Involving Children in in the Cross-Cultural Adaptation Process of an Accessible Language Comprehension Assessment Instrument J.N. Bootsma a,b , O. Kraus de Camargo a,c , J.W. Gorter a,b , J.J.M. Geytenbeek d , K.J. Oostrom d , D. McCauley a , S. Hopmans a a CanChild, McMaster University, Hamilton, Ontario; b School of Rehabilitation Science, McMaster University, Hamilton, Ontario; c Department of Pediatrics, McMaster University, Hamilton, Ontario; d Amsterdam UMC, Amsterdam, the Netherlands Background ● Cerebral Palsy (CP) is the leading cause of childhood onset physical disability, affecting approximately 1 in 500 babies. Communication impairments are common, and approximately 1/5 children with CP cannot speak 1 . This does not mean they don’t understand language. Existing language tests require verbal or fine motor responses. ● The Computer Based Instrument for Low Motor Language Testing 2 (C-BiLLT) is the first accessible test of language comprehension. Participants can use a variety of access methods to respond to the items. ● Originally developed in Dutch, our international research group is in the process of cross-culturally adapting the C-BiLLT into for use in English speaking Canadian children, using these four steps: 1. Forward translation Dutch - English 2. Analysis of content and equivalence of the translated items by individual experts and in group meeting 3. Pilot test of the face validity with Canadian children 4. Validation and feasibility study Methods Participants: A convenience sample of 9 children, ages 4 to 8.5 years, typically developing (n=6) or with a diagnosis of CP (GMFCS I-III, verbal). Procedure: Together with the test facilitator, participants reviewed the 86 C-BiLLT items. They were invited to share feedback on the wording, the image and the concept of all items, using an elicitation protocol. Analysis: Children’s responses were thematically organised using the template analysis technique 3 . A priori expected themes were confusion, dislike, unfamiliarity and suggestion, related to the concept, wording and/or image. Results: Unforeseen Issues Next Steps Acknowledgements We are grateful to all participating families and children. This project was funded by a Hamilton Academic Health Sciences Organization Innovation Grant (HAH-18-003). Aims of step 3 I) To assess the cultural acceptability of the Canadian-English C-BiLLT items for Canadian children II) To assess the linguistic validity of the Canadian-English C-BiLLT items for Canadian children Figure 1. a two-year old boy with CP completing the C-BiLLT using two buttons References Junior Scientist Awarded to Awarded by The C-BiLLT team at CanChild Congratulations on receiving this award. You have been great, keep up the great work. Figure 4. The certificate children received after completion Figure 2. Original item 59: Who used to play outside, but doesn’t anymore? Some participants were confused by this item. “Anyone could not want to go outside”, one of them argued. We changed the item to Who wants to play outside, but now has to go to work? In the Netherlands, ‘playing outside’ is a typical children’s activity, hence Dutch children likely select the Mom as the answer. Conceptual Linguistic Figure 3. Original item 68: A small jar of jam is next to the red jar of jam. Some participants felt ‘next to’ was also depicted in the bottom left picture. We changed the item to: A small jar of jam is beside the red jar of jam. The participants identified some problematic items that we had not anticipated. Items under review Rationale Where is the mailbox? Modernization Cultural eating habits Cultural eating habits Where is the gift? Chocolate sprinkles Pancakes Cheese Toast Walking the dog Going to walk the dog Conceptual Table 1. Examples of items that needed adjustments Conclusion - 12 out of the 86 items of the C-BiLLT needed additional adaptation: - 4 conceptual changes - 4 changes in wording - 5 image changes - We learned that young participants can provide great feedback and suggestions. - Younger participants generally had more trouble expressing their opinions and their reasoning behind it. Validation Study 60-80 typically developing children (ages 1.5 – 8.5 years) from daycares and elementary schools in the Hamilton area will complete the C-BiLLT. They will also complete standardized, validated language comprehension tests for concurrent validity and a measure of non-verbal intelligence for discriminant validity. Feasibility Study 20 children with CP (ages 1.5 – 12 years) with Cerebral palsy (GMFCS IV or V, severe speech impairment) will complete the C-BiLLT and, if possible, a standardized, validated vocabulary instrument. The child’s family and members of the rehabilitation team will be consulted to find the optimal response method for the child. Jael Bootsma (bootsj1@mcmaster.ca) 1. Shevell, M. I., Dagenais, L., & Hall, N. (2009). Comorbidities in cerebral palsy and their relationship to neurologic subtype and GMFCS level. Neurology, 72(24), 2090-2096. 2. Geytenbeek, J. J., Mokkink, L. B., Knol, D. L.,Vermeulen, R. J., & Oostrom, K. J. (2014). Reliability and validity of the C-BiLLT: a new instrument to assess comprehension of spoken language in young children with cerebral palsy and complex communication needs. Augmentative and Alternative Communication, 30(3), 252-266. 3. Brooks, J., McCluskey, S., Turley, E., & King, N. (2015). The utility of template analysis in qualitative psychology research. Qualitative Research in Psychology, 12(2), 202-222.
