Self-report measures for use with children: a review and comment

Understanding Critical Health Literacy Among Adolescents: Psychometric Properties of the CHLA Questionnaire in Lower Secondary Schools in Norway

BACKGROUND

Schools are important arenas for the promotion of critical health literacy (CHL) among adolescents. Key domains of CHL are information appraisal, understanding social determinants of health, and abilities to act on determinants of health. In this paper, we examine the psychometric properties of the Critical Health Literacy for Adolescents Questionnaire (CHLA-Q).

METHODS

A cross-sectional survey study was performed at 5 schools in Norway. Respondents included 522 pupils aged 13-15 years old. Confirmatory factor analysis (CFA) was conducted to examine the structural validity. Internal reliability was assessed using ordinal Cronbach's alpha.

RESULTS

The estimated model had acceptable closeness of fit. Five of 6 scales displayed adequate internal reliability.

CONCLUSION

The results indicate acceptable fit of the CHLA-Q framework and that 5 of the 6 scales are applicable to inform future research and interventions. More research is needed on measurement of the second domain of CHL.

Developing Indicators to Measure Critical Health Literacy in the Context of Norwegian Lower Secondary Schools

A critical health literacy (CHL) approach is recommended for promoting health in the school context. This construct is complex and includes three interconnected domains: (A) appraisal of critical information, (B) awareness of the social determinants of health (SDH), and (C) collective action to promote health and well-being. In recent literature reviews, no measurement instrument that covers all three domains of CHL in the school-context was found. Our aim was to develop self-reported measurement scales for each domain of CHL. The development process reported in this study was conducted in two stages. In the first stage, an initial item pool was generated based on literature reviews and focus group interviews (N = 15) with adolescents (steps 1–2). In the next steps, items were adjusted and removed based on the feedback from an expert panel and from representatives from the target group (steps 3–5). In stage two, we aimed to reduce the number of items and develop scales for each domain. We then piloted the current draft, which consists of 28 items (N = 114). A sub-sample (N = 10) of the participants were interviewed after they completed the survey to examine the instrument’s face validity. Cronbach’s α was used to assess the internal reliability of the scales; the reliability was promising for scales A (α = 0.83) and C (α = 0.85) but was below the recommended value for scale B (α = 0.61). The model fit indices were promising (TLI_scaleA = 0.97, RSMEA_scaleA = 0.055, TLI_scaleB = 1.05, RMSEA_scaleB = 0.00, TLI_scaleC = 0.95, RMSEA_scaleC = 0.074). The piloted version of scales A and C were positively correlated with subjective health literacy, health-related quality of life, and subjective health; however, we found no such correlations for scale B. The post-survey group interviews led to some adjustments in scales A and B. The revised version of CHLA-Q must be tested using a larger sample; this will enable more robust statistical testing of the properties of the items and the scale.

How I Feel About My School-Adaptation and Validation of an Educational Well-Being Measure among Young Children in Sweden

The well-being of children has received increasing attention in recent years. Nevertheless, we lack adequate brief self-report tools that enable us to consider young children's well-being in policy evaluations and educational research. This study describes the adaptation and first validation of the Swedish version of How I Feel About My School (HIFAMS), a subjective well-being questionnaire suitable for children aged 4 to 12 years, which was originally developed in the United Kingdom (UK). Descriptive statistics with analysis of psychometric properties and confirmatory factor analysis (CFA) are based on the perceived well-being of 228 children in preschool and school aged 5 to 8 years old. The CFA endorsed a good fit to a one-factor model, and the scale showed moderate internal consistency (rα = 0.63). The results are largely in line with the findings of the original HIFAMS. We conclude that the Swedish version can be applied in early preschool/school settings and could provide first-hand information about children's well-being from the first years of education until elementary school grades. Practitioners in early education settings might benefit from HIFAMS assessments when seeking to understand children's current well-being to provide support to children with special educational needs or children at risk for mental health issues. Researchers could use the HIFAMS to standardize child well-being evaluations in policy evaluations and interventional studies.

