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Child and Adolescent Scale of Participation

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Purpose

The CASP is a brief, caregiver-completed questionnaire that measures participation in children and young adults across 4 domains: home participation, school participation, community participation, and home and community living activities. The measure is primarily used with children with chronic health conditions and/or disabilities.

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Instrument Details

Acronym CASP

Area of Assessment

Activities of Daily Living
Functional Mobility
Life Participation
Occupational Performance
Social Relationships

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Cost Description

This assessment can be obtained from Bedell (2011).

CDE Status

Availability

Please visit this website for more information about the instrument: Child and Adolescent Scale of Participation

Classification

Supplemental: Mitochondrial Disease (Mito) and Traumatic Brain Injury (TBI)

Exploratory: Cerebral Palsy (CP), Spinal Cord Injury (SCI)-Pediatric, and Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post-concussion)

Key Descriptions

  • 20 ordinal-scaled items across 4 subsections
  • Maximum total score is 80 (20 items x 4) and the minimum total score is 20 (20 items x 1)
  • Items should be scored individually, with 1 = Unable to participate, 2 = Very limited, 3 = Somewhat limited, and 4 = Age expected/Full participation. Only applicable items should be scored—if an item is not applicable to the child or adolescent, it should not count towards the total score.
  • The total score is the sum of all “applicable” items divided by the maximum total score of applicable items. Subsection total scores can also be used depending on the specific aims of the project. Items deemed as “Not applicable” can either be omitted from score calculations, or the scorer can take the average of the subsection and use the resultant as the score for the non-applicable item. When there are many non-applicable items (e.g. for young children), users should focus on item-level responses rather than sum scores.
  • The questionnaire can be administered in two ways: 1) self-administered by a parent or guardian in person or via mail survey and 2) administered by an interviewer in person or via telephone.

Number of Items

20

Equipment Required

  • CASP printed form
  • Writing Utensil

Time to Administer

10 minutes

Required Training

No Training

Age Ranges

Child

6 - 12

years

Adolescent

13 - 17

years

Instrument Reviewers

Bernadette Brady,  Rachel Cochran,  Katie Coddington, and Kori Wilson (Master of Occupational Therapy Students)

Faculty mentor: Danbi Lee, PhD, OTD, OTR/L

Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle

ICF Domain

Participation
Activity

Measurement Domain

Activities of Daily Living

Considerations

Many items included in the CASP may not be applicable to children younger than 6 years old. As such, it may be more appropriate to focus on item-level responses for young children instead of calculating total scores. Additionally, some caregivers may not have accurate knowledge of the child’s educational participation due to varying caregiver involvement in the classroom.

A study that examined assessments for children with ABI and CP based on the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines suggested that several of the psychometric studies of CASP (i.e., Bedell, 2004, 2009, 2016; Golos & Bedell, 2018; and de Kloet et al., 2015) presented doubtful to inadequate methodological quality (Resch et al., 2020).

 

Pediatric Disorders

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Normative Data

Mixed Disabilities: (McDougall et al., 2013; n=409; Mean age = 14 years (2.2); cerebral palsy n=142; acquired brain injury n=58; communication/cleft lip‐palate n=44; spina bifida n=32; autism spectrum disorder n=30; developmental delay n=25; amputation n=16; other n=62)

Impairment

CASP Score

Mean (SD)

Range

Cerebral palsy

68.3(8.9)

28–80

Acquired brain injury

70.3(7.4)

48–80

Communication/cleft lip‐palate

72.1(7.3)

43–80

Spina bifida

68.6(8.2)

49–80

Autism spectrum disorder

65.3(7.8)

48–79

Developmental delay

69.9(6.5)

50–80

Amputation

76.7(2.7)

71–80

Other

69.5(8.2)

41–80

 

Mixed Disabilities: (Bedell, 2009; n = 313; Mean age = 12.8(4.6); acquired brain injury n=76; developmental disability n=61; no identified disability n=52; Learning/attention/sensory n=24)

