Innovations In Clinical Neuroscience

SEP-OCT 2014

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ] 144 or phrase was consulted in the D-F- BFS lists for a suitable age-appropriate alternative. Column 4 identifies the substitute word for this word or phrase f inally selected. Column 5 identifies the final wording of the question in age-appropriate language. The first block of rows illustrates the layout for the ages 6- to 8-year-old version, the second block of rows illustrates the layout for the ages 9- to 12-year-old version, and the third block of rows illustrates the layout for the ages 13- to 17-year-old version. The resultant three final pediatric versions of the S- STS are presented in Appendices D, E and F. The Education Advisory Committee made a number of recommendations about the implementation of the pediatric scales: 1. The version for 6- to 8-year-olds should be clinician-rated and read orally to the child by the clinician. A parent should ideally be present during the interview, although in some circumstances at the discretion of the clinician this interview might need to be alone (e.g., when there is known child abuse by the parent or guardian or where the parent or guardian is not mentally competent to provide accurate information). Because 6- to 8-year-old children may not always be good reporters of their own behavior, it is preferable to have someone present with whom the child has a good relationship. The questions should be directed to the child. The parent or guardian should be asked at the start of the interview to avoid answering for the child unless the child provides information that appears to the parent to be erroneous. In situations when both parties give discrepant information, the clinician should discuss this with both parties and try to resolve the discrepancy in the interest of making an accurate assessment. While the child is the main focus of the questions in the interview, all relevant information from all reliable sources that can inform an accurate assessment of each suicidality item should be considered. Although this linguistic validation process is based on w ritten language and simplifying the choice of words accordingly, we expect that most children in the 6- to 8-year-old group will understand the language and concepts even better when it is presented orally rather than in written form. In support of this statement, Beck et al state, "Young children's listening and speaking competence is in advance of their reading and writing competence. That is, they can understand much more sophisticated content presented in oral language than they can read independently." 13 2. The version for 9- to 12-year-olds should be either clinician-rated or self-rated depending on the child's reading and cognitive skills and the child's relationship with the parent and the clinician. Usually this rating is best done with both the parent and clinician present, rather having the child self-rate alone. However, children with high IQs and at the upper end of this age range may prefer or feel more comfortable doing the self-rating. Cognitively delayed children in all age groups will obviously need more clinician assistance in completing the task. This decision is best made at the clinician's discretion. 3. The version for 13- to 17-year-olds should be self-rated, since adolescents tend to be more self- conscious and less likely to involve parents and others in the their inner lives or in the interviews. 4. The 6- to 8-year-olds and some of the 9- to 12-year-olds may have difficulty properly understanding the spectrum of graded response options to the questions. This can complicate getting accurate information. Comprehension can be tested at the beginning of the interview. To manage this issue, it is acceptable to use a variety of adjunctive aids to visually illustrate the escalating and graded nature of the response options, like pictographs or increasing numbers of physical objects, like blocks or other manipulables as currently used in the elementary school s ystem for this purpose. It is too early in the development stage of these pediatric versions of the S- STS to recommend any one manipulable or pictograph over another with confidence. Future research is needed to further explore the optimal choice of pictographs or manipulables to assess these graded responses. In general, most children have adequate discriminative ability and a logical capacity for cognitive operations by age 6. DISCUSSION The system adopted for the development of the pediatric versions of the S-STS has been used by a small number of clinicians and other people involved with suicidal children. The feedback they provided has been useful in evolving the scale, and their experience with the pediatric S-STS scales has been positive. However, from these beginnings, a more extensive and formally structured cognitive debriefing process is needed to get feedback on the scale from children, adolescents, and those directly involved in working with the children and adolescents clinically. Cognitive debriefing is the process by which a scale is tested in a target population and target language group to determine whether the patients understand the concepts and items as the patient-reported outcome scale developers intended. Cognitive debriefing uses follow-up questions in field test interviews to better understand how patients interpret the scale questions and to collect all the concepts considered by each scale item. It is done to ensure that the validated instrument is contextually relevant and culturally acceptable to the target population. Linguistic validation into other languages and the cognitive debriefing process follows the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommended

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