Assessment of Children's Hand Skills

Instrument Name: Assessment of Children's Hand Skills

Abbreviation: ACHS

Points for Consideration:

Shown to have a significant ceiling effect, reducing clinical validity.

Description of Tool:

The Assessment of Children's Hand Skills is an ObsRO + ClinRO designed to measure functional hand skill performance in children aged 2 to 12 years. The tool includes 22 activity items and 20 hand skill items. Assessments are made in the child's home, school, or community environments by trained therapists.

Minimum Qualification Required by COA Administrator: MA or BA

Comment:

The ACHS builds upon the Children’s Hands Skills Framework (CHSF)

Year: 2010

Objective of Development:

To measure real-life hand skill performance which is referred to as the use of the hands while performing meaningful activities within natural contexts

Population of Development: Age range (therapeutic indication):

2-12 years (Hand Injuries)

Pediatric Population(s) in which COA has been used:

Nervous system diseases; Mental disorders; Congenital, Hereditary, and Neonatal Diseases and Abnormalities

COA type:

Number of Items 42

Mode of Administration:

Data Collection Mode:

Time for Completion: Less than 60 minutes

Response Scales: 6-point verbal rating scales ranging from 1 "Very ineffective, indicating that the activity completion has been negatively disrupted because the child is unable to perform the hand skill or needs others’ assistance." 2 "= Ineffective, indicating that the examiners sees some problems in the hand skill, which has obviously disrupted the child’s activity performance and results in the child’s ineffective use of time or increased effort" 3 "Slightly ineffective, indicating that the examiner sees some problems in the hand skill, which has minimally disrupted the child’s activity completion" 4 "Slightly effective (or functional), indicating that the child performs the hand skill with functional competence and proficiency that supports the activity completion; however, the examiner sees some miNor problems (e.g. atypical or irregular patterns) when the child performs the hand skill" 5 "= Effective, indicating that the child performs the hand skill with reasonable but Not perfect competence and proficiency; the examiner does Not see any problems when the child performs the hand skill" 6 "Very effective, indicating that the child performs the hand skill with perfect competence and proficiency; the examiner does Not see any problems when the child performs the hand skill"

Summary of Scoring:

Available Scores:
Global score (score range not reported)
Score by items (score range not reported)

Weighting:
No

Score Interpretation:
Higher score: Better performance

Evidence of Literature Review: None identified

Evidence of Instrument Review: Yes

Evidence of Clinical or Expert Input: Yes

Evidence of concept elicitation in target patient population: None identified

Evidence of a Saturation Grid: None identified

Evidence for Selection of Data Collection Method: None identified

Recall/Observation Period:

Evidence for Selection of Reponse Options: None identified

Evidence of cognitive interviewing of draft instrument in target patient population: Yes

Evidence of Preliminary Scoring of Items and Domains: Yes

Evidence related to respondent and administrator burden: None identified

Evidence of a Conceptual Framework: None identified

Evidence of an item-tracking matrix: None identified

Evidence related to item selection: Yes

Evidence of re-testing the final version: None identified

Internal consistency (Cronbach's alpha): None identified

Test-retest Reliability (ICC):

Chien CW (2014)
For the 22 activity items:
1- Intraclass Correlation Coefficient (ICC): 0.93
- Kappa Coefficient: ranged from 0.71 to 1.00
- % agreement: ranged from 88.9% to 100%
- Was a definition of stability applied to identify stable patients: No
- Time frame or interval between the two administrations: 2 weeks
- Population/Disease: Children with disabilities; n=12 aged from 5 years and 8 months to 10 years and 6 months (mean age= 7 years and 7 months)

2- Intraclass Correlation Coefficient (ICC): 0.61
- Kappa Coefficient: ranged from 0.04 to 1.00
- % of agreement: ranged from 74.1% to 100%
- Was a definition of stability applied to identify stable patients: No
- Time frame or interval between the two administrations: 2 weeks
- Population/Disease: Children with disabilities; n=12 5 aged from 5 years and 8 months to 10 years and 6 months (mean age= 7 years and 7 months)

For the 20 hand skill items:
3- Intraclass Correlation Coefficient (ICC): 0.93
- Weighted Kappa Coefficient: ranged from 0.49 to 0.90
- % agreement: ranged from 63.0% to 90.7%
- Was a definition of stability applied to identify stable patients: No
- Time frame or interval between the two administrations: 2 weeks
- Population/Disease: Children with disabilities; n=12 aged from 5 years and 8 months to 10 years and 6 months (mean age= 7 years and 7 months)

4- Intraclass Correlation Coefficient (ICC): 0.73
- Weighted Kappa Coefficient: ranged from 0.01 to 0.78
- % of agreement: ranged from 41.7% to 98.1%
- Was a definition of stability applied to identify stable patients: No
- Time frame or interval between the two administrations: 2 weeks
- Population/Disease: Children with disabilities; n=12 aged from 5 years and 8 months to 10 years and 6 months (mean age= 7 years and 7 months)

Inter-rater/ inter-interviewer reliability (kappa):

Chien CW (2014)

For the 22 activity items:
1- Intraclass Correlation Coefficient (ICC): 0.37
- Kappa Coefficient: ranged from 0.03 to 1.00
- % of agreement: ranged from 72.2% to 100%
- Population/Disease: Children with disabilities; n=12, aged from 5 years and 8 months to 10 years and 6 months

For the 20 hand skill items:
2- Intraclass Correlation Coefficient (ICC): 0.81
- Weighted Kappa Coefficient: ranged from 0.01 to 0.66
- % of agreement: ranged from 20.0 to 84.6
- Population/Disease: Children with disabilities; n=12, aged from 5 years and 8 months to 10 years and 6 months

Evidence of test-retest or inter-rater reliability: Yes

Concurrent validity (convergent, divergent):

Chien CW, Brown T (2011)
1- Correlation coefficient used: Spearman's Nonparametric correlation coefficient
- Measure: Vineland Adaptive Behavior Scales (VABS), Developmental Coordination Disorder Questionnaire (DCDQ), Movement Assessment Battery for Children-Second Edition (MABC-2)
- Results: Significant correlations were found between ACHS, VABS domains, DCDQ domain, and MABC-2 domain: p<0.01 for all results VABS (n ranged from 89 to 126): VABS personal living skills: 0.78 VABS fine motor skills: 0.74 DCDQ (n=36): DCDQ total score: 0.82 DCDQ fine motor/handwriting: 0.79 MABC-2 (n=30): MABC-2 aiming and catching component score: 0.53 MABC-2 aiming and catching standardised score: 0.51 - Population/Disease: Children typically developing and with disabilities; n see above, age: from a sample between 2 and 12 years 2- Correlation coefficient used: Spearman's Nonparametric correlation coefficient - Measure: Vineland Adaptive Behavior Scales (VABS), Movement Assessment Battery for Children-Second Edition (MABC-2) - Results: Significant correlations were found between ACHS, VABS domains, and MABC-2 domain: p<0.01 for all results VABS (n ranged from 44 to 60): VABS personal living skills: 0.74 VABS fine motor skills: 0.60 MABC-2 (n=13): MABC-2 aiming and catching component score: 0.74 MABC-2 aiming and catching standardised score: 0.73 - Population/Disease: Children typically developing; n see above, age: from a sample between 2 and 12 years 3- Correlation coefficient used: Spearman's Nonparametric correlation coefficient - Measure: Vineland Adaptive Behavior Scales (VABS), Movement Assessment Battery for Children-Second Edition (MABC-2) - Results: Significant correlations were found between ACHS, VABS domains, and MABC-2 domain: VABS (n ranged from 45 to 66): p<0.01 VABS personal living skills: 0.77 VABS fine motor skills: 0.82 MABC-2 (n=17): p<0.05 MABC-2 aiming and catching component score: 0.57 MABC-2 aiming and catching standardised score: 0.54 - Population/Disease: Children with disabilities; n see above, age: from a sample between 2 and 12 years 4- Correlation coefficient used: Pearson's correlation coefficient - Measure: Vineland Adaptive Behavior Scales - Classroom Edition (VABS-CE) - Results: Significant correlations were found between ACHS and VABS-CE in the three groups: p<0.05 for all results Typically developing children (n=139): 0.82 Children with disabilities (n=114): 0.75 Total group of children (n=253): 0.81 - Population/Disease: Children typically developing and with disabilities; n see above, age: from a sample between 2 and 12 years Chien CW (2012) 5- Correlation coefficient used: Spearman's Nonparametric correlation coefficient - Measure: Vineland Adaptative Behavior Scales (VABS) and Developmental Coordination Disorder Questionnaire (DCDQ) - Results: Significant correlations were found between ACHS, VABS and DCDQ: p<0.01 for all results VABS (n ranged from 62 to 127): Personal Living Skills subscale: 0.87 Fine Motor Skills subscale: 0.64 DCDQ (n=54): Total score: 0.79 Fine motor/handwritting factor: 0.76 - Population/Disease: Children typically developing and with disabilities; n see above, age: from a sample of children between 2-12 years (mean age= 6 years 11 months (SD= 2 year 10 months)) 6- Correlation coefficient used: Spearman's Nonparametric correlation coefficient - Measure: Vineland Adaptative Behavior Scales (VABS) and Developmental Coordination Disorder Questionnaire (DCDQ) - Results: Significant correlations were found between ACHS, VABS and DCDQ: p<0.01 for all results VABS (n ranged from 46 to 79): Personal Living Skills subscale: 0.89 Fine Motor Skills subscale: 0.59 DCDQ (n=29): Total score: 0.79 - Population/Disease: Children typically developing; n see above, age: from a sample of children between 2-12 years (mean age= 6 years 11 months (SD= 2 year 10 months)) 7- Correlation coefficient used: Spearman's Nonparametric correlation coefficient - Measure: Vineland Adaptative Behavior Scales (VABS) and Developmental Coordination Disorder Questionnaire (DCDQ) - Results: Significant correlations were found between ACHS, VABS and DCDQ: p<0.01 for all results VABS (n ranged from 16 to 48): Personal Living Skills subscale: 0.77 Fine Motor Skills subscale: 0.66 DCDQ (n=25): Total score: 0.62 Fine motor/handwritting factor: 0.58 - Population/Disease: Children with disabilities; n see above, age: from a sample of children between 2-12 years (mean age= 6 years 11 months (SD= 2 year 10 months))

Known-group validity:

Chien CW, Brown T (2011)
KNown-groups validity:
- Measure/Groups of patients: Children typically developing (n=64) and with disabilities (n=70)
- A priori hypotheses: Mean logit scores would be significantly different between groups
- Were hypotheses confirmed: Yes
- Results: Mean logit score of children typically developing was significantly higher than children with disabilities: t test, t=5.24, p<0.01; Mean (SD) Typically developing: 3.0 (3.2) With disabilities: 0.6 (2.3) - Population/Disease: Children typically developing and with disabilities ; n see abov, age: from a sample between 2 and 12 years

Evidence of Translatability Assessment: None identified

Evidence related to missing data: None identified

Evidence for Selection of Recall Period: Yes

Evidence of Administration Instructions and Training Provided: None identified

Evidence of concurrent validity: Yes

Evidence of known-groups validity: Yes

Evidence of ability to detect change over time: None

Ability to detect change (Responsiveness):

None identified

Evidence of responder thresholds: None identified

Chien CW, Brown T, McDonald R. A framework of children's hand skills for assessment and intervention. Child Care Health Dev. 2009 Nov;35(6):873-84
(Pubmed Abstract: https://pubmed.ncbi.nlm.nih.gov/19702641/)

Chien CW, Brown T, McDonald R. Examining content validity and reliability of the Assessment of Children's Hand Skills (ACHS): a preliminary study. Am J Occup Ther. 2010 Sep-Oct;64(5):756-67
(Full Text Article: https://ajot.aota.org/article.aspx?articleid=1854531)

Chien CW, Brown T, McDonald R. Rasch analysis of the assessment of children's hand skills in children with and without disabilities. Res Dev Disabil. 2011 Jan-Feb;32(1):253-61
(PubMed Abstract: https://pubmed.ncbi.nlm.nih.gov/21041063/)

Chien CW, Brown T, McDonald R, et al. Convergent and discriminant validity of a naturalistic observational assessment of children's hand skills. Hong Kong Journal of Occupational Therapy 2011, 21(2): 64-71
(Abstract: https://journals.sagepub.com/doi/10.1016/j.hkjot.2011.10.003)

Chien CW, Brown T, McDonald R. Cross-cultural validity of a naturalistic observational assessment of children's hand skills: a study using Rasch analysis. J Rehabil Med. 2011 Jun;43(7):631-7
(Pubmed Abstract: https://pubmed.ncbi.nlm.nih.gov/22448991/)

Chien CW, Brown T, McDonald R. Examining construct validity of a new naturalistic observational assessment of hand skills for preschool- and school-age children. Aust Occup Ther J. 2012 Apr;59(2):108-20
(PubMed Abstract: https://pubmed.ncbi.nlm.nih.gov/22448991/)

Chien CW, Scanlon C, Rodger S, et al. Intra- and inter-rater reliability of the Assessment of Children’s Hand Skills based on video recordings. British Journal of Occupational Therapy 2014, 77(2): 82-90
(Abstract: https://journals.sagepub.com/doi/abs/10.4276/030802214X13916969447191)

Chien CW, Brown T, McDonald R, et al. The contributing role of real-life hand skill performance in self-care function of children with and without disabilities. Child Care Health Dev. 2014 Jan;40(1):134-44
(Pubmed Abstract: https://pubmed.ncbi.nlm.nih.gov/22928608/)

See (PubMed results)
https://pubmed.ncbi.nlm.nih.gov/?term=%22Assessment+of+Children%27s+Hand+Skills%22&sort=date

None identified

Original: English for Australia

Translations:
Taiwanese for Taiwan, Turkish for Turkey

Taiwanese for Taiwan:
Chien CW, Brown T, McDonald R. Cross-cultural validity of a naturalistic observational assessment of children's hand skills: a study using Rasch analysis. J Rehabil Med. 2011 Jun;43(7):631-7
Turkish for Turkey:
Gün F, Temizkan E, Bumin G. Validity and reliability of the Turkish versions of Assessment of Children's Hand Skills and Children's Hand-Skills Ability Questionnaire in children with hemiplegic cerebral palsy. Child Care Health Dev. 2021 Mar;47(2):191-200

Chi-Wen Chien, PhD, MEd (Hons)
Department of Rehabilitation Sciences
The Hong Kong Polytechnic University
Hung Hom
Kowloon
Hong Kong (SAR)
China
Phone: +852 2766 6703
E-mail: will.chien@polyu.edu.hk OR ocatpickup@yahoo.com.tw

Free access but need to purchase the published manual, according to the author Dr. Chi-Wen Chien. For more information on purchasing and downloading the ACHS please visit the ACHS webpage (http://www.childrenhandskills.com/)
With author’s written permission

Children's Hand Skills website (http://www.childrenhandskills.com/)

None identified