A pilot study of the reliability and validity of the Caregiver Activity Survey – Intellectual Disability (CAS-ID)

Background People with Down's syndrome (DS) are at increased risk of Alzheimer‐type dementia (AD) when compared to the general population. Despite AD being a serious progressive disorder, little attention has been paid to the impact of the illness on formal caregivers. In the general population, the Caregiver Activity Survey (CAS) is used to measure time spent by family caregivers assisting people with AD in their day‐to‐day activities of living. In order to plan appropriate models of health and social care effectively for people with AD and DS, it is imperative that the care requirements of individuals at different stages of dementia are realized. An amended version of this survey, the Caregiver Activity Survey – Intellectual Disability (CAS‐ID), was developed and tested for use by professional caregivers in the present study. Methods The CAS‐ID was administered to 30 people with DS and their caregivers. Convergent validity was tested by comparing the results of the CAS‐ID to other validated tests for cognitive and functional impairment in individuals with DS. Test–retest and inter‐rater reliability were investigated. Results The final version of the CAS‐ID consists of eight items: dressing, bathing/showering, grooming, toileting, eating and drinking, housekeeping, nursing care‐related activities, and supervision/ behaviour management. The scale had excellent test–retest reliability, and correlated strongly with the Down Syndrome Mental Status Examination (DSMSE; r = ?0.770), the Test for Severe Impairment (TSI; r = ?0.881) and the Daily Living Skills Questionnaire (DLSQ; r = ?0.855). Conclusions The present authors provide preliminary evidence for the validity and reliability of the CAS‐ID. This instrument offers a means of identifying and measuring care and resources requirements as this population experiences symptoms of dementia. Such information may help assist healthcare professionals in planning supports and services to address the care challenges evidenced at different stages of the disease process.     

The ComFor: an instrument for the indication of augmentative communication in people with autism and intellectual disability

Background The ComFor (Forerunners in Communication) is an instrument to explore underlying competence for augmentative communication. More specifically, it measures perception and sense‐making of non‐transient forms of communication at the levels of presentation and representation. The target group consists primarily of individuals with autism and intellectual disability (ID) without or with only limited verbal communication. The ComFor is suitable for children and adults with a developmental level between 12 and 60 months. This paper describes the theoretical framework and structure of the ComFor, the results of a study on its psychometric properties and its clinical uses. Method The ComFor was tested on a sample of 623 children and adults from the Netherlands and Flanders: a group with autism and ID (n = 310); a group with ID without autism (n = 174); and a control group of typically developing children (n = 139). Results The data generally support the reliability and validity of the ComFor. Internal consistency, inter‐rater and test–retest reliability were found to be good. Construct validity (internal structure, convergent and divergent patterns) was established in different ways. The criterion‐related validity has yet to be established, as predictive data are not available at the moment. Conclusion Taken together, the results indicate that the ComFor is a promising instrument to explore underlying competence for augmentative communication. Areas for future research are outlined and the clinical relevance is discussed.     

Evaluation of three nurse‐administered depression rating scales on acute admission and continuing care geriatric psychiatry wards

Several instruments measuring depression in institutional settings have been described but individual instruments have only occasionally been compared with each other. Some psychometric properties, including internal consistency, test‐retest and inter‐rater reliability, and concurrent validity of three nurse‐administered depression rating scales were evaluated on acute admission and continuing care geriatric psychiatry wards. The Depressive Signs Scale (DSS) was significantly correlated with the Depression in Dementia Mood Scale (DDMS) (rho = +0.59) and the Cornell Scale (rho = +0.71). The DDMS was correlated with the Cornell Scale (rho = +0.32). The internal consistency, as measured by Cronbach's alpha, for the DSS, the DDMS and the Cornell Scale was 0.47, 0.64 and 0.74 respectively. The test‐retest reliability of the DSS, the DDMS and the Cornell Scale was 0.73, 0.62 and 0.83 respectively. The DSS and the Cornell scale had poor inter‐rater reliability, but the DDMS had satisfactory inter‐rater reliability of 0.59. These scales, with a novel form of administration, are not suitable for detecting significant clinical depression in acutely admitted and continuing‐care geriatric psychiatry inpatients. However, the DDMS has satisfactory properties for use in measuring presence and quantity of depressive symptoms. Copyright © 2001 Whurr Publishers Ltd.     

