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Translation of the Evaluation of Sensory Processing into Mandarin Chinese for use in Taiwan

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Translation of the Evaluation of Sensory Processing into Mandarin Chinese for use in Taiwan

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Content INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UME 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 com er and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back of the book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6” x 9” black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. UMI A Bell & Howell Information Company 300 North Zeeb Road, Ann Arbor MI 48106-1346 USA 313/761-4700 800/521-0600 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. NOTE TO USERS This reproduction is the best copy available UMI Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TRANSLATION OF THE EVALUATION OF SENSORY PROCESSING INTO MANDARIN CHINESE FOR USE IN TAIWAN by Chia-Ting Su 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) December, 1998 Copyright 1998 Chia-Ting Su Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UMI Number: 13 9477 9 Copyright 199 8 by Su, Chia-Ting All rights reserved. UMI Microform 1394779 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 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UNIVERSITY O F S O U T H E R N CALIFORNIA T H E G R A D U A T E SC 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 8 0 0 0 7 This thesis, •written by Chia-Ting Su____________________________________ under the direction o f kh Thesis Committee, and approved by all its members, has been pre sented to and accepted by the Dean of The Graduate School, in partial fulfillment of the requirements for the degree of Master of Arts 7 November 13, 1998 D a te___ THESIS COMMITTEE Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGEMENTS I am extremely grateful to my thesis chair, Diane Parham, Ph.D., for her guidance, support, encouragement, and help. I appreciate the guidance and encouragement of my committee members, Florence Clark, Ph.D. and Ruth Zemke, Ph.D. This thesis could not have been completed without contributions from the bilingual experts, bilingual translators, monolingual reviewers, and participants. They deserve very special thanks. I also want to thank my friends and family for their supports. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS ACKNOWLEDGMENTS....................................................................ii LIST OF TABLES ............................................................................... v ABSTRACT...........................................................................................vi CHAPTER I. THE PROBLEM.................................................................... 1 Rationale and Significance of the Study.................................1 Research Approach...................................................................5 Assumptions............................................................................. 6 Limitations ............................................................................... 6 E. LITERATURE REVIEW ...................................................... 7 Valid Translation......................................................................7 Development of the E S P ..........................................................22 Chinese Culture in Taiw an...................................................... 27 HI. METHODOLOGY............................................................... 30 Step 1: Cultural Relevance...................................................... 30 Step 2: Back-Translation ........................................................ 31 Step 3: Pretest........................................................................... 34 IV. RESULTS ............................................................................. 37 Revision of ESP for Cultural Relevance................................ 37 Back-Translation ......................................................................38 Pretest ....................................................................................... 47 Summary o f Revisions Made during Translation..................48 V. DISCUSSION ........................................................................ 50 Result A nalysis......................................................................... 50 Recommendations for Further Study......................................53 REFERENCES ..................................................................................... 55 APPENDIX A ........................................................................................59 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iv APPENDIX B ...................................................................................... 68 APPENDIX C ...................................................................................... 71 APPENDIX D ...................................................................................... S O APPENDIX E ...................................................................................... 89 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LIST OF TABLES v L Revision of English source items after initial back-translation................39 2. Items that required repeated translation and back-translation without changing the source version.......................................................................................... 42 3. Items that required repeated back-translation without changing the source version or the Mandarin Chinese version....................................................43 4. Number of revisions in instructions and each sensory system related to translation steps..............................................................................................48 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. VI ABSTRACT The purpose of this study was to generate a valid translation of the Evaluation of Sensory Processing (ESP) for cross-cultural study. Specifically, the goals were to revise the ESP for cultural relevance in Taiwan and translate the ESP into Mandarin Chinese. In the translation, revisions were made to account for language and cultural differences. For validating the translation, three bilingual experts in the field of sensory integration were involved to make revisions based on cultural differences. Then the back-translation method was applied using four bilingual and two monolingual reviewers. The translated ESP was pilot tested with six parents who are Taiwanese. Their responses regarding the clarity and relevance of the questionnaire were used to refine the final translation. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1 CHAPTER I THE PROBLEM The purpose of this study was to generate a valid translation of the Evaluation of Sensory Processing (ESP) for cross-cultural study. Specifically, the goals were to revise the ESP for cultural relevance in Taiwan and translate the ESP into Mandarin Chinese. This study was part of a long-term project involving development of the ESP. Rationale and Significance of the Study "Culture is a set of shared understandings held in common by members of a group" (Mosey, 1986, p. 173). Humans engage in and interpret occupations through culture, and the environments people grow up and live in are different across cultures (Kielhofner, 1995). Cross-cultural studies have constantly emphasized and demonstrated the importance of environmental influence on child development. Different developmental patterns exist among children with different cultural backgrounds. Cultural differences have been demonstrated even for tasks thought to reflect neurological maturation, such as perceptual-motor and sensory integrative measures (Mao, 1995; Saeki, Clark, & Azen, 1985). According to Ayres (1979), sensory integration is defined as the “organization of sensation for use” (p.5). Typical children will appropriately filter, organize, and interpret sensory information from their bodies and environments, and then respond successfully to challenges during daily activities. The feedback from these successful experiences will facilitate the development of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 more complex sensory integration and more confidence to explore environments (Ayres, 1972, 1979; Parham & Mailloux, 1996). For instance, imagine a child trying to learn how to ride a bicycle. In the beginning, training wheels may be needed with the bicycle. When the child successfully rides the bicycle by appropriately integrating vestibular, proprioceptive, and visual information required for this activity, he or she will have a successful sensory integration experience in relation to steering the bicycle with training wheels. The child will have the ability, intention, and confidence based on this success to learn how to ride a bicycle without training wheels. However, children who have problems in sensory integration cannot efficiently filter, organize, or interpret sensory information from their bodies and environments. Therefore, they often fail to do some common activities that are simple for others, and need to make extra efforts to accomplish these activities. This may cause avoidance of exploring their environment and hinder their participating in and learning some important occupations. Additionally, these children are often misunderstood because their problems may be fluctuating and unpredictable. As a result, they may feel lower self-esteem, lower self-confidence, be more frustrated, and more stressed in daily occupations than other children (Parham & Mailloux, 1996). Consider a child who is diagnosed as having tactile defensiveness, which means hyperresponsivity and discomfort in response to certain types of tactile stimulation that do not bother most people (Ayres, 1972; 1979; Parham & Mailloux, 1996). The child is often affected in ordinary self-care Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 3 activities. He or she may feel bothered wearing turtleneck shirts or be choosy about fabric in clothing, dislike certain foods because o f the texture, and hate bathing, or having his or her hair washed or cut. Such children are overly sensitive to being touched and may fear that some one may touch him or her. Some social activities, such as waiting in line, and games, such as playing tag, may be threatening to the child. Some classroom activities involving grass, sand, glue, or paint against bare skin may irritate the child. Parents and teachers may misinterpret the source of the child’s problems as behavioral or other psychosocially based. As a result, the child may experience more anxiety, suffering, and frustration in daily life. The child’s overly sensitive responses or avoidance of some irritating tactile activities may decrease the opportunities for learning skills in some important occupations (Ayres, 1979; Parham & Mailloux, 1996). To understand presenting problems, occupational therapists are not only concerned with the individual, but also the family and environments in which the individual lives, so that multifaceted tools are needed in evaluation (Parham & Mailloux, 1996). Additionally, proper identification of the behaviors that indicate problems in sensory integration is a critical issue when applying the sensory integration perspective (Fisher, Murray, & Bundy, 1991). Therefore, a number of evaluation tools to gain information about children’s sensory integrative abilities and performances have been employed by occupational therapists, including interviews and questionnaires, observation, standardized tests, and consideration Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 4 of available services and resources (Dunn, 1994; Parham & Mailloux, 1996). Each evaluation tool has its specific characteristics, and each is needed for gaining a holistic understanding of problems in sensory integration. For instance, the results of a standardized test, such as the Sensory Integration and Praxis Tests (SEPT), are useful for developing a diagnosis and planning effective intervention. However, the scores do not detect how the child performs in natural environments (Dunn, 1994). Additionally, the child’s attention span and endurance may be too short to tolerate a standardized sensory integration evaluation (Johnson, 1996). Sensory history questionnaires, such as the ESP, do not have these limitations. Using a sensory history questionnaire enables therapists to gather information from parents or other caregivers about the child’s response to sensory stimulation around his or her natural settings (Dunn, 1994; Johnson, 1996; Parham & Mailloux, 1996). Interests in using sensory integration theory and testing have been increasing internationally (Benschoten, 1981; Saeki, 1982; Saeki et al., 1985). However, there are still few valid and reliable sensory history questionnaires or checklists in Taiwan. Actually most evaluation tools used in Taiwan, where occupational therapy has only been developed for about twenty years, are either “homemade” or literally translated from the original American version and presumed to be free of cultural bias (Fisher, Liu, Velozo, & Pan, 1992; Li, Bundy, & Beer, 1995). However, a standardized evaluation may not be valid when literally translated and applied to persons from a cultural group other than one on Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 5 which it was standardized (Fisher et aL, 1992; Pan & Jeng, 1996). Therefore, a sensory history questionnaire should be translated with the consideration o f language and cultural differences and further tested through cross-cultural studies before being applied clinically in Taiwan. When translating items on a sensory history questionnaire, differences in cultural environments should be addressed to ensure cultural relevance. For example, the sound of a lawn mower is mentioned in one item on the ESP, but a lawn mower may not be a familiar object in other countries such as Taiwan. In cross-cultural studies, items translated literally word for word are often problematic. Rather than literal translation, the meaning the author attempted to express should be translated and revised in a manner that is relevant to other cultures (Brislin, Lonner, & Thorndike, 1973; Fisher et al., 1992). Research Approach A sensory history questionnaire, the ESP, was developed and revised by several students and faculty members at the University of Southern California. This instrument was translated into Mandarin Chinese with high priority placed on cultural relevance in Taiwan. In the translation, revisions were made to account for language and cultural differences. For validating the translation, revisions were made based on cultural differences, and then the back-translation method was applied. The translated ESP was pilot tested with six parents who are Taiwanese. According to their responses regarding the clarity and relevance of the questionnaire, further revisions were made. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Assumptions 1. The natural environment children grow up and develop in are different across cultures. 2. Environmental factors influence child behaviors. 3. The ESP is a valid and reliable tool for assessing the child’s sensory integration. 4. After appropriate translation and revisions, the ESP will be applicable for cross-cultural evaluation. Limitations 1. The culture and language structures of America and Taiwan are not similar. More differences in language and culture between source and target versions may cause greater difficulties in translation (Sechrest, Fay, & Zaidi, 1972). Therefore, exact translation may be difficult for a few items. 2. The pilot study involved only six participants, a very small group, selected for convenience. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 7 CHAPTER H LITERATURE REVIEW This chapter will review literature pertinent to the valid translation of the ESP for use in Taiwan. This chapter will be divided into three major topics: (1) a discussion o f issues in valid translation, including cultural and linguistic considerations, (2) a brief introduction to the development of the ESP, and (3) a discussion of Chinese culture in Taiwan from the perspective o f occupational therapy. Valid Translation In cross-cultural studies, translation is a major problem. Any obtained results will not be rigorous enough to satisfy the scientific standard until different- language versions of the same instrument are proved to be equivalent (Brislin et al., 1973; Candell & Hulin, 1986). To produce a valid translation, issues such as different types of translation problems, problems o f equivalence in translation, how to write translatable source versions, and how to make a translation must be discussed. The studies dealing with these issues in relatively extensive detail were published in the 1970’s. Most are the focus of this section of the literature review. Contemporary cross-cultural researchers accept and cite these earlier works in regard to translation methodology (Bravo, Canino, Rubio-Stipec, & Woodbury- Farina, 1991, 1993; Bullinger, Anderson, Celia, & Aaronson, 1993; Candell & Hulin, 1986; Chien-Hou & Tien-Miau, 1986; Fisher et al., 1992; Hall et al., 1993; Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 8 Hulin, 1987; Li et al., 1995; Mathias, Fifer, & Patrick, 1994; Sim & Kim, 1993; Ware et al., 1995). Types of Translation Problems Generally, there are four main types o f translation problems in cross- cultural studies. First, researchers usually need to introduce some research rationale or objectives to the potential subjects or informants. Attention should be paid to the equivalence of introductions in translation (Brislin et al., 1973; Sechrest et al., 1972). The second type of translation problem are instructions (Brislin et al., 1973; Sechrest et al., 1972). In cross-cultural studies, instructions are usually assumed to be equivalent without paying enough attention to their translation. The fact that instructions are generally brief may contribute to this assumption (Sechrest et al, 1972). However, Werner and Campbell (1970) believe that it is more difficult to translate shorter passages than to translate longer ones. When Ware et al. (1995) asked translators to rate levels of difficulty in translation, ratings indicated that instructions cause more difficulty than the questionnaire itself. The researchers suggest that instructions should be simplified. The third type of translation problem concerns questionnaires or other verbal stimuli, such as attitude questionnaires or incomplete sentences (Brislin et al., 1973; Sechrest et al., 1972). This problem is so apparent that almost no investigators are unaware of it. It even occurs in the same culture when subjects come from different subcultures. For example, scholarly language may not be Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 9 completely understood by people who use vernacular language. Moreover, dialect differences and regional differences in colloquial speech and idioms may also contribute to potential subcultural research problems. In this situation, translation may be necessary within the same language. For example, academic or standard English may need to be translated into colloquial English (Sechrest et al., 1972). The fourth type of translation problem involves translating subject responses from one language or dialect into another for the possibility of making comparisons (Brislin et al., 1973; Sechrest et al., 1972). If the questionnaire has limited response alternatives, such as true or false, translation will be made before the subject responds. On the other hand, translation is made after the subject responds when there are open-ended questions, interviews, projective tests, and the like (Sechrest et al., 1972). The same attention was paid to translating the instructions for the ESP, which includes the research objectives, as to translating the questionnaire itself. Because of the limited response alternatives in the ESP, translation was made before any subject responds. Problems of Equivalence in Translation Achieving equivalence between the source version and the target version is most important in translation. An equivalent translation means conveying the same meaning from the source version into the target version. It involves not only lingual but also cultural considerations. Often, achieving literal equivalence in the target language fails to express the fundamental meaning of the source language. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 10 Empathy with the target culture is needed to adjust a cultural symbol in the source language into a cultural symbol in the target language that evokes the same functional responses (Bravo et al.,1991, 1993; Brislin et al., 1973; Candell & Hulin, 1986; Mathias et al., 1994; Sechrest et al., 1972; Sim & Kim, 1993; Ware et al., 1995; W emer& Campbell, 1970). Hence, more differences in language and culture between source and target versions may cause greater difficulties in translation (Sechrest et al., 1972). The problems of equivalence are classified into five types by Sechrest et al. (1972). They are vocabulary, idiomatic, grammatical-syntactical, experiential, and conceptual equivalence. The first three equivalent problems concern purely linguistic considerations while the other two involve cultural considerations. Vocabulary is perhaps the most obvious kind of equivalence. Translators find an equivalent term in the target language for a term used in the source language, such as “happy.” However, a good translation does not simply rely on using a good dictionary. Since dictionary language is often not the language of probable respondents (Sechrest et al., 1972), translators should be familiar with the language prospective test respondents use (Bravo et al., 1993; Sechrest et al., 1972). Furthermore, most words have a number of meanings, so that there may be several possible translations for one sentence. How clear the information is written in the source version is important for translators when choosing the most accurate meaning for translation (Sechrest et al., 1972; Werner & Campbell, 1970). Sometimes, the words in the source language have no equivalent words in Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 11 the target language. For example, “husband” and “duty” are difficult to render in Japanese (Brislin et al., 1973). In this situation, using a phrase in the target language to express the source term is suggested. The degree of difficulty in finding vocabulary equivalence is not equal between all pairs of languages. For instance, it is easier to find equivalent vocabulary when translating English into Urdu than when translating English into Tagalog (Sechrest et al., 1972). It would likely be easier to translate English into a Western European language, such as German or Spanish, than an Eastern Asian one such as Chinese. When idioms are employed in one language, they are never proper for direct translation. However, idioms are so commonly used in daily life that completely avoiding idioms in writing instructions or items may produce a form that is too pedantic for the general population in any culture. Moreover, idioms are certainly unavoidable when translating subject responses. The best way to achieve idiomatic equivalence in translation is to translate the meaning instead of the literal words (Sechrest et al., 1972). Grammar and syntax vary enormously across languages. These differences may influence the equivalence in translating even single words. For instance, gerund does not exist in Urdu, so that it is difficult to translate gerund, such as eating and playing, into Urdu. This problem becomes more conspicuous when translating longer passages. For example, there is no subjunctive mood in Tagalog dialect, consequently making it difficult to find an equivalent meaning for the English conditional subjunctive in translation. “If I had the money, I would have Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1 2 bought the dress.” will be translated into “If I have the money, I bought the dress.” in Tagalog (Sechrest et al., 1972). In addition, the same surface structures in sentences may have different deep structures, contributing to ambiguity in translation. For example, “the shooting of the hunters was terrible” could mean either “the hunters were shooting” or “the hunters were shot.” Using simple sentences instead of complicated sentences in the source version may simplify translations (Werner & Campbell, 1970). However, few studies have considered this problem (Sechrest et al., 1972). The daily activities, social relationships, and simply the overall ways of life may diverge greatly across cultures. This often causes problems in translation. For example, swimming in lakes is not accepted by people living in Puerto Rico for health reasons, and traveling in trains makes no sense for them because there are presently no passenger trains in Puerto Rico (Bravo et al., 1993). Ware et al. (1995) found that bowling is an activity not commonly found in other countries. A florist is a familiar term to most Americans, but it would be impossible to achieve an equivalent meaning by literal translation in the Philippines because there are no flower shops there. “I seldom speak up in the classroom” can be translated well from the lingual perspective, but the meaning will not be equivalent in Pakistan because of the experiential differences between Pakistani and American respondents (Sechrest et al., 1972). American students who seldom speak up in the classroom may be considered passive, but the same behavior in other cultures may be encouraged as good behavior. Saturday morning has a different meaning Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 13 for Koreans than for Americans because Saturday is a regular work day for most Koreans (Sim & Kim, 1993). In cases such as these, translators should consider why the term is used in the source version and then find an equivalent term that can reflect the same experience in the target version. Minor rewording is needed to achieve experiential equivalence (Brislin et al., 1973; Sechrest et al., 1972; Ware et al., 1995), which is called cultural translation by Werner and Campbell (1970). For example, Bravo et al.(1993) use “swimming in the sea or rivers” instead of “swimming in lakes.” Since working as a florist is supposed to reflect a feminine activity in an American test, the term “market vendor,” which is largely a women’s job in the Philippines, can be used in the target version in place of florist (Sechrest et al., 1972). After consulting three bilinguals, Saturday morning was changed to Sunday morning in the study by Sim and Kim (1993). Achieving experiential equivalence is not easy in translation. In some cases, it may even be impossible to find experiential equivalence because a counterpart may not exist or may be too vague in another culture. For instance, “department store” can not be translated into Urdu because it does not exist in Pakistan. The closest term is “large shop.” This problem often occurs in translating household objects, animals, architectural features, terrain features, biological specimens, and so forth. In this kind of situation, translation experts suggest eliminating such items (Brislin et al., 1973; Sechrest et al., 1972). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 14 A concept frequently used and well understood in one country may not be appropriately conveyed in translation due to language or cultural differences. For example, it may be quite easy to translate “love” literally, but the connotations of the word may be hard to translate into other languages (Sechrest et al., 1972). Sim and Kim (1993) found that the word “spire” is hard to translate in the non- Christian Korean culture because o f its connotation of reaching toward the heavens. To solve this problem, Kim and Sim refined the translation by further analyzing the original intent and secondary implied meaning of the source instrument with an expert who is familiar with the instrument to refine the translation. In some cases, a concept does not even exist in another culture. For instance, the concept “homosexual” was not found in the Philippines (Sechrest et al., 1972). To achieve conceptual equivalence, consulting a number of bilingual speakers is suggested. Since the subjects or respondents of the target population may have a wild variety of backgrounds, it is preferable that bilingual speakers come from different walks of life. However, in reality most of them have similar background and typically they are better educated than the general population (Sechrest et al., 1972). Even though equivalence of meaning is the most important factor in translation, there are still few criteria that can be used to detect when equivalence has been achieved in the translation (Brislin, 1970). The Criterion One identified by Brislin (1970) has been suggested as a useful guide (Brislin, 1970; Brislin et al., 1973; Sechrest et al., 1972). In Criterion One, Brislin asked two monolingual Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 15 raters to examine one source version and one version in source language back- translated from the target version. The monolingual raters compared the two versions and detected “errors that might make differences in the meaning people would infer” (p. 197). The detection of these errors was then used to correct the translation. The process of refining the translation continued in an iterative process until no errors were found. The corrected target version was proved to be well translated after administration to subjects. Writing a Translatable English Source Version To obtain equivalence in translation, the context o f the source version and how it is written is very important (Brislin, 1970; Brislin et al., 1973). Wemer and Compel (1970) suggested that providing redundancy for the same concept in the source version can decrease the possibility of confusion in translation. The same concept asked in two or more questions helps translators confirm the meaning of the source version and aids translation-checkers in finding errors more easily when these questions are translated differently. Responses to these questions will help researchers determine the consistency of the instrument and the quality of the translation. Redundancy also helps respondents to easier understand the purposes of the questions (Brislin et al., 1973). In addition, providing more context for any difficult item in the source version allows for easier translation. Adding context can narrow the possibilities of meaning and make the item more specific (Brislin et al., 1973; Wemer & Campbell, 1970). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 16 Brislin (1970) used three levels of difficult essays for three content areas to examine how the source version influences the translation. However, essays of the most difficult level had been discarded in the pretest because translators were unable to find equivalent words in target languages for these difficult English words. Ninety-four University of Guam bilingual students, who represented ten non-Indo-European languages including Chamorro, Palauan, Tagalog, and Korean, translated or back-translated the other six essays incorporating three content areas and two levels o f difficulty. The results showed that the level designed to be easier caused fewer errors, and the content areas of intelligence between different races and child-rearing methods caused fewer errors than the area of art. Brislin (1970) speculated that two reasons contributed to these results: (1) students may have more interest in and more experience with the content areas of racial intelligence and child-rearing than with art; (2) because the art essays were written in more detail than the other two, they did not allow context and redundancy to ease translation. Brislin suggested that translators be familiar with the source version and that detailed description is avoided in the source version for easier translation. In addition, Wemer and Campbell (1970) suggested five rules for writing a translatable source version: (1) employ short, simple sentences o f less than sixteen words; (2) use the active English tense rather than the passive tense; (3) avoid metaphors and colloquialisms, as they may be the most difficult to find equivalent terms for in the target language; (4) repeat nouns instead of using Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 17 pronouns; (5) avoid hypothetical phrasings or the subjunctive mood, such as verb forms with “would” or “could.” Brislin et al. (1973) agreed with these rules and added another five rules: (1) avoid adverbs and prepositions telling “where” or “when,” for example, “frequent,” ""beyond,” and “upper;” (2) use specific instead of general terms, such as “pigs,” “cows,” or other specific animals rather than “livestock;” (3) use possessive forms as little as possible; (4) avoid sentences with two different verbs that mean different actions; (5) avoid vague words. The ESP is largely compatible with the above suggestions for a translatable English source version. Redundancy is provided in the ESP, such as in item #5 and #23 of the tactile system: ""Does your child seem to lack the normal awareness of being touched?” and ""Does your child appear to lack the normal awareness of being touched?” Adding context is also seen in many items; item #2 in the vestibular system for example, adds “going up and down stairs or riding swing, teeter totters, slides, or other playground equipment” to specify the term “movement.” Furthermore, most sentences used are simple of less than sixteen words, and active English tense is used in most items. In addition, metaphors and colloquialisms, vague words, adverbs and prepositions telling “where” or “when,” pronouns, hypothetical phrasings, or the subjunctive mood are rarely used. However, the ESP source version does not meet every suggestion made above, such as avoiding the possessive form. When the English source version of the ESP needs to be revised for a valid translation, the above suggestions will be taken into consideration. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 18 Methods of Translation Back-translation has received the most attention o f all the translation methods and is often considered one of the best methods (Brislin et al., 1973; Hulin, 1987; Wemer & Campbell, 1970). This method employs at least two bilinguals who are familiar with the source and target languages. At least one bilingual first makes a translation from the source version into the target version, and the translated material is then back translated into the source language by the other bilingual. The back-translated version and the source version can be compared to find any differences in meaning. Reasons contributing to any discrepancies between the source and back-translated versions may include mistakes in either the first translation or the back translation. If the two versions are not identical, investigators will confer with the bilinguals to identify and correct the errors in translation. This process will continue until no mistakes in meaning are found. This method provides a most useful technique for investigators to control the quality of translation, especially when these investigators do not understand the target language and culture. Moreover, translation techniques may not be the only problem. Some phrases in the source language, such as “take advantage of,” may be impossible to translate well into the target language. In this situation, the source and the target versions should be equally open to revision, which is called decentering. Back-translation provides insight into the process of decentering (Brislin, 1970; Brislin et al., 1973; Sechrest etal., 1972; Wemer & Campbell, 1970). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 19 Back-translation is widely used as the accepted method in translation (Bravo et al., 1991, 1993; Brislin, 1970; Bullinger et al., 1993; Chien-Hou & Tien-Miau, 1986; Fink, 1963; Fisher et al., 1992; Hall et al., 1993; Hulin, 1987; Li et al., 1995; Mathias et al., 1994; Sim & Kim, 1993; Sechrest et al., 1972; Sinaiko, 1963; Ware et al., 1995; Wemer & Campbell, 1970). Yet, little has been written regarding the use of back-translation. Some researchers who mentioned the use of back-translation made few comments about their experiences with using this method. Brislin (1970), Fink (1963), Sinaiko (1963), and Wemer and Campbell (1970) reported their successful experience with using back-translation in relatively extensive detail, and attributed their success to two possible reasons. First, the source English versions of these studies are all open to revision. Secondly, if the structure of the source language is closer to the target language, the difficulty in translation may be less. However, willingness to revise the source version is most likely the more potent reason for success in back-translation (Brislin et al., 1973). Researchers’ satisfaction with the results o f back-translation does not indicate true equivalence in translation. Brislin (1970) provided some possible reasons for a spurious sense of equivalence when using back-translation. First, translators may have a shared set of rules for translating some non-equivalent words and sentences, such as “amigo” and “friend.” Second, some content o f the poorly translated target version may be translated into a good back-translated version. Third, the grammatical forms of the source version may be kept in the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 0 target version. In this case, the target version can be easily back-translated, but will produce confusion in the target population, who use grammar from the target language rather than from the source language. Jacobsen, Kumata, and Gullahom (1960) expressed concern about the spurious equivalence that may be produced by back-translation. Researchers (Bravo et al., 1991, 1993; Brislin, 1970; Brislin et al., 1973; Bullinger et al., 1993; Hall et al., 1993; Mathias et al., 1994; Sechrest et al., 1972; Sim & Kim, 1993; Wemer & Campbell, 1970) suggest that using more than one translation method may alleviate these problems. Other translation methods will be introduced below. Direct translation is a method in which one or more than one bilingual translator translates one language into another. One flaw in this method is that most of the translations are inadequately checked. In addition, translators can subjectively influence the translation due to their personal characteristics, such as their language skills, or understanding of the culture and respondents to the materials. Since these problems are almost undetectable in direct translation, this method should be abandoned (Sechrest et al., 1972). In a method called the use of bilinguals, researchers ask bilinguals to take a test in both the source and target versions, and then compare their responses to gain insight into the equivalence of translation. Researchers can compare bilinguals’ responses by using matched t-tests. This method was applied in Brislin’s study (1970) as Criterion Two. Two Chamorro and two Palauan bilinguals rated the meaning errors in the source and target versions. However, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 1 pretesting of this Criterion showed that this method was very time-consuming and raters found it difficult to determine meaning errors due to the vast language differences. Furthermore, the hypothesis that one bilingual may have two personalities, one for each language, may contribute to the lack of equivalence in some items (Brislin et al., 1973). In another method, two or three people make their own translations independently, and other individuals compare their results to choose an optimal translation of each item. This method is called the committee approach, which usually involves a group of people sitting around a table discussing the merits of each item (Brislin et al., 1973). The problem is that researchers using this method have no control over shared misunderstandings of certain items, and in addition, people may be reluctant to criticize one another (Wemer & Campbell, 1970). Since translators are usually from different subcultures than the subjects who are to respond to the instrument being developed, this may cause undetected errors in translation. Thus, adding a pretest is necessary even after a careful translation (Brislin, 1970; Brislin et al., 1973; Bullinger et al., 1993; Sechrest et al., 1972). A pretest consists of asking a sample from the target population to provide opinions on the comprehensibility, feasibility, and acceptance of the translated instrument in order to refine the translation. Brislin (1970) asked ten Chamorro-speaking college students to give their opinions about a carefully translated scale. This scale had been open to revision and refined through several repetitions of back-translation until no errors in meaning could be found. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 2 However, the ten students still discovered several more mistakes. Bullinger et al. (1993) suggested that one forward and one backward translation and a pretest are the minimal requirements for translating an instrument. Summary To produce a valid translation, both cultural and language differences should be of concern. First, the source version must be open to revision or deletion o f some contents that are not relevant to the culture in target population. Second, back-translation is suggested as a good method to control the quality o f translation through its iterative process. The source and target versions have to be open to revision in the process. Third, pretest is necessary to gain opinions from the target population rather than experts or bilinguals to refine the translation. In the process of translation, attention should be paid to the entire contents of the instrument, including the instructions. Development of the ESP The sensory history questionnaire is an important evaluation tool for occupational therapists to gather valuable information about a child’s sensory integration ability in functional terms (Johnson, 1996; LaCroix, 1993; LaCroix et al., 1997). However, few sensory history questionnaire versions are developed on the basis o f a rigorous procedure for instrument development. Therefore, the validity and reliability of most existing sensory history questionnaire versions may not meet stringent scientific criteria (Johnson, 1996; LaCroix, 1993). For a developing profession such as occupational therapy, the establishment of valid, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 23 reliable, and sensitive evaluation tools is important in the seeking of professional status (Fisher & Short-Degraff, 1993; Gillette, 1982). In the last few years, several students and faculty members at the University of Southern California have developed a sensory history questionnaire called the ESP following a rigorous procedure for instrument development (LaCroix et al., 1997). The ESP has been developed according to the instrument development procedure discussed by Benson and Clark (1982). Its development was initiated with the process of item-generation. A total of 679 items were generated by combining the items of existing sensory history questionnaires, creating new items through an extensive review of literature relating to sensory processing, and adding new items suggested by experts in the field of sensory integration and by parents of children with sensory integration dysfunction. In addition, a table of specifications was developed to delineate the scope and emphasis of the test by relating items to test objectives. Objectives of the ESP include assessing problems in sensory processing, classifying items into different sensory systems, and detecting abnormal sensory processing in natural settings. The proposed number of items in each sensory system on the final instrument originally were as follows: tactile, 25; vestibular, 22; proprioceptive, 17; auditory, 13; visual, 13; olfactory, 5; and gustatory, 5 (LaCroix, 1993). In later studies, Johnson (1996) suggested a revised table of specifications in response to initial validity and reliability findings. The revised number of items in each sensory system were as follows: Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 24 tactile, 18; vestibular, 15; proprioceptive, 12; auditory, 10; visual, 10; and olfactory/gustatory, 5. The next step was to assess the content validity of these 679 items. A panel of twenty-one experts in the field of sensory integration was asked to rate individually how much each item related to each sensory system using a 3-point scale (-1 = not a measure o f the domain, 0 = undecided as to whether the item measures the domain, +1 = a definite measure of the domain). Experts were also asked to indicate whether each item was considered to be a good item for evaluating sensory processing. The index of item-objective congruence (Rovinelli & Hambleton, 1977) was used to calculate how relevant each item is to each sensory system. In addition, percentage of agreement about whether each item was good for a sensory history questionnaire was calculated. The results showed that 191 items had good content validity. The good content validity means that these items met or exceeded the minimum criterion (.70) on the index of item- objective congruence and also had strong inter-rater agreement (75% or greater) of being good items. However, because there were to be 100 items in the end instrument, the pilot instrument should contain 200 items according to Benson and Clark (1982). Because only one item in the gustatory system had met the original criteria, 9 items in that system were added based on more lenient criteria, 50% agreement of being good items. The number of items in each sensory system on the pilot instrument were as follows: tactile, 60; vestibular, 36; proprioceptive, 28; auditory, 32; visual, 22; olfactory, 12; and gustatory, 10. All of these items Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 25 were translated into a Likert-type format. This was Version 1 of the ESP (LaCroix, 1993). The next step was to collect descriptive data. The pilot instrument was distributed to 250 families with typically developing preschool-age children, but only 37 were returned. The genders and ages of the target children in these 37 families were as follows: 15 were girls and 22 were boys; 16 were three years old, 19 were four years old, and 2 were five years old. In this study, 116 items were ranked “rarely” or “never” by 75% or more of the parents. The results indicated that these items may describe behaviors uncommon in typical developing children. On the other hand, there were 10 items on which at least 50% of the parents responded “ always” or “often.” The results suggested that these items may describe some common behaviors for children at certain ages. However, the sample size in this study was too small to make any significant conclusions regarding age or gender differences (Johnson, 1996; LaCroix et al., 1997). Additionally, four mothers were interviewed about their opinions on this pilot instrument. Two of them had children with sensory integration disorders and the other two had children without sensory integration disorders. These mothers felt that answering questions that describe children’s behavior in natural environments, like those posited by this instrument, might help them to better understand their children and to identify problem areas sooner. They also commented that other professions had never asked them these kind of questions Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 26 before, and that they wished to be asked more similar questions (Johnson, 1996; LaCroix et al., 1997). In addition, Version 1 was qualitatively evaluated for its clarity to parents. Five parents were interviewed item by item. Four of them had children with known sensory integration disorders, and one had a child without a disorder. These children were between the ages of three years, zero months and six years, eleven months. Their parents filled out the ESP and explained their answers verbally. They also made suggestions for rewording items. According to the results, 41 items were reworded for clarity and 8 items were eliminated because they contained professional jargon. The revised version was Version 2 of the ESP. Furthermore, one non-native English speaker, who was included in this study, frequently misinterpreted the questions. This finding highlights the importance of cultural and linguistical relevance in the questionnaire (Johnson, 1996). The validity of Version 2 was examined by using contrasting groups. In this study, 30 children with sensory integration disorders and 59 children without sensory integration disorders were involved in this study. Thirty of these 59 children were matched with those children with sensory integration disorders for age, sex, ethnicity, and socioeconomic status. All the children were between the ages of three years, zero months and six years, eleven months. Their parents were asked to fill out Version 2 of the ESP. Using the Wilcoxon signed rank test, the results showed that 84 items were significantly different (p < 5) between the two Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 27 groups. This means that these 84 items are sensitive in detecting sensory processing problems in children (Johnson, 1996). However, the results also showed weak validity and reliability in both the gustatory and olfactory systems. The decision was made to drop the existing items in the two systems and to generate new items in a single gustatory/olfactory system. It was believed that valid items might be more easily arrived at by combining the gustatory and olfactory systems into a single system because of the closely related function between these two systems. Hence, 29 new items were generated by a group of experts, and a content validation procedure used by - LaCroix (1993) was conducted. As a result, 15 items with good validity were incorporated into the ESP. In addition, some slight rewording was made based on Johnson’s (1996) suggestions. The resulting revised instrument was Version 3 of the ESP (see Appendix A). Further research, such as testing inter-rater reliability, is in the process of being developed so as to refine the Version 3 (Parham, 1997; Parham, LaCroix, Johnson, Mailloux, & Roley, 1997). Chinese Culture in Taiwan For appropriate use of the ESP in Taiwan, cultural relevance should be considered. The ESP is an evaluation tool developed by occupational therapists. Fortunately, the philosophy of occupational therapy is largely compatible with Chinese culture in Taiwan. For example, the underlying reason for the use of a traditional Chinese activity called “Kung Fu” is to maintain and improve physical and mental health, which corresponds to the belief o f activity as a treatment Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 28 modality in occupational therapy. In traditional Chinese medicine, health is defined as physical and spiritual harmony with nature. Disturbance of the harmony causes illness. This belief is similar to occupational therapy’s philosophy that health is maintained and promoted by a balanced life style. Both occupational therapy and Chinese culture value the importance of environment to an individual’s health (Jang, 1993). However, some differences do exist between Chinese culture and occupational therapy. One major difference may be the role of the sick person. In traditional Chinese culture, patients are encouraged to be dependent, and their, families and practitioners have a tendency to do everything for them. Moreover, some patients’ belief in karma and fatalism may decrease their motivation to solve their dependency. On the other hand, occupational therapists encourage patients’ independence and self-help. Therapists try to maximize patients’ independence as much as possible (Jang, 1993). In recent years, child rearing in Taiwan has become more Westernized (Li et al., 1995), but there are still some differences compared to the population on which the ESP was based. For instance, children in urban areas usually have very limited space in which to play. Parents discourage exploratory or adventurous activities, especially activities that carry the risk of physical injury (Li et al., 1995). Most Taiwanese parents highly value the importance of education and the academic performance of their children. The effect o f sensory integration Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 29 treatment on learning disorders has gained increasing attention and interest in the last few years. However, there are few valid and reliable tools to evaluate sensory integration disorders in Taiwan (Yao, 1997). The ESP can be used as a useful screening tool for pediatric occupational therapy in hospitals, as well as the few private clinics and schools that employ occupational therapists. Although there is no existing literature on Taiwanese parents’ ratings on a sensory history questionnaire, it is conceivable that the same response to one item may have different meanings for children in Taiwan and America due to the cultural differences. For example, a child with bare feet is mentioned in two - tactile items on the ESP, but Taiwanese children may be prohibited or discouraged from going barefoot in outdoor activities because of the risk of physical injury. Because of such cultural differences, items that are discriminating in the United States may not be discriminating in Taiwan. For the appropriate use of the ESP in Taiwan, careful consideration of cultural differences in translation and in applications of the translated ESP in further cross-cultural studies are necessary. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 30 CHAPTER m METHODOLOGY This chapter discusses the methodology used in this study to translate the ESP. The source version was Version 3 of the ESP. The source and target versions in this translation were open to revision. The revised source version was intended specifically for the form of Mandarin Chinese used in Taiwan, and may be used to make revisions in the original American version. Attaining equivalence of meaning between the source and target versions was the goal. The accomplished target version was relevant to Taiwanese culture and understandable to most Taiwanese adults. The translation was accomplished through three steps: cultural relevance, back-translation, and pretest. Step 1: Cultural Relevance Three bilingual experts in the field of sensory integration were involved in this step. They were citizens of Taiwan, were native speakers of Mandarin Chinese, had passed the criterion for English competency at the University of Southern California for international graduate students, had lived in the United States for more than two years, and also had passed the course OT 610 (Sensory Integrative Dysfunction) at the University of Southern California. First, the bilingual experts were contacted individually by the researcher by telephone. The researcher explained the purpose of this step as follows: “A sensory history questionnaire called the ESP will be translated into Mandarin Chinese to apply to people in Taiwan. However, a few items of the ESP are not Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 31 relevant to most Taiwanese people’s experiences. For example, in item #28, the sound of a lawn mower is described as an irrelevant or background noise, but it may not be familiar to most people in Taiwan. These items may be easy to translate literally into Mandarin Chinese, but the literal translation may fail to accurately convey the meaning in the source version. To validly translate the source version, these items must be revised. Please review all the items of the ESP and provide your opinions on whether any of them should be revised for cultural relevance in Taiwan, and if so, how it should be revised. In addition, if you have any ideas for new items that are relevant to Taiwanese culture, please let me - know.” This explanation was made in Mandarin Chinese because it is their native language. The Version 3 of the ESP was then distributed to each person. The researcher collected all their opinions and discussed the information with each of them by telephone. When a consensus was reached and each agreed with the final revision of the English version, this revised ESP was the source version in the next step. Step 2: Back-Translation Four bilinguals and two monolingual reviewers participated in this step. The bilinguals were citizens of Taiwan, had passed the criterion for English competency at the University of Southern California for international graduate students, and had lived in the United States for more than one year. The researcher in this study was one of them. The researcher and one other bilingual Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 32 were registered occupational therapists and had sensory integration training. They translated the English version into Mandarin Chinese. Their background as occupational therapists was thought to be helpful in remaining the original meaning of the items as measures of sensory processing. The other two bilinguals, called back-translators, translated the Mandarin Chinese version into English. Because they did not have any occupational therapy or sensory integration background, their interpret action of the Mandarin Chinese version was assumed to be similar to the interpretations of most Taiwanese parents who do not have such experience. The monolingual reviewers spoke English as their native language, had passed the course OT 610 (Sensory Integrative Dysfunction) at the University of Southern California, and had previously conducted research o f the ESP. The faculty thesis advisor was one of them. First, the two bilingual translators who had backgrounds in occupational therapy translated the ESP from the culturally revised English version into Mandarin Chinese. The researcher translated the instructions as well as items representing the auditory system, the gustatory/olfactory system, the proprioception system, and the first 21 items of the tactile system. The other bilingual translators translated items representing the vestibular system, the visual system, and the remaining 40 items of the tactile system into Mandarin Chinese. The translations were made based on rendering the meaning of the source version into the target language rather than on literal translation. After each bilingual translator finished his and her translations separately, they reviewed the entire Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 33 Mandarin Chinese version together, made a few revisions, and reached a consensus on the initial Mandarin Chinese version. This Mandarin Chinese version was then back-translated into English by back-translators who had not seen the source version of the ESP. These back-translators were instructed as follows: “Render the meaning of the Mandarin Chinese version into English rather than translate every Chinese word into an English word.” This explanation was made in Mandarin Chinese, their native language. One of the back-translators translated the instructions and items representing the auditory system, the gustatory/olfactory system, the proprioception system, and the first 21 items of the tactile system of the initial Mandarin Chinese version into English, and the other back-translator translated items representing the vestibular system, the visual system, and the remaining 40 items of the tactile system into English. After each back-translator finished her translations separately, they reviewed each other’s translation. They then discussed the problematic translations with each other and reached a consensus on the initial back-translated version. The back-translated English version of the ESP and the ESP version revised from step 1 were compared by the two monolingual English reviewers according to Criterion One (Brislin, 1970). Monolingual reviewers examined the source and the back-translated versions, and wrote down errors that might make differences in meanings. The monolingual reviewers were asked to “detect any errors that might make differences in the meaning people would infer” (Brislin, 1970, p. 197). The researcher then discussed these errors with the monolingual reviewers Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 34 to decide whether the errors seemed to related to the translation from English to Mandarin Chinese, from Mandarin Chinese to English, or could stem from either of the translations. After a consensus was reached, some items of the source version were revised for easier translation, and then these items were retranslated into Mandarin Chinese and back-translated into English. It was also decided that some problematic items were not required to be revised in the source version because translators made errors in translation. Some o f these items needed to be retranslated into Mandarin Chinese and back-translated into English again, and others only needed to be back-translated into English. These retranslations were made by the same translators and examined by the same monolingual reviewers. At this point, no further mistakes in meaning were found. Step 3: Pretest In addition to the bilinguals and experts, opinions from the target population are necessary to refine the translation. A total of six parents were involved in this step. Five of them lived in Taiwan and were recruited by the researcher’s friends or their friends. Four of the parents were mothers and one was an aunt who was raising a six-year old nephew. The children being rated on the questionnaire were two six-year olds, two four-year olds, and one five-year olds. Four were girls and one was a boy. The researcher explained the goal of this step as follows in Mandarin Chinese by telephone: “We are developing an instrument, called the ESP, for use in Taiwan. The ESP can help us understand how a child uses his or her senses Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 3 5 every day at home and in school. To refine the ESP, your opinions will be valuable in helping us develop a version that is relevant to Taiwanese culture and understandable to most Taiwanese parents.” They were asked to sign consent form letters (see Appendix B). The Mandarin Chinese version o f the ESP, revised from Step 2, was then mailed to each participant. They were asked to read the instructions and fill out the questionnaire carefully. After completing the questionnaire, they were interviewed by telephone and asked the following questions in Mandarin Chinese: “Are there any problems with the meaning of the instructions? Are there any - items you do not understand? Are there any items that are difficult to understand or confusing? Please tell me your opinions so we can solve these problems.” During the discussion, the researcher paid close attention to any items where parents chose the response “not applicable.” Parents were asked to provide their particular opinions on refining these items. To further ensure that Taiwanese parents will interpret individual items appropriately, a sixth mother of a four year old boy was recruited to do a detailed item-by item interview. She lived in Los Angeles, grew up in Taiwan, and spoke Mandarin Chinese as her first language. In addition to the same procedure for the initial five parents, she explained verbally to the researcher the reasons behind her responses to the questionnaire. The interview was conducted by telephone and lasted for approximately one hour. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 36 These parents’ opinions were collected and summarized in a written memo to the thesis advisor. The researcher discussed these opinions with the faculty thesis advisor to reach a decision on the final revisions. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 37 CHAPTER IV RESULTS Revision of ESP for Cultural Relevance After a consensus was reached by three bilingual experts, it was determined that 16 items in the ESP version 3 should be revised for cultural relevance in Taiwan. These consisted o f 5 items in the auditory system, 4 items in the gustatory/olfactory system, 3 items in the tactile system, 2 items in the vestibular system, and 2 items in the visual system. No revisions were made in the proprioception system. In the auditory system, “vacuum” was changed to “juicer” on items #8 and #13, “heater” was changed to “air conditioner” on item #12, “bracelets and necklaces” was changed to “watches” on item #14, and “a lawn mower” was changed to “the sound of a car or motorcycle” on item #28. In the gustatory/olfactory system, “ketchup” was changed to “soy sauce” on items #4 and #8, “orange juice” was changed to “guava juice” on item #8, “cooked spinach” was changed to “preserved eggs” on item #11, and “cat food” was changed to “dog food” on item #12. In the tactile system, “sunglasses” was changed to “respirators” on item #19, and “glitter” was changed to “watercolor” on items #12 and #31. In the vestibular system, “merry-go-rounds” was changed to “the spin chair (It is an equipment in the playground. Children can sit in the chairs and turn round.)” on items #14, and “merry-go-rounds” was changed to “the spin chair” on item #28. In the visual system, “b with p” was changed to “6 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 38 with 9” on item #1, “letters” was changed to “phonetic signs,” and “saw for was” was changed to “good for children” (The two words in Mandarin Chinese are written oppositely, just like was and saw.) on item #18. The revised version (see Appendix C) was the source version in the next step. B ack-T ranslation After the ESP (revised in step one) was translated into Mandarin Chinese and back-translated into English, the initial back-translated version and the source version were examined by the two monolingual reviewers. One of the monolingual reviewers detected 29 items with problems, and the other one detected 38 items. A total of 47 items were found with problems by one or two reviewers, and 20 of them were found by both reviewers. After a meeting with the two monolingual reviewers, it was decided to retranslate 26 items. Eleven items of the source version were revised, in order to produce English wording that is better suited for translation (see Table 1). These items were then translated into Mandarin Chinese, and back-translated into English. Two items were retranslated into Mandarin Chinese without changing the English source version, and then back-translated into English (see Table 2). Thirteen items were back-translated into English again without changing either the English source or the initiated Chinese translation (see Table 3). These 26 revised items were distributed to the two monolingual reviewers. After the researcher discussed these items with each o f the reviewers separately, it was agreed that no items needed to be translated or back-translated again. The Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 39 Table 1 Revision of English source items after initial back-translation Item Number Item Wording 2 (s) Auditory System Does your child startle or become distressed by loud or 2 (r) unexpected sounds? Does your child startle or become disturbed by loud or 5 (s) unexpected sounds? Do you notice your child being bothered by any sounds which 5(0 occur during daily life tasks, such as tasks of personal hygiene, dressing, eating, home making, school work, play/leisure? Do you notice your child being bothered by any sounds which 24 (s) occur during daily life tasks, such as tasks of personal hygiene, dressing, eating, home making, play/leisure, and school work? Does your child have trouble interpreting the meaning of simple 24 (r) or common words? Does your child have trouble understanding the meaning of 15 (s) simple or common words? Proprioception System Does your child jump a lot? 15 (r) Does your child jump often? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 40 Table 1. (continued) Item Number Item Wording 20 (s) Compared with, other children the same age, does your child seem to seek out activities that involve jumping, crashing into things, pushing, pulling or falling? 20 (r) Compared with other children the same age, does your child seem to seek out activities that involve jumping, colliding into things, pushing, pulling or falling? Tactile System 3 (s) Is your child irritated by the feel o f certain clothing? 3(r) Is your child annoyed by the texture of certain clothing? 9 (s) Does your child seem excessively ticklish? 9 (r) Does your child seem excessively sensitive to being tickled? Vestibular System 5(s) Does your child demonstrate distress when he/she is moved or riding on moving equipment? 5(r) Does your child demonstrate disturbance when he/she is moved or riding on moving equipment? 26 (s) Does your child tend to need movement in order to "get going," for example, after waking up from a nap? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 41 Table 1. (continued) Item Number Item Wording 26 (r) Does your child tend to need movement in order to "get going," for example, need to move around the room after waking up from a nap? 30 (s) Is your child fearful of activities in which he/she moves through space? 30 (r) Is your child fearful of activities in which he/she moves whole body through space, for example, going down the slide? Visual System 12 (s) Does your child have difficulty with unusual visual environments such as a bright colorful room or a dimly lit room? 12 (r) Does your child have difficulty functioning in unusual visual environments such as a bright colorful room or a dimly lit room? Note, (s) = source version; (r) = revised version Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 42 Table 2 Items that required repeated translation and back-translation without changing the source version. Item Number Item Wording Proprioception System Does your child not notice falling? Does your child not notice that she/he is going to fall? Does your child not notice that she/he is going to fall, is falling, or has fallen? Tactile System Does your child pull away from light touch? Does your child avoid light touches? When your child is touched lightly, does he/she remove his/her body from the touch? Note, Is) = source version; (bl) = initial back-translation version; (b2) = secondary back-translation version 8(s) 8 (bl) 8(b2) 4 (s) 4 (bl) 4(b2) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 43 Table 3 Items that required repeated back-translation without changing the source version or the Mandarin Chinese version. Item Number Item Wording Auditory System 10 (s) Does your child fail to act upon a request to do something, or fail to understand directions? 10 (bl) Can’t your child follow instructions or understand them? 10 (b2) Does your child fail to follow instructions or understand them? 20 (s) Does your child hear sounds other people don't notice or have trouble tuning out certain sounds, such as, a clock or watch ticking? 20 (bl) Does your child hear sounds ignored by others? Or does he/she have difficulty in ignoring certain sounds, such as the ticketing sounds of the watch or clock? 20 (b2) Does your child hear sounds ignored by others? Or does he/she have difficulty in ignoring certain sounds, such as the ticking sounds of the watch or clock? 22 (s) Does your child appear to make noise for noise's sake? 22 (bl) Dose your child make noises because he/she wants to hear them? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 44 Table 3. (continued) Item Number Item Wording 22 (b2) Does your child make noises because he/she wants to hear them? 27 (s) Does your child have difficulty paying attention when there are other noises nearby? 27 (bl) Can’t your child concentrate when there’re noises nearby? 27 (b2) Does your child have difficulties in concentrating when there’re noises nearby? Gustatory/Olfactory System 7 (s) Does your child complain o f being hurt by a taste or a smell? 7 (bl) Does your child complain o f being painful when she/he smell or taste certain smells or tastes? 7 (b2) Does your child complain o f being in pain because she/he smell or taste certain smells or tastes? Proprioception System 23 (s) Does your child crave hugging or rough playing? 23 (b 1) Does your child crave hugging or rude games? 23 (b2) Does your child crave hugs or rough games? 25 (s) Does your child have difficulty sitting erect, or choose to lie down instead of sitting up? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 45 Table 3. (continued) Item Number Item Wording 25 (bl) Does your child have difficulties in sitting upright, or does he rather lying down instead of sitting up? 25 (b2) Does your child have difficulties in sitting upright, or does he choose to lie down instead of sitting up? Tactile System 11 (s) Does your child enjoy tickling as a form of play? 11 (bl) Does your child enjoy playing games of titillation? 11 (b2) Does your child enjoy playing games of tickle? 17 (s) Does your child seem driven to touch different textures? 17 (bl) Does your child seem to constantly touch clothes of different materials? 17 (b2) Does your child seem to constantly touch different textures? 21 (s) Does your child dislike wearing pants or complain about the feel of them brushing against his/her legs? 21 (bl) Does your child hate to wear pants or complain that the pans lightly touch his/her legs? 21 (b2) Does your child hate to wear pants or complain that the pants lightly touch his/her legs? 30 (s) Does your child have a tendency to touch things constantly? 30 (bl) Does your child tend to touch objectives continuously? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 46 Table 3. (continued) Item Number Item Wording 30 (b2) Does your child tend to touch objects continuously? 54 (s) Does it bother your child when a familiar person at home or school is close by? 54 (b 1) At home or school, does it bother your child when a familiar person is closed by? 54 (b2) At home or school, does it bother your child when a familiar person is close by? Visual System 19 (s) Does your child lose his/her place on a page while reading, copying, solving problems, or performing manipulations? 19 (b I) Does not your child find the location on the page while reading, copying, solving problems, or performing manipulations? 