Reliability and validity of the revised Triple C: Checklist of Communicative Competencies for adults with severe and multiple disabilities.
The revised Triple C is a quick caregiver checklist that reliably maps early communication in adults with severe ID.
01Research in Context
What this study did
The team updated the Triple C checklist. This tool maps how adults with severe or multiple disabilities communicate. It moves from unintentional signals to early symbols like pictures or signs.
Staff or family fill out the form. The study tested if different raters would score the same adult the same way. It also checked if the scores matched what the adult really could do.
What they found
The revised Triple C came out solid. Raters agreed with each other. Scores lined up with other measures of early communication.
In plain words, the checklist gives a clear picture of where an adult stands on the communication ladder.
How this fits with other research
Lecavalier et al. (2006) warned that Likert-type self-report scales flop with moderate to profound ID. The Triple C sidesteps this problem by using caregiver report instead of asking the adult directly.
Hove et al. (2008) and Hoogstad et al. (2026) show the same pattern. Caregiver checklists for psychiatric symptoms and PTSD also hold up well with adults who have severe ID. All three studies back the same rule: when the disability is severe, ask the caregiver, not the client.
Lopata et al. (2020) used teacher checklists with autistic elementary students without ID. That worked too. Together these papers stretch across age and severity, but each keeps the reporter matched to the person’s ability level.
Why it matters
If you serve adults who barely speak, you now have a quick, free tool to chart their best way to reach out. Use the Triple C at intake, share the profile with the whole team, and build goals that climb the communication ladder one rung at a time.
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02At a glance
03Original abstract
AIMS: Few tools are available to assess the communication skills of adults with severe and multiple disabilities functioning at unintentional to early symbolic levels. An exception is the Triple C: Checklist of Communicative Competencies. In this study, aspects of support worker and clinician agreement, internal consistency and construct validity of a revised version of the Triple C were explored. METHOD: Triple C checklists were completed for 72 adults with severe intellectual disabilities (ID) by 118 support workers and stages were assigned by the researchers. Two support workers completed checklists for each of 68 adults with ID. Three researchers also conducted direct observations of 20 adults with ID. RESULTS: The average support worker agreement for items across the five stages of the Triple C ranged from 81% to 87%; agreement for stage assignment based on first and second support worker checklists was moderate to high (k = 0.63). Internal consistency was high (KR20 = 0.97); the stages were found to tap one factor (accounting for approximately 74% of variance), interpreted to be unintentional to early symbolic communication. Agreements between stages based on researcher observations and support worker-completed checklists were 35% and 71% across first and second support workers. CONCLUSION: The revised Triple C provides a reliable means of gathering data on which to determine the communication skills of adults with severe and multiple disabilities. The results support a collaborative use of the Triple C, such that a speech-language pathologist or other communication specialist works with a support worker to ensure understanding of the skills observed and development of appropriate intervention strategies.
Journal of intellectual disability research : JIDR, 2009 · doi:10.1111/j.1365-2788.2008.01121.x