Transcultural adaptation to Portuguese of the Mind Excessively Wandering Scale ( MEWS ) for evaluation of thought activity Adaptação transcultural da Mind Excessively Wandering Scale para avaliação de atividade mental

Introdução: O conceito de devaneio se refere a períodos nos quais a atenção e o conteúdo do pensamento de distanciam da ideia original ou da atividade que estava sendo realizada. O fenômeno ocorre na população em geral, e a Escala Mind Excessively Wandering Scale (MEWS) avalia sua frequência, intensidade e desfechos negativos associados. Objetivos: Descrever a adaptação transcultural da MEWS. Métodos: A adaptação transcultural envolveu cinco etapas: tradução, retrotradução, apreciação da equivalência semântica e administração em amostra de conveniência composta de 20 adultos com transtorno do déficit de atenção com hiperatividade (TDAH) e 20 controles normais. Resultados: Os resultados demonstraram equivalência satisfatória entre as versões original e traduzida. Uma versão síntese para o português brasileiro é apresentada. Conclusão: A MEWS fornece informações importantes sobre atividade mental, algo particularmente importante em casos de TDAH. A versão em português brasileiro deverá ser bem acolhida, permitindo investigar respostas específicas ao tratamento e obter novas medidas de desfechos. Descritores: TDAH, devaneio, atenção. Abstract


Introduction
Mind wandering can be translated in a literal sense into Portuguese as "devaneio."The original concept of this term encompasses the idea of periods in which attention and content of thoughts depart from the original idea or the activity being performed at the moment these thoughts occur. 1 This experience can be considered universal, often experienced by any individual, without necessarily translating a pathological symptom.It is estimated that around 24 to 50% of the waking time is involved with thoughts that are not directly related to the task performed at the moment. 1,2nd wandering is currently classified into two subtypes: spontaneous and deliberate. 3The first refers to the displacement of thinking during the execution of an activity that requires attention maintenance (for example during a lesson, a conversation or during studies).The deliberate subtype, however, refers to the practice of deliberately or intentionally shifting thoughts.For example, when planning what to do at dinner while driving a vehicle, or planning work activities while performing an unrelated task.It is important to emphasize that the intensity and frequency with which mind wandering occurs is the main evaluation criterion to determine any impairment entailed by its excess.
The spontaneous subtype, when occurring in excessive frequency and intensity, is often related to psychiatric disorders, in particular attention deficit hyperactivity disorder (ADHD). 4ADHD is a neurodevelopmental disorder, characterized by symptoms of inattention, hyperactivity and impulsivity. 5It is the most common psychiatric disorder in childhood; in approximately 60% of cases, symptoms persist in adulthood. 6It is estimated that about 2.5% of adults have ADHD. 7though the diagnosis of ADHD is based solely on reports of inattention, hyperactivity and impulsivity, there are extensive reports in the literature regarding ceaseless thought activity (thoughts in constant motion), sensations of difficulty in controlling one's own thoughts and reports of different thoughts unrelated to the activity being performed. 4,8Apparently, the inattentive behavior in ADHD is directly related to the excess and intensity of mind wandering.

In 2016, Mowlem et al. validated the Mind Wandering
Excessively Scale (MEWS), with great potential to measure this symptomatic dimension.Items from the scale are scored on a 4-point Likert-type scale (0 = not at all or rarely; 1 = some of the time; 2 = most of the time; 3 = nearly all of the time or constantly).The scale was administered to adult patients diagnosed with ADHD and showed statistically significant internal consistency, sensitivity and specificity in the diagnosis of ADHD. 3 In addition, the scale allowed to distinguish between ADHD and controls, with good psychometric properties: good internal consistency (α > 0.9), high sensitivity (0.9) and specificity (0.9) for the ADHD diagnosis.
Eigenvalues indicated a unidimensional structure to the MEWS; Cronbach's alpha coefficients were higher than all comparable existing instruments for ADHD diagnosis.The preliminary scale had 15 items, which were then changed to 12 after psychometric analysis.
The suggested cut-off was 15. 3 Mind wandering has not been investigated in other psychiatric disorders, with the single exception of major depression 9,10 ; in addition, there are no studies in languages other than English.
The main objective of this study was to perform a cross-cultural adaptation of the MEWS into Brazilian Portuguese.

