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Interrater reliability of the Evaluation of Sensory Processing (ESP)

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Interrater reliability of the Evaluation of Sensory Processing (ESP)

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Content INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand comer and continuing from left to right in equal sections with small overlaps. 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INTERRATER RELIABILITY OF THE EVALUATION OF SENSORY PROCESSING (ESP) by Chia-Chun Chang A Thesis Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF ARTS (Occupational Therapy) May 1999 © 1999 Chia-Chun Chang R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . UMI Number: 1395128 UMI Microform 1395128 Copyright 1999, by UMI Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. UMI 300 North Zeeb Road Ann Arbor, MI 48103 R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . U N IV E R SIT Y O F S O U T H E R N C A L IFO R N IA T H E G R A D U A T E S C H O O L U N IV E R S IT Y P A R K L O S A N G E L E S . C A L IF O R N IA 80007 This thesis, w ritten by CHIA-CHUN CHANG under the direction o f hJsL— Thesis Committee, and approved by a ll its members, has been pre sented to and accepted by the D ean of The G raduate School, in pa rtia l fulfillm ent of the requirements for the degree of MASTER OF ARTS j j ate February I, 1999 THESIS COMMITTEE C hairm an f r ryv-v '.k ts \ \ \ R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . ACKNOWLEDGEMENTS u Special thanks are extend to my thesis chair Diane Parham, Ph.D. for her wisdom, guidance and patience through the challenging stages of this entire process. I am deeply indebted to my thesis committee members Ruth Zemke, Ph.D. and Diane Kellgrew, Ph.D. for their knowledge and valued advice in the completion of this thesis. I am very grateful for the willing cooperation of parents, and for the invaluable assistance of Zoe Mailloux, Ema Blanche, Susan Knox, and Sue Trautman, and staffs o f these OT clinics that participated in the study. I also wish to express gratitude to Mallisa Willison for her consultation for statistic analysis and Teresa Lee for her assistance of paper editing. Most of all, I want to thank my families, whose incredible love, support, and encouragement, assist me going through the hardest of times and kept me moving forward to pursue higher academic achievement. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . TABLE OF CONTENTS ACKNOWLEDGEMENTS.................................................................................................. ii LIST OF TABLES...................................................................................................................v ABSTRACT...........................................................................................................................vi CHAPTER I. THE PROBLEM ..........................................................................................................1 Rationale and Significance of the study.......................................................... 1 Assumptions...................................................................................................... 4 Limitations......................................................................................................... 5 II. LITERATURE REVIEW ....................................................................................... 6 Introduction........................................................................................................ 6 Validity & Reliability...................................................................................... 6 V a lid ity .................................................................................................... 7 R eliability..................................... 8 Other Sensory History Questionnaires...........................................................17 Introduction............................................................................................. 17 Touch Inventory for Elementary-School-aged Children........................ 17 Touch Inventory for Preschoolers...........................................................19 Knickerbocker Sensorimotor History Questionnaire...........................21 Sensory Profile..........................................................................................21 The Sensory Rating Scale for Infants and Young Children.................. 23 S um m ary................................................................................................25 The Evaluation of Sensory Processing (ESP) Questionnaire........................26 Description of the E S P ........................................................................... 26 Purpose of the E S P ................................................................................. 27 Development of the E S P ........................................................................28 Validity of the E S P ................................................................................ 32 Reliability of the E SP.............................................................................35 S um m ary................................................................................................35 Conclusion......................................................................................................37 R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . IE. METHODOLOGY Introduction.................................................................................................... 39 Subjects...........................................................................................................39 Instrument...................................................................................................... 42 Procedure....................................................................................................... 42 Data Analysis.................................................................................................. 44 IV. RESULTS..................................................................................................................47 Introduction.................................................................................................. 47 Percentages of Agreement . 47 Correlations Between Fathers’ and Mothers’ Item S c o res........................... 49 Internal Consistency........................................................................................57 V. DISCUSSION....................................................................................................... 60 Introduction...................................................................................................... 60 Percentages of A greem ent............................................................................. 60 ICC and Spearman Correlation Coefficients.................................................. 61 Differences in Parental Agreement Between Typically Developing and SI Dysfunction G roups........................................................................................62 Lim itations...................................................................................................... 63 Implication and Future S tudies......................................................................64 REFERENCES.......................................................................................................................66 APPENDIX............................................................................................................................. 73 A. Evaluation Sensory Processing Questionnaire (Version 3 ) ................................. 73 B. Parents Q uestionnaire...........................................................................................82 C. Consent to Participate in R e se arch ......................................................................84 D. Cover Letter............................................................................................................ 88 E. The Range, Means, Standard Deviation of Parents Item Scores........................90 R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . LIST OF TABLES V 1. Original and Revised Tables of Specifications........................................................ 29 2. Internal Consistency of ESP-Version 2 (Parham, 1 9 9 7 )........................................... 31 3. Item Distributions Across Content Domains in the Different Versions of ESP. . 32 4. Psychometric Properties of the ESP............................................................................. 36 5. Summary of demographic characteristics of both g ro u p s........................................40 6. Percentages of Agreement for Interrater Reliability Between Mothers and Fathers for the Each Sensory System of ESP and Total E SP................................................. 48 7. ICC and Spearman Correlation Coefficient in the Auditory System....................50 8. ICC and Spearman Correlation Coefficient in the Gustatory/Olfactory System ..51 9. ICC and Spearman Correlation Coefficient in the Proprioceptive System . . . . 52 10. ICC and Spearman Correlation Coefficient in the Tactile System.......................53 11. ICC and Spearman Correlation Coefficient in the Vestibular System..................... 55 12. ICC and Spearman Correlation Coefficient in the Visual System........................56 13. The numbers of items that have moderate to good reliability in ICC and Spearman correlation index......................................................................................... 58 14. Comparison of Mean Item Scores of Mothers and Fathers......................................59 15. Internal Consistency of Mothers’ and Fathers’ Ratings for the Combined Group . 60 R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . Abstract VI The purpose in this study was to explore the interrater reliability of the pilot version of the Evaluation of Sensory Processing (ESP) questionnaire. Parents of 20 typically developing children and 15 children with sensory integrative dysfunction participated in the study. Percentages of agreement, intraclass correlation coefficients (ICC), and Spearman correlation coefficients were computed to analyze the relationship between parents’ responses to items on the ESP. The means of the exact percentages o f agreement for each sensory' system and the total ESP demonstrated only fair interrater reliability, however, high agreement (>75%) was found on all sensory systems (except the visual system for the SI dysfunction group), when agreement within one level was assessed. The results of the ICC and Spearman correlation coefficient showed that although several items had moderate (>.50) to high (>.75) correlation coefficients, a large number of items contained discrepancies between parents’ ratings of their children’s behaviors. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . CHAPTER I 1 THE PROBLEM Introduction The purpose of the present study was to explore the interrater reliability of an instrument designed to assess a child’s sensory processing in the context of natural environments and situations. Fifteen children with sensory integration disorders and twenty children without any known disorders participated in the study. Their parents (both father and mother) were asked to complete the Evaluation of Sensory Processing (ESP) questionnaire. The correlation between parents’ responses on the ESP then was analyzed by calculations of percentages of agreement between parent ratings, as well as by computation of correlation coefficients. Rationale and Significance of the Study Since much of the care of children for medical and psychosocial problems depends on information obtained from parents, a few years ago several students and faculty members at the University of Southern California began developing an instrument utilizing parent report that can be used to supplement the insufficient data that comes from clinical observations and standardized evaluations in the pediatric field. The ESP, which continues to undergo development, was developed as a parent (care-giver) report assessment tool that can be used to identify and quantify children’s sensory responsiveness, as well as to help occupational therapists obtain more information from R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . different resources and build a more comprehensive picture of children. The ESP (Research Version 3) is a 185-item behavior inventory of sensory processing problems for young children. The response choices of each item are rated on a 5-point Likert-type scale (always, often, sometimes, rarely, and never). This questionnaire examines children’s responses to sensory information in the environment from six sensory systems. These subscales are the auditory, gustatory/olfactory, proprioceptive, tactile, vestibular, and visual systems. Reliability has been defined as the consistency or stability of measurement scores between raters or over repeated testing (Wilkinson & McNeil, 1996). According to Portney and Watkins (1993), “Reliability is fundamental to all aspects of clinical research, because without it we cannot have confidence in the data we collect, nor can we draw rational conclusions from those data” (p.53). The various types o f reliability can be classified as interrater reliability (agreement), test-retest reliability, intrarater reliability, and internal reliability (consistency) (Ottenbacher & Tomchek,1993). The method which is chosen to test the reliability is dependent on the character of that instrument. In general, before an instrument is considered appropriate for measurement within a given research study, the instrument developers have a responsibility to demonstrate the reliability of the scores obtained from their tool (Yegidis & Weinbach, 1996). If a newly developed evaluation tool does not demonstrate consistency under different conditions, it will not be expected to be a useful instrument. So, when the assessment data come from different sources, it is critically important to test the R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 3 consistency between responses (Bennett & Peterson, 1995). As the ESP is based on parents’ reports, the consistency between parents must be investigated. Interrater reliability is defined as the extent to which different assessors, raters, or observers agree on the scores they provide when assessing, coding, or classifying subjects’ performances (Kazdin,1991). Berk (1979) defined interrater reliability as the estimation o f agreement between or among raters. Interrater reliability is especially important when the measure is subjectively rather then objectively scored. The goal is to provide evidence that the same score would be awarded by two or more independent judges. Benson and Clark (1982) described a step-by-step process for developing a new instrument. These steps were divided into four phases: (1) Planning, (2) Construction, (3) Quantitative evaluation, (4) Validation. The development of the ESP was based on this model. LaCroix (1993) took the initial step of developing the ESP questionnaire. She reviewed numerous articles related to sensory history questionnaires and indicators of sensory processing problems, and collected questionnaire items from them. Through interviewing parents and therapists, she added several new items to be included in the sensory history questionnaire, finally generating a total 679 of items. After expert review and content validation processes using quantitative analysis, 200 items were determined to have strong content validity. These 200 items comprised the first research version of the ESP. Johnson (1996) took the second major step by using contrasting groups to examine the criterion-related validity of ESP items. Five parents participated in the pilot R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . study, which used a qualitative method to examine ESP item clarity. Based on their comments, some items were revised and some dropped. After that, parents of two groups of children (with and without sensory integration disorders) matched in age, sex, ethnicity, and socio-economic status participated in item analysis study. Parents of both groups were asked to complete the 192 items of the ESP questionnaire. Their responses were compared by using the Wilcoxon signed rank test; results indicated a significant difference between the matched groups on 84 items. A later analysis of internal consistency conducted by Parham (1997) indicated good reliability for 5 of the 7 sensory systems. According to LaCroix’s and Johnson’s initial validity studies, the ESP has strong content validity and also evidence of construct validity. However, reliability was not established beyond internal consistency, thus, an important next step is evaluating the interrater reliability of ESP questionnaire. Interrater reliability was assessed in the proposed study for a clinic-referred group and for a group of children without known or suspected disabilities. It was hypothesized that the percentages of agreement and the correlations between parents’ ratings on ESP items will demonstrate a high (> 75% agreement and r > .75) interrater reliability. Assumptions 1. Because parents are the main caregivers in the life of their child, they are ideal respondents to a child behavior questionnaire such as the ESP. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 5 2. Although in most families the mother spends more time interacting with the child than the father does, both parents are familiar enough with the child's behavior to complete the ESP. 3. A child’s behavior reflects his/her responses to sensory input. 4. The ESP can measure a child’s sensory processing functions. Limitations 1. Because the group of clinic-referred children (children with sensory integration dysfunction) was a convenience sample, the results may not be representative of other clinic-referred groups. 2. Because the children without disabilities were not randomly selected (it is a sample of convenience), this sample was not representative o f all children from 3 to 8 years of age. 3. Parents’ reports of child behavior may be influenced by their attitudes toward the child and by family interactions. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . CHAPTER H 6 LITERATURE REVIEW Introduction This chapter is divided into three sections. First, validity and reliability, critical psychometric properties o f a test, will be discussed. In addition, the types of methods for estimating the reliability o f an instrument will be described. Second, several sensory history questionnaires or surveys will be introduced, and their reliability and validity will be summarized. Third, the process of developing the ESP, including reliability and validity studies conducted previously, will be reviewed. Validity and Reliability After reviewing articles about measurement in rehabilitation professions, Johnston, Findley, DeLuca, and Katz (1991) state that “the field greatly needs more formal study of the reliability and validity of its measurement and assessment procedures” (p.l 14). As a member of the rehabilitation team, occupational therapy has a responsibility to develop reliable instrument tools and to provide reliable assessment processes (Ottenbacher & Tomchek, 1993). Generally, before an assessment tool can be accepted as an appropriate instrument for clinical use, the developer should provide some indices documenting the quality of the measurement. Reliability and validity are the most important criteria that can be used to indicate the quality of a measurement (Yegidis & Weinbach, 1996). R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . Validity refers to the degree that an instrument measures what it purports to measure (Yegidis & Weinbach, 1996), whereas reliability refers to the degree of consistency that an instrument can provide after a period of time, over repeated testing, or with use by different people (Benson & Clark, 1982; Polit & Hungler,1995). Actually, the concepts of validity and reliability are broad and each of them have several subtype categories and assessment approaches. The method that is chosen depends on not only the purpose of the research study, but also on the nature of the instrument (Benson & Clark, 1982; Polit & Hungler,1995). Validity Validity is used to meet one or more of the three following purposes : (1) “to measure achievement in a content area”, (2) “to predict performance in regard to some criterion”, and (3) “ to provide a measure of a construct” (Yegidis & Weinbach, 1996, p. 133). Validity can be classified into the three categories of content validity, criterion validity, and construct validity (Yegidis & Weinbach, 1996; Benson & Clark,1982). According to Dunn (1989) “ evidence of validity is accumulated knowledge and cannot be obtained from the results of a single investigation” (p. 152). Construct validity is defined as the degree to which an instrument measures the construct under investigation (Polit & Hungler,1995). It is the extent to which the test is shown to measure theoretical constructs or traits (Dunn, 1989). Benson & Clark (1982) state that “ construct validity is the most difficult and perhaps the most important form to obtain” (p.799). R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . Criterion validity refers to the degree to which scores on an instrument are correlated with some external criterion (Polit & Hungler,1995). When the purpose of an instrument is to measure certain characteristics or behaviors of individuals, or to predict their future performance, criterion validity is required (Benson & Clark, 1982). It can also be used when the emphasis is on testing the relationship between a newly developed instrument and other accepted instruments that measure the same variables (Benson & Clark, 1982; Polit & Hungler,1995). Often, correlation coefficients are used to demonstrate criterion validity (Yegidis & Weinbach, 1996). Content validity concerns the degree to which the content in an instrument adequately measures the construct or domain o f interest. According to Polit & Hungler (1995) “there are no completely objective methods of assuring the adequate content coverage of an instrument” (p.354). Thus, the content validity of an instrument is based on careful planning and precise execution during the development process (Polit & Hungler, 1995). Most of the time, experts in the content area are used to help define content area or to evaluate the usefulness of test items; sometimes they may even be asked to judge the content validity of that instrument (Polit & Hungler, 1995; Yegidis & Weinbach, 1996). R eliability According to Polit & Hungler (1995), the reliability of an instrument can be defined in terms of “consistency” or “accuracy”(p. 374). Based on the concept of consistency, a reliable instrument shows the same results under different conditions, R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 9 such as across raters or over time. The fewer the variations shown in the results of repeated measurements, the higher the reliability of the instrument. This may be examined by, for example, applying a test to the same subject twice during an interval of one week. In other words, we can say that “ reliability can be equated with the stability, consistency, or dependability of a measuring tool” (Polit & Hungler 1995, p.347). Before discussing reliability in terms of “accuracy,” the classical true score model should be introduced first. This model was published by Charles Spearman in 1904 (Crocker & Algina, 1986). It was expressed in the form “X = T + E” (Crocker & Algina, 1986), which means that the observed test score (X) can be considered the composite of a true score (T) component and an error o f measurement (E) component (Wilkinson & McNeil,1996; Crocker & Algina, 1986). The true score refers to a hypothetical score that would be obtained if a measurement were infallible, and therefore would not be affected by any chance factors (Polit & Hungler, 1995). The error score of measurement refers to the degree of deviation between true scores and observed scores when measuring a characteristic (Polit & Hungler, 1995). From the above equation, we find that the fewer the errors of measurement, the closer the observed test score and true score are. Hence, if an instrument can accurately reflect the true scores of the measurement, it would appear to be a reliable instrument. Maximizing the true score component and minimizing the error score can increase the reliability of a measurement (Polit & Hungler, 1995). According to Wilkinson & McNeil (1996), the reliability of a test will be affected by four measurement factors that are R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 10 sources of the error component, namely, test length, item difficulty, item choice, and group homogeneity. Several strategies may be used to improve the reliability of an instrument. Yegidis & Weinbach (1996) suggested that conducting a pilot study can help researcher to correct or refine the instrument; standardizing environmental factors and testing procedures can help prevent the occurrence of unexpected factors during the test which may influence the test result; and providing sufficient numbers of items can help reduce errors caused by too few items representing specific content. Wilkinson & McNeil (1996) report that if the test can be shown to have strong construct validity the number of ambiguous items probably will be diminished, thus errors of measurement will be reduced and reliability will increase. In general, the degree to which a measurement is reliable is usually examined by using a correlation coefficient index (Yegidis & Weinbach, 1996; Benson & Clark, 1982). The correlation coefficient index indicates the magnitude and direction of the relationship between two measurements. Usually the possible range of correlation coefficients is from -1.00 to +1.00. If the reliability score is between -1.00 and 0.00, it means that the two variables are inversely related; they have a negative relationship (Polit & Hungler, 1995). However, if the reliability score is between 0.00 to +1.00 the two variables have positive relationship, and of course, higher values indicate higher reliability (Polit & Hungler, 1995). Like validity, reliability can be assessed from different perspectives. Stability (test-retest reliability), internal consistency (homogeneity), and equivalence (parallel R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . form reliability or interrater reliability) will be discussed separately in the following sections (Polit & Hungler, 1995; Benson & Clark, 1982). However, the purpose of this study is to test the interrater reliability of ESP, so the main focus will be on interrater reliability and its unique characteristics. Test-retest reliability. The stability o f an instrument is demonstrated when the same scores are obtained after administering the same form of a test successively to the same sample group (Polit & Hungler, 1995). Stability reliability, also known as test- retest reliability (Polit & Hungler, 1995; Benson & Clark, 1982), refers to testing the same group of individuals twice using the same measuring instrument, then comparing the two sets of scores using a correlation statistical procedure (Polit & Hungler, 1995; Benson & Clark, 1982). The correlation coefficient indicates the degree of association between the two sets of scores (Polit & Hungler, 1995), so the higher the positive correlation obtained, the higher the reliability o f the instrument. Usually, if there is no reason to expect that the variable the researcher intends to measure will change, then the same results should be obtained after testing the variable with the same instrument on two separate occasions (Yedigis & Weinbach, 1996). In designing a good test-retest reliability study, the test interval between the first and second administration should be well considered, because many factors may change during this period of time (Deitz, 1989). If the time interval is too short, the memory of the first test may influence a participant’s second performance (Deitz, 1989; Polit & Hungler, 1995). However, if the time interval is too long, changes in the participant may R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 12 render the variables that are being tested inapplicable. Hence, Anastasi (1988) suggests that the time interval should not exceed six months. Generally speaking, “the longer the interval between testings, the lower the reliability” (Deitz, 1989, p. 128). Altemate-form reliability. Altemate-form reliability, also known as parallel-form or equivalence reliability, refers to the degree of similarity between alternate forms of the same instrument (Polit & Hungler, 1995). The procedure of testing parallel form reliability is to administer two forms of the same instrument to participants, but there is much debate as to the time interval between the two measures. Several authors state that the two forms should be presented in random order to participants, and tests should be administered in immediate succession (Benson & Clark, 1982; Polit & Hungler, 1995, Wilkinson & McNeil, 1996). However, Nunnally (1978) suggests an interval of two weeks between the administration of the two forms “in order to allow for the occurrence of variation in attitude and ability” (cited from Deitz, 1989, p. 130). According to Yegidis & Weinbach (1996), the two forms can be administered “with or without a delay between administration” (p. 130). If several forms are available for a measuring instrument, for example, IQ tests, Scholastic Assessment Tests (SAT), or Graduate Record Exams (GRE), the degree of correlation and consistency in the context is called into question (Yegidis & Weinbach, 1996). Usually, the Pearson correlation coefficient between the two sets of scores is used as a reliability index (Benson & Clark, 1982) to demonstrate that different versions of the instrument can produce the same results (Yegidis & Weinbach, 1996) or can measure the same variable (Polit & Hungler, 1995). In addition, this statistical method can assist the R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 13 researcher “ to assess the errors o f measurement resulting from errors in item sampling7 ' (Polit & Hungler, 1995, p.352). Internal consistency. Studies of internal consistency examine the consistency of items or subscales o f an instrument (Ottenbacher, 1995); in other words, they estimate the homogeneity of items (Deitz, 1989; Polit & Hungler, 1995) from one test administration (Wilkinson & McNeil, 1996). The index of internal consistency can demonstrate the degree to which test items are all measuring the same attribute or dimension (Polit & Hungler, 1995). It provides an estimate of the reliability of a measurement instrument when constructing an alternate form of the instrument or administering the same instrument two or more times is not applicable (Deitz, 1989). Three methods can be used to assess internal consistency (Benson & Clark, 1982; Polit & Hungler, 1995). The first and also the oldest one, is the split-half technique (Polit & Hungler, 1995 ). In this approach, the items of an instrument are divided into two equivalent halves. Several ways can be used for this process, and usually the odd- even split is adopted (Deitz, 1989; Polit & Hungler, 1995). The item scores from the two halves are then used to compute a correlation coefficient. From the above procedure, the reliability index is computed based on half of the items of the original instrument, so the result tends to “ underestimate systematically the reliability of the entire scale” (Polit & Hungler, 1995, p. 350). However, the Spearman-Brown formula can be used to correct this problem (Deitz, 1989; Polit & Hungler, 1995). R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 14 The other two methods are the coefficient alpha (also known as Cronbach’s alpha) and the Kuder-Richardson formula 20 (KR-20) (Benson & Clark, 1982; Deitz, 1989; Polit & Hungler, 1995). The KR-20, which is a special version of the coefficient alpha, can only be used for tests with dichotomously scored items (Polit & Hungler, 1995). The coefficient alpha is used for tests with multiple-scored items (Deitz, 1989). The normal range of internal consistency values falls between 0.00 and +1.00; the higher the values, the higher the degree o f consistency between items. According to Nunnally (1978), if the coefficient alpha is too low, this may be caused by an insufficient number of items contained in the test or a lack of commonality among items (Deitz, 1989). If this is the case, then the revision of the instrument is needed. Interrater reliability. Interrater reliability refers to the consistency of two or more test scores when these scores are determined by different raters or observers (Deitz, 1989). This type of reliability is especially important for observational research in which the method of data collection depends largely on raters’ judgments regarding participant performance (Polit & Hungler, 1995). Since the measurement is subjectively scored by the rater (Wilkinson & McNeil, 1996), it gives the rater considerable latitude. Thus, whether the same score can be obtained by another rater under the same circumstances is often questioned. The goal of interrater reliability is to determine the degree to which the same score would be awarded by two independent raters (Polit & Hungler, 1995; Wilkinson & McNeil, 1996). Interrater reliability can then be assessed by using statistical techniques to compute an index of equivalence or agreement. Depending on R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 15 different types of research design and different methods of data collection, researchers should choose different statistical techniques to estimate interrater reliability. In the pediatric field, the developmental researcher has traditionally used correlation statistic methods to compute the reliability index (Dunn, 1989). The Pearson product-moment correlation coefficient (r) is the most widely used correlation coefficient (Polit & Hungler, 1995). The Pearson’s r and other correlation coefficient indices can demonstrate the degree o f association or covariation between two sets of scores (Ottenbacher, 1995), and they focus on consistency across data. However, correlation methods do not demonstrate the range of agreement observed (Jacob, Grounds, & Haley, 1982; Hulbert, Gdowski, & Lachar, 1986 ). Moreover, the Pearson product- moment correlation can only measure the linear association between variables (Ottenbacher & Tomchek, 1993; Jacob, Grounds, & Haley,1982 ). Thus, a situation may be possible in which a high correlation coefficient can coexist with significant disagreement between raters, especially when the results of two set of scores are ranked in a similar order, but the actual magnitude of raters’ scores are totally different (Ottenbacher & Tomchek, 1993). Ottenbacher (1995) states that correlation coefficients only indicate consistency among raters, but do not reflect agreement. Berk (1979) also argued that it is not appropriate to use standard psychometric definitions of reliability, which are based on variance components of observed and true scores, in the analysis of interrater reliability. He advocated measuring agreement between or among raters as a more appropriate method for estimating interrater reliability, because this index can better reflect the R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 16 extent of direct agreement among raters. Agreement is defined as interchangeability among raters or assessment instruments, which can be used to test whether raters or instruments can produce the same scores (Ottenbacher, 1995). According to Ottenbacher (1995), several statistical tools can be used to assess agreement, such as percentage of agreement, Kappa, weighted Kappa, and various chance corrected measures of proportion. Percentage of agreement, which is often used in categorical data, is a simple method for assessing interrater agreement (Berk, 1979). It can prevent the covariation problem that comes with Pearson product-moment correlation, and it allows examination of agreement on individual items of a scale. However, percentage of agreement has been criticized for not considering the effects of chance agreement (Berk, 1979; Ottenbacher & Tomchek, 1993), and it tends to overestimate observer agreements (Polit & Hungler, 1995). In addition, the application of percentage of agreement is restricted to two-observer studies (Berk, 1979). After reviewing 16 different indices of interobserver agreement and six methods for estimating coefficients of interobserver reliability, Berk (1979) concluded that the intraclass correlation-generalizability theory approach seemed to be the most acceptable procedure for analyzing interrater reliability data. The intraclass correlation coefficient (ICC) is based on the analysis of variance (ANOVA) model, which can be used to estimate true and error variance components associated with the measurement process (Ottenbacher, 1995). Several advantages are reported in using ICC. First, it is appropriate for use in the assessment of quantitative (Berk, 1979) and continuous data (Ottenbacher & Tomchek, 1993). Second, it can be used with more than two sets of data; R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 17 for example, more than two raters, one rater over several trials, or more than two scores per participant (Ottenbacher & Tomchek, 1993). Third, it can provide estimates of both association and agreement (Ottenbacher & Tomchek, 1993). However, there are different versions of the intraclass correlation coefficient, so a researcher should consider the following factors before deciding which version to use: (I) whether to use one-way or two-way ANOVA, (2) whether to use random or fixed effects design, and (3) which variance components to include (Ottenbacher & Tomchek, 1993). Once these issues have been resolved, the ICC can provide a powerful and flexible method for examining interrater reliability (Ottenbacher & Tomchek, 1993). Other Sensory History Questionnaires Introduction In order to gather information on children’s sensory integrative abilities and performance, several methods including standardized tests, interviews, clinical observations, and sensory history questionnaires are used by occupational therapists in clinical settings (Parham & Mailloux,1996). In the past few decades, a number of sensory history questionnaires or surveys have been developed which can be used to gather information from parents, teachers, or even children themselves to identify children’s behaviors while conducting their daily tasks in a natural environment. In addition, these surveys can add to any insufficient information provided by standardized tests on child performance, and can also reflect parent perception o f the child’s sensory responsiveness, which may enhance communication and collaboration between parents R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 18 and therapists. The following sections will identify and review several existing sensory history questionnaires. Their validity and reliability will be the focus of discussion. Touch Inventory for Elementarv-School-Aged Children (TIE) The Touch Inventory for Elementary-School-Aged Children, which is often referred to as the TIE, is a self-rating scale developed by Royeen (1985). It contains 26 items which can be used to distinguish between children who have or do not have tactile defensiveness. In the TIE, the child verbally reports his/her feelings or responses to each item by using a 3-point Likert scale (“no”, “a little”, or “a lot”). Several studies were conducted by Royeen to assess the validity and reliability of TEE. First, from literature review and suggestions by sensory integration experts, she collected 80 behavioral items associated with tactile defensiveness. After review by Dr. Ayres and a panel of experts, 47 items were included in the questionnaire (Royeen, 1985). Second, Royeen performed a study to test the internal consistency and criterion- related validity of TIE. One hundred and two children (80 in a normal group and 22 in a tactually defensive group) from a large suburban school district participated in the study. A 49-item TIE scale was administered to these subjects individually during regular school hours by a research assistant. After a subsequent item analysis, 21 items were eliminated due to their failure to discriminate between normal and tactually defensive children. Moreover, 2 items were dropped because of sexual and cultural bias. The internal consistency of the remaining 26 items was analyzed using SPSS. The resulting coefficient alpha of .79 (p< .01) was rounded off to .80, which is the accepted value for R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 19 internal consistency recommended by Benson & Clark (1982). A classification analysis was then conducted and the results showed that TIE has a classification rate that can correctly distinguish up to 85% of children with tactile defensiveness from children without tactile defensiveness (Royeen,1986). Later, a test-retest reliability study was performed with 26 children (aged 5.6-12.6 years), and the results showed that r_= .59 (p = .001) (Royeen, 1987). This result is very close to the minimal acceptable test-retest reliability index r = .60 cited by Benson & Clark (1982). According to Royeen this moderate coefficient may be due to the study’s relatively small sample size, a 2-week interval between the test and the retest, and limited variance of the response format (Royeen, 1987). Recently, other authors conducted a study on test-retest reliability and correlation between mother and child ratings on TEE (Bennett & Peterson, 1995). Test-retest reliability of children’s ratings at two points in time within a one-week interval was calculated by using the Pearson product-moment correlation and Kappa. The result from the Pearson procedure indicated strong test-retest reliability (r_= .91); however, Kappa, a conservative statistic, purportedly demonstrated only moderate agreement between test and retest scores (Kappa coefficient not reported by authors). The Pearson product- moment correlation between mothers’ ratings of their children on a modified version of the scale and their children’s first test scores was moderate (r_= -56, joj= .001), but there was only slight or fair agreement between mothers and children when using the Kappa statistic (Kappa coefficient not reported by authors). R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 20 In general, the reliability of TIE (including internal consistency, test-retest reliability, interrater reliability) is minimally acceptable, but only its construct and criterion-related validity have been assessed. Further evaluation to provide strong evidence of TEE’s reliability is necessary. In addition, its ability to measure what it purports to measure will need to be examined. Touch Inventory for Preschoolers (TIP) Due to the lack of proper instrumentation to evaluate the tactile defensiveness of young children, Royeen developed The Touch Inventory for Preschoolers (TIP), a suitable assessment tool for preschool aged children (Royeen, 1987). The TIP is a parent questionnaire consisting of 5-point Likert-format items. After review by a panel of experts, 46 questions on a children’s reactions to different tactile experiences were included in the questionnaire. To test the internal consistency of TIP, a pilot study was conducted using two teachers as informants to collect data from 25 African-American preschool children on their typical responses to tactile experiences. Results showed that the standardized alpha was .896, which was above the minimal acceptable standard (.80) recommended by Benson & Clark (1982). This supports the item homogeneity of this questionnaire. However, studies using large sample sizes and different informants will be needed to validate other psychometric properties of TIP. In addition, further study in the light of its ability to identify discrete tactile processing difficulties are also important. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 21 Knickerbocker Sensorimotor History Questionnaire (KSHQ) The Knickerbocker Sensorimotor History Questionnaire (KSHQ) is another instrument which has been used to gather a child’s sensory and motor history based on information from parents (Knickerbocker, 1983). This tool uses a yes/no rating scale to assess all areas of sensory processing in children, in addition to other areas of performance, including social adjustment and academic skills. Carrasco (1990) conducted a study to evaluate the internal consistency of the KHSQ by analyzing 20 KSHQ forms from available records at a medical center. Cronbach’s alpha was used to compute the internal consistency o f each subscale and the results showed that alpha ranged from .59 (social adjustment) to .77 (tactile system) suggesting relatively low to acceptable internal consistency. However, because only a small sample size (N = 20) was used in Carrasco’s study, caution must be taken when interpreting these results. Sensory Profile The Sensory Profile is a sensory history questionnaire that was developed to measure a child’s response to sensory experiences in his/her life context (Dunn, 1994). The 99 items are divided into six sensory categories (auditory, visual, taste/smell, movement, body position, touch) and two behavior categories (emotional/social, activity level). A 5-point Likert scale (always, frequently, occasionally, seldom, and never) is used by parents to report their child’s behavior responses. To determine which behavioral responses are unusual in typical normal children, a convenience sample o f 64 typical children aged 3 to 10 years were recruited for the R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . study (Dunn, 1994). These children were selected by a research team o f occupational therapists working in public schools. The children were then divided into 8 groups according to their age, so that there were 8 children in each age group. Data were analyzed using multivariate analysis o f variance (MANOVA). The results showed that 67 o f the 99 item s on the sensory profile can be considered unusual behaviors in typical children because 80% of parents or more reported that their children “seldom” or “never’ exhibited these behaviors. Comparing the gender and age factors, the results indicated that 4 items showed significant differences between boys and girls, but only one item showed a significant difference between the group of younger children (3 to 6 years) and the group of older children (7 to 10 years). Dunn & Westman conducted a study to collect data on a national sample of children without disabilities by using a 125-item revision of the Sensory Profile (Dunn & Westman, 1997). Parents of 1,115 children ranging in age from 3 to 10 years old completed the questionnaire. To compare gender and age (young: 3 - 6 years, old: 7-10 years) factors, multivariate analysis of variance (MANOVA) was used to analyze data on each of the 8 categories of the Sensory Profile. The results indicated that only two items approached a meaningful difference related to age, but no meaningful differences were found between boys and girls. Another finding was that among the 125 items, 91 (73%) were determined to be uncommon behaviors for this national sample of children without disabilities (Dunn & Westman, 1997). Although items in the Sensory Profile seem to be useful in distinguishing between behaviors of children with and without autism (Kientz & Dunn, 1997), no studies have R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . been done to evaluate its reliability. Thus, further work is needed to determine the questionnaire’s consistency and stability over repeated testing or among raters. The Sensory Rating Scale for Infants and Young Children (SRS) Due to the lack of appropriate assessment tools for clinical pediatric therapists to evaluate infants’ and toddlers’ responses to different sensory experiences, Provost and Oetter conducted a project to develop a sensory history questionnaire that could be used to detect sensory defensive behaviors in children beginning from birth until they were 3 years old (Provost and Oetter,1993). The Sensory Rating Scale for Infants and Young Children (SRS) was developed as a 5-point Likert scale, which can be used by parents or caregivers to report their child’s sensory experience responses. The items in SRS were formulated through literature review and suggestions by experts. To strengthen the construct and content validity o f SRS, a group of consultants (including occupational therapists, physical therapists, early childhood specialists, pediatricians, and parents) specializing in infant and toddler population joined in the review of the questionnaire items. Their suggestions were adopted to enhance respondents’ understanding of the questions and to help clarify items. Finally, two forms of the SRS — one for the younger group (birth-8 months) and one for the older group (9 months-3 years) — were constructed. There are 88 items in Form A (younger group) and 136 items in Form B (older group), but both forms consist o f 6 sections (touch, movement & gravity, hearing, vision, taste & smell, temperament & general sensitivity). R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . To test the internal consistency of SRS, parents of 120 children without any medical and developmental problems were asked to fill out the questionnaire. Cronbach’s coefficient alpha was used to assess the internal consistency of each section and of the entire test. Cronbach’s alpha score for the total test for Form A was .90 and the score for Form B was .83. Cronbach’s alpha scores for each section ranged from .46 to .82. To assess test-retest reliability, the same parent (27 mothers and 9 fathers) who completed the SRS was asked to fill out the form again after an interval of one week. The results of percentages of agreement and Pearson product-moment coefficients correlation obtained from the total SRS scores were high ( 87%; r_> .8). In the interrater reliability study the parents of 30 children (12 boys and 18 girls) completed the SRS questionnaire. The father’s SRS scores then were compared with the mother’s SRS scores. The Pearson correlation of the total SRS score between parents was rj= .43 ( p_< -05), which indicated only moderate agreement. The mean of the exact percentage of agreement between fathers’ and mothers’ scores ranged from 49.4% to 62.4%. However, the means o f the percentage of agreement within one point and the percentages of agreement for low and high scores were above 86%. Provost and Oetter (1993) indicated that data from the percentage of agreement within one point and percentages of agreement for low and high scores are considered more important for clinical use, thus, with a mean above 86%, SRS demonstrates adequate interrater reliability. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 25 In general, the SRS shows an acceptable internal consistency, intrarater reliability and interrater reliability. However, using the Pearson product-moment coefficient method to analyze interrater reliability only demonstrates the degree of correlation between fathers’ and mothers’ score, but it does not indicate the range o f agreement between two sets of scores. Because the ICC statistic can provide estimates of both association and agreement, it may offer stronger evidence to support the interrater reliability of instruments such as the SRS and the ESP, which is the focus of this proposal. In addition, further research on the validity and reliability of the SRS, as well as on various types of children with disabilities, is necessary. Summary This section reviewed several sensory history questionnaires developed by different authors in the past few decades, the KSHQ (Carrasco, 1990), TIE (Royeen, 1986), TIP (Royeen, 1987), Sensory Profile (Dunn, 1989), and SRS (Provost & Oetter, 1993). Although they are all categorized as sensory history questionnaires, they are clearly different from one other. While the TIE and TIP both assess only one sensory system, the tactile system, and are specific to one tactile processing problem (tactile defensiveness), the TIP is for preschool children, while the TIE focuses on older children of elementary school age. The SRS is also specific to one type of sensory problem (called sensory defensiveness), but it is designed for infants and toddlers. On the other hand, the Sensory Profile and KSHQ assess not only different aspects of sensory R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 26 processing in multiple sensory systems but also other areas of performance (for example, two behavioral categories in Sensory Profile, academically related questions in KSHQ). Although many sensory history questionnaires have been developed, questions about their ability to properly identify children’s sensory processing problems still remain, because few studies have been conducted on their validity and reliability. In order to ensure that they are reliable and valid assessment instruments for detecting sensory processing problems, further studies to examine their psychometric properties are needed in the future. The Evaluation of Sensory Processing (ESP) Questionnaire Description of the ESP The Evaluation of Sensory Processing (ESP) is a child behavior inventory in the form of a parent questionnaire. It is appropriate for examining children from preschool age to elementary school age, in contrast to the SRS, which focuses on infants and toddlers. The ESP was designed to assess various aspects of sensory processing problems in young children, whereas the TIP and TIE only assess one aspect of sensory processing problems (tactile defensiveness). Although the ESP, Sensory Profile, and KSHQ all examine different forms of sensory processing in multiple sensory systems, only the ESP focuses solely on sensory processing. It does not assess other areas of performance (e.g., academic performance questions in KSHQ). According to the different characteristics of each sensory system, items of the ESP can be distinctly grouped into 6 categories: the auditory, gustatory/olfactory, R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 27 proprioceptive, tactile, vestibular, and visual systems. The present version (Research Version 3) consists of 185 items, with each subcategory containing different numbers of items: auditory system = 31 items, gustatory/olfactory system = 15 items, proprioception system =25 items, tactile system = 61 items, vestibular system = 33 items, and visual system =20 items. However, the revision process is still ongoing and the final goal is to establish a questionnaire with 80 to 100 items. A copy of Research Version 3 of the ESP is attached in Appendix A. Parents (or caregivers) record their child’s responses to sensory experiences in their daily life situations by using a Likert-type format. Each item is rated on a 5-level scale: always, often, sometimes, rarely, and never. Purpose of the ESP Assessment of children in occupational therapy depends heavily on information obtained from adults, especially parents. Behavior rating scales provide an expedient and cost-efficient method of gathering information from parents in a standardized format. Initially, the ESP was intended to help occupational therapists describe and quantify children’s sensory responsiveness in the context of natural environments and situations. However, the ultimate goals have broadened to now encompass three purposes. First, it is designed to be a diagnostic tool. Data of the ESP come from parents’ reports, so this instrument can add to the information derived from standardized evaluation tools and clinical observations. In addition, because the design of the ESP focuses on sensory processing problems in different sensory systems, it will assist occupational therapists in identifying the child’s problem and in making diagnostic R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 28 decisions. Secondly, it may serve as a parent education tool. Occupational therapists can use items of the ESP to give concrete behavioral examples or to illustrate explanations of sensory processing problems to people who are not familiar with sensory integration concepts. By making a complex theory easier to understand, communication between parents and therapists will be enhanced. Thirdly, it may be useful as an outcome evaluation tool. If items in the ESP prove to be sensitive enough to detect a child’s behavioral changes over time, it may be used to test the effectiveness of intervention programs. The process of developing the ESP, as well as its validity and reliability, are described in the following paragraphs. Development o f the ESP The development of the ESP is an ongoing project that has involved collaborative efforts between students and faculty members at the Department of Occupational Therapy at the University of Southern California, and clinicians and researchers at Pediatric Therapy Network (PTN) in Torrance, California. The process of developing the ESP was based on a 4-phase model: (1) planning, (2) construction, (3) quantitative evaluation, and (4) validation, as described by Benson & Clark (1982). LaCroix (1993) took the first step in developing the ESP. After reviewing literature about sensory processing problems, she listed an initial “Table of Specifications” which proposed the number of items and content domains for the final R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 2 9 version of the instrument. Six content domains containing one hundred items were suggested (see Table 1). Table 1 . Original and Revised Tables of Specifications Content Domain Original Table of Specifications (LaCroix, 1993) Revised Table of Specifications (Johnson, 1996) Auditory 13 10 Gustatory/O Ifactory 5/5 5 Proprioception 17 12 Tactile 25 18 Vestibular 22 15 Visual 13 10 Total 100 70 Next, after searching through numerous articles related to sensory history questionnaires and indicators of sensory processing disorders, LaCroix found 15 different versions of sensory history questionnaires published in the 1970s and 1980s by several authors. By compiling items from these questionnaires, and generating new items through review of pertinent literature and interviews with parents and therapists, a total of 679 items was assembled. This was followed by a rigorous expert review and content validation process, which determined that 200 items had strong content validity. (The content validation process used by LaCroix is described in greater detail in the next section of this chapter.) A 200-item ESP questionnaire (Research Version 1) was R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 3 0 established through these procedures. This version contained 32 auditory, 10 gustatory, 12 olfactory, 28 proprioception, 60 tactile, 36 vestibular, and 22 visual items. After good content validity was established, a pilot study of Version 1 of the ESP was conducted to test typically developing preschool children (LaCroix & Mailloux, 1995). Of the 250 questionnaires mailed to families in the southern California area, however, only 37 were returned (for 15 girls & 22 boys). Among the 200 items, behaviors in 116 items were rated as rarely or never observed by 75% or more of the parents. Therefore, these items are likely to be sensitive to behaviors that are unusual in typical preschool children. Johnson (1996) took the next step by using qualitative research methods to interview 5 parents following their completion of the ESP (Version 1). Four of the parents had children with known sensory integration disorders and one had a child without sensory disorders (Johnson, 1996). This pilot study was conducted to gather information on item clarity from parents, because they may have had different interpretations of the questions in Version 1 than the experts and therapists. Parents’ suggestions and recommendations were reviewed and discussed by Johnson and her thesis professor. Finally, 41 items were reworked for clarity and 8 items were eliminated because they contained professional jargon. These revisions resulted in the production o f Research Version 2 which contained 192 items, 31 auditory, 11 gustatory, 12 olfactory, 25 proprioception, 61 tactile, 33 vestibular, and 19 visual items. Johnson (1996) conducted a study to measure the criterion-related validity of Version 2 of the ESP to determine if its items could discriminate between children with R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . 31 and without SI disorders. Results are described in the following criterion-related validity section. Based on the results of the initial validity findings, a revision of the original “Table of Specifications” was proposed by Johnson (see Table 1). Using Johnson's data (1996), Parham (1997) analyzed the internal consistency of the ESP to examine if items in each sensory system were measuring the same characteristic. The results are shown in Table 2. The results showed that items in the gustatory and olfactory sensory systems had weak reliability. Because LaCroix (1993) and Johnson (1996) also had found evidence of weak validity in these sensory systems, a decision was thus made to drop existing items in the gustatory and olfactory systems, and to generate new ones. Moreover, the two systems were combined into a single gustatory/olfactory sensory system because their functions are often linked together. Table 2. Internal Consistency of ESP - Version 2 (Parham, 1997) Sensory System Numbers of items Coefficient alpha Auditory 31 .92 Gustatory 11 .32 Olfactory 12 .76 Prioceptive 25 .85 Tactile 61 .95 Vestibular 33 .83 Visual 20 .84 To generate new gustatory/olfactory items, the same procedure for content validation used by LaCroix (1993) was adopted, and 15 items determined to be “good R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . items” were chosen to replace the old ones and included in version 3. To further clarify items for Version 3, a small change in wording for some items of Version 2 was made following Johnson’s suggestions (Johnson, 1996). Finally, a 185-item Research Version 3 was built (A comparison of the different versions is shown on Table 3). Table 3. Item Distributions Across Content Domains in the Different Versions of ESP Content Domain Research Version 1 Research Version 2 Research Version 3 Auditory 32 31 31 Gustatory/Olfactory 10/12 11/12 15 Proprioception 28 25 25 Tactile 60 61 61 Vestibular 36 33 33 Visual 22 19 20 Total number of items 200 192 185 Validity of the ESP Content validity. As noted earlier, the initial step of developing the ESP questionnaire was taken by LaCroix, who generated 679 items after exhaustively reviewing numerous articles related to existing sensory history questionnaires and pertinent literature. The next step was to select 200 items with the strong content validity. Twenty-one experts from the sensory integration field were called on to analyze these 679 items to see if they adequately represented sensory processing in seven distinct R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . sensory systems. A three-point scale (-1= not a measure of the domain, 0= undecided as to whether the item measures the domain, +1= a definite measure of the domain) was used to score each item’s relationship to each o f the sensory systems. Every item was rated by at least 4 experts. The results of the content validity o f each item were computed using the index of item-objective congruence (Rovinelli & Hambleton, 1977) and by examining the percentage of agreement among experts that the item was a good item. An item was considered a good item if it could meet the minimum accepted criteria (.70 or above on the index of item-objective congruence and 75% or greater in percentage of agreement by experts that the item was good), and 191 met this criteria. However, no items in the gustatory sensory system met the criteria because they all failed to meet the criterion for percentage of expert agreement. In order to include some items in this system, the accepted criterion was reduced to 50% agreement among experts for the gustatory system only. Finally, a 200-item ESP questionnaire was formulated (Research Version 1). Because every item of the ESP was selected based on the judgments of several sensory integration experts, their representation o f processing in distinct sensory systems was validated. Since the ESP questionnaire has strong content validity, it potentially can become a useful instrument that which can be utilized to distinguish problem areas specifically related to sensory processing difficulties. Criterion-related validity. The criterion-related validity of Version 2 of the ESP was tested by Johnson, who conducted a study to determine if the ESP could discriminate R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 34 between children with sensory integration (SI) disorders and those without SI disorders (Johnson, 1996). Parents of 30 children with SI disorders and 59 children without SI disorders scored the 192-item ESP form. Among the 59 typical children, 30 were matched in age, gender, ethnicity, and socioeconomic status with 30 children in the SI disordered group. An item analysis was conducted using the Wilcoxon signed rank test, and 84 items indicated a significant difference between the matched groups (p < .05). The other criterion-related validity study was conducted using Research Version 3 (Parham, 1997). Two groups of children (12 with autism and 12 without disability) who were matched in age and gender participated in the study. Their parents were asked to complete the 185-item ESP questionnaire. The Mann-Whitney test (2-tailed) was performed for each item and 19 items were found to be significantly different (p < .05). The results of both studies will be useful when selecting items for the final version of the ESP. Other types of validity. The validity of an instrument can be judged on the basis of three types of categories: content validity, criterion-related validity, and construct validity. According to the literature reviewed, the ESP demonstrates strong content validity and promising criterion-related validity, but its construct validity has not been evaluated. However, the validation of an instrument is a continuous process, and a series of formal and systematic studies will be needed in the future to provide further evidence of ESP validity. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . Reliability of the ESP Internal consistency. The data from Johnson's study (1996) were used to test the internal consistency of ESP items (Version 2) by Parham (1997). Cronbach's alpha technique was applied to examine to what extent items in each sensory system are measuring the same characteristic (see Table 3). Except for the gustatory and olfactory systems the results of the alpha coefficients ranged from .83 (vestibular) to .95 (tactile), thus demonstrating that most items on the ESP are quite reliable (See Table 3). Other types of reliability. Reliability can be assessed from different aspects, however, at this time, only the internal consistency of ESP has been examined. In order to provide evidence that ESP is a reliable instrument, the stability (test-retest reliability) and equivalence (interrater reliability) of the ESP should be investigated as soon as possible. Summary In considering the psychometric properties of the ESP, two types of validity and one type of reliability have been examined (see Table 4), and their results show that the ESP has strong content validity, promising criterion-related validity, and acceptable internal consistency. However, the consistency of ESP scores across raters or over time have not been measured. Gwyer (1989) suggested that during the development of the edition phase, that it is a good time to “begin to evaluate the reliability of the items and total test being created” (p.56), since the results of reliability studies can assist ESP R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . developers in selecting items for the final instrument. According to Gwyer (1989), the edition phase is the “tryout phase” (p.44), during which the instrument developer can refine his/her ideas and clarify test items and procedures by using numerous pilot studies. Table 4. Psychometric Properties of the ESP Psychometric Property Study Version Content Validity LaCroix, 1993 Version 1 Criterion-related Validity LaCroix & Mailloux, 1995 Johnson, 1996 Parham, 1997 Version 1 Version 2 Version 3 Construct Validity X X Internal Consistency Parham, 1997 Version 2 Test-retest Reliability X X Altemate-form Reliability not applicable not applicable Interrater Reliability X X Note. X= no studies conducted to date The present study is a reliability study designed to examine the interrater reliability (an important psychometric property of an assessment instrument) of the ESP. If strong agreement and high correlation can be found between parent ratings of their children, it will support the claim that the ESP is a reliable parent report instrument. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 37 Furthermore, it will help the developers of ESP to eliminate unreliable items in the present version and to ensure that only reliable items will be included in the final version of ESP. Conclusion In summary, this chapter provides an overview of two important psychometric characteristics of an instrument: (1) validity, which refers to instrument content and whether the measure assesses the domain of interest, and (2) reliability, which generally refers to the consistency of the measure. In addition, methods of obtaining validity and reliability are also described. According to the purpose of this study, emphasis is placed on the interrater reliability of an instrument. The literature review addresses the functions, reliability, and validity o f ESP and several sensory history questionnaires developed in the last two decades. Compared with other sensory history questionnaires, the ESP is designed (1) to be a parent report measurement, (2) to assess children from preschool to elementary school ages, (3) to assess the content domains of six sensory systems, and (4) to focus on target behaviors which are specific indicators of sensory problems. In several studies conducted to examine the psychometric properties of the ESP, strong content validity, promising criterion-related validity, and acceptable internal consistency were found. Nonetheless, in order to ensure that only reliable items will be selected for the final version, Gwyer (1989) states that “it is prudent to provide as much reliability data at possible at this point in the test development” (p.56). R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 38 The present study is an interrater reliability study designed to examine the consistency between ESP scores rated by fathers and mothers of children with and without sensory integration disorders. The goal of the study is not only to provide evidence that the same score would be awarded by two parents, but also to help ESP developers in item selection for formulating the final instrument. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . CHAPTER m 39 METHODOLOGY Introduction This study evaluated the consistency between ESP item ratings assigned by fathers and mothers of children with and without sensory integration disorders. Its purpose is not to assess particular dimensions of children’s behavior problems nor to evaluate the overall adequacy of the ESP. Rather, the goal is specifically to assess interparental agreement. Since parents play an important role in providing clinical and research information used to interpret children’s behavioral problems, the consistency of data between fathers and mothers needs to be investigated. The index of interrater reliability can demonstrate whether raters are in agreement when recording their observations. Subjects The participants were parents in 35 families in which the child was between the ages of three years, zero months, and eight years, two months. Parents were divided into two study groups: the sensory integration (SI) dysfunction children group (n=15) and typically developing children group (n=20). Because this research is designed to test agreement between fathers’ and mothers’ reports of the ESP questionnaire, only two- parent families (not necessarily the biological parents) were eligible. For both SI dysfunction and “typically developing” children, the family was excluded if the family R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 40 included a stepparent who has lived with the child for less than 1 year. Although other demographic characteristics were not controlled, descriptive data on parental education and parental occupation were collected. Table 5 presents demographic data of the participating families. Table 5 Summary of Demographic Characteristics of Both Participation Families TvDicallv DeveloDina (n=20) n (%) SI Dysfunction (n=15) n (%) Child’ s Gender Female 9 (45%) 5 (33%) Male 11 (55%) 10(67% ) Child’s Ethnicity Caucasian 13(65%) 11 (73%) Asian 7 (35%) 1 (7%) Other 0 (0%) 3 (20%) Parental Education High School 0 (0%) 3 (20%) (Mother) College 3(15%) 2(13% ) University 7 (35%) 8 (54%) Graduate School 10(50%) 2(13% ) (Father) High School 1 (5%) 2(13% ) College 4 (20%) 0 (0%) University 3(15%) 7 (47%) Graduate School 12 (60%) 6 (40%) Child's Age(months) 37-48 5 (25%) 6 (40%) 49-60 3 (15%) 3 (20%) 61-72 5 (25%) 3 (20%) 72-84 6 (30%) 3 (20%) 85 more 1 (5%) 0 (0%) Mean 61.50 55.53 SD 15.78 12.99 Participants in the referred group were parents of children with sensory integration disorders. Their children were identified by occupational therapists with knowledge of sensory integration theory and who had experience with sensory integration treatment. Fifteen families were recruited from four clinical facilities in the Los Angeles area that provide occupational therapy services to children with developmental and R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithou t p erm issio n . 41 behavioral concerns. The children (5 girls, 10 boys) in the SI dysfunction group ranged in age from 39 to 76 months (M = 55.5 months, SD = 12.99). Participants in the typically developing group were defined as parents of children without sensory integration disorders or any other major medical or developmental problems, and who have never been referred for any developmental or behavioral problems. Twenty families were recruited in three ways: (1) through USC child care centers, (2) acquaintances of the researcher, or (3) referred by friends. All participants except one from North Carolina, live in the greater Los Angeles area. The children (9 girls, 11 boys) in the typically developing group ranged in age from 39 to 86 months (M = 61.5 months, SD = 15.78). A t-test showed that the children in this group did not differ in age significantly from children in the SI dysfunction group (F = .576, p < .05). Although the research design in this study does not involved pair-matching between children from the SI dysfunction group and children from the typically developing group, several characteristics (children’s age, gender, ethnicity, and parents’ occupation and educational level) of the participating families ideally should be comparable between groups to enhance confidence in the interpretation of findings. The distributions of the age and gender are similar, however, the proportion of Asian children in typically developing group is higher than the Asian children in SI dysfunction group. This is probably because the ethnicity of the researcher is Asian, and some children in typically developing group were recruited by friends or acquaintances of the researcher. Another difference between the two groups was the parental educational level. In the typically developing group, there are more parents with graduate degrees than in the R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . other group. This may be due to the fact that some of the children in the typically developing group were recruited from USC Child Care Centers, which means that their parents may be professors or staff members of the university who may have higher educational levels. Instrument The Research Version 3 of the Evaluation of Sensory Processing (ESP) questionnaire was utilized to conduct this study. The ESP contains 185 items which can be divided into six domain categories: (auditory system = 31 items, gustatory/ olfactory system = 15 items, proprioception system =25 items, tactile system = 61 items, vestibular system = 33 items, and visual system = 20 items). The detailed description of the instrument is presented in chapter 2 and the test items can be found in Appendix A. A demographic questionnaire was attached to the back of the ESP (see Appendix B). Procedure Permission was obtained from the research committee o f the Institutional Review Board of the University o f Southern California before conducting this study. For the referred group, the research protocols were sent to administrators of Pediatric Therapy Network (PTN), Therapy West, Therapy In Action, and Center for Developing Children in Southern California, to invite their participation in the study. These are private facilities that provided occupational therapy services to the children with developmental and sensory processing problems. After receiving permission to conduct this study, the R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . 43 researcher provided the study plans, processes, and the inclusion criteria and exclusion criteria for subjects in written form to the coordinator o f each facility, as well as consent forms (see Appendix C); ESP questionnaires; cover letters (see Appendix D); and stamped, researcher-addressed envelopes. The coordinator of each facility helped the researcher select children from their facilities who meet the recruitment criteria. The children’s parents then were asked to sign a form giving their consent to participate in this study. A package of materials including two sets of ESP questionnaires, a cover letter, a parent questionnaire, and one stamped, researcher-addressed envelope were given to the parents. After they completed the questionnaire they returned it by mail to the researcher. Since these coordinators were highly experienced occupational therapists, they were available to help the researcher answer parents’ questions about the study or the ESP questionnaire. In addition, parents were informed that they could contact the researcher directly by phone, in the case of questions concerning the study or about particular ESP items. However, the researcher did not receive any phone calls from parents during the period of data collection. For the typically developing group, if children were referred by friends or acquaintances of the researcher, consent forms and ESP questionnaires were distributed by mail, along with a stamped, researcher-addressed envelope. A cover letter explaining the purpose of the study, instruction on how to complete the ESP, and a request to return the questionnaire within two weeks was also sent Furthermore, a reminder postcard was R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 44 sent two weeks later and a follow-up letter was mailed one month later to no-response participants to increase the response rate. Five of the typically developing children were recruited from the two USC Child Care centers. The research protocol was first sent to USC Child Care Center's research committee for reviewing and inviting their participation. After receiving permission, teachers of eligible age groups were oriented to the study and the recruitment criteria, then they helped the researcher to select children from their classes who met the recruitment criteria. Then the parents of those children were given a cover letter, a stamped and researcher-addressed envelope, two sets of ESP questionnaires, and consent forms by the teachers at the child care centers. The questionnaires were mailed individually to the researcher. Teachers were asked to remind the parents to fill out the questionnaire after two weeks from receiving the research package. Fathers and mothers in all families were asked to score the questionnaire based on their own experiences with and perceptions of their child’s behavioral responses. They were told that they do not need to fill out the ESP questionnaire at the same time, but can do so at their convenience. In addition, they should complete the form independently without discussing it with each other, then both forms should be returned to the researcher. It was suggested that they answer every item and do so fairly quickly. Since most of the questionnaires were distributed by others (coordinators in private clinics, teachers at the USC Child Care Center, and friends of the researcher), the researcher did not contact the parents directly. Moreover, it is difficult to trace whether all the packages of questionnaires were sent out and received by the parents. According R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 45 to the researcher’s records, the return rate was estimated to be approximately 18%. Two hundred and thirty research packages were sent out, and forty-three were returned to the researcher. Unfortunately, no information about the characteristics of nonrespondents was obtained. Eight packages could not be used because the child exceeded the age range, only one parent filled out the questionnaire, or in one case family, they filled out a package for each of their two children. Only one child in a family could be a participant in this study. Data Analysis General descriptive statistics including range, means, and standard deviation were calculated first after the data were gathered. Items which were unmarked or responses of N/A were dealt with as missing data during computations. To assess the interrater reliability of the ESP, percentages of agreement, Spearman correlation, and intraclass correlation coefficient (ICC) techniques were performed. Agreement between fathers’ and mothers’ scores on ESP items was analyzed by computing the percentage of agreement for each item. Agreement between mothers and fathers was calculated in two ways: (I) exact agreement on an item (e.g., always with always, often with often and so forth); (2) agreement on an item within one rating level (plus or minus one level, e.g., always with often, sometimes with rarely, sometimes with often ). Because the questionnaire is scored subjectively by fathers and mothers, agreement scores within one level were considered an appropriate reliability index for clinical interpretation. In addition, Spearman correlation coefficients and ICC were R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 46 calculated to assess the degree to which fathers’ and mothers’ assessment of their children in item scores were associated. Spearman’s rank correlation coefficient was performed because the rating scale of the ESP questionnaire is ordinal. Regarding the ICC, three types of models exist that depend on how the raters are chosen and assigned to the subjects (Shroup & Fleiss, 1979). ICC model (type 2,1) was used in this study. According to Portney and Watkins (1993), the ICC model (type 2,1) is “used most often in interrater reliability studies, where all n subjects are measured by k raters, and these raters are considered representative of a large population of similar raters” (p.512). Correlations ranging from .50 to .75 are considered to indicate moderate reliability; and correlations above .75 are considered indicative of good reliability (Portney & Watkins, 1993). Cronbach’s alpha was computed to estimate the internal consistency of items within each sensory system, as well as all the items of the ESP together, for mothers’ and fathers’ scores. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . CHAPTER IV 47 RESULTS Introduction This chapter presents the results of the statistical analysis of the collected data. First, to determine the degree of inter-parent agreement, percentages of agreement were computed. Then, to analyze the interrater reliability, Spearman correlations and intraclass correlations (ICC) were used. Finally, the internal consistency of items within each sensory system for mothers’ versus fathers’ ratings was examined by using Cronbach’s alpha. Percentages of Agreement The range, means, and standard deviations of the percentages of agreement for items within each sensory system of the ESP and for the total items of the ESP of both study groups are presented in Table 6. For the typically developing group, the means of the exact percentages of agreement between mothers and fathers for each sensory system and for the total ESP ranged form 40.40% to 51.89%. For the SI dysfunction group, the means of the exact percentages of agreement for each sensory system and for the total ESP ranged from 35.47% to 56.45%. The mean percentages of agreement within one rating level for the typically developing group ranged from 81.52% to 88.6% and the mean for the total ESP was 83.95%. In the SI dysfunction group, the mean percentages of agreement within one R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 48 level for the total ESP was 79.96%, and the means for each system ranged from 72.33% to 83.56%. Table 6 Percentages of Agreement for Interrater Reliability Between Mothers and Fathers for the Each Sensory System of ESP and Total ESP Typically Developing Group SI Dysfunction Group In = 201 (n = 15) Range_______ Mean SD Range Mean SD Auditory Exact % 25.81-83.87 50.00 15.54 19.35-64.52 41.29 14.07 % +1 level 67.74-100.00 88.60 8.44 45.16-96.77 79.14 13.51 Gust/Olfactory Exact % 20.00-60.00 51.89 18.34 40.00-86.67 56.45 15.30 % +1 level 46.67-100.00 81.67 13.66 60.00-100.00 83.56 11.78 Proprioceptive Exact % 20.00-72.00 40.40 12.97 16.00-60.00 35.47 11.30 % + 1 level 52.00-96.00 82.00 11.05 52.00-92.00 76.00 11.41 Tactile Exact % 22.95-73.77 43.47 12.79 18.03-62.30 42.40 12.98 % +1 level 65.57-98.36 84.42 8.88 65.57-93.44 82.17 8.10 Vestibular Exact % 12.12-72.73 45.91 17.84 18.18-78.79 45.65 18.09 % +1 level 33.33-96.97 81.52 16.00 63.64-96.97 82.47 9.42 Visual Exact % 10.00-80.00 48.50 21.34 15.00-60.00 36.67 12.49 % ± 1 level 55.00-95.00 84.25 11.73 35.00-90.00 72.33 17.41 Total Exact % 23.78-72.97 46.13 12.49 25.41-61.62 42.38 9.77 % +1 level 64.86-95.14 83.95 7.77 70.27-92.97 79.96 7.50 Generally, the agreement between fathers and mothers in the typically developing group was greater than in the SI dysfunction group, with the exception of the exact percentages of agreement for the gustatory/olfactory system, and the percentages of agreement within one level in the gustatory/olfactory system and the vestibular system. R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . 49 T-test results suggested no significant difference in the interparent agreement between the two groups (p > .05). Correlations Between Fathers’ and Mothers’ Item Scores In this part of the statistical analysis, three groups (typically developing group, and SI dysfunction group, and combined group) were used to compute the interrater reliability coefficients. The combined group included all the participants from the other two groups. First, for each group, the range, means, and standard deviations of the fathers' and mothers’ item scores were calculated separately (see Appendix E). The interrater reliability value between the fathers’ and mothers’ scores for individual items were then computed with the Spearman correlation coefficient and the intraclass correlation coefficient (ICC). The following tables present the results of interrater reliability index of each sensory system. According to Portney & Watkins (1993), an ICC value above .75 indicates good reliability and a value below .75 were moderate to poor reliability. Table 7 presents the Spearman correlation coefficients and ICC scores of the 31 items of the auditory system. The Spearman results showed that 15 itemsfr, ranging from .408 to .723) for the combined group, 5 items (r,= .546 to .716) for the typically developing group, and 2 items (r,= .624 to.642) for the SI dysfunction group were significantly correlated (p < .01). As shown in Table 7, a moderate ICC was found for 1 1 items ( .535 to .717) in combined group, 7 items (.502 to .696) in the typically developing group, and 9 items (.516 to .638) in the SI dysfunction group. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 50 T able7 ICC and Spearman Correlation Coefficients in the Auditory System Combined Group Control Group SID GrouD Spearman ICC Spearman ICC Spearman ICC Auditory 1 0.122 0.361 -0.166 -0.113 0.518* 0.638 Auditory 2 0.408 ** 0.337 0.461 * 0.378 0.312 0.272 Auditory 3 0.723 ** 0.717 0.716 ** 0.685 0.203 0.180 Auditory 4 0.223 0.233 0.116 0.151 0.277 0.278 Auditory 5 0.150 0.129 -0.059 0.037 -0.048 -0.077 Auditory 6 0.235 0.227 1.000 0.057 0.128 0.208 Auditory 7 0.551 ** 0.582 0.284 0.327 0.534* 0.435 Auditory 8 0.419** 0.354 0.389 * 0.412 0.396 0.254 Auditory 9 0.312 * 0.324 0.162 0.404 0.114 0.096 Auditory 10 0.594 ** 0.567 0.325 0.355 0.428 0.542 Auditory 11 0.464** 0.395 0.572 ** 0.561 0.046 0.023 Auditory 12 0.278 0.195 0.221 0.240 0.220 0.084 Auditory 13 0.603 ** 0.603 0.546 ** 0.502 0.642** 0.676 Auditory 14 0.395 * 0.379 0.322 0.317 0.527 * 0.476 Auditory 15 0.592 ** 0.568 0.552 ** 0.509 0.431 0.436 Auditory 16 0.540 ** 0.600 0.379 * 0.470 0.582 * 0.622 Auditory 17 0.354* 0.563 0.344 0.577 0.363 0.516 Auditory 18 0.160 0.306 -0.134 -0.120 0.624 ** 0.521 Auditory 19 0.559 ** 0.670 0.329 0.696 0.606 * 0.595 Auditory 20 0.380 * 0.350 0.334 0.307 0.558 * 0.486 Auditory 21 0.329 * 0.356 0.438 * 0.487 0.230 0.228 Auditory 22 0.097 0.092 -0.010 -0.056 0.187 0.172 Auditory 23 0.091 0.167 -0.081 -0.067 0.134 0.141 Auditory 24 0.513 ** 0.535 0.072 0.205 0.344 0.316 Auditory 25 0.428 ** 0.439 0.246 0.158 0.400 0.410 Auditory 26 -0.100 -0.061 -0.028 0.145 -0.233 -0.255 Auditory 27 0.370 * 0.351 0.109 0.106 0.182 0.132 Auditory 28 0.598 ** 0.619 0.165 0.327 0.569 * 0.538 Auditory 29 0.473 ** 0.495 0.256 0.406 0.412 0.351 Auditory 30 0.331 * 0.297 0.681 ** 0.583 0.206 0.206 Auditory 31 0.532 ** 0.582 0.374 0.438 0.570 * 0.552 Note: * . Correlation is significant at the .05 level. **. Correlation is significant at the .01 level. Table 8 shows the ICC and Spearman correlation between the 15 gustatory/ olfactory item scores for the three study groups. The Spearman correlation showed that 4 items (rs of .430 to .499) for the combined group, 1 item (r = .643) for the typically developing group, and 3 items (rs of .679 to .987) for the SI dysfunction group were R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . 51 significantly correlated (p < .01). ICC results for the SI dysfunction group showed that 2 items had good reliability ( high ICCs o f .764 & .769) and 6 items (ranging from .509 to .705) had a moderate ICC index. However, for the combined group, only 2 items, and for the typically developing group, only 1 item, yielded a moderate ICC index. Table 8 ICC and Spearman Correlation Coefficients in the Gustatory/Olfactory System Combined G Control GrouD SID Group Spearman ICC Spearman ICC Spearman ICC Gust/Olf 1 0.447** 0.549 0.344 0.458 0.681 ** 0.678 Gust/Olf 2 0.365 * 0.396 0.038 0.158 0.987 ** 0.764 Gust/Olf 3 0.353 * 0.493 0.188 0.033 0.562* 0.769 Gust/Olf 4 0.277 0.371 0.049 0.034 0.580 * 0.705 Gust/Olf 5 0.387 * 0.448 0.073 0.075 0.592 * 0.608 Gust/Olf 6 0.233 0.222 -0.083 -0.035 0.439 0.430 Gust/Olf 7 0.298 * 0.452 0.177 0.413 0.679 ** 0.649 Gust/Olf 8 0.266 0.385 0.109 0.223 0.415 0.414 Gust/Olf 9 0.438 ** 0.434 0.341 0.087 0.263 0.313 Gust/Olf 10 0.297 * 0.377 0.402 * 0.443 0.221 0.340 Gust/Olf 11 0.499 ** 0.584 0.643 ** 0.632 0.448 * 0.586 Gust/Olf 12 -0.130 -0.106 a a -0.157 -0.120 Gust/Olf 13 0.291 * 0.293 0.327 0.285 0.146 0.293 Gust/Olf 14 0.430 ** 0.443 0.403 * 0.353 0.331 0.509 Gust/Olf 15 0.208 0.214 0.133 0.162 0.230 0.213 Note: *. Correlation is significant at the .05 level. **. Correlation is significant at the .0 1 level. a . Cannot be computed because at least one o f the variables is constant. Table 9 presents the ICC and Spearman correlation between 25 proprioceptive item scores for the three study group. As can be seen in this table, 15 items (with r, ranging from .396 to .775) for the combined group, 2 items (r,of .687 to .707) for the typically developing group, and 5 items (r, of .623 to .872) for the SI dysfunction group were significantly correlated at the p < .01 level. When computing the ICC index, 1 R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithou t p erm issio n . item(.809) for the combined group, 1 item (.773) in the typically developing group, and items (.759 to .805) for the SI dysfunction group demonstrated good reliability (ICO.75). Table 9 ICC and Spearman Correlation Coefficients in the Proprioceptive System Combined G Control G SID G Spearman ICC Spearman ICC Spearman ICC Proprio 1 0.417 ** 0.411 -0.075 0.122 0.530 * 0.440 Proprio 2 0.018 -0.058 0.098 0.136 0.172 0.212 Proprio 3 0.547 ** 0.369 0.687 ** 0.700 0.213 0.293 Proprio 4 0.351 * 0.110 0.468* 0.421 0.072 0.140 Proprio 5 0.504 ** 0.161 0.441 * 0.426 0.596 * 0.539 Proprio 6 0.178 -0.079 0.415 * 0.417 -0.151 -0.046 Proprio 7 0.577 ** 0.574 0.422 * 0.599 0.337 0.315 Proprio 8 0.258 0.231 -0.073 -0.133 0.579 * 0.464 Proprio 9 0.329 * 0.307 -0.070 -0.060 0.371 0.436 Proprio 10 0.443 ** 0.430 0.360 0.385 0.481 * 0.460 Proprio 11 0.451 ** 0.507 0.327 0.431 0.501 * 0.499 Proprio 12 0.197 0.219 -0.219 -0.207 -0.232 -0.172 Proprio 13 0.516 ** 0.563 0.276 0.424 0.558 * 0.479 Proprio 14 0.396 ** 0.438 0.197 0.172 0.623 ** 0.630 Proprio 15 0.570** 0.553 0.453 * 0.457 0.551 * 0.451 Proprio 16 0.775 ** 0.809 0.707 ** 0.773 0.823 * * 0.805 Proprio 17 0.367 * 0.422 0.509 * 0.600 • 0.216 0.262 Proprio 18 0.469 ** 0.554 0.397 * 0.617 0.531 * 0.525 Proprio 19 0.644 ** 0.681 0.462 * 0.487 0.872 ** 0.817 Proprio 20 0.387 * 0.420 0.097 0.145 0.503 * 0.517 Proprio 21 0.529 ** 0.540 0.413 * 0.423 0.642 ** 0.645 Proprio 22 0.454** 0.522 0.140 0.097 0.479 * 0.495 Proprio 23 0.303 * 0.358 0.334 0.370 0.210 0.284 Proprio 24 0.615 ** 0.576 0.415 * 0.417 0.849 ** 0.759 Proprio 25 -0.187 -0.224 0.108 0.081 -0.561 * -0.441 Note: *. Correlation is significant at the .05 level. * * . Correlation is significant at the .01 level. Table 10 presents the ICC and Spearman correlation coefficients of the 61 tactile item scores for the three groups. The Spearman correlation procedures showed that 29 items(r, ranging from .396 to .806) for the combined group, 14 items(rI of .519 to .762) R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . for the typically developing group, and 14 items (rs of .595 to.843) for the SI dysfunction group were significantly correlated (p < .01). The ICC indicated good reliability for 1 item (.794) in combined group, and 3 items (.772 to .784) in the SI dysfunction group. Table 10 ICC and Spearman Correlation Coefficients in the Tactile System Combined GrouD Control Gt o u d SID Group Spearman ICC Spearman ICC Spearman ICC Tactile 1 0.402 ** 0.505 0.332 0.339 0.485 * 0.553 Tactile 2 0.152 0.154 0.157 0.117 0.098 0.224 Tactile 3 0.477 ** 0.442 0.280 0.245 0.559 * 0.592 Tactile 4 0.452 ** 0.610 0.280 0.351 0.630 ** 0.747 Tactile 5 0.151 0.253 0.145 0.251 0.102 0.191 Tactile 6 0.367 * 0.376 0.134 0.112 0.491 * 0.582 Tactile 7 0.534** 0.511 0 .434* 0.392 0.590 * 0.581 Tactile 8 0.205 0.199 0.112 0.112 0.360 0.403 Tactile 9 0.093 0.351 0.135 0.441 0.026 0.234 Tactile 10 0.582 ** 0.595 0.531 ** 0.579 0.597 ** 0.591 Tactile 11 0.214 0.203 0.215 0.209 0.120 0.092 Tactile 12 0.388 * 0.459 0.604 ** 0.716 0.255 0.277 Tactile 13 0.645 ** 0.616 0.679 ** 0.613 0.595 ** 0.554 Tactile 14 0.188 0.087 -0.147 -0.204 0.655 ** 0.600 Tactile 15 0.778 ** 0.733 0.695 ** 0.703 0.843 ** 0.684 Tactile 16 0.430 ** 0.428 0.602 ** 0.668 0.327 0.262 Tactile 17 0.295 * 0.299 0.319 0.375 0.421 0.396 Tactile 18 0.661 * * 0.634 0.519 ** 0.511 0.819 ** 0.772 Tactile 19 0.606 ** 0.622 0.352 0.326 0.723 ** 0.734 Tactile 20 0.213 0.228 0.118 0.144 0.321 0.270 Tactile 21 0.272 0.349 0.330 0.387 -0.160 -0.147 Tactile 22 0.345* 0.279 0.366 0.262 0.254 0.308 Tactile 23 -0.050 -0.080 0.370 0.455 -0.394 -0.349 Tactile 24 0.507 ** 0.506 0.435 * 0.433 0.529 * 0.573 Tactile 25 0.476 ** 0.461 0.509 * 0.489 0.454 0.381 Tactile 26 0.079 0.057 0.026 -0.011 a a Tactile 27 0.588 ** 0.675 0.239 0.226 0.779 ** 0.784 Tactile 28 0.447 ** 0.462 0.393 * 0.407 0.452 * 0.464 Tactile 29 0.193 0.165 0.303 0.186 0.100 0.150 Tactile 30 0.580 ** 0.600 0.497 * 0.590 0.562 * 0.564 Tactile 31 0.539 ** 0.492 0.609 ** 0.583 0.454 0.361 Tactile 32 0.349* 0.439 0.378 0.326 0.430 0.516 Tactile 33 0.508 ** 0.495 0.564 ** 0.518 0.272 0.350 Tactile 34 0.224 0.137 0.232 0.183 -0.079 0.348 R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . 54 Tactile 35 0.645 ** 0.610 0.497 * 0.503 0.620 ** 0.717 Tactile 36 0.526 ** 0.456 0.571 ** 0.528 0.433 0.372 Tactile 37 0.570 ** 0.576 0.326 0.338 0.796 ** 0.745 Tactile 38 0.133 0.259 0.172 0.145 0.129 0.286 Tactile 39 -0.026 -0.047 -0.219 -0.197 0.226 0.154 Tactile 40 0.354 * 0.400 0.336 0.347 0.259 0.212 Tactile 41 0.240 0.347 0.145 0.251 0.535 * 0.522 Tactile 42 0.066 0.050 0.015 -0.011 0.074 0.051 Tactile 43 0.600 ** 0.597 0.713 ** 0.724 0.256 0.303 Tactile 44 0.612 ** 0.618 0.618 ** 0.605 0.448 * 0.570 Tactile 45 0.396 ** 0.310 0.178 0.095 0.659 ** 0.600 Tactile 46 0.614 ** 0.625 0.604** 0.595 0.411 0.487 Tactile 47 0.515 ** 0.528 0.201 0.062 0.638 ** 0.605 Tactile 48 -0.011 0.052 0.317 0.375 -0.393 -0.336 Tactile 49 0.184 0.177 0.211 0.240 0.169 0.160 Tactile 50 0.378 * 0.372 0.408 * 0.420 0.357 0.317 Tactile 51 0.041 0.074 0.040 0.060 0.076 0.073 Tactile 52 0.324 * 0.309 0.284 0.339 0.363 0.297 Tactile 53 0.385 * 0.386 0.340 0.183 0.271 0.193 Tactile 54 -0.036 0.081 -0.062 0.053 -0.028 0.050 Tactile 55 0.178 0.219 -0.031 -0.313 0.288 0.286 Tactile 56 0.338 * 0.288 0.298 0.282 0.301 0.258 Tactile 57 0.155 0.096 0.139 0.084 0.109 0.051 Tactile 58 0.547 ** 0.469 0.543 ** 0.508 0.566 * 0.442 Tactile 59 0.470 ** 0.567 0.235 0.296 0.631 ** 0.643 Tactile 60 0.408 ** 0.363 0.328 0.287 0.519 * 0.490 Tactile 61 0.806 ** 0.794 0.762 ** 0.712 0.797 ** 0.781 Note: *. Correlation is significant at the .05 level. * * . Correlation is significant at the .01 level. a. Cannot be computed because at least one o f the variables is constant Table 11 presents the ICC and Spearman correlation coefficients of the 33 vestibular item scores for the three study groups. As can be seen, 9 items (with rs ranging from .404 to .711) for the combined group, 4 items (r, o f .552 to .786) for the typically developing group, and 3 items (r, of .608 to .909) for the SI dysfunction group were significantly correlated at the p < .01 level. The ICC index was high for 1 item (.796) for the combined group, 2 items (.794 & .800) in the typically developing group, and 3 items (.755 to .898) for the SI dysfunction group indicating good reliability (>.75). R ep ro d u ced w ith p erm issio n o f th e cop yright ow n er. Further reproduction prohibited w ith out p erm issio n . 55 Table 1 1 ICC and Spearman Correlation Coefficients in the Vestibular System Combined Group Control Group SID Group Spearman ICC Spearman ICC Spearman ICC Vestibular 1 0.447** 0.439 0.361 0.242 0.552 * 0.680 Vestibuiar 2 0.192 0.254 0.371 0.404 -0.066 0.023 Vestibular 3 0.600 ** 0.723 0.725 ** 0.794 -0.071 -0.057 Vestibular 4 0.347 * 0.353 0.143 0.138 0.608 ** 0.594 Vestibular 5 0.324 * 0.359 0.552 ** 0.414 0.083 0.276 Vestibular 6 0.104 0.121 0.169 0.176 0.063 0.012 Vestibular 7 0.410 ** 0.412 0.610** 0.700 0.118 0.032 Vestibular 8 0.467 ** 0.420 0.327 0.399 0.555 * 0.420 Vestibular 9 0.145 0.212 0.131 0.234 0.141 0.200 Vestibular 10 0.238 0.374 0.142 0.226 0.381 0.549 Vestibular 11 0.337 * 0.143 0.439 * 0.273 0.148 0.006 Vestibular 12 0.192 0.102 0.105 0.059 0.250 0.126 Vestibular 13 0.078 0.131 0.062 0.132 0.048 0.034 Vestibular 14 0.480 ** 0.490 0.282 0.258 0.909 ** 0.898 Vestibular 15 0.323 * 0.335 0.511 * 0.511 0.093 0.106 Vestibular 16 0.135 0.157 0.172 0.318 0.037 -2.0E -15 Vestibular 17 0.102 0.067 0.093 0.061 0.117 0.131 Vestibular 18 0.367 * 0.469 0.116 0.110 0.432 0.493 Vestibular 19 0.711 ** 0.796 0.786 ** 0.800 a a Vestibular 20 0.472 ** 0.546 0.414 * 0.323 0.557 * 0.755 Vestibular 21 0.375 * 0.417 -0.008 0.017 0.551 * 0.559 Vestibular 22 0.431 ** 0.632 0.200 0.200 0.489 * 0.611 Vestibular 23 0.341 * 0.231 0.346 0.261 0.315 0.202 Vestibular 24 0.342 * 0.317 0.081 -0.037 0.661 ** 0.760 Vestibular 25 0.294 * 0.221 0.349 0.280 0.105 0.050 Vestibular 26 0.176 0.174 0.000 0.010 0.427 0.389 Vestibular 27 -0.090 0.047 0.030 0.095 -0.288 -0.079 Vestibular 28 0.391 * 0.467 -0.280 -0.173 0.525 * 0.549 Vestibular 29 0.237 0.297 0.266 0.348 0.191 0.234 Vestibular 30 0.282 0.265 0.182 0.120 0.401 0.356 Vestibular 31 0.404** 0.514 0.463 * 0.361 0.346 0.575 Vestibular 32 0.216 0.207 0.076 -0.053 0.299 0.369 Vestibular 33 -0.022 0.014 -0.339 -0.365 -0.320 0.148 Note: *. Correlation is significant at the .05 level. **. Correlation is significant at the .01 level. a. Cannot be computed because at least one o f the variables is constant Table 12 presents the ICC and Spearman correlation coefficients of 20 visual item scores for the three groups. As can be seen, only 4 items (rs ranging from .398 to .525) in combined group were significantly correlated at the p < .01 level. Although 2 R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithou t p erm issio n . 56 items for the combined and SI dysfunction groups, and 3 items for the typically developing group showed a moderate ICC index, no item with good reliability was found in the visual system using the ICC. Table 12 ICC and Spearman Correlation Coefficients in the Visual System Combined Group Control GrouD SID Group Spearman ICC Spearman ICC Spearman ICC Visual 1 0.318 0.309 0.383 0.385 0.162 0.185 Visual 2 0.112 0.120 0.413 * 0.478 -0.184 -0.139 Visual 3 0.398 ** 0.431 0.245 0.229 0.548* 0.567 Visual 4 0.163 0.082 -0.132 -0.118 -0.081 -0.170 Visual 5 0.511 ** 0.528 0.149 0.236 0.523* 0.548 Visual 6 0.353 * 0.388 0.289 0.318 0.138 0.153 Visual 7 -0.038 0.053 0.142 0.204 -0.347 -0.268 Visual 8 -0.066 -0.049 0.129 0.046 -0.330 -0.296 Visual 9 0.493 * * 0.512 0.394 * 0.474 0.396 0.392 Visual 10 0.185 0.196 0.145 0.135 0.321 0.247 Visual 11 0.116 0.290 0.183 0.584 0.066 0.192 Visual 12 0.268 0.468 0.148 0.579 0.339 0.382 Visual 13 0.180 0.275 0.143 0.496 -0.049 0.072 Visual 14 0.148 0.344 0.011 0.385 0.172 0.238 Visual 15 0.341 * 0.494 0.040 0.422 0.384 0.354 Visual 16 0.162 0.292 0.216 0.465 -0.030 0.050 Visual 17 0.525 ** 0.483 0.363 0.317 0.407 0.382 Visual 18 a a a a a a Visual 19 0.422 0.424 0.495 0.533 a a Visual 20 a a a a a a Note: *. Correlation is significant at the .05 level. **. Correlation is significant at the .01 level. a. Cannot be computed because at least on o f the variables is constant Table 13 presents the number of items that have moderate to good reliability in the ICC and Spearman correlation, as well as those items that have statistical significance in the Spearman correlation. Statistical significance only indicates that an observed score probably is not the result o f chance; it does not mean that the correlation coefficient represents a strong relationship. Thus, the level of reliability depends on the magnitude R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 57 of a correlation index. As can be seen, although 116 items for the combined group were statistically significant, only 43 items had moderate correlation between the ratings o f fathers and mothers. The results of the number of items computed by the ICC were similar to those computed by the Spearman correlation. An examination of the proportion of the number o f items with moderate correlation in relation to the total number of items for the combined group showed that 26 % (48/185) of the items in the ESP demonstrated moderate to good reliability; approximately 30-36 % of the items in the auditory, proprioceptive, and tactile systems had moderate reliability, and only 10-13 % o f the items in the gustatory/ olfactory and visual systems demonstrated moderate to good reliability. Comparison of Mothers’ and Fathers’ Ratings For each item, the mean scores of fathers’ and mothers’ ratings were compared for each group (See Table 14). Results showed that for the combined group, the mean scores of mothers’ were higher the fathers’ in 50 % of the total items. This was also the case for 60% of the control group. However, for the SI dysfunction group, the mean scores of fathers’ ratings were higher than the mothers’ in 55% of the total items. In order to compare the reliability of mothers’ with fathers’ ratings, Cronbach’s alpha was computed to estimate the internal consistency o f items within each sensory system, as well as all the items of the ESP together, for mothers’ and fathers’ scores. Results are shown in Table 15. Alphas were high ( > .85) for all but the gustatory/ olfactory items for both parents, and for mothers’ vestibular items. In Table 14, one can R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. Table 13 The numbers of items that have moderate to good reliability in ICC and Spearman correlation index Auditorv Gust/Olf ProDri Tactile Vestibular Visual Total C T SI C T SI C T SI C T SI C T SI C T SI C T SI Spearman * * (p<01) 15 5 2 4 1 3 15 2 5 29 14 14 9 4 3 4 0 0 76 26 27 * (p<.05) 7 4 8 6 2 4 5 10 11 10 7 10 10 4 6 2 2 2 40 29 41 total 22 9 10 10 3 7 20 12 16 39 21 24 19 8 9 6 2 2 116 55 68 Spearman rs>.7 5 0 0 0 0 0 1 1 0 3 2 2 5 0 1 1 0 0 0 3 3 10 ,5< r,<.7 5 10 5 10 0 1 5 8 3 10 18 13 15 2 4 7 2 0 2 40 26 49 total 10 5 10 0 1 6 9 3 13 20 15 