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Children's Assessment of Participation and Enjoyment & Preferences for Activities of Children

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Purpose

CAPE: Assess a child’s participation in activities outside of obligatory school activities by examining the diversity, intensity, and location of the child’s activities as well as the involvement of others and the child’s enjoyment of these activities.

PAC: Evaluates the child’s preferences for these same activities.

Link to Instrument

Instrument Details

Acronym CAPE/PAC

Area of Assessment

Life Participation
Quality of Life
Social Relationships
Patient Satisfaction

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$199.00

Diagnosis/Conditions

  • Cerebral Palsy
  • Parkinson's Disease + Neurologic Rehabilitation

Key Descriptions

  • Includes 55 activity cards
  • Can be completed as a self-administered assessment, in which the child should complete the assessment without parental assistance, or in an interview-administered format
  • CAPE Interview Administration:
    A) Sequence cards according to outline and arrange them in the appropriate order
    B) Start with an example, then proceed by asking the child if he or she has done the first activity listed in the last four months
    C) If a child responds "no," record 0 in the diversity column
    D) If a child responds "yes," record 1 and proceed to the subsequent dimensions
    E) Record responses and score each measure
  • Each activity card explores and scores the 5 domains and their respective scales below:
  • Diversity: "Have you done this activity in the past 4 months?"
    (1) yes
    (0) no
  • Intensity: "If yes, how often?"
    (1) 1 time in the past 4 months
    (2) 2 times in the past 4 months
    (3) 1 time a month
    (4) 2-3 times a month
    (5) 1 time a week
    (6) 2-3 times a week
    (7) 1 time a day or more
  • With Whom: "With whom do you do this most often?"
    (1) alone
    (2) with family
    (3) with other relatives
    (4) with friends
    (5) with others
  • Where: "Where do you do this most often?"
    (1) at home
    (2) at a relative's home
    (3) in your neighborhood
    (4) at school (but not during classes)
    (5) in your community
    (6) beyond your community
  • Enjoyment: "How much do you like doing this activity?"
    (1) not at all
    (2) somewhat, sort of
    (3) pretty much
    (4) very much
    (5) love it
  • PAC Interview Administration:
    1) Remove Category Cards from stack of Activity Cards
    2) Place PAC cue cards visibly in front of the child and in the appropriate order
    3) Allow the child to sort the Activity Cards into three stacks that correspond to the three cue cards: (1) I would not like to do at all, (2) I would sort of like to do, or (3) I would really like to do
    4) Record responses and score each measure

Number of Items

CAPE: 55 items

PAC: 55 items

Equipment Required

  • Writing utensil
  • Summary score sheets
  • Assessment manual for administration and scoring
  • Record forms booklet
  • Activity cards (55)
  • Category cards (10)
  • PAC cue cards (3)
  • Photocopies of visual response pages from manual (6)

Time to Administer

45-65 minutes

CAPE: 30 to 45 minutes
PAC: 15-20 minutes

Required Training

Reading an Article/Manual

Age Ranges

Children & Adolescents

6 - 21

years

Instrument Reviewers

Initially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Shikha Bansal, Amy Early, and Caniece Leggett.

ICF Domain

Participation
Activity

Measurement Domain

Emotion

Considerations

“Children reported the intensity of participation in activities themselves. Especially for younger children, four months is a long period of time. Although research shows that even young children have a good idea about time when it is put in a meaningful context, one could imagine that reporting how often an activity is done is less accurate and could influence reliability coefficients” (Bult et al., 2010).

“Participating families primarily had an intact family unit and were middle to upper-middle class. This study’s results should be interpreted cautiously in the context of socioeconomic status” (Potvin et al., 2013).

“Clinicians should be prepared to provide structural support and visual supports to children with HFA when completing the CAPE/PAC” (Potvin et al., 2013).

“The findings emphasize that cultural validation needs to contain not only language translation but also validation of test content on the item level” (Ullenhag et al., 2012).

“The cross-cultural adaptation of CAPE allows us to carry out comparative studies and to exchange information in other languages, countries, and cultures that also have some version of the instrument” (Longo et al., 2012).

