Population-Specific Assessments
While most of the measures listed previously are designed for general use in the assessment of psychosocial functioning in children and adolescents, an increasing number of measures are being developed specifically for use with pediatric rehabilitation populations.
Population-specific measures are more sensitive to the unique adjustment challenges that these youth face.The Parents of Children with Disabilities Inventory (PCDI) (137) was designed to assess not only the frequency of disability-related stressors, but also parent perceptions of the stressors, which are an important factor in family adjustment. Four areas of concern are measured: medical and legal, concerns for the child,
Measures of Single Dimensions
| INSTRUMENT (REF.) | DESCRIPTION | COMMENTS |
| Revised | Self-report of | Items assessing |
| Children’s | anxiety. Includes a | physiological |
| Manifest | lie scale to assess | symptoms must |
| Anxiety Scale for Children (RCMAS) (129) | response bias. | be interpreted with caution in rehabilitation population. |
| Children’s | Self-report measure | Well-recognized |
| Depression | of depression. Five | scale. Some |
| Inventory (CDI) | subscales: negative | questions have |
| (130) | mood, interpersonal problems, ineffectiveness, anhedonia, and negative selfesteem. | been raised about the psychometric properties. |
| Behavior Rating | Parent, teacher, and | Allows for |
| Inventory of | self-report rating | assessment of |
| Executive | scales. Measures | executive skills |
| Function System | behavior regulation | in naturalistic |
| (BRIEF) (131) | and metacognition. Two response-bias scales included. | environment, which is important, as this can be hard to validly assess in clinical settings. |
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concerns for the family, and concerns for the self. Limited psychometric data is available, though initial estimates of reliability and concurrent and construct validity appear adequate. Further validation and normative studies are needed.
The Pediatric Inventory of Neurobehavioral Symptoms (PINS) (138) has the advantage of having been specifically designed for the assessment of personality, emotional, and behavioral issues associated with traumatic brain injury. It has the disadvantage of having less research support, though there is some evidence of construct validity. It is comprised of 54 items, and can be completed by parent or teacher. Five general scales are obtained: mental inertia, social inappropriateness, dissociation of affect and behavior, episodic symptoms, and biologic symptoms.
The Pediatric Pain Questionnaire (PPQ) (139) is a structured interview completed with patients and parents. It measures both pain intensity and location, using body outline and visual analogue, as well as the emotional and perceptual experience. There are separate forms for children, adolescents, and parents. The adolescent form also covers the social and environmental influences on the experience.
History taking is an integral part of the process, including extensive history of treatments, child and family pain history, and environmental aspects. The analogue scale provides no numbers or markings, but instead elicits present and worst pain intensity of the past week. Different semantic anchors are used for children (not hurting versus hurting a lot), along with happy and sad faces.
The adolescent and parent versions are anchored by no pain and severe pain and pain descriptors of hurting and discomfort. The body outlines are age-appropriate on the children and adolescent forms. The child can indicate four levels of pain intensity by coloring in the body outline with a choice of eight crayons. The child chooses colors to demonstrate the intensity gauged by four categories of pain descriptors. In this way, the child can show multiple sites and register the appropriate range of intensity in each. A separate list of pain descriptors is provided that assesses the evaluative, emotional, and sensory quality of the child's own experience. Words are provided for younger children or anyone who may have trouble generating labels.The multidimensional aspect of the PPQ is appealing for anyone who has struggled to understand the experience of pain in children. It allows for engaging visual representations as well as standard language expression. Expecting parent reports to match the child's is erroneous. As in the adult literature, the subjectivity of the pain experience mitigates against this being the case. Comparison of child and parent reports is useful more as a gauge of convergence in the relationship between parent and child, not as a validating measure. Despite the unusual structure of some of its components, reliability and validity have been shown for the PPQ, and it holds considerable promise.
Measurement of health-related quality of life (HRQOL) represents an important component in the assessment of psychosocial functioning in pediatric populations. The PedsQL (140) is designed to measure HRQOL through brief child and/or parent ratings, with separate scales designed for different age groups within the 2-to-18-year range. Physical, emotional, social, and school functioning scales are included in the generic core scale, and supplemental condition-specific modules are available for asthma, rheumatology, diabetes, cancer, and cardiac conditions.
Additional diseasespecific measures of HRQOL are available for use with other populations such as epilepsy (141) and cystic fibrosis (142). A listing of population-specific measures is shown in Table 3.10.The assessment of disease-related knowledge should not be overlooked. Most children with chronic
| Population-Specific Measures | ||
| INSTRUMENT (REF.) | DESCRIPTION | COMMENTS |
| Parents of Children with Disabilities Inventory (PCDI) (137) | Assesses frequency and perceptions of family stressors in the areas of medical/legal, concerns for child, concerns for family, concerns for self. | Limited psychometric data available. Assessment of perceptions of stressors is important, as this construct is related to adjustment. |
| Pediatric Inventory of Designed to assess sequelae associated with traumatic Neurobehavioral Symptoms brain injury. Five domains assessed: mental inertia, (PINS) (138) social inappropriateness, dissociation of affect and behavior, episodic symptoms, and biologic symptoms. | Limited research on scale, though some construct-validity data is available. | |
| Pediatric Pain Assesses pain intensity and location, as well as Questionnaire (PPQ) (139) emotional and perceptual experience. Different scales for children, adolescents and parents. | In-depth assessment of highly subjective experience. | |
| PedsQL (140) | Measures health-related quality of life through child and parent ratings. Generic core scale measures physical, emotional, social, and school functioning. Condition-specific modules available for asthma, rheumatology, diabetes, cancer, and cardiac conditions. | Measures important aspect of functioning in pediatric populations. Disease-specific measures tap unique issues within separate illnesses. |
illness or disability face the dual challenge of needing to cope with higher demands (as compared to normal populations) in terms of medical treatment regimens, using lower general coping resources due to primary symptoms and secondary deficits. Treatment adherence is of critical concern. Assessment of general developmental maturity and psychosocial adjustment is a key indicator for addressing this issue. There is also evidence that knowledge of the disease and treatment is important in children and especially adolescents (143). Informal assessment of patient understanding may help identify barriers to treatment adherence.