Primary Image

Preschool Activity Card Sort

Preschool Activity Card Sort

Last Updated


The PACS measures preschool age children’s participation in various age-appropriate activities, which can aid developing their occupational profile or identifying gaps in certain areas.

Acronym PACS

Area of Assessment

Activities of Daily Living
Executive Functioning
General Health
Infant & Child Development
Life Participation
Reasoning/Problem Solving
Social Relationships
Social Support
Upper Extremity Function

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil


Not Free

Actual Cost


Key Descriptions

  • The Preschool Activity Card is a semi-structured ecological assessment that parents can use to measure participation of their preschool children.
  • A parent is interviewed about their child by responding to the question “Does your child participate in this activity?” in relation to 85 photographs, which depict various activities typical for preschool aged children.
  • Activity cards are categorized into seven domains:
    1) Self-Care
    2) Community Mobility
    3) High Demand Leisure
    4) Low Demand Leisure
    5) Social Interaction
    6) Domestic Activities
    7) Education
  • For each activity photo, the parent can respond with the following options:
    A) Yes, my child participates (does not require independence)
    B) Yes, with adult assistance (beyond that customarily offered to a preschooler)
    C) Yes, with environmental accommodation
    D) No, my child does not participate

Number of Items


Equipment Required

  • PACS cards
  • Preschool Activity Card Sort database
  • Pencil or pen

Time to Administer

31-60 minutes

5-10 minutes per categories; up to 60 minutes total with no interruptions for all 7 categories

Required Training

No Training

Age Ranges

3 - 6


Instrument Reviewers

Initially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Emily Keating, Jackie Mats'ela, and Shoma Webster.

Body Part

Upper Extremity
Lower Extremity

ICF Domain


Measurement Domain

Activities of Daily Living
General Health


  • The original PACS did not have information on cultural considerations for the intended population (C. Berg & A. Stoffel, personal communication, March 2017).

  • A Spanish translation of the PACS is available for use with Hispanic and Latino families in the U.S (Stoffel & Berg, 2008).

  • The PACS underwent a language translation process in order to be used with preschoolers in Arabic speaking countries (Malkawi, Hamed, Abu-Dahab, Al-Heresh, & Holm, 2015).

  • Floor effects may emerge if a preschool-aged child’s activities do not match the presented activities in PACS.

Pediatric Disorders

back to Populations

Normative Data

Not established. Q-sort methodology provides an individual profile rather than any normative data.

Test/Retest Reliability

Children Aged 3-6: (Berg & LaVesser, 2006; n = 20)

  • Excellent test-retest reliability: (ICC = .93)

Interrater/Intrarater Reliability

Children Aged 3-6: (Berg & LaVesser, 2006)

  • Excellent interrater reliability: (ICC = .91)

Construct Validity

  • Construct validity of the original PACS has not been established.

  • For the Spanish translation of PACS, an initial evaluation of construct validity was evaluated by Stoffel and Berg (2008) as the measured outcome of participation was evaluated between Spanish-speaking and English-speaking families and showed early support for construct validity.

Content Validity

  • The Preschool Activity Card Sort was developed with input from 10 expert pediatric occupational therapists (OTs) and 10 parents of typically developing preschool aged children. Parents and OTs reviewed each photo for accurate representation of age appropriate activities and added captions to clarify 10 pictures’ intended interpretations. Parent reviewers discarded 4 cards because they were “not for preschoolers” and suggested 5 additional activity cards. OTs discarded 7 activity cards and added 14 (Berg & Lavesser, 2006).

  • The Arabic version of the Preschool Activity Card Sort includes 23 items and demonstrates high content validity (Malkawi, Hamed, Abu-Dahab, Al-Heresh, & Holm, 2015).


Berg, C., & LaVesser, P. (2006). The Preschool Activity Card Sort. OTJR: Occupation, Participation, Health, 26(4), 143-151.

Malkawi, S.H., Hamed, R.T., Abu-Dahab, S.M.N., Al-Heresh, R.A., & Holm, M.B. (2015). Development of the Arabic version of the Preschool Activity Card Sort (A-PACS): Arabic Preschool Activity Card Sort. Child: Care, Health and Development, 41(4), 559-568.

Phillips, R., Olds, T., Boshoff, K., & Lane, A. (2013). Measuring activity and participation in children and adolescents with disabilities: A literature review of available instruments. Australian Occupational Therapy Journal, 60, 288–300.

Schranz, C., Sood, D., & LaVesser, P. (2014). Influence of home environment on participation in home activities of children with an Autism Spectrum Disorder. The Open Journal of Occupational Therapy, 2(3), 2.

Stoffel, A., & Berg, C. (2008). Spanish translation and validation of the Preschool Activity Card Sort. Physical & Occupational Therapy in Pediatrics, 28(2), 171-189.