Construct validity of the Persian version of the Child Occupational Self-Assessment in children with attention-deficit/hyperactivity disorder in Iran.
Mahsa Sattari, Farzaneh Yazdani, Mehdi Rassafiani and 1 others
PMID 32009864WHAT IT FOUND
The Persian COSA works for Iranian children with ADHD, but only after removing specific items.
Items about buying things alone and moving around independently failed to fit, likely due to cultural restrictions. Clinicians should use the modified 23-item competence and 21-item value scales.
Key findings
01Items regarding buying things independently and moving around alone did not fit the model, suggesting they do not measure the intended constructs in this cultural context.
02The competence scale supported unidimensionality only after removing misfit items and participants, while the value scale required the removal of four items to achieve sufficient fit.
03Children with ADHD in this sample rated communication and social activities as the most difficult and most important, unlike basic self-care tasks.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study included only children with ADHD who had an IQ above 90, so results may not apply to children with lower cognitive function or other diagnoses. A significant number of participants (22.4% for competence, 23% for value) did not meet fit requirements, suggesting the tool may not be universally applicable even within this group. The ceiling effect indicates the items were too easy for many children, potentially reducing the tool's sensitivity to detect subtle changes in competence. Cultural factors heavily influenced item fit, meaning the modified scale is specific to the Iranian context and may not generalize to other cultures without further validation.
The easy way to misread this
Do not assume the standard 25-item COSA is valid for Iranian children with ADHD. The study shows that items about independent mobility and shopping are culturally inappropriate and must be removed to achieve a valid measurement.