Piloting the adaptation of the Kaufman Assessment Battery for Children—2nd edition (KABC-II) to assess school-age neurodevelopment in rural Zimbabwe

Abstract

Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. However, most available tools were developed in high-income settings and may lack cross-cultural validity. Methods: We piloted and adapted two subtests (pattern reasoning and story completion) within the Kaufman Assessment Battery for Children-2nd edition (KABC-II) for use in rural Zimbabwean children aged 7 years old, both within the planning domain. After initial assessments of face validity, we substituted and added items in the test battery through a co-design process with fieldworkers and child development experts. To assess how successful the changes were, T-tests adjusting for unequal variances were used to compare scores between the original and adapted versions of the same subtest. ANOVA and pairwise analysis was performed to compare the performance of KABC-II subtests across domains. Intraclass correlation coefficient was calculated to explore the variability between domains. Results: Initial test scores on the planning domain were significantly lower than the other three domains of learning, sequential memory and simultaneous reasoning (P<0.001) in 50 children. Modified subtests were administered to another 20 children, who showed story completion scores that were 0.7 marks higher (95% CI 0.0, 1.4; P=0.05) and pattern reasoning scores 1.8 marks higher (95% CI 0.5, 3.2; P=0.01). Overall, the planning domain mean score increased from 8.1 (SD 2.9) to 10.6 (SD 3.4). The intra class correlation coefficient between all four KABC-II domains was initially 0.43 (95% CI 0.13, 0.64) and after modification was 0.69 (95% CI 0.37, 0.87), suggesting an increase in the construct validity. Conclusions: The KABC-II planning domain was successfully adapted to improve cross-cultural validity. Construct validity was enhanced, based on increased inter-correlations among scales. This pilot has since been applied to the SHINE follow-up study. The process of co-design to modify tests for new settings may be beneficial for other commonly used neurodevelopmental tools.

Characterising school-age health and function in rural Zimbabwe using the SAHARAN toolbox

“…Children engaged well with all the cognition tests. The KABC-II required some modifications for a rural population in 2 out of the 8 subtests, as described elsewhere [ 61 ]. The School Achievement Test (SAT) was performed in 73 (91%) children (see S1 File ); in the first 7 children a Shona version of the Early Grade Reading Assessment (EGRA) was performed, but scores on this tool were extremely low due to a floor effect, since the tool was too advanced for the participants tested.…”

“…The KABC-II does require considerable training, though in this study it was conducted online by experienced trainers. With permission, we adapted two KABC-II subtests which used Western images and concepts unfamiliar to rural African children [ 61 ]. Finally, this cross-sectional study only measured a single time-point, so any associations with improvements or declines in function over time could not be detected.…”

The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Protocol for school-age follow-up

“…Briefly, SAHARAN includes a caregiver questionnaire, child questionnaire and direct tests undertaken with the child, focused on three domains: cognitive function, growth and body composition, and physical function. The primary outcome of the long-term follow-up study is cognitive function, assessed by the mental processing index (MPI)—the total score from eight subtests of the Kaufman Assessment Battery for Children 2 nd edition (KABC-II) 13 . The subtests measure four domains of cognitive processing across learning, planning, simultaneous and sequential memory.…”