motor and 20 school process skill items on a 4-point rating scale.
• 2 linear graphs represent the quality of schoolwork performance measures: (1) school motor quality of performance and (2) school process quality of performance.
  • • Formal training in administration
  • • Paper, pen
  • • Computer and program
  • • Manual
Two schoolwork performance measures: (1) school motor quality of performance and (2) school process quality of performance
Sense and Self-Regulation Checklist (SSRC; Silva & Schalock, 2012)Behavioral self-regulation and sensory processing paradigm
  • Population: Children age <6 yr with developmental delay.
  • Perspective: Third party— parent or caregiver.
  • Purpose: To identify areas of sensory and self-regulation difficulty to assess the child’s response to treatment.
  • • Measures 2 domains: sensory difficulties and self-regulation.
  • • Sensory difficulties domain has 6 subdomains: touch–pain, auditory, visual, taste–smell, hyperreactive to noninjurious stimuli, and hyporeactive to noninjurious stimuli (additional category created: abnormal touch–pain).
  • • Self-regulation domain has 6 categories: sleep, appetite–digestion, self-soothing, orientation–attention, aggressive behavior, and self-injurious behavior.
• Scored on a 4-point rating scale: 0 (never), 1 (rarely), 2 (sometimes), and 3 (often)Sum totalCaregivers must have elementary school education and read English, Spanish, or Chinese.Two domain scores (1 for sensory and 1 for self-regulation)
Sensory Experiences Questionnaire (SEQ; Little et al., 2011)Sensory processing model
  • Population: Children ages 7–72 mo with suspected autism and related developmental disorders.
  • Perspective: Parent or caregiver report.
  • Purpose: Brief caregiver questionnaire for young children with suspected autism and developmental delays; used to identify sensory processing patterns (hypo- and hyperresponsiveness) in the context of daily activities. It is designed to be used as a supplement to diagnostic and developmental assessments.
  • • Brief (10–15 min) caregiver report
  • • Yields 4 dimensional subscale scores as well as a total score.
  • • Items reflect 5 sensory domains: tactile, auditory, visual, vestibular–proprioceptive, and gustatory–olfactory.
  • • Contains qualitative questions regarding parent compensatory strategies used in response to the sensory processing problems experienced by the child.
  • • Takes 10–15 min to complete.
  • • Caregiver responses are based on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always).
  • • Higher scores indicate more sensory processing problems.
Total score and 4 subscale scores (hyperresponsiveness, hyporesponsiveness, social, and nonsocial)
  • • Assessment form
  • • Pen
Raw total score and 4 subscale scores
Sensory Profile Caregiver Questionnaire (SPCQ; Ohl et al., 2012)Dunn’s Model of Sensory Processing
  • Population: Children ages 3–12 yr.
  • Perspective: Third party: parent report or caregiver questionnaire.
  • Purpose: To provide information about children’s tendencies to respond to stimuli and which sensory systems are likely contributing or creating barriers to functional performance.
  • Sensory Profile contains >125 items organized into 3 sections: (1) sensory processing, which contains 6 item categories that measure children’s responses to information taken in through the sensory systems; (2) modulation, which contains 5 item categories that measure children’s ability to monitor and regulate information to generate an appropriate response to the situation; and (3) behavioral and emotional responses, which contains 3 item categories that measure children’s emotional and behavioral responses to sensory experiences.
  • • Need manual for scoring guidelines.
  • • Caregivers record the frequency with which their child displays each item behavior on a 5-point Likert scale (1 = always, 2 = frequently, 3 = occasionally, 4 = seldom, 5 = never).
  • • Responses are totaled on a Summary Score Sheet that yields 2 scores: section score and factor score.
  • • Section score, which provides a visual summary of children’s sensory processing, modulation, and behavioral and emotional response abilities
  • • Factor score, which captures children’s responses to sensory experiences on the basis of not solely their sensory systems but also other aspects of sensory processing
  • • Quadrant score, which measures the degree to which children miss, obtain, detect, or are bothered by sensory input
  • • Manual
  • • Assessment sheets
  • • Summary score
  • • Sheet
  • • Pen
Section, factor, and quadrant scores
Slosson Visual Motor Performance Test (SVMPT; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 4–18 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Screening tool to identify people with visual–motor perceptual problems in which hand–eye coordination is involved; measures a person’s ability to interpret and translate visually perceived geometric patterns.
