Adaptation and validation of two autism-related measures of skills and quality of life in Ethiopia

Although most children with autism and other neurodevelopmental disorders live in low- and middle-income countries, assessment tools are lacking in these settings. This study aims to culturally adapt and validate two questionnaires for use in Ethiopia: the Autism Treatment Evaluation Checklist and the Pediatric Quality of Life Inventory™ Family Impact Module. Both questionnaires were adapted to be suitable for administration in low-literate caregivers and translated using the backward translation procedure. The factor structure, reliability and validity were investigated using caregiver-reports on 300 children with neurodevelopmental disorders or physical health conditions. Confirmatory factor analysis of the Pediatric Quality of Life Inventory™ Family Impact Module data indicated an acceptable fit of the hypothesised eight-factor structure. Internal consistency was high for both measures. Test–retest reliability was excellent for the Autism Treatment Evaluation Checklist and moderate to excellent for the Pediatric Quality of Life Inventory™ Family Impact Module. Both questionnaires demonstrated adequate known-group validity, with moderate to very large effect size group differences between case and control groups. The questionnaires correlated moderately with each other. In conclusion, the Ethiopian adaptations of the Autism Treatment Evaluation Checklist and the Pediatric Quality of Life Inventory™ Family Impact Module are valid and reliable tools for use in parents of children with neurodevelopmental disorders including autism. These adapted measures may also be valuable for use in other low-income settings. Lay abstract Although most children with autism and other neurodevelopmental disorders live in low- and middle-income countries, reliable tools to assess these conditions are often not available in these settings. In this study, we adapted two questionnaires developed in Western high-income contexts for use in Ethiopia – the Autism Treatment Evaluation Checklist and the Pediatric Quality of Life Inventory™ Family Impact Module. Both measures are completed by a child’s caregiver and both are relatively short and easy to complete. The Autism Treatment Evaluation Checklist is used to monitor the developmental issues of the child, while the Pediatric Quality of Life Inventory™ Family Impact Module measures the impact of the child’s condition on the caregiver. We translated both tools into the Ethiopian language Amharic, and adapted them to the local cultural context. Three hundred caregivers, half of whom were parents of children with neurodevelopmental disorders, and half were parents of children with physical health problems, completed the questionnaires through a face-to face interview, so that non-literate caregivers could also take part. Both tools performed adequately, measured what we aimed to measure and were reliable. Both the Autism Treatment Evaluation Checklist and Pediatric Quality of Life Inventory™ are suitable tools to assess children with developmental and other health problems in Ethiopia and their caregivers. We believe that more similar tools should be developed or adapted for use in low-income countries like Ethiopia, to gain a better understanding of developmental problems in those settings, and allowing clinicians and service providers to use these tools in their practice. Moreover, these tools can be used in future studies to evaluate interventions to improve support for families.

Perceived Listening Difficulty in the Classroom, Not Measured Noise Levels, Is Associated With Fatigue in Children With and Without Hearing Loss

Purpose The purpose of this study was to examine if classroom noise levels and perceived listening difficulty were related to fatigue reported by children with and without hearing loss. Method Measures of classroom noise and reports of classroom listening difficulty were obtained from 79 children (ages 6–12 years) at two time points on two different school days. Forty-four children had mild to moderately severe hearing loss in at least one ear. Multiple regression analyses were conducted to evaluate if measured noise levels, perceived listening difficulty, hearing status, language abilities, or grade level would predict self-reported fatigue ratings measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale. Results Higher perceived listening difficulty was the only predictor variable that was associated with greater self-reported fatigue. Conclusions Measured classroom noise levels showed no systematic relationship with fatigue ratings, suggesting that actual classroom noise levels do not contribute to increased reports of subjective fatigue. Instead, perceived challenges with listening appears to be an important factor for consideration in future work examining listening-related fatigue in children with and without hearing loss.

Quality of life and emotional vulnerability in a national cohort of adolescents living with Fontan circulation

Introduction: To investigate quality of life and mental health after Fontan completion, we aimed to characterise outcomes in a representative group of adolescent patients. The study was part of the pre-transition clinical work-up in adolescents with Fontan-type palliation of univentricular CHD. The programme covers the entire paediatric Fontan patient population in Norway. Methods: Our cross-sectional study included 42 adolescents with Fontan circulation aged 15–18. We recruited a control group of 29 healthy peers. Quality of life was measured by the Pediatric Quality of Life Inventory Questionnaire, while mental health was assessed with the Strength and Difficulties Questionnaire. Results: Fontan patients scored lower than healthy controls on the Pediatric Quality of Life Inventory total (p = 0.004), the physical (p < 0.001) and social (p = 0.001) functioning subscale, and the Strength and Difficulties Questionnaire subscale of emotional symptoms (p = 0.035). Compared to two of the healthy teens (7%), seven patients (16%) in the Fontan group scored as having impaired mental health (p = 0.224). The female/male ratio for individuals with impaired health was 7:2 (p = 0.003). Conclusions: Compared to healthy controls, adolescents after Fontan-type palliation in Norway have good health-related quality of life and mental health, despite having slightly lower score than healthy individuals, mainly in physical domains and school functioning. Compared to healthy controls and healthy teenagers, these adolescents have somewhat more emotional problems, and compared to male patients, female patients more often have impaired mental health.

