Psychometric validation of the Family Outcomes Survey-Revised in Japan

According to a revision of Japan's Basic Law for Persons with Disabilities in 2011, Article 17 stipulated the government's obligation to provide early intervention to children with disabilities. However, the concept of family outcomes in early intervention has not really been considered in Japan yet. This article describes the development and validation of the Japanese version of the Family Outcomes Survey Revised (FOS-R). Our goal was to determine whether this survey for assessing how families of children with disabilities are affected by early intervention would be appropriate for use in early intervention in Japan. Both the Japanese version of the FOS-R and an anonymous, self-administered questionnaire about background factors were given to 394 mothers of children who were either currently using or had in the past year used early intervention at an early intervention facility or medical institution. Survey responses were obtained from 335 mothers (response rate of 85.0%). The total number of subjects in the analysis was 301 mothers who answered the Japanese version of the FOS-R completely. To assess content validity, another survey was given to 115 experts involved in supporting children with disabilities and their families. The family outcomes indicator items as well as the helpfulness indicators items showed good psychometric properties. Although the components of the FOS-R worked better as individual subscales than as a single scale, we confirmed that a total score was also psychometrically valid. We also confirmed both content validity and external validity. The Japanese version of the FOS-R appears to be a valid tool for assessing the benefits experienced by families as a result of services received, but further research is needed to determine the nature of practices most likely to lead to positive family outcomes.     

Reliability and validity of the Japanese version of the Behavior Problem Inventory-Short Form

BackgroundThe Behavior Problems Inventory-Short Form (BPI-S), which assesses behavior problems in individuals with intellectual disabilities (ID), is a shorter version of the BPI-01. This study investigated the reliability and validity of the BPI-S Japanese version (BPI-S-J) for adolescents/adults with ID and behavior problems.MethodsThe test–retest reliability included participants with ID and behavioral problems who were enrolled in welfare services. For test–retest reliability, 42 caregivers independently responded to the BPI-S-J every two weeks. Inter-rater reliability was independently assessed using the BPI-S-J by two caregivers who were familiar with the 42 participants. The participants of the validity assessment were 227 students from special needs schools or patients with ID admitted to medical institutions. The total frequency total score was compared based on the degree of ID. To examine the criterion-related validity, we analyzed the total frequency score, the total score of the Criteria for Determining Severe Problem Behavior (CDSPB) and the total score of the Aberrant Behavior Checklist-Japanese version (ABC-J).ResultsThe BPI-S-J of test–retest reliability was satisfactory (intra-class correlation; ICC) = 0.954), and the total score significantly (ICC = 0.721) represented good inter-rater reliability. For the validity, the BPI-S-J score of participants who had severe and profound ID was significantly higher than those who had mild and moderate ID. Significant correlations were observed between the BPI-S-J score and CDSPB score (r = 0.499), and the ABC-J score (r = 0.699), indicating adequate criterion-related validity.ConclusionThis study showed the utility of the BPI-S-J to assess behavior problems in the Japanese ID population.     

Conceptualizing and measuring family quality of life

Background Increasing emphasis on family-centred approaches to services and supports for families of children with disabilities has surfaced the issue of accountability for family outcomes. We present a review of literature about the impacts of children with disabilities on families as a backdrop to proposing family quality of life as a concept that encompasses impacts of disability and one that can be used to assess the impact of supports and services on families. Method We briefly introduce the Beach Center Family Quality of Life Scale, providing information about its factor structure, reliability and convergent validity. Results The Beach Center Family Quality of Life Scale contains 25 items assessing family ratings of importance and satisfaction with five domains: Family interaction, Parenting, Emotional well-being, Physical/material well-being and Disability-related supports. Conclusion We present a framework for utilizing a measure of family quality of life as a long-term outcome in concert with other short-term measures of service outcomes for families.     

Time costs of caring for children with severe disabilities compared with caring for children without disabilities

To assess time costs of caring for children with severe disabilities in the community compared to caring for children without disabilities, a diary- and questionnaire-based study was carried out. Sixteen complete data sets were obtained from families with children who have disabilities (mean age 8.7 years) and 31 complete data sets from families with normally developing children (mean age 4.9 years). Diagnoses in the study group included cerebral palsy, autism, Sanfillipo syndrome, lissencephaly, and osteogenesis imperfecta. Items of personal care per waking hour were significantly greater in children with disabilities than non-disabled children (p<0.001). In the study group, there was no correlation (r=-0.12) between age and frequency of care whereas a significant correlation was observed between degree of disability as measured by the Functional Independence Measure for children (WeeFIM) and frequency of care items (r=0.89). Twelve of the 16 mothers in the study group were not in paid employment. Twelve had little or no extended family support. Benefits awarded did not correlate with the degree of disability as measured by the WeeFIM (r=-0.11). Care needs of children with severe disabilities are significantly greater than those of non-disabled children and do not decrease with advancing age. Mothers of children with disabilities are unable to work outside the home because of these care needs. This brings the family income, even when benefits are included, to a level that is less than peer families with non-disabled children. A Functional Disability Score may help to achieve more appropriate allocation of state resources.     