Psychometric evaluation of a Swedish version of the Reiss Screen for Maladaptive Behavior

Background People with intellectual disability (ID) are afflicted by mental health problems to a greater extent than other individuals, and the coexistence of ID and mental health problems involves diagnostic as well as treatment difficulties. Methods A Swedish version of the Reiss Screen for Maladaptive Behavior (RSMB), an instrument used for identification of mental health problems in people with intellectual disability (ID) was evaluated in terms of inter‐rater agreement, internal consistency, item grouping and criterion validity based on a random sample and a clinical group of adults with ID. Results The Swedish version of the RSMB had moderate‐to‐low inter‐rater agreement on specific items and good internal consistency. The total score was considered to be a fairly reliable measure of a positive or negative result on the RSMB. A principal component analysis yielded seven interpretable components. A close resemblance in sets of items between the Swedish version and the original version of RSMB was found for three subscales: Aggressive Behaviour, Avoidance Disorder and Depression (Behavioural Signs). The outcome of the criterion validity analysis indicated a higher rate of false negatives than false positives. Conclusions The potential influence of concurrent psychopharmacological treatment is discussed. It is concluded that the Swedish version of the RSMB can be used as intended by staff as a primary screening device for the identification of mental health problems among people with ID in a Swedish setting.     

The Prudhoe Cognitive Function Test, a scale to assess cognitive function in adults with Down's syndrome: inter-rater and test–retest reliability

Background The Prudhoe Cognitive Function Test (PCFT) was designed to measure cognitive function in subjects with all degrees of intellectual disability (ID) and to be administered by non‐specialist raters. The aim of the present study was to measure the test–retest and inter‐rater reliability of the PCFT. Methods Three raters, one a specialist and two non‐specialists, administered the PCFT to 14 subjects with Down's syndrome on two occasions separated by 4 weeks. Results The intra‐class correlation coefficients (ICCs) between the rater pairs (n = 3) were 0.99, 0.99 and 0.98 (P < 0.01). Floor effects were recorded for two items. The ICC for test–retest reliability was 0.99 (P < 0.01). Conclusions The PCFT is a highly reliable instrument when used by either specialist or non‐specialist raters. It has excellent temporal stability.     

Reliability of the Charcot‐Marie‐Tooth functional outcome measure

The CMT‐FOM is a 13‐item clinical outcome assessment (COA) that measures physical ability in adults with Charcot‐Marie‐Tooth disease (CMT). Test‐retest reliability, internal consistency and convergent validity have been established for the CMT‐FOM. This current study sought to establish inter‐rater reliability. Following an in‐person training of six international clinical evaluators we recruited 10 participants with genetically diagnosed CMT1A, (aged 18‐74 years, 6 female). Participants were evaluated using the CMT‐FOM over 2 days. Participants were given at least a 3 hour rest between evaluations, and were assessed twice each day. Following the provision of training by master trainers, all 13 items of the CMT‐FOM exhibited excellent inter‐rater reliability for raw scores (ICC_1,1 0.825‐0.989) and z‐scores (ICC_1,1 0.762‐0.969). Reliability of the CMT‐FOM total score was excellent (ICC_1,1 0.983, 95% CI 0.958‐0.995). The CMT‐FOM is a reliable COA used by clinical evaluators internationally. The next steps are to establish further validation through psychometric evaluation of the CMT‐FOM in the Accelerate Clinical Trials in CMT (ACT‐CMT) study.     

Psychometric comparisons of three measures for assessing motor functions in preschoolers with intellectual disabilities

