Reliability In Children Research Articles

The influence of environmental reliability in the marshmallow task: An extension study

This study is an extension of an experiment where the reliability of children’s environment was manipulated before children completed the Marshmallow Task (Cognition, 2013, Vol. 126, pp. 109–114). In that experiment, Kidd, Palmeri, and Aslin found a significant difference in waiting time between two conditions in which the experimenter demonstrated reliability (by returning with promised reward) or unreliability (by not returning with rewardP). Children who had an unreliable experimenter did not wait as long during the Marshmallow Task, suggesting that delay gratification performance may be, in part, based on a rational decision. Due to the important theoretical and practical implications of this finding, we repeated the procedure of this experiment with 60 3- to 5-year-old children (twice as many as in the original study), but in a more familiar context (e.g., children’s school instead of a lab). Using Bayesian analyses, we found an effect (albeit smaller than in the original study) of experimenter reliability as well as a significant gender by condition interaction effect.

Peer Review Report For: Negligible heritability of language laterality assessed by functional transcranial Doppler ultrasound: a twin study [version 1; peer review: 1 approved with reservations]. Wellcome Open Research 2019, 4:161

Background: Prior studies have estimated heritability of around 0.25 for the trait of handedness, with studies of structural brain asymmetry giving estimates in a similar or lower range. Little is known about heritability of functional language lateralization. This report describes heritability estimates using functional language laterality and handedness phenotypes in a twin sample previously reported by Wilson and Bishop (2018). Methods: The total sample consisted of 194 twin pairs (49% monozygotic) aged from 6 to 11 years. A language laterality index was obtained for 141 twin pairs, who completed a protocol where relative blood flow through left and right middle cerebral arteries was measured using functional transcranial Doppler ultrasound (fTCD) while the child described animation sequences. Handedness data was available from the Edinburgh Handedness Inventory (EHI) and Quantification of Hand Preference (QHP) for all 194 pairs. Heritability was assessed using conventional structural equation modeling, assuming no effect of shared environment (AE model). Results: For the two handedness measures, heritability estimates (95% CI) were consistent with prior research: .25 (.03 - .34) and .18 (0 – .31) respectively for the EHI and QHP. For the language laterality index, however, the twin-cotwin correlations were close to zero for both MZ and DZ twins, and the heritability estimate was zero (0 - .15). Conclusions: A single study cannot rule out a genetic effect on language lateralisation. It is possible that the low twin-cotwin correlations were affected by noisy data: although the split-half reliability of the fTCD-based laterality index was high (0.85), we did not have information on test-retest reliability in children, which is likely to be lower. We cannot reject the hypothesis that there is low but nonzero heritability for this trait, but our data suggest that individual variation in language lateralisation is predominantly due to stochastic variation in neurodevelopment.

Reliability and validity of a sedentary behavior questionnaire for South American pediatric population: SAYCARE study

BackgroundMulticenter studies from Europe and the United States have developed specifically standardized questionnaires for assessing and comparing sedentary behavior, but they cannot be directly applied for South American countries. The aim of this study was to assess the reliability and validity of the South American Youth Cardiovascular and Environmental (SAYCARE) sedentary behavior questionnaire.MethodsChildren and adolescents from seven South American cities were involved in the test-retest reliability (children: n = 55; adolescents: n = 106) and concurrent validity (children: n = 93; adolescents: n = 94) studies. The SAYCARE sedentary behavior questionnaire was administered twice with two-week interval and the behaviors were parent-reported for children and self-reported for adolescents. Questions included time spent watching television, using a computer, playing console games, passive playing (only in children) and studying (only in adolescents) over the past week. Accelerometer was used for at least 3 days, including at least one weekend day. We compared values of sedentary time, using accelerometers, by quartiles of reported sedentary behavior time and their sum.ResultsThe reliability of sedentary behavior time was moderate for children (rho ≥0.45 and k ≥ 0.40) and adolescents (rho ≥0.30). Comparisons between the questionnaire and accelerometer showed a low overall agreement, with the questionnaire systematically underreporting sedentary time in children (at least, − 332.6 ± 138.5 min/day) and adolescents (at least, − 399.7 ± 105.0 min/day).ConclusionThe SAYCARE sedentary behavior questionnaire has acceptable reliability in children and adolescents. However, the findings of current study indicate that SAYCARE questionnaire is not surrogate of total sedentary time.

The Premonitory Urge for Tics Scale in a large sample of children and adolescents: psychometric properties in a developmental context. An EMTICS study

Premonitory urges are uncomfortable physical sensations preceding tics that occur in most individuals with a chronic tic disorder. The Premonitory Urge for Tics Scale (PUTS) is the most frequently used self-report measure to assess the severity of premonitory urges. We aimed to evaluate the psychometric properties of the PUTS in the largest sample size to date (n = 656), in children aged 3–16 years, from the baseline measurement of the longitudinal European Multicenter Tics in Children Study (EMTICS). Our psychometric evaluation was done in three age-groups: children aged 3–7 years (n = 103), children between 8 and 10 years (n = 253), and children aged 11–16 years (n = 300). The PUTS exhibited good internal reliability in children and adolescents, also under the age of 10, which is younger than previously thought. We observed significant but small correlations between the severity of urges and severity of tics and obsessive–compulsive symptoms, and between severity of urges and ratings of attention-deficit/hyperactivity disorder and internalizing and externalizing behaviors, however, only in children of 8–10 years. Consistent with previous results, the 10th item of the PUTS correlated less with the rest of the scale compared to the other items and, therefore, should not be used as part of the questionnaire. We found a two-factor structure of the PUTS in children of 11 years and older, distinguishing between sensory phenomena related to tics, and mental phenomena as often found in obsessive–compulsive disorder. The age-related differences observed in this study may indicate the need for the development of an age-specific questionnaire to assess premonitory urges.

Negligible heritability of language laterality assessed by functional transcranial Doppler ultrasound: a twin study

Background: It is widely assumed that individual differences in language lateralisation have a strong genetic basis, yet prior studies show low heritability (around 0.25) for the related trait of handedness, and two twin studies of structural brain asymmetry obtained similarly low estimates. This report describes heritability estimates from a twin study of language laterality and handedness phenotypes. Methods: The total sample consisted of 194 twin pairs (49% monozygotic) aged from 6 to 11 years. A language laterality index was obtained for 141 twin pairs, who completed a protocol where relative blood flow through left and right middle cerebral arteries was measured using functional transcranial Doppler ultrasound (fTCD) while the child described animation sequences. Handedness data was available from the Edinburgh Handedness Inventory (EHI) and Quantification of Hand Preference (QHP) for all 194 pairs. Heritability was assessed using conventional structural equation modeling, assuming no effect of shared environment (AE model). Results: For the two handedness measures, heritability estimates were consistent with prior research: 0.23 and 0.22 respectively for the EHI and QHP. For the language laterality index, however, the twin-cotwin correlations were very close to zero for both MZ and DZ twins, and the heritability estimate was zero. Conclusions: A single study showing negligible heritability for language laterality cannot rule out a genetic effect on language lateralisation. It is possible that the low twin-cotwin correlations were affected by noisy data: although the split-half reliability of the fTCD-based laterality index was high (0.85), we did not have information on test-retest reliability in children, which is likely to be lower. We cannot rule out the possibility that true heritability of differences in language lateralization is non-zero, but results indicate that the heritability of this trait is low at best. Stochastic variation in neurodevelopment appears to play a major role in determining cerebral lateralisation.

Looking smart: Preschoolers' judgements about knowledge based on facial appearance.

Preschoolers use others' behaviours to make inferences about what traits they possess (Harris etal., 2018, Ann. Rev. Psychol., 69, 251). The current study examined whether 4- and 5-year-olds also associate others' behaviour with how they appear on the surface. Specifically, we asked whether children's sensitivity to different face-traits (e.g., Cogsdill etal., 2014, Psychol. Sci., 25, 1132) would bias them to associate knowledgeable behaviours with faces that adults rate as highly competent- or trustworthy-looking. We find that preschoolers expect puppets with trustworthy-looking faces to be knowledgeable about the functions of familiar objects. In contrast, children did not match a puppet's knowledge to facial features that adults rate as varying in competence. These data suggest that children, like adults, are biased to associate facial appearance and behaviour. Furthermore, this bias appears to be rooted in a response to the same facial features that have been found to govern judgements of trustworthiness across development (e.g., Jessen & Grossmann, 2016, J. Cogn. Neurosci., 28, 1728). Statement of contribution What is already known on this subject? Preschoolers selectively trust others using epistemic and non-epistemic cues (Harris etal., 2018). Preschoolers associate specific faces with trustworthiness and competence (Cogsdill etal., 2014). What the present study adds? Preschoolers infer that trustworthy-looking characters will behave knowledgeably. Preschoolers do not infer that competent-looking characters will behave knowledgeably. Children's reliability judgements are influenced by others' appearance.

