1. UNICEF/WG MODULE ON CHILD FUNCTIONING: TESTING and ANALYSIS

2. Content and structure
Questions ask about difficulties the child may have in doing certain activities
Questionnaires for children 2-4 and 5-17
Response categories (with the exception of behavior (2-4) and emotions (5-17) are:
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

3. Domains of Functioning
Seeing years
Hearing years
Mobility years
Self-care
Fine motor
Communication/Comprehension
Learning
Remembering
Emotions: anxiety and depression
Controlling behaviour
Focusing attention and concentrating
Coping with change
Relationships
Playing

4. Cognitive Testing Cognitive testing
January 2013, Belize
April 2013, Oman
July 2013, Montenegro
2012/13/14/15/16, USA
March 2016, India
April 2016, Jamaica
Comparative report completed and decisions made on final set of questions included in field testing

5. Cognitive testing of the child functioning module
Child disability questions perform differently than adult disability questions due to:
Parent proxy
Parent’s knowledge of “what is normal” for children of the same age
Relationship between parent and child
Parental frustration with child
Potential for false positives.
Domains most sensitive to false positives : those that generate parent frustration (learning/remembering, communication, attention/completing a task)

6. Cognitive testing of the child functioning module
Relevance of comparison with other children of the same age: respondents do not always make this comparison/such comparison is not always possible.
Domains most likely to be effected: Self-care, Emotions, Attention
Responses “some difficulty” may lead to false positives
Questions were modified to reduce risks of bias, clarify concepts and facilitate interview process

7. Example Hearing Domain: Round #1 Does [name] have difficulty hearing?
This question is intended to focus on auditory hearing.
Many respondents, however, focused on listening.
Round #2
Does [name] have difficulty hearing sounds like peoples’ voices or music?

8. Example of possible constructs
Compared with children of the same age, does [name] have difficulty with self-care such as feeding or dressing him/herself?
Activities Considered by Respondent
General Conceptualization
Physical capability of child to do an array of complex activities including feeding, dressing, bathing, combing hair, getting in and out of bed
Only Feeding
Physical capability of child to feed themselves
Willingness of child to eat what he/she is given; whether child is a “fussy” eater
Only Dressing
Physical capability of child to put on clothes
Willingness of child to wear appropriate clothing
Both Feeding and Dressing
Physical capability of child to feed and dress themselves
Willingness of child to eat what he/she is given coupled with the willingness of child to wear appropriate clothing
Visual Representation of Thematic Schema

9. Field Testing
Independent field testing on earlier version of the module completed in Haiti (Brown University, 2013), Cameroon & India (London School of Hygiene and Tropical Medicine, 2013), and Italy (NSO, 2013)
Field testing of complete version of the module in Samoa (NSO, 2014) and El Salvador (NSO, 2015) with technical assistance from UNICEF/WG
Module also used in surveys in Zambia (National Disability Survey, 2014) and Mexico (MICS, 2016)
Dedicated methodological work in Serbia (NSO, 2016)

10. Field test in Serbia
Primary goal of the field test was to assess the performance of the Child Functioning module in the field
Secondary goal was to compare:
the 2-4 year old questionnaire of the Child Functioning module with the 2-4 year old questionnaire of the Ten Questions (TQ) module
the 5-17 year old questionnaire of the Child Functioning module with the 5-17 year old questionnaire of the Washington Group short set of questions.

11. Feedback from interviewers
Questions to be filled out by interviewers at the time of the survey, right after the corresponding questions asked
whether the interviewer had to repeat the question
whether the respondent asked for clarifications of words or concepts
whether the respondent had difficulties with response categories

12. Findings Questionnaire administered without any major problems
Reactions of the respondents were mostly neutral to positive
Repetitive to read out loud response categories
Developed recommendations on implementation: one randomly selected child per household in countries with high levels of fertility
No need to repeat responses categories after first set of questions unless needed

13. Cut-offs (recommended for international comparisons)
For questions that use the standard WG response options: no difficulty, some difficulty, a lot of difficulty and cannot do at all – cut-off for inclusion is set at a lot of difficulty or cannot do at all
For controlling behavior (2-4) cut-off for inclusion is set at a lot more
For emotions (5-17) the most severe cut-off (daily) is used
Overall measure: % of children with functional difficulties in at least one domain

14. Analysis of findings from testing
Within range disability prevalence obtained across the different settings
Similar patterns in terms of characteristics of the population of children with functional disability
Most common functional difficulties across contexts: controlling behavior, managing emotions, learning

15. Prevalence rates by different cut-offs
Cut-offs - at least one domain coded as:
Age
Prevalence
Samoa
Serbia
Some difficulty, A lot of difficulty, or Cannot do at all
Weekly or Daily (anxiety and depression: 5-17)
More or A lot more (controlling behavior)
MILD - SEVERE
2-4
15.5
9.4
5-17
9.0
25.0
2-17
10.4
22.7
A lot of difficulty or Cannot do at all
Daily (anxiety and depression: 5-17)
MODERATE - SEVERE
2.9
3.8
4.3
4.5
4.0
Samoa, 2015 / Serbia, 2016

16. Disability by School attendance
Ever attended school
Prevalence
Without disability
With disability
YES
96.4
90.8 NO
3.6
9.2
Samoa, 2015

17. Child Functioning Module
Results across modules
Children aged 2-4
Children aged 5-17
Child Functioning Module
TQSI
WG Short Set
Seeing
0.5
0.6
0.3
Hearing
0.0
0.2
Walking
0.8
Learning/Cognition
9.1
0.9
Self-Care NA
Understanding
2.1
Being understood/ Communicating
4.4
0.4
TOTAL PREVALENCE (using all the questions in the modules)
3.8
18.4
3.5
1.3
Serbia, 2016

18. Conclusions
Questions carefully drafted to reflect multitude of domains and reduce risk of missing out children with different functional difficulties
Domains are not meant to be looked at in isolation
Questions carefully tested and cut-offs selected to reduce risk of false positives
Not recommended to reduce number of questions, change response categories, modify content or change cut-offs