Measurement properties of instruments that assess participation in young people with autism spectrum disorder: a systematic review

Participation measures that evaluate attendance and involvement for young people aged 15 to 25 years with cerebral palsy: a systematic review

PURPOSE

To identify participation-focused measures used for young people with cerebral palsy (CP), evaluate their psychometric evidence, and map item content to the International Classification of Functioning, Disability, and Health (ICF), and family of Participation-Related Constructs (fPRC) frameworks.

METHODS

Four databases (PubMed, Embase, Web of Science, CINAHL) were searched for papers that involved young people with CP aged 15 to 25 years and reported original data from a participation measure. Each measure was examined for validity, reliability, responsiveness (using the COSMIN checklist), clinical utility, the inclusion of accessible design features, self- and/or proxy-report from people with communication support needs, and item content according to ICF and fPRC.

RESULTS

Of 895 papers, 80 were included for review. From these, 26 measures were identified. Seven measures (27 papers/resources) were participation-focused, capable of producing a score for participation Attendance and/or Involvement. Of these, all measured Attendance (n = 7) but fewer than half measured Involvement (n = 3). Few included studies (37%) reported including some self-report of people with communication support needs.

CONCLUSIONS

Participation measures for young people with CP are evolving but require more: (i) emphasis on measurement of involvement; (ii) investigation of psychometric properties; and (iii) adaptation to enable self-report by young people with communication support needs.

Occupational Therapy Outcome Measures in Preschool Children With Autism Spectrum Disorders: A Scoping Review

With the rising prevalence of autism spectrum disorder (ASD), early assessment of preschool children is vital for occupational therapists. This scoping review aimed to provide detailed information about outcome measures used in occupational therapy interventions in preschool children with ASD and map the focus of the outcome measures based on the International Classification of Functioning, Disability, and Health (ICF) components. A thorough search from 2000 to 2022 was conducted that employed ICF linking rules to categorize the outcome measures. Seventy-four outcome measures were identified. They predominantly targeted body function and activity/participation, with less emphasis on environmental factors, and none assessed body structure. The most common measures were Vineland Adaptive Behavior Scale (VABS-2), Canadian Occupational Performance Measure (COPM), and Parenting Stress Index-Short Form (PSI-SF). This study offers a diverse array of outcome measures and underscores the potential of the ICF framework in enhancing evaluations, particularly concerning broader environmental components as one of the primary facilitating/hindering factors in the participation of children with ASD.

Content validity of the instrument 'Picture My Participation' for measuring participation of children with and without autism spectrum disorder in mainland China

BACKGROUND

Picture My Participation (PMP) is a valid instrument for measuring participation of children with disabilities, but it has not yet been evaluated for its content validity for children with autism spectrum disorders (ASD) in mainland China.

AIM

To explore the content validity of the simplified Chinese version of PMP (PMP-C; Simplified) for children with ASD and typically developing (TD) children in mainland China.

METHODS

A sample of children with ASD (n = 63) and TD children (n = 63) recruited through purposive sampling were interviewed using the PMP-C (Simplified), which contains 20 items of everyday activities. Children rated attendance and involvement on all activities and selected three most important activities.

RESULTS

Children with ASD selected 19 of 20 activities as the most important activity while TD children selected 17 activities. Children with ASD used all scale points for rating attendance and involvement on all activities. TD children used all scale points for rating attendance and involvement in 10 and 12 of 20 activities, respectively.

CONCLUSION

The contents of 20 activities of PMP-C (Simplified) were relevant for all children and especially for children with ASD for assessing participation in community, school and home activities.

Participation Patterns of Israeli Children with and without Autism, and the Impact of Environment

AIMS

Participation is vital to children's quality of life, yet it is often limited for those with autism spectrum disorder (ASD). An improved understanding of the factors that may support or hinder their participation is important. This study aims to explore the participation patterns of children with and without ASD in the home, school, and community settings, as well as to explore the impact of environmental factors on the participation of children with ASD.