Development and validation of a questionnaire to measure the service needs of families with children with developmental disabilities

The aim of this project was to develop and validate a Service Needs Questionnaire (SNQ) on the service needs of families with children with developmental disabilities. The SNQ and a measure of parenting stress were administered to 105 parents of children diagnosed with learning/behaviour problems and 233 parents of children attending primary schools. Initial Rasch analysis results indicated inadequate distinction of the categories and the fit statistics of three items were outside the acceptable range. The categories were collapsed and the removal of two misfitting items resulted in a scale which conformed to the Rasch expectations. For validity, the scale correlated positively with parenting stress, and it could differentiate between parents of children diagnosed with learning/behaviour problems and those attending primary schools. The internal consistency estimate (the Cronbach α) was above .70. The SNQ could be used to help identify the needs of families with children with developmental disabilities.     

Usefulness of the Supports Intensity Scale (SIS) for persons with other than intellectual disabilities

In response to the shift from a system-centred care model to a person-centred support model, the Supports Intensity Scale (SIS) has been developed as an instrument to assess the support needs of persons with intellectual disabilities. The instrument is used as a tool for constructing individual support plans, as well as a tool for resource allocation. The aim of the present study was to evaluate the usefulness of the SIS for persons with other than intellectual disabilities. Therefore, the psychometric properties of the SIS were investigated in a sample of 1303 persons with other than intellectual disabilities. Confirmatory factor analysis failed to support the originally proposed six-factor model within this sample. However, an explorative examination of the underlying structure resulted in a shortened version of the SIS, including four subscales and 22 items. Further analyses revealed satisfying results for reliability, construct validity, and criterion validity of the shortened assessment tool (SIS-NID).     

Assessing the reading comprehension of adults with learning disabilities

Background This study’s aim was to begin the process of measuring the reading comprehension of adults with mild and borderline learning disabilities, in order to generate information to help clinicians and other professionals to make written material for adults with learning disabilities more comprehensible. Methods The Test for the Reception of Grammar (TROG), with items presented visually rather than orally, and the Reading Comprehension sub‐test of the Wechsler Objective Reading Dimensions (WORD) battery were given to 24 service‐users of a metropolitan community learning disability team who had an estimated IQ in the range 50–79. Results & conclusions These tests were demonstrated to have satisfactory spilt‐half reliability and convergent validity with this population, supporting both their use in this study and in clinical work. Data are presented concerning the distribution across the sample of reading‐ages and the comprehension of written grammatical constructions. These data should be useful to those who are preparing written material for adults with learning disabilities.     

Development of a psychosomatic complaints scale for adolescents

There have been only a few questionnaires that can be used to comprehend the psychosomatic complaints of adolescents. Therefore, the objective of the present investigation was to develop a scale for high school students in order to comprehend psychosomatic complaints deriving from psychologic problems. The collection of scale items was performed referring to the health actual situation survey carried out on Japanese school children in the past, and 30 items with a high incidence of psychosomatic complaints were selected out of them and were set as scale items. A survey to assess reliability and validity of the 30 items of the psychosomatic complaint scale was then conducted on the subjects of 759 high school students in total over 3 years. At assessment of validity of the scale, one-factor structure was confirmed by factor analysis and both the eigenvalue and factor loading were found to be at acceptable levels. Further, at assessment of the reliability of the scale, both Cronbach's alpha coefficient indicating internal consistency and the correlation coefficient indicating reproducibility were found to be high. It was concluded that the psychosomatic complaint scale developed in the present investigation was excellent in validity and reliability and was highly practical, having a reduced number of items.     

Reliability and validity of questionnaire for neurobehavioral disability following traumatic brain injury

The neurobehavioral disability recognized in traumatic brain injury (TBI) is a severe sequela, but there is no appropriate classification due to its various manifestations. In the present study a questionnaire for a simple investigation of this disability was prepared, and its reliability and validity verified. The survey was conducted on 72 patients with TBI by the caregiver of each patient. As a result, good reliability was indicated by the split-half method (coefficient of reliability: 0.95, obtained using Spearman-Brown correction formula). The total score of the questionnaire had a significant correlation with the total score of the simultaneously conducted Japanese version of Neuropsychiatry Inventory at the 0.01 level (Spearman's rank correlation, 0.47). It also had a significant correlation with the total score of the simultaneously conducted Japanese version of the Dysexecutive Questionnaire at the 0.05 level (Spearman's rank correlation, 0.36). Six factors constituting this neurobehavioral disability were extracted from a factor analysis of the questionnaire survey. These factors are angry outburst, avolition, deficits of sympathy, depressed mood, discourse deficits, and degradation of appearance. Each factor indicated good internal consistency (Cronbach alpha, 0.86-0.94). The present results indicate that this questionnaire has good reliability and validity, therefore it can be a significant indicator in TBI neurobehavioral disability study.     

Reliability and validity of the Japanese version of the Modified Checklist for autism in toddlers (M-CHAT)

Early detection and intervention is essential for children with autism spectrum disorders (ASD). Therefore, we examined the reliability and validity of the Japanese version of the Modified Checklist for autism in toddlers (M-CHAT), a 23-item, yes–no questionnaire regarding early autistic symptoms completed by parents of children at 18–24 months of age. Herein, the reliability of the M-CHAT was investigated for children 4–20 months of age. The M-CHAT score (the number of failed items) was found to be significantly correlated among 24 mother–father pairs (Pearson's r = .933), representing good inter-rater reliability. The test–retest reliability was satisfactory, with 22 mothers providing almost equal M-CHAT scores on two different occasions (r = .990). Significant correlations were observed between the M-CHAT score and the Childhood Autism Rating Scale-Tokyo version score in 25 two-year-old children (r = .581), indicating good concurrent validity. The M-CHAT score was significantly higher in 20 children later diagnosed with ASD compared with reference children (n = 1167), revealing sufficient discriminant validity. A short version of the M-CHAT using 9 items was proposed and effectively differentiated children with ASD from reference children. The efficacy of the Japanese version of the M-CHAT was demonstrated for first-level screening in the general population.     

The application of migraine disability assessment questionnaire (MIDAS)

Migraine is a recurring and disabling pain disorder. The prevalence is estimated as 9.1% in Taiwan. Patients suffer from significant loss of work, time at school or ability to perform household chores, as well as other family or leisure activities. Treatment strategies during migraine attacks should be tailored based on the severity of disability. Stewart and Lipton (1999) developed the Migraine Disability Assessment Questionnaire (MIDAS) to assess the severity of disability related to migraine. This simple, self-administered, 7-item questionnaire focuses on disability in three domains (school or paid work, household chores, and family, social, or leisure activities) in the first 5 items of the questionnaire. The internal consistency, test-retest reliability, validity, ease of use, and clinical utility were all tested with good results. The questionnaire offers a simple tool to improve physician-patient communication. As for treatment strategies, a recent large-scale study done in the USA showed that it is more efficacious to treat migraine patients by adopting a strategy of stratified care based on different disability status than a stepped-care strategy. The simple questionnaire, MIDAS, has received world-wide popularity and has been translated into Japanese, Italian and Turkish. All of these versions showed good reliability and validity. Recently, one of our studies demonstrated that the Taiwan version also yielded comparable internal consistency, reliability, and validity. We hope that the MIDAS questionnaire can be widely adopted in Taiwan to help physicians assess their patients' disability related to migraine and provide clues for clinical management.     

The development and validation of the Epilepsy and Learning Disabilities Quality of Life (ELDQOL) scale

Few suitable instruments exist for use with people, especially children, with both epilepsy and learning disabilities. One such measure is the Epilepsy and Learning Disabilities Quality of Life scale (ELDQOL), which has recently undergone revision following feedback from relevant users. This article reports on the final psychometric testing phase of this scale. ELDQOL consists of 70 items covering seizure severity, seizure-related injuries, antiepileptic drug side effects, behavior, mood, physical, cognitive, and social functioning, parental concern, communication, overall quality of life, and overall health. Revalidation involved a qualitative phase, to ascertain users' opinions on the wording, coverage, and layout of the questionnaire, and a quantitative phase, to examine internal consistency, test-retest reliability, and validity. There is very good evidence of the reliability and validity of the final version of ELDQOL, making it a promising instrument for assessing quality of life in children/young adults with epilepsy and learning disabilities.     

