教育情境下智力与发展性残疾儿童的功能和适应性行为评估：基于ICF评估内容和心理测量特性研究

doi:10.3969/j.issn.1006-9771.2024.03.001

Abstract

Abstract:

Objective To explore the content and the psychometric properties of assessment tools used for evaluating functioning and adaptive behavior in school-age children with intellectual and developmental disabilities within educational settings.

Methods The most used assessment tools included Vineland Adaptive Behavior Scales (VABS), Supports Intensity Scale for Children (SIS-C), Strengths and Difficulties Questionnaire (SDQ) and Repetitive Behavior Scale-Revised (RBS-R), for assessing functioning and adaptive behavior children with intellectual and developmental disabilities. Employing the framework and methods of the International Classification of Functioning, Disability, and Health (ICF), this research encoded and categorized the assessment dimensions and items of the four tools, and explored their psychometric properties.

Results VABS's assessment content was solely focused on activities and participation, including speaking (d330), conversation (d350), toileting (d530), eating (d550), drinking (d560), basic interpersonal interactions (d710), complex interpersonal interactions (d720), changing and maintaining body positions (d410-d429), carrying, moving and handing objects (d430-d449), and walking and moving (d450-d469). SIS-C assessed activities and participation, and environmental factors, including washing oneself (d510), caring for body parts (d520), community life (d910), using transportation (d470), school education (d820), basic learning (d130-d159), looking after one's health (d570), basic interpersonal interactions (d710), and products and technology for education (e130). SDQ focused on body functions, and activities and participation, including emotional functions (b152), global psychosocial functions (b122), attention functions (b140), and basic interpersonal interactions (d710). RBS-R focused on body functions, and activities and participation, including involuntary movement reaction functions (b755), involuntary movement functions (b765), looking after one's health (d570), energy and drive functions (b130), undertaking a single task (d210), carrying out daily routine (d230), attention functions (b140), and handling stress and other psychological demands (d240). VABS was characterized by good specificity and excellent sensitivity. SIS-C demonstrated very good internal consistency, reliability and validity. SDQ was good in internal consistency, with excellent credibility and validity. RBS-R showed good internal consistency, reliability and validity.

Conclusion SDQ and RBS-R cover both body functions, and activities and participation, SIS-C covers activity and participation, and environmental factors, while VABS solely assesses activities and participation. In terms of body functions, the assessment items primarily focus on mental functions (b130-b189) and movement functions (b750-b799). For activities and participation, the tools assess content across eight domains of functioning. Regarding environmental factors, the assessment content mainly includes products and technology for education (e130), as well as design, construction and building products and technology of buildings for public use (e150). VABS, SIS-C, SDQ, and RBS-R are all norm-referenced measures, with moderate to excellent internal consistency, and good to excellent reliability and validity.

Key words: intellectual and developmental disabilities, functioning, adaptive behavior, psychometric properties, assessment tool

CLC Number:

R494

ZHANG Qing, SUN Jiangang, YANG Hongrong, GAO Shaoyu, WU Aihong, WANG Yongli. Research on content and psychometric properties of evaluations of functioning and adaptive behaviors in children with intellectual and developmental disabilities in educational settings using ICF[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 249-256.

Figures/Tables 2

Table 1

Content analysis of measurements using ICF"

评估工具	评估维度与评估项目	ICF编码
VABS	沟通能力：评估个体的口头和非口头沟通技能	言语表达(d330)、交谈(d350)
	日常生活技能：评估个体在个人自理、家务和社区生活中的能力	盥洗自身(d510)、护理身体各部(d520)、如厕(d530)、吃(d550)、喝(d560)、照顾个人的健康(d570)、做家务(d640)
	社交技能：评估个体在人际交往、休闲活动和应对能力方面的表现	基本人际交往(d710)、复杂人际交往(d720)
	运动技能：评估幼儿的粗大运动和精细运动技能(通常适用于较小的儿童)	改变和维持身体姿势(d410-d429)，搬运、移动和操纵物体(d430-d449)，步行和移动(d450-d469)
SIS-C	家庭生活活动：评估在家庭环境中进行的日常活动，如饮食、个人卫生	盥洗自身(d510)、护理身体各部(d520)、如厕(d530)、吃(d550)、喝(d560)、照顾个人的健康(d570)、做家务(d640)
	社区生活活动：评估在社区环境中的参与，如使用公共交通、购物	社区生活(d910)、利用交通工具(d470)、获得商品和服务(d620)、基本经济交易(d860)
	学校参与活动：评估在学校环境中的参与以及所需要的支持、在校期间获取知识和/或技能有关的活动	学校教育(d820)、基本学习(d130-d159)、应用知识(d160-d179)、其他特指的学习和应用知识(d198)、学习和应用知识，未特指(d199)
	健康和安全：评估个体在健康维护和安全方面的需求	照顾个人的健康(d570)
	社交参与：评估个体在社交活动方面的需求	基本人际交往(d710)、复杂人际交往(d720)、社会活动(d9205)
	辅助性支持：评估个体在使用辅助工具和技术方面的需求	教育产品和技术(e130) 公共建筑的设计、建造和建筑产品和技术(e150)
SDQ	情绪症状	气质和人格功能(b126)、情感功能(b152)
	行为问题	整体心理社会功能(b122)、高水平认知功能(b164)
	多动/注意力问题	注意力功能(b140)、高水平认知功能(b164)
	同伴关系问题	基本人际交往(d710)、复杂人际交往(d720)
	亲社会行为	整体心理社会功能(b122)、基本人际交往(d710)
RBS-R	刻板行为：评估重复性的身体动作，如摇摆、扭动	不随意运动反应功能(b755)、不随意运动功能(b765)、改变和维持身体位置(d410-d429)
	自伤行为：评估自我伤害的行为，如咬自己	照顾个人的健康(d570)
	强迫行为：评估强迫性的仪式行为，如反复检查物品	能量和驱力功能(b130)、从事单项任务(d210)
	仪式化行为：评估日常活动中的固定程序，如以特定顺序进行活动	进行日常事务(d230)
	受限行为：评估对特定兴趣或活动的过度专注	注意力功能(b140)、控制应激和其他心理需求(d240)
	撤回行为：评估与社交撤回相关的行为，如避免眼神接触	复杂人际交往(d720)

Table 1

Table 2

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评估工具	主要内容	适应人群	评估性质	心理测量特性	心理测量特性指标
VABS	沟通能力日常生活技能社交技能运动技能	从出生到90岁： 1.智力和发育障碍； 2.ASD； 3.多动症； 4.脑外伤； 5.听力障碍； 6.痴呆症/阿尔茨海默病	常模参照测量	特异性良好，敏感性优秀	1.特异性86% 2.敏感性92%^[15]
VABS	沟通能力日常生活技能社交技能运动技能		常模参照测量	特异性良好，敏感性优秀，诊断效果中等~优秀	1.特异性87% 2.敏感性98% 3. AUC：0.89(95%CI 0.79~0.93)^[16]
SIS-C	家庭生活活动社区生活活动学校参与活动健康和安全社交参与辅助性支持	5~16岁IDD儿童和青少年	常模参照测量	内部一致性非常好，效度中等~良好	1.Cronbach α = 0.93~0.95 2.建构效度0.61~0.85 (P < 0.01)^[19]
SIS-C	家庭生活活动社区生活活动学校参与活动健康和安全社交参与辅助性支持	5~16岁IDD儿童和青少年	常模参照测量	内部一致性非常好，各领域得分之间呈中度~强的相关性，构建效度中等~优秀	1.Cronbach α = 0.93~0.99 2.效标关联效度0.70~0.94 (P < 0.01) 3.建构效度0.66~0.94 (P < 0.01)^[20]
SDQ	情绪症状行为问题多动/注意力问题同伴关系问题亲社会行为	3~17岁的儿童和青少年	常模参照测量	内部一致性优秀，建构效度良好~优秀，诊断效果良好~优秀	1. Cronbach α = 0.89~0.94 2.建构效度0.89~0.97 (P < 0.01) 3. AUC：0.88 (95%CI 0.84~0.91) (P < 0.001)^[23]
SDQ	情绪症状行为问题多动/注意力问题同伴关系问题亲社会行为	3~17岁的儿童和青少年	常模参照测量	内部一致性一般~良好	Cronbach α = 0.53~0.86^[24]
RBS-R	刻板行为自伤行为强迫行为仪式化行为受限行为撤回行为	6~17岁儿童	常模参照测量	内部一致性优秀，模型拟合度优秀	1. Cronbach α = 0.90~0.99 2. CFI > 0.97, GFI > 0.95, RMSEA <0.05^[26]
RBS-R	刻板行为自伤行为强迫行为仪式化行为受限行为撤回行为	6~17岁儿童	常模参照测量	内部一致性中等~优秀，重测信度非常优秀	1. Cronbach α = 0.70~0.93 2. 重测信度：ICC = 0.96~0.98 (P < 0.001)^[27]

Research on content and psychometric properties of evaluations of functioning and adaptive behaviors in children with intellectual and developmental disabilities in educational settings using ICF

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