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Involving Children in in the Cross-Cultural Adaptation Process of an Accessible Language Comprehension Assessment Instrument
J.N. Bootsmaa,b, O. Kraus de Camargoa,c, J.W. Gortera,b, J.J.M. Geytenbeekd, K.J. Oostromd, D. McCauleya, S. HopmansaaCanChild, McMaster University, Hamilton, Ontario; bSchool of Rehabilitation Science, McMaster University, Hamilton, Ontario; cDepartment of Pediatrics, McMaster University, Hamilton, Ontario; dAmsterdam UMC, Amsterdam, the Netherlands
Background● Cerebral Palsy (CP) is the leading cause of
childhood onset physical disability, affectingapproximately 1 in 500 babies. Communicationimpairments are common, and approximately 1/5children with CP cannot speak1. This does notmean they don’t understand language. Existinglanguage tests require verbal or fine motorresponses.
● The Computer Based Instrument for Low MotorLanguage Testing2 (C-BiLLT) is the first accessibletest of language comprehension. Participants canuse a variety of access methods to respond to theitems.
● Originally developed in Dutch, our internationalresearch group is in the process of cross-culturallyadapting the C-BiLLT into for use in Englishspeaking Canadian children, using these four steps:
1. Forward translation Dutch - English2. Analysis of content and equivalence of the
translated items by individual experts and ingroup meeting
3. Pilot test of the face validity with Canadianchildren
4. Validation and feasibility study
MethodsParticipants:A convenience sample of 9 children,ages 4 to 8.5 years, typically developing (n=6)or with a diagnosis of CP (GMFCS I-III, verbal).
Procedure: Together with the test facilitator,participants reviewed the 86 C-BiLLT items.They were invited to share feedback on thewording, the image and the concept of allitems, using an elicitation protocol.
Analysis: Children’s responses were thematicallyorganised using the template analysistechnique3. A priori expected themes wereconfusion, dislike, unfamiliarity and suggestion,related to the concept, wording and/or image.
Results: Unforeseen Issues Next Steps
Acknowledgements
We are grateful to all participating families and children. This project was funded by a Hamilton Academic Health Sciences Organization Innovation Grant (HAH-18-003).
Aims of step 3I) To assess the cultural acceptability of
the Canadian-English C-BiLLT items for Canadian children
II) To assess the linguistic validity of theCanadian-English C-BiLLT items forCanadian children
Figure 1. a two-year old boy withCP completing the C-BiLLT usingtwo buttons
References
Junior ScientistAwarded to
Awarded by
The C-BiLLT team at CanChildCongratulations on receiving this award. You have
been great, keep up the great work.
Figure 4. The certificate children receivedafter completion
Figure 2. Original item 59: Who used toplay outside, but doesn’t anymore?
Some participants were confused by this item. “Anyone could notwant to go outside”, one of them argued. We changed the item toWho wants to play outside, but now has to go to work? In theNetherlands, ‘playing outside’ is a typical children’s activity, henceDutch children likely select the Mom as the answer.
Conceptual
Linguistic
Figure 3. Original item 68: A small jar of jam is next to the red jar of jam.
Some participants felt ‘next to’ was also depicted in the bottom leftpicture. We changed the item to: A small jar of jam is beside the redjar of jam.
The participants identified some problematicitems that we had not anticipated.
Items under review
Rationale
Where is the mailbox? Modernization
Cultural eating habits
Cultural eating habits
Where is the gift?
Chocolate sprinkles Pancakes
Cheese Toast
Walking the dog Going to walk the dog Conceptual
Table 1. Examples of items that needed adjustments
Conclusion- 12 out of the 86 items of the C-BiLLTneeded additional adaptation:
- 4 conceptual changes- 4 changes in wording- 5 image changes
- We learned that young participants canprovide great feedback and suggestions.
- Younger participants generally had moretrouble expressing their opinions andtheir reasoning behind it.
Validation Study
60-80 typically developing children (ages 1.5 –8.5 years) from daycares and elementary schoolsin the Hamilton area will complete the C-BiLLT.They will also complete standardized, validatedlanguage comprehension tests for concurrentvalidity and a measure of non-verbal intelligencefor discriminant validity.
Feasibility Study
20 children with CP (ages 1.5 – 12 years) withCerebral palsy (GMFCS IV or V, severe speechimpairment) will complete the C-BiLLT and, ifpossible, a standardized, validated vocabularyinstrument.The child’s family and members of therehabilitation team will be consulted to find theoptimal response method for the child.
Jael Bootsma ([email protected])
1. Shevell, M. I., Dagenais, L., & Hall, N. (2009). Comorbidities in cerebral palsy and theirrelationship to neurologic subtype and GMFCS level. Neurology, 72(24), 2090-2096.
2. Geytenbeek, J. J., Mokkink, L. B., Knol, D. L., Vermeulen, R. J., & Oostrom, K. J. (2014). Reliability and validity of the C-BiLLT: a new instrument to assess comprehension of spoken language in young children with cerebral palsy and complex communicationneeds. Augmentative and Alternative Communication, 30(3), 252-266.
3. Brooks, J., McCluskey, S., Turley, E., & King, N. (2015). The utility of template analysis in qualitative psychology research. Qualitative Research in Psychology, 12(2), 202-222.
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