Psychometric properties of the Repetitive Behavior Scale-Revised for individuals with autism spectrum disorder in Japan

Restricted and repetitive behaviors (RRBs) constitute a core symptom of autism spectrum disorder (ASD). The Repetitive Behavior Scale-Revised (RBS-R) is a widely used questionnaire administered by parents or caregivers to assess RRBs in individuals with ASD. This study evaluated the psychometric properties of the RBS-R Japanese Version (RBS-R-J). The ASD and non-ASD groups comprised 274 and 36 participants, respectively. We examined corrected item-total correlation, Cronbach's alpha, and RBS-R-J scores of different diagnostic groups, as well as correlations between RBS-R-J scores and intelligence quotient (IQ), autistic symptoms, adaptive/maladaptive functioning, aberrant behaviors, and sensory processing. All items showed moderate corrected item-total correlations. Cronbach's alpha coefficient was .93. We found significant differences in the mean RBS-R-J scores of the low-functioning ASD group and the intellectual disabilities group, and of low-functioning and high-functioning ASD groups. RBS-R-J scores negatively correlated with IQ and scores on the Sensory Profile (Japanese version) and Adaptive Behavior Composite of the Maladaptive Behavior Index of the Vineland Adaptive Behavior Scales-Second Edition (VABS-II; Japanese version), but positively correlated with scores on the peak and current symptoms subscales of the Pervasive Developmental Disorders Autism Society Japan Rating Scale, the VABS-II, and the Aberrant Behavior Checklist-Community (Japanese version). From these results, we conclude that RBS-R-J showed good reliability, diagnostic validity, and convergent validity, indicating that it is a reliable, valid instrument for use among ASD individuals in clinical and research settings.     

Rasch analysis of the assessment of children's hand skills in children with and without disabilities

The Assessment of Children's Hand Skills (ACHS) is a new assessment tool that utilizes a naturalistic observational method to capture children's real-life hand skill performance when engaging in various types of activities. The ACHS also intends to be used with both typically developing children and those presenting with disabilities. The purpose of this study was to further investigate the construct validity of the ACHS using the Rasch analysis. Participants included 64 typically developing children and 70 children with disabilities in the age range of 2-12 years. Rasch analysis results confirmed the appropriateness of the ACHS's 6-level rating scale in this combined group of children. All 22 activity items and 19 of the 20 hand skill items in the ACHS formed a unidimensional scale and were ordered according to difficulty as clinically and developmentally expected. The ACHS also exhibited sufficient response validity and item-difficulty range when applied to children with disabilities as well as typically developing, preschool-age children. Furthermore, less than half of the ACHS items were found to exhibit differential item functioning with regard to gender (5 activity items) and disability (2 activity items and 7 hand skill items). Therefore, the ACHS shows preliminary evidence of construct validity for its clinical use in assessing children's hand skill performance in real-life contexts.     

The reliability and validity of the multidimensional scale of perceived social support (MSPSS) in mothers of children with developmental disabilities in Saudi Arabia

BackgroundSocial support is critical to the well-being for mothers of children with developmental disabilities (DD). The Multidimensional Scale of Perceived Social Support (MSPSS) has not been assessed for reliability and validity among such mothers in the Saudi Arabian context.MethodAn Arabic version of the MSPSS was developed and administered to 606 mothers who had a child with DD (188 with autism spectrum disorder and 418 with intellectual disability), and who were purposefully recruited from three regions in Saudi Arabia.ResultsThe scale showed high internal consistency with minor changes when dropping one item from the scale each time. Convergent reliability and discriminant validity were established. Confirmatory factor analysis revealed a very good fit of a three-factor model compared to a zero- and higher-order model. No significant difference was observed to report invariant groups in measurement invariance analysis.ConclusionsOur study is the first to measure perceived social support among mothers of children with DD in Saudi Arabia, as well as to validate an Arabic version of the MSPSS in this context. Our Arabic translation of the MSPSS is reliable and valid for researchers and clinicians to use when working with this population. We recommend adopting the MSPSS for measuring perceived social support by a zero-order or higher-order three-factor model.     