19 (b2) Does your child lose the location on the page while reading, copying, solving problems, or performing manipulations? Note. Is) = source version; (bl) = initial back-translation version; (b2) = secondary back-translation version Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 47 final back-translated version is showed in Appendix D. This revised Mandarin Chinese version was used in the next step. Pretest According to the 5 parents living in Taiwan, the instructions and items of the Mandarin Chinese version of the ESP were easily understood and relevant to Taiwanese culture. One parent found one erroneous character and one missing word in the instructions, and one missing word on item #1 in the Auditory system. These mistakes were corrected after the researcher discussed them with the faculty thesis advisor. Only three items were answered “not applicable” by three of the parents: items #18, #19, and #20 in the visual system. The reason was that their child had not reached the age to start reading and writing. One of the parents suggested that the word “seem” should be deleted in all of the items because it may increase the uncertainty of the answers. For the equivalence of meanings in the translation, no revision was made in response to this suggestion. In the detailed interview, the sixth parent thought that “functional performance” mentioned in item # 12 in the visual system was an undefined term. The researcher and the faculty thesis advisor changed this item from “Does unusual visual environments, such as a bright colorful room or a dim room, make your child have difficulty in his/her functional performance?” to ‘Does an unusual visual environment, such as a bright colorful room or a dim room, make your child have difficulty paying attention?.” The sixth parent also felt that “Is he/she unable to ignore certain sounds?” sounded better than “does he/she have Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 48 difficulty in ignoring certain sounds?” mentioned in item # 20 in the auditory system. Because her suggestion was not equivalent to the meaning in the source version, there was no revision for this suggestion. In addition, she thought that the answer “no” would be more appropriated than “never” in a lot of items. No revision was made for this suggestion, because the ESP uses a Likert scale and “never” is designed as one of the ordinal choices. She also suggested that another answer, such as “I don’t know” or “I am not sure,” should be added, because some behaviors are rarely observed by parents. For the equivalence o f meanings in the translation, no revision was made in response to this suggestion. However, this suggestion may lead to revisions in the source version, and will be considered by the ESP research team in the future. The final Mandarin Chinese version of the ESP is shown in Appendix E. Summary o f Revisions Made during Translation The number of revisions made in each step are summarized in table 4: Table 4 Number of revisions in instructions and each sensory system related to translation steps Stepl Step2 Step3 Total Instructions 0 0 2 2 Auditory system 5 7 1 13 Gustatory/Olfactory 4 1 0 5 system Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 49 Table 4. (continued) Stepl Step2 Step3 Total Proprioception system 0 5 0 5 Tactile system 3 8 0 11 Vestibular system 2 3 0 5 Visual system 2 2 1 5 Total 16 26 4 46 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 50 CHAPTER V DISCUSSION Result Analysis In the 3-step process o f translation (cultural relevance, back-translation, and pretest), a total of 46 revisions were made (see Table 4). Each step in the process contributed uniquely to the refinement o f the translation. Examination o f Table 4 shows that each step in the procedure detected a different number of items as problematic. Furthermore, when the researcher examined the items identified in each step, it was clear that the items were not the same, except item # 12 in the visual system revised during both step 2 and 3. Furthermore, the type of problems identified at each step was qualitatively different. This may support the belief that more than one method should be used in translation (Bravo et al., 1991, 1993; Brislin, 1970; Brislin et al., 1973; Bullinger et al., 1993; Hall et al., 1993; Mathias et al., 1994; Sechrest et al., 1972; Sim & Kim, 1993; Werner & Campbell, 1970). The responses of the bilingual experts in step one of this study were consistent with the literature in that revisions in the source version are necessary for achieving equivalent meaning when translations are made between two different cultures (Brislin et al., 1973; Sechrest et al., 1972; Ware et al., 1995; Werner & Campbell, 1970). For example, a lawn mower is a familiar tool to Americans. In the source version, the sound of a lawn mower reflects a common background noise in daily living. However, a lawn mower is rarely used in daily life for the Taiwanese because most people live in apartments. Therefore, “a lawn Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 51 mower” was changed to “the sound o f a car or motorcycle,” which reflects a common background noise in Taiwan. In another example, ketchup is a seasoning used frequently in American food. Even though ketchup is also familiar to most Taiwanese, it is not used as often. Thus, “ketchup” was changed to “soy sauce,” which is used in Taiwan almost as commonly as ketchup is used in America. In addition, these revisions may be helpful to gaining some insight into cultural differences (Werner & Campbell, 1970). In back-translation, the responses from the reviewers were consistent with the assumption that both the source version and target version should be open to revision for success in translation (Brislin, 1970; Brislin et al., 1973; Sechrest et al., 1972; Werner & Campbell, 1970). For example, the word “falling” was translated into “is going to fall” in the target version. However, the connotations o f‘Tailing” in the source version not only include “is going to fall,” but also “is falling” and “has fallen.” Therefore, “is going to fall, is falling, or has fallen” was used instead of “is going to fall” in the target version. This revision follows the suggestion in the translation literature to use a phrase in the target language to express a source term that has no equivalent word in the target language (Sechrest et al., 1972). In another example, “interpret” means “ to understand or explain the meaning of,” and was used to mean “understand” in the original source version. However, it was translated into “explain” in the target language in the first translation because the original source version was ambiguous to the translators. Thus, the word “interpret” was changed to “understand” in the source version, and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 52 then an equivalent translation of this item was made in the repeated back- translation process. This is consistent with the notion that how the source version is written is important in translation (Brislin, 1970; Brislin et al., 1973; Sechrest et al., 1972; Werner & Campbell, 1970). Furthermore, the idea that adding context in the source version can narrow the possibilities o f meaning and make the item more easily translated (Brislin et al., 1973; Werner & Campbell, 1970) was helpful in this study. For example, the item ‘Is your child fearful of activities in which he/she moves through space?” in the source version was translated into “Is your child afraid of doing the activities which involve spatial movements?” in the target version, which was found not equivalent by the monolingual English reviewers. Thus, the item in the source version was revised to ‘Is your child fearful of activities in which he/she moves whole body through space, for example, going down the slide?” Then, the back- translated item in the target version “Is your child afraid of doing the activities which involve movements of her/his whole body in the space, such as going down the slide?” was thought to be equivalent. In this study, mistakes were still detected in pretest even after careful revision for cultural relevance and back-translation. This was consistent with the notion that adding a pretest is necessary even after a careful translation (Brislin, 1970; Brislin et al., 1973; Bullinger et al., 1993; Sechrest et al., 1972). In addition, it was difficult to find participants who were willing to answer a 185-item Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 53 questionnaire for this study. Almost all the people who refused to participate said, “I do not have time to read so many items.” In comparing the process of producing the ESP version 3 (see “Development of the ESP” in Chapter II) with the 3-step translation process in this study, the results support the belief that achieving an equivalent translation is more efficient than generating an entirely new questionnaire (Ware et al., 1995). In addition, having different language versions of the same instrument may permit cross-cultural comparisons. For example, using the Mandarin Chinese version of the ESP in Taiwan may raise the questions about whether there are differences in sensory processing between American and Taiwanese children. As the use of sensory integration theory increases internationally, it is important for occupational therapists to consider cultural differences in applying the instruments developed and standardized in another culture (Benschoten, 1981). Use of a rigorous translation process, such as the one used in this study, can ensure that differences founds between cultural groups are due to cultural differences rather than translation problems. Recommendations for Further Study The revisions made in the source version included 16 items in the cultural relevance step and 11 items from the back-translation step. These revisions may be used for reference when translations are made from America to another country with similar language and culture to Taiwan. In addition, these revisions may also be used for reference in the process of refining the source version. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 54 Further research, such as evaluating inter-rater reliability, is in the process of being conducted so as to refine the ESP Version 3. The final reliable and valid instrument is anticipated to have only about 70 items (Parham, 1997; Parham, LaCroix, Johnson, Mailloux, & Roley, 1997). To meet the same standards of the final version developed in America, the same research should be replicated in Taiwan to refine the translated version. In addition, comparing the results of cross-cultural studies can test the equivalence of the translation (Mathias et al., 1994; Ware et al., 1995; Werner & Campbell, 1970) and may help to gain some insight into cultural differences (Werner & Campbell, 1970). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 55 REFERENCES Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles: Western Psychological services. Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western Psychological services. Benschoten, R. R. V. (1981). A cross-cultural study of administration of the Southern California Sensory Integration Tests. Unpublished master’s thesis, University of Southern California, Los Angeles. Benson, J., & Clark, F. (1982). A guide for instrument development and validation. American Journal of Occupational Therapy. 36U2L 789-800. Bravo, M., Canino, G. J., & Rubio-Stipec, M., & Woodbury-Farina, M., (1991). A cross-cultural adaptation o f a psychiatric epidemiologic instrument: The diagnostic interview schedule’s adaptation in Puerto Rico. Culture. Medicine and Psychiatry. 15. 1-18. Bravo, M., Woodbury-Farina, M., Canino, G. J., & Rubio-Stipec, M. (1993). The Spanish translation and cultural adaptation of the diagnostic interview schedule for children (DISC) in Puerto Rico. Culture. Medicine and Psychiatry. 17, 329-344. Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology. If 31. 185-216. Brislin, R., Lonner, W., & Thorndike, R. (1973). Cross-cultural research methods. New York: John Wiley & Sons. Bullinger, M., Anderson, R., Celia, D., & Aaronson, N. (1993). Development and evaluating cross-cultural instruments from minimum requirements to optimal models. Quality of Life Research. 2. 451-459. Candell, G. L., & Hulin, C. L. (1986). Cross-language and cross-cultural comparisons in scale translations: Independent sources of information about item nonequivalence. Journal o f Cross-Cultural Psychology. 17141. 417-440. Dunn, W. W. (1994). Performance of typical children on the sensory profile: An item analysis. American Journal o f Occupational Therapy. 48(1 U. 967-974. Fink, R. (1963). Interviewer training and supervision in a survey of Laos. International Social Science Journal. 15. 21-34. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 56 Fisher, A. G., Liu, Y., Velozo, C. A_, & Pan, A. W. (1992). Cross-cultural assessments of process skills. American Journal of Occupational Therapy. 4 6 0 01. 876-885. Fisher, A. G., Murray E. A., & Bundy, A. C. (1991). Sensory integration: Theory and practice. Philadelphia: F. A. Davis. Fisher, A. G., & Short-Degraff, M. (1993). Nationally speaking: Improving functional assessment in occupational therapy—Recommendations and philosophy for change. American Journal o f Occupational Therapy. 47(3'). 199- 201 . Gillette, N. P. (1982). Nationally speaking: A data base for occupational therapy—Documentation through research. American Journal of Occupational Therapy. 36(8). 499-501. Hall, K. S., Hendrie, H. C., Brittain, H. M., Notron, J. A., Rodgers, D. D., Prince, C. S., Pillay, N., Blue, A. W., Kaufert, J. N., Nath, A., Shelton, P., Postl, B. D., & Osuntokun, B. O. (1993). The development of dementia screening interview in two distinct languages. International Journal of Methods in Psychiatric Research. 3. 1-28. Hulin, C. L. (1987). A psychometric theory of evaluations of item and scale translations: Fidelity across languages. Journal of Cross-cultural Psychology. 18(2), 115-142. Hwang, C. H., & Wang, T. M. (1986). Cross-cultural adaptation of a developmental test (DIAL-R) for young children in Taiwan. Journal of Cross- cultural Psychology. l l (A '). 475-492. Jacobsen, E., Kumata, H., & Gullahom, J. (1960). Cross-cultural contributions to attitude research. Public Opinion Quarterly. 24. 205-223. Jang, Y. (1993). Chinese culture and occupational therapy. Journal o f Occupational Therapy Association R.O. C.. 11.95-104. Johnson, C. L. (1996). A study of a pilot sensory history questionnaire using contrasting groups. Unpublished master’s thesis, University o f Southern California, Los Angeles. LaCroix, J. E. (1993). A study of content validity using the sensory history questionnaire. Unpublished master’s thesis, University of Southern California, Los Angeles. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 57 LaCroix, J., Johnson, C., & Parham, L. D. (1997). The development of a new sensory history: the Evaluation of Sensory Processing. Sensory integration Special interest Section Quarterly. 20(11 3-4. Li, W., Bundy, A. C., & Beer, D. (1995). Taiwanese parental values toward an American evaluation of playfulness. The Occupational Therapy Journal of Research. 15f4). 237-258. Mao, H. F. (1995). Performance of Chinese children in Taiwan on Beery’s Developmental Test of Visual-Motor Integration. Journal of Occupational Therapy Association R.O. C.. 13. 13-24. Mathias, S.D., Fifer, S. K., & Patrick, D. L. (1994). Rapid translation of quality of life measures for international clinical trials: Avoiding errors in the minimalist approach. Quality of Life Research. 3. 403-412. Pan, A. W., & Jeng, D. H. (1996). The study of the assessment of motor and process skills (AMPS) on normal Taiwanese subjects. Journal of Occupational Therapy Association R.O. C.. 14(2), 127-136. Parham, L. D. (1997). Application for measurement conference: A proposal submitted to the American Occupational Therapy Foundation and the Psychological Corporation. Unpublished manuscript, University of Southern California, Los Angeles. Parham, L. D., LaCroix, J., Johnson, C., Mailloux, Z., & Roley, S. (1997). Manual-draft: Evaluation of Sensory Processing JESPV Unpublished manuscript, University of Southern California, Los Angeles. Parham, L. D., & Mailloux, Z. (1996). Sensory integration. In J. Case- Smith, A. S. Allen, & P. N. Pratt (Eds.), Occupational Therapy for Children, (pp. 307-356). St. Louis: Mosby. 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. Saeki, K. (1982). Performances of Japanese and Japanese-American children on the Southern California motor accuracy-revised and design copying tests at ages 4 through 10: A cross-cultural study. Unpublished master’s thesis,. University of Southern California, Los Angeles. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 58 Saeki, K., Clark, F. A., & Azen, S. P. (1985). Performance of Japanese and Japanese-American children on the motor accuracy-revised and design copying tests of the Southern California Sensory Integration Tests. American Journal of Occupational Therapy. 39(21. 103-109. Sechrest, L., Fay, T. L., & Zaidi, S. M. H. (1972). Problems of translation in cross-cultural research. Journal o f Cross-Cultural Psychology. 3(T). 41-56. Sim, H., & Kim, J. (1993). The development and validation of the Korean version of the MBTI. Journal of Psychological Type. 26. 18-27. Ware, J. E., Keller, S. D., Gandek, B., Brazier, J. E., Sullivan, M., & The IQOLA Project Group. (1995). Evaluating translation of health status questionnaires. International Journal of Technology Assessment in Health Care. U(3), 525-551. Werner, 0., & Campbell, D. T. (1970). Translation, wording through interpreters, and the problem o f decentering. In R. Naroll & R. Cohen (Eds.) A handbook of method in cultural anthropology, (pp. 398-420). New York: The Natural History Press. Yao, K. G. (1977). Another sound: More discussion on the efficacy of sensory integration. Journal of Occupational Therapy Association R.O. C.. 15.45- 50. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. APPENDIX A Evaluation of Sensory Processing ESP Research Version 3 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 60 ESP Evaluation of Sensory Processing Research Version 3 Instructions: Please read each question carefully and answ er 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. The key is also printed on the first page of the questionnaire. 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 m any children demonstrate. Your honest answer, therefore, is very important to us. None of the questions are intended to be ’trick" questions. Sometimes parents are not sure when to check ’Never" versus "N/A. ’ The N/A option should only be used 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 of machinery operating?" the N/A response should be checked only if the child h as 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. Dr. Diane Parham, at the University of Southern California, for clarification. She can be reached by telephone at 213-342-2879. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 61 ESP Research Version 3 A ALWAYS Child’s name O OFTEN Child's age years months s SOMETIMES Name o f adult completing this form R RARELY Relationship to child N NEVER Date N/A NOT APPLICABLE ITEM 1 A 1 O 1 S 1 R 1 N ! N/A A uditory System i. Is your child bothered by o r fearful o f the sound made by a toilet flushing? 