Methods
This study was part of a larger study on ADHD, approved by the ethics committee of Hospital Copa D'Or (CAAE 05089412220025249).The authors followed general guidelines of the method proposed by Herdman et al. 11 The process of cross-cultural adaptation occurred in five consecutive steps: a) step 1, translation of the original instrument; b) step 2, back-translation; c) step 3, formal appreciation of equivalence; d) step 4, debriefing with a convenience sample; and e) step 5, final criticism by experts in the field.
Step 1 consisted of two translations of the original scale in English into Brazilian Portuguese, performed independently.The first one (T1) was carried out by a qualified professional in Letters and with specialization in English, and the second (T2) by a psychiatrist with experience in ADHD and fluent in the English language, able to identify the concept that sustains each of the items of the original instrument.In this step, operational equivalence was respected, aiming to maintain original characteristics, keeping the same number of items (12), the same statement and the same four frequency response options.
Step 2 consisted of backward translations of T1 and T2 into English, respectively by another professional in Letters (R1) and a psychologist with experience in ADHD and fluent in the English language (R2).Both backtranslations occurred independently, and both backtranslators were blind to the profile of the professionals involved in the first stage.
Step 3 involved the formal appreciation of semantic equivalence with professionals with the same profile as in previous steps.For the judgment of semantic equivalence, the general and referential meanings of the terms and expressions of each of the 12 items were evaluated.
Referential meanings refer to the literal correspondence between words in the original scale and the backtranslations.General meanings refer to the concepts to which a single word or a set of words allude, considering aspects more subtle than the literal equivalence.That is, in semantic equivalence, we consider not only the meaning of the words between the two languages, but also try to achieve the same effect that the items have in were also asked to report any difficulty in understanding the items; all comments were registered.
Step 5 consisted of the collection and discussion of comments from step 4 by the same professionals involved in step 3.

Results
Table 2 presents examples from steps 1, 2, and 3 for five MEWS items that were considered the most difficult ones to translate.The two translations of the scale (T1 and T2) had good measures of semantic equivalence to the original instrument.No items were rated as completely changed.Two items were classified as greatly changed and required further discussion in step 3.For this reason, a third translation was proposed (T3).This last translation included modifications in order to make items more easily understood by individuals in a broader range of schooling levels, without changing the intended sense of each item.All items modified in T3 were evaluated by the original author of the instrument so that the intended meaning remained unchanged.The expressions "in a fog," "on the go" and "switch thoughts off" were replaced with a colloquial equivalent judged to be more easily understood, conveying in a coherent way what was intended to be evaluated.In addition, some grammatical restructuring was undertaken to make items more clear and concise.
Steps 4 and 5 contributed to the evaluation of possible difficulties during the administration of the scale.Items 5 and 6 were considered to be somewhat similar by some patients and we discussed this information with the scale author (PA).However, no changes were suggested for the final version (Table 3).
different cultures.The evaluation of semantic equivalence was done by structuring a form in which the items and their back-translations were arranged in pairs (T1-R1; T2-R2).Professionals scored the equivalence in four levels: unchanged; changed a little; greatly changed; and completely changed.After joint assessment and discussion, a synthesis-based version was prepared based on the evaluation and judgment of all scale items.Five professionals with extensive clinical experience in ADHD (psychiatrists and psychologists), who did not participate in the previous stages, from distinct university institutions, received the synthesis version to comment and critique, based on clinical experience.The author of the original instrument was accessed to clarify doubts about the original idea of each item.From this work, a new synthesis version was elaborated considering the contributions after discussion with all involved.Subsequently, in step 4, the synthesis version was administered to a convenience sample comprising 20 adult controls and 20 patients diagnosed with adult ADHD, with no relevant axis-I disorder.The sociodemographic data of the subjects evaluated are presented in the Table 1.Patients were recruited among individuals referred for neuropsychological testing at Centro de Neuropsicologia Aplicada, at Instituto D'Or de Pesquisa e Ensino (IDOR), in Rio de Janeiro.They were diagnosed by experienced psychiatrists in accordance to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).All individuals signed an informed consent form.Adults of both sexes were involved and all individuals either had at least college level or were attending college.In order to comply with this step, each respondent was asked to answer the MEWS and provide real-life examples.They

Table 3 -
Mind Wandering Excessively Scale, final version in Portuguese

Table 2 -
Examples of items in the Mind Excessively Wandering Scale (MEWS): translations (T1 and T2), back-translations (R1 and R2) and synthesis version