PEDI CAT Manual 1 3 6 PDF

Senior Authors
Stephen M. Haley PhD, PT, FAPTA

Wendy J. Coster PhD, OTR/L, FAOTA
Helene M. Dumas PT, MS
Maria A. Fragala-Pinkham PT, DPT, MS
Richard Moed, MPA
Contributