Adaptation of the Child Development Clinical Risk
               Indicators instrument to retrospective parent report

Machado, Fernanda Prada; Palladino, Ruth Ramalho Ruivo; Cunha, Maria Claudia

doi:10.1590/2317-1782/2014001IN

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Original Articles • CoDAS 26 (02) • Apr 2014 • https://doi.org/10.1590/2317-1782/2014001IN copy

Adaptation of the Child Development Clinical Risk Indicators instrument to retrospective parent report

Authorship SCIMAGO INSTITUTIONS RANKINGS

PURPOSE:

To adapt the Child Development Clinical Risk Indicators (IRDI) instrument to retrospective report for parents of children from 3 to 7 years old and administer it in two groups.

METHODS:

Participated on the study 72 subjects - parents of children aged from 2 years and 11 months to 7 years and 7 months - divided into two groups: Research Group and Control Group. The proposed modification to parent report transformed the 31 indicators (affirmations) into retrospective self-administered questions to parents, with responses in Likert scale. The IRDI-questionnaire was administered in the two groups.

RESULTS:

The IRDI-questionnaire showed to be easy and quick to administer (average 15 minutes) and with low cost. The analysis of the questions obtained a good internal consistency value. The comparison between the groups by the parents' answers to the 31 questions showed difference in 16 questions.

CONCLUSION:

The items of the IRDI-questionnaire concern the main Autism Spectrum Disorders risk signs pointed out in literature. The parents' answers showed differences between the studied groups.

Speech, Language and Hearing Sciences; Autistic disorder; Questionnaires; Communication; Language

Variable	Group			p-value*
	Control	Study
	n (%)	n (%)
Gender
Male	23 (63.9)	29 (80.6)		0.114
Female	13 (36.1)	7 (19.4)
Parents' school education
Incomplete grade school	3 (8.3)	6 (16.7)		0.690
Complete grade school	2 (5.6)	3 (8.3)
Incomplete high school	3 (8.3)	2 (5.6)
Complete high school	11 (30.6)	13 (36.1)
Incomplete higher education	5 (13.9)	4 (11.1)
Complete higher education/ college degree	7 (19.4)	6 (16.7)
Incomplete graduate school	3 (8.3)	0 (0)
Complete graduate school	2 (5.6)	2 (5.6)
Informant
Mother	31 (86.1)	34 (94.4)		0.429
Father	5 (13.9)	2 (5.6)
Total	36 (100)	36	(100)

Variable	n	Mean (SD)	Median (Min–Max)
Age at the time of the diagnosis	36	42.5 (7.5)	43.5 (29.0–57.0)
Time elapsed between the diagnosis and the administration of the questionnaire	36	20.3 (15.0)	20.0 (0–46.0)