20 2 5 8 2 0 2 43 29 59 ICC ICC>, 75 0 0 0 0 0 2 1 1 3 1 0 3 1 2 3 0 0 0 3 3 11 ,5<ICC<.75 11 7 9 2 1 6 8 4 5 18 16 18 4 2 7 2 3 2 45 33 47 total 11 7 9 2 1 8 9 5 8 19 16 21 5 4 10 2 3 2 48 36 58 Note: C is combined group, T is typical developing group, SI is SI dysfunction group. rs is Spearman correlation coefficient index. Total means total number o f items have m oderate and good reliability 0 0 59 see, that Cronbach’s alpha was performed on only 2 and 3 cases of mothers7 and fathers7 scores, respectively for the visual system. This was because the last three items in the visual system had a very high percentage of N/A responses. Items 18, 19, and 20 ask parents if their child has difficulty in reading, writing, and copying, for example “Does your child have difficulty shifting gaze from the board to the paper when copying from the board?7 7 These questions are not appropriate for the preschool children in this study, who are not in formal academic settings, thus many N/A responses were found in the data. Table 14 Comparison of Mean Item Scores of Mothers and Fathers _____________________ Auditory Gusto Proprio Tactile Vesti Visual_______Total Number of items Combined Group Mom's score higher 23 9 17 24 13 7 93 (50%) Dad's score higher 8 5 7 29 17 13 79 (43%) Same 0 1 1 8 3 0 13 (7%) Control Group Mom’s score higher 19 8 22 36 15 11 111 (60%) Dad's score higher 10 6 3 25 14 8 66 (36%) Same 2 1 0 0 4 1 8 (4%) SID Group Mom's score higher 21 8 4 20 10 5 68 (37%) Dad's score higher 7 6 18 38 19 14 102 (55%) Same 3 1 3 3 4 0 14 (7.50%) One Missing 1 1 (0.50%) R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 60 Table 15 Internal Consistency of Mothers’ and Fathers’ Ratings for the Combined Group Auditory Gusto/Olf Proprio Tactile Vesti Visual Total Mothers’ Alpha 0.894 0.775 0.914 0.953 0.773 0.975 0.980 No.of cases 26 31 25 17 27 2 6 Fathers’ Alpha 0.899 0.795 0.894 0.941 0.874 0.853 0.978 No.of cases 24 26 24 21 22 3 8 Note: No. o f cases represent the number o f cases for whom all relevant items were scoreable. Cases were dropped if any items were left blank or marked N /A (not applicable) by rater. R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . CHAPTERV 61 DISCUSSION Introduction The purpose of this study is to explore the interrater reliability of items on the ESP questionnaire. The development o f the ESP is an ongoing project, and the scoring system is still under construction, hence, the present study focused on the interparental agreement and correlation of ratings of individual items. The relationship between parents’ responses on the ESP was analyzed using the ICC and Spearman correlation coefficients, as well as by calculating percentages of agreement. This chapter is a discussion of the results of this study o f item reliability. The limitations of the study, its implications, and suggestions for future research are also reported. Percentage of Agreement The results of the study only partially supported the hypothesis that the percentages of agreement obtained on the interparental measures o f the ESP would be reasonably high (> 75%) for both groups. The means of the exact percentages of agreement for each sensory system and the total ESP were over 40% (except for the proprioceptive and visual systems in the SI dysfunction group), demonstrating fair interrater reliability. However, high agreement ( > 75%) between fathers and mothers was found on all sensory systems (except the visual system for the SI dysfunction group) as well as the total ESP when percentage of agreement within one rating level was evaluated. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 62 A factor that might have contributed to the low results of the exact percentage of agreement was the 5-level scoring system o f the ESP. The questionnaire is scored subjectively by both parents, and it is likely that they may have different perceptions of the same behaviors. Thus, it is difficult to obtain exact agreement between parents for each item. In comparing the results of the typically developing group from this study (n = 20) to the normal sample (n = 30) of Provost & Oetter’s study, the SRS seemed to have higher interparent agreement than the ESP. The means of the exact percentage of agreement for the SRS subsections and total score were between 49.4% and 62.4% (compared to ESP means ranging from 40.4% to 51.89%). The means of the percentage of agreement within one rating level for the SRS subsections and total score were above 86% (compared to ESP means ranging from 81.52 % to 88.6). ICC and Spearman Correlation Coefficient The results of the Spearman correlation coefficient showed some significant but, overall, relatively low to moderate correlations between the item scores of mothers and fathers. Despite the fact that several items had moderate to high agreement & correlation coefficients, the results of the ICC and the Spearman correlation always showed that a large number of items contained discrepancies between mothers’ and fathers’ ratings of their children’s behaviors (see Table 14). Although the results of this study failed to show that most items have moderate to good reliability, revision of the ESP is still continuing and the final version aims to reduce the number of items to 70. After R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . 63 eliminating unreliable or redundant items, a greater proportion of items with good reliability can be expected. One reason for the low correlations may be that the sample size was too small. However, it is also likely that the different perspectives of fathers and mothers in assessing their child’s behavior, situational variations in a child’s behavior with one parent versus the other, or some combination o f both effects may contribute to the fair to moderate interrater reliability of this study. An additional factor that might affect the interrater reliability values for some items was a lack of variability among subjects’ scores. This may occur “when samples are homogeneous, when raters are all very lenient or strict in their scoring, or when the rating system falls within a restricted range.” (Portney & Watkins, p. 514). Since calculation of correlation coefficients is based upon variance, lack of variance may have lowered the magnitude o f the coefficient for some items. Differences in Parental Agreement Between Typically Developing and SI Dysfunction Groups Both the exact percentages of agreement and the percentages of agreement within one rating level were generally higher (except for the gustatory/olfactory system) for the typically developing group than for the SI dysfunction group. The generally lower percentages of agreement for the SI dysfunction group may be due parents having disparate observations, experiences, and explanations for the behavioral responses of their children, which may be less consistent than behavior of typically developing R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 64 children. The results of one psychology study showed that parental agreement tended to be higher when parent rated more extreme behaviors than when they rated behaviors that are less concrete and more difficult to observe (Walker & Bracken, 1996). Behaviors indicative of sensory integrative problems, such as those addressed in the ESP, are often subtle and may be unnoticed by some parents. Interestingly, more items with moderate to high correlations ( > .50) using the Spearman and ICC index were found for the SI dysfunction group than the typically developing group (59 versus. 29 in Spearman analysis; 58 versus 36 in ICC) (see Chapter 4, Table 14). The greater variability in scores of the SI dysfunction group may be the primary factor contributing to this result. Another interesting finding was that for the SI dysfunction group, the mean item scores of mothers was lower than fathers. However, the reverse was found for typically developing and combined groups. For most ESP items, a lower score indicates a greater likelihood of having a problems problem with sensory processing. Perhaps mothers of children with SI problems are more likely than fathers to be sensitize to the children’s sensory processing problems. Usually, mothers spend more time interacting with their children, thus they may see behavior indicators of problems occurring more frequently than do fathers. In addition, perhaps mothers in the SI dysfunction group were more involved in their child’s therapy program, had more discussion or communication with the occupational therapist, and therefore they may have been more likely to perceive certain behaviors as a problem. Future research to examine gender-linked in parental ratings is warranted. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 65 Limitations This study has several limitations that should be recognized. O f primary concern is the relatively small sample size (n = 20 in the typically developing group and n = 15 in the SI dysfunction group), and the unequal distributions of child gender and ethnicity. The recruitment criteria of this study stipulated that only two-parent families (not necessarily the biological parents) were eligible, thus decreasing the number of available parents. In addition, asking each parent to complete this 185-item questionnaire reduced the available pool even further. A second limitation is that a convenience sample was used in this study. Since the participants in the SI dysfunction group came from four pediatric clinics in the greater Los Angeles area, the results are not statistically generalizable to a larger population o f children with SI dysfunction. This sample selection may also have introduced a systematic bias to the study. Another limitation of the study is that because the ESP is a written questionnaire filled out independently by parents at home, there always exists a potential for misunderstanding or misinterpreting the question items or response choices. Implication and Future Studies In this study the major concern was the interrater reliability between mothers and fathers who assess their children. Interrater reliability will help the researcher to assume that the scores obtained from parents’ ratings are likely to be representative of their child’s true scores, therefore the results can be interpreted and applied with more R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 6 6 confidence. The Spearman and ICC correlation coefficient for each item score was only poor to moderate; however, the mean percentages of agreement within one rating level were above 80%, demonstrating good reliability when the criterion for agreement allows for slight differences in parent ratings. Provost and Oetter (1993) advocated use of percentages of agreement within one rating level as the most important measure of interrater reliability in an instrument such as this one. Using this more lenient criterion, most items of the ESP have acceptable interrater reliability. The results of this interrater reliability study will assist ESP developers in eliminating unreliable items in the present version in order to ensure that only reliable items will be selected in the final version o f the instrument. Comparisons of reliability and validity data from several studies will be used to decide whether individual items should be retained, revised, or eliminated. In addition, once the final version and scoring system have been established, using the ICC and Spearman correlation coefficients to compute the interrater reliability of each sensory system score and the total ESP score may lead to a more complete and meaningful image of the instrument’s reliability. Since some factors (small sample size, homogeneity of the study group) affected the results of the present study, future investigations with the ESP should emphasize a larger sample size, wider age range, and the recruitment of children from various settings. Additionally, children with other diagnoses should be included to examine how different types of behavior may influence parents’ scoring and reliability. The present study also indicates the need for continuing research on the factors involved in the perceptions and parenting behaviors of mothers and fathers with SI dysfunctional R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 67 children. This would include investigation of the effect o f child’s age, and child’s and parent’s gender, on the degree of agreement and on the magnitude o f differences between fathers’ and mothers’ ratings. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. 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Interparent agreement on the personality inventory for children: Are substantial correlations sufficient? Journal of Abnormal Child Psychology. 14(1). 115-122. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 70 Jacob, T., Grounds, L., & Haley. R. (1982). Correspondence between parents' reports on the behavior problem checklist. Journal of Abnormal Child Psychology. 10(4). 593-608. Johnson, C. (1996). A studv of a pilot sensory history questionnaire using contrasting groups. Unpublished master's thesis, University of Southern California, Los Angeles. Johnston, M. V., Findly, T. W., DeLuca, J., & Katz, R. T. (1991). Research in physical medicine and rehabilitation XU. Measurement tools with applications to brain injury. American Journal of Physical Medicine and Rehabilitation. 70. 114-130. Kazdin, A. E. (1992). Research design in clinical psychology (2nd ed.). Needham Heights, MA: Allyn and Bacon. Kientz, M. A., & Dunn, W. (1997). A comparison of the performance of children with and without autism on the Sensory Profile. American Journal of Occupational Therapy. 51(7). 530-537. LaCroix, J. E. (1993). A study of content validity using the sensory history questionnaire. Unpublished master’s thesis , University of Southern California, Los Angeles. LaCroix, J. E., & Mailloux, Z. (1995, April). Evaluation of sensory processing. Paper presented at the American Occupational Therapy Association National Conference, Denver, CO. LaCroix, J. E., Johnson, C. & Parham, D. (1997). The development of a new sensory history: The evaluation of sensory processing. Sensory Integration Special Interest Section Quarterly. 20( 1) 3-4. Larson, K. A. (1982). The sensory history of developmentally delayed children with and without tactile defensiveness. American Journal of Occupational Therapy. 36 (9), 590-596. Law, M. (1987). Measurement in occupational therapy: Scientific criteria for evaluation. Canadian Journal of Occupational Therapy. 54 (3). 133-138. Nunnally, J. C. (1978). Psychometric theory (2nd ed.). New York: Macgraw-Hill. Ottenbacher, K. J., & Tomchek, S. D. (1993). Reliability analysis in therapeutic research: Practice and Procedures. American Journal of Occupational Therapy. 47( 1). 10- 16. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 71 Ottenbacher, K. J. (1995). An examination of reliability in developmental research. Journal of Developmental Behavior Pediatric. 16(3). 177-182. Parham, L. D., & Mailloux, L. D. (1996). Sensory integration. In J. Case-Smith, A.S. Allen, & P.N. Pratt (Eds.), Occupational therapy for children (3 rd ed.) (pp.307- 356). St. Louis: Mosby. Parham, L. D. (1997, April). Sensory questionnaire validity for children with autism. Paper presented at the annual conference of the American Occupational Therapy Association, Orlando, FL. Portney, G., & Watkins, M. P. (1993). Foundations of clinical research: Applications to practice. Norwalk, CT: Appleton & Lange. Polit, D. F., & Hungler, B. P. (1995). Nursing research. Philadelphia: Lippincott. Portney, G. L., & Watkins, M. P. (1993) Foundations of Clinical Research: Applications to Practice. Norwalk, CT: Appleton & Lange. Provost, B., & Oetter, P. (1993). The sensory rating scale for infants and young children: Development and reliability. Physical and Occupational Therapy in Pediatrics. 13(4), 15-35. Rovinelli, R. J., & Hambleton, R. K. (1977).On the use of content specialists in the assessment of criterion-referenced test item validity. Dutch Journal for Educational Research. 2 .49-60. Royeen, C. B. (1985). Domain specifications of the construct tactile defensiveness. American Journal of Occupational Therapy. 39(9). 596-599. Royeen, C. B. (1986). The development o f a touch scale for measuring tactile defensiveness in children. American Journal of Occupational Therapy. 40(6), 414-419. Royeen, C. B. (1987). TIP-Touch inventory for pre-schoolers: A pilot study. Physical and Occupational Therapy in Pediatrics. 7 (1). 29-40. Walker, K. C., & Bracken, B. A. (1996). Inter-parent agreement on four preschool behavior rating scales: effects o f parent and child gender. Psychology in the Schools. 33 (4). 273-283. Wilkinson, W. K., & McNeil, K. (1996). Research for the helping professions. Pacific Grove, CA: Brooks/Cole Publishing Company. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 72 Yegidis, B. L., & Weinbach, R. W. (1996). Research methods for social workers (2nd ed.). Needham Heights, MA: Allyn and Bacon. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 73 APPENDIX A Evaluation of Sensory Processing Questionnaire (Version 3) R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 74 ESP Evaluation of Sensory Processing Research Version 3 Instruction : Please read each question carefully and answer each as accurately and honestly as you can. Indicate only one answer for each question by checking the appropriate box, using the key below: A = Always, O = Often, S = Sometimes, R = Rarely, N = Never, N/A = Not applicable. Please keep in mind that we are trying to find out which of these questions pick up on unusual behaviors, and which ones relate to behaviors that many children demonstrate. Your honest answer, therefore, is very important to us. None of the questions are intended to be “trick” questions. For most of the questions, the N/A option is shaded and should not be checked. If the N/A box is not shaded, it should be checked only if the child has never been exposed to the situation in question. For example, for the item “ Is your child bothered by loud background noise such as construction work nearby or sounds o f machinery operating?” the N/A response should be checked only if the child has never been exposed to background noises such as construction work or machinery operating. If you are not sure of the meaning of a particular item, or if you are unsure of how to answer it, please call the primary investigator, Chia-Chun Chang, at the University of Southern California, for clarification. She can be reached by telephone at (626) 588-1415. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 75 ESP Research Version 3 A ALWAYS Child’s name O OFTEN CZuK Ts aee years months S SOMETIMES Name of adult completing this form R RARELY Relationship to child N NEVER Date N7A NOT APPLICABLE n r . v t i a Auditory System is your chiid bothered by or fearful o f the sound m ade by a toilet flushing1 | 2 D oes -our child startle or becom e distressed by loud or un expected sounds1 ! i D oes -our c.mid nave trouble understanding w hat oth er p eop le mean w hen ; thev sav som ething1 1 ; o s r n s / a ’ i ! ! ! ! a i D oes your child seem to hear sounds that other p eop le tend to not notice1 1 ! ! 1 ; S ; D o you notice your child being bothered by any sounds w hich occu r during | daily life tasks, such as tasks o f personal hygiene, dressing, eating, hom e ! 1 making, school work, play/leisure1 !■ I ! 5 : is your child bothered by loud background noise such as construction w ork nearbv or sounds o f machinery operating1 ! ! : , ' I D oes your child seem to have trouble rem em bering w hat is said to him/her1 1 i i 8 1 Is your child bothered by any hou sehold or ordinary sounds, such as 1 soueakv shoes, the vacuum, the b lo w dryer, d o g barking, etc.1 . -- ^ j 1 9 1 D oes your child seem to understand oral directions? i ; i 10 ; D oes your child fail to a n upon a request to do som ething, o r fail to i i understand directions? 1 .! ; ' 11 j D oes your child respond negatively to loud n oises as in running away, 1 crying, or holding hands over ears? i i ! 2 Is vour child distracted by subtle sounds, such as fluorescent light bulbs. i • ; ‘ ! heaters, 'in s, refrigerators1_________________________ !s vour cn ld coihered by the sound o f the vacuum 1 is vour c.-oic oocnered oy cfte sound made by certain accessories such as . bracelets and necklaces? . 1 : I : I S : D oes your child appear to not bear certain sounds? 1 1 i .6 Is your child d istricted by sounds not normally noticed by oth er people? 1 ! ; i ? : D ocs your child mind the sound o f the hairdryer? | IS • D oes your child mind the sound o f squeaky shoes? ! ! 1 19 i Is your child frightened o f sounds w hich do not usually con vey alarm to 1 1 other children the same age? i : l ■ - 0 D oes your chiid hear sounds oth er p eop le don’ t n otice or have trouble tuning out certain sounds, such as, a clo c k or w atch ticking? 1 121 | D oes your child ask others not to talk or sing or m ake noise? 1 i I R ep ro d u ced with p erm issio n o f th e cop yright ow ner. Further reproduction prohibited w ithout p erm issio n . 