Development, psychometrics and feasibility of the School Participation Questionnaire: A teacher measure of participation related constructs

School Participation Questionnaire (SPQ): Italian Translation, Cultural Adaptation, and Pilot Testing in Children with Neurodevelopmental Disorders

INTRODUCTION

According to leading occupational therapy models, the environment appears to be a key element in fostering occupational performance and participation. There is an emerging need to identify an instrument that can assess these aspects in the school environment. Currently, there are no rating scales in Italy for the school participation of children with neurodevelopmental disorders. For this reason, this study aims to culturally adapt and translate the School Participation Questionnaire (SPQ) to Italian and to pilot test the translated Italian version on children with neurodevelopmental disorders.

METHODS

The original scale was translated from English to Italian using the guidelines "Translation and Cultural Adaptation of Patient Reported Outcomes Measures-Principles of Good Practice". The psychometric properties analyzed were the following: content validity, construct validity, cross-cultural validity, and internal consistency. Construct validity was assessed using the Italian version of the Sensory Processing Measure (SPM).

RESULTS

The Italian version of the SPQ was administered to 22 children. The mean ± SD of the score was 9.32 ± 1.36; Cronbach's α was 0.935 (p < 0.01). The Pearson's correlation coefficient with the SPM scores was -0.622 (p < 0.01).

CONCLUSIONS

This pilot testing study for the validation of the Italian version of the SPQ showed good validity and reliability results. Thanks to this study, it would be possible to further analyze the tool for the evaluation of the environment and school participation of children with neurodevelopmental disorders, in particular autism spectrum disorder. It is a quick and easy instrument that focuses on the environment as an active variable in the child's occupational performance.

Participation-related constructs and participation of children with additional support needs in schools

AIM

To investigate associations between participation-related constructs and participation frequency and involvement in inclusive schools.

METHOD

In this cross-sectional study, teachers of children with additional support needs, including intellectual disability, autism, and learning difficulties, completed measures. Participation-related constructs were measured using the School Participation Questionnaire; participation frequency and involvement were measured using the Participation and Environment Measure for Children and Youth. A series of multilevel linear mixed-effects regression models with maximum likelihood estimates and bootstrap confidence intervals with p-values were obtained. Final models included participation-related constructs and participation, controlling for demographic and diagnostic confounders (including age, sex, language, level of school support, and autism).

RESULTS

Six hundred and eighty-eight children (448 [65.1%] males; mean age 8 years 7 months [range 4 years 10 months-12 years 13 months, standard deviation 2 years 1 months]) were assessed by 252 teachers. Across a series of models, participation-related constructs were consistently associated with more intensive participation (competence, environment, identity p < 0.001; symptoms p = 0.007), independent of confounders. More frequent participation remained associated with three of four participation-related constructs (competence, identity p < 0.001; environment p = 0.021). Age (p = 0.046), language (p = 0.002), and level of school support (p = 0.039) also remained significantly associated with frequency of participation.

INTERPRETATION

Children with additional support needs in inclusive schools may have several participation barriers. Policies and interventions to improve participation are needed.

WHAT THIS PAPER ADDS

Across a series of models, participation-related constructs were associated with frequency and intensity of participation. Only participation-related constructs were associated with participation intensity. Demographic and diagnostic variables were associated with frequency, not intensity, of participation. Teacher assessment is valid for assessment of participation and participation-related constructs.

Much more than just being present: participation of children with intellectual disabilities in mainstream schools

Although school engagement is crucial to child development, research on children with intellectual disabilities in mainstream schools is scant. This sequential, explanatory mixed-methods study examined the ways in and extent to which children with intellectual disabilities participate in mainstream school activities, as well the personal and environmental factors that affect their participation. A total of 101 general teachers provided quantitative data, while eight children with intellectual impairments and their teachers and peers provided qualitative data. In the quantitative survey, no significant differences were observed between children with and those without intellectual disabilities regarding school absence, but a low similarity existed in their extent of participation. Children with intellectual disabilities engaged most frequently in life-skills and after-school activities and least frequently in social and volunteer activities. School participation was affected by the degree of disability and environmental variables. We derived two themes from qualitative research: (1) school participation of children with intellectual disabilities; and (2) factors associated with school participation of children with intellectual disabilities. The results suggest strategies that may promote the participation of children with intellectual disabilities in mainstream schools.

Psychometric properties of the School Participation Questionnaire: Testing a measure of participation-related constructs

AIM

To explore concurrent validity, convergent validity, interrater reliability, test-retest reliability, and Rasch model analysis of the School Participation Questionnaire (SPQ), a tool for teachers to assess personal and environmental determinants of school participation.

METHOD

Teachers of children with additional support needs, including intellectual disability, autism, and learning difficulties completed measures. Data were collected using the SPQ and the Participation and Environment Measure for Children and Youth (PEM-CY). Test-retest and interrater reliability were assessed using intraclass correlation coefficients (ICCs). Internal consistency was assessed with Cronbach's alpha. Concurrent and convergent validity were explored via correlations with the PEM-CY. Further psychometrics were examined using a Rasch model.

RESULTS

One hundred and eighty-seven children (136 [72.7%] male; mean age 9y [range 5y 6mo-12y 10mo, SD 2y]) were assessed by 67 teachers. Cronbach's alpha, test-retest, and interrater reliability were acceptable-excellent across each SPQ scale (alphas=0.89, 0.9, 0.94, 0.79; test-retest ICCs=0.64, 0.61, 0.78, 0.62; interrater ICCs=0.85, 0.71, 0.90, 0.81). Concurrent and convergent validity were confirmed with significant positive correlations between SPQ and PEM-CY. After Mokken and Rasch model analysis, person and item reliability were good, and unidimensionality was confirmed. Mean administration time was 8.2 minutes.

INTERPRETATION

The results suggest that the SPQ is a rapid, reliable, and valid tool for assessment of participation-related indicators in schools.

Development of a Pathway for Multidisciplinary Neurodevelopmental Assessment and Diagnosis in Children and Young People

There is a variable standard of access to quality neurodevelopmental assessment and diagnosis. People may have negative experiences, encountering lengthy waiting times, and inconsistent practices. Practitioners need guidance on standards and practices for assessment and diagnosis matched to new ways of working. In this paper, we present a new pathway and recommendations for multidisciplinary neurodevelopmental assessment and diagnosis for children and young people (<19 years), developed by the Scottish Government funded National Autism Implementation Team (NAIT). Our research used the Medical Research Council guidance for the development of complex interventions and included several iterative stages. Stage 1: n = 44 stakeholders attended an event on developing new practices for diagnosis and assessment. Stage 2: a literature synthesis was completed by the research team of clinical guidelines and diagnosis and assessment tools. Stage 3: an event with n = 127 stakeholders included discussion and debate of the data from stages 1 and 2. Recommendations and a draft pathway were written. Stage 4: successive drafts of recommendations and the pathway documentation were circulated among an advisory group, including multidisciplinary clinical experts and people with lived experience, until the final pathway was agreed upon. The finalised pathway includes guidance on terminology, assessment, diagnosis, triage, time standards and engagement of people with lived experience. The new pathway has been adopted by the Scottish Government. The pathway and associated documentation are freely available online for use by others.