Insights about Screen-Use Conflict from Discussions between Mothers and Pre-Adolescents: A Thematic Analysis

Digital screens have become an integral part of everyday life. In the wake of the digital swell, pre-adolescents and their parents are learning to navigate seemingly new terrain regarding digital media use. The present study aimed to investigate parent and pre-adolescent perceptions of screen use and the source of conflict surrounding digital media. We employed a qualitative thematic analysis of 200 parent and pre-adolescent dyads discussing screen use. Our analysis showed five overarching themes for screen use perceptions and conflict: screen time, effects of screen use, balance, rules, and reasons for screen use. In contrast to previous studies that mainly focused on parental perceptions, we were also able to shed light on pre-adolescent perceptions of screen use and the difference in opinions with their parents. Furthermore, we found that patterns of the source of screen use conflict were oftentimes rooted in the age-old developmental tug of war between autonomy-seeking pre-adolescents and authority-seeking parents. Though navigating autonomy-granting and seeking behavior is familiar to developmental scientists, negotiating these challenges in a new digital world is unfamiliar. Autonomy support, open dialogue, and playful interaction between parents and children are needed to understand and resolve conflict of digital media use in family contexts.

[What Are the Individual, Family, and Social Characteristics Differentiating Prepubertal from Pubertal Anorexia Nervosa?]

Prepubertal anorexia nervosa may entail multiple physical effects. When the onset occurs before puberty, the disorder might be associated with a poorer prognosis and a greater resistance to treatment. Until now, prepubertal anorexia nervosa studies have mostly dealt with symptomatology, but rarely with associated factors.

OBJECTIVE:

This study aims to differentiate prepubescent from pubescent anorexia nervosa regarding individual, family and social characteristics.

METHOD:

At admission in programs specialized in eating disorders, female patients (n = 19 prepubertal and 126 pubertal) and their parents filled in questionnaires (EDI-3, BDI II, IPPA, FACES IV, IDPESQ) on key individual, family and social characteristics associated with anorexia nervosa. Prepubertal and pubertal patient results were compared for each measured variable. Pubertal development and anorexia presence were assessed by a paediatrician in all patients.

RESULTS:

Prepubertal patients account for 13.8% of all cases and have a lower percentile rank than pubertal patients. The many questionnaire results showed little or no difficulty at personal, family or social level and no difference with older patients.

CONCLUSIONS:

These results contribute to challenge our current understanding of prepubertal anorexia nervosa and the prepubescent patient capacity to report their difficulties, which highlights the importance of using several respondents when defining clinical profiles.

Psychometric Properties of the Chinese Version of the Children's Resourcefulness Scale in Taiwanese Children

This study reports the psychometric properties of a Chinese version of the Children's Resourcefulness Scale (C-CRS) for Taiwanese children. An instrument for assessing resourcefulness skills in children and adolescents, the CRS was translated into Mandarin Chinese, and a cross-sectional investigation was conducted with a convenience sample of 368 fifth and sixth graders recruited from three geographically diverse locations in Taiwan. Internal consistency statistics from the total sample and subgroups were between .57 and .71 with lower alphas for subgroups with disadvantaged socioeconomic status. Findings suggest that the C-CRS has the potential to assess children's resourcefulness skills in the Taiwanese population.

Internal consistency, test-retest reliability and measurement error of the self-report version of the social skills rating system in a sample of Australian adolescents

The social skills rating system (SSRS) is used to assess social skills and competence in children and adolescents. While its characteristics based on United States samples (US) are published, corresponding Australian figures are unavailable. Using a 4-week retest design, we examined the internal consistency, retest reliability and measurement error (ME) of the SSRS secondary student form (SSF) in a sample of Year 7 students (N = 187), from five randomly selected public schools in Perth, western Australia. Internal consistency (IC) of the total scale and most subscale scores (except empathy) on the frequency rating scale was adequate to permit independent use. On the importance rating scale, most IC estimates for girls fell below the benchmark. Test-retest estimates of the total scale and subscales were insufficient to permit reliable use. ME of the total scale score (frequency rating) for boys was equivalent to the US estimate, while that for girls was lower than the US error. ME of the total scale score (importance rating) was larger than the error using the frequency rating scale. The study finding supports the idea of using multiple informants (e.g. teacher and parent reports), not just student as recommended in the manual. Future research needs to substantiate the clinical meaningfulness of the MEs calculated in this study by corroborating them against the respective Minimum Clinically Important Difference (MCID).

