This meta-analytic review of 148 studies on child and adolescent direct and indirect aggression examined the magnitude of gender differences, intercorrelations between forms, and associations with maladjustment. Results confirmed prior findings of gender differences (favoring boys) in direct aggression and trivial gender differences in indirect aggression. Results also indicated a substantial intercorrelation (r = .76) between these forms. Despite this high intercorrelation, the 2 forms showed unique associations with maladjustment: Direct aggression is more strongly related to externalizing problems, poor peer relations, and low prosocial behavior, and indirect aggression is related to internalizing problems and higher prosocial behavior. Moderation of these effect sizes by method of assessment, age, gender, and several additional variables were systematically investigated.

Purpose The Patient-Reported Outcomes Measurement Information System (PROMIS) aims to develop self-reported item banks for clinical research. The PROMIS pediatrics (aged 8–17) project focuses on the development of item banks across several health domains (physical function, pain, fatigue, emotional distress, social role relationships, and asthma symptoms). The psychometric properties of the anxiety and depressive symptom item banks are described. Methods Participants (n = 1,529) were recruited in public school settings, hospital-based outpatient and subspecialty pediatrics clinics. The anxiety (k = 18) and depressive symptoms (k = 21) items were split between two test administration forms. Hierarchical confirmatory factor-analytic models (CFA) were conducted to evaluate scale dimensionality and local dependence. IRT analyses were then used to finalize item banks and short forms. Results CFA results confirmed that anxiety and depressive symptoms are separate constructs and indicative of negative affect. Items with local dependence and DIF were removed resulting in 15 anxiety and 14 depressive symptoms items. The psychometric differences between short forms and simulated computer adaptive tests are presented. Conclusions PROMIS pediatric item banks were developed to provide efficient assessment of health-related quality of life domains. This sample provides initial calibrations of anxiety and depressive symptoms item banks and creates PROMIS pediatric instruments, version 1.0.

An aim of the National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) initiative is to develop item banks and computerized adaptive tests (CAT) that are applicable across a wide variety of chronic disorders. The PROMIS Pediatric Cooperative Group has concentrated on the development of pediatric self-report item banks for ages 8-17 years. The objective of the present study is to describe the Item Response Theory (IRT) analysis of the NIH PROMIS pediatric pain item bank and the measurement properties of the new unidimensional PROMIS Pediatric Pain Interference Scale. Test forms containing pediatric pain items were completed by a total of 3,048 respondents. IRT analyses regarding scale dimensionality, item local dependence, and differential item functioning were conducted. A pain item pool was developed to yield scores on a T-score scale with a mean of 50 and standard deviation of 10. The recommended 8-item unidimensional short form for the PROMIS Pediatric Pain Interference Scale contains the item set which provides the maximum test information at the mean (50) on the T-score metric. A simulated CAT was computed that provides the most information at five possible score locations (30, 40, 50, 60, and 70 on the T-score metric).

Objective The intent of the study was to develop and validate a comparable health literacy test for Spanish-speaking and English-speaking populations. Study Design The design of the instrument, named the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E), combined a word recognition test, as appearing in the Rapid Estimate of Adult Literacy in Medicine (REALM), and a comprehension test using multiple-choice questions designed by an expert panel. We employed the item response theory in developing and validating the instrument. Data Collection Validation of SAHL-S&E involved testing and comparing the instrument with other health literacy instruments in a sample of 201 Spanish-speaking and 202 English-speaking subjects recruited from the Ambulatory Care Center at the University of North Carolina Healthcare System. Principal Findings Based on item response theory analysis, 18 items were retained in the comparable test. The Spanish version of the test, SAHL-S, was highly correlated with another Spanish health literacy instrument, SAHLSA (r = 0.88, p < 0.05). The English version, SAHL-E, had high correlations with REALM (r = 0.94, p < 0.05) and the English Test of Functional Health Literacy in Adults (r = 0.68, p < 0.05). Significant correlations were found between SAHL-S&E and years of schooling in both Spanish and English-speaking samples (r = 0.15 and r = 0.39, respectively). SAHL-S&E displayed satisfactory reliability of 0.80 and 0.89 in the Spanish and English-speaking samples, respectively. IRT analysis indicated that the SAHL-S&E score was highly reliable for individuals with a low level of health literacy. Conclusions The new instrument, SAHL-S&E, has good reliability and validity. It is particularly useful for identifying individuals with low health literacy and could be used in clinical or community settings to screen for low health literacy among Spanish and English speakers.

Purpose This paper describes a large-scale administration of the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric items to evaluate measurement characteristics. Methods Each child completed one of seven test forms containing items from a pool of 293 PROMIS items and four legacy scales. PROMIS items covered six domains (physical function, emotional distress, social role relationship, fatigue, pain, and asthma). Results From January 2007 to May 2008, 4,129 children aged 8–17 were enrolled. The sample was 51% female, 55% aged 8–12, 42% minority race and 17% were Hispanic ethnicity. Approximately, 35% of the children participating in the survey consulted a clinician for a chronic illness diagnosis or treatment within 6 months prior to study enrollment. Conclusions The final PROMIS pediatric item banks include physical function (n = 52 items), emotional distress (n = 35 items), social role relationships (n = 15 items), fatigue (n = 34 items), pain (n = 13 items), and asthma (n = 17 items). The initial calibration data were provided by a diverse set of children with varying health states (e.g., children with a variety of common chronic illnesses) and racial/ethnic backgrounds.