METHODS

78 parents of children aged 6-12, attending mainstream educational settings (30 with ASD; 48 without ASD) completed the Participation and Environment Measure for Children and Youth and a demographic questionnaire.

RESULTS

Children with ASD were rated significantly lower than children without ASD in participation, and their parents expressed a greater desire to change their participation while reporting lower overall environmental support. Among the ASD group, significant differences in participation were found across the three settings, with the highest participation scores at home. Environmental factors that support or limit children's participation were identified.

CONCLUSIONS

The results highlight the importance of environmental factors in children's participation. It is essential to evaluate different environmental settings; identifying the supportive and limiting environmental factors will enhance interventions for children with ASD.

Interventions to Support Participation in Education for Autistic Students (2013-2021)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on interventions to support autistic1 children and youth (up to 18 yr old) and focuses on participation in education settings.

Interventions to Support Participation in Play for Autistic Children and Youth (Dates of Review: 2013-2021)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings to support participation in play for autistic1 children and adolescents (birth to 18 yr).

Interventions to Support Participation in Sleep for Autistic Children and Adolescents (2013-2021)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on interventions to support participation in sleep for autistic1 children and adolescents (birth to 18 yr).

Interventions to Support Participation in Basic and Instrumental Activities of Daily Living for Autistic Children and Adolescents (2013-2021)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings from the systematic review on interventions to support participation in basic and instrumental activities of daily living by autistic1 children and adolescents (birth to 18 yr).

Assistive Products and Technology to Facilitate Activities and Participation for Children with Disabilities

We aimed to identify activity limitations and participation restrictions encountered by children and youth with disabilities for which assistive products and technology could be helpful. We used a convergent, parallel, mixed-methods design involving a nationwide, French survey composed of closed questions (quantitative) and open questions (qualitative) that enlightened the quantitative data. A total of 1055 responses were received, and 962 included: 92 from children and youth with disabilities, 493 from relatives and 377 from professionals. Difficulties frequently checked and described in detail were participation in recreational activities, leaving the house and traveling, participating in a group, and getting ready. Transversal explanations for difficulties were spontaneously provided (e.g., lack of accessibility and mobility). Solutions proposed included personal assistive devices to facilitate home life, high-tech devices, devices to compensate for impaired body functions, and adaptation of the familiar environment and daily activities. Few public solutions were proposed. The necessity of human assistance was emphasized. The mixed-methods design and involvement of different stakeholders identified common, macroscopic trends in difficulties encountered and desired solutions. Products and technology are required in the following domains: the familiar environment, accessibility and mobility, sports and leisure, high-technology, and family support. We provide suggestions to facilitate the development of innovative solutions.

Systematic review of the psychometric properties of cultural adaptations and translations of the Children's Assessment of Participation and Enjoyment (CAPE)

BACKGROUND

The Children's Assessment of Participation and Enjoyment (CAPE) is the most widely used questionnaire for the assessment of children participation. While several cultural adaptations and translations exist, the quality of the methods used to produce them, as well as their psychometric properties, remains unclear. The aim of this systematic review was to evaluate the different translated and/or culturally adapted versions of the CAPE for children and youth with and without disabilities.

METHOD

A search was performed in five electronic databases CINAHL (EBSCO), MEDLINE (OVID), EMBASE (ELSEVIER), PSYCINFO (OVID), and WEB OF SCIENCE Core Collection (CLARIVATE), for articles available in French or English with the last update in July 2022. All studies related to a cultural adaptation and/or translation of the CAPE were retained and evaluated based on established guidelines for cross-cultural adaptations and measurement properties. The extraction was done independently by two authors. A critical appraisal of translation and psychometric properties methods was performed. Critical appraisal of the articles was done using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures tool and the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology.

RESULTS

The search identified 642 studies (321 duplicates removed), 16 of which underwent full-text review. Nine studies met all inclusion criteria and underwent analysis. According to the recommended steps for cross-cultural adaptations, one study performed 100% of the steps and two others performed 80%. None of the studies met all the recommendations for the evaluation of psychometric properties. A full evaluation of reliability and internal consistency were reported by 74% of studies. None of the studies reported a full evaluation of responsiveness, agreement and/or construct validity.