7 6 T E M A O S R N N /A 22 Does your child appear to m ake noise for noise’ s sake? 23 Compared to other children the sam e age does your child seem to under react to loud noises? 24 Does your child have trouble interpreting the m eaning o f sim ple or common words? 25 Does your child respond negatively or seem bothered by unexpected sounds or noises, as in running away, crying, o r holding hands over ears? 26 Does your child seem confused as to th e direction from w here sounds are coming? 27 Does your child have difficulty paying attention when there are other noises nearby? 28 Is your child easily distracted by irrelevant or background noises such as a lawn mower outside, children talking in the back o f the room, crinkling paper, air conditioners, refrigerators, fluorescent lights? 29 Does your child seem too sensitive to sounds? 30 Does your child ask “what?” a lot, or need to have words, especially directions repeated? 31 Does your child like to sing or dance to m usic? Gustatory/ Olfactory System l. Does your child gag, vomit, or com plain o f nausea when sm elling odors such as soap, perfume, or cleaning products? 2 . Does your child respond to odors that o ther people do not notice? j. i Does your child complain that foods are too bland or refuse to eat bland foods? i -» • t Does your child season his/her food heavily or indicate a desire for heavy season ina, such as excessive salt, ketchup, or other spices? N As an infant did your child resist eating when new flavors o f pureed baby foods were introduced? 6 . Does your child prefer very salty foods? 7. Does your child complain o f being hurt by a taste or a smell? 8. Does your child like unusual com binations o f flavors such as ketchup with ice cream or salt in orange juice? 9. Does your child like to taste non-food item s such as glue or paint? 10 Does your child gag when sm elling food odors such as cooked broccoli or garlic? 11 Does your child gag when anticipating an unappealing food such as cooked spinach? 12 Does your child gag at a sound associated with an unpleasant odor such as the sound o f a can o f cat food being opened 13 Does your child prefer to eat spicy foods? 14 Does your child prefer to eat sour foods or candies? 15 Is your child distracted by sm ells on h is/her hands? R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . 77 | ITEM A O S R N N /A Proprioception System l. Does your child grasp objects so tightly th at it is difficult to use the object? 2 Does your child tire easily after sitting o r lying in the sam e position for awhile? 3. Does your child grind his/her teeth? 4. Does your child seem driven to seek activities such as pushing, pulling, dragging, lifting, and jumping? 5. Does your child climb high into tree, ju m p o ff tail walls or furniture, etc.? 6. Does your child like giving bear hugs? 7. Does your child seem unsure o f how far to raise or lower the body during movement such as sitting down o r stepping over an object? 8. Does your child not notice falling? 9. Does your child like to be under heavy blankets, covers or pillows? 10. Does your child tend to break toys? 1 1 . Does your child chew on pens, straw s, etc.? 12. Does your child grasp objects so loosely th at it is difficult to use the object? 13. Does your child chew on nonfood objects? 14. Does your child seem to exert too m uch pressure for the task, for example, walks heavily, slams doors, or presses too hard when using pencils or cravons? 15. Does your child jump a lot? 16. Does your child have difficulty playing w ith anim als appropriately, such as petting them with too much force? 17. Does your child have difficulty positioning him /herself in a chair? 18. Does your child frequently hit. bump, an d /o r push other children? 1 19. Does your child seem generally weak? \ 20. Compared with other children the sam e age, does your child seem to seek out activities that involve jum ping, crashing into things, pushing, pulling or falling? i j 21. i Does your child like getting bear hugs? 22. Does your child taste o r chew on toys, clothes, or other objects more than other children? 23. Does your child crave hugging or rough playing? 24. Does your child like to chew on hard candy? 25. Does your child have difficulty sitting erect, or choose to lie down instead o f sitting up? Tactile System l. Does your child dislike going barefoot, n o t like to take his/her shoes o ff or insist on alwavs wearing shoes? 2. Does it bother your child to play gam es w ith bare feet? j . tsyour child irritated by the feel o f certain clothing? R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 78 ITEM A O S R N N/A 4. Does your child pull aw ay from light touch? 5. Does your child seem to lack th e norm al aw areness o f being touched? 6. Does your child resist or d islike w earing clothing o f certain textures? 7. Does your child react negatively to the feel o f new clothes? 8. ! Does your child tend to prefer to w ear long sleeve shirts and long pants regardless o f the weather, for instance prefers to w ear long sleeves even when it is warm outside? 9. Does your chiid seem excessively ticklish? 10. Does your child like to cuddle up w ith a blanket or stuffed anim al or special pillow? 11. Does your child enjoy tickling a s a form o f play? 12. Does your chiid avoid playing w ith "messy'' things such as finger paint, mud. sand, glue, glitter, or clav? 13. Does your child show an unusual dislike for having his/her hair combed, brushed or styled? 14. Do rough bedsheets bother your child? 15. Does wearing turtieneck shirts bother your chiid? 16. Does your child prefer to touch rath er than be touched? 17. Does your child seem driven to touch different textures? 18. Does your child prefer to go barefoot? 19. Does your child refuse to w ear h ats, sunglasses, or other accessories? 20. Does wearing fuzzy shirts bother your child? 21. Does your child dislike w earing pants or com plain about the feel o f them brushing against his/her legs? 22. Does your child tend to w ear coats or sw eaters w hen they are not needed? 23. Does your child appear to lack th e norm al aw areness of being touched? 24. | Does your child prefer the textures o f certain clothing? 1 25. j Does your child overreact to m inor injuries? 1 26. j Does your child complain about irritating bum ps on the bedsheets? 27. | Does it bother your child to have his/her finger o r toe nails cut? 28. ■ Does your child struggle against being held? 29. , Does your child dislike playing gam es w ith his/her bare feet? 30. Does your child have a tendency to touch things constantly? 31. Does your child dislike getting h is/her hands m essy or ask to wash hands when using things like glue and glitter? 32. Does your child avoid or dislike playing w ith gritty things? 33. Do tags or collars on clothing bother your child? 34. Does your child dem onstrate an aversion to an y form o f clothing? 35. Does your child prefer certain textures o f clothing or particular fabrics? 36. Does it bother your child to have his/her face touched? 37. Does it bother your child to have his/her face w ashed? 38. Does your child object to being touched by fam iliar people? 39. Does it bother your child if he/sh e can not see w ho is touching him /her when among fam iliar people at hom e or school? R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . i ITEM A | 0 S R N I N/A 40. j Does the feel ot new clothes bother your child? 41. Does your child resist or dislike wearing snort sleeved shirts or short pants? 42. 1 Does your child seem to lack awareness o f being touched by others? 43. Does your child ask you to take the tags and labels out o f clothing or only wear clothes which have had the tags and labels removed? 44. Is your child irritated by tags on clothing? 43. i Is your child bothered by h air brushing against his/her face? 46. | Does your child dislike the feeling o f certain clothing? 1 i 47 1 Does your child have an unusually high tolerance for pain? ; 48. , Does your child demonstrate an excessive need to touch? 44 i Does your child display an unusual need for touching certain textures, , 1 surfaces, objects or tovs? ! -0 . j Does your child startle easily when being touched unexpectedly? J 51. | Does wearing fuzzy socks bother your child? 52. Does your child dislike eating messy foods w ith his/her hands? 53. Does your child tend to feel pain less than others? 54. Does it bother your child when a fam iliar person at hom e or school is close bv? 35. i Does your child avoid touching different textures? i 56. Does your child appear to resist eating certain foods because o f their texture? 37. | Does your child strongly dislike being tickled? 58. Does your child avoid foods o f certain textures? 59. Does your child avoid getting his/her hands in finger paint, paste, sand. clay. mud. glue, etc.? 60. Does your child seek messy play activities? 61 ; Does it bother your child to have his/her h air cut? 1 Vestibular System 1 1 J Does your child rock while sitting? | | j ; _. | Does your child seem excessively feartul o f m ovem ent, as in going up i j and down stairs or riding swings, teeter totters, slides, or other ! playground equipment? ; j . Does your child get nauseous or vomit due to m ovem ent experiences? ; * 4 Does your child like to swing? Does your child demonstrate distress when he/she is moved or riding on moving equipment? 6. Does your child's head move along with his/her eyes in activities such as reading, following along with a parent reading or playing a com puter game? /. Is your child frequently and easily confused about his/her location for example, gets lost in stores, or can’ t find the w ay to a fam iliar classroom? 8. Does your chiid have good balance? 1 R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 80 I ITEM A O S R N N/A 9. Does your child have to exert m ore effort to move th an others, tire easily from exertion and or require m ore sleep than others? 10. Does your child avoid balance activities such as w alking on curbs or on uneven ground? 11. Is your child fearful o f heights, such as escalators, glass elevators, stairs, etc.? 12. Does your child like fast movements, such as being w hirled about or tossed in the air bv an adult? 13. Does your child like to clim b very high? 14. Does your child like fast spinning carnival rides, such as merry-go- rounds? 15. Is your child fearful o f acriviries which require good balance? 10. When your child shifts his/her body does he/she fall out o f his chair? 17. is your child unable to catch him /herself when falling? 1 18. Does your child seem to not get dizzy when others usually do? | 19. | Does your child get car sick? 20. I Does your child seem generally weak? j 21. | Does your child spin and whirl more than other children? 1 ! 22. i Does your child rock him self/herself when stressed? 1 ! 11 Does your child like to be inverted or tipped upside down or enjoy doing activities that involve inversion, such as hanging upside down or doing somersaults? 24. Is your child fearful o f swinging or bouncing, or was fearful o f this as an infant? 25. Does your child experience discomfort, nausea, or dizziness following movement, especially rotation? 26. Does your chiid tend to need movement in order to "get going," for example, after waking up from a nap? 27. Does your chiid dislike sudden or quick movement such as suddenly stopping or goine over a bump while riding in the car? 28. Compared with other children the sam e age does your child seem to ride longer or harder on certain playground equipment for example, swing, merry-go-round? 29. Does your child avoid rapid or spinning movement? 30. Is your child fearful o f activities in which he/she moves through space? 31. Does your chiid dem onstrate distress when his/her head is in any other position than upright or vertical such as having the head tilted backward or upside down? 32. Does your child react negatively to, dislike, appear threatened by, or exhibit a fear reaction to movement? 33. Does your child enjoy excessive spinning and twirling? R ep r o d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . 81 V is u a l S y s te m ITEM A O s R N N /A I. Does your child have trouble telling the difference bexween printed figures that appear sim ilar, for exam ple, differentiating b w ith p, or + with x? n Is your child sensitive to or bothered by light, especially bright light (blinks, squints, cries, or closes eyes, etc.)? 3. When looking at pictures, does your child focus on patterns or details instead o f the main pictures? 4. Is your child able to look at som ething far away? 5. Does your child have difficulty keeping his/her eyes on the task or activity at hand? 6. Does your child have trouble m aintaining his/her visual focus on one task or object for verv lone? 1 7. ! 1 Does your child rub his/her eyes, com plain o f headaches, or have eyes which water after readine or looking at books? i s. 1 Does your child have difficulty with visually focusing on things far awav? ! 9. | Does your child become easily distracted by visual stim uli? 10. Does your child have trouble locating things laying o n top o f other things, especially things o f the same color, o r have trouble finding an object when it is am idst a group o f other things? 11. Does your child close one eye and/or tip his/her head back when looking at something or someone? 12. Does your child have difficulty with unusual visual environm ents such as a bright colorful room or a dimlv lit room ? 13. Does your child have difficulty with visually focusing on things close? 14. Does your child have difficulty controlling eye m ovem ents during activities such as following objects like a ball with eyes, keeping place while reading, or copying from blackboard to the desk? 15. Compared to other children the sam e age does your ch ild seem to be easily distracted by visual stimuli? 16. Does your child have trouble following objects w ith his/h er eyes? 17. Does your child have difficulty nam ing, discrim inating, or matching colors, shapes or sizes? 18. Did your child make reversals in words or letters w hen w riting or copying or read words backwards (such as reading saw for was) after the first grade? 19. Does your child lose his/her place on a page while reading, copying, solving problems, or performing m anipulations? 20. In school does your child have difScuityshifting gaze from the board to the paper when copying from the board? R ep ro d u ced with p erm issio n o f th e copyright ow n er. Further reproduction prohibited w ithout p erm issio n . 82 APPENDIX B Parents Questionnaire R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . Parent Questionnaire • Child's Name:____________________ • Telephone:_______________________ • Sex: Female_______ M ale________ • Race:_________________________ • Age:______years,_______ months • Do both parents live with this child? Yes, N o,______ If yes, have both parents lived with the child for the past year? Yes,_____No,_____ • Was this child the product of a multiple birth? Yes, N o,______ • Was the baby premature (less than 37 weeks gestation age at birth) ? Yes,_____N o,_____ • Does your child have any of the following diagnoses ? (check all that apply) Attention deficit disorder Autism Learning disability Speech or Language delay General developmental delay Cerebral Palsy Other medical condition ( explain:____________________ ) II. Parents’ Occupation (please be specific): Mother_____________________ Father______________________ in. Highest Completed Level of Education (please check one for mother and one for father): Mother Father Graduate School _____ _____ College/ University (4 years)______________________ _____ _____ Partial College/ University_____________________________ _____ High_ School___________________________________ _____ _____ Partial High School (10-11th grade) _____ _____ Junior High (7-9th grade) _____ _____ Less than 7th grade _____ _____ Parent(s) Names: ________________________________ Parent(s) Signature: R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . APPENDIX C Consent to Participate in Research R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 85 ‘ CONSENT TO PARTICIPATE IN RESEARCH TITLE OF PROJECT: INTERRATER RELIABILITY OF THE EVALUATION SENSORY PROCESSING (ESP) PRINCIPAL INVESTIGATOR: Chia-Chun Chang DEPARTMENT : Occupational Science and Occupational Therapy 24-HOUR TELEPHONE NUMBER: (626) 588-1415 PURPOSE OF THE STUDY: You are invited to participate in a study of a sensory history questionnaire called the Evaluation of Sensory Processing (ESP). A sensory history questionnaire is an evaluation tool that assists therapists in gathering valuable information about a child’s sensory processing in the home and in the natural environment. We hope to learn which of the ESP items provide information that parents agree on when they fill it out the questionnaire separately, without sharing their responses with each other. The results of the study will help us to refine and shorten the questionnaire. You are invited as a possible participant in this study because you, your spouse, and your child have the appropriate background requirements for participation in the study. PROCEDURE: If you decide to participate, we will ask you to fill out a 184 item questionnaire about your child’s behavioral responses to various types of sensory experiences. A total of about thirty minutes is expected for completing the whole questionnaire. Your spouse will be asked to complete the same questionnaire for the same child, but the two of you should complete the questionnaire without seeing, hearing, or discussing each other’s responses. When they are completed, you will mail the 2 questionnaires to us in the attached addressed envelope. RISKS: There are no risks involved in this study. Your child will not be examined or observed in any way as part of this study. The only inconvenience that might occur is that you will spend the time to answer a 184 item questionnaire. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . 86 BENEFITS: No specific benefits are expected through participation in this study. However, your participation will help us to develop a briefer, better questionnaire, which in the future may benefit many children with problems in sensory processing. ALTERNATIVE TREATMENT: The alternative is not to participate in the study. CONFIDENTIALITY STATEMENT: Any information that is obtained in connection with this study and that can be identified with you, your spouse, or your child will remain confidential. The results from this study will be treated in such a manner that no one, except for the principal investigator, will be able to identify who participated in this study. All test forms will be kept in strict confidentiality. OFFER TO ANSWER QUESTIONS: Your participation in the study will be under the direction of Chia-Chun Chang, at (626) 588-1415. A committee exists which has reviewed and continues to review this study from a scientific and ethical point of view. If you have any questions about this research, please feel free to contact the principle investigator Chia-Chun Chang, at (626) 588- 1415. If you have any questions regarding your rights as a study participant, you may contact the Institutional Review Board Office, trailer # 25, Unit I, 1200 N. State Street, Los Angeles, CA 90033, USA, at 213-223-2340. You will be given a copy of this form to keep. COERCION AND WITHDRAWAL STATEMENT: Your decision whether or not to participate will not interfere with your child’s future care and education at any institution, including or his/her school. If you decide to participate, you are free to withdraw your consent and discontinue participation at any time. INJURY STATEMENT: If you require medical treatment as a result of injury arising from your participation in this study, the financial responsibility for such care will be yours. R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm ission . 87 CALIFORNIA LAW REQUIRES THAT YOU MUST BE INFORMED ABOUT: 1. The nature and purpose of the study. 2. The procedures in the study and any drug or device to be used. 3. Discomforts and risks to be expected from the study. 4. Benefits to be expected from the study. 5. Alternative procedures, drugs or devices that might be helpful and their risks and benefits. 6. Availability of medical treatment should complications occur. 7. The opportunity to ask questions about the study or the procedure. 8. The opportunity to withdraw at any time without affecting your future care at this institution. 9. A copy of the written consent form for the study. 10. The opportunity to consent freely to the study without the use of coercion. 