Reliability outcomes and inter-limb differences in ankle joint stiffness in children with unilateral cerebral palsy depend on the method of analysis

Children with cerebral palsy (CP) present increased passive ankle joint stiffness, measured as the slope of the torque-angle curve relationship. However, large discrepancies in results exist among studies, likely because of various methodologies used. The purpose of this study was to determine the influence of different calculation methods on the outcomes and their inter-session reliability in children with unilateral CP (UCP).Thirteen children (mean age: 9.8 years) with spastic UCP underwent passive ankle mobilization at 2°/s on both legs using a dynamometer, on two occasions separated by one week. Passive ankle joint stiffness was calculated as the slope of the torque-angle curve using linear regression on three different relative ranges of torque (i.e. 30%–100%, 20–80% and 50–90% of maximal torque for method 1, 2 and 3, respectively) for both the paretic and non-paretic legs.Inter-session reliability was significantly lower on paretic leg (mean CV = 13.8%, ICC = 0.62) when compared to non-paretic leg (mean CV = 6%, ICC = 0.85), and method 3 presented lower reliability outcomes (mean CV = 11.7%, ICC = 0.75) than methods 1 (mean CV = 7.5%, ICC = 0.78) and 2 (mean CV = 6.6%, ICC = 0.79). Paretic values (0.24 Nm/°) were not different from the non-paretic leg (0.25 Nm/°), although significantly higher when considering the same angular sector (0.18 Nm/°).Passive ankle joint stiffness measurement can be reliably performed in children with UCP using method 1 and 2 while method 3 should be avoided. The non-paretic leg may be used for comparison with the paretic leg when taking into account differences in maximal dorsiflexion angle between legs.ClinicalTrials.gov Identifier: NCT02960932.

Validity and reliability of the modified Tal score in Chilean children. A multicenter study

In pediatrics, it is decisive to assess the severity of bronchial obstruction; to this end, different clinical scoring scales have been developed, including the modified Tal score. The objective of this study was to determine its validity and reliability in children seen at two emergency departments of Concepción, Chile. Prospective, cohort study. Children younger than 36 months old diagnosed with bronchitis and/or bronchiolitis during the winter and spring months of 2015 were included. Concurrent criterion validity was determined based on the correlation between the score and oxygen saturation, as a reference standard. Predictive validity was assessed based on the association between the score and the probability of a new visit to the emergency department in the following 7 days. The area under the ROC curve was estimated. Reliability between kinesiologists and physicians was established based on the intraclass correlation coefficient (ICC). A p value < 0.05 was considered statistically significant. A total of 102 children were assessed; a weak correlation between the score and oxygen saturation was observed among kinesiologists (Rho = -0.41). An association was observed between the score and the probability of a new visit to the emergency department. The area under the curve measured by both health care providers was > 0.80. Inter-observer reliability between physicians and kinesiologists showed a weak correlation (ICC = 0.17). The modified Tal score shows an adequate predictive validity, but a poor validity when correlated to oxygen saturation, and a weak inter-observer reliability.

Intra- and inter-tester reliability of spasticity assessment in standing position in children and adolescents with cerebral palsy using a paediatric exoskeleton

Background The L-STIFF tool of the Lokomat evaluates the hip and knee flexors and extensors spasticity in a standing position. It moves the lower limb at a controlled velocity, measuring joint resistance to passive movements. Since its reliability in children with cerebral palsy remains unknown, our goal was to evaluate the relative and absolute reliability of L-STIFF in children with cerebral palsy. Methods Reliability was determined in 16 children with cerebral palsy by two experienced therapists. The changes in resistive torque in hip and knee in both flexion and extension were measured. Relative and absolute reliability were estimated using the intraclass correlation coefficient, standard error of measurement, and minimal detectable change. Reliability was assessed on three levels: (1) intra- and (2) inter-tester within session, and (3) intra-tester between sessions. Results Intraclass correlation coefficients were moderate to excellent for intra-tester reliability (all p ≤ 0.01). The standard error of measurement ranged from 0.005 to 0.021 Nm/° (i.e., 7–16%) and minimal detectable change from 0.014 to 0.059 Nm/°. Inter-tester intraclass correlation coefficients ranged from 0.32 to 0.70 (all p ≤ 0.01), standard error of measurement ranged from 0.012 to 0.029 Nm/° (i.e., 6–39%), and minimal detectable change ranged from 0.033 to 0.082 Nm/°. L-STIFF reliability was better during fast and medium movement speeds compared to slow speeds. Conclusions The assessment tool L-STIFF is a promising tool for quantifying lower limb spasticity in children with cerebral palsy in a standing position. However, the results should be interpreted carefully. Implications for Rehabilitation L-STIFF is a promising tool for evaluating lower limb spasticity in standing position. A special care must be given to the installation and alignment of the participant into the Lokomat to minimize erroneous spasticity measurement. Relative standard error of measurement and minimal detectable change should be used to analyze changes spasticity.