CONCLUSIONS

This review demonstrated limitations in the robustness of the methods used to develop and evaluate translated and culturally adapted versions of CAPE. To ensure valid and reliable results when conducting future research using the CAPE, it is recommended to fully evaluate the psychometric properties of the existing versions and to produce other translated and culturally adapted versions of the questionnaire.

Participation in preschool activities of children with autistic spectrum disorder and comparison to typically developing children

BACKGROUND

Participation is essential to children's development and is a major focus of intervention. This study aimed to describe the participation patterns of children with ASD, in comparison to typically developing (TD) children.

METHODS

70 preschoolers participated: 33 children with ASD, attending non-inclusive-education settings; and 37 TD children, attending mainstream educational settings. Two occupational therapists assessed their participation through structured observations in self-care activities, play, learning, and social participation areas; demographic and environmental questionnaires were also completed.

RESULTS

In the ASD group, frequency of participation was found to be significantly higher in ADL and learning than in other areas; level of performance was found to be significantly lower in social participation than in other areas. The TD group scored significantly higher than did the ASD group in most areas and scales. Initial findings tentatively showed that a structured educational environment for children with ASD may increase participation frequency.

CONCLUSIONS

The findings are consistent with recognized disabilities in play and social participation among children with ASD, and their limitations in participation, compared to their TD peers in most areas. Further studies are needed to evaluate additional psychometric properties of the different scales, and the impact of educational environments on participation.

The Structured Preschool Participation Observation (SPO) for Children with ASD: Adaptation, Initial Psychometric Properties, and Children's Participation

Aims: Due to the lack of tools evaluating participation of children with ASD in the educational setting, this study aimed to adapt the Structured Preschool Participation Observation (SPO), which assess the participation of preschool children attending mainstream-educational settings to children with ASD attending non-inclusive special education (content validity), to measure its initial psychometric properties (internal reliability, inter-rater reliability), and to describe children's participation characteristics, creating an effective tool to fill this gap.Methods: Content validity was evaluated by 21 experts using questionnaires. Thirty-five children with ASD were observed in their educational setting using the adapted tool (SPO-ASD).Results: Content validity was satisfactory regarding the items and their classification into occupational areas. Moderate to excellent internal consistency (α = .73-.92) and inter-rater reliability (ICC = .61-.95, p<.05) were found for all scales and most areas. Children's participation frequency was high in learning and activities of daily living (ADL), low in play and social participation. Performance level was low in social participation. Enjoyment level was low, and needed assistance in ADL was high.Conclusions: Based on our initial evaluation, the SPO-ASD may be suitable for assessing participation of children with ASD attending special education preschools. Additional studies are needed to more securely establish its psychometric properties.

Choosing Performance-Based Outcome Measures of Daily Living Skills and Socialization for Clinical Trials in Autistic Children

IMPORTANCE

Robust and psychometrically sound performance-based outcome measures are needed for clinical trials of occupational therapy interventions for children with autism.

OBJECTIVE

To demonstrate a systematic approach for choosing psychometrically sound performance-based outcome measures of daily living skills and socialization for use in clinical trials of occupational therapy interventions for children with autism.

DESIGN

Rapid literature review to identify appropriate measures for studies with this population followed by quality indicator ratings and a nominal group process.

SETTING

University.

PARTICIPANTS

Four experts in autism and pediatric outcome measurement. Outcomes and Measures: Twenty-one outcome measures of daily living skills and socialization were identified and reviewed.

RESULTS

Seven measures met the inclusion criteria. The Assessment of Motor and Process Skills and the Evaluation of Social Interaction-Second Edition, received the highest ratings and group consensus. Several other measures were also scored highly.

CONCLUSIONS AND RELEVANCE

Careful assessment of psychometric properties is an important component of choosing outcome measures for a clinical trial, but burden of assessment and study objectives are important considerations. What This Article Adds: This project demonstrates use of a systematic process for choosing outcome measures for a planned clinical trial.