Consists of 14 geometric figures; each is copied 3 times.Administration takes approximately 20 min, and scoring time is approximately 10 min.One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual–Motor Integration (TVMI; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 4–17 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Standardized norm-referenced test of visual–motor integration; used to document presence and degree of visual–motor difficulties in children.
  • • Consists of 30 geometric figures.
  • • Uses a copying format whereby children copy figure into designated space.
Administration takes approximately 20 min, and scoring time is approximately 10 min.One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual-Motor Skills–Revised (TVMS–R; Brown, Unsworth, & Lyons, 2009)Perceptual–motor theory
  • Population: Children ages 3–13 yr.
  • Perspective: Performance based; professional scores performance on the basis of specific criteria.
  • Purpose: Assesses children’s ability to translate, with their hands, what they visually perceive to gain an understanding of the children’s strengths and weaknesses in visual–motor integration abilities.
  • • Consists of 23 geometric figures.
  • • Uses a copying format whereby children copy figure into designated space.
  • • Administration takes approximately 20 min, and scoring time is approximately 10 min.
  • • When scoring, it allows therapist to categorize a child’s visual–motor errors and accuracies.
One total score
  • • Pencil
  • • Test booklet
  • • Manual
  • • Raw score
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Test of Visual–Perceptual Skills–Revised (TVPS–R; Tsai, Lin, Liao, & Hsieh, 2009)Perceptual–motor theory
  • Population: Children ages 4–12 yr.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To assess children’s visual–perceptual strengths and weaknesses.
  • • Consists of 112 items grouped into 7 subscales.
  • • Total score ranges from 0 to 112 points, and subscale scores range from 0 to 16 points.
Sum total
  • 7 subscale scores are calculated: visual discrimination, visual memory, visual–spatial relationships, visual form constancy, visual sequential memory, visual figure–ground, and visual closure.
  • • Answer sheet
  • • Test manual
  • • Book of item plates
  • • Total raw score and subscale scores
  • • Standard score
  • • Percentile
  • • Stanine
  • • Age equivalent
Weekly Calendar Planning Activity (WCPA; Toglia & Berg, 2013; Weiner, Toglia, & Berg, 2012)Cognitive–behavioral and ecological practice models
  • Population: Adolescents and adults age 16 and older.
  • Perspective: Performance-based assessment; professional scores performance on the basis of specific criteria.
  • Purpose: To measure everyday executive function skills of adolescents and adults.
  • • 18 appointments are presented in a randomly ordered list.
  • • The participant is required to enter the appointments into a 1-wk schedule while recognizing and managing conflicts and adhering to 5 written rules.
  • • The rules include ( 1) leave Wednesday free, (2) do not cross out appointments once they are entered, (3) inform the examiner when it is a specified time, (4) do not respond to distracting questions from the examiner, and (5) inform the examiner when finished.
  • • Strategies used during the task are recorded on a list of 16 preidentified strategies.
  • • Strategies used during the task are recorded on a list of 16 preidentified strategies.
  • • Scores calculated include total accuracy of appointment placement on the calendar, errors made in appointment placement, planning time and total task time, number of rules followed, and type of strategies used.
  • • Total accuracy of appointment placement on the calendar
  • • Total errors made in appointment placement
  • • Self-report errors
  • • Inaccuracy errors
  • • Repetition errors
  • • Planning time
  • • Total task time
  • • Number of rules followed
  • • Number of strategies used
  • • Type of strategies used
  • • Paper
  • • Pencil
  • • WCPA pro forma
  • • WCPA test manual
  • • WCPA test booklet
  • • Table, chair, and quiet room for test taker
  • • Total accuracy of appointment placement on the calendar
  • • Total errors made in appointment placement
  • • Self-report errors
  • • Inaccuracy errors
  • • Repetition errors
  • • Planning time
  • • Total task time
  • • Number of rules followed
  • • Number of strategies used
  • • Type of strategies used
Table Footer NoteNote. DCD = developmental coordination disorder; ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2007); PEO = Person–Environment–Occupation model.
Note. DCD = developmental coordination disorder; ICF = International Classification of Functioning, Disability and Health (World Health Organization, 2007); PEO = Person–Environment–Occupation model.×
Table Footer NoteSuggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 2). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237
Suggested citation: Brown, T., & Bourke-Taylor, H. (2014). Centennial Vision—Children and youth instrument development and testing articles published in the American Journal of Occupational Therapy, 2009–2013: A content, methodology, and instrument design review (Table 2). American Journal of Occupational Therapy, 68, e154–e216. http://dx.doi.org/10.5014/ajot.2014.012237×
×
Table 3.
Critique of Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013
Critique of Children and Youth Instrument Development and Testing Articles Published in the American Journal of Occupational Therapy, January 2009–September 2013×
Instrument and AuthorPurpose of Instrument and PracticalityLevel of Evidence and Stage of Instrument DevelopmentRelevance to Occupational Therapy PracticeRelevance to Occupational Therapy TheoryRelevance to Occupational Therapy ResearchLimitations of StudyStrengths of Study
Adolescents and Adults Coordination Questionnaire (AAC–Q; Saban, Ornoy, Grotto, & Parush, 2012)
  • Purpose: Descriptive and discriminative
  • Practicality: Self-report 12-item scale; very easy to administer and score
  • Level III
  • Stage 7: reliability assessment
Can assist as an initial screening tool for adolescents and adults suspected of having DCD.Scale can be used to assess theoretical assumptions of motor control theory and other related constructs.
  • • Can be used to investigate the prevalence of DCD in the adult population.
  • • Can be used to evaluate the effectiveness of interventions targeted at adults with DCD.
  • • Study completed in 1 geographic area so there may be bias in the results.
  • • Authors did not include copy of the scale in the published article.
  • • No construct validity regarding whether scale items load on a single DCD factor was reported.
  • • Preliminary psychometric properties of scale look promising.
  • • Provision of cutoff scores is helpful for clinical applications.
  • • Is brief, user friendly, and ecologically valid.
Assessment of Children’s Hand Skills (ACHS; Chien, Brown, & McDonald, 2010)
  • Purpose: Descriptive, discriminative, predictive, and potential for evaluative
  • Practicality: Have to purchase test booklets and manual; have to receive specialist training to administer and score instrument; need well-honed observation skills to be able to score instrument
  • Level III
  • Stage 7: reliability assessment
  • • Can be used to assess a comprehensive range of hand skills for use with different populations of children.
  • • Could be used as an outcome measure after a round of intervention has been provided.
  • • Uses naturalistic observation and fits with an occupation-centered assessment approach to provide occupational therapists with information about children’s hand skill performance in meaningful occupations that are completed in daily contexts.
  • • Is a top-down assessment tool that provides information about children’s activity performance.
Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Requires specialized training to administer and score.
  • • Not commercially available; have to contact author directly.
  • • Only preliminary psychometric data have been reported by its author; no external researchers have evaluated the instrument.
  • • Uses naturalistic observation and fits with an occupation-centered assessment approach to generate information about children’s hand skill assessment performance in meaningful occupations that are completed in daily contexts.
  • • Strong preliminary psychometric evidence about construct validity of instrument using Rasch analysis approach
Assessment of Motor and Process Skills (AMPS; Gantschnig, Page, Nilsson, & Fisher, 2013)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Specific qualification required to administer the AMPS with children for clinical or research purposes
  • Level III
  • Stages 8 and 10: reliability and validity study
Standardized assessment of motor and processing skills during functional tasks; provides clinical information about areas for goals and service direction.Good tool to investigate underpinnings of MOHO and for occupational performance when a child has motor or processing differences.May be very useful in research, particularly retrospective data analysis that investigates relationships between underlying skills and performance.Continued psychometric evaluation needed to determine sensitivity to change over time.Large centrally held AMPS database offers the possibility of numerous knowledge translation research opportunities.
Ayres Sensory Integration (ASI) Fidelity Measure (Parham et al., 2011)
  • Purpose: Discriminative and predictive
  • Practicality: Requires experienced and expert individual to rate features of therapy session to get accurate measures of fidelity to ASI principles covered
  • Level IV
  • Stage 3: content validity evaluation
Adherence to the ASI Fidelity Measure’s structural and process elements will increase the likelihood that interventions labeled ASI and provided by qualified therapists are faithful to ASI principles not only in research but also in education and practice.
  • The Fidelity Measure provides an international standard by which to determine
  • whether an intervention represents ASI, which ensures that the ASI model is applied correctly.
  • The Fidelity Measure provides an international standard by which to determine
  • whether an intervention represents ASI.
  • • Did not field test the ASI Fidelity Measure with novice clinicians.
  • • Did not investigate the construct validity of the ASI Fidelity Measure.
  • • Very experienced expert panel was engaged to establish the content validity of the ASI Fidelity Measure.
  • • Expert panel had international representation, which decreases risk of geographic bias.
Box and Block Test (Jongbloed-Pereboom, Nijhuis-van der Sanden, & Steenbergen, 2013)
  • Purpose: Discriminative
  • Practicality: Requires manual and specific boxes, blocks, and scoring sheet; little training necessary
  • Level III
  • Stages 7 and 8: reliability and validity study
Standardized assessment of gross dominant and nondominant hand function that may easily be used for pretest–posttest.May be useful to investigate underpinnings of biomechanical model.May be used to investigate efficacy of biomedical or occupational therapy interventions and measure outcomes on 1 or both upper extremities.Continued psychometric evaluation needed to determine sensitivity to change over time.Norm-referenced, easily administered hand function tool that does relate to real-life functional hand use.
Child Occupational Self Assessment (COSA; Kramer, Kielhofner, & Smith, 2010)
  • Purpose: Descriptive and evaluative
  • Practicality: Can be administered in 1 of 3 ways: standard pencil and paper, card sort, and matrix format
  • Level III
  • Stages 7 and 8: reliability and validity study
  • • Child-centered and child-reported tool that measures extent to which child is meeting expectations and responsibilities in daily activities and the importance of those activities.
  • • Directs clinical intervention by identifying important activities that might be prioritized in therapy.
Sound tool that may be used in research that investigates underpinnings of MOHO or any PEO model.May be used to investigate efficacy of occupational therapy interventions from clients’ perspectives.
  • • Extend validity and reliability studies to include randomized sampling and standardized administration of the measure when data are collected from across cultures and world regions. Further validity studies might include and analyze data from the perspective of other child and environmental variables.
  • • Also requires evaluation of responsiveness to change.
MOHO-based assessment tool that measures child’s subjective experience of occupation in a psychometrically sound way for clinical or research purposes.
Children’s Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC; Potvin, Snider, Prelock, Kehayia, & Wood-Dauphinee, 2013)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Child rates the intensity (frequency), social aspect, location, enjoyment, and preference for leisure and recreational pursuits. Easy to administer and score.
  • Level III
  • Stages 8 and 10: evaluation of the scale’s measurement properties by other than the scale’s authors
Very relevant to practice; provides child’s perspective about participation in home and community contexts.Useful in studies investigating theoretical underpinnings of occupational therapy theory (e.g., Canadian Model of Occupational Performance and Engagement, ICF).May be used as client-centered outcome measure.Continued psychometric evaluation needed to determine sensitivity to change over time.Good reliability and validity evidence reported.
Children’s Leisure Assessment Scale (CLASS; Rosenblum, Sachs, & Schreuer, 2010) 
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Easily administered tool to measure participation in leisure activities among children ages 10–18 yr.
  • Level III
  • Stages 7 and 8: reliability and validity study
May be used clinically to determine a leisure activity preference for young children without disability.May be useful to investigate relationship between childhood occupations and any PEO model.May be useful in research about childhood occupations, participation, and other child-related factors.Requires further evaluation to determine discriminant validity for children with and without disability, as well as sensitivity to change over time.Offers very descriptive preference and participation profile of children’s leisure preferences.
Comprehensive Observations of Proprioception (COP; Blanche, Bodison, Chang, & Reinoso, 2012)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Relatively easy to obtain and administer; takes 15 min of observing child in a naturalistic environment
  • Level III
  • Stage 8: validity and dimensionality assessment
Can be used to assess children’s proprioceptive processing skills.Derived from literature based on sensory integration.Could be used to evaluate the effectiveness of occupational therapy intervention programs or could be used to describe clinical features of children with suspected developmental delay or motor skill problems.
  • • Still in early stages of psychometric development and validation.
  • • No normative scores are available.
  • • Has not been evaluated or applied in studies by others than Blanche, Bodison, et al. (2012) .
  • • Blanche, Bodison, et al. have documented the phases and components of the development of the COP.
  • • Preliminary evidence of COP’s interrater reliability, face validity, content validity, construct validity, criterion validity, and factor structure has been reported.
Developmental Test of Visual–Motor Integration (VMI; Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Have to purchase test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs or to establish the visual–motor baseline skills of certain diagnostic groups of clients.
  • • Does not provide information about children’s occupational performance.
  • • Test booklets and manual have to be purchased, creating cost issue.
  • • Well established, with strong psychometric characteristics
  • • Test has been widely used.
  • • Large standardization group on which normative scores are based
Do-Eat (Josman, Goffer, & Rosenblum, 2010)
  • Purpose: Descriptive, discriminative, and predictive
  • Practicality: Child is required to participate in 3 tasks, with appropriate equipment and environment needed: making sandwich, making chocolate milk, and handwriting.
