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RehabMeasures Instrument

Child Occupational Self Assessment v 2.2

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The Child Occupational Self Assessment (COSA) is a self-report of occupational competence and value for everyday activities influenced by components of the Model of Human Occupation (MOHO). The COSA measures how competently children feel engaging in and completing activities and the values associated with these activities (Kramer, Kielhofner, & Smith 2010).

Link to Instrument

Instrument Details

Acronym COSA

Area of Assessment

Occupational Performance

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil


Not Free

Actual Cost



  • Pediatric + Adolescent Rehabilitation

Key Descriptions

  • The COSA can be administered in 1 of 3 ways, depending on each child’s abilities:
    1) Youth rating form with pictures
    2) Youth rating form without pictures
    3) Card sort
  • Children are reminded to that there is no right or wrong answer and to pick the best choice for how they feel.
  • There is no “score” for the COSA. Therapists may use MOHO theory to interpret the COSA and select the most appropriate way to share this interpretation with others (Kramer et al., 2014).

Number of Items


Equipment Required

  • Paper and Pencil
  • Stimulus card for the Card-sort Administration

Time to Administer

25 minutes

Required Training

Reading an Article/Manual

Age Ranges


6 - 12



13 - 17


Instrument Reviewers

Initially reviewed by Kayla Smith, BA, Daiva Ragas, BA, Adam Kaltenhauser, BA, Occupational Therapy students at the University of Illinois at Chicago in April 2015.

ICF Domain



The following factors should be considered:

  • Age
  • Appropriateness of item context
  • Appropriateness of rating scale structure given youth’s abilities
  • Youth’s capacity to identify interest and reflect on performance.
  • Youth must be able to identify interests and reflect on performance; consider acuity level
  • Therapist should consider if content of items is appropriate for therapy context (e.g. most items cover everyday activities of a school-aged youth). Items may not facilitate addressing specific fine motor or vocational skills (Kramer et al., 2014); consider level of care and setting
  • Some translation inaccuracies were identified in the Dutch version of the COSA

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Pediatric Disorders

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Internal Consistency

(Keller & Kielhofner, 2005) 

  • Competence Items: Excellent (Cronbach's Alpha= .085)

  • Competence Scale: Excellent (Cronbach's Alpha= 0.88) 

  • Values Items: Excellent (Cronbach's Alpha= 0.82)

  • Values Scale: Excellent (Cronbach's Alpha= 0.91)

Floor/Ceiling Effects

(Keller & Kielhofner, 2005) 

  • Excellent: no floor/ceiling effects


Kramer, J. M., Kielhofner, G., & Smith, E. V. (2010). Validity evidence for the Child Occupational Self Assessment. American Journal of Occupational Therapy64(4), 621-632. 

Kramer, J., Ten Velden, M., Kafkes, A., Basu S., Federico J., and Kielhorner G. (2014). Child Occupational Self-Assessment (COSA) Version 2.2. Chicago, IL: The Model of Human Occupation Clearinghouse. 

Keller, J., & Kielhofner, G. (2005). Psychometric characteristics of the Child Occupational Self-Assessment (COSA), part two: Refining the psychometric properties. Scandinavian Journal of Occupational Therapy12(4), 147-158. 

Ten Velden, M., Couldrick, L., Kinébanian, A., & Sadlo, G. (2012). Dutch children’s perspectives on the constructs of the Child Occupational Self-Assessment (COSA). OTJR: Occupation, Participation, and Health, 33 (1), 50-58.