UNICEF/WG MODULE ON CHILD
FUNCTIONING: TESTING and
ANALYSIS
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
Domains of Functioning
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Seeing
Hearing
Mobility
Self-care
Fine motor
Communication/Comprehension
Learning
Remembering
Emotions: anxiety and depression
Controlling behaviour
Focusing attention and concentrating
Coping with change
Relationships
Playing
2-17 years
5-17 years
2- 4 years
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
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)
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
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?
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
Only Dressing
Both Feeding and
Dressing
Physical
capability of
child to feed
themselves
Physical
capability of
child to put on
clothes
Physical capability of
child to feed and
dress themselves
Willingness of
child to eat what
he/she is given;
whether child is
a “fussy” eater
Willingness of
child to wear
appropriate
clothing
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
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)
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.
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
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
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
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
Prevalence rates
by different cut-offs
Prevalence
Cut-offs - at least one domain coded as:
Age
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
5-17
2-17
15.5
9.0
10.4
9.4
25.0
22.7
 A lot of difficulty or Cannot do at all
 Daily (anxiety and depression: 5-17)
 More or A lot more (controlling behavior)
MODERATE - SEVERE
2-4
5-17
2-17
2.9
4.3
4.0
3.8
4.5
4.3
Samoa, 2015 / Serbia, 2016
Disability by
School attendance
Prevalence
Ever attended school
Without
With
disability disability
YES
96.4
90.8
NO
3.6
9.2
Samoa, 2015
Results across modules
Children aged 2-4
Serbia, 2016
Seeing
Hearing
Walking
Learning/Cognition
Self-Care
Understanding
Being understood/
Communicating
TOTAL PREVALENCE
(using all the
questions in the
modules)
Children aged 5-17
Child Functioning
Module
TQSI
Child Functioning
Module
WG Short Set
0.5
0.0
0.0
0.0
NA
0.0
0.6
0.6
0.0
0.8
9.1
NA
2.1
4.4
0.5
0.0
0.3
0.9
0.2
NA
0.4
0.3
0.2
0.2
0.3
0.3
NA
0.5
3.8
18.4
3.5
1.3
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