Activities Scale for Kids

Last Updated

June 05, 2025

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Purpose

Self-report measure of children between ages 5 to 15 years old who have musculoskeletal disabilities of their perceived physical disability and limited participation in activities.
Assess a child with musculoskeletal conditions status at a single point in time or to monitor changes associated with time or therapeutic intervention.
ASKp: considers environment which children must function and what the child usually does in that environment (activities the child actually “did do” over the past week).
ASKc: measures what the child believes he or she could do and does not take the usual environment into account (activities the child “could have done” (capability) in the past week).

Link to Instrument

Acronym ASK, ASKc (Capacity), ASKp (Performance)

Area of Assessment

Activities & Participation
Movement
Sensation & Pain
General Health & Development
Bodily Functions

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Free to students, physicians, clinical practice, and not-funded academic users. Costs may apply for funded academic users, healthcare organizations, commercial users, and IT companies. Cost ranges from $150-$900 depending on whether the instrument will be used for clinical practice or multi-site research.

CDE Status

NINDS CDE Notice of Copyright
Activities Scale for Kids (ASK)

Classification

Supplemental – Highly Recommended: Cerebral Palsy (CP)

Pediatric and Congenital Conditions

Non-Patient

Clinicians may choose to administer ASKp and/or ASKc versions, which are two different questionnaires, concurrently or alone, depending on objective of the assessment
Number of items in the instrument: 30 care giver/self-report items of each questionnaire with 7 sub domains
Higher score indicates higher perceived function
Brief description of item scoring: aggregated into one summary score 7 sub-domains: personal care (3 items), dressing (4 items), other skills (4 items), locomotion (7 items), play (2 items), standing skills (5 items), and transfers (5 items).
Children chose response options, scored 4-0, respectively:
- ASKp: “4- all of the time”, “3 - most of the time”, “2-sometimes”, “1- once in a while”, “0- none of the time”, “not applicable”
- ASKc: “4- with no problem”, “3- with a little problem”, “2- with a moderate problem”, “1- with a big problem”, “0- I could not”
Minimum score: 0, maximum score: 100

Number of Items

Pen or any colored pencil/marker
Calendar

10-30 minutes

Required Training

No Training

Child

5 - 12

years

Adolescent

13 - 15

years

Instrument Reviewers

Initially reviewed on 6/5/2025 by Janet Kim, OTR/L, CHT and Cristin M. Holland, PhD, OTR/L, Columbia University, Vagelos College of Physicians and Surgeons, Department of Rehabilitation and Regenerative Medicine, Programs in Occupational Therapy.

Body Structure

Head
Neck
Upper Extremity
Back
Lower Extremity

ICF Domain

Body Structure
Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Cognition
Emotion
General Health
Motor
Sensory

Professional Association Recommendation

Global Alliance for Musculoskeletal health: https://gmusc.com/
American Juvenile Arthritis Organization: https://rarediseases.org/organizations/american-juvenile-arthritis-organization/
Cerebral Palsy Research Network: www.cprn.org/
Muscular Dystrophy Association: www.mda.org

Considerations

Children have to answer questions to best of their ability, thus children with cognitive deficits or delays may not be able to answer appropriately.

Statistics presented that were based on non-English language versions have been noted in this instrument review. The ASK was originally developed in English and valid versions have been translated and adapted for the following languages: Spanish, German, Italian, Nepali.

Standard Error of Measurement (SEM)

Children with a variety of musculoskeletal disorders: (Young et al., 1995; n = 28, mean age = 11.6 (3.1) years, age range = 5-15; calculated SEM)

SEM for stage 4 field testing = 0.58

Children with functional disabilities caused by musculoskeletal, neurological or rheumatic diseases: (De Oliveira et al., 2022; n = 67, mean age = 12.13 (2.61) years, male = 43%; ASK translated/adapted into Brazilian Portuguese language)

Inter-evaluator:
- SEM for ASKp = 0.62
- SEM for ASPc = 0.43
Inter-evaluator:
- SEM for ASKp = 1.79
- SEM for ASPc = 0.74

Children with Cerebral Palsy (CP): (Costi et al., 2022; n = 220, mean age = 10.6 ± 2.9 years, calculated SEM; ASKp translated/adapted into Italian language)

SEM by Group on ASKp for Children With Cerebral Palsy (CP)*

Group	n	SEM
Total sample	206	1.26
Female	92	1.93
Male	114	1.67
Unilateral CP	63	1.71
Bilateral CP	143	1.59
No intellectual deficit	186	1.27
Mild intellectual deficit	20	4.10

*Data based on responses (n = 206) that included a sufficient number of answers to calculate a summary score.