BackgroundPediatric self-report should be considered the standard for measuring patient reported outcomes (PRO) among children. However, circumstances exist when the child is too young, cognitively impaired, or too ill to complete a PRO instrument and a proxy-report is needed. This paper describes the development process including the proxy cognitive interviews and large-field-test survey methods and sample characteristics employed to produce item parameters for the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric proxy-report item banks.MethodsThe PROMIS pediatric self-report items were converted into proxy-report items before undergoing cognitive interviews. These items covered six domains (physical function, emotional distress, social peer relationships, fatigue, pain interference, and asthma impact). Caregivers (n = 25) of children ages of 5 and 17 years provided qualitative feedback on proxy-report items to assess any major issues with these items. From May 2008 to March 2009, the large-scale survey enrolled children ages 8-17 years to complete the self-report version and caregivers to complete the proxy-report version of the survey (n = 1548 dyads). Caregivers of children ages 5 to 7 years completed the proxy report survey (n = 432). In addition, caregivers completed other proxy instruments, PedsQL™ 4.0 Generic Core Scales Parent Proxy-Report version, PedsQL™ Asthma Module Parent Proxy-Report version, and KIDSCREEN Parent-Proxy-52.ResultsItem content was well understood by proxies and did not require item revisions but some proxies clearly noted that determining an answer on behalf of their child was difficult for some items. Dyads and caregivers of children ages 5-17 years old were enrolled in the large-scale testing. The majority were female (85%), married (70%), Caucasian (64%) and had at least a high school education (94%). Approximately 50% had children with a chronic health condition, primarily asthma, which was diagnosed or treated within 6 months prior to theinterview. The PROMIS proxy sample scored similar or better on the other proxy instruments compared to normative samples.ConclusionsThe initial calibration data was provided by a diverse set of caregivers of children with a variety of common chronic illnesses and racial/ethnic backgrounds. The PROMIS pediatric proxy-report item banks include physical function (mobility n = 23; upper extremity n = 29), emotional distress (anxiety n = 15; depressive symptoms n = 14; anger n = 5), social peer relationships (n = 15), fatigue (n = 34), pain interference (n = 13), and asthma impact (n = 17).

Objectives The objectives of the present study are to investigate the precision of static (fixed-length) short forms versus computerized adaptive testing (CAT) administration, response pattern scoring versus summed score conversion, and test-retest reliability (stability) of the Patient Reported Outcomes Measurement Information System (PROMIS®) pediatric self-report scales measuring the latent constructs of depressive symptoms, anxiety, anger, pain interference, peer relationships, fatigue, mobility, upper extremity functioning and asthma impact with polytomous items. Methods Participants (N = 331) between the ages of 8 and 17 were recruited from outpatient general pediatrics and subspecialty clinics. Of the 331 participants, 137 were diagnosed with asthma. Three scores based on item response theory (IRT) were computed for each respondent: CAT response pattern expected a posteriori estimates, short form response pattern expected a posteriori estimates, and short form summed score expected a posteriori estimates. Scores were also compared between participants with and without asthma. To examine test-retest reliability, 54 children were selected for retesting approximately two weeks after the first assessment. Results A short CAT (maximum 12 items with a standard error of 0.4) was found, on average, to be less precise than the static short forms. The CAT appears to have limited usefulness over and above what can be accomplished with existing static short forms (8–10 items). Stability of the scale scores over a two week period was generally supported. Conclusions The study provides further information on the psychometric properties of the PROMIS pediatric scales and extends the previous IRT analyses to include precision estimates of dynamic versus static administration, test-retest reliability, and validity of administration across groups. Both the positive and negative aspects of using CAT vs. short forms are highlighted.

Objective-To create self-report physical function (PF) measures for children using modern psychometric methods for item analysis as part of Patient Reported Outcomes Measurement Information System (PROMIS).Study Design and Setting-PROMIS qualitative methodology was applied to develop two PF item pools comprised of 32 mobility and 38 upper extremity items. Items were computer administered to subjects aged 8-17 years. Scale dimensionality and sources of local dependence (LD) were evaluated with factor analysis. Items were analyzed for differential item functioning (DIF) between genders. Items with LD, DIF, or low discrimination were considered for removal. Computerized adaptive testing performance was simulated, and short forms were constructed.Results-3,048 children (51.8% female, 40% non-white, 22.7% chronically ill) participated. At least 754 respondents answered each item. Factor analytic results confirmed two dimensions of PF. Fifty-two of 70 items tested were retained. A 23 item mobility bank and a 29 item upper extremity bank resulted, and 8 item short forms were created. The item banks have high information from the population mean to 3 standard deviations below. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The Patient Reported Outcomes Measurement Information System (PROMIS) was created through a National Institutes of Health initiative to improve patient reported outcomes (PRO) assessment (1). PROMIS uses modern psychometric methods, including item response theory (IRT), to construct item banks from which static short forms or computerized adaptive tests (CAT) may be created to measure outcomes in a more efficient and precise manner than is possible using classical test theory(2). We describe the development of PROMIS physical function (PF) scales for pediatrics. Conclusions-PROMIS NIH Public AccessItem banks developed to satisfy the assumptions of IRT offer several advantages related to the measurement properties of IRT. Necessary conditions for item bank development are unidimensionality, that a scale measures a single underlying construct, lack of local dependence (LD), or that items share no covariance beyond that of the underlying construct, and lack of differential item functioning (DIF), meaning that people from different groups, (e.g., age, gender) who have a given level of an underlying trait, have the same probability of a given response. IRT based scales include the property of interval level scaling for better interpretation of change, calibration of items across a broad range of an underlying trait to overcome floor/ceiling effects, increas...