Background Deficit in motor performance is common in children with intellectual disabilities (ID). A motor function measure with sound psychometric properties is indispensable for clinical and research use. The purpose of this study was to compare the psychometric properties of three commonly used clinical measures for assessing motor function in preschoolers with ID: the Bruininks‐Oseretsky Test of Motor Proficiency‐Second Edition, the Movement Assessment Battery for Children‐Second Edition and the Peabody Developmental Motor Scale‐Second Edition (PDMS‐2). Method One hundred and ninety‐one children aged 3–6 years with ID were evaluated with the three measures at three time points: two baseline measurements with a 1‐week interval before the intervention, and a follow‐up measurement after 6 months of paediatric rehabilitation programme. One hundred and forty‐one participants completed all of the assessments. The distribution (ceiling and floor effects) and reliability (internal consistency and test–retest reliability) of each measure were examined. Concurrent validity, predictive validity, and responsiveness were examined as well. Results All measures, except for the PDMS‐2, had significant floor effects or ceiling effects at one or more time points. The three measures had good internal consistency (Cronbach α ≥ 0.86) and test–retest reliability (intraclass correlation coefficient ≥ 0.96). The Spearman ρ correlation coefficient for each pair of the three measures was ≥0.80, indicating high concurrent validity. The predictive validity of the three measures was satisfactory (Spearman ρ ≥ 0.52). The responsiveness of the three measures was moderate (0.47 ≤ effect size ≤ 0.74). The minimal detectable changes of the three measures were satisfactory. Conclusions All three measures showed sufficient reliability, validity and responsiveness in preschoolers with ID, but the PDMS‐2 is recommended for its superior psychometric properties.     

Validity and reliability of the Spanish versions of the Bech-Rafaelsen's mania and melancholia scales for bipolar disorders

Objective: To assess classical psychometric properties of the Spanish versions of the Bech‐Rafaelsen’s mania (MAS) and melancholia (MES) scales. Method: Observational, prospective, and multicentric study in bipolar out‐patients. Convergent validity was assessed against the Young Mania Rating Scale and the Montgomery‐Åsberg Depression Rating Scale. Discriminant validity, reliability, and sensitivity to change, were also assessed. Results: One hundred and thirteen bipolar patients with a manic episode and 102 bipolar patients with a depressive episode were included. Both the MAS and the MES showed appropriate convergent validity (r > 0.90), discriminant validity (P < 0.0001), internal consistency (Cronbach’s alpha >0.80), test–retest reliability [intraclass correlation coefficient (ICC) = 0.69 for the MAS and 0.94 for the MES], inter‐rater reliability (ICC > 0.80), and sensitivity to change at 4 weeks since inception (P < 0.0001; within‐group effect size ≥1.8). Conclusion: The Spanish versions of both scales present appropriate psychometric estimates in bipolar patients treated in ambulatory care.     

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.     

Expressed Emotion about children: reliability and validity of a Camberwell Family Interview for Childhood (CFI‐C)

A Camberwell Family Interview for Childhood (CFI‐C) was developed by adding questions about the family impact of the child's problems to a semi‐structured interview on child psychiatric symptoms. The whole CFI‐C took under an hour to administer; the questions about family impact added 15–20 minutes. The inter‐rater reliability was good (kappa 0.64–1.0). Mothers of 25 boys aged four to nine years referred with disruptive behaviour, and 25 matched controls were interviewed twice in five months. Test‐retest stability was fair to good (kappa 0.36–1.0). Discriminant validity between referred and control samples was strong for critical comments, positive comments and warmth, but not significant for emotional overinvolvement or hostility. The same three scales showed strong discriminant validity between child symptom domains, being strongly correlated with conduct symptoms (kappa = 0.49–0.71) but not emotional symptoms (kappa = 0.10–0.17). Sensitivity to change with treatment was shown by a reduction in the mean number of critical comments from 4.7 to 2.9, an increase in positive comments from 2.3 to 3.9, and an increased score on the warmth scale from 2.1 to 2.6. The CFI‐C is a useful instrument for the study of the relationship between parenting style and child psychiatric symptoms. Copyright © 2000 Whurr Publishers Ltd.     

Psychometric properties of the revised Developmental Behaviour Checklist scales in Dutch children with intellectual disability

The present study assessed the reliability and validity of the revised scales of the Developmental Behaviour Checklist (DBC) in a Dutch sample of children with intellectual disability (ID). The psychometric properties of the parent and teacher versions of the DBC were assessed in various subsamples derived from a sample of 1057 Dutch children (age range = 6–18 years) with ID or borderline intellectual functioning. Good test–retest reliability was shown both for the parent and teacher versions. Moderate inter‐parent agreement and high one‐year stability was found for the scale scores. Construct validity was satisfactory, although limited by high informant variance. The DBC scales showed good criterion‐related validity, as indicated by significant mean differences between referred and non‐referred children, and between children with and without a corresponding DSM‐IV diagnosis. The reliability and validity of the revised DBC scales are satisfactory, and the checklist is recommended for clinical and research purposes.     

