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[Validation of a screening questionnaire for activities of daily living (M-ADL) in handicapped children].

BACKGROUND
The issue to what extent acitivities of daily living are impaired becomes increasingly relevant for social integration and for the indication and evaluation of therapies in children with developmental disorders and handicaps. The study presents the validation of a screening questionnaire for activities in children (M-ADL).


PATIENTS
The validity of the M-ADL was examined in 2 studies with 3-7-year old children with the full spectrum of severity of cerebral palsy. In study I, the concurrent validity with the Pediatric Evaluation of Disability Inventory (PEDI) has been studied in 33 children. In study II, the predictive validity was evaluated by comparing 63 handicapped children with a stratified sample of 217 normal children of the same age.


METHOD
The scales of the M-ADL covered eating/drinking, self care at home, toileting, manual ability (summarised as "self care") and mobility. In section A, a general estimation from 0 (full support) to 10 (independent) and in section B a rating based on preset graded scales is given. The correlation of the two ratings has been taken to estimate the criterion validity. Further, the subjective bias of the rater has been estimated by comparison of the absolute values in both sections between the groups.


RESULTS
The M-ADL domains showed a very good concurrent validity with those of the PEDI (r=.78-r=.92). The sensitivity and specificity were excellent, particularly for ratings in section B. The criterion validity was high (mobility domain r=.76, self care domain r=.82). Comparison of the subjective bias showed that parents of CP children over-estimated the activities level of their children compared with controls showing the same values in both sections (group differences, t-test: 95% CI for mobility 0.47-1.46, p<0.001, self care 0.91-1.48, p<0.001).


CONCLUSIONS
The M-ADL is a valid standardised instrument of functional independence in handicapped children, which needs little time and requires no special training for the examiner. In addition to other ADL measures, manual ability, e.g. playing, doing handicrafts, using a pen, is rated. Further, a subjective bias of the raters can be estimated. The instrument may serve as a tool for quick information on the level of activities according to the International Classification of Functioning, Disability and Health (ICF).