Reliability and validity of a Comprehensive Environmental Questionnaire for community-living elderly with healthcare needs

Background: Although environmental factors play an important role in the quality of life of the elderly, no currently available scale is adequate for the comprehensive assessment of the environments of community‐living elderly in Japan. The present study developed a Comprehensive Environmental Questionnaire to assess factors affecting quality of life and examined its reliability, criterion‐related validity, and construct validity among community‐living elderly with healthcare needs. Methods: Participants were 178 elderly adults without dementing disorders, aged 60 years and older, who were currently using day care services or home‐visit rehabilitative services. Participants were selected from five regions of Japan. We asked participants to complete the Comprehensive Environmental Questionnaire—provisional version twice (with a 1 month interval in between) and World Health Organization Quality of Life—brief form at baseline. Results: Based on exploratory factor analysis, we restructured the Comprehensive Environmental Questionnaire—provisional version to the final version, with 14 items and a three‐factor structure. Cronbach's alpha for internal consistency for all items was 0.82. Spearman's rank correlation coefficients for test–retest reliability were 0.4 or greater for 10 items, and were statistically significant (P < 0.001) for all items. The correlation coefficient of the total score of the Comprehensive Environmental Questionnaire and the environment domain score of the World Health Organization Quality of Life—brief form was 0.63 (P < 0.001). Confirmatory factor analysis indicated that the Comprehensive Environmental Questionnaire as a second‐order factor model was an adequate fit to the data. All standardized path coefficients in the model were statistically significant (P < 0.01). Conclusion: The present study established high levels of reliability, criterion‐related validity, and construct validity for the Comprehensive Environmental Questionnaire, with the exception of test–retest reliability for four items among community‐living elderly with healthcare needs.     

Reliability and validity of a Norwegian version of the quality of life in epilepsy inventory (QOLIE-89)

PURPOSE: To develop a Norwegian version of the Quality of Life in Epilepsy Inventory (QOLIE-89) and to confirm its psychometric properties. METHODS: The QOLIE-89 was adapted to Norwegian language through a translation-backtranslation procedure. The assessment included 397 patients with epilepsy. We assessed internal consistency and test-retest reliabilities. Construct validity was assessed by correlating scales with items of the 15D health status questionnaire, and discriminant validity was assessed by comparing scores for known groups. RESULTS: The internal consistency reliability (Cronbach's alpha, 0.76-0.92) and test-retest reliability (intraclass correlation coefficient, 0.67-0.96) for the individual domains were acceptable. Spearman's rank correlations between QOLIE-89 domain scores and corresponding 15D single-item scores were high (p, 0.47-0.76), and generally higher than the associations between noncorresponding items. Most QOLIE-89 items discriminated well between patients according to seizure status, psychiatric comorbidity, and working status; less well after antiepileptic drug use and neurologic comorbidity. CONCLUSIONS: In this cross-sectional survey, the Norwegian version of the QOLIE-89 was reliable and showed properties supporting construct validity, at a level comparable with the original U.S. version.     

Japanese version of home form of the ADHD-RS: An evaluation of its reliability and validity

Using the Japanese version of home form of the ADHD-RS, this survey attempted to compare the scores between the US and Japan and examined the correlates of ADHD-RS. We collected responses from parents or rearers of 5977 children (3119 males and 2858 females) in nursery, elementary, and lower-secondary schools. A confirmed factor analysis of ADHD-RS confirmed the two-factor solution (Inattentive and Hyperactive-Impulsive) same as previous studies. ADHD-RS scores were not related to IQ, but were negatively associated with standardized achievement test scores. Males showed stronger ADHD tendencies than did the females, and the scores ended to decline as the children grew older. Japanese children scored lower than did their US children in Hyperactive-Impulsive among all of the sex-age groups. Japanese version of home form of the ADHD-RS was developed with good reliability and validity. More researches of ADHD in Japanese children are required.     

Reliability and validity of the subjective burden scale in family caregivers of elderly relatives with dementia

The reliability and validity of the Subjective Burden Scale (SBS) were investigated in 255 Japanese family caregivers of elderly relatives with dementia. Values of the Cronbach's alpha reliability, split-half reliability (r), and test-retest reliability (r) were .87, .80, and .72, respectively. The SBS score was significantly positively correlated with the degree of mental health, which was assessed with the Japanese version of the 60-item General Health Questionnaire (r = .41). The family caregivers who gave up the caregiving of their relatives showed significantly higher SBS scores than those who did not. The SBS scores for caregivers indicated satisfactory predictive validity both in the degree of their mental health and in the prospects of family caregiving about 6 months later. These findings suggest that the SBS is adequately reliable and valid and can be used to assess the subjective burden of Japanese caregivers.