Collection of Simultaneous Psycho-Behavioral Scores on a Variety of Different Instruments

APPENDIX 3

Collection of simultaneous psycho-behavioral scores on a variety of different instruments provides an opportunity to examine the concurrent validity of those instruments. Results of selected correlations between the various instruments used to validate the PACBIS are shown in Table A2. In general, the correlations shown are simultaneously recorded assessments using the instruments being correlated; however, child and parent self-report scores were only obtained in the PREOP and POSTOP periods. Therefore, correlations between scores recorded during induction of anesthesia and self-report scores are for the self-report scores recorded in the PREOP period.

In the PREOP period, mYPAS correlated strongly with child self-report of distress and with the CAMPIS-SF Child Coping score. Observation of distress on the CAMPIS-SF and OSBD correlated with child self-report of pain, but only for younger subjects. PREOP parent self-report of distress and coping ability did not correlate with measures of child anxiety (mYPAS) or distress (CAMPIS-SF).

In the IND period, the mYPAS, CAMPIS-SF Child Distress, and OSBD scores correlated with PREOP child self-assessment of pain for younger children. Parent self-report of distress and coping did not correlate with CAMPIS-SF Coping Promoting and Distress Promoting scores. Parent self-report of distress did correlate with ICC scores, while parent self-report of coping ability showed inverse correlation with child distress as measured by the CAMPIS-SF and the OSBD, and borderline significant (P = 0.06) inverse correlation with the ICC. During induction of anesthesia, strong correlations were seen between mYPAS and ICC scores and Child Distress (CAMPIS-SF and OSBD), child coping (inverse correlation, CAMPIS-SF), and Parent Distress Promoting (CAMPIS-SF). CAMPIS-SF Parent Coping Promoting scores did not correlate with mYPAS or ICC scores during induction.

In the POSTOP period, child self-report of distress or pain correlated with CAMPIS-SF Child Distress scores for both younger and older subjects. OSBD scores correlated only with child-self-report of pain for younger subjects. Parent self-report of distress and coping ability did not correlate with either child distress or CAMPIS-SF Parent Coping Promoting or Parent Distress Promoting scores.

There was significant correlations between CAMPIS-SF and OSBD in assessing child distress during PREOP (rs = 0.61, P < 0.0001) , IND (rs = 0.85, P < 0.0001) and PACU (rs = 0.76, P < 0.0001) periods.

Several general trends can be observed. Measures of child anxiety and/or distress tend to demonstrate congruent validity against each other. The mYPAS shows excellent congruent validity against simultaneous child self-report of distress in younger subjects, and strong divergent validity against Child Coping on the CAMPIS-SF. The ICC and mYPAS demonstrate strong concurrent validity against child distress measured by both the CAMPIS-SF and the OSBD, and strong divergent validity against the CAMPIS-SF Child Coping score.

CAMPIS-SF Parent Coping Promoting and Parent Distress Promoting scores did not show strong validity against parent self-report of distress or coping ability; however, this may represent more of a deficiency of parental self-report for these psycho-behavioral constructs than a deficiency on the part of the CAMPIS-SF, as the CAMPIS-SF Parent Distress Promoting score demonstrated strong predictive validity against both the mYPAS and the ICC. Parental self-report of coping ability did show predictive validity against child distress and compliance during induction of anesthesia. As for the PACBIS, Parent Coping Promoting behaviors showed no impact on distress or behavioral compliance during induction of anesthesia.