1 1 * > Does your child startle or become distressed by loud or unexpected sounds? i 3. Does your child have trouble understanding what other people mean when they sav something? [ 4. Does your child seem to hear sounds that other people tend to not notice? | J. Do you notice your child being bothered by any sounds which occur during daily life tasks, such as tasks o f personal hygiene, dressing, eating, home making, school work, plav/leisure? 6. Is your child bothered by loud background noise such as construction work nearby or sounds o f machinery operating? 7. Does your child seem to have trouble remembering what is said to him/her? 8. Is your child bothered by any household or ordinary sounds, such as soueakv shoes, the vacuum, the blow drver. dog barking, etc.? 9. Does your child seem to understand oral directions? 10 Does your child fail to act upon a request to do something, or fail to understand directions? 11 Does your child respond negatively to loud noises as in running away, crving. or holding hands over ears? 12 Is your child distracted by subtle sounds, such as fluorescent light bulbs, heaters, fans, refrigerators? 13 Is your child bothered by the sound o f the vacuum? 14 Is your child bothered by the sound made by certain accessories such as bracelets and necklaces? 15 Does your child appear to not hear certain sounds? 16 Is your child distracted by sounds not normally noticed by other people? 17 Does your child mind the sound o f the hairdryer? 18 Does your child mind the sound of squeaky shoes1 19 Is your child frightened o f sounds which do not usually convey alarm to other children the same age? 20 Does your child hear sounds other people don’ t notice or have trouble tuning out certain sounds, such as. a clock or watch ticking1 21 1 Does your child ask others not to talk or sing or make noise? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 62 ITEM 1 A 1 0 s R . V N/A 22 Does your child appear to make noise for noise's sake? 23 Compared to other children the same age does your child seem to under react to loud noises? 24 Does your child have trouble interpreting the meaning o f simple or common words? 25 Does your child respond negatively o r seem bothered by unexpected sounds or noises, as in running awav. crying, or holding hands over ears? 26 Does your child seem confused as to the direction from where sounds are coming? 27 Does your child have difficulty paying attention when there are other noises nearbv? 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 paoer. air condiuoners. refrigerators, fluorescent lights? 29 Does your child seem too sensitive to sounds? 30 Does your child ask “what?" a lot. o r need to have words, especially directions repeated? 31 Does your child like to sing or dance to music? G ustatory/ O lfactory System i. Does your child gag, vomit, or complain of nausea when smelling odors such as soap, perfume, or cleaning products? 2. Does your child respond to odors that other people do not notice? 3. Does your child complain that foods are too bland or refuse to eat bland foods? 4. Does your child season his/her food heavily or indicate a desire for heavy seasoning, such as excessive salt, ketchuo. or other soices? 5. 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 combinations o f flavors such as ketchup with ice cream or salt in orange iuice? 9. Does your child like to taste non-food items such as glue or paint? 10 Does your child gag when smelling food odors such as cooked broccoli or garlic? 1 1 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 of a can o f cat food being ODened 1 3 | Does your child prefer :o eat spicy foods? 1 M I Does your child prefer to eat sour foods or candies? I 15 1 Is your child distracted by smells on his/her hands? 1 Reproduced with permission o, ,he copyrigh, owner. Further reproduction prohibited without permission 63 I ITEM | A 1 O 1 S 1 R 1 N 1 N/A ProorioccD tion Svstem !. Does your child grasp objects so tightly that it is difficult to use the object? 2. Does your child tire easily afler sitting or lying in the same 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? S Does your child climb high into trees, jump off tall 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 or stepping over an oofect? 8 Does your child not notice falling? ! 9. Does your child like to be under heavy blankets, covers or pillows? . I 10. Does your child tend to break toys? U. Does your child chew on pens, straws, etc.? 12. Does your chiid grasp objects so loosely that it is difficult to use the obiect? 13. Does your child chew on nonfood objects? 14. Does your child seem to exert too much pressure for the task, for example, walks heavily, slams doors, o r presses too hard when using pencils or cravons? 15. Does your child jump a lot? 16. Does your child have difficulty playing with animals 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, and/or push other children? 19. Does your child seem generally weak? 20. Compared with other children the same age. does your child seem to seek out activities that involve jumping, crashing into things, pushing, pulling or falling? 21. Does your child like getting bear hugs? 22. Does your child taste or 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 of sitting up? T actile Svstem i. Does your child dislike going barefoot, not like to take his/her shoes off or insist on alwavs wearing shoes? 2. Does it bother your child to play games with bare feet? 1 3. Is your child irritated by the feel of certain clothing? . 1 4. | Does your child pull away from light touch? 1 5. | Does your child seem to lack the normal awareness of being touched? ! 1 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 64 ITEM A O s R 1 \ N/A 6. Does your child resist o r dislike wearing clothing o f certain textures? 1 7. Does your child react negatively to the feel o f new clothes? 8. Does your child tend to prefer to wear long sleeve shirts and long pants regardless o f the weather, for instance prefers to wear long sleeves even when it is warm outside? 9. Does your child seem excessively ricklish? 10. Does your child like to cuddle up with a blanket or stuffed animal or special pillow? 11. Does your child enjoy tickling as a form o f play? 12. Does your child avoid playing with "messy" things such as finger paint, mud. sand. glue. glitter, or dav? 13. Does your child show an unusual dislike for having his/her hair combed, brushed or styled? 14. Do rough bedsheets bother your child? 1 15. Does wearing turtleneck shirts bother your child? I 1 16. Does your child prefer to touch rather 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 wear hats, sunglasses, or other accessories? 20. Does wearing fuzzy shirts bother your child? 21. Does your child dislike wearing pants or complain about the fed of them brushing against his/her legs? 22. Does your child tend to wear coats or sweaters when they are not needed? 23. Does your child appear to lack the normal awareness of being touched? 24. Does your child prefer the textures o f certain clothing? | 25. Does your child overreact to minor injuries? 26. Does your child complain about irritating bumps on the bedsheets? 1 27. | Does it bother your child to have his/her finger or toe nails cut? 1 28. | Does your child struggle against being held? 1 29. | Does your child dislike playing games with his/her bare feet? 1 1 30. Does your child have a tendency to touch things constantly? 1 1 31. Does your child dislike getting his/her hands messy or ask to wash hands when using things like glue and glitter? 32. Does your child avoid or dislike playing with gritty things? 1 33. Do lags or collars on clothing bother your child? 1 34. Does your child demonstrate an aversion to any form of dothing? 1 35. Does your child prefer certain textures o f clothing or particular fabrics? 1 36. Does it bother your child to have his/her face touched? i 37 Does it bother your child to have his/her face washed? 38. Does your child object to being touched by familiar people? 39. Does it bother your child if he/she can not see who is touching hin/her when among familiar people at home o r school? : 40. Does the feel o f new clothes bother your child? | i 41. Does your child resist or dislike wearing short sleeved shirts or short pants? - I i 42. Does your child seem to lack awareness o f being touched by others? | I Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 65 ITEM A o s R N N/A 43. Does your child ask you to take the tigs and labels out o f clothing or only wear clothes which have had the taas and labels removed? 44. Is your child irritated by tags on clothing? 45. Is your child bothered by hair brushing against his/her face? 46. Does your child dislike the feeling o f certain dothing? 47. Does your child have an unusually high tolerance for pain? 48. Does your child demonstrate an excessive need to touch? 49. Does your child display an unusual need for touching certain textures, surfaces, objects or toys? 50. Does your child startle easily when being touched unexpectedly? 51 Does wearing fuzzy socks bother your child? 52. Does your child dislike eating messy foods with his/her hands? 53. Does your child tend to feel pain less than others? 54. Does it bother your child when a familiar person at home or school is close bv’ 55. Does your child avoid touching different textures? 56. Does your child appear to resist eating certain foods because of their texture? 57. Does your child strongly dislike being ridded? 58. Does your child avoid foods o f certain textures? 59. Does your child avoid gening 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 hair cut? Vestibular System I. Does your child rock while sitting? 1 n Does your child seem excessively fearful o f movement, as in going up and down stairs or riding swings, teeter totters, slides, or other playground equipment? 3. Does your child get nauseous or vomit due to movement experiences? 4. Does your child like to swing? 5. 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 activines such as reading, following along with a parent reading or playing a computer same? 7. Is your child frequently and easily confused about his/her location for example, gets lost in stores, or can't find the wav to a familiar classroom? 8 Does your child have good balance? 1 9. Does your child have to exert more effort to move than others, tire easily from exertion and or require more sleep than others? 10. Does your child avoid balance activities such as walking on curbs or on uneven ground? - 11. Is your child fearful o f heights, such as escalators, glass elevators, stairs, etc.? Reproduced wi,b p e n s i o n o, .be copyrtgb, owner. Further reproduction prohibited without permission 66 ITEM | A O s R N N/A 12. Does your child like fast movements, such as being whirled about or tossed in the air bv an adult? 13. Does your child like to climb very high? 14. Does your child like fast spinning carnival rides, such as merry-go-rounds? 15. Is your child fearful o f activities which require good balance? 16. When your child shifts his/her body does he/she fall out of his chair? 17. Is your child unable to catch him/herself when felling? 18. Does your child seem to not get dizzy when others usually do? 19. Does your child get car sick? 20. Does your child seem generally weak? 21. Does your child spin and whirl more than other children? 22. Does your child rock himselffherself when stressed? 23. 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 inftnt? 25. Does your child experience discomfort, nausea, or dizziness following movement, especially rotau'on? 26. Does your child tend to need movement in order to "get going." for example, after waking up from a nap? 27. Does your child dislike sudden or quick movement such as suddenly stopping or going over a bump while riding in the car? 28. Compared with other children the same age does your child seem to ride longer or harder on certain playground equipment for example, swing, merrv-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 child demonstrate 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 vour child enjoy excessive spinning and twirling? Visual Svstem 1. Does your child have trouble telling the difference between printed figures that appear similar, for example differentiating b with p. or * * ■ with x? 2. Is your child sensitive to or bothered by light, especially bright light fblinks. souims. cries, or closes eves, 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 something far away? 5. Does your child have difficulty keeping his/her eyes on the task or activity at hand? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 67 ITEM 1 A O S R N N/A 6. Does your child have trouble maintaining his/her visual focus on one task or obiect for verv long? 7. Does your child cub his/her eyes, complain of headaches, or have eyes which water after reading or looking at books'7 8. Does your child have difficulty with visually focusing on things fer away? 9. Does your child become easily distracted by visual stimuli? 10. Does your child have trouble locating things laying on top of other things, especially things o f the same color, or have trouble finding an object when it is amidst 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 environments such as a bright colorful room or a ditnlv lit room? 13. Does your child have difficulty with visually focusing on things close? 14. Does your child have difficulty controlling eye movements during activities such as following objects (ike a ball with eyes, keeping place while reading, or copving from blackboard to the desk? 15. Compared to other children the same age does your child seem to be easily distracted bv visual stimuli? 16. Does your child have trouble following objects with his/her eyes? 17. Does your child have difficulty naming, discriminating, or matching colors, shapes or sizes? 18. Did your child make reversals in words or letters when writing 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 oroblems. or performing manipulations? 20 In school does your child have difficulty shifting gaze from the board to the paper when copving from the board? lile: Senhtstdoc 1997 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 68 APPENDIX B Informed Consent Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 69 INFORMED CONSENT for TRANSLATION OF THE EVALUATION OF SENSORY PROCESSING INTO MANDARIN CHINESE FOR USE IN TAIWAN PRINCIPLE INVESTIGATOR: Chia-Ting Su DEPARTMENT: Occupational Therapy 24-HOUR TELEPHONE NUMBER (310) 641-9022 PURPOSE OF THE STUDY: You are invited to participate in a study of the Taiwanese version of the Evaluation o f Sensory Processing (ESP), a parent questionnaire designed to help us understand how a child uses his or her senses at home and in school. It has been carefully translated from English into Mandarin Chinese for use in Taiwan. We hope to learn which herns need further revision for clarity, understandability, and applicability of the ESP to Taiwanese parents. You are invited as a possible participant in this study because of your Taiwanese background and your child who is in the target age group in this study. There will be five parents involved in the study. PROCEDURE: If you decide to participate, we will ask you to fill out the Taiwanese version of the ESP. The ESP is a questionnaire that asks 184 questions about your child’s behavioral responses to various types of sensory experiences in daily life. Parents who live in the United States will be asked to apply their knowledge of the current Taiwanese culture to fill out it. It will take approximately thirty minutes. After completing the ESP, you will be interviewed by telephone or in a meeting and asked opinions on the clarity, understandability, and applicability of the ESP. This will take approximate sixty minutes. RISKS: There are no risks other than the inconvenience of spending the time to fill out the ESP and discussing items with the researcher. Your child will not be examined or observed in any way as part of this study. BENEFITS - No specific benefits to you or your child are expected. However, your participation may contribute to the development o f better services for Taiwanese children eventually. 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 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 70 Form Valid For Enrollment From cca g tor _ F E B 91999 will remain confidential. Institutional Review Board OFFER TO ANSWER QUESTIONS:-------------------------------- ------------------------------------------ Your participation in the study will be under the care o f Chia-Ting Su at (310) 641-9022 who you may contact with any questions or concerns regarding your participation. Any questions or concerns that you may have about participation related injuries should be discussed with the Principal Investigator, OTR at Chia-Ting Su at (310) 641-9022. If you have any questions regarding your rights as a study subject, you may contact the Institutional Review Board Office 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 future care at any institution where your child receives care or schooling. If you do 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. 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 o f 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 o f coercion. 11. Statement regarding liability for physical injury, if applicable. AGREEMENT: YOUR SIGNATURE INDICATES THAT YOU HAVE DECIDED TO PARTICIPATE HAVING READ THE INFORMATION PROVIDED ABOVE. Signature of Parent Date Signature of Witness Relationship to Parent Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. APPENDIX C Evaluation of Sensory Processing ESP Revised Research Version 3 (Cultural Relevance for Taiwan) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 72 ESP Evaluation of Sensory Processing Revised Research Version 3 (Cultural Relevance for Taiwan) Instructions: 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, 0 = Often, S = Sometimes, R = Rarely, N = Never, N/A = Not applicable. The key is also printed on the first page o f the questionnaire. Please keep in mind that we are trying to find out which o f 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 o f the questions are intended to be “trick” questions. Sometimes parents are not sure when to check “Never” versus “N/A.” The N/A option should only be used 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 noise such as construction work or machinery operating. If you are not sure o f the meaning o f a particular item, or if you are unsure o f how to answer it, please call the primary investigator, Chia-Ting Su, OTR, at the University o f Southern California, for clarification. He can be reached by telephone at 310-641-9022. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 7 a A ALWAYS O OFTEN S SOMETIMES R RARELY N NEVER N/A NOT APPLICABLE ITEM 1 A 1 o 1 s 1 R 1 N 1 N/A A uditorv Svstem l. Is your child bothered by or fearful of the sound made by a toilet flushing? 