Abstract
Development in the first years of life is often characterized by a child’s aptitude for completing discrete tasks, such as walking or stacking blocks. Real-life participation requires the child to incorporate skills into everyday activities. The ITACS is a newly developed assessment that measures a child’s engagement in daily activities. This presentation will provide an overview of the ITACS and discuss its initial psychometrics.
Primary Author and Speaker: Catherine Hoyt
Contributing Authors: Ashley Chuck, Taniya Varughese, Laura Fisher, Regina Abel, Allison King
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. Available standardized assessments for this age record a child’s ability to successfully complete discrete skills but fail to capture whether the child incorporates those skills into daily routines that are meaningful to the family.The Infant Toddler Activity Card Sort (ITACS) is a newly developed early intervention (EI) assessment tool that measures a young child’s occupational engagement in everyday life activities using parent report. The purpose of this study was to determine the concurrent and discriminant validity, and the test-retest reliability of the ITACS.
We used across-sectional cohort design to evaluate concurrent and discriminant validity and a prospective design to determine test-retest reliability. Caregivers of children 0-48 months with or without a reported developmental delay were recruited.To maximize generalizability, caregivers were approached at a variety of settings, including clinics, parks and community events or through personal contacts. To support analysis, we aimed to recruit at least 200 caregivers, with a minimum of 25% reporting their child to have a delay and 50% completing the ITACS twice.
Following informed consent, caregivers used a tablet to provide demographic information and complete a brief screening form to determine if the child was typically developing or had a developmental delay. At baseline, caregivers completed both the ITACS and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). The PEDI-CAT was selected because it is one of the few tools for this age range that tests similar constructs and is available on a tablet. After two weeks, caregivers received an email with a private link to complete the ITACS a second time. Kendall’s tau b was calculated to determine concurrent validity between the ITACS and PEDI-CAT. A Mann-Whitney U test determined discriminant validity, and an intraclass correlation evaluated test-retest reliability.
A total of 208 caregivers participated in this study, and 53 (26%) reported their child had a developmental delay. Most caregivers were female (86%), married (79%), and white (64%). Nearly a quarter (23%) of participants were African American. Among children with a developmental delay there were significant correlations between the number of items endorsed on the ITACS and PEDI-CAT normative scores in daily activities (τb= -.249) and mobility (τb= -.225). There was a statistically significant difference in ITACS responses between groups (z= -7.59, p< .001). A total of 117 caregivers (56%) completed the ITACS a second time. Sufficient reliability was obtained among children who were typically developing (ICC= .739, p < .001, α= .850) while children reported to have a delay had moderate test-retest reliability (ICC of .629, p < .001, α = .771).
The findings from this study demonstrate that the ITACS has acceprable concurrent validity with the PEDI-CAT, indicating that it is measuring a similar, yet distinct construct of participation. Further, caregiver responses on the ITACS distinguished between typically developing children and those with a developmental delay. Test-retest reliability was moderate for children with a reported delay, which we believe is due to parents modifying behaviors based on the completing the assessment. The ITACS is a valid and reliable tool for measuring the occupational development and engagement of infants and toddlers. Our results showed that the ITACS is a valid measure of participation. We believe that this tool can be used for goal setting in order to improve occupational development and engagement in daily activities.
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