Want to know about kids’ health? Ask the children!
Survey success depends on age, cognitive ability
If you want to know about children’s health, shouldn’t you ask the kids?
With adolescents, the answer is clearly, "Yes." You won’t learn everything you want to know just by asking their parents. But how young can children be and adequately answer direct questions?
"There’s a group of people who feel that kids — even very young — can and should be responding for themselves. We tend to be pretty conservative," says Linda Asmussen, MS, senior research associate with the American Academy of Pediatrics in Oak Grove Village, IL, which is developing condition-specific surveys. "We’re trying to figure out at what age kids become good reliable respondents," she says.
Asmussen is convinced that age is only one aspect. Cognitive ability and reading level also come into play. For example, when she interviewed children for a draft survey, she found many of them had trouble recalling events that happened two weeks ago.
"Some of these issues are complex, and you’re asking a child to think retrospectively and recall a time period — a month, the last few weeks. That’s hard for a child to do," she says.
Although John Wasson, MD, research director of the Dartmouth Primary Care Cooperative Information Project (COOP) in Hanover, NH, asks parents to discuss a few of the COOP charts with children ages 2 to 9, he relies predominantly on parent reports with young children.
"When you do test-retest reliability on young kids on these items, it isn’t good," he says, noting that a 7-year-old may respond negatively about feelings or emotions one moment but feel great an hour later.
The COOP charts are as much a trigger for discussion as an assessment tool, he says. "It becomes a useful conversation, that the parent tunes into the kid and the kid does have values that matter," he says.
Jeanne Landgraf, MA, vice president for scientific services of HealthAct, a Boston firm that integrates assessment in the clinical setting, developed the Child Health Questionnaire with comparable surveys for parents and children, ages 10 to 17. She favors using both the parent-completed and child self-reported forms to gain a full picture of a child’s health status. "If there is a discrepancy, let’s understand the discrepancy," she says.
Her own experience illustrates the importance of both perspectives. When she was developing the child version, her daughter, then in second grade, picked up a copy and began answering the questions. She paused on a question about how difficult it is to do "things that take a lot of energy, such as playing soccer, running, or hiking."
Her daughter played soccer — but Landgraf didn’t know that she frequently had trouble breathing when she exerted herself. Her daughter eventually was diagnosed with asthma.
"What she thought was the norm in breathing was not the norm," she says. "That clued me in that we can’t be doing this in the absence of kids."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content