 

Impairments

CASP Score

Mean (SD)

Range

Acquired brain injury

85(14)

31-100

Developmental disability

73(12)

46-96

No identified disability

97(4)

83-100

Learning/attention/sensory

84(12)

59-100

 

Test/Retest Reliability

Chronic Health Conditions: (De Bock et al., 2019; n = 327; Mean age = 7.08 years (1.36); healthy n = 103; mild chronic health condition n = 174; severe chronic health condition n = 50; German Sample; Sample subset of n = 22 (n=19 with chronic health conditions; n=3 unspecified) used to test test-retest reliability)

  • Excellent test-retest reliability: (ICC=.97)

 

Acquired Brain Injury: (Bedell, 2004; n = 60; Mean age at discharge = 9.7 years (4.7 years); Mean age at follow-up = 13.2 years (5.2 years); time post discharge from inpatient rehabilitation range = 4 months to 6.5 years; sample subset of n = 33 used for test-retest reliability)

  • Excellent test retest reliability: (ICC = 0.94)

 

Acquired and Traumatic Brain Injury: (de Kloet et al., 2015; Cohort 1 n = 140, Median Age= 14 (5-22), Cohort 2 n = 27, Median Age = 16 (7-22); Severity: mild, moderate, severe, unknown; Dutch Sample; Cohort 2 used to test test-retest reliability)

  • Excellent test retest reliability: (ICC = 0.90)

Interrater/Intrarater Reliability

Mixed Disabilities: (Hwang et al., 2013; n = 231; Mean age = 11.6 (3.5); Taiwanese sample)

  • Rasch analysis showed nonsignificant DIF for each item (P, 0.082–0.922) between parents and other legal guardian reporters.

Internal Consistency

Mixed Disabilities: (Hwang et al., 2013)

  • Excellent: Cronbach's alpha range from 0.88 to 0.96*
  • Rasch analysis showed appropriate fit indexes (MnSqr1.4) with all items with excellent item reliability (0.97) and error estimates between 0.095 and 0.122.

 

Mixed Disabilities: (McDougall et al., 2013)

  • Poor to Excellent: Cronbach’s alpha range from 0.67 to 0.87 for youth report
  • Excellent: Cronbach’s alpha range from 0.86 to0.95 for parents

 

Chronic Health Conditions: (de Bock et al., 2019; Sample subset of n = 290 used to test internal consistency)

  • Excellent Cronbach’s alpha range from 0.92 to 0.98*

 

Acquired Brain Injury: (Bedell, 2004)

  • Excellent: Cronbach’s alpha = 0.9
  • Adequate to Excellent correlation between each item and total test score (point biserial correlations range from 0.67 to 0.81)
  • Rasch analysis suggests that three CASP items (i.e., work, shopping – managing money, and educational activities with others) may be misfitting or deviating somewhat from the expected pattern. (Mean square fit>1.3)

 

Acquired Brain Injury: (Chamberon et al., 2016; n = 85; Mean age at assessment = 10.51(3.4); Mean age at onset = 5.66 (3.9))

  • Excellent: Cronbach’s alpha = 0.84

 

Acquired and Traumatic Brain Injury: (de Kloet et al., 2015; Cohort 1 used to test internal consistency)

  • Excellent: Cronbach’s alpha = 0.95 for total score*

 

Mixed Disabilities: (Bedell, 2009)

  • Excellent Cronbach’s alpha = 0.96 for total CASP*

 

Traumatic Brain Injury and Arm Injury: (Golos & Bedell, 2016; n = 926; Age range = 0 – 18 years old; Mean time post injury = 3-36 months; Severity: mild, moderate, severe)

  • Adequate to Excellent: Cronbach’s alpha = 0.731- 0.956

*Scores higher than .9 may indicate redundancy in the scale questions

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Acquired and Traumatic Brain Injury: (de Kloet et al., 2015)

  • Adequate concurrent validity of CASP total and subdomains with the parent reported Pediatric Quality of Life Inventory (r=0.330-0.451) and Pediatric Stroke Outcome Measure (r=-0.557- -0.309) assessments.
  • Poor concurrent validity of CASP total with the patient reported CAPE patient participation diversity (r=0.082) and CAPE patient participation intensity (r=0.050).

Construct Validity

Construct validity:

Mixed Disabilities: (Hwang et al., 2013)

  • Rasch analysis supported unidimensionality of CASP-C with 83.7% variance in observations explained by the measures.
  • Based on Rasch analysis, the order of item difficulty of the CASP-C approximated the item difficulty order of the English version.

 

Mixed Disabilities: (Bedell, 2009)

  • Rasch analysis supported one unidimensional construct with the item difficulty order similarly matching the expected pattern of life situations that participants would be less challenged by.

 

Acquired Brain Injury: (Bedell, 2004)

  • Based on Rasch analysis, item difficulty seemed to correspond with the degree of complexity, familiarity and predictability associated with each item’s specified activity and context. Activities involving more simple actions or skills acquired at a younger age and activities that occurred at home and with family members generally were less difficult to participate.

 

Known group validity

Mixed Disabilities: (Hwang et al., 2013)

  • Significantly different CASP scores between mild intellectual disability and severe intellectual disability on all summary scores (p<0.01) except for the home and community living activities domain (p=0.055).
  • Significantly different CASP scores between the intellectual and physical disability groups for the daily living factor summary scores (higher score in children with intellectual disability).

 

Factor analysis:

Mixed Disabilities: (Bedell, 2009)

  • Exploratory factor analysis identified three conceptually similar factors that contributed 63% of the total variance: 1) participation in social, leisure, communication items, 2) participation in advanced daily living, and 3) participation in basic daily living and mobility

 

Mixed Disabilities: (Hwang et al., 2013)

  •  Exploratory factor analysis identified 2-factors (‘daily living’ factor and the ‘social/

leisure/communication’ factor) that are highly correlated (r = 0.78) and accounted for 64.1% of the total variance explained

 

Mixed Disabilities: (McDougall et al., 2013)

  • Exploratory factor analysis identified three conceptually similar factors that contributed 44% of the variance in the youth report and 65% in the parent report: 1) Social, leisure participation/communication, 2) advanced daily activities, and 3) basic daily activities/mobility

 

Acquired Brain Injury: (Bedell, 2004)

  • Exploratory factor analysis identified two factors   : that together contributed ~78% of the total variance: 1) participation in movement-related activities and some home and community activities, and 2) participation in communication at home, school and the community and social-based school activities.

 

Acquired Brain Injury: (Chamberon et al., 2016)

  • Factor analysis yielded a 5-factor structure explaining 88% of the total variance.

 

Traumatic Brain Injury and Arm Injury: (Golos, 2016; n = 926; Age range 0 – 18 years old; Mean time post injury = 3-36 months; Severity: mild, moderate, severe)

Exploratory factor analysis identified four factors that contributed 69% of the variance explained: 1) Home participation, 2) home and community living participation, 3) neighborhood and community participation, 4) school participation

 

Discriminant validity:

Acquired Brain Injury: (Bedell, 2004)

  • Adequate correlation between CASP summary score and Child and Adolescent Scale of Environment (CASE) summary score (r = -0.57)
  • Adequate correlation between CASP summary score and Child and Adolescent Factors Inventory (CAFI) summary score (r = -0.58)

 

Traumatic Brain Injury and Arm Injury (Golos & Bedell, 2018; n = 515; Age range = 0-18; TBI Severity: Mild, Moderate, Severe; No severity classification for “arm injury” participants; English speaking (n = 492, 95.5%); Spanish speaking (n = 23, 4.5%))

  • CASP scores in the severe TBI group were significantly lower (p < 0.05) than the CASP scores in the arm and mild TBI groups, but not significantly lower than the moderate TBI group scores
  • No significant differences between the arm, mild TBI, and moderate TBI groups
  • Pre-injury scores: no significant difference (F = 1.841 (3,511), p = 0.139) but with a medium effect size (Partial η2 = 0.11).
  • Post-injury scores:
    • 3 months: CASP scores in the severe TBI group were significantly lower than scores for the arm and mild TBI groups (p < 0.01) and the moderate TBI group (p < 0.05).
    • 12 months: CASP scores in the severe TBI group were significantly lower than scores in the arm group (p < 0.05).
    • 24 months: no significant score differences were found between groups.
    • 36 months: CASP scores in the severe TBI were significantly lower than scores for the arm and mild TBI groups (p < 0.01) and the moderate TBI group (p < 0.05).

 

Convergent Validity:

Acquired Brain Injury: (Bedell, 2004)

  • Excellent correlation between CASP summary score and the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Self-Care Subscale (r = 0.72)
  • Excellent correlation between CASP summary score and the PEDI Functional Skills Social Function Subscale (r = 0.65)
  • Adequate correlation between CASP summary score and the PEDI Functional Skills Mobility Subscale (r = 0.51)

 

Traumatic Brain Injury and Arm Injury: (Golos, 2016; n = 926; Age range 0 – 18 years old; Mean time post injury = 3-36 months; Severity: mild, moderate, severe)

  • Adequate to Excellent convergent validity of CASP with with Pediatric Quality of Life Inventory (r = 0.504 - 0.602)
  • Adequate to Excellent convergent validity of  CASP with  Adaptive Behavior Assessment System—Second Edition (ABAS-II)(r = 0.488 - 0.650)
  • p < 0.01

Content Validity

  • CASP was initially developed as a follow-up survey and later was revised based on feeback from content and measurement experts (Bedell., 2004)
  • Content validity of the Chinese version of CASP (CASP-C)  was determined by mapping items onto the ICF Activity and Participation chapters. (Hwang et al., 2013)
  • Content validity of the German version was determined by eight experts who rated comprehensibility, importance, and conceptual comprehensiveness of the instrument on a 5-point rating scale.  Conceptual comprehensiveness was rated 4.4 (88% of a maximum of 5), 4.1 (82%), 4.2 (84%), and 4.6 (91%) for all the subscales. The authors concluded that these results “corresponded to good to excellent content validity” (p.8, De Bock et al., 2019)

Floor/Ceiling Effects

Mixed Disabilities: (Hwang et al., 2013)

  • Adequate ceiling and floor effects were identified on the CASP-C. Only 5% of children obtained full scores, and only 1% of children obtained the lowest score possible.

Acquired Brain Injury : (Bedell, 2004)

  • Adequate ceiling effects: 12% (n = 7) of participants scored at ceiling
  • Adequate floor effects: 1.5% (n = 1) of participants scored at floor

Acquired and Traumatic Brain Injury: (de Kloet et al., 2015)

  • Poor ceiling effects were identified for Cohort 1, 45% of patients achieved the highest score
  • Adequate ceiling effects were identified for Cohort 2, 11% of patients achieved the highest score
  • Adequate floor effects were identified for both Cohort 1 and Cohort 2, with 0.7% (approaching excellent effects) of patients from Cohort 1 obtaining the lowest possible score and 3.7% of patients from Cohort 2 obtaining the lowest possible score

Responsiveness

Traumatic Brain Injury and Arm Injury: (Golos & Bedell, 2018)

  • Significant within group CASP score differences from pre-injury to 3 months post-injury for the moderate TBI and severe TBI groups (p < 0.001).
  • Significant time effect between groups (p < 0.001), with a significant group effect (= 0.002), both with small effect sizes (Partial η2 = 0.025; 0.029).
  • Significant interaction effect between time and type of group p = 0.021), also with a small effect size (Partial η2 = 0.013).
  • Change on post injury scores over time:
    • Arm group: no significant score differences were found over time (p > 0.05)
    • Mild TBI group: significant increases in scores from 3 months to 12 months (p < 0.05) and 3 months to 36 months (p < 0.001)
    • Moderate TBI group: no significant score differences were found over time, but a difference (increase) that approached significance was found from 3 months to 36 months (p = 0.056)
    • Severe TBI group: significant score differences (increases) were found from 3 months to 12 months (p = 0.01) and from 3 months to 24 months (p < 0.05)

