Date Presented 04/9/21
Development in the first years of life is often characterized by a child’s aptitude to complete discrete tasks, such as walking or stacking blocks. True participation requires the child to incorporate skills into everyday activities. This presentation will provide an overview of the Infant Toddler Activity Card Sort, the initial psychometrics, and a Rasch analysis.
Primary Author and Speaker: Catherine R. Hoyt
Contributing Authors: Ching-Fan Sheu
PURPOSE: Development is rapid in the first 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 child and family. The Infant Toddler Activity Card Sort (ITACS) is a newly developed early intervention assessment tool that measures a child’s occupational engagement in everyday life activities using caregiver report. The purpose of the present study was to use Rasch analysis to determine if the ITACS items comprehensively measure the construct of child engagement.
DESIGN: A prospective design was used to gather responses from primary caregivers of children 0-48 months of age on the ITACS. Caregivers were asked to complete the ITACS twice, at baseline and two weeks later as a repeat assessment for a larger study.
METHOD: 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. Caregivers were presented with 40 photographs depicting common activities of infants and toddlers and selected whether each activity presented a challenge for their child. As a part of the ITACS, caregivers prioritized the top five challenging activities. Demographic information was summarized using descriptive statistics. Dichotomous item responses were analyzed with RA using Winsteps version 4.4. Three key components of Rasch modeling were the focus of these analyses: item and person fit, the Wright map with Rasch-derived measure scores, and reliability and separation statistics.
RESULTS: A total of 60 child/caregiver dyads participated in this study. The dichotomous caregiver-reported responses (present vs. absent) on the 40 individual ITACS items were used in Rasch analysis and three iterations of the model were completed. The final model included 51 child/caregiver dyads and 67 ITACS assessments with a good spread of ability measure (6.47 logits). All items demonstrated adequate infit except for sleeping (range 0.68-1.54). Five items (sleeping, eating at restaurants, brushing teeth, crawling, and interact with pets) demonstrated high Mean Square (MNSQ) outfit statistics and one (take a bath) demonstrated low MNSQ outfit. The ITACS items demonstrated a good spread of difficulty measures (6.27 logits), and a clear ceiling was observed. Three activity items were rarely endorsed as concerns-smiling, breastfeeding, and playing with adults. The activities most likely to be reported as challenging were crying/communicating and going to school. Person and item reliability statistics were adequate (0.79 and 0.80, respectively). The separation between individuals and between items were adequate to good (1.96 and 1.99, respectively).
CONCLUSIONS: The study findings indicate that the ITACS items are measuring a unidimensional construct, activity engagement in early childhood. The Rasch analysis of caregiver responses suggest that some activities are more likely to be considered challenging and may be important targets for intervention. These results provide evidence to further validate the ITACS as a caregiver report measure and support its use in the early intervention setting to facilitate caregiver driven goal development.
IMPLICATIONS FOR PRACTICE: The results from this study provide further validation for the ITACS, which can be used in early intervention occupational therapy practice to support family-centered and coaching model intervention approaches.
References
Hoyt, C. R., Fernandez, J. D., Varughese, T. E., Grandgeorge, E., Manis, H. E., O’Connor, K. E., et al. (2019). The Infant Toddler Activity Card Sort: A Caregiver Report Measure of Children’s Occupational Engagement in Family Activities and Routines. OTJR, 40, 36–41. https://doi.org/10.1177/1539449219852030.
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