Cerebral Palsy

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Standard Error of Measurement (SEM)

CAPE:

Cerebral Palsy (CP): (Longo, Badia, Orgaz, & Verdugo, 2012; n = 27; age = [8, 18])

  • SEM for Diversity: 3.26

  • SEM for Intensity: 0.71

  • SEM for With Whom: 0.89

  • SEM for Where: 1.00

  • SEM for Enjoyment: 0.86

Minimal Detectable Change (MDC)

Cerebral Palsy (CP): (Longo et al., 2012)

Smallest detectable change (SDC):

  • SDC for Diversity: 9.01

  • SDC for Intensity: 1.96

  • SDC for With whom: 2.46

  • SDC for Where: 2.76

  • SDC for Enjoyment: 2.38

Test/Retest Reliability

CAPE:

Cerebral Palsy (CP): (Longo et al., 2012)

  • Adequate test-retest reliability for Diversity (ICC = 0.54)

  • Adequate test-retest reliability for Intensity (ICC = 0.74)

  • Adequate test-retest reliability for With Whom (ICC = 0.71)

  • Excellent test-retest reliability for Where (ICC = 0.76)

  • Excellent test-retest reliability for Enjoyment (ICC = 0.80)

Criterion Validity (Predictive/Concurrent)

Cerebral Palsy: (Sakzewski, Boyd, & Ziviani, 2007; age = [5, 13])

  • Not Established

Construct Validity

CAPE:

Cerebral Palsy (King, King, Rosenbaum, Kertoy, Law, & Hurley, 2004; Sakzewski et al., 2007; Longo et al., 2012)

  • Small to moderate correlation between Participation Intensity and Environment, Family, and Child variables. CAPE activity types differentiate among different groups.

  • Poor compared with environment, family, and child variables with CP (r = [0.10, 0.20]).

  • Significant positive relations were obtained among three domains of CAPE: Diversity, Intensity and Enjoyment.

  • Significant differences (discriminant validity) favoring typically developing children and adolescents in the Diversity and Intensity domains were observed.

Responsiveness

Not Established among children with Cerebral Palsy aged 5 to 13 (Sakzewski et al., 2007)

Non-Specific Patient Population

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Standard Error of Measurement (SEM)

CAPE:

Typically Developing Children: (Fink, Gebhard, Erdwelns, Haddenhorst, & Nowak, 2016; n = 120; age = [12, 18]; German Version)

  • SEM for Diversity: 3.43

  • SEM for Intensity: 0.40

  • SEM for Enjoyment: 0.26

PAC:

Typically Developing Children: (Fink et al., 2016; n = 120; age = [12, 18]; German Version)

  • SEM for Preference: 0.11

Minimal Detectable Change (MDC)

CAPE:

Typically Developing Children: (Fink et al., 2016)

Smallest Detectable Change (SDC)

  • SDC for Diversity: 9.51

  • SDC for Intensity: 1.10

  • SDC for Enjoyment: 0.73

PAC:

Typically Developing Children: (Fink et al., 2016)

Smallest detectable change (SDC)

  • SDC for Preference: 0.30

Test/Retest Reliability

CAPE:

Typically Developing Children: (Potvin, Snider, Prelock, Kehayla, & Wood, 2013; n = 13; age = [7, 13])

  • Adequate test-retest reliability for Social Aspect (ICC = 0.65)

  • Adequate test-retest reliability for Diversity (ICC = 0.65)

  • Adequate test-retest reliability for Intensity (ICC = 0.65)

  • Adequate test-retest reliability for Location (ICC = 0.55)

  • Adequate test-retest reliability for Enjoyment (ICC = 0.56)

Typically Developing Children: (Fink et al., 2016)

  • Adequate overall test-retest reliability for Diversity (ICC = 0.65)

  • Adequate overall test-retest reliability for Intensity (ICC = 0.66)

  • Adequate overall test-retest reliability for Enjoyment (ICC = 0.58)

PAC:

Typically Developing Children: (Potvin et al., 2013)

  • Adequate test-retest reliability for Preference (ICC = 0.73)

Typically Developing Children: (Fink et al., 2016)

  • Excellent test-retest reliability for Preference (ICC = 0.83)

Internal Consistency

CAPE:

Children without Disabilities: (Ullenhag, Almqvist, Granlund, & Krumlinde-Sundholm, 2012; n = 337; age = [6, 17]; Dutch sample)

  • Poor internal consistency for Skill-based Activities (Cronbach’s alpha = 0.58)

  • Poor internal consistency for Self-improvement (Cronbach’s alpha = 0.62)

  • Poor internal consistency for Social Activities (Cronbach’s alpha = 0.66)

  • Poor internal consistency for Physical Activities (Cronbach’s alpha = 0.68)

  • Excellent internal consistency for Recreational Activities (Cronbach’s alpha = 0.81)

Typically Developing Children: (Anastasiadi & Tzetzis, 2013; n = 253; age = [6, 21]; Greek version)

  • Poor internal consistency (Cronbach’s alpha = 0.64)

Typically Developing Children: (Anastasiadi, 2013)

  • Excellent internal consistency (Cronbach’s alpha = 0.92)

Responsiveness

Effect size was calculated in order to explore the differences between typically developing children and children with disabilities. The Diversity scale showed an effect size of 0.46, considered a medium effect. The Intensity (0.28), With Whom (0.22), and Where (0.28) scales all showed a small effect size (Colón, Rodríguez, Ito, & Reed, 2008).

