Validity and reliability of the Mastication Observation and Evaluation (MOE) instrument.
The eight-item MOE is a fast, trustworthy way to score chewing skill in kids 6-72 months, including those with cerebral palsy.
01Research in Context
What this study did
Remijn et al. (2014) built a short checklist for watching how kids chew. They called it the MOE — Mastication Observation and Evaluation.
The final form has only eight items. Observers watch a child eat and score each item in under five minutes.
They tested the checklist on typically developing kids and on kids with cerebral palsy. All children were between 6 and 72 months old.
What they found
The eight-item MOE showed good internal consistency. Different raters also gave similar scores — a sign the tool is reliable.
No child hit a floor or ceiling. That means the scale can show small gains or losses in chewing skill.
How this fits with other research
Ellinoudis et al. (2011), Hua et al. (2013), and Leung et al. (2014) all checked the MABC-2 for preschool motor skills. Like the MOE, they found solid reliability in the same age band. Together they show that short, watch-and-score tools can work for young kids.
Whitehouse et al. (2014) used a chew-tracking protocol to treat feeding disorders. Their study proves chewing can change with help. The MOE now gives clinicians a quick way to measure that change.
Goh et al. (2018) validated EDACS for swallowing severity in cerebral palsy. The MOE fills the missing chew side of the same mealtime coin.
Why it matters
If you run feeding programs, you now have an eight-item scale that takes minutes, not hours. Use it before and after treatment to show parents and payers that chewing really improved. No special gear is needed — just the checklist, a spoon, and food the child can eat safely.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Print the MOE sheet, watch your client eat one bite, and score all eight items to get a baseline number you can graph later.
02At a glance
03Original abstract
The Mastication Observation and Evaluation (MOE) instrument was developed to allow objective assessment of a child's mastication process. It contains 14 items and was developed over three Delphi rounds. The present study concerns the further development of the MOE using the COSMIN (Consensus based Standard for the Selection of Measurement Instruments) and investigated the instrument's internal consistency, inter-observer reliability, construct validity and floor and ceiling effects. Consumption of three bites of bread and biscuit was evaluated using the MOE. Data of 59 healthy children (6-48 mths) and 38 children (bread) and 37 children (biscuit) with cerebral palsy (24-72 mths) were used. Four items were excluded before analysis due to zero variance. Principal Components Analysis showed one factor with 8 items. Internal consistency was >0.70 (Chronbach's alpha) for both food consistencies and for both groups of children. Inter-observer reliability varied from 0.51 to 0.98 (weighted Gwet's agreement coefficient). The total MOE scores for both groups showed normal distribution for the population. There were no floor or ceiling effects. The revised MOE now contains 8 items that (a) have a consistent concept for mastication and can be scored on a 4-point scale with sufficient reliability and (b) are sensitive to stages of chewing development in young children. The removed items are retained as part of a criterion referenced list within the MOE.
Research in developmental disabilities, 2014 · doi:10.1016/j.ridd.2014.03.035