Do symptoms of sluggish cognitive tempo in children with ADHD symptoms represent comorbid internalizing difficulties?

OBJECTIVE

Symptoms of sluggish cognitive tempo (SCT) are correlated with inattention and internalizing difficulties. The purpose of the present study was to determine whether symptoms of SCT reflect comorbid internalizing disorder with ADHD or a separate syndrome.

METHOD

Using a clinical sample of youth evaluated for behavioral and learning difficulties (N = 73), this study examined whether SCT remains associated with symptoms of ADHD after accounting for comorbid symptoms of anxiety and depression reported by children and parents.

RESULTS

SCT symptoms were correlated with inattention and parent reports of child depression, but not with parent-reported anxiety or child reports of internalizing problems. Inattention (in the absence of hyperactivity/impulsivity) remained uniquely associated with SCT even after accounting for internalizing problems.

CONCLUSION

The findings confirm SCT as a correlate of inattention and support its construct validity as separate from comorbid internalizing problems. Further research on the clinical utility of SCT is needed.

Self-control as predictor of school grades, life balance, and flow in adolescents

BACKGROUND

Recently, several studies have shown that strength of self-control is a crucial factor in determining positive outcomes in individuals' lives. Most attention has been directed to the relationships that self-control has with learning and academic achievement.

AIMS

This article analyses the effects of self-control not only on school grades but also on the experience of life balance and flow. It is theorized that students with a higher level of self-control are better able to distribute their time in a satisfying way over academic and leisure matters, and are better able to shield their studying against distractions.

SAMPLES

A total of 697 eighth graders with a mean age of 13.4 years participated in the longitudinal study.

METHOD

Students completed a questionnaire containing measures of self-control, school grades, subjective life balance, and flow while studying at the beginning and at the end of the school year. Structural equation modelling was used to analyse the relationships between the constructs.

RESULTS AND CONCLUSIONS

Results of cross-lagged analyses show that self-control predicted school grades, life balance, and flow. The findings suggest that self-control may assist adolescents to be better prepared, not only for school, but also for coordinating their investments in different areas of their lives.

Do controlling maternal behaviours increase state anxiety in children's responses to a social threat? A pilot study

Past research has demonstrated a link between controlling parenting and child anxiety. However, the causal nature of this association has not yet been established since most previous studies have utilised cross-sectional designs. The aim of the current study was to implement an experimental design to examine the impact of maternal control on children's state anxiety when faced with a social threat. Mothers of 26 children aged 7-13 years were randomly allocated to conditions in which they were either required to be overly controlling or minimally controlling during preparation of a practice speech by their child. In a subsequent speech that children were required to prepare alone, children whose mothers had previously been overly controlling during the practice showed greater anxiety than did children whose mothers had previously been minimally controlling. This pilot study describes a novel paradigm that has the potential to address issues related to the causal role of specific parenting behaviours in the experience of negative emotions.

PSYCHOMETRIC PROPERTIES OF THE TURKISH VERSION OF THE CHILDREN'S SELF-REPORT SOCIAL SKILLS SCALE

The factor structure, psychometric properties, and utility of the Children's Self-Report Social Skills Scale (CS4) developed by Danielson and Phelps (2003) was investigated for the first time with a Turkish sample. Translation and back-translation did not reveal any specific problems. Results suggested that the Turkish translation of the CS4is a reliable instrument for the assessment of children's social skills.

Characteristics of Health-related Self-report Measures for Children Aged Three to Eight Years: A Review of the Literature

AIMS

To review and make recommendations about the format and quality of health-related self-report measures for children aged 3-8 years.

METHODS

Literature searches used to identify measures of QOL, self-esteem, self-concept and mental health. The format (i.e., scale type, presentation style) and quality (i.e., item generation, reliability, validity, responsiveness) of measures were compared and evaluated.

RESULTS

Fifty three measures were identified: QOL (n = 25, 47%), self-esteem/concept (n = 15, 28%), mental health (n = 13, 25%). Likert scales were used most frequently to represent response choices (n = 34, 64%). The authors of 11 (21%) measures provided justification for their scale choice. Items were most commonly presented in written format (n = 24, 45%). Item content was generated from the respondent population in only 21 (40%) measures. Twenty-seven (51%) measures reported internal reliability between 0.70 and 0.90, and 12 (23%) reported reproducibility in this range. Although validity was reported for 48 (91%) measures, evidence for three or more aspects occurred for only 9 (17%). Eleven (21%) measures evidenced responsiveness to change.

CONCLUSION

Authors should provide clearer evidence for reliability and responsiveness. Newly developed instruments need to meet established standards, and further studies should assess the impact of scale and presentation types on the psychometrics of measures.

Factor Structure of the Pictorial Scale of Perceived Competence and Social Acceptance With Two Pre-Elementary Samples

Competing models of the factorial structure of the Pictorial Scale of Perceived Competence and Social Acceptance (PSPCSA) were tested for fit using multisample confirmatory factor analysis. The best fitting model was tested for invariance (a) across samples of middle-class (n = 251) and economically disadvantaged (Head Start, n = 117) kindergarten children (whose ages ranged from 67 to 86 months), and (b) over time (at the end of preschool and kindergarten) for the Head Start sample. For kindergarten children, regardless of socioeconomic status, the factor structure of the PSPCSA was consistent with the 2-factor model of Competence and Acceptance. This model also fit reasonably well for Head Start children at the end of their preschool year. However, in addition to providing broad support for the dimensionality of the measure, our findings highlight important concerns about the PSPCSA.

Repressive adaptive style in children with chronic illness

OBJECTIVE

The primary objectives of this study were 1) To assess whether previously reported findings of high levels of repressive adaptation in children with cancer are unique to the cancer population or are generally characteristic of children with serious chronic illness and 2) to assess the utility of including a new measure of anger expression in the adaptive style measurement paradigm.

METHODS

Measures of defensiveness, trait anxiety, and anger expression were obtained from three groups of children: those with cancer (N = 130), those with chronic illnesses (diabetes, cystic fibrosis, and juvenile rheumatoid disorders; N = 121), and healthy control participants (N = 368). Based on their self-reports, participants were categorized according to the adaptive style paradigm as either high anxious, low anxious, defensive high anxious, or repressor. The prevalence of these categories was compared across groups.

RESULTS

Children in the cancer and chronic illness groups both reported significantly higher levels of defensiveness and lower levels of anxiety than did the healthy control participants. Application of the adaptive style paradigm produced a significantly higher percentage of children identified as repressors in the both cancer and chronic illness groups relative to healthy children. Children classified as repressors also reported significantly less expression of anger than did nonrepressors.

CONCLUSIONS

An increased prevalence of repressive adaptation is not unique to children with cancer, but may be generally characteristic of children with serious chronic illness. Use of anger in place of anxiety as the repressed affect produced a similar distribution of adaptive styles in the study populations.

Children's responses to overt and relational aggression

Investigated children's responses for coping with overt and relational aggression. Children in Grades 3 through 6 (N = 491) in a rural Midwestern public school district completed a survey designed to assess how students cope when they are the targets of peer aggression. Children endorsed greater use of internalizing and distancing strategies for coping with relational aggression and greater use of externalizing strategies for coping with overt aggression. In addition, older children reported greater use of externalizing and less use of internalizing and distancing strategies than younger children. Significant differences were also found between boys and girls. Regardless of type of aggression, girls endorsed greater use of problem-solving and support strategies and less use of externalizing strategies than boys. Coping of high target children and of children who frequently received prosocial treatment from peers were also examined.

