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Doctor of Philosophy




Stewart, Shannon, S. L.


Background. With no standardized approach for early assessment of childhood development in Canada, and with a lack of a comprehensive assessment-to-intervention system that amalgamates social, psychiatric, medical, functional, psychological, and environmental constructs, the interRAI 0-3 was developed to support intervention efforts based on the needs of young children and their families. The interRAI 0-3 includes over 650 items that seek clinical information, developmental milestones, and context items regarding the family and social relationships surrounding the child. The newly developed interRAI 0-3 was most recently evaluated to examine the reliability and validity of the Expressive and Receptive Language and the Gross Motor Scales as well as examine the outcomes of an at-risk subsample of preterm children.

Method. Participant data included children and families (n = 640) from 17 health agencies and childcare centres in Ontario, Canada. Data were collected as part of a pilot study using the full interRAI 0-3 assessment. Criterion validity of the interRAI 0-3 was investigated using a matched sample of participants who completed the Ages and Stages Questionnaire, third edition (ASQ-3) (n = 102) independently from the interRAI 0-3 within a 3-day period of time. Upon intake within child and family agencies across Ontario participating in the pilot study, assessors who received training on the interRAI 0-3 began to collect data with the child and family using the above measures. The interRAI 0-3 training included an overview of the form, manual, coding procedures, and practice using case studies. Paediatricians, Psychiatrists, Psychologists, infant therapists, early childhood educators, child and youth workers, child life specialists, and early intervention teams administered the interRAI 0-3, with parents completing the ASQ-3.

Results. The Expressive and Receptive Language scale for children aged 20-24 and 24-28 months demonstrated a high level of internal consistency, with Cronbach’s alpha reaching between 0.88 and 0.89, respectively. The Gross Motor Scale for children in the 24 to 30-month age interval also demonstrated a high level of internal consistency, with Cronbach’s alpha at 0.893. Inter rater reliability of the Expressive and Receptive Language Scale (ICC = .98, [95% CI, .97, .99], p< .001) and the Gross Motor Scale (ICC = .87, [95% CI, .72, .94], p< .001) was obtained for a sample of 23 participants, showing strong agreement between raters on both scales. Pearson’s product-moment correlation between the interRAI 0-3 and ASQ-3 language items was considered moderate, r(100) = .68, p< 0.001, demonstrating a positive relationship between findings on the interRAI 0-3 and the criterion measure. Similarly, the gross motor scale showed a strong positive correlation, r(102) = .877, p< .01 with the ASQ-3 motor items. There was also a statistically significant association between childhood performance on interRAI 0-3 language milestones and ASQ-3 achievement of items in the communication domain, χ2(1) = 26.65, p < 0.001, whereas the interRAI 0-3 gross motor scale was considered statistically significant after running bivariate analysis against the ASQ-3, χ2(1) = 45.84, p < 0.001. Results of logistic regression for the Language scale show that with an increase in achievement of communication milestones on the ASQ-3, the odds of pass performance on the interRAI 0-3 language items increases by 4.3% (AOR = 1.043, 95% C.I. = 1.027-1.060), and the sensitivity of model was 77.8%, with specificity slightly lower, at 72.9%. Results of the predictive model also show that with an increase in achievement of gross motor milestones from the ASQ-3, the odds of achievement on the interRAI 0-3 increases by 6.2% (AOR = 1.062, 95% C.I. = 1.040-1.084). Sensitivity and specificity of the model was also calculated, with excellent findings of 89.6% and 84.6%, respectively. A final subset of children born preterm were also examined for their gross motor milestone achievement based on extent of prematurity. The distributions of gross motor scores were significantly different across categories of prematurity H(3) = 15.520, p = .001. Gross motor scores decreased from 40 weeks’ gestation (mean rank = 310.77), to moderate to late preterm (mean rank = 258.96), and to very preterm (mean rank = 234.54), however extremely preterm (mean rank = 236.28) performed comparably to very preterm.

Conclusion. The interRAI 0-3 Expressive and Receptive Language and Gross Motor scales were found to be conceptually sound on the basis of exploratory factor analysis. The changing context of the assessor was also evaluated for stability in observation and scoring. Inter-rater reliability for the both domains shows preliminary evidence of agreement between assessors. There were corresponding findings of concurrent validity between the interRAI 0-3 and the ASQ-3 as the comparison measure of child development. Additionally, scores from the interRAI 0-3 on the Expressive and Receptive Language and Gross Motor items were found to have significant positive correlations with the ASQ-3 for children between 0-47 months. Analyses also show that the ASQ-3 strongly predicts outcomes on the interRAI 0-3 Expressive and Receptive Language and Gross Motor items. Analysis of an at-risk subset of children born preterm also show poorer achievement of gross motor outcomes, which is a final measure of known-groups validity. The interRAI 0-3 was developed based on the observed need for a singular assessment that would encompass a comprehensive range of aspects related to child and family risk and linked to clinically relevant and evidence-informed interventions. This is the first study of its kind investigating the psychometric properties of the interRAI 0-3.

Summary for Lay Audience

Current assessment of childhood development is routinely done without the use of standardized tools for recognizing precursors of atypicality. The interRAI 0-3 has been constructed for use by all professionals who work with children between 0-47 months of age. The interRAI 0-3 amalgamates information regarding a child's health, development and issues in the environment and uses triggers to identify areas of risk. Action plans are automatically generated for clinicians to enhance the standard of care and triage for better use of resources. This tool has undergone preliminary validation of the language and gross motor domains of the interRAI 0-3, finding strong reliability and validity for use in clinical and non-clinical settings.

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Creative Commons Attribution-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-No Derivative Works 4.0 License.

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