Variable	Category	Group				p-value*
		Control		Study
		n	%	n	%
1. When the child would cry or scream, did the mother know what they wanted?	Always	9	(25.0)	13	(36.1)	0.072
	Often	18	(50.0)	8	(22.2)
	Sometimes	7	(19.4)	10	(27.8)
	Rarely	0	(0.0)	4	(11.1)
	Never	1	(2.8)	1	(2.8)
	Do not remember	1	(2.8)	0	(0.0)
2. Would the mother speak to the child in a style directed particularly to them ("motherese")?	Always	15	(41.7)	10	(27.8)	0.737
	Often	9	(25.0)	12	(33.3)
	Sometimes	8	(22.2)	8	(22.2)
	Rarely	3	(8.3)	3	(8.3)
	Never	1	(2.8)	2	(5.6)
	Do not remember	0	(0.0)	1	(2.8)
3. Would the child react to the motherese?	Always	14	(38.9)	9	(25.0)	0.278
	Often	9	(25.0)	6	(16.7)
	Sometimes	8	(22.2)	8	(22.2)
	Rarely	4	(11.1)	7	(19.4)
	Never	1	(2.8)	4	(11.1)
	Do not remember	0	(0.0)	2	(5.6)
4. Would the mother propose anything to the child and wait for their reaction?	Always	13	(36.1)	12	(33.3)	0.779
	Often	14	(38.9)	15	(41.7)
	Sometimes	7	(19.4)	6	(16.7)
	Rarely	1	(2.8)	2	(5.6)
	Never	0	(0.0)	1	(2.8)
	Do not remember	1	(2.8)	0	(0.0)
5. Was there any exchange of looks (eye contact) between the child and the mother?	Always	25	(69.4)	16	(44.4)	0.006
	Often	10	(27.8)	5	(13.9)
	Sometimes	1	(2.8)	5	(13.9)
	Rarely	0	(0.0)	8	(22.2)
	Never	0	(0.0)	1	(2.8)
	Do not remember	0	(0.0)	1	(2.8)
6. Would the child start to differ day from night?	Always	11	(30.6)	12	(33.3)	0.005
	Often	12	(33.3)	4	(11.1)
	Sometimes	9	(25.0)	4	(11.1)
	Rarely	1	(2.8)	5	(13.9)
	Never	0	(0.0)	8	(22.2)
	Do not remember	3	(8.3)	3	(8.3)
7. Would the child use different signals in order to express their different needs?	Always	9	(25.0)	6	(16.7)	0.100
	Often	14	(38.9)	8	(22.2)
	Sometimes	10	(27.8)	10	(27.8)
	Rarely	2	(5.6)	4	(11.1)
	Never	0	(0.0)	6	(16.7)
	Do not remember	1	(2.8)	2	(5.6)
8. Would the child request their mother and make a pause in order to wait for the mother’s response?	Always	12	(33.3)	5	(13.9)	0.002
	Often	9	(25.0)	3	(8.3)
	Sometimes	10	(27.8)	6	(16.7)
	Rarely	2	(5.6)	12	(33.3)
	Never	1	(2.8)	8	(22.2)
	Do not remember	2	(5.6)	2	(5.6)
9. Would the mother address to the child using short sentences?	Always	17	(47.2)	15	(41.7)	0.368
	Often	11	(30.6)	17	(47.2)
	Sometimes	6	(16.7)	3	(8.3)
	Rarely	0	(0.0)	1	(2.8)
	Never	1	(2.8)	0	(0.0)
	Do not remember	1	(2.8)	0	(0.0)
10. Would the child react (smile, vocalize) when addressed by the mother or by anybody else?	Always	24	(66.7)	8	(22.2)	<0.001
	Often	12	(33.3)	10	(27.8)
	Sometimes	0	(0.0)	10	(27.8)
	Rarely	0	(0.0)	4	(11.1)
	Never	0	(0.0)	4	(11.1)
	Do not remember	0	(0.0)	0	(0.0)
11. Would the child actively search for the mother’s look?	Always	19	(52.8)	4	(11.1)	<0.001
	Often	14	(38.9)	12	(33.3)
	Sometimes	2	(5.6)	8	(22.2)
	Rarely	1	(2.8)	8	(22.2)
	Never	0	(0.0)	3	(8.3)
	Do not remember	0	(0.0)	1	(2.8)
12. Would the mother provide support to the initiatives of the child without sparing them of the effort?	Always	17	(47.2)	11	(30.6)	0.080
	Often	14	(38.9)	11	(30.6)
	Sometimes	5	(13.9)	8	(22.2)
	Rarely	0	(0.0)	4	(11.1)
	Never	0	(0.0)	0	(0.0)
	Do not remember	0	(0.0)	2	(5.6)
13. Would the child ask for the help of other people without falling into passivity?	Always	8	(22.2)	2	(5.6)	0.031
	Often	10	(27.8)	10	(27.8)
	Sometimes	11	(30.6)	6	(16.7)
	Rarely	2	(5.6)	12	(33.3)
	Never	4	(11.1)	5	(13.9)
	Do not remember	1	(2.8)	1	(2.8)
14. Would the mother notice that some requests made by the child could be a way of drawing her attention?	Always	12	(33.3)	3	(8.3)	<0.001
	Often	18	(50.0)	4	(11.1)
	Sometimes	4	(11.1)	11	(30.6)
	Rarely	1	(2.8)	9	(25.0)
	Never	0	(0.0)	6	(16.7)
	Do not remember	1	(2.8)	3	(8.3)
15. During bodily care, would the child actively search for games and loving playfulness with the mother?	Always	22	(61.1)	7	(19.4)	0.005
	Often	7	(19.4)	7	(19.4)
	Sometimes	4	(11.1)	11	(30.6)
	Rarely	2	(5.6)	3	(8.3)
	Never	1	(2.8)	7	(19.4)
	Do not remember	0	(0.0)	1	(2.8)
16. Would the child manifest like or dislike toward anything?	Always	12	(33.3)	10	(27.8)	0.030
	Often	18	(50.0)	8	(22.2)
	Sometimes	5	(13.9)	12	(33.3)
	Rarely	1	(2.8)	4	(11.1)
	Never	0	(0.0)	2	(5.6)
	Do not remember	0	(0.0)	0	(0.0)
17. Do mother and child share a particular private language between themselves?	Always	14	(38.9)	9	(25.0)	0.023
	Often	12	(33.3)	6	(16.7)
	Sometimes	8	(22.2)	8	(22.2)
	Rarely	1	(2.8)	3	(8.3)
	Never	0	(0.0)	9	(25.0)
	Do not remember	1	(2.8)	1	(2.8)
18. Would the child feel uncomfortable with people to whom they were not familiar with?	Always	9	(25.0)	5	(13.9)	0.119
	Often	6	(16.7)	6	(16.7)
	Sometimes	15	(41.7)	9	(25.0)
	Rarely	4	(11.1)	9	(25.0)
	Never	2	(5.6)	7	(19.4)
	Do not remember	0	(0.0)	0	(0.0)
19. Would the child possess favorite objects?	Always	13	(36.1)	11	(30.6)	0.404
	Often	9	(25.0)	6	(16.7)
	Sometimes	9	(25.0)	6	(16.7)
	Rarely	1	(2.8)	4	(11.1)
	Never	3	(8.3)	7	(19.4)
	Do not remember	1	(2.8)	2	(5.6)
20. Would the child "make cute stunts"?	Always	14	(38.9)	4	(11.1)	<0.001
	Often	18	(50.0)	9	(25.0)
	Sometimes	4	(11.1)	14	(38.9)
	Rarely	0	(0.0)	4	(11.1)
	Never	0	(0.0)	4	(11.1)
	Do not remember	0	(0.0)	1	(2.8)
21. Would the child search for the adult’s look of approval?	Always	9	(25.0)	3	(8.3)	<0.001
	Often	18	(50.0)	5	(13.9)
	Sometimes	5	(13.9)	10	(27.8)
	Rarely	2	(5.6)	7	(19.4)
	Never	0	(0.0)	8	(22.2)
	Do not remember	2	(5.6)	3	(8.3)
22. Would the child accept semi-solid, solid, and varied food in their diet?	Always	12	(33.3)	18	(50.0)	0.198
	Often	14	(38.9)	7	(19.4)
	Sometimes	8	(22.2)	6	(16.7)
	Rarely	2	(5.6)	3	(8.3)
	Never	0	(0.0)	2	(5.6)
	Do not remember	0	(0.0)	0	(0.0)
23. Would the mother alternate moments of dedication to the child with other interests?	Always	11	(30.6)	6	(16.7)	0.564
	Often	12	(33.3)	13	(36.1)
	Sometimes	8	(22.2)	9	(25.0)
	Rarely	3	(8.3)	6	(16.7)
	Never	1	(2.8)	2	(5.6)
	Do not remember	1	(2.8)	0	(0.0)
24. Would the child deal well with brief absences by the mother and react to long ones?	Always	11	(30.6)	7	(19.4)	0.179
	Often	11	(30.6)	9	(25.0)
	Sometimes	8	(22.2)	5	(13.9)
	Rarely	5	(13.9)	7	(19.4)
	Never	1	(2.8)	7	(19.4)
	Do not remember	0	(0.0)	1	(2.8)
25. Would the mother offer toys as an alternative to the interest of the child for the mother’s body?	Always	11	(30.6)	3	(8.3)	0.122
	Often	10	(27.8)	12	(33.3)
	Sometimes	8	(22.2)	7	(19.4)
	Rarely	2	(5.6)	3	(8.3)
	Never	4	(11.1)	5	(13.9)
	Do not remember	1	(2.8)	6	(16.7)
26. Would the mother no longer feel obliged to satisfy all the child would ask for?	Always	4	(11.1)	8	(22.2)	0.037
	Often	9	(25.0)	3	(8.3)
	Sometimes	15	(41.7)	7	(19.4)
	Rarely	4	(11.1)	7	(19.4)
	Never	3	(8.3)	10	(27.8)
	Do not remember	1	(2.8)	1	(2.8)
27. Would the child look curiously toward what was interesting to the mother?	Always	12	(33.3)	3	(8.3)	<0.001
	Often	16	(44.4)	7	(19.4)
	Sometimes	8	(22.2)	10	(27.8)
	Rarely	0	(0.0)	9	(25.0)
	Never	0	(0.0)	5	(13.9)
	Do not remember	0	(0.0)	2	(5.6)
28. Would the child like to play with objects used by the parents?	Always	14	(38.9)	3	(8.3)	0.002
	Often	13	(36.1)	10	(27.8)
	Sometimes	7	(19.4)	9	(25.0)
	Rarely	0	(0.0)	8	(22.2)
	Never	1	(2.8)	5	(13.9)
	Do not remember	1	(2.8)	1	(2.8)
29. Would the mother request the child to name what they wanted, not settling for gestures alone?	Always	16	(44.4)	14	(38.9)	0.287
	Often	9	(25.0)	16	(44.4)
	Sometimes	7	(19.4)	2	(5.6)
	Rarely	2	(5.6)	2	(5.6)
	Never	2	(5.6)	1	(2.8)
	Do not remember	0	(0.0)	1	(2.8)
30. Would the parents impose minor behavior rules to the child?	Always	18	(50.0)	12	(33.3)	0.302
	Often	12	(33.3)	16	(44.4)
	Sometimes	6	(16.7)	5	(13.9)
	Rarely	0	(0.0)	1	(2.8)
	Never Do not remember	0 0	(0.0) (0.0)	2 0	(5.6) (0.0)
31. Would the child differentiate their parents’ objects from their own?	Always	9	(25.0)	3	(8.3)	<0.001
	Often	16	(44.4)	5	(13.9)
	Sometimes	9	(25.0)	9	(25.0)
	Rarely	0	(0.0)	11	(30.6)
	Never	0	(0.0)	6	(16.7)
	Do not remember	2	(5.6)	2	(5.6)
Total		36	(100)	36	(100)

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[1] Correspondence address: Fernanda Prada Machado Graduate Program in Speech Language Pathology and Audiology, Rua Monte Alegre, 499, São Paulo (SP), Brazil, CEP: 05014-000. E-mail: fernandapradamachado@gmail.com