Content validation of common measures of functioning for young children against the International Classification of Functioning, Disability and Health and Code and Core Sets relevant to neurodevelopmental conditions.
Emily D'Arcy, Kerry Wallace, Angela Chamberlain and 5 others
PMID 34369196WHAT IT FOUND
No single standard assessment for young children with neurodevelopmental conditions covers enough of the ICF framework to be comprehensive on its own.
Clinicians need to use a battery of measures alongside clinical reasoning to get a complete picture of a child's functioning.
Key findings
01None of the measures reviewed were comprehensive enough to cover all concepts across the three domains of the ICF, with even the most comprehensive measures covering less than 60% of the eND Set codes.
02Only two of the measures directly assessed environmental factors, meaning most standard assessments do not evaluate the impact of the child's environment on their functioning.
03Different measures were better suited to assessing different domains, so no single tool is best for all aspects of a child's functioning.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study assessed the full item banks of the measures, but in clinical practice, tools like the PEDI-CAT or Vineland-3 use computer-adaptive or basal/ceiling rules, meaning a child might not be asked all questions. This makes the study's findings an overestimation of the actual content validity achieved in real-world assessments. The ICF codes used for comparison were only at the second level, so the study could not determine if a measure covered the detailed sub-codes within a category. Some items could not be linked to defined ICF codes, particularly those related to modern technology or early infant development, suggesting the ICF framework itself may be incomplete for this population.
Declared interests
Two of the authors are parents to autistic children. There was no other involvement from the autistic or autism communities in this research. The study was not funded by the publishers of the assessments tested.
The easy way to misread this
Do not assume that a high score on a comprehensive measure like the Vineland-3 or ABAS-3 means the child's functioning has been fully assessed. These tools cover less than 60% of the relevant ICF framework and largely ignore environmental factors, so a single score is an incomplete picture of the child's actual abilities and support needs.