2. Does your child startle or become distressed by loud or unexpected sounds? 3. Does your child have trouble understanding what other people mean when thev sav something? 4. Does your child seem to hear sounds that other people tend to not notice? 5. Do you notice your child being bothered by an}1 sounds which occur during daily life tasks, such as tasks o f personal hygiene, dressing, eating, home making, school work, plav/lcisure? 6. Is your child bothered by loud background noise such as construction work nearbv or sounds of machinerv operating? 7. Does your child seem to have trouble remembering what is said to him/her? 8. Is your child bothered by any household or ordinary sounds, such as squeakv shoes, the juicer, the blow drver. dog barking, etc.? 9. Does your child seem to understand oral directions? 10 Does your child fail to act upon a request to do something, or fail to understand direcu'ons? 11 Does your child respond negatively to loud noises as in running away, erring, or holding hands over ears? 12 Is your child distracted by subtle sounds, such as fluorescent light bulbs, air conditioner, fans, refrigerators? 13 Is your child bothered by the sound of the juicer? 14 Is your child bothered by the sound made by certain accessories such as watches? 15 Does your child appear to not hear certain sounds? 16 Is your child distracted by sounds not normally noticed by other people? 17 Docs your child mind the sound of the hairdryer? 18 Does your child mind the sound o f squeaky shoes? 19 Is your child frightened of sounds which do not usually convey alarm to other children the same age? 20 Does your child hear sounds other people don't nou'ce or have trouble tuning out certain sounds, such as. a clock or watch ticking? 21 Does your child ask others not to talk or sing or make noise? ESP Version (Step 1) Child’s name ___________________________ Child’s age__________ years_____________months Name of adult completing this form_____________ Relationship to child___________________________ Date Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 74 ITEM A 1 0 S R N N/A 22 Does your child appear to make noise for noise's sake? 23 Compared to other children the same age does your child seem to under react to loud noises? 24 Does your child have trouble interpreting the meaning o f simple or common words? 25 Does your child respond negatively or seem bothered by unexpected sounds or noises, as in running awav. crvine. or holding hands over ears? 26 Does your child seem confused as to the direction bom where sounds are comine? 27 Does your child have difficulty paying attention when there are other noises nearbv? 28 Is your child easily distracted by irrelevant or background noises such as the sound of a car o r motorcycle outside, children talking in the back of 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 Docs your child like to sing o r dance to music? Gustatory/ Olfactory System l. Docs your child gag. vomit, o r complain of nausea when smelling odors such as soap, perfume, or cleaning products? 2. Does your child respond to odors that other people do not notice? 3. Does your child complain that foods are too bland o r refuse to eat bland foods? 4. Does your child season his/her food heavily or indicate a desire for heavy- seasoning. such as excessive salt, sov sauce, or other spices? 5. As an infant did your child resist eating when new flavors of purecd 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 combinations of flavors such as soy sauce with ice cream or salt in guava fuice? 9. Does your child like to taste non-food items such as glue or paint? 10 Does your child gag when smelling food odors such as cooked broccoli or garlic? 11 Docs your child gag when anticipating an unappealing food such as preserved eggs? 12 Does your child gag at a sound associated with an unpleasant odor such as the sound of a can o f dog 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 smells on his/her hands? | 1 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 15- | ITEM 1 A 1 o 1 s 1 R 1 N I N/A Proprioception Svstem i. Does your child grasp objects so tightly that it is difficult to use (be object? 2. Does your child tire easily after sitting or lying in the a m f 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 trees, jump off tall 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 or stepping over an object? 8. Does your child not notice falling? 9. Does your child like to be under heavy blankets, covers o r pillows? 10. Does your child tend to break toys? 11. Does your child chew on pens, straws, etc.? 12. Does your child grasp objects so loosely that it is difficult to use the object? 13. Does your child chew on nonfood objects? 14. Does your child seem to exert loo much 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 with animals 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, and/or push other children? 19. Does your child seem generally weak? 20. Compared with other children the same age. does your child seem to seek out activities that involve jumping, crashing into things, pushing, pulling or falling? 21. Does your child like getting bear hugs? 22. Does your child taste or chew on toys, clothes, or other objects mote 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 of sitting up? Tactile Svstem l. Does your child dislike going barefoot, not like to take his/her shoes off or insist on alwavs wearing shoes? 2. Does it bother your child to play games with bare feet? 3. Is your child irritated by the feel of certain clothing? 4. Does your child pull away from light touch? 5. Does your child seem to lack the normal awareness o f being touched? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 76 ITEM A 0 s R N N/A 6. Does your child resist or dislike wearing clothing o f certain textures? 7. Does your child react negatively to the feel of new clothes? 8. Does your child tend to prefer to wear long sleeve shirts and long pants regardless o f the weather, for instance prefers to wear long sleeves even when it is warm outside? 9. Does your child seem excessively u'cklish? 10. Does your child like to cuddle up with a blanket or stuffed animal or special pillow? 11. Does your child enjoy tickling as a form o f play? 12. Does your child avoid playing with "messy" things such as finger paint, mud. sand. Blue, watereolor. or clav? 13. Does your child show an unusual dislike for having his/her hair combed, brushed orstvled? 14. Do rough bedsheets bother your child? 15. Does wearing turtleneck shirts bother your child? 16. Does your child prefer to touch rather than be touched? 17. Does vour child seem driven to touch different textures? 18. Does your child prefer to go barefoot? . 19. Does your child refuse to wear hats, respirators, or other accessories? 20. Does wearing fuzzy shirts bother your child? 21. Does your child dislike wearing pants or complain about the feel of them brushing against his/her legs? 22 Does vour child tend to wear coats or sweaters when thev are not needed? 23. Does your child appear to lack the normal awareness of being touched? 24. Does your child prefer the textures of certain clothing? 25. Docs your child overreact to minor injuries? 26. Does your child complain about irritating bumps on the bedsheets? 27. Does it bother your child to have his/her finger or toe nails cut? 28. Does your child struggle against being held? 29. Does your child dislike playing games with his/her bare feet? 30. Does your child have a tendency to touch things constantly? 31. Does your child dislike getting his/her hands messy or ask to wash hands when using things like glue and watereolor? 32. Does your child avoid or dislike playing with gritty things? 33. Do tags or collars on clothing bother your child? 34. Does your child demonstrate an aversion to any form of 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 vour child to have his/her lace washed? 38. Does your child object to being touched by familiar people? 39. Does it bother your child if he/she can not see who is touching him/her when among familiar people at home or school? 40. Does the feel of new clothes bother your child? 41. Does your child resist or dislike wearing short sleeved shirts or short pants? 42. Does vour child seem to lack awareness of being touched by others? 1 4 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 77 ITEM A O S R N N/A 43. Does your child ask you to take the tags and labels out o f clothing o r oniy wear clothes which have had the tags and labels removed? 44. Is your child irritated by tags on clothing? 45. Is your child bothered by hair brushing against his/her face? 46. Does your child dislike the feeling o f certain clothing? 47. Does your child have an unusually high tolerance for pain? 48. Does your child demonstrate an excessive need to touch? 49. Does your child display an unusual need for touching certain textures, surfaces, obiects or tovs? 50. Does your child startle easily when being touched unexpectedly? 51. Does wearing fuzzy socks bother your child? 52. Does your child dislike eating messy foods with his/her bands? 53. Does your child tend to feel pain less than others? 54. Does it bother your child when a familiar person at home or school is close bv? 55. Does your child avoid touching different textures? 56. Does your child appear to resist eating certain foods because of their texture? 57. Does your chiid strongly dislike being tickled? 58. Docs your child avoid foods of certain textures? 59. Does your child avoid gening his/her hands in finger paint, paste, sand, clav. mud. glue, etc.? 60. Does your child seek messy play activities? 61 Does it bother your child to have his/her hair cut? V e s tib u la r S y ste m I. Does your child rock while sitting? 2 _ Does your child seem excessively fearful of movement, as in going up and down stairs or riding swings, teeter totters, slides, or other plavground equipment? 3. Does your child get nauseous or vomit due to movement experiences? 4. Does your child like to swing? 5. 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 o r playing a computer game? 7. Is your child frequently and easily confused about his/her location for example, gets lost in stores, or can't find the wav to a familiar classroom? 8. Does your child have good balance? 9. Does your child have to exert more effort to move than others, tire easily from exertion and or require more sleep than others? 10. Does your child avoid balance activities such as walking on curbs or on uneven ground? U . Is your child fearful of heights, such as escalators, glass elevators, stairs, etc.? 5 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 78 ITEM A O s R N N /A 1 2. Does your child like fast movements, such as being whirled about or tocw t in the air bv an adult? 13. Does vour child like to climb veiv high? 14. Does your child like last spuming carnival rides, such as the spin chair? (It is an equipment in the playground. Children can sit in the chairs and turn round). 15. Is your child fearful o f activities which require good balance? 16. When your child shifts his/her body does he/she tail out of bis chair? 17. Is vour child unable to catch him/herself when Calling? 18. Dees your child seem to not get dizzy when others usually do? 19. Does your child get car sick? 20. Does your child seem generally weak? 21. Does your child spin and whirl more than other children? 22. Does your child rock himself/herself when stressed? 23. 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 (his as an infant? 25. Does your child experience discomfort, nausea, or dizziness following movement, especially rotation? 26. Does your child tend to need movement in order to 'get going." for example, after waking up from a nap? 27. Does your child dislike sudden or quick movement such as suddenly stopping or going over a bump while riding in the car? 28. Compared with other children the same age does your child seem to ride longer or harder on certain playground equipment for example, swing, the spin chair? 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 child demonstrate 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 lear reaction to movement? 33. Does vour child enjoy excessive spinning and twirling? V isu al S y ste m 1. Dees your child have trouble telling the difference between printed figures that appear similar, for example, differentiating 6 with 9. or + ■ with x? 2. Is your child sensitive to or bothered by light, especially bright light (blinks, souints. cries, or closes eves, etc:)? 3. When looking at pictures, does your child focus on patterns or details instead of the main pictures? 4. Is your child able to look at something far away? 5. Does your child have difficulty keeping his/her eyes on the task or activity at hand? 6 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 79 ITEM A O S R N N/A 6. Does your child have trouble maintaining his/her visual focus on one task or object for very long? 7. Does your child rub his/her eyes, complain of headaches, or have eyes which water after reading or looking at books? 8. Does your child have difficulty with visually focusing on things far awav? 9. Does your child become easily distracted bv visual stimuli? 10. Does your child have trouble locating things laying on top of other things, especially things of the same color, or have trouble finding an obiect when it is amidst a group o f other things? 11. Does your child close one eye and/or tip his/her head back when looking at somethin? or someone? 12. Does your child have difficulty with unusual visual environments such as a bright colorful room o r a dimlv lit room? 13. Does your child have difficulty with visually focusing on things close? 14. Does your child have difficulty controlling eye movements during activities such as following objects like a ball with eyes, keeping place while reading. or copving from blackboard to the desk? 15. Compared to other children the same age does your child seem to be easilv distracted bv visual stimuli? 16. Does your child have trouble following objects with his/her eyes? 17. Does your child have difficulty naming, discriminating, or matching colors, shapes or sizes? 18. Did your child make reversals in words or phonetic signs when writing or copying or read words backwards (such as reading “good" for “children") after the first grade? 19. Does your child lose his/her place on a page while reading, copying, solving problems, or performing manipulations? 20. In school does your child have difficulty shifting gaze from the board to the paper when copving from the board? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. APPENDIX D Evaluation of Sensory Processing ESP Research Version 3 (Back-Translation Version) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 8 1 Assessment of Dealing with Sensory Information Back-Translation Version Instructions: Please read each question carefully and try your best to answer correctly and honestly. The answer for each question can only be chosen from one o f the following six items which are: always, often, sometimes, rarely, never, and not applicable. Please note that we are trying to find out the questions which can screen unusual behaviors, and the questions which represent the behaviors o f most children. Therefore, your honest answer is very important for us. There will be no “trick” in all questions. Sometimes parents cannot make sure when to choose “never,” and when to choose “not applicable.” When the child has never met the situation described in the question, the answer should be “not applicable.” For example, for the question: “Is your child bothered by surrounding loud noise, such as machinery operating or construction work around your home?” If your child has never met this situation, you should choose “not applicable" for this question. If you are not sure the meaning o f some questions, o r if you are not sure how to answer the question, please feel free to call Chia-Ting Su, OTR, at the University o f Southern California. He is the principal investigator in this study. He can answer your questions. His telephone is 310- 641-9022. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 82 A ssessm ent o f dealing w ith sen so ry inform ation Child’s name________________________________ Child’s age__________years____________ months Your name___________________________ Relationship w ith the child_______________________ Date______________ ITEM A lw iy t O fica S u u w m n w R jptfy N o e Anditorv Svstem I. Is your child afraid of or troubled by the flushing sound of the toilet? 2. Is your child disturbed by or scared o f hearing loud or unexpected sounds? 3. Does your child have difficulties in understanding the meaning of what people sav? 4. Does your child seem to hear sounds that are ignored by others? 5. Is your child troubled by any sounds of daily life, for example, the sound of personal hygiene, dressing, eating, housekeeping, play, leisure, and school work? 6. Is your child troubled by the loud noises in his/her surroundings, such as the noises o f the nearbv construction sites or the operation of machinerv? 7. Does your child seem to have difficulty in remembering what is said to him/her? 8. Is your child troubled by any household or ordinary sounds, for example, the squeaky sounds made by shoes, the sounds o f Juicer or dryer, or the doc’s barks? 9. Does your child seem to understand oral instructions? 10 Does your child fail to follow instructions or understand them? 11 Does your child respond negatively to loud noises, for example, running awav. crying, or covering his/her ears bv hands? 12 Is your child distracted by trivial sounds, for example, the sound of fluorescent light bulbs, air conditioner, fans, o r refrigerators? 13 Is your child troubled by the sound o f the Juicer? 14 Is your child troubled by the sounds o f accessories such as watches? 15 Does your child seem to not bear certain sounds? 16 Is your child distracted by sounds that are usually not noticed by other people? 17 Does your child care about the sound of the hairdryer? 18 Does your child care about the squeaky sound made by shoes? 19 Is your child scared of sounds that children o f the same age are usually not scared of? 20 Does your child hear sounds ignored by others? O r does he/she have difficulty in ignoring certain sounds, such as the ticking sounds of the watch or clock? 21 Does your child ask others stop talking, singing, or making noises? j Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 83 ITEM Atwj* Ofln K « v c r Set m etica b ie 22 Does your child malce noises because be/she wants to hear them? 23. Compared with children o f the same age, does your child under react to loud noises? 24 Does your child have difficulties in understanding regular or simple words? 