Development of a Short Form of the Five Facet Mindfulness Questionnaire–Adolescents for Children and Adolescents

The Five Facet Mindfulness Questionnaire (FFMQ) assesses several dimensions of mindfulness. The objective of this study was to develop a short version of the FFMQ for children and adolescents. The main sample consisted of 829 participants (51% boys; 10–18 years old). From this initial sample, 789 participants (49% boys) completed the FFMQ at a 6-month follow-up. A second independent sample (N = 418, 50% boys; 12–16 years old) was used to confirm the factor structure. Confirmatory factor analyses with the full version supported a structure composed of 5 correlated factors (1 per facet) plus 2 correlated method factors representing the method effect (positive and negative) of the items. From this model, the FFMQ–A–SF was derived, consisting of 25 items (5 per facet). The measure displayed adequate internal consistency, and invariance was confirmed over time and across different age groups. The analysis of the relationship between mindfulness facets and temperament and psychological problems provided additional evidence for the construct validity of the questionnaire. It is concluded that the FFMQ–A–SF presents acceptable validity and reliability in children and adolescents. However, the positive versus negative wording of the items could affect the responses of younger participants.

Identifying Subclinical Coronary Abnormalities and Silent Myocardial Ischemia After Arterial Switch Operation.

The incidence of late coronary complications is reported around 8% after arterial switch operation (ASO) for d-transposition of the great arteries, but the affected patients are usually asymptomatic. Exercise stress test (EST) and myocardial perfusion imaging (MPI) are common non-invasive modalities to screen for silent myocardial ischemia, but their diagnostic reliability in children after ASO is unclear. We retrospectively reviewed asymptomatic patients following ASO with EST, MPI, and coronary imaging studies (CIS) and examined the reliability of each test in identifying abnormal coronary lesions responsible for myocardial ischemia. Thirty-seven asymptomatic patients (24 males; ages 12.7 ± 3.7years) had EST, in which 27 and 33 patients also underwent MPI and CIS, respectively. Exercise capacity was comparable to the age- and sex-matched 37 controls. In seven patients with angiographically proven moderate to severe coronary abnormalities, only two patients had positive EST and/or MPI, and five patients were negative including one patient who later developed exercise-induced cardiac arrest due to severe proximal left coronary artery stenosis. Two patients with positive EST or MPI showed no correspondingcoronary abnormalities by CIS. Occurrence of acquired late coronary abnormalities did not correlate with the original coronary anatomy or initial surgical procedures. There is no single reliable method to identify the risk of myocardial ischemia after ASO. Although CIS are regarded as a gold standard, multidisciplinary studies are essential to risk-stratify the potential life-threatening coronary lesions after ASO in children.

Dichotic Listening Test-Retest Reliability in Children.

Purpose The objective of the study was to compare test-retest reliability of three dichotic listening tests: SCAN-3 Competing Words Test (Words; Keith, 2009a , 2009b ), Double Dichotic Digits Test (Digits; Musiek, 1983a ), and Bergen Dichotic Listening Test With Consonant-Vowel Syllables (Syllables; Hugdahl & Hammar, 1997 ). Method Sixty English-speaking children, 7-14 years old with normal hearing, had a single study visit during which each test was administered twice. Changes on retest were summarized by within-subject standard deviation ( S w), compared among tests, and compared with binomial model predictions. Correlates of variance were explored. Results Scores based on 40 items were more precise ( S w = 5%) than those based on 20-30 items ( S w = 6%-8%). All 3 tests had reliability within bounds predicted by binomial model. Changes on retest for Words and Digits Test were weakly associated with age, but this is confounded by the trend for older children to have higher Words and Digits scores. Conclusions Digits Right, Digits Left, and Words Total scores-each based on 40 items-had the best reliability among the clinically used scores. Scores based on fewer items were less precise. Poor precision may contribute to misdiagnosis in clinic and to nondifferential misclassification in research. More precise estimates of dichotic listening ability require longer tests.