Children with Hematopoietic Stem Cell Transplantation (HSCT): (Lawitschka et al., 2021; n = 55, median age = 12 years, age range = 4-23 years, male = 64%; ASKp translated/adapted into German language)

SEM for Patient and HCST Characteristics at study enrollment

Group	n	SEM
Female	19	0.167
Male	36	0.242
no-cGVHD	36	0.167
severe cGVHD	12	0.296
moderate cGVHD	7	0.289
Moderate & severe cGVHD	19	0.277

cGVHD: Chronic graft-versus-host disease

Minimal Detectable Change (MDC)

Children with a variety of musculoskeletal disorders: (Young et al., 1995; calculated MDC)

MDC for stage 4 field testing = 1.61

Children with functional disabilities caused by musculoskeletal, neurological or rheumatic diseases: (De Oliveira et al., 2022)

Inter-evaluator:

MDC for ASKp = 1.83
MDC for ASPc = 1.52

Intra-evaluator:

MDC for ASKp = 3.12
MDC for ASPc = 2.01

Children with CP: (Costi et al., 2022; MDC calculated)

MDC by Group on ASKp for Children With Cerebral Palsy (CP)*

Group	n	MDC
Total sample	206	3.49
Female	92	5.19
Male	114	4.63
Unilateral CP	63	4.75
Bilateral CP	143	4.40
No intellectual deficit	186	3.52
Mild intellectual deficit	20	4.10

*Data based on responses (n = 206) that included a sufficient number of answers to calculate a summary score.

Children with HSCT: (Lawitschka et al., 2021)

MDC for Patient and HCST Characteristics at study enrollment

Group	n	MDC
Female	19	0.462
Male	36	0.671
no-cGVHD*	36	0.463
severe cGVHD*	12	0.820
moderate cGVHD*	7	0.801
Moderate & severe cGVHD*	19	0.768

*cGVHD: Chronic graft-versus-host disease

Normative Data

Children with broad range of diagnoses experiencing limitations in physical activity: (Young et al., 2000)

Disability summary scores (n = 200)

	Mean	SD
ASKp scores (max range 0-100)	68.2	24.12
ASKc scores (max range 0-100)	76.8	20.71

Children with functional disabilities caused by musculoskeletal, neurological or rheumatic diseases: (De Oliveira et al., 2022)

Summary statistics on ASK questionnaire (n = 67)

Mean

ASKp scores

87.7

17.9

ASKc scores

Children with CP: (Costi et al., 2022)

Summary Scores on ASKp for Children With Cerebral Palsy (CP)*

Group	n	Mean	Median
Total	206	75.5	80
Female	92	74.5	78
Male	114	76.4	80
5-10 years old	112	70.3	74
11-13 years old	3.0	79.7	85
14-15 years old	2.0	83.0	90

*Data based on responses (n = 206) that included a sufficient number of answers to calculate a summary score.

Test/Retest Reliability

Children with a variety of musculoskeletal disorders: (Young et al., 1995; mean time between assessments = 2 weeks)

Excellent test-retest reliability for ASKp (ICC = 0.97) and for ASKc (ICC = 0.98)

Children with HSCT: (Lawitschka et al., 2021)

Excellent reliability: ICC = 0.90

Interrater/Intrarater Reliability

Children with a variety of musculoskeletal disorders: (Young et al., 1995; mean time between assessments = 2 weeks))

Excellent interrater reliability between parent’s and children’s ASK summary scores: (ICC = 0.96)
Excellent intra-rater reliability among children for ASK summary scores: (ICC = 0.97)

Internal Consistency

Children with a variety of musculoskeletal disorders: (Young et al., 1995)

Excellent internal consistency: Cronbach’s alpha = 0.99*

Children with functional disabilities caused by musculoskeletal, neurological or rheumatic diseases: (De Oliveira et al., 2022)

Excellent internal consistency: Cronbach’s alpha > 0.9* overall and for all domains of both ASKp and ASKc

Children with HSCT: (Lawitschka et al., 2021; Cronbach’s alpha assessed for patients who answered all questions only)

Excellent: Cronbach’s alpha at seven different time intervals ranged from α = 0.91* to α = 0.97*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Children with broad range of diagnoses experiencing limitations in physical activity: (Young et al., 2000; )

Excellent correlation between clinician-reported and child-reported ASKc scores based on structured observation (r = 0.92; 95% CI: 0.82-0.97)

Construct Validity

Convergent validity:

Children with broad range of diagnoses experiencing limitations in physical activity: (Young et al., 2000)

Excellent correlations between the ASK and the Childhood Health Assessment Questionnaire (CHAQ)
- ASKp: (r = 0.82, 95% CI: 0.76-0.86)
- ASKc: (r = 0.85, 95% CI: 0.76-0.86)
- Indicates both instruments are measuring the same construct and physical disability.

Children with functional disabilities caused by musculoskeletal, neurological or rheumatic diseases: (De Oliveira et al., 2022)

Adequate correlations between:
ASKp and PedsQL (Pediatric Quality of Life Inventory) (r = 0.522, p < 0.001)
ASKc and PedsQL (r = 0.537, p < 0.001)

Children with HSCT: (Lawitschka et al., 2021)

Adequate correlation between the ASKp and the KPS (Karnofsky performance scale)/PSS (Lansky play performance scale) score (r = 0.599; p< 0.001)

Discriminant validity:

Children with broad range of diagnoses experiencing limitations in physical activity: (Young et al., 2000)

Excellent discriminant validity between the ASKp and the constructs of the Health Utilities Index (HUI)
- HUI Constructs of emotion: (r = 0.15)
- HUI Constructs of speech: (r = 0.09)
- Indicates these instruments are measuring different constructs
Significant differences in ASKp summary scores found between mild, moderate, and severely disabled groups of children as determined by clinician’s global ratings at time of referral to the study (p < 0.0001)

Children with CP: (Costi et al., 2022)

Significant ability of ASKp scores to discriminate between different levels of function in ADL by age group, with adolescents perceiving fewer limitations in the activities than children (83.0 (18.0) vs. 70.3 (16.6), respectively; p < 0.001)
Significant ability of ASKp scores to discriminate between individuals with different levels of CP, with those with unilateral CP perceiving fewer limitations than those with bilateral CP (82.5 (13.6) vs. 72.4 (19.0), respectively; p < 0.002)
Significant ability of ASKp scores to discriminate between individuals with different levels of need for assistive devices, with those needing devices for indoor mobility perceiving more limitations than individuals who did not use assistive devices or those who use devices for outdoor mobility only (66.1 (18.3) vs. 83.6 (12.8), and vs. 80.4 (17.4), respectively; both p < 0.001)
Significant ability of ASKp scores to discriminate between different levels of intellectual ability, with individuals without intellectual disability perceiving fewer limitations than those with mild disability (77.2 (17.3) vs. 60.3 (18.3), respectively; p < 0.001)

Children with HSCT: (Lawitschka et al., 2021)

Adequate ability of the ASKp to discriminate between patients who needed devices vs. patients without devices (ASKp correctly classified 90% of the patients overall, with 50% (5 of 10) needing devices correctly classified and 98% (44 of 45) of those that needed no devices correctly classified)
Poor ability of the ASKp to discriminate between patients with chronic graft-versus-host disease (cGVHD) and those without cGVHD (ASKp correctly classified 71% of patients with cGVHD overall, with 97% (35 of 36) of patients without cGVHD correctly classified, but only 21% (4 of 19) of patients with cGVHD correctly classified)

Content Validity

Children with a variety of musculoskeletal disorders: (Young et al., 1995)

Kappa coefficient (0.70) indicated items generated by parents and children were similar; Wilcoxon’s signed rank test (p = 0.055) indicated a significant difference in the level of importance given to each activity item

Floor/Ceiling Effects

Children with broad range of diagnoses experiencing limitations in physical activity: (Young et al., 2000)

The distribution of ASK scores were examined among those children who were assessed as nondisabled by the Health Utilities Index Mark III (HUI3) (a screening tool for disability of children in the general population), yet were reported to be disabled by the referring clinician, to determine whether the ASK could detect disability missed by the screening measure

Adequate: Ceiling effects for ASKp of 4%
Excellent: No floor effects

Children with HSCT: (Lawitschka et al., 2021)

Ceiling effects increased with time:
- Adequate ceiling effects of 2% at T0 (1 patient), 7% at T3 (3 patients), and 9% at T6 (3 patients)
- Poor ceiling effects of 23% at T9 (6 patients), 35% at T12 (9 patients), 22% at T15 (5 patients), and 33% at T18 (9 patients)

Responsiveness

Children with broad range of diagnoses experiencing limitations in physical activity: (Young et al., 2000)

Responsiveness of ASK and CHAQ*

Scale	Change (SD)	Absolute Responsiveness ES	Relative Responsiveness ES
Predicted to get worse (n = 11)
ASKp	-33.5 (27.2)	1.59	0.84
ASKc	-30.6 (28.3)	1.18	0.63
CHAQ	-36.5 (28.5)	1.89	Reference criteria
Predicted to improve (n = 23)
ASKp	25.7 (21.9)	1.79	1.08
ASKc	18.4 (17.3)	1.91	1.15
CHAQ	29.7 (26.6)	1.66	Reference criteria

ASKp: Activities Scale for Kids - Performance; ASKc: Activities Scale for Kids – Capacity; CHAQ: Childhood Health Assessment Questionnaire; ES: Effect size

*Data based on responses (n = 206) that included a sufficient number of answers to calculate a summary score.

Effect sizes indicate ASKp is as responsive or slightly more responsive than the CHAQ, while the ASKc is less responsive than the ASKp. The clinical meaningfulness of these differences is uncertain.

Standard Error of Measurement (SEM)

Healthy Children: (Plint et al., 2003; n = 122, mean age = 10.45 (2.99) years, age range = 5-15 years, female = 68 (55.7%))

SEM for entire group (n = 122): 0.271

Minimal Detectable Change (MDC)

Healthy Children: (Plint et al., 2003)

MCD for entire group (n = 122): 0.751

Normative Data

Healthy Children: (Plint et al., 2003; n = 122)

Mean score for ASKp: 93.12 (6.45)
Median score for ASKp: 95.54
Score range on ASKp: 74.14 to 100

Construct Validity

Discriminant validity:

Healthy Children: (Plint et al., 2003)

Significant ability of the ASKp to discriminate between children with no disabilities and those with:
- mild disabilities (mean score = 85.86 (13.77), p = 0.005; Young et al., 2000)
- moderate disabilities (mean = 52.66 (22.53), p < 0.001)
- severe disabilities (mean = 21.00 (10.23), p < 0.001)

Floor/Ceiling Effects

Healthy Children: (Plint et al., 2003)

The high median score (95.54) near the maximum score (100) on the scale suggests that the ASKp questionnaire has a ceiling effect with respect to normal children.

Bibliography

Costi, S., Filippi, M. C., Braglia, L., Beccani, L., Corradi, I., Bruzzi, E., Signorelli, C., & Pelosin, E. (2022). Reliability and construct validity of the Activities Scale for Kids in Italian children with cerebral palsy. Disability and Rehabilitation, 44(21), 6445–6451. https://doi.org/10.1080/09638288.2021.1966519

De Oliveira, V. G. C., Balau, L. C., Arrebola, L. S., Young, N. L., & Yi, L. C. (2022). Translation, cross‐cultural adaptation, validity and reliability of the Brazilian Portuguese version of Activity Scale for Kids questionnaire. Child Care Health and Development, 49(4), 725–731. https://doi.org/10.1111/cch.13085

Lawitschka, A., Brunmair, M., Bauer, D., Zubarovskaya, N., Felder-Puig, R., Strahm, B., Bader, P., Strauss, G., Albert, M., Von Luettichau, I., Greinix, H., Wolff, D., & Peters, C. (2020). Psychometric properties of the Activities Scale for Kids-performance after allogeneic hematopoietic stem cell transplantation in adolescents and children. Wiener Klinische Wochenschrift, 133(1–2), 41–51. https://doi.org/10.1007/s00508-020-01641-w

Plint, A. C., Gaboury, I., Owen, J., & Young, N. L. (2003). Activities scale for kids: an analysis of normals. Journal of Pediatric Orthopaedics, 23(6), 788–790. https://doi.org/10.1097/01241398-200311000-00018

Young, N. L., Williams, J. I., Yoshida, K. K., & Wright, J. G. (2000). Measurement properties of the Activities Scale for Kids. Journal of Clinical Epidemiology, 53(2), 125–137. https://doi.org/10.1016/s0895-4356(99)00113-4

Young, N. L., Yoshida, K. K., Williams, J. I., Bombardier, C., & Wright, J. G. (1995). The role of children in reporting their physical disability. Archives of Physical Medicine and Rehabilitation, 76(10), 913–918. https://doi.org/10.1016/s0003-9993(95)80066-2

Last Updated

Discover Careers at Shirley Ryan AbilityLab

Purpose

Link to Instrument

Area of Assessment

Administration Mode

Cost

Cost Description

CDE Status

Number of Items

Required Training

Instrument Reviewers

Body Structure

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Construct Validity

Content Validity

Floor/Ceiling Effects

Responsiveness

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Normative Data

Construct Validity

Floor/Ceiling Effects

Bibliography

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