The Lille Apathy Rating Scale: Validation of a caregiver‐based version

Apathy is reported in 16.5% to 70% of Parkinson's disease (PD) patients. Our recently developed Lille Apathy Rating Scale (LARS) has been specifically validated for patient‐based assessment of apathy in PD. The aim of the present study was to validate a caregiver‐based version of the LARS. Sixty consecutive PD patients and their respective caregivers participated in the study. An informant‐based version of the LARS (LARS‐i) was developed to rate apathy via a caregiver‐based structured interview. Apathy was also assessed in a patient‐based interview using the LARS and the informant‐ and clinician‐rated versions of the Apathy Evaluation Scale (AES). Cronbach's alpha and standardized alpha coefficients were 0.872 and 0.877, respectively, and the split‐half reliability was 0.901 (revealing good internal consistency). The test‐retest and inter‐rater reliability values were 0.960 and 0.996, respectively. Criterion‐related validity (according to an independent, expert diagnosis) was good. Scores on the LARS and the LARS‐i were highly correlated. However, apathy was rated significantly more severely by the caregiver than by the patient. This difference was significantly higher for demented than nondemented PD patients. The LARS‐i was seen to have excellent psychometric properties and appears to be valid for use in PD with respect to the patient‐based LARS and the informant‐ and clinician‐rated versions of the AES. © 2008 Movement Disorder Society     

Feasibility, reliability and validity of the Spanish version of Psychiatric Assessment Schedule for Adults with Developmental Disability: a structured psychiatric interview for intellectual disability

Background Over 30% of people with intellectual disability (ID) have a comorbid psychiatric disorder. However, there are few assessment instruments available for international use and cross‐cultural validation studies of these instruments are rare. The aim of the present study was to standardize the Spanish version of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS‐ADD‐10), a semi‐structured interview for people with ID. Methods After a conceptual translation, feasibility (i.e. applicability, acceptability and practicality) and reliability analyses were carried out. The predictive validity of the PAS‐ADD‐10 CATEGO‐5 codings was also examined (i.e. positive and negative predictive values). Four independent raters with wide‐ranging experience in quantitative evaluation and psychiatric assessment of ID evaluated a sample of 80 subjects with ID and borderline intellectual functioning at the AFANAS occupational centre in Jerez, Southern Spain. The ICD‐10 codes were used for psychiatric diagnosis. Results The practicality of the PAS‐ADD‐10 is limited because of the need for previous standardization of SCAN interviews. Nevertheless, its overall feasibility was judged adequate by raters and the PAS‐ADD‐10 was considered extremely useful for training. Test–retest and inter‐rater reliability kappa values were moderate to high. The CATEGO coding showed limited validity because of overdiagnosis of anxiety disorders and underdiagnosis of mood and psychotic disorders (positive predictive value = 74%, negative predictive value = 76%). Conclusions The PAS‐ADD‐10 is a useful tool for standard psychiatric assessment of people with ID; however, CATEGO codings show low validity and a series of modifications should be considered before this instrument is used extensively in Spain. In this regard, a study on the clinical usefulness of the PAS‐ADD‐10 in patients with ID and severe mental disorders has been undertaken.     

Family burden related to clinical and functional variables of people with intellectual disability with and without a mental disorder

