Date Presented 04/06/19
While many pediatric assessments are based on developmental milestones, achievement of discrete skills may not truly capture their use in functional contexts. Difficulties in transferring skills to everyday life may manifest in specific activity deficits, creating a need for direct measures of participation. The Infant Toddler Activity Card Sort (ITACS) was created to fill this gap by summarizing occupational development in early childhood. Here, we describe the ITACS test-retest reliability.
Primary Author and Speaker: Ashley Chuck
Additional Authors and Speakers: Laura Pilney
Contributing Authors: Catherine Hoyt, Taniya Varughese, Evelyn Shen, Allison King, Regina Abel, Hannah Manis, Kelly Baker, Emma Grandgeorge, Jianna Fernandez
PURPOSE: Children with developmental delays (DD) often face challenges in communication, daily life, socialization, and motor skills, which become the foundation for more complex tasks as the child ages. Pediatric assessments are used to identify these delays, show progress in therapy, and justify the need for continued services. However, currently used assessments rely on developmental milestones, which often measure isolated skills within domains and may not necessarily reflect the child’s skills in a functional context and their level of involvement in family and life activities. Thus, direct measures of participation in everyday activities are needed to reflect the impact and necessity of therapy for children with DD. The Infant Toddler Activity Card Sort (ITACS) is the first activity card sort for children ages 0-3 and is unique in its use of participation as a standard of pediatric development. This study evaluated the test-retest reliability of the ITACS. By achieving satisfactory test-retest reliability, the ITACS may demonstrate its ability to track changes in participation over time and provide a summary of occupational development during the critical period of early childhood.
DESIGN: A cross-sectional mixed methods design was used. Parents and caregivers of children ages 0-48 months, with and without developmental delay, were recruited from community sites, such as playgrounds and shopping malls, or during regularly scheduled visits with early intervention providers through Washington University’s occupational therapy clinic and St. Louis Children’s Hospital.
METHOD: Participants selected concerns from 40 activity photographs and used a Likert scale 1-7 to rate the child’s performance of the pictured skill and their own confidence in supporting development of the skill. Two weeks after baseline, participants received an email with a link to complete the ITACS a second time. Intra-class correlation coefficients (ICC) were calculated between baseline and follow-up responses using IBM SPSS Statistics (Version 23).
RESULTS: Out of 261 approached, a total of 187 participants completed the ITACS at baseline. Of the 187, 101 completed the follow-up, with 92 reporting their child to be typically developing (TD) and 9 reporting their child to have developmental delay (DD). Of the 101, the majority of caregivers was female, married, Caucasian, the child’s biological mother, and had some college education. The average child age was 23.37 months; 55% of children were male. The ICC estimate was .780 based on a mean-rating (k=2), absolute-agreement, 2-way mixed-effects model. Separate ICC estimates were calculated for TD and DD populations (in TD, ICC > .75; in DD, ICC < .75).
CONCLUSION: The ITACS demonstrated satisfactory test-retest reliability over a two-week period in a sample of caregivers of children with both typical and delayed development. When separated into TD and DD samples, the ITACS’ demonstrated reliability was satisfactory for TD and moderate for DD. The difference in reliability between TD/DD samples may indicate that completing the ITACS may increase caregivers’ awareness of their child’s performance, leading to increased observation of activity concerns or encouragement of the child’s skill development. Upon further research, parents and providers may use the ITACS to develop a better understanding of how children are engaging in their everyday activities and environment, allowing for more informed treatment and intervention planning.
IMPACT STATEMENT: Through measuring engagement in everyday life activities, the ITACS offers an innovative method of assessing early behavior and development that identifies targets for intervention and represents the level at which children are participating in meaningful childhood activities.
References
Boyle CA, Boulet S, Schieve L, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan MD. Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008. Pediatrics. 2011; 27: 1034-1042.
Scattone, D., Raggio, D.J., & May, W. (2011). Comparison of the Vineland Adaptive Behavior Scales, Second Edition, and the Bayley Scales of Infant and Toddler Development. Psychological Reports,109(2), 626-634.
Hebbeler, K., Spiker, D., Bailey, D., Scarborough, A., Mallik, S., Simeonsson, R., & Singer, M. (2007). Early intervention for infants & toddlers with disabilities and their families: participants, services, and outcomes. Final report of the National Early Intervention Longitudinal Study (NEILS). https://www.sri.com/sites/default/files/publications/neils_finalreport_200702.pdf.
Baum, C.M., Edwards, D. Activity card sort, 2nd ed. Bethesda, MD: AOTA Press; 2008.
