Date Presented 04/04/19
Early intervention therapists rely on developmental milestone-focused assessments to identify deficits and justify services. However, these measures fail to assess a child’s ability to incorporate discrete skills into functional activities. The Infant Toddler Activity Card Sort (ITACS) will meet this need.
Primary Author and Speaker: Catherine Hoyt
Contributing Authors: Jianna Fernandez, Ashley Chuck, Laura Pilney, Taniya Varughese, Regina Abel, Allison King
PURPOSE: Development is rapid in the first three years of life, and developmental delays appearing during this critical period have the potential to persist throughout the child’s life. Early intervention (EI) strives to address family centered goals and foster the development of age appropriate skills. Available standardized assessments for infants and toddlers record a child’s ability to complete discrete developmental milestones but fail to capture whether the child incorporates those skills into daily routines that are meaningful to the family. A measure of the child’s engagement in functional activities will allow providers to objectively document outcomes that reflect the family-centered approach, providing evidence of progress to justify continued services. To fill this need, we developed the Infant Toddler Activity Card Sort (ITACS). The ITACS will support EI therapists in engaging parents in goal setting and intervention planning to ensure the delivery of family-centered services.
DESIGN: A cross-sectional mixed methods cohort design was used to develop ITACS items and measure test-retest reliability.
METHOD: We recruited caregivers of children 0-48 months from the community to complete a semi-structured interview, written diary or online survey about their child’s daily activities. Responses were coded and analyzed using grounded theory. Activities described by ≥ 25% of caregivers were considered for the ITACS.Pictures of children performing the activities were emailed to 10 content experts to consolidate and validate items using the Delphi method. The resulting activity list was used to develop the ITACS, and a cohort of caregivers were recruited to pilot-test the assessment. Caregivers viewed the activity photos on an iPad and identified whether or not they had concerns for their own child in performing the specific activity. Using a Likert scale 1-7, caregivers rated their child’s current ability to engage in the activity and the caregiver’s confidence in supporting the development of that skill.Two weeks after baseline, caregivers were asked to complete the ITACS again online. Intraclass correlations were used to determine test-retest reliability.
RESULTS: Twenty-three caregivers participated in the initial qualitative development of the ITACS. Nine were recruited from daycare centers, 11 from personal relationships and three from a place of worship. Responses from caregivers resultedin 62 activities. Similar activities were consolidated to reduce the list to 41 items. Following the Delphi method, four more items were removed, five photos were replaced, and four additional items were included. The resultant 40 items and photographs were validated by the same expert group. A total of 187 caregivers completed the ITACS at baseline. Of those, 101 (54%) also completed the follow-up. An intraclass correlation of .780 was determined between baseline and follow-up ITACS results.
CONCLUSION: The ITACS is the first picture-based measure of infant/toddler activity engagement that was developed using caregiver and expert opinion. Initial testing shows that the ITACS is a feasible and reliable tool for measuring caregiver-perceived occupational development. Future research will determine ITACS activity subdomains using a confirmatory factor analysis and concurrent validity of the ITACS as compared to the Pediatric Evaluation of Disability Inventory, Computerized Adaptive Test.
IMPACT STATEMENT: A validated tool measuring occupational development of infants and toddlers will support occupational therapists in engaging caregivers in determining goals, providing family centered services and measuring meaningful outcomes of early intervention.
References
Berg, C., & LaVesser, P. (2006). The preschool activity card sort. Otjr-Occupation Participation and Health, 26(4), 143-151. doi:10.1177/153944920602600404
Hsu, C. C., & Sandford, B. A. (2007). The Delphi Technique: Making Sense of the Consensus. Practical Assessment, Research & Evaluation, 12(10).
Roebroeck, M. E., Jahnsen, R., Carona, C., Kent, R. M., & Chamberlain, M. A. (2009). Adult outcomes and lifespan issues for people with childhood-onset physical disability. Dev Med Child Neurol, 51(8), 670-678. doi:10.1111/j.1469-8749.2009.03322.x
