The Assessment of children's hand skills (ACHS): theoretical framework, development, and validation

Hand skill use is essential for children’s development and successful participation in everyday activities. Children with a range of health conditions are likely to present with impaired hand skills, which impede their participation in play, education, or self-care activities. Therefore, an applicable conceptual framework and assessment tool is needed to guide intervention in promoting children’s daily life participation impacted by hand skill impairments. This study aimed to develop and validate the Children’s Hand Skills Framework (CHSF) and the Assessment of Children’s Hand Skills (ACHS). The CHSF and ACHS were developed through literature, test item, and content expert reviews. In the CHSF, children’s hand skills were divided into six main categories: manual gesture, body contact hand skills, arm-hand use, adaptive skilled hand use, bimanual use, and general quality. Each of the six categories was further broken down into three to seven sub-categories, covering a comprehensive range of functional hand skills. The conceptualisation of the CHSF was used as the basis for developing the ACHS so as to assess children’s hand skill performance. The ACHS allows, via naturalistic observation, to evaluate how effective 2−12 year old children are at using their hands when engaged in daily activities. It consists of 20 hand skill items that are rated on a six-level rating scale and the 22 activity items. The ACHS also includes a parent-report questionnaire to help select appropriate activities and suitable environments for observations. The measurement properties (including reliability and validity) of the ACHS were investigated. A group of 54 Australian children (30 typically developing children and 24 with known disabilities) were included for reliability examination. The test-retest reliability was found to be satisfactory at both the individual item and total scale level. Moderate inter-rater agreement at the total scale level was demonstrated, but individual items exhibited varied inter-rater agreement. Two samples of 138 Australian children and 134 Taiwanese children (totaling 128 typically developing children and 144 children with disabilities) were recruited to examine the validity of the ACHS. The Rasch Measurement Model was used for validity analyses. Difficulty ordering and rating scale performance of the ACHS items were validated via content and empirical evidence. Unidimensionality of the ACHS items was upheld after removing one misfitting hand skill item. Item invariance was also verified by investigating differential item functioning (DIF) related to gender, health condition, and cultural group. Furthermore, the ACHS was able to discriminate children with known differences in health conditions, and the children’s ACHS scores significantly correlated with their daily living skills and similar hand skill outcomes. In summary, this study provided preliminary reliability and validity evidence of the ACHS as a viable and useful children’s hand skill assessment tool. It can be used with confidence by clinicians and researchers to assess children’s real-life hand skill performance within naturalistic contexts. The validation of the ACHS also provides empirical support for hand skill structure of the proposed CHSF. The CHSF has the potential to provide a holistic view of both children’s hand skills and relevant factors for assessment and intervention planning.