Bibliography

Bedell, G. (2009). Further validation of the Child and Adolescent Scale of Participation (CASP). Developmental Neurorehabilitation, 12(5), 342-351. https://doi.org/10.3109/17518420903087277

Bedell, G. (2011, August 19). The Child and Adolescent Scale of Participation (CASP) administration and scoring guidelines. Gary Bedell Measurement Tools. http://sites.tufts.edu/garybedell/files/2012/07/CASP-Administration-Scoring-Guidelines-8-19-11.pdf

Chamberon, M., Catale, C., Kerrouche, B., Touré, H., Laurent-Vannier, A., Brugel, D., Pineau-Chardon, E., Mariller, A., Benkhaled, O., Kieffer, V., Beauchamp, M., & Chevignard, M. (2016). Validation and psychometric properties of the Child and Adolescent Scale of Participation (CASP) in a sample of children with acquired brain injury. Annuals of Physical and Rehabilitation Medicine, 59(Supplement), e59-e64. https://doi.org/10.1016/j.rehab.2016.07.144

De Bock, F., Bosle, C., Graef, C., Oepen, J., Philippi, H., & Urschitz, M. S. (2019). Measuring social participation in children with chronic health conditions: Validation and reference values of the Child and Adolescent Scale of Participation (CASP) in the German context. BMC Pediatrics, 19(125), 1-13. https://doi.org/10.1186/s12887-019-1495-6

De Kloet, A. J., Berger, M. A. M., Bedell, G. M., Catsman-Berrevoets, C. E., van Markus-Doornbosch, F., & Vliet Vlieland, T. P. M. (2015). Psychometric evaluation of the Dutch language version of the Child and Family Follow-up Survey. Developmental Neurorehabilitation, 18(6), 357-364. https://doi.org/10.3109/17518423.2013.850749

Golos, A., & Bedell, G. (2016). Psychometric properties of the Child and Adolescent Scale of Participation (CASP) across a 3-year period for children and youth with traumatic brain injury. NeuroRehabilitation, 38(4), 311-319. http://dx.doi.org.offcampus.lib.washington.edu/10.3233/NRE-161322

Golos, A., & Bedell, G. (2018). Responsiveness and discriminant validity of the Child and Adolescent Scale of Participation across three years for children and youth with traumatic brain injury. Developmental Neurorehabilitation, 21(7), 431-438. https://doi.org/10.1080/17518423.2017.1342711

Hwang, A. W., Liou, T. H., Bedell, G. M., Kang, L. J., Chen, W. C., Yen, C. F., Chang, K. H., Liao, H. F., & Component Task Force of Disability Evaluation System. (2013). Psychometric properties of the Child and Adolescent Scale of Participation – Traditional Chinese version. International Journal of Rehabilitation Research, 36(3), 211-220. https://doi.org/10.1097/MRR.0b013e32835d0b27

McDougall, J., Bedell, G., & Wright, V. (2013). The youth report version of the Child and Adolescent Scale of Participation (CASP): Assessment of psychometric properties and comparison with parent report. Child: Care, Health, and Development, 39(4), 512-522. https://doi.org/10.1111/cch.12050

Resch, C., van Kruijsbergen, M., Ketelaar, M., Hurks, P., Adair, B., Imms, C., de Kloet, A., Piskur, B., & van Heugten, C. (2020). Assessing participation of children with acquired brain injury and cerebral palsy: A systematic review of measurement properties. Developmental Medicine & Child Neurology, 62(4), 434-444. https://doi.org/10.1111/dmcn.14465

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