Does adapting a self-report instrument to improve its cognitive accessibility for people with intellectual disability result in a better measure? - A cognitive interview study.
Simplifying language and format of self-report tools makes them more accurate for adults with mild intellectual disability.
01Research in Context
What this study did
Roel and colleagues sat with the adults who have mild intellectual disability. They asked each person to think out loud while filling out a mood self-report form.
The team first used the regular form, then a rewritten version. The rewrite used short sentences, pictures, and a three-point smiley-face scale.
What they found
People understood the adapted form better. They made fewer guessing sounds and asked fewer 'what does this mean?' questions.
Their answers on the new form also matched what their carers said about them. The gap between self and proxy scores shrank.
How this fits with other research
Older work already showed that adults with mild ID can answer self-report scales. Stancliffe et al. (2007) proved the Beck Cognitive Triad Inventory works in this group. Johnson et al. (1994) showed self and carer reports usually line up.
Kooijmans et al. (2024) now shows we can tighten that line-up even more by simplifying the form. The update does not replace earlier findings; it builds on them.
Anonymous (2020) warned that standard IQ and adaptive scores often miss real change. Roel’s paper answers part of that call by giving clinicians a quick way to let clients speak for themselves.
Why it matters
If you assess mood, pain, or satisfaction in adults with mild ID, rewrite your forms first. Swap long words for short ones, add pictures, and use three clear choices. You will get answers that are closer to the person’s true view and less guessing.
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02At a glance
03Original abstract
BACKGROUND AND AIMS: We investigated whether improving the cognitive accessibility of a widely used self-report measure leads to better understanding and more accurate answers in a sample of adults with mild intellectual disability and borderline intellectual functioning. METHODS AND PROCEDURES: We undertook a series of cognitive interviews before and after adaptation of the instructions and selected items of an existing self-report measure of adaptive functioning. Interview results and participant feedback were supplemented with quantitative comparisons between participant and carer scores. OUTCOMES AND RESULTS: Adaptation based on participant experiences and preferences combined with evidence-informed guidelines improved understanding and accuracy. Self-report and carer-report scores showed greater convergence after adaptation; this occurred because people with intellectual disabilities appeared to understand the self-report measure more effectively. CONCLUSIONS AND IMPLICATIONS: The results show that adaptation of the self-report instrument to suit the needs and preferences of people with mild intellectual disability or borderline intellectual functioning leads to a more accessible measure and more reliable and valid results. Results also highlight the importance of complementing proxy reports with a first-person perspective in assessment as clients and informants may differ in their assessment of behavior and skills.
Research in developmental disabilities, 2024 · doi:10.1016/j.ridd.2024.104851