  • Level III
  • Stages 7 and 8: reliability and validity study
Offers capability to measure the functional abilities of children with DCD; also assists in goal development.Good tool to investigate underpinnings of functional skills and performance.Good application for research purposesContinued psychometric evaluation needed to determine sensitivity to change over time.Psychometrically and theoretically sound tool specific to children with DCD
Evaluation of Social Interaction (ESI; Griswold & Townsend, 2012)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: The evaluator (occupational therapist) observes the child as he or she engages in desired relevant activities in natural context with usual social partners.
  • Level III
  • Stage 8: validity assessment
  • • Clinically useful way to measure children’s social interactions in natural settings.
  • • Provides standardized way to measure differences in social interaction and measure change over time.
Can be used to evaluate underpinnings of social interactions and participation.Useful for occupational therapy research to evaluate underpinnings of social interactions and participation and for efficacy studies evaluating occupational therapy interventions.Test–retest and interrater reliability studies needed for pediatric population; sensitivity to change over time needs evaluation before validation as outcome measure.Good reliability and validity for pediatric population.
Evaluation Tool of Children’s Handwriting (ETCH; Brossard-Racine, Mazer, Julien, & Majnemer, 2012; Duff & Goyen, 2010)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: The evaluator observes and then rates a child’s handwriting using 1 of 2 handwriting versions: manuscript and cursive. Provides standardized before-and-after measure of handwriting competency.
  • Level III
  • Stages 8 and 10: validity assessment
Highly useful in pediatric occupational therapy practice in school and clinic settings.Specific handwriting legibility and functionality for children in elementary school.Can be used to evaluate the effectiveness of a handwriting intervention program or to differentiate between typical and atypical handwriting—determine need and eligibility for services.
  • • Requires sensitivity to change over time and randomized sampling.
  • • Might be used in efficacy studies to investigate efficacy and efficiency of occupational therapy interventions that aim to improve handwriting.
Good reliability and validity evidence reported.
Family L.I.F.E. (Looking Into Family Experiences; Honaker, Rosello, & Candler, 2012)
  • Purpose: Descriptive and discriminative
  • Practicality: Requires manual and therapist–family collaboration to identify 5 key family occupations and limiting factors
  • Level III
  • Stage 7: reliability assessment
Engages families and therapists in a collaborative partnership and promotes family-centered practice.Tool may be useful to evaluate the tenets of occupational adaptation or family-centered practice models.Useful research tool to identify subjective family issues pre- and postintervention.Further psychometric evaluation required for validation and reliability.Emphasizes clinical and research consideration of a very important factor in the support system available to a child with a disability: the family.
Health Promoting Activities Scale (HPAS; Bourke-Taylor, Law, Howie, & Pallant, 2012)
  • Level III
  • Stage 8: validity and dimensionality assessment
May be used in clinical practice in numerous contexts working with caregivers.Provides evidence about the associations among participation in meaningful self-selected leisure pursuits, mental health, and well-being.
  • • Psychometrically sound scale with low response burden that measures the person’s perspective.
  • • May be used as an outcome measure because scoring relates to the frequency of participation.
Initial study did not include secondary validation of diagnosis of mental health condition; did not include test–retest reliability or tests of sensitivity to change over time.Psychometrically sound at initial stages of development; novel measurement of complex and meaningful human occupation.
Life Participation for Parents (Fingerhut, 2013)
  • Purpose: Descriptive and evaluative
  • Practicality: Families with a child with a disability complete paper questionnaire about family occupations.
  • Level III
  • Stages 7 and 8: reliability and validity study
Clinically useful to facilitate family-centered service delivery; allows focus on strategies to improve satisfaction with occupational participationGood tool to investigate and evaluate family-centered practice, other theoretical frameworks (ICF, PEO, ecological approach)Useful tool for subjective family status when there is a child with a disability in the family.Continued psychometric evaluation needed to determine sensitivity to change over time.Psychometrically sound family-centered tool that could be used easily in both clinical practice and theory.
Loewenstein Occupational Therapy Cognitive Assessment (LOTCA; Josman, Abdallah, & Engel-Yeger, 2011)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Requires standardized kit and score sheets
  • Level III
  • Stages 8 and 10: evaluation of scale’s measurement properties by those other than authors
Clinical application for occupational therapists may include school readiness or use in other settings to determine eligibility or areas for interventions. May have feasibility as screening tool for school entry.May be useful to investigate relationships between cognition and occupational performance in daily occupations; supports numerous theoretical concepts in occupational therapy.May be used to investigate efficacy of occupational therapy interventions, although sensitivity to change has not been established among children.Further research is needed to establish validity in relation to cross-cultural studies, other child and sociodemographic factors, and actual functional performance in childhood occupation. Requires longitudinal predictive studies. Also, sensitivity to change across time requires investigation if to be used as an outcome measure.Standardized assessment of cognition for young children with capacity to differentiate among children with and without readiness to enter school and early school performance and other issues.
Manual Ability Classification System (MACS; Kuijper, van der Wilden, Ketelaar, & Gorter, 2010)
  • Purpose: Descriptive, discriminative, and predictive
  • Practicality: Involves therapists observing hand skills use and using decision-making tree to classify hand function. The manual is freely available.
  • Level III
  • Stages 8 and 10: validity study
Excellent clinical application to promote communication among children, families, and professionals and provides observational measure of hand function that may result in functional goal setting.May be used to investigate theoretical underpinnings of occupational therapy theory that uses a PEO approach.Application to research is good. Provides researchers with easily rated manual classification system alongside the widely used Gross Motor Function Classification System and more recent Communication Function Classification System.
  • • This particular study used correlational analysis for an ordinal classification scale and the PEDI caregiver scales (Part 2) rather than the PEDI functional skills scale (Part 1).
  • • The conclusion that the MACS is related to the performance of daily self-care skills is inappropriately drawn because PEDI Part 1 was not used in the study. Therefore, findings must be interpreted with caution.
The MACS has good reliability and validity and provides a functional classification to facilitate communication among people with cerebral palsy, families, and professionals.
McDonald Play Inventory (McDonald & Vigen, 2012)
  • Descriptive, discriminative, and evaluative
  • Practicality: Child self-report scale that requires minimal resources
  • Level III
  • Stages 7 and 8: reliability and validity assessment
Can be used to assess children presenting with play-related problems.Provides evidence about children’s self-reported perceptions about their play and play style.Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Convenience sample
  • • Limited psychometric data have been published about the scale.
  • • Assesses an important area of children’s occupational performance.
  • • Accesses children’s perspectives about their play.
  • • Promising psychometric data about the scale have been reported.
Melbourne Assessment of Unilateral Upper Limb Function (MAUULF; Spirtos, O’Mahony, & Malone, 2011)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Standardized kit required, as well as some informal training and preparation for administration and scoring.
  • Level III
  • Stages 7 and 10: evaluation of scale’s measurement properties by those other than authors
Standardized assessment of quality of functional movement for 1 upper extremity.Good tool for rigorous evaluation of quality of upper-limb movement for biomedical interventions as well as occupational therapy interventions.Useful for pre– and post–upper-extremity evaluation for various interventions for children with hemiplegia.Detailed training and instructions needed for clinicians to learn how reliably administer and score the MAUULF.Psychometrically sound upper-extremity test that precisely measures functional arm and hand movement.
Motor-Free Visual Perception Test–Revised (MVPT–R; Tsai, Lin, Liao, & Hsieh, 2009)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Fairly straightforward to administer and score
  • Level III
  • Stages 7 and 10: reliability assessment
Can be used to establish the baseline of a child’s visual–perceptual skills.Can be used to investigate the underpinnings of perceptual–motor theory.Can be used to establish the effectiveness of an intervention program or explore the links between visual–perceptual skills and children’s occupational performance.
  • • Small sample size.
  • • Data gathered in 1 geographic location.
  • • No link to occupational performance of children made.
  • • Answer sheets, test plate book, and test manual have to be purchased, creating cost issue.
  • • Provides evidence of the reliability properties of the MVPT–R.
  • • Is evidence of use of scale in a cross-cultural context.
Occupational Self Assessment (OSA; Taylor, Lee, Kramer, Shirashi, & Kielhofner, 2011)
  • Purpose: Descriptive and discriminative
  • Practicality: Self-report scale on which participants are asked to answer or rate 21 statements; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity assessment
Can be used with a variety of client groups, including those with mental health issues or physical disabilities or older adults.Derived from constructs related to the MOHO.Can be used to evaluate the intervention programs; can be used to operationalize constructs from the MOHO and can provide empirical evidence about the MOHO.
  • • Data were gathered from 1 geographical area.
  • • Convenience sampling was used.
  • • Good sample size to minimize chance of Type I error.
  • • Use of Item Response Theory provides further evidence of the scale’s construct validity.
Pediatric Outcomes Data Collection Instrument (Mulcahey et al., 2013)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Outcome measure designed for children with brachial plexus injury that is administered via computer adaptive test
  • Level III
  • Stages 7 and 8: reliability and validity assessment
Can be used to assess the upper-extremity function of children presenting with brachial plexus injuries.Provides evidence about the upper-extremity function of children presenting with brachial plexus injuries.Could be used to evaluate the effectiveness of occupational therapy intervention programs or as an outcome measure.Limited psychometric data reported.This study provides preliminary psychometric results of application to children with brachial plexus injuries.
PEDI–Computer Adaptive Test (Kao, Kramer, Liljenquist, Tian, & Coster, 2012)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Measures caregiver’s or parent’s estimation of the functional abilities of child with disabilities
  • Level II
  • Stage 7 and 8: reliability and validity study
Offers capability to measure the functional abilities of children with disabilities via computerized data collection. Clinical application and availability are not described in the articles.Excellent tool to investigate participation in daily occupations of children with disabilities in 4 main areas: daily activities, social-cognitive, mobility, and responsibility.Good application for research because data collection is computerized and convenient for participants who are parents.Application to clinical practice and scoring interpretation unknown—not described in article.Psychometrically and theoretically sound computerized instrument.
Preschool Imitation and Praxis Scale (PIPS; Vanvuchelen, Roeyers, & De Weerdt, 2011)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Have to observe child completing motor skill activities and rate his or her performance
  • Level III
  • Stage 7: reliability assessment
May assist clinicians in evaluating and reevaluating preschoolers’ imitation ability.Can be used to investigate the underpinnings of motor development or sensory processing.Can be used to evaluate the effectiveness of an intervention program or could be used to investigate whether certain diagnostic groups present with distinct motor skill difficulties.
  • • No validity evidence reported.
  • • Does not provide much information on the occupational performance of children.
Promising preliminary reliability evidence is reported.
Quality of Life in School (QoLS) Version 2 (Weintraub & Bar-Haim Erez, 2009)
  • Purpose: Descriptive
  • Practicality: Child rates how true statements are about his or her school-related QoL; easy to administer and score
  • Level III
  • Stage 8: very early validation study
Provides a tool to evaluate typically developing students’ perceptions of school-related QoL. May have immediate application to students with psychosocial challenges.May be used to investigate theoretical underpinnings of the relationship between occupation and QoL.May be used in research to explore aspects of school performance, subjective student school-related QoL, and other cultural or environmental factors.
  • • Requires further reliability and validity studies to ensure that the tool discriminates between children who do and do not enjoy, participate well, or academically achieve in school.
  • • Needs to be validated for children with disability.
The tool has a well-documented explanation of its psychometric development that contributes to the user’s confidence and actual rigor of the tool.
School Function Assessment (Hwang & Davies, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Requires specialized skills to administer, score, and interpret; based on interview with person who knows how child functions in school environment
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s activity performance in a school environment.Is a top-down assessment tool that provides information about children’s activity participation.
  • • Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Could provide a baseline for children’s school-related occupations.
  • • Requires specialized training to administer and score.
  • • Is quite time consuming to administer and score.
  • • Scale booklet and manual have to be purchased, creating cost issue.
  • • Well established with strong psychometric characteristics.
  • • Test has been widely used.
  • • Very compatible with an occupation-focused perspective on service provision.
School Version of the Assessment of Motor and Process Skills (Munkholm, Berg, Löfgren, & Fisher, 2010)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Valid and clinically useful tool for measuring the quality of schoolwork task performance as it is observed in the natural classroom setting
  • Level III
  • Stages 8 and 10: validity assessment
Can be used to assess children’s motor and process skills in a classroom environment.
  • • Is a MOHO-based tool.
  • • Builds a body of knowledge about motor and process skills.
Could be used to evaluate the effectiveness of occupational therapy intervention programs or as an outcome measure.Requires completion of a 5-day course in which raters are trained and calibrated; some potential users may not be able to afford the course tuition fees.
  • • Well-validated and standardized scale
  • • Strong evidence of dimensionality
  • • Assesses children’s motor and process skills in a naturalistic environment.
  • • Test users have to complete extensive training course and become calibrated before using instrument independently.
Sense and Self-Regulation Checklist (Silva & Schalock, 2012)
  • Purpose: Descriptive, discriminative, and predictive
  • Practicality: Easily administered and scored parent–caregiver measure
  • Level III
  • Stages 7 and 8: reliability and validity study
May have some application to clinical occupational therapy practice based on a biopsychosocial or biomedical framework; limited application to other types of clinical occupational therapy practice.May be used in research to further investigate the relationships within a biomedical framework.May be used in research to further investigate the relationship among sensory processing, behavior, and self-regulation among children with autism spectrum disorder.Further validation research required to demonstrate application to clinical occupational therapy use.Promising initial psychometric properties, although further validity studies might include and analyze data from the perspective of other child and environmental variables.
Sensory Experiences Questionnaire (SEQ; Little et al., 2011)
  • Purpose: Descriptive, discriminative, and evaluative
  • Practicality: Sensory processing
  • Level III
  • Stage 7: reliability assessment
Can be used to assess children presenting with sensory processing issues.Provides evidence about sensory processing issues; could provide support for Dunn’s Sensory Processing Model.Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Limited psychometric data have been published on the SEQ.
  • • Participants for reliability study were recruited from 1 geographic region.
Brief parent-report scale, minimum respondent burden
Sensory Profile Caregiver Questionnaire (Ohl et al., 2012)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Parent-report scale; time consuming to score and interpret
  • Level III
  • Stages 8 and 10: validity assessment
Can be used to assess children’s sensory processing skills.Provides evidence about children’s sensory processing and potential contributions and how this could affect their occupational performance in daily contexts.Could be used to evaluate the effectiveness of occupational therapy intervention programs or as an outcome measure.
  • • Many items to answer.
  • • Limited validity data available.
  • • Scale booklet and manual have to be purchased, creating cost issue.
  • • Comprehensive coverage of sensory processing issues in a classroom context.
  • • Asks for parent and teacher feedback.
  • • Based on practice model.
Slosson Visual–Motor Performance Test (Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Have to purchase test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs.
  • • Does not provide information about children’s occupational performance.
  • • Not widely used by therapists.
  • • Limited psychometric data published about test by external authors.
  • • Scale booklet and manual have to be purchased, creating cost issue.
Preliminary evidence of reliability and validity reported by test authors in test manual is promising.
Test of Visual–Motor Integration (TVMI; Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Requires purchase of test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs or to establish the visual–motor baseline skills of certain diagnostic groups of clients.
  • • Does not provide information about children’s occupational performance.
  • • Not widely used by therapists.
  • • Limited psychometric data published about test by external authors.
Preliminary evidence of reliability and validity reported by test authors in test manual is promising.
Test of Visual–Motor Skills–Revised (TVMS–R; Brown, Unsworth, & Lyons, 2009)
  • Purpose: Discriminative, predictive, and evaluative
  • Practicality: Requires purchase of test booklets and manual; relatively easy to administer and score
  • Level III
  • Stages 8 and 10: validity and dimensionality assessment
Can be used to assess children’s visual–motor integration skills.Is a bottom-up assessment tool that provides information about children’s body functions and structures.Could be used to evaluate the effectiveness of occupational therapy intervention programs or to establish the visual–motor baseline skills of certain diagnostic groups of clients.
  • • Does not provide information about children’s occupational performance.
  • • Limited psychometric data published about test by external authors.
  • • Scale booklet and manual have to be purchased, creating cost issue.
Preliminary evidence of reliability and validity reported by test authors in test manual is promising.
Test of Visual–Perceptual Skills–Revised (TVPS–R; Tsai, Lin, Liao, & Hsieh, 2009)
  • Purpose: Descriptive, discriminative, predictive, and evaluative
  • Practicality: Fairly straightforward to administer and score
  • Level III
  • Stages 7 and 10: reliability assessment
Can be used to establish the baseline of a child’s visual–perceptual skills.Can be used to investigate the underpinnings of perceptual motor theory.Can be used to establish the effectiveness of an intervention program or explore the links between visual–perceptual skills and children’s occupational performance.
  • • Small sample size
  • • Data gathered in 1 geographic location.
  • • No link to occupational performance of children made.
  • • Answer sheets, test plate book, and test manual have to be purchased, creating cost issue.
  • • Provides evidence of the reliability properties of the TVPS–R.
  • • Provides evidence for use of scale in a cross-cultural context.
Weekly Calendar Planning Activity (WCPA; Toglia & Berg, 2013; Weiner, Toglia, & Berg, 2012)
  • Purpose: De