25. Is your child troubled or does he/she respond negatively to unexpected sounds or noises, for example, tunning away, crying, or covering his/her ears with hands? 26 Is your child confused to the direction where sounds come from? 27 Does your child have difficulties in concentrating when there’re noises nearbv? 28. Is your child easily distracted by irrelevant or surrounding noises, for example, the sound o f a car or motorcycle outside, children talking in the back of the room, crinkling sounds made by the paper, air conditioners, refrigerators, fluorescent lights? 29 Does your child seem too sensitive with sounds? 30. Does your child often ask “what?”, or need to have words repeated (especially oral instructions)? 31 Does your child like to sing or dance while there’s music? Gustatory/ Olfactory System I. Does your child gag. throw up, or feel sick in his/her stomach when he/she smells odors such as soap, perfume, or cleaning products? 2. Does your child respond to odors that others do not notice? 3. Does your child complain that foods are too tasteless or refuse to eat tasteless foods? 4. Does your child season his/her food heavily or tend to eat food with heavy seasoning, for example, foods with excessive salt, soy sauce, or other seasonings? 5. Did your child refuse to eat baby foods with new tastes while he/she was babv? 6. Does your child prefer foods that are very salty? 7. Does your child complain of being in pain because she/he smell or taste certain smells or tastes? 8. Does your child like weird combination of tastes, for example, the taste of adding sov sauce to ice cream or that o f adding salt to guava fuices? 9. Does your child like tasting things that are not eatable such as glues or paints? 10 Does your child gag when he/she smells food odors such as cooked broccoli o r garlic? 11 Does your child gag when she/he knows that there will be a food that he/she doesn’t like such as preserved eggs? 12 Does your child gag when he/she bear the sounds which remind him/her certain unpleasant smells such as the sounds of opening a can of dog food? 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 the smells on his/her hands? 1 2 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 84 ITEM A f * r« y « O ftca 3 am boot N e w e r N o t •pplkttok Proprioception System I. Does your child hold things too tight to use them? 2. Does your child feel tired easily after sitting on or tying at the same position for some time? 3. Does your child grind his/her teeth? 4. Does your child seem to constantly look for activities like pushing, pulling, dragging. lifting, or tumping? 5. Does your child like to climb up to the high portions of trees or jump down horn tall walls or furniture, etc.? 6. Does your child like to hug people tight? 7. Does your child seem unsure of how high or low he/she should move when he/she moves his/her body, for example, sitting down o r stepping over things? 8. Does your child not notice that she/he is going to fall, is falling, or has fallen? 9. Does your child like to be under thick blankets, covers or pillows? 10. Does your child tend to destroy toys? 11. Does your child bite pens, straws, or other things? 12. Does your child hold things too loose to use them? 13. Does your child bite something that is not eatable? 14. Does your child seem to use too much force to do things, for example, walking heavily, closing the doors heavily, or using too much force when using pencils o r cravons? 15. Does your child jump often? 16. Does your child have difficulty in appropriate playing with animals, for example, using too much force to touch them? 17. Does your child have difficulty in sitting on a chair? 18. Does your child often hit. bump, or push other kids? 19. Does your child seem generally weak? 20. Compared with other children of the same age. does your child seem to seek activities related to jumping, crashing into things, pushing, pulling, or falling? 21. Does your child like to be hugged tight? 22. Compared with other children, does your child taste or bite toys, clothes, or other things more often? 23. Does your child crave hugs or rough games? 24. Does your child love to chew hard candies? 25. Does your child have difficulties in sitting upright, or does he choose to lie down instead o f sitting up? Tactile System l. Does your child hate walking bare-footed, taking off shoes, o r does he/she alwavs insist on wearing shoes? 2. Is your child troubled if he/she is bare-footed when playing games? 3. Does the texture o f certain clothing bother your child? 4. When your child is touched lightly, does he/she remove his/her body from the touch? 3 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 85 ITEM O ft* * Rjitfr N ev er N o t 5. Doer your child seem to lack the n o rm l sense o f being touched? 6. Does your child resist o r hale wearing clothes o f certain materials? 7. Does your child respond negatively when wearing new dothes? 8. Does your child tend to prefer to wear shirts with long sleeve and long pants no matter the oondition o f the weather, for example, he/she prefers to do so when the weather is warm? 9. Is your child extremely sensitive o f tickles? 10. Does your child like to bold blankets, stuffed animals, or special pillows? 11. Does your child enjoy playing games of tickle? 1 12. Does your child avoid playing dirty things such as finger paint mud. sand. glue, watercolor. orclav? 13. Does your child especially hate when his/her hairs are combed, lightly touched, or stvled? 14. Do rough bedsheets trouble your child? 15. Does wearing turtlenecks trouble your child? 16. Does your child prefer to touch others instead o f being touched? 17. Does your child seem to constantly touch different tenures? 18. Does your child prefer walking bare-footed? 19. Does your child refuse to wear hats, mouthpieces, or other accessories? 20. Does wearing fuzzy clothes trouble your child? 21. Does your child hate to wear pants or complain that the pants lightly touch his/her legs? 22. Does your child lend to wear coats or sweaters when they are not needed? 23. Docs your child appear to lack of normal awareness of being touched? 24. Does your child prefer certain kinds o f textures of clothes? 25. Docs your child overreact to mild injury? 26. Does your child be irritated by the uneven bed sheets and complain about it? 27. Does it bother your child when cutting finger or toe nails? 23. Does your child struggle and resist when she/he is held? 29. Does your child hate to play games with his/her bare feet? 30. Does your child tend to touch objects continuously? 31. Does your child hate to dirty his/her hands or ask to wash hands when using some things like glue and watercolor? 32. Does your child hate o r resist playing with gritty things7 33. Do tags or collars o f clothes bother your child? 34. Does your child hate some kinds o f clothes? 35. Does your child prefer certain textures of clothes or fabrics? 36. Is your child bothered when his/her face is touched? 37. Is your child bothered when his/her face is washed? 38. Does your child object to being touched by familiar people? 39. Is your child bothered when she/he cannot see the person who is touching her/him in the familiar crowd at home or school? 40. Is your child bothered by wearing new clothes? 41. Does your child resist or hate wearing short shirts o r short pants? 42. Does your child seem to lack o f awareness o f being touched? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 8 6 ITEM A Jwm OOa S o m e R jraly S o l w o ttu fe lc 43. Does your child ask you to remove the label on the clothes or only wear the clothes of which the labels have been removed? 44. Does your child feel annoyed because of the label on the clothes? 45. Is your child bothered because the hair lightly touches his/her face? 46. Does your child hate wearing certain clothes? 47. Is the pain tolerance of your child unusually high? 48. Does your child have too much need of touch? 49. Does your child have an unusual need to touch certain textures, surfaces, obiects or tovs? 50. Is your child shocked easily by unexpected touch? 51. Is your child bothered by wearing fuzzy socks? 52. Does your child hate to use hands to eat the foods which may dirty his/her hands? 53. Does your child feel less pain than others do? 54. At home or school, does it bother your child when a familiar person is close bv? 55. Does your child avoid touching objects with different textures? 56. Does your child seem to resist eating certain foods because of their texture? 57. Does your child strongly hate being tickled? 58. Does your child resist eating certain foods because o f their textures? 59. Does your child avoid contacting paste, sand, clay, mud, glue, or finger paint with hands? 60. Does your child love to play the games that will dirty himself/herself? 61 Is your child bothered by hair cut? V e s tib u la r S v stem 1. Does your child rock while sitting? 2. Is your child too afraid of movement, like in going up and down stairs or riding swings, teeter totters, slides, or other equipment in the olav ground? 3. Does your child get nauseous or vomit because of movement experiences? 4. Does your child like to swing? 5. Does your child appear disturbed when riding or staying passively on moving equipment? 6. Does your child move his/her head along with the eyes when reading, plaving a computer game or when vou read to him/her? 7. Is your child fiequently and easily confused to locate where he/she is. for example, gets lost in stores, or can't find the familiar classroom? 8. Does your child have good balance? 9. Does your child need to pay more effort than others when doing activities, feel fatigue easily due to effort or need more sleep than others? 10. Does your child avoid balance activities like walking on curbs or on uneven ground? 11. Is your child afiaid of heights, such as escalators, glass elevators, stairs, etc.? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 87 ITEM A h n y i Oftcs Samp N«v«r Hoc m etioble 12. Does your child like speedy movements, such as being whirled or tossed in the air bv an adult? 13. Does your child like to climb very high? 14. Does your child like speedy spinning rides, like the spin chair? (It is an equipment in the playground. Children can sit in the chairs and turn round). 15. Is your child afraid of the activities which require good balance? 16. When your child moves his/her body does be/she fell out of the chair? 17. Is your child unable to balance him/herself when felling? i 18. Does your child seem to not feel dizzy when others do? 19. Does your child have car sick? 1 20. Does your child seem generally weak? 1 21. Does your child spin and whirl more than others? t 22. Does your child rock himself/herself when he/she feel stressed? 1 23. Does your child like to be inverted, tipped upside down, or enjoy doing similar activities such as hanging upside down or doing somersaults? 24. Is your child afraid of swinging o r bouncing, or was afraid o f this when he/she was an infant? 25. Does your child feel uncomfortable, nauseous, or dizzy after movement, especially rotation? 26. Does your child need to do some activities to get energy, for example, he/she needs to walk up and down the room after waking up horn a nap? 27. Does your child hate sudden or fast movements such as suddenly stopping or passing over a bump while she/he is in the car? 28. Does your child appear to play longer or harder than other same-aged children on certain playground equipment such as swing, the spin chair? 29. Does your child avoid rapid or spinning movements? 30. Is your child afraid of doing the activities which involve movements of her/his whole bodv in the space, such as going down the slide? 31. Does your child seem distressed when his/her head is not in upright or vertical position such as having the head tilted backward or upside down? 32. Does your child have negative reaction to, hate, feel threatened by, or is afraid o f movement? 33. Does your child like excessive spinning and twirling very much? Visual Svstem 1. Does your child have difficulty in telling similar figures such as 6 with 9. or + with x? 2. Is your child sensitive to or bothered by light, especially bright light (blinks, squints, cries, or closes eves, etc.)? 3. Does your child focus on certain patterns or details and ignore the main part when looking at pictures? 4. Is your child able to see something that is far away? 5. Does your child have difficulty in maintaining his/her eyes on the task or activity at hand? 6 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 88 ITEM A J*iyi one* S o m e -4 * n c t fUrvty Sever S o t •P B b c tb lc 6. Docs your child have difficulty in keeping his/her eyes on one task or object fora vetv long time? 7. Does your child rub his/her eyes, complain about headaches, or his/her eves water after reading books? 8. Does your child have difficulty in focusing on things which are far awav? 9. Does your child become distracted easily because of visual stimuli? 10. Does your child have difficulty in finding things which lay on top of other things, especially things of the same color, or have difficulty in finding an object among a group of other things? 1 1 . Does your child close one eve or tip his/her head backward while looking at something or somebody? 12. Does unusual visual environments, such as a bright colorful room or a dim room, make your child have difficulty in his/her functional performance? 13. Does your child have difficulty in focusing on things which are dose? 14. Does your child have difficulty in controlling his/her eye movements when doing activities such as following a ball with eyes, following the order o f context of the book while reading, or copying something from the blackboard? 15. Docs your child appear to be distracted easily because of visual stimuli when comparing to other same-aged children? 16. Docs your child have difficulty in following objects with eyes? 1 7 . Docs your child have difficulty in naming, telling, or matching colors, shapes or sizes? IS. After the first grade, did your child write or copy words or phonetic signs in reverse order or read words backwards (such as reading “good" for “children"')? 19. Docs your child lose the location on the page while reading, copying, solving problems, or performing manipulations? 20. Does your child have difficulty in shifting gaze from the blackboard to the paper when copving from the blackboard at school? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission APPENDIX E Evaluation of Sensory Processing ESP Mandarin Chinese Version (for use in Taiwan) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. jgTjrfg : • S®P«3HffiRtgafeTf!IA®S • • m & • • mm • - a** * • BiaE^ff3Sstfea®!^giig®a^^«ifTSss?i&sa*fts^Bass»fTS- w ^ x s f p s ^ ^ a B E i s r ^ K s “s e ^ r * F i B f ^ s “^f w * s a® ES«asa^aim fflasfiffis»»jK i5a^ • vm “ ^ esK ^ M gsaat^ sfW ftfF fffH gp® - «® S !^xfiM iD 3i^f^S M «w w r?" I l c i ^ l ! 6 l i l i l f ^ f a 5 « • ISftStiSS “3 ^ " • $ n * & © « s g « £ • f i K T ® g i » ® M ^ f i 9 f l R t i f f e « e B ^ s • t e m&m 3 zft$^m.wx ■ r t j s i m ^ s w s i * • t e t t m s s i (3io ) 641-9022 • Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 91 e m m * 3iAJ&S______________________ m & A m v m ftM m _______________ m i a m ____________ S 3 S i f t fir fir m m m & ■ a ^FM ft l. s s i s t a s c s a 1 1 * ? 2. 3. 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Further reproduction prohibited without permission. 92 IS & fif « Ef f£ 'F ffi 2 2 2 3 2 4 2 5 ft£ IS 6a * 3 g f f ic - & £% ¥& {-& & • 26 2 7 2 8 ? » & w m m r z s m 5? # • • « S c 5 ^ « ? • 2 3 ? - iiffi& B m . tt& W - 2 9 im ^ w p -s i& w s m s ig p s i ? 3 0 ffritt/.i'Eit&sf&a -f+ e ? - s c s s m s ts d s ? 3 1 1 . ® fi9/ j ^ 5 ?]sjt®siEg - &7 K ■ • ® ± * SScSSIS? 2 . 3. 4. ? ® ssn i§ * w a * s ® - 3c&fS3 3 sfcS- • 5 . 6. 7 . 8 . fefiU d'K S IX nE ^tiK l^n^oi ? <£SiEBiffifai!(c«ftRjO£-SS!c E 0L&nSJel8rf-K • 9. 1 0 U 1 2 teW d'S iB eil JS< & ffi/^tM c8 ®SiaW M ^»i a ; ^ fftS K 3 »IISS (s& w & iim si ? 1 3 1 4 1 5 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 93 a * « # m b? & fi£ I ^ F S 5fe I « i. 2. 3. 4. i m t m w & k - m m & m * t z - m - m • 5. w ? 6. f^/J'B fcS*G SA JS»35K fi9«S ? 7. ^ » 3 c # tE " S ? 8. « K a 9 /J'K « iS i£ fiS Jffi^ i5 IS fe a - lE S S c® - ScQ eSfeSm iS ? 9. 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V i& I'l'& & 5 -t8 fem $ L tT 8 m ! I M ? 3cSfc-f£/i6J!35iaBiJtf8rfa m ? . 25. « ? 26. fS W d 'K S J Ift—^ S iftsS frsa iW iiS ? fe£/.N SJg3fcfJH B 5£S F*liE—^ • 27. w w d'K a-SfJBBsiRseftaflgti-f’ P S ? iK JE iS cad i^atiife^ -' 28. S(SI^J'£Et§fct: • fftetJ/J'&i£Scf®JS«S -2gWf9^ffiS5tgfi<ll2JgB? tK ^ S n S E S . - S23EMJ1SS? 29. K & j'i'm & m g .& m 'm w ttto w g ? 30. ftreg /iv S & w ia & iS sra ^ ^ s& sfflS ffiB g g ftiis ? ■ 31. 85 • ? 32. ffK -^ ld • ttft'l'E & r ftm jm & jm s . ■ SSIWJR - S S c » * ScSfQ «S? 33. ®8<J/i'i5?^7if5«iaJKJg«Wig©0JI ? 1. ftrag/j'& if##?—fa s s s & ffiifc jB s g w ® s k s ? t f t s s s u -6" m “9" * 3 c S “+" IQ • 2. {fc*I'I'&fi-S3fe*& • • & S 3cS l!l® aP .g ? (fifcfeii a e ® * - 5?fir * s a a K tp fr S ) 3. «WW/J'KaESBHM-af • » S t S S * c tI®ettffl3K3tfflffiSBa®J5£S w s m s s ? 4. 5. § 3 f c s ^ ia s t ix { ^ g ® w ® ? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 97 s s m s « * * r ff¥ s 4> ffl 6. 7. - tr& m n * t s s s a f • s a m w s ? 8. 9. 10. U. 12. • Vm.&&mdEKlE}K'Sc}g%:&8 S9SKI • /i'Satfi£S*5S^cSJS»S ? 13. § 3feiE2aS53K®W SJi»5 ? 14. - izvm m & m im 5? ’ f!KW /J'KSKaSIIB«fl«jftf^frW a3SW ? 1 5. 16. flp aM '& sst s x a s& viiim m m f& s ? 17. • JBSK - Uyc/jMttfRB? • S¥S93cS!?fwaR«S ? 18. f f i ^ s t s a w s ? f £ s t s m f t ^ 3 f c • 19. ® ft£j'i'&}£BSJ9 * iJ>S • ' SUEEm • ? 20. • » 8 « i / J 'i O J g ^ l s J S ^ S f i S i a 8 a L 2 M W H « • 5 ? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. IMAGE EVALUATION TEST TARGET (QA-3) ✓ / A IIW IG E . I n c 1653 East Main Street Rochester, NY 14609 USA Phone: 716/482-0300 Fax: 716/288-5989 © 1993, Applied Im age, Inc., All Rights Reserved permission of the copyright owner. Further reproduction prohibited without permission.

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Asset Metadata

Creator Su, Chia-Ting (author)

Core Title Translation of the Evaluation of Sensory Processing into Mandarin Chinese for use in Taiwan

Degree Master of Arts

Degree Program Occupational Therapy

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

Tag anthropology, cultural,health sciences, rehabilitation and therapy,Language, Modern,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-27981

Unique identifier UC11341902

Identifier 1394779.pdf (filename),usctheses-c16-27981 (legacy record id)

Legacy Identifier 1394779.pdf

Dmrecord 27981

Document Type Thesis

Rights Su, Chia-Ting

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