Forks in the road, routes chosen, and journeys that beckon: A selective review of scholarship on children's testimony

SummaryIn this brief review, we reflect upon the key contributions of research examining children's eyewitness testimony. Children's testimonial ability became a focus of interest for researchers about 40 years ago in the wake of several high‐profile child abuse cases that prompted questions about children's reliability in the face of problematic interviewing and other suggestive influences. Since that time, scholars have examined children's capacity to provide accurate and detailed descriptions of their experiences and also evaluated the impact of various suggestive techniques. We have learned much about the conditions that are likely to promote reliable testimony from children and, conversely, when we might have cause for concern about the veracity of their reports. We highlight here some methodological and translational issues that have plagued the field and suggest some areas for future research focus.

Measurement reliability of phonation threshold pressure in pediatric subjects.

Phonation threshold pressure (PTP), the minimum subglottal pressure (Ps ) required for phonation, is sensitive to changes in laryngeal biomechanics and is often elevated with pathology. Little is reported on PTP in children; challenges with task performance and measurement reliability represent barriers to routine clinical assessment. Pilot study evaluating PTP and Ps measurement reliability in children using labial and mechanical interruption. Twenty-two subjects aged 4 to 17 years (10.7 ± 3.9 years) participated. Ten trials were performed for each method; task order was randomized. For labial interruption, subjects produced /pα/ five times at softest (onset PTP) and comfortable amplitude. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times for 250 ms each; mechanical interruption was performed with a mouthpiece and mask. PTP was recorded as the difference between Ps and supraglottal pressure at phonation cessation (offset PTP). Mean PTP and Ps and intrasubject coefficients of variation were compared. Correlations with age were evaluated. Mean PTP (P < .001) and Ps (P = .005) were higher for labial interruption. Intrasubject coefficients of variation for PTP (P = .554) and Ps (P = .305) were similar across methods. Coefficient of variation was related to age for mechanical-mask trials only (r = -0.628, P = .00175). Differences in means are likely related to differences in task and PTP hysteresis effect. Reliability is comparable with all methods; using a mouthpiece may be preferable to a mask for mechanical interruption. Measurement of PTP is noninvasive, reliable, and may be a useful adjunct in pediatric voice assessment. 3b Laryngoscope, 129:1520-1526, 2019.

Re-evaluation of the Latent Structure of Common Childhood Disorders: Is There a General Psychopathology Factor (P-Factor)?

In the field of psychopathology, there is high comorbidity between different disorders. Traditionally, support for two broad correlated dimensions of internalizing and externalizing symptoms has consistently emerged for children and adolescents. To date, oblique 2 and 3 first-order factor models (factors for externalizing and internalizing, and fear, distress, and externalizing) and bi-factor models with the corresponding two and three group factors have been suggested for common internalizing and eternalizing child and adolescent disorders. The present study used confirmatory factor analyses to examine the relative support for these models in adolescents (≥ 12 to 18 years; N = 866) and children (6 to < 12 years; N = 1233) and the reliability and convergent and divergent validities of the psychopathology factor (P-factor) and group factors in the optimum bi-factor model. All participants were from a clinic and underwent Diagnostic and Statistical Manual of Mental Disorders, 4th Edition clinical diagnosis. The findings showed that the bi-factor model with two group factors (internalizing and externalizing) was the optimum model for both children and adolescents. For both groups, findings showed relatively higher reliability for the P-factor than the group factors, although the externalizing group factor showed substantial reliability in adolescents, and both the externalizing and internalizing group factors also showed substantial reliability in children. The factors of the optimum bi-factor model also showed good convergent and discriminant validities. The implications for theory and clinical and research practice related to psychopathology are discussed.

Breath-Hold Blood Oxygen Level-Dependent MRI: A Tool for the Assessment of Cerebrovascular Reserve in Children with Moyamoya Disease.