11. Statement regarding liability for physical injury, if applicable. AGREEMENT: YOUR SIGNATURE INDICATES THAT YOU HAVE DECIDED TO ALLOW TO PARTICIPATE HAVING READ THE INFORMATION PROVIDED ABOVE. Signature of participant Date Print name of participant Date Signature ofWitness Date R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . APPENDIX D Cover Letter R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . Septem ber8, 1998 8 9 Dear Parents: My name is Chia-Chun Chang. I am in the master's degree program at the Department of Occupational Science and Occupational Therapy, at the University of Southern California. I am cunrently in the process of completing my master thesis. The title is “ Interrater Reliability of the Evaluation Sensory Processing (ESP)” . The purpose and process of this research are described in the consent form. if you decide to participate in this research study, please fill out the following materials inside this package: three consent forms, one parent questionnaire, and two copies of the ESP questionnaires (one for the mother to fill out and one for the father to fill out ). Please fill out the ESP questionnaires separately, without any discussion and without seeing the other parent’s response. When completed, simply drop off these questionnaires in the mail using the enclosed self-addressed, stamped envelope, except for one of the consent forms, which is for you to keep. Your cooperation and participation in this research yields valuable insights for therapists. Your answers will be held in strictest confidence. Thank you for your time. Sincerely yours, Chia-Chun Chang R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . APPENDIX E The Range, Means, Standard Deviation of Parents Item Scores R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n . Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission. Combined Group Control Group SID Group Moms' Score Dads' Score Moms' Score Dads' Score Moms' Score Dads' Score Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Auditory 1 1-5 4 54 0 92 3-5 4.89 0.40 3-5 4 65 0 75 4-5 4 90 0 31 1-5 4.40 1 12 3-5 4 87 0 52 Auditory 2 2-5 3 50 086 1-5 3.38 0.92 2-5 3 60 0 75 1-5 3 42 0 96 2-6 336 1 01 2-5 3 33 0.90 Auditory 3 2-5 3.37 1 00 2-5 3.29 1 07 3-5 4 00 073 2-5 3 80 1 01 2-4 2.53 0 64 2-4 2 60 0 74 Auditory 4 2-5 3 57 1.01 2-5 3.88 1.07 2-5 3 85 0 99 2-5 4 00 1 1 1 2-5 3 20 094 2-5 3 73 1 03 Auditory 5 2-5 4.18 0.97 2-5 4.11 0,83 3-5 4 53 0.70 3-5 4 40 068 2-5 3.73 1.10 2-5 3.73 0.88 Auditory 6 1-5 3 70 1.05 1-5 3.56 1.19 3-5 4.00 0.67 1-5 3 83 1 29 1-5 3.29 1 33 2-5 3.21 097 Auditory 7 2-5 3,63 0.94 1-5 3.27 1.04 3-5 4.10 0.64 2-5 3 79 085 2-5 300 0.93 1-4 2.57 0.85 Auditory 8 2-5 400 1 19 1-5 3.60 1.06 2-5 4 20 1.11 2-5 3 85 099 2-5 3.73 1.28 1-5 3.27 1.10 Auditory 9 1-4 1.83 086 1-4 1.77 0.81 1-3 1.50 0.69 1-4 1.60 075 1-4 227 0.88 1-4 2.00 0.85 Auditory 10 1-4 2.94 0.80 2-5 3.00 0.84 2-4 3.25 0.64 2-5 3.35 0 75 1-4 2.53 0.83 2-4 2.53 0.74 Auditory 1 1 1-5 3.80 1.21 1-5 3.57 1.04 2-5 4.25 1.02 2-5 3 85 0.99 1-5 3.20 1.21 1-5 3 20 1.01 Auditory 12 3-5 4.54 0.70 2-5 4.40 0.91 3-5 4.70 0.66 3-5 4.55 0.76 3-5 4.33 0.72 2-5 4.20 1.08 Auditory 13 1-5 4.03 1.20 1-5 3.69 1.45 2-5 4.25 1.07 1-5 3.95 1.43 1-5 3,73 1,33 1-5 3.33 1.45 Auditory 14 4-5 4.91 0.28 4-5 4.81 0.40 4-5 4.90 0.31 4-5 4 84 0 37 4-5 4,93 0.26 4-5 4.77 0.44 Auditory 15 2-5 4.40 0 95 2-5 4.00 1.08 4-5 4 75 0.44 2-5 4 45 0 83 2-5 3.93 1.22 2-5 3.40 1.12 Auditory 16 2-5 4.40 0.81 2-5 4.17 0.98 3-5 4 70 0.57 2-5 4.40 0.94 2-5 4.00 0.93 2-5 3.87 0.99 Auditory 17 2-5 4.36 0.93 1-5 4.38 1.10 2-5 4.30 1 03 1-5 4.35 1 14 3-5 4.46 0.78 2-5 4.43 1.09 Auditory 18 2-5 4.73 0.67 4-5 4.87 0.34 3-5 4.78 055 4-5 4 82 0.39 2-5 4.67 0.82 4-5 4.93 0.27 Auditory 19 2-5 4.38 0.99 1-5 4.17 1.07 2-5 4.65 0.75 2-5 4.50 0.76 2-5 4.00 1.18 1-5 3.73 1,28 Auditory 20 2-5 4.69 0.68 2-5 4.43 0.92 2-5 4.65 0 75 2-5 4.65 0.81 3-5 4.73 0.59 2-5 4.13 0.99 Auditory 21 2-5 3.89 0.99 2-5 3.86 1.03 2-5 3.95 0.94 2-5 3.80 1 01 2-5 3.80 1.08 2-5 3.93 1.10 Auditory 22 1-5 3.26 0.85 1-5 3.17 0.92 3-5 3,25 055 2-5 3.30 0 80 1-5 3.27 1.16 1-5 3.00 1.07 Auditory 23 2-5 4.43 0.78 1-5 3.91 0.95 4-5 4 60 0.50 3-5 420 0.62 2-5 4.20 1.01 1-5 3.53 1.19 Auditory 24 1-5 4.00 1.21 1-5 3.97 1.22 3-5 4.60 0 60 2-5 4.60 075 1-5 3.20 1.37 1-5 3.13 1.25 Auditory 25 1-5 3.94 1.21 1-5 3.69 1.18 2-5 4.40 094 2-5 4 15 0 99 1-5 3.33 1.29 1-5 3.07 1 16 Auditory 26 2-5 4.31 0.83 2-5 4.32 0.73 3-5 4 40 060 3-5 4.50 061 2-5 4.20 1.08 2-5 4.07 0 83 Auditory 27 1-5 3 31 1.11 2-5 3.34 1.00 3-5 4 05 0 69 2-5 365 0 93 1-3 2.33 072 2-5 2 93 096 Auditory 28 1-5 4 03 112 1-5 3.71 1.15 3-5 4 60 0 60 2-5 4.20 0 89 1-5 3.27 1.22 1-5 3 07 1.66 Auditory 29 1-5 4.12 1.12 1-5 3.91 1.09 3-5 4 55 0 69 2-5 4 30 0 86 1-5 350 1.34 1-5 340 1.18 Auditory 30 1-5 3.47 1 1 1 1-5 3.97 1 10 3-5 3 75 0 64 1-5 385 1 04 1-5 307 1.49 2-5 4 13 1 19 Auditory 31 1-5 2.09 1 27 1-5 2.00 1 06 1-3 1 60 0 75 1-3 1 70 0 73 1-5 2.73 1 53 1-5 2 40 1 30 Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission. Combined Group Control Group SID Group Moms* Score Dads' Score Moms' Score Dads' Score Moms' Score Dads' Score Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Gust/Olf 1 3-5 4.63 0.77 2-5 4 74 0.74 3-5 4 55 0.83 2-5 4 70 0 73 3-5 4 73 0 70 2-5 4.80 0.77 Gust/Olf 2 2-5 4.37 1.00 2-5 4.40 0.95 2-5 4 20 1 06 2-5 4 20 1.01 2-5 4.60 0.91 2-5 4.67 0.82 Gust/Olf 3 1-5 4.43 1.09 1-5 4.37 1.06 1-5 4 55 0.94 2-5 4 50 0 83 1-5 4.27 1.28 1-5 4,20 1.32 Gust/Olf 4 1-5 3.89 1 43 1-5 3.94 1.19 1-5 4 00 1.38 1-5 4 05 1 10 1-5 3.73 1 53 1-5 3,80 1.32 Gust/Olf 5 1-5 3.71 1.13 1-5 3.21 1.07 2-5 3.80 0.83 2-5 347 0.77 1-5 3.60 1 45 1-5 2.87 1.30 Gust/Olf 6 1-5 3.34 1.21 1-5 3.49 1.22 1-5 3 40 1.05 1-5 360 1.14 1-5 327 4.44 1-5 3.33 1.35 Gust/Olf 7 3-5 4.86 0.43 2-5 4.67 0.74 3-5 4.80 0.52 2-5 4.53 0.90 4-5 4.93 0.26 4-5 4.86 0.36 Gust/Olf 8 2-5 4.66 0.80 3-5 4.66 0.64 4-5 4 80 0.41 3-5 4.75 0.55 2-5 4.47 1.13 3-5 4.53 0.74 Gust/Olf 9 2-5 4.51 0.92 2-5 4.20 1.05 4-5 4 95 0.22 2-5 460 0.82 2-5 3,93 1.16 2-5 3.67 1,11 Gust/Olf 10 3-5 4.71 0.67 2-5 4.63 0.73 3-5 4.80 0.52 3-5 4.65 0.59 3-5 4.60 0,83 2-5 4.60 0,91 Gust/Olf 1 1 1-5 4.60 0.98 2-5 4.37 1.09 3-5 4.80 0.62 2-5 4.35 1.09 1-5 4,43 1.29 2-5 4.40 1.12 Gust/Olf 12 3-5 4.84 0.52 2-5 4.83 0.60 3-5 4.82 0.53 5-5 5.00 0.00 3-5 4.86 0.53 2-5 4.64 0.84 Gust/Olf 13 1-5 3.83 1.15 2-5 3.94 0.91 2-5 3.75 0.97 3-5 3.90 0.85 1-5 3,93 1.39 2-5 4.00 1.00 Gust/Olf 14 1-5 3.69 1.30 1-5 3.51 1,36 1-5 3.50 1.24 1-5 3.35 1.27 1-5 3,93 1.39 1-5 3.73 1.49 Gust/Olf 15 2-5 4.43 0.88 2-5 4.37 0,84 2-5 4.20 1.06 2-5 4.25 0.91 4-5 4.73 0.46 3-5 4.53 0.74 vO Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission. Combined Group Control Group SID Group Mons' Score Dads' Score Mons' Score Dads' Score Mons' Score Dads' Score Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Proprio 1 3-5 4 43 0 65 2-5 4 40 085 4-5 4 70 0 47 2-5 4 65 075 3-5 4 07 0.70 2-5 4 70 0 88 Proprio 2 2-5 4.14 1 06 2-5 4.14 0.91 3-5 4 45 0.89 2-5 3 95 1 05 2-5 3.73 1.16 3-5 4 40 0 63 Proprio 3 1-5 3.79 1 25 1-5 3.76 1.09 1-5 4 10 1 25 1-5 3 94 1 16 1-5 3.36 1.15 2-5 3.53 0.99 Proprio 4 1-5 3.17 1.40 1-5 2.94 1.21 1-5 3 65 1.31 1-5 3 10 1 21 1-5 2.53 1 30 1-5 273 1.22 Proprio 5 1-5 3.29 1.34 1-5 3.41 1.18 1-5 3 80 1 20 2-5 3 65 1 09 1-5 2.60 1.24 1-5 3.07 1 27 Proprio 6 1-5 2.71 093 1-5 2.94 1.01 1-5 2 70 0.92 1-5 2 75 1 02 1-5 2 73 0.96 2-5 325 097 Proprio 7 2-5 4.17 0.92 3-5 4.15 0,78 3-5 4.65 0.67 3-5 4 40 0.75 2-5 3.53 0.83 3-5 3.79 0.70 Proprio 8 1-5 4.32 1.20 1-5 4.29 1.05 3-5 4 74 0.56 1-5 4 25 1.02 1-5 3.80 1.57 1-5 4.33 1.11 Proprio 9 1-5 3.14 1.12 2-5 3.11 0.87 2-5 3.55 1.00 2-5 345 083 1-5 2.60 1.06 2-4 2.67 0.72 Proprio 10 1-5 3.91 0.98 2-5 3.80 0.93 3-5 4.15 0.67 2-5 3 85 0.88 1-5 3,60 1.24 2-5 3.73 1.03 Proprio 11 1-5 3.82 1.31 1-5 3.80 1.11 2-5 4.26 0.87 2-5 3 95 0 94 1-5 3.27 1.58 1-5 3.60 1.30 Proprio 12 2-5 4 12 1.08 2-5 4.34 0.84 3-5 4 76 0 65 4-5 4 70 0 47 2-5 3.33 0.98 2-5 3.87 0,99 Proprio 13 1-5 3.64 1,27 1-5 3.51 1.29 2-5 4.22 0,81 2-5 3 95 1.15 1-5 2,93 1.39 1-5 2.93 1.28 Proprio 14 1-5 3.80 1 23 1-5 3.77 1.17 3-5 4.40 0.60 1-5 3 90 1 17 1-5 3.00 1.41 2-5 3.60 1.18 Proprio 15 1-5 2.77 1.14 1-5 2.69 1.05 1-4 3.20 0,95 2-5 3.05 0.94 1-5 2,20 1.15 1-4 2.20 1.01 Proprio 16 1-5 3.97 1.19 1-5 3.59 1.36 2-5 4,30 0.98 2-5 4 12 111 1-5 3.50 1.34 1-5 300 1 41 Proprio 17 2-5 4.03 0.95 2-5 4.37 0.84 3-5 4.35 0.81 2-5 4.40 088 2-5 3.60 0.99 3-5 4.33 0.82 Proprio 18 2-5 4.14 1.06 1-5 3.86 1.06 2-5 4.45 0.83 1-5 3.95 1.05 2-5 3.73 1.22 2-5 3.73 1.10 Proprio 19 2-5 4.63 0.81 1-5 4.51 0.98 2-5 4.70 0.80 3-5 4 60 0.75 2-5 4.53 0.83 1-5 4.40 1.24 Proprio 20 1-5 3.63 1.35 1-5 3.20 1.32 2-5 4.10 0.97 2-5 345 1.15 1-5 3.00 1.56 1-5 2.87 1.51 Proprio 21 1-4 2.26 0.90 1-4 2.49 1.01 1-3 2 21 0.79 1-4 2 50 0 95 1-4 2.33 1.05 1-4 2.47 1.13 Proprio 22 1-5 3.71 1.45 1-5 3.77 1.26 2-5 4.40 0.88 2-5 4 30 0 98 1-5 2 80 1.57 1-5 3.07 1.28 Proprio 23 1-5 2.89 1.16 1-5 285 1.13 1-5 3 20 111 1-5 3 00 1 03 1-5 2.47 1.13 1-5 2.64 1 28 Proprio 24 1-5 3.71 1.24 1-5 3.55 1.12 2-5 3 68 111 1-5 3 53 1 07 1-5 3.75 1.48 2-5 3.58 1.24 Proprio 25 1-5 4.14 1.03 2-5 4 17 0.86 3-5 4 50 0.61 2-5 4 10 0 97 1-5 3.67 1.29 3-5 4.27 0.70 vO Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. Combined Group Control Group SID Group Moms' Score Dads' Score Moms' Score Dads' Score Moms' Score Dads' Score Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Taclile 1 1-5 4.40 0.88 2-5 4.54 082 4-5 4 50 0 51 3-5 4 60 060 1-5 4.27 1 22 2-5 4 47 1 06 Tactile 2 2-5 4.51 074 3-5 4 57 0 70 3-5 4 55 0 60 3-5 4 45 076 2-5 4.47 0 92 3-5 4 73 0 59 Taclile 3 2-5 3.77 0.94 2-5 3 54 1 01 3-5 3 55 0 89 2-5 3 25 1,02 2-5 4.07 096 2-5 3,93 088 Taclile 4 1-5 4.37 094 2-5 4 37 0 88 3-5 4 50 0 69 3-5 4 45 076 1-5 4 20 1 21 2-5 4 27 1 03 Taclile 5 1-5 4.66 0.80 3-5 4 57 0 70 4-5 4 85 0 37 3-5 4 70 0 57 1-5 4 40 1 12 3-5 4.40 0 83 Tactile 6 1-5 3.89 1.05 2-5 369 1 02 2-5 3 60 0 94 2-5 3 50 1 00 1-5 4.27 1.10 2-5 393 1 03 Taclile 7 2-5 4.09 0.92 2-5 409 1.04 2-5 3 85 0 88 2-5 3 80 111 2-5 4.40 0.91 3-5 447 0 83 Taclile 8 3-5 4.77 0.55 3-5 4.65 0.60 3-5 4 85 0 49 3-5 4 58 069 3-5 4.67 0.62 4-5 4.73 0.46 Tactile 9 1-5 4.29 0.93 1-5 4.20 0.99 1-5 4 30 0 98 2-5 4 20 0.95 3-5 4.27 0.88 1-5 4.20 1.08 Taclile 10 1-5 2,60 1.09 1-5 2.68 1 27 1-5 245 1 10 1-5 2 47 1.17 1-5 2.80 1.08 1-5 2.93 1.39 Tactile 1 1 1-4 2.17 0.82 1-4 2.40 0.81 1-4 2.45 083 1-4 2 50 0.76 1-3 1.80 0,68 1-4 2.27 0.88 Tactile 12 1-5 3.77 1.29 1-5 4 09 1.12 2-5 3.95 1 00 1-5 4 15 1.04 1-5 3.53 1.60 2-5 4.00 1.25 Tactile 13 1-5 3.43 1.17 1-5 3.63 1.17 2-5 3 75 0 91 1-5 3 90 1.07 1-5 3.00 1.36 1-5 3.27 1 22 Tactile 14 2-5 4.50 0.91 3-5 442 0.76 2-5 4.21 1 05 3-5 4 20 0.86 3-5 4.83 0.58 4-5 4.73 0.47 Tactile 15 1-5 3.97 1.09 2-5 3.97 1 13 1-5 3 70 1 08 2-5 3 59 1.12 2-5 4.42 1.00 2-5 446 0.97 Tactile 16 1-5 3.91 1.10 2-5 4 00 097 2-5 4 06 0 94 2-5 3 90 1 02 1-5 3.73 1.28 2-5 4 13 092 Tactile 17 1-5 3.54 1.09 1-5 3.60 1.22 2-5 390 1 02 1-5 3 45 1.32 1-5 3.07 1.03 2-5 3,80 1.08 Tactile 18 1-5 291 1.17 1-5 2.60 1 22 1-5 300 1 12 1-5 2 55 1.10 1-5 2.80 1.26 1-5 2.67 1.40 Tactile 19 1-5 3.38 1.35 1-5 3 29 1 15 2-5 384 1 07 2-5 3 60 0.80 1-5 2 80 1 47 1-5 2.87 1.36 Taclile 20 2-5 4.12 0.96 2-5 4.03 0 95 2-5 3.95 1 03 2-5 3 80 1.06 3-5 4 36 084 3-5 4.33 0.72 Tactile 21 1-5 4.43 0.88 3-5 4.43 0 81 1-5 4 25 1 02 3-5 4 10 0.85 3-5 4.67 0.62 3-5 4.87 0.52 Tactile 22 3-5 4.63 0,60 3-5 4.49 074 3-5 4 60 0 60 3-5 4 35 0.88 3-5 467 062 4-5 4.67 0.49 Tactile 23 2-5 4.76 0.65 3-5 4.57 0.74 4-5 4 89 0 32 3-5 4 75 0 55 2-5 4.60 091 3-5 4 33 0.90 Taclile 24 2-5 3,57 1.12 1-5 3.66 1.14 2-5 325 1 12 2-5 3 55 1.00 2-5 4.00 1.00 1-5 3.80 1 32 Tactile 25 2-5 4.03 1.01 2-5 3 91 1.01 2-5 3 90 0 97 2-5 3 50 1 00 2-5 4 20 1.08 3-5 4.47 074 Taclile 26 2-5 4.80 0.58 3-5 4.80 0 53 2-5 4 70 0 73 3-5 4 65 0.67 4-5 4.93 026 5-5 5.00 0 00 Tactile 27 1-5 3.32 1.34 1-5 3.54 1 36 2-5 3 70 086 2-5 4 05 0.89 1-5 2.79 1 72 1-5 2.87 1.60 Tactile 28 1-5 3.80 1.08 2-5 3.80 0 83 3-5 4.30 0 66 3-5 3 95 083 1-5 3.13 1 19 2-5 360 0,83 Tactile 29 2-5 4.34 0.80 2-5 4 46 0 78 2-5 4 35 081 3-5 4 60 0 60 3-5 4 33 0 82 2-5 4.27 096 Tactile 30 1-5 3.60 1 17 1-5 362 1 16 2-5 3 95 1 05 1-5 3 80 1 24 1-5 3 13 1 19 2-5 3.36 1.01 > 0 Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission. Taclile 31 1-5 3.62 1 68 2-5 4 03 0 98 Tactile 32 1-5 3.94 1 00 2-5 4.37 0.84 Taclile 33 1-5 3.09 1.27 1-5 3 49 1 46 Tactile 34 2-5 4.12 1.01 1-5 3 94 1 1 1 Taclile 35 1-5 3.66 116 2-5 3 77 1 09 Taclile 36 2-5 4.09 089 2-5 397 1 01 Taclile 37 1-5 3.37 1.03 2-5 3 63 1.03 Taclile 38 1-5 4.34 0.91 3-5 4 29 0 67 Tactile 39 1-5 4.21 098 2-5 4.18 0.83 Tactile 40 3-5 4.23 0.81 2-5 4 17 095 Taclile 41 4-5 4.83 0.38 3-5 4.77 055 Taclile 42 3-5 4.77 0.49 3-5 4.57 0 65 Tactile 43 1-5 3.66 1.21 2-5 3.71 1.32 Taclile 44 1-5 3.31 1.30 1-5 3.57 1.38 Tactile 45 2-5 4.26 0.89 3-5 4.34 0.73 Taclile 46 2-5 3.97 0.95 2-5 3.97 0.98 Taclile 47 1-5 3.69 1.08 1-5 3 38 1.30 Taclile 48 1-5 3.69 1.05 2-5 3.77 0 88 Taclile 49 1-5 3.89 1.18 2-5 4.03 0.98 Taclile 50 2-5 4.06 0.95 2-5 4.14 081 Taclile 51 3-5 4.55 0.68 3-5 4.67 0.54 Taclile 52 1-5 3.74 1.36 2-5 4.29 0.99 Taclile 53 1-5 3.94 1.16 1-5 3.94 1.24 Taclile 54 3-5 4.66 0.59 2-5 4.37 0.84 Taclile 55 2-5 4.06 0.97 3-5 4 37 069 Taclile 56 1-5 3.23 1.21 1-5 3.54 1.15 Tactile 57 4-5 4.69 0.47 3-5 4 54 0.61 Taclile 58 1-5 3.49 1.27 1-5 3.60 1.12 Taclile 59 1-5 3.86 1.22 1-5 4 34 0.94 Taclile 60 2-5 3.43 0.85 1-5 3 20 1 1 1 Tactile 61 1-5 3.50 1.62 1-5 3.40 1 46 1-5 3 80 1 32 2-5 4 05 3-5 4 35 0 67 3-5 4 45 1-5 2 80 1 06 1-5 3 10 2-5 3 84 1 01 2-5 3 85 1-5 3 25 1 21 2-5 3 55 3-5 4 30 0 73 2-5 4 05 2-5 3 60 075 2-5 3 80 3-5 4 50 061 3-5 4 40 2-5 4 32 0 89 2-5 4.16 3-5 4 00 0.86 2-5 3.85 4-5 4 85 0 37 3-5 4.70 4-5 4 85 0 37 3-5 4.65 1-5 3 35 1 14 2-5 3.40 1-5 3.05 1 15 1-5 3.20 2-5 4 15 0 88 3-5 4.25 2-5 3.60 094 2-5 3.70 3-5 4 10 0 72 1-5 4.05 2-5 3.95 0.89 2-5 3.75 2-5 4.25 097 2-5 4.00 2-5 4.00 0.86 2-5 4.15 3-5 4 53 0.77 3-5 4.58 1-5 3 95 1 19 2-5 4.25 3-5 4 40 0 68 2-5 4.50 4-5 4 75 0 44 2-5 4 50 3-5 4 30 0 80 3-5 4.55 2-5 3 55 089 1-5 365 4-5 4 55 0 51 3-5 4 50 2-5 3 75 1 02 1-5 3.65 3-5 4 20 0 89 3-5 4.55 2-5 340 0 82 1-5 3 30 1-5 4 16 1 26 1-5 3 90 1-5 3 36 1 22 2-5 4 00 1 00 1-5 3 40 1 12 2-5 4 27 1 03 1-5 347 1 46 2-5 4 00 1 07 2-5 4 47 0 92 1-5 4 07 1 16 3-5 4 20 0 86 2-5 4 07 1 10 2-5 3 80 1 01 2-5 3 87 1 06 1-5 3 07 1 28 2-5 340 0 99 1-5 4 13 1 19 3-5 4 13 0 74 1-5 4 07 1 10 3-5 4 20 0 68 3-5 4 53 0 64 3-5 4 60 0 63 4-5 4.80 041 3-5 4 87 052 3-5 4.67 0,62 3-5 4.47 0 74 1-5 4 07 1 22 2-5 4 13 1 13 1-5 3.67 1 45 2-5 407 1 22 2-5 4.40 091 3-5 447 064 3-5 4.47 0.74 3-5 4 33 072 1-5 3.13 1.25 1-5 2 53 1 13 1-5 3 33 1.18 2-5 3.80 0.86 1-5 3.40 1.30 2-5 4.07 0.80 2-5 4.14 1.10 3-5 4.13 0.74 4-5 4.58 0.51 4-5 4.79 0,43 1-5 3.43 1 55 2-5 4.33 090 1-5 3 33 1.40 1-5 3.20 1 32 3-5 4.53 0.74 3-5 4.20 0.77 2-5 3.73 1.10 3-5 4.13 0 74 1-5 2.80 1 47 1-5 3.40 1 12 4-5 487 0 35 3-5 460 0,63 1-5 3 13 1 51 1-5 3 53 1 13 1-5 3 40 1 45 1-5 4 07 1 16 2-5 3 47 0 92 2-5 3 07 1 03 1-5 2 67 1 68 1-5 2.73 1 44 1 00 0 69 1 62 1 09 1 05 1 00 1.06 0 60 0 96 1.04 0.57 0 59 1 39 1.40 0.79 1.08 1.03 0.91 1.12 0.88 0.61 1 07 083 0.89 0.60 1 18 061 1 14 0 69 1 17 1 29 o Ul Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. C om bined Group Moms' Score Dads' Score Control G roup Moms' Score Dads' Score SID Group Moms' Score Dads' Score Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Vestibular 1 1-5 4.43 0.95 1-5 3 94 1 13 3-5 4 55 0.69 1-5 3,79 118 1-5 4.27 1 22 2-5 4 13 1 06 Vestibular 2 2-5 4.54 0.85 2-5 449 0.78 2-5 4 55 0.83 2-5 4.40 0.88 2-5 4.53 0 92 3-5 4 60 0 63 Vestibular 3 2-5 4.60 0.91 2-5 4 69 0 72 2-5 4.40 1.10 2-5 4.50 0.89 3-5 4.87 0 52 4-5 4 93 0 26 Vestibular 4 1-4 1.71 0.86 1-3 1.74 071 1-3 1.70 0.80 1-3 1.89 0.66 1-4 1.73 0.96 1-3 1 53 0 74 Vestibular 5 2-5 4 3 1 0.93 2-5 4 34 0.80 2-5 4 45 0.89 3-5 4.45 0.69 2-5 4.13 099 2-5 4 20 0 94 Vestibular 6 1-5 3.24 1.30 1-5 3 10 1.40 1-5 3 2 1 1 40 1-5 3.22 1 52 2-5 3.29 1 20 1-5 2 92 1 24 Vestibular 7 2-5 4.31 0.93 2-5 4 29 0 83 2-5 4 45 0.89 2-5 4.25 0.91 2-5 4.13 0 99 3-5 4 33 0 72 Vestibular 8 1-5 2.03 0.95 1-4 1.83 089 1-3 1 85 0.75 1-4 1.75 0.91 1-5 2.27 1.16 1-3 1 93 0 88 Vestibular 9 2-5 4.31 0.96 2-5 4.37 0.84 2-5 4.40 088 3-5 4.35 0.81 2-5 4.20 1.08 2-5 440 0.91 Vestibular 10 2-5 4.49 0.82 2-5 426 0.92 3-5 4.60 0.68 2-5 4.25 0.97 2-5 4.33 0.98 3-5 4.27 088 Vestibular 1 1 1-5 4.31 1.02 2-5 4.43 085 2-5 4.35 0.93 2-5 4.20 0.95 1-5 4.27 1.16 3-5 4.73 059 Vestibular 1 2 1-4 1.97 0.89 1-5 2.00 0.97 1-4 2.05 0.94 1-3 2.10 0.85 1-4 1.87 0.83 1-5 1.87 1.13 Vestibular 13 1-5 2.89 1.02 1-5 2.86 0.97 2-5 3.10 0.85 1-5 3.05 0.89 1-5 2.60 1.18 1-5 2.60 1.06 Vestibular 14 1-4 2.47 1.05 1-4 2.33 1.03 1-4 2.20 0.95 1-4 2.32 1.06 1-4 2.92 1.08 1-4 2.36 1 03 Vestibular 15 2-5 4.06 0.94 2-5 4.26 0.89 2-5 4.15 0.93 2-5 4.25 0.91 2-5 3.93 0.96 3-5 4.27 088 Vestibular 16 2-5 4.49 0.74 2-5 4.51 0.82 3-5 4.60 0.60 3-5 4.60 0.75 2-5 4,33 0.90 2-5 4.40 091 Vestibular 17 2-5 3.71 1.03 2-5 4.03 0.98 2-5 3.65 1.14 2-5 4.20 1.06 2-5 3.79 0.89 2-5 3.80 0,86 Vestibular 16 1-5 3,97 1.25 1-5 3.91 1.16 2-5 4.40 0.82 2-5 4.32 0,89 1-5 3.40 1.50 1-5 340 1.30 Vestibular 19 2-5 4.60 0.95 1-5 4.40 1.03 2-5 4.30 1.17 1-5 4,10 1.25 5-5 5.00 0.00 4-5 4.80 0.41 Vestibular 20 2-5 4.77 0.77 2-5 4.57 0.74 2-5 4.75 0.79 3-5 4.60 0.60 2-5 4.80 0.77 2-5 4.53 0.92 Vestibular 2 1 2-5 4.14 1.03 1-5 3.43 1.14 3-5 4.45 0,69 1-5 3.75 1.02 2-5 3.73 1.28 1-5 3.00 1.20 Vestibular 22 1-5 4.50 1.08 2-5 4.53 0.86 4-5 4.84 0.37 4-5 4.84 0.37 1-5 4.07 1,49 2-5 4.13 1.13 Vestibular 23 1-4 2.71 0.86 1-5 2.89 1.23 1-4 2.75 0.85 1-5 2.85 1.18 1-4 2.67 0.90 1-5 2.93 1.33 Vestibular 24 2-5 4.51 0.82 3-5 4.60 0.69 2-5 4.40 0.82 3-5 4.55 0.69 2-5 4.67 0.82 3-5 4.67 0 72 Vestibular 25 2-5 4.34 0.97 3-5 4.57 0.65 2-5 4.25 1.02 3-5 4.40 0.68 2-5 4.47 0.92 3-5 4.80 0.56 Vestibular 26 2-5 4.03 0.92 2-5 3,97 0.92 3-5 4.15 0.81 2-5 3.95 1.00 2-5 3.87 1.06 2-5 4 00 085 Vestibular 27 2-5 4.26 0.92 2-5 4.54 0.74 2-5 4,15 0.93 2-5 4.50 0.89 2-5 4.40 0.91 4-5 4.60 051 Vestibular 28 1-5 3.47 1.31 1-5 3.66 1.24 3-5 4.11 0.66 1-5 4.05 1.00 1-5 2.67 1.50 1-5 3 13 1 36 Vestibular 29 1-5 4.14 1.06 2-5 4.40 0.81 1-5 4 15 1.09 3-5 4.40 0.75 2-5 4,13 1.06 2-5 4 40 091 Vestibular 30 1-5 4.03 1.07 2-5 4.37 0.88 3-5 4 15 0.88 3-5 4.45 0.83 1-5 387 1.30 2-5 4 27 096 Vestibular 3 1 1-5 4.49 0.94 2-5 4.49 0.85 2-5 4 35 0.81 3-5 4.65 0.59 1-5 4.07 1.10 2-5 4 27 1 10 Vestibular 32 3-5 4.54 0.81 3-5 4.54 0.66 2-5 4 65 0.75 3-5 4,65 0.59 3-5 4.13 0.83 3-5 4 40 074 Vestibular 33 1-5 3.17 1.31 1-5 3.17 1.22 1-5 3.75 1.16 2-5 3.55 1.15 1-5 2.87 1.36 1-5 267 1 18 v O O ' Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission. Combined Group Control Group SID Group Moms' Score Dads' Score Moms' Score Dads' Score Moms' Score Dads' Score Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Range Mean SD Visual 1 2-5 4.00 0 89 1-5 3 89 1 13 3-5 4 1 1 0 76 3-5 4 17 0 86 2-5 375 1 16 1-5 3 40 1.43 Visual 2 2-5 4.09 1 01 2-5 4 17 0 82 3-5 4 35 0 81 2-5 4.10 0.85 2-5 3 73 1 16 3-5 4 27 0 80 Visual 3 1-5 3.63 1.19 2-5 3 91 1 01 2-5 4 00 1 03 2-5 405 0.89 1-5 3.13 1 25 2-5 3 73 1.16 Visual 4 1-5 1.83 1.07 1-5 1 89 0 72 1-3 1 40 0 68 1-2 1 60 0.50 1-5 240 1 24 1-3 2 27 0 80 Visual 5 1-5 3.51 1.29 1-5 3 43 1 17 2-5 4 25 0 97 1-5 385 1 09 1-5 2 53 0 99 1-5 2 87 1 06 Visual 6 1-5 3.29 1.27 1-5 343 1 17 2-5 3 95 0 89 2-5 380 0.89 1-5 2.40 1 18 1-5 2 93 1 33 Visual 7 2-5 4.51 0.78 2-5 4 60 0,85 2-5 4 45 0 89 2-5 4.55 0,89 3-5 4.60 0.63 2-5 4.67 0.82 Visual 8 2-5 4.31 0.90 2-5 4 23 1.00 3-5 4 55 0 69 2-5 4.50 0.83 2-5 4.00 1.07 2-5 3 87 1.13 Visual 9 1-5 3.31 1.18 1-5 3 40 1.29 2-5 395 0 89 1-5 3.70 1.26 1-5 2.47 0.99 1-5 300 1.25 Visual 10 2-5 3.80 0.87 1-5 4 1 1 0.99 3-5 4 05 083 3-5 4.15 0.88 2-5 3.47 0.03 1-5 4.07 1.16 Visual 1 1 1-5 4.40 1.09 2-5 4 63 0 69 3-5 4.80 0 52 2-5 4.65 0.75 1-5 3.87 1.41 3-5 4.60 0,63 Visual 12 2-5 4.40 0.88 1-5 4 29 0.93 2-5 4 70 0 73 1-5 4.30 1.03 2-5 4.00 0.93 3-5 4.27 0.80 Visual 13 1-5 4.54 0.92 1-5 4 40 0.98 3-5 4 80 0 52 1-5 4.50 1.00 1-5 4.20 1.21 2-5 4.27 0.96 Visual 14 2-5 4.12 1.04 2-5 4 38 0.99 2-5 4 50 0 83 2-5 4.50 0.83 2-5 3.57 1.09 2-5 4.21 1.19 Visual 15 1-5 3,71 1.38 1-5 3 94 1.21 2-5 4 50 083 1-5 4.30 1.03 1-5 2.67 1.29 1-5 347 1.30 Visual 16 1-5 4.06 1.14 2-5 4.26 1.01 2-5 4 50 0.83 2-5 4.45 0,89 1-5 3.47 1.25 2-5 4.00 1.13 Visual 17 1-5 4.03 1,22 1-5 4 20 1.18 2-5 4.55 0 76 1-5 4.60 0.94 1-5 3.33 1.40 2-5 3.67 1.29 Visual 18 3-5 4.40 0,89 1-5 3.50 1.76 4-5 4.67 0.58 2-5 4.25 1.50 3-5 4,00 1.41 1-3 2.00 1.41 Visual 19 3-5 3.70 0.82 3-5 4 00 0.91 3-5 3 56 0.73 3-5 4.20 0.92 5-5 5.00 0.00 3-4 3.33 0,58 Visual 20 4-5 4.50 0,55 1-5 4.00 1.73 4-5 4 50 0 55 4-5 4.75 0.50 0 1-1 1.00 0.00 vO * -4 IMAGE EVALUATION TEST TARGET (Q A -3 ) ✓ / ✓ « v M i £ 4 ( i s / , 1 . 0 l.l 1.25 5 -i L L_ u; u. 1 .4 !M 2.2 2.0 1 . 8 1 . 6 150m m A P P L I E D A IIWiCBE . In c — 1653 E ast Main Street R ochester. NY 14609 USA - = 2 = = P h one: 7 1 6 /482-0300 Fax: 7 1 6 /2 8 8 -5 9 8 9 O 1993. Applied Image. Inc.. All Rights R eserved R ep ro d u ced with p erm issio n o f th e copyrigh t ow n er. Further reproduction prohibited w ithout p erm issio n .

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Asset Metadata

Creator Chang, Chia-Chun (author)

Core Title Interrater reliability of the Evaluation of Sensory Processing (ESP)

School Graduate School

Degree Master of Arts

Degree Program Occupational Therapy

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag health sciences, rehabilitation and therapy,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Parham Diane (committee chair), Diane (committee member), Kellegrew (committee member), Zemke, Ruth (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-30114

Unique identifier UC11337537

Identifier 1395128.pdf (filename),usctheses-c16-30114 (legacy record id)

Legacy Identifier 1395128.pdf

Dmrecord 30114

Document Type Thesis

Rights Chang, Chia-Chun

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA