Rating Scale Use by Children With Disabilities on a Self-Report of Everyday Activities

Abstract

Kramer JM, Smith EV Jr, Kielhofner G. Rating scale use by children with disabilities on a self-report of everyday activities. Objective To examine whether children with disabilities interpret a self-report of perceived competence and importance of everyday activities in a consistent manner and use the rating scales as intended. If not, are differences in how children interpret the scale associated with personal or contextual variables? Design Assessment and rating scale development using the Mixed Rasch Model. Setting Rehabilitation clinics, schools, and research sites in the United States and Europe. Participants Children (N=407) aged 6 to 17 years; all had a diagnosed disability or received occupational therapy services. Interventions Not applicable. Main Outcome Measure The Child Occupational Self Assessment; 25 items representing everyday activities and two 4-point scales: competence and importance. Results For each scale, 2 groups of children were identified. Approximately 50% of the children used the rating scales as intended. The remainder used the scales as reversed 2-point scales; these children were younger and more likely to have an intellectual disability. Country and practice setting were also associated with rating scale use. All items but 1 had acceptable fit to the Rasch model, and groups of children differed in the relative competence and importance reported. Conclusions Personal and contextual variables are associated with children with disabilities' use of self-report rating scales. Younger children and children with intellectual disabilities use a modified response pattern.