There is a critical need for a reliable and clinically feasible imaging technique that can enable prognostication and selection for revascularization surgery in children with Moyamoya disease. Blood oxygen level-dependent MR imaging assessment of cerebrovascular reactivity, using voluntary breath-hold hypercapnic challenge, is one such simple technique. However, its repeatability and reliability in children with Moyamoya disease are unknown. The current study sought to address this limitation. Children with Moyamoya disease underwent dual breath-hold hypercapnic challenge blood oxygen level-dependent MR imaging of cerebrovascular reactivity in the same MR imaging session. Within-day, within-subject repeatability of cerebrovascular reactivity estimates, derived from the blood oxygen level-dependent signal, was computed. Estimates were associated with demographics and intellectual function. Interrater reliability of a qualitative and clinically applicable scoring scheme was assessed. Twenty children (11 males; 12.1 ± 3.3 years) with 30 MR imaging sessions (60 MR imaging scans) were included. Repeatability was "good" on the basis of the intraclass correlation coefficient (0.70 ± 0.19). Agreement of qualitative scores was "substantial" (κ = 0.711), and intrarater reliability of scores was "almost perfect" (κ = 0.83 and 1). Younger participants exhibited lower repeatability (P = .027). Repeatability was not associated with cognitive function (P > .05). However, abnormal cerebrovascular reactivity was associated with slower processing speed (P = .015). Breath-hold hypercapnic challenge blood oxygen level-dependent MR imaging is a repeatable technique for the assessment of cerebrovascular reactivity in children with Moyamoya disease and is reliably interpretable for use in clinical practice. Standardization of such protocols will allow further research into its application for the assessment of ischemic risk in childhood cerebrovascular disease.

Measuring the Reliability and Construct Validity of the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI-CAT) in Children With Cerebral Palsy

ObjectiveThe purpose of this study was to (1) investigate the construct validity and (2) test-retest reliability of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) in children with cerebral palsy (CP). DesignA prospective convenience cross-sectional sample. SettingMultidisciplinary CP clinic in a tertiary level pediatric children’s hospital. ParticipantsEnglish- and Spanish-speaking school-aged children (N=101) with a diagnosis of CP, stratified by Gross Motor Function Classification System level, who presented to our multidisciplinary clinic. Participants were excluded if they underwent recent surgery (<6mo) or botulinum neurotoxin A injection (<3mo). A subset of 17 families participated in retest reliability. Main Outcome MeasuresConvergent and divergent validity were evaluated using Spearman correlation coefficient analysis; test-retest reliability was assessed using intraclass correlation coefficients (ICCs). ResultsMean age was 12±3.7 years. Convergent validity was established between Mobility (PEDI-CAT) and Functional Mobility Scale (FMS) (5 m, r=0.85; 50 m, r=0.84; 500 m, r=0.76; P<.001). In ambulant children, convergent validity was established between Daily Activities (PEDI-CAT vs Pediatric Quality of Life CP [PedsQL-CP] [r=0.85, P<.001]) and between Social/Cognitive (PEDI-CAT) and Speech and Communication (PedsQL-CP) (r=0.42, P<.001). In nonambulant children, convergent validity was established between Daily Activities (PEDI-CAT) and Personal Care (Caregiver Priorities and Child Health Index of Life with Disabilities [CPCHILD]) (r=0.44, P<.001) and between social/cognitive (PEDI-CAT) and Communication (CPCHILD) (r=0.64, P<.001). A lack of correlation between Daily Activities, Social/Cognitive, and Responsibility (PEDI-CAT) and FMS and between the Mobility (PEDI-CAT) and Communication (PedsQL) domains confirmed divergent validity. Test-retest reliability was excellent for all domains of the PEDI-CAT (ICC=0.96-0.99). ConclusionsThe PEDI-CAT is an outcome measure that demonstrates strong construct validity and reliability in children with CP.

Patterns and reliability of children's skin temperature prior to and during sleep in the home setting.

The relationship between patterns of change in skin temperature and sleep is well recognized. In particular, there is a rapid rise in distal skin temperature (Tdistal) and slower rise in proximal skin temperature (Tproximal) prior to sleep onset. The difference between Tdistal and Tproximal is known as the distal-proximal gradient (DPG). Rise in DPG is known as a measure of distal vasodilation, which contributes to the drop in core body temperature (Tcore) that is important to sleep onset and maintenance. Patterns of change in skin temperature before and during sleep are reported for neonates, infants, adults and elderly, however they are not known for school aged children. Therefore, the current observational study aimed to determine the patterns and reliability of skin temperatures (Tskin) and DPG in relation to sleep of school aged children in their home settings. Participants (22 children, aged 6-12) completed the Children's Sleep Habits Questionnaire and used Thermochron iButtons and actigraphy for four school nights in their typical sleep settings. There were evident patterns of Tskin change before and during sleep. In particular, Tdistal was lower but rose more rapidly than Tproximal after reported bedtime and prior to sleep onset. This reflected a timely rise in DPG, and shows that distal vasodilation precedes sleep onset in school aged children. The measures of Tskin and sleep were practical for children in their home settings, and the observed patterns were consistent across consecutive school nights. Environmental and behavioural strategies that manage skin temperature before and during sleep should be explored for their potential as valuable components of treatment of childhood insomnia.

Hand-Use-at-Home Questionnaire: validity and reliability in children with neonatal brachial plexus palsy or unilateral cerebral palsy

Objective: To investigate construct validity and test–retest reliability of the parent-rated Hand-Use-at-Home questionnaire (HUH) in children with neonatal brachial plexus palsy or unilateral cerebral palsy. Design and subjects: For this cross-sectional study, children with neonatal brachial plexus palsy or unilateral cerebral palsy, aged 3–10 years, were eligible. Main measures: The HUH, Pediatric Outcome Data Collection Instrument Upper Extremity Scale (neonatal brachial plexus palsy only), and Children’s Hand-Use Experience Questionnaire (unilateral cerebral palsy only) were completed. The HUH was completed twice in subgroups of both diagnoses. Lesion-extent (indication of involved nerve rootlets in neonatal brachial plexus palsy as confirmed during clinical observation and/or nerve surgery) and Manual Ability Classification System levels (unilateral cerebral palsy) were obtained from the medical records. Spearman correlation coefficients between the HUH and all clinical variables, agreement, standard error of measurement, smallest detectable change and intra-class correlation were calculated. Results: A total of 260 patients participated (neonatal brachial plexus palsy: 181), of which 56 completed the second HUH (neonatal brachial plexus palsy: 16). Median age was 6.9 years for children with neonatal brachial plexus palsy, 116 had C5-C6 lesions. Median age for children with unilateral cerebral palsy was 6.4 years, 33 had Manual Ability Classification System Level II. The HUH correlated moderately with lesion-extent (rs =−0.5), Pediatric Outcome Data Collection Instrument Upper Extremity Scale (rs = 0.6) and Children’s Hand-Use Experience Questionnaire (rs = 0.5) but weakly with Manual Ability Classification System levels (rs = −0.4). Test–retest reliability was excellent (intra-class correlation2,1 = 0.89, standard error of measurement = 0.599 and smallest detectable change = 1.66 logits) and agreement was good (mean difference HUH1 − HUH2 = 0.06 logits). Conclusion: The HUH showed good construct validity and test–retest reliability in children with neonatal brachial plexus palsy or unilateral cerebral palsy.

The Eating and Drinking Ability Classification System: concurrent validity and reliability in children with cerebral palsy.

As there is little evidence for concurrent validity of the Eating and Drinking Ability Classification System (EDACS), this study aimed to determine its concurrent validity and reliability in children and adolescents with cerebral palsy (CP). After an extensive translation procedure, we applied the German language version to 52 participants with CP (30 males, 22 females, mean age 9y 7mo [SD 4y 2mo]). We correlated (Kendall's tau or Kτ ) the EDACS levels with the Bogenhausener Dysphagiescore (BODS), and the EDACS level of assistance with the Manual Ability Classification System (MACS) and the item 'eating' of the Functional Independence Measure for Children (WeeFIM). We further quantified the interrater reliability between speech and language therapists (SaLTs) and between SaLTs and parents with Kappa (κ). The EDACS levels correlated highly with the BODS (Kτ =0.79), and the EDACS level of assistance correlated highly with the MACS (Kτ =0.73) and WeeFIM eating item (Kτ =-0.80). Interrater reliability proved almost perfect between SaLTs (EDACS: κ=0.94; EDACS level of assistance: κ=0.89) and SaLTs and parents (EDACS: κ=0.82; EDACS level of assistance: κ=0.89). The EDACS levels and level of assistance seem valid and showed almost perfect interrater reliability when classifying eating and drinking problems in children and adolescents with CP. The Eating and Drinking Ability Classification System (EDACS) correlates well with a dysphagia score. The EDACS level of assistance proves valid. The German version of EDACS is highly reliable. EDACS correlates moderately to highly with other classification systems.