Few studies have been found that to assess the factors that explain higher levels of family burden in adults with intellectual disability (ID) and intellectual disability and mental disorders (ID-MD). The aims of this study were to assess family burden in people with ID and ID-MD and to determine which sociodemographic, clinical and functional disability variables account for family burden. The sample is composed of pairs of 203 participants with disability and their caregivers, of which 33.5% are caregivers of people with ID and 66.5% of ID-MD. Assessments were performed using scales of clinical and functional disability as the following instruments: Weschler Adult Intelligence Scale-III (WAIS-III), Inventory for Client and Agency Planning (ICAP), Psychiatric Assessment Schedule for Adults with Development Disability (PAS-ADD checklist), Disability Assessment Schedule of the World Health Organization (WHO-DAS-II) and family burden (Subjective and Objective Family Burden Inventory - SOFBI/ECFOS-II). People with ID-MD presented higher levels of functional disability than those with ID only. Higher levels of family burden were related to higher functional disability in all the areas (p < 0.006-0.001), lower intelligence quotient (p < 0.001), diagnosis of ID-MD (p < 0.001) and presence of organic, affective, psychotic and behavioral disorders (p < 0.001). Stepwise multiple regression showed that behavioral problems, affective and psychotic disorder, disability in participation in society, disability in personal care and presence of ID-MD explained more than 61% of the variance in family burden. An integrated approach using effective multidimensional interventions is essential for both people with ID and ID-MD and their caregivers in order to reduce family burden.     

A measure of subjective burden for dementia care: the Caregiving Difficulty Scale – Intellectual Disability

Background It has been suggested in the literature on family caregiving for persons with Alzheimer's dementia (AD) that levels of objective and subjective burden among carers often predict institutionalization of the persons with AD. There is a paucity of measures to assess whether perceived burden among formal caregivers may also predict movement to more restrictive settings for persons with intellectual disabilities (ID) and AD. This study focused upon the development of a measure of subjective burden, The Caregiving Difficulty Scale – Intellectual Disability (CDS-ID) as a first step in addressing this measurement deficit. Methods An existing caregiver subjective burden scale, the Caregiving Hassles Scale (CHS) was adapted for use with 203 staff caregivers of persons with ID and AD. Preliminary testing of existing CHS items and proposed new items was carried out in two countries, Ireland and the USA. Confirmatory factor analysis with the existing items and exploratory factor analysis with existing and proposed new items for the scale was used to establish the content and test the psychometric properties of a revised scale, the CDS-ID Results On the existing CHS items, staff carers appeared to experience greater subjective burden than has been reported for family caregivers. However, the psychometric properties of the CHS found with this population were poor. Factor analysis produced a revised scale, the CDS-ID with three subscales with Cronbach alphas ranging from 0.75 to 0.93 and 38 items overall. Conclusions This new scale when used with objective burden and other scales offers an opportunity to more systematically measure the difficulties staff experience when caring for persons with ID who present with symptoms of AD.     

Objective measurement of attention deficit hyperactivity disorder symptoms outside the clinic using the QbCheck: Reliability and validity

Objective measurements of ADHD symptom levels can be a highly valuable complement to ratings. However, sometimes it is not feasible to bring patients into the clinic/lab for assessment. The aim of the present study was therefore to evaluate the psychometric properties of the QbCheck, an online computerized test that measures errors and reaction time as well as activity during testing using the computer's built‐in web camera. Study I (n = 27 adolescents/adults) investigated test–retest reliability and concurrent validity of the QbCheck. Study II included 142 adolescents/adults (69 with ADHD/73 controls) and investigated convergent and diagnostic validity, as well as usability, of the QbCheck. In Study I, the QbCheck showed high test–retest reliability and high concurrent validity. In Study II, high convergent validity was observed when studying associations between the QbCheck performed in the home and the QbTest performed at the clinic. In addition, the QbCheck discriminated well between patients with ADHD and controls, with a sensitivity of 82.6 and a specificity of 79.5. The QbCheck appears to be a valuable test with good psychometric properties and will thereby enable assessment of ADHD symptom levels in adolescents and adults outside the clinic in the home setting.     

An adapted version of the Rosenzweig Picture-Frustration Study (PFS-AV) for the measurement of hostility in violent forensic psychiatric patients

Background The original Rosenzweig Picture‐Frustration Study (PFS), designed to measure reactive aggressive behaviour in adults, contains 24 pictures of ambiguous situations in which someone is making a remark that can be interpreted as provocative. Aim An adapted version of Rosenzweig's PFS (PFS‐AV) was developed to assess the hostile thoughts elicited by interpersonal frustrating situations in forensic psychiatric patients with a conduct disorder or an antisocial personality disorder. Methods Patients were asked to give their responses in a few words on paper, which were then evaluated for hostility using a seven‐point Likert scale. The patients also completed questionnaires on personality and on aggressive and socially competent behaviour. Results Twelve of the 24 pictures that had a good internal consistency, inter‐rater reliability, and test–retest reliability were selected. In support of the instrument's concurrent validity, scores on the PFS‐AV were positively correlated with those on the aggressive behaviour questionnaires but less strongly than the correlations between the aggressive behaviour questionnaires mutually. The validity of the PFS‐AV was demonstrated by the positive correlation between PFS‐AV hostility and neuroticism, and by the negative correlation with extraversion, openness, agreeableness and conscientiousness. A relatively low but positive correlation was found with social anxiety and a negative correlation was found with social skills in situations where approaching behaviour may be exhibited. Conclusion The adapted version of the PFS‐AV appears reliably and validly to measure hostility in violent forensic psychiatric patients. Copyright © 2007 John Wiley & Sons, Ltd.     

Family impact in intellectual disability, severe mental health disorders and mental health disorders in ID. A comparison

Family impact (or family burden) is a concept born in the field of mental health that has successfully been exported to the ambit of intellectual disability (ID). However, differences in family impact associated with severe mental health disorders (schizophrenia), to ID or to mental health problems in ID should be expected. Seventy-two adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshops and vocational employment programmes in Madrid (Spain), 203 adults diagnosed with schizophrenia from four Spanish Community Mental Health Services (Barcelona, Madrid, Granada and Navarra) and 90 adults with mental health problems in ID (MH-ID) from the Parc Sanitari Sant Joan de Déu Health Care Site in Sant Boi de Llobregat, Barcelona (Spain) were asked to participate in the present study along with their main caregivers. Family impact experienced by caregivers was assessed with the ECFOS-II/SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva/Objective and Subjective Family Burden Interview). In global terms, results showed that the higher family impact was found between caregivers to people with MH-ID. The interaction of both conditions (ID and mental health problems) results in a higher degree of burden on families than when both conditions are presented separately. There was also an impact in caregivers to people with schizophrenia, this impact being higher than the one detected in caregivers to people with intellectual disability. Needs of caregivers to people with disability should be addressed specifically in order to effectively support families.     

The utility of the Generalized Anxiety Disorder Severity Scale (GADSS) with older adults in primary care

Background: The Generalized Anxiety Disorder Severity Scale (GADSS) is an interview rating scale designed specifically for assessing symptom severity of generalized anxiety disorder (GAD), which has demonstrated positive psychometric data in a sample of adult primary care patients with GAD and panic disorder. However, the psychometric properties of the GADSS have not been evaluated for older adults. Methods: This study evaluated the psychometric properties of the GADSS, administered via telephone, with a sample of older primary care patients (n=223) referred for treatment of worry and/or anxiety. Results: The GADSS demonstrated adequate internal consistency, strong inter‐rater reliability, adequate convergent validity, poor diagnostic accuracy, and mixed discriminant validity. Conclusions: Results provide mixed preliminary support for use of the GADSS with older adults. Depression and Anxiety, 2009. Published 2008 Wiley‐Lis, Inc.     

Validation of personal digital photography to assess dietary quality among people with intellectual disabilities

Background Dietary assessment is a challenge in general, and specifically in individuals with intellectual disabilities (ID). This study aimed to evaluate personal digital photography as a method of assessing different aspects of dietary quality in this target group. Method Eighteen adults with ID were recruited from community residences and activity centres in Stockholm County. Participants were instructed to photograph all foods and beverages consumed during 1 day, while observed. Photographs were coded by two raters. Observations and photographs of meal frequency, intake occasions of four specific food and beverage items, meal quality and dietary diversity were compared. Evaluation of inter‐rater reliability and validity of the method was performed by intra‐class correlation analysis. Results With reminders from staff, 85% of all observed eating or drinking occasions were photographed. The inter‐rater reliability was excellent for all assessed variables (ICC ≥ 0.88), except for meal quality where ICC was 0.66. The correlations between items assessed in photos and observations were strong to almost perfect with ICC values ranging from 0.71 to 0.92 and all were statistically significant. Conclusion Personal digital photography appears to be a feasible, reliable and valid method for assessing dietary quality in people with mild to moderate ID, who have daily staff support.