The Impact of Anxiety on the Participation of Children on the Autism Spectrum

Anxiety is common in children on the autism spectrum, however its impacts are not fully understood. Participation is an important outcome, linked to the health and wellbeing of children. This study examined the relationship between anxiety and participation using parent reports for 131 children on the autism spectrum, aged 6-13 years. Hierarchical multiple regressions explored child and family factors in relation to participation in Home and Community settings. Anxiety was a unique, significant predictor of the frequency of children's participation (but not involvement in activities) in both settings, when controlling for autism characteristics, communication skills and family income. Anxiety symptomatology may contribute to the less frequent participation of children on the autism spectrum in home and community activities.

Participation Measures for Infants and Toddlers Aged Birth to 23 Months: A Systematic Review

AIMS

Participation is a key health outcome; however little is known specifically about how to measure participation of infants and toddlers. The aim of this review was to identify and examine the psychometric properties of participation measures for infants and toddlers aged birth to 23 months according to family of Participation-Related Constructs (fPRC).

METHODS

Four electronic databases were searched to identify (i) measures available in English, (ii) that quantify at least one participation concept of 'attendance' and/or 'involvement' according to the fPRC, (iii) with psychometric data for infants or toddlers aged from birth to 23 months published in a full text, peer reviewed journal. Psychometric quality was examined using the COSMIN checklist.

RESULTS

Four measures met the inclusion criteria: Child Engagement in Daily Life (CEDL) measure, Daily Activities of Infants Scale (DAIS), Test of Playfulness (ToP), and Young Children's Participation and Environment Measure (YC-PEM). All measured 'attendance' and three also measured 'involvement'. Measures showed unknown to moderate validity and unknown to moderate reliability, with the CEDL reporting the strongest psychometric properties.

CONCLUSION

There are few measures that evaluate infant and toddler participation. Further research is needed to develop psychometrically sound participation measures that evaluate 'attendance' and 'involvement' for this population.

Assessing participation of children with acquired brain injury and cerebral palsy: a systematic review of measurement properties

AIM

To examine which instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) align with attendance and/or involvement constructs of participation; and to systematically review measurement properties of these instruments in children with ABI or CP, to guide instrument selection.

METHOD

Five databases were searched. Instruments that quantified 'attendance' and/or 'involvement' aspects of participation according to the family of participation-related constructs were selected. Data on measurement properties were extracted and methodological quality of the studies assessed.

RESULTS

Thirty-seven instruments were used to assess participation in children with ABI or CP. Of those, 12 measured attendance and/or involvement. The reliability, validity, and responsiveness of eight of these instruments were examined in 14 studies with children with ABI or CP. Sufficient measurement properties were reported for most of the measures, but no instrument had been assessed on all relevant properties. Moreover, most psychometric studies have marked methodological limitations.

INTERPRETATION

Instruments to assess participation of children with ABI or CP should be selected carefully, as many available measures do not align with attendance and/or involvement. Evidence for measurement properties is limited, mainly caused by low methodological study quality. Future studies should follow recommended methodological guidelines.

WHAT THIS PAPER ADDS

Twelve instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) aligned with attendance/involvement. Seven instruments have some psychometric evidence supporting their use with children with CP. For children with ABI, only the Child and Adolescent Scale of Participation has shown preliminary evidence of measurement properties.

The Need for a Developmentally Based Measure of Social Communication Skills

The ability to demonstrate and quantify changes in social communication skills has been hindered by a lack of existing measures with appropriate standardization and psychometric properties. Such a measure would be helpful for research in many populations but would be particularly crucial for detecting incremental changes in youth with neurodevelopmental disorders who might gain skills but still lag substantially behind same-age peers. Although study designs and statistical methods are under development to try to account for slow and/or nonlinear, but potentially meaningful, improvements,¹ there is a dearth of measures designed to capture growth and loss of social communication skills. This opinion piece outlines the argument for such a measure and the primary issues to consider in its development.