Pediatric Disorders

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Standard Error of Measurement (SEM)

CAPE:

Children with Physical Disabilities: (Bult, Verschueren, Gorter, Jongmans, Piskur, & Ketelaar, 2010; n = 71; age = [6, 18])

  • SEM for Recreational Activities: 0.57

  • SEM for Physical Activities: 0.41

  • SEM for Social Activities: 0.67

  • SEM for Skill-based Activities: 0.42

  • SEM for Self-improvement Activities: 0.62

Children with Disabilities or Chronic Conditions (Fink et al., 2016)

  • SEM for Diversity: 4.25

  • SEM for Intensity: 0.22

  • SEM for Enjoyment: 0.30

PAC:

Children with Disabilities or Chronic Conditions (Fink et al., 2016)

  • SEM for Preference: 0.13

Minimal Detectable Change (MDC)

CAPE:

Children with Physical Disabilities: (Bult et al., 2010)

Smallest Detectable Change (SDC)

  • SDC for Recreational Activities: 1.58

  • SDC for Physical Activities: 1.14

  • SDC for Social Activities: 1.86

  • SDC for Skill-based Activities: 1.16

  • SDC for Self-improvement Activities: 1.72

Children with Disabilities or Chronic Conditions: (Fink et al., 2016)

Smallest Detectable Change (SDC)

  • SDC for Diversity: 11.77

  • SDC for Intensity: 0.60

  • SDC for Enjoyment: 0.82

PAC:

Children with Disabilities or Chronic Conditions (Fink et al., 2016)

Smallest Detectable Change (SDC)

  • SDC for Preference: 0.36

Test/Retest Reliability

CAPE:

Children with High Functioning Autism (HFA): (Potvin et al., 2013; n = 14; age = [7, 13])

  • Adequate test-retest reliability for Diversity (ICC = 0.73)

  • Excellent test-retest reliability for Intensity (ICC = 0.75)

  • Poor test-retest reliability for Social Aspect (ICC = 0.20)

  • Adequate test-retest reliability for Location (ICC = 0.72)

  • Excellent test-retest reliability for Enjoyment (ICC = 0.76)

Children with Disabilities or Chronic Conditions: (Fink et al., 2016)

  • Adequate overall test-retest reliability for Diversity (ICC = 0.68)

  • Excellent overall test-retest reliability for Intensity (ICC = 0.80)

  • Adequate overall test-retest reliability for Enjoyment (ICC = 0.59)

Children with Physical Disabilities: (Bult et al., 2010)

  • Adequate test-retest reliability for Recreational Activities (ICC = 0.71)

  • Adequate test-retest reliability for Physical Activities (ICC = 0.68)

  • Adequate test-retest reliability for Social Activities (ICC = 0.61)

  • Excellent test-retest reliability for Skill-based Activities (ICC = 0.78)

  • Adequate test-retest reliability for Self-improvement Activities (ICC = 0.72)

Children with Disabilities: (King et al., 2004; n = 48; age [6, 14])

Diversity

  • Adequate test-retest reliability for Recreational Activities (ICC = 0.70)

  • Excellent test-retest reliability for Physical Activities (ICC = 0.78)

  • Adequate test-retest reliability for Social Activities (ICC = 0.74)

  • Adequate test-retest reliability for Skill-based Activities (ICC = 0.67)

  • Excellent test-retest reliability for Self-improvement Activities (ICC = 0.77)

Intensity

  • Adequate test-retest reliability for Recreational Activities (ICC = 0.74)

  • Excellent test-retest reliability for Physical Activities (ICC = 0.81)

  • Adequate test-retest reliability for Social Activities (ICC = 0.72)

  • Adequate test-retest reliability for Skill-based Activities (ICC = 0.73)

  • Excellent test-retest reliability for Self-improvement Activities (ICC = 0.79)

Enjoyment

  • Adequate test-retest reliability for Recreational Activities (ICC = 0.73)

  • Poor test-retest reliability for Physical Activities (ICC = 0.12)

  • Adequate test-retest reliability for Social Activities (ICC = 0.57)

  • Adequate test-retest reliability for Skill-based Activities (ICC = 0.41)

  • Adequate test-retest reliability for Self-improvement Activities (ICC = 0.40)

PAC:

Children with High Functioning Autism (HFA): (Potvin et al., 2013)

  • Adequate test-retest reliability for Preference (ICC = 0.69)

Children with Disabilities or Chronic Conditions: (Fink et al., 2016)

  • Excellent test-retest reliability for Preference (ICC = 0.83)

Interrater/Intrarater Reliability

CAPE:

Children with Physical Disabilities: (Bult et al., 2010)

  • Excellent interrater reliability for Recreational Activities (ICC = 0.75)

  • Adequate interrater reliability for Physical Activities (ICC = 0.66)

  • Adequate interrater reliability for Social Activities (ICC = 0.65)

  • Excellent interrater reliability for Skill-based Activities (ICC = 0.83)

  • Adequate interrater reliability for Self-improvement Activities (ICC = 0.72)

Internal Consistency

CAPE:

Children with Disabilities: (Colón et al., 2008; n = 249; age = [6, 15]; Spanish sample)

  • Adequate internal consistency overall (Cronbach’s alpha = 0.85)

  • Adequate internal consistency for Informal Domain (Cronbach’s alpha = 0.84)

  • Poor internal consistency for Formal Domain (Cronbach’s alpha = 0.46)

Children with Disabilities: (King et al., 2004)

Time 1:

  • Poor internal consistency for Recreational Activities (Cronbach’s alpha = 0.61)

  • Poor internal consistency for Physical Activities (Cronbach’s alpha = 0.42)

  • Poor internal consistency for Social Activities (Cronbach’s alpha = 0.62)

  • Poor internal consistency for Skill-based Activities (Cronbach’s alpha = 0.32)

  • Poor internal consistency for Self-improvement Activities (Cronbach’s alpha = 0.48)

Time 2:

  • Poor internal consistency for Recreational Activities (Cronbach’s alpha= 0.65)

  • Poor internal consistency for Physical Activities (Cronbach’s alpha = 0.52)

  • Poor internal consistency for Social Activities (Cronbach’s alpha = 0.62)

  • Poor internal consistency for Skill-based Activities (Cronbach’s alpha = 0.30)

  • Poor internal consistency for Self-improvement Activities (Cronbach’s alpha = 0.46)

PAC:

Children with Disabilities: (Colón et al., 2008)

  • Excellent internal consistency for overall scale (Cronbach’s alpha = 0.92)

  • Excellent internal consistency for Formal Domain (Cronbach’s alpha = 0.90)

  • Adequate internal consistency for Informal Domain Cronbach’s alpha = 0.70)

Children with Disabilities: (King et al., 2004)

Time 1:

  • Adequate internal consistency for Recreational Activities (Cronbach’s alpha = 0.70)

  • Adequate internal consistency for Physical Activities (Cronbach’s alpha = .74)

  • Poor internal consistency for Social Activities (Cronbach’s alpha = 0.67)

  • Adequate internal consistency for Skill-based Activities (Cronbach’s alpha = 0.75)

  • Adequate internal consistency for Self-improvement Activities (Cronbach’s alpha = 0.74)

Time 2:

  • Adequate internal consistency for Recreational Activities (Cronbach’s alpha = 0.74)

  • Adequate internal consistency for Physical Activities (Cronbach’s alpha = 0.75)

  • Poor internal consistency for Social Activities (Cronbach’s alpha = 0.68)

  • Adequate internal consistency for Skill-based Activities (Cronbach’s alpha = 0.77)

  • Adequate internal consistency for Self-improvement Activities (Cronbach’s al

Criterion Validity (Predictive/Concurrent)

Children with Disabilities: (King et al., 2004)

  • Poor criterion validity comparison with Self-perception Profile for Children and Self-perception Profile for Adolescents with Cerebral Palsy (r = [0.15, 0.24])

Construct Validity

CAPE:

Children with Physical Disabilities: (Bult et al., 2010)

  • Small to moderate correlations were found between CAPE scores and several child, family and environmental factors.

Children with Disabilities: (King et al., 2004)

  • Poor to adequate construct validity correlations among activity types are low (r = [0.22, 0.44])

  • Adequate construct validity correlations between Active Physical Activities and Social Activities (r = 0.44)

  • Adequate construct validity correlations between Active Physical Activities and Recreational Activities (r = 0.40)

PAC:

Children with Disabilities: (King et al., 2004)

  • Poor to adequate construct validity correlations among PAC Preference Scores for given activity types (r = [0.27, 0.55])

  • Adequate construct validity correlations found between Skill-Based Activities and Self-Improvement Activities (r = 0.55)

  • Poor correlations between Self-Improvement Activities and Active Physical Activities (r = 0.27)

  • Poor correlations between Self-Improvement Activities and Social Activities (r = 0.30)

Content Validity

CAPE:

High Functioning Autism (HFA): (Potvin et al., 2013)

  • Adequate content validity (reported qualitatively)

PAC:

High Functioning Autism (HFA): (Potvin et al., 2013)

  • Adequate content validity (reported qualitatively)

Responsiveness

Effect sizes were calculated in order to explore the differences between typically developing children and children with disabilities. The Diversity scale showed a medium effect size of 0.46. The Intensity (0.28), With Whom (0.22), and Where (0.28) scales all showed small effect sizes (Colon et al., 2008).

Bibliography

Anastasiadi, I. & Tzetzis, G. (2013). Construct validation of the Greek version of the Children’s Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC). ​Journal of Physical Activity and Health, 10, ​523-532. https://www.ncbi.nlm.nih.gov/pubmed/22977221

Bult, M. K., Verschuren, O., Gorter, J. W., Jongmans, M. J., Piskur, B., & Ketelaar, M. (2010). Cross-cultural validation and psychometric evaluation of the Dutch language version of the Children’s Assessment of Participation and Enjoyment (CAPE) in children with and without physical disabilities. ​Clinical Rehabilitation, 24​(9), 843-853. https://doi.org/10.1177/0269215510367545

Colón, W. I., Rodríguez, C., Ito, M., & Reed, C. N. (2008). Psychometric evaluation of the Spanish version of the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children. ​Occupational Therapy International, 15​(2), 100–113. https://doi.org/10.1002/oti.250

Fink, A., Gebhard, B., Erdweins, S., Haddenhorst, L., & Nowak, S. (2016). Reliability of the German version of the Children’s Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC). ​Child: Care, Health and Development, 42​(5), 683-691. https://doi.org/10.1111/cch.12360

Imms, C., Froude, E., Adair, B., & Shields, N. (2016). A descriptive study of the participation of children and adolescents in activities outside of school. ​BMC Pediatrics, 16​(1), 84. https://doi.org/10.1186/s12887-016-0623-9

King, G. A., King, S., Rosenbaum, P., Kertoy, M., Law, M., & Hurley, P. (2004). CAPE/PAC manual: Children's Assessment of Participation and Enjoyment & Preferences for Activities of Children. San Antonio, TX: PsychCorp.

King, G. A., Law, M., King, S., Hurley, P., Hanna, S., Kertoy, M., & Rosenbaum, P. (2006). Measuring children's participation in recreation and leisure activities: Construct validation of the CAPE and PAC. ​Child Care, Health and Development, 33​(1), 28–39. https://doi.org/10.1111/j.1365-2214.2006.00613.x

Longo, E., Badia, M., Orgaz, B., & Verdugo, M. A. (2012). Cross-cultural validation of the Children's Assessment of Participation and Enjoyment (CAPE) in Spain. ​Child Care, Health & Development, 40​(2), 231–241. https://doi.org/10.1111/cch.12012

Potvin, M. C., Snider, L., Prelock, P., Kehayia, E., & Wood, D. S. (2013). Children's Assessment of Participation and Enjoyment/Preference for Activities of Children: Psychometric properties in a population with High-Functioning Autism. American Journal of Occupational Therapy, 67​(2), 209–217. https://doi.org/10.5014/ajot.2013.006288

Sakzewski, L., Boyd, R., & Ziviani, J. (2007). Clinimetric properties of participation measures for 5- to 13-year-old children with Cerebral Palsy: A systematic review.​ Developmental Medicine and Child Neurology, 49​(3), 232-240. https://doi.org/10.1111/j.1469-8749.2007.00232.x

Ullenhag, A., Almqvist, L., Granlund, M., & Krumlinde-Sundholm, L. (2012). Cultural validity of the Children's Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC). ​Scandinavian Journal of Occupational Therapy, 19​(5), 428–438. https://doi.org/10.3109/11038128.2011.631218

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