Perceived efficacy and goal setting in young children

One of the central tenets of client-centred occupational therapy is to enable clients to select goals to work on in therapy (Law, 1998). The process of identifying and prioritizing goals is fairly abstract, therefore occupational therapy goals for children are often prescribed by the therapist or by parents and teachers. The purpose of this study was to pilot test a measure and a process that would provide young children with the opportunity to assess their performance on daily tasks and to establish goals for occupational therapy intervention. Parents and children completed the Perceived Efficacy and Goal Setting System (PEGS), a measure of children's perception of their competence performing fine and gross motor tasks. Children 5-9 years of age were able to discriminate among tasks and to rate whether or not they were able to perform each task competently. They were also able to use this information to select and prioritize goals for intervention. While parents often rated the child's competence lower than the child did, there was a high level of agreement regarding which tasks were difficult for the child. Parents and children often did not agree about the specific selection or priority of these tasks for intervention, however, which highlights the need for further research.

IDENTIFYING PSYCHOSOCIAL DYSFUNCTION IN SCHOOL-AGE CHILDREN: THE PEDIATRIC SYMPTOM CHECKLIST AS A SELF-REPORT MEASURE

The Pediatric Symptom Checklist (PSC) is a brief, well-validated parent-report questionnaire designed to detect psychosocial dysfunction in school-age children during pediatric primary care visits. This study assessed the utility of the PSC when completed by children (PSC-Y) ages 9-14 in a public school when parents are not available (n = 173). The PSC-Y identified 20% of children as having psychosocial problems, a rate similar to other low-income samples. When compared with teacher ratings of attention and behavior problems, the PSC-Y showed a sensitivity of 94% and a specificity of 88%. The PSC-Y correlated significantly with teacher and parent measures of child dysfunction, and with child-reported symptoms of depression and anxiety. Three quarters of the children identified by the PSC-Y were not identified by parents on the PSC. These children had impairment on all other measures, but fewer than one in five had received mental health services, suggesting the PSC-Y identified children with unmet mental health needs. The PSC-Y has the potential to be a rapid, easily administered tool for large-scale mental health screening in schools.

Mother-child agreement on self-report of anxiety in abused children

This study investigates the lack of agreement in maternal and child report of child anxiety with a sample of abused and nonabused clinic-referred children. Based on the literature, it was predicted that nonabused clinic-referred children would report more symptoms of anxiety than their mothers would report for them. It was also predicted that mothers of abused children would report greater anxiety symptoms for their children than the children's self-report. Finally, it was predicted that maternal psychopathology, specifically anxiety, would increase the probability that mothers would overreport their children's anxiety. Mother-child agreement based on anxiety symptoms assessed by the Quay Behavior Problem Checklist and the Revised-Children's Manifest Anxiety Scale was obtained on 54 male and female outpatients, 5 to 16 years of age. Overall, mothers reported significantly more anxiety for their children, than the children's own self-report, irrespective of abuse history. The implications of the findings are discussed with respect to the validity of maternal and child report. Directions for future research are also offered.

The reproducibility of the Childhood Asthma Questionnaires: measures of quality of life for children with asthma aged 4-16 years

This paper reports the internal consistency and reproducibility of the Childhood Asthma Questionnaires, measures of quality of life and symptom distress in paediatric asthma. A total of 535 children aged 4-16 years completed age appropriate forms of the questionnaire, over 1- or 3-week intervals. Pearson correlation coefficients between 0.63 and 0.84 for subscales of the questionnaires indicated good test-retest reliability while intraclass correlation coefficients in a very similar range showed that scores also remained at the same level on the two occasions. Comparisons between children with asthma and healthy non-asthmatics indicate that these are likely to be true estimates of stability. Internal consistency varied widely but was higher for older children and longer subscales. Implications of the findings for the use of the questionnaires in the evaluation of new asthma treatments are discussed.