Is an alibi a paper shield? An investigation of the factors that influence alibi credibility judgments

Alibis are a potentially powerful piece of evidence for innocence, but examination of criminal cases suggests that honestly offered alibis may fail to prevent wrongful convictions. Currently, little is known regarding how evaluators judge the credibility of alibis. Three studies investigated the effect of alibi moral desirability, suspect race (White/Indigenous Canadian), alibi evidence strength, and Authoritarianism on participants’ legal judgments. Participants read a fictitious police file (Experiment 1: N = 300; Experiment 2: N = 286) or newspaper article (Experiment 3: N =235) and rated a male suspect’s/defendant’s statement honesty, alibi accuracy, and the likelihood of his guilt, among other dependent measures, then completed the Authoritarianism-Conservatism-Traditionalism scale (ACT; Duckitt et al., 2010) and, in Experiment 3, the Revised Religious Life Inventory (Hills et al., 2005). In Experiments 1 and 2, participants were asked to sign a petition supporting the suspect. Results indicated that providing an alibi can be beneficial or detrimental to the suspect, depending on contextual factors and the narrative itself. In Experiments 1 and 2, alibi moral desirability affected participants’ responses, though different patterns emerged at Ryerson and at Iowa State, and moral desirability influenced judgments primarily for the Indigenous suspect. Consistent with Olson and Wells’ (2004) taxonomy, Experiment 1 showed that the strength of the physical evidence supporting an alibi is a primary determinant of judgments of its credibility. In Experiment 3, participants provided less favourable ratings for the Indigenous defendant than the White defendant, particularly when they already had more negative general feelings about Indigenous people, though this was not found in Experiment 2. More participants signed the petition when the alibi was morally desirable at Iowa State, and for the Indigenous suspect. Across all studies, higher scores on the ACT’s Authoritarianism subscale were associated with responses that were less favourable for the suspect/defendant, and many participants did not accurately define the term “alibi.” Understanding the complexities of decision-making in this context will help us better understand why some (honest) alibis are rejected, and how stereotypes and assumptions regarding the alibi provider may lead to bias in the investigation and adjudication of criminal cases.

Is an alibi a paper shield? An investigation of the factors that influence alibi credibility judgments

Alibis are a potentially powerful piece of evidence for innocence, but examination of criminal cases suggests that honestly offered alibis may fail to prevent wrongful convictions. Currently, little is known regarding how evaluators judge the credibility of alibis. Three studies investigated the effect of alibi moral desirability, suspect race (White/Indigenous Canadian), alibi evidence strength, and Authoritarianism on participants’ legal judgments. Participants read a fictitious police file (Experiment 1: N = 300; Experiment 2: N = 286) or newspaper article (Experiment 3: N =235) and rated a male suspect’s/defendant’s statement honesty, alibi accuracy, and the likelihood of his guilt, among other dependent measures, then completed the Authoritarianism-Conservatism-Traditionalism scale (ACT; Duckitt et al., 2010) and, in Experiment 3, the Revised Religious Life Inventory (Hills et al., 2005). In Experiments 1 and 2, participants were asked to sign a petition supporting the suspect. Results indicated that providing an alibi can be beneficial or detrimental to the suspect, depending on contextual factors and the narrative itself. In Experiments 1 and 2, alibi moral desirability affected participants’ responses, though different patterns emerged at Ryerson and at Iowa State, and moral desirability influenced judgments primarily for the Indigenous suspect. Consistent with Olson and Wells’ (2004) taxonomy, Experiment 1 showed that the strength of the physical evidence supporting an alibi is a primary determinant of judgments of its credibility. In Experiment 3, participants provided less favourable ratings for the Indigenous defendant than the White defendant, particularly when they already had more negative general feelings about Indigenous people, though this was not found in Experiment 2. More participants signed the petition when the alibi was morally desirable at Iowa State, and for the Indigenous suspect. Across all studies, higher scores on the ACT’s Authoritarianism subscale were associated with responses that were less favourable for the suspect/defendant, and many participants did not accurately define the term “alibi.” Understanding the complexities of decision-making in this context will help us better understand why some (honest) alibis are rejected, and how stereotypes and assumptions regarding the alibi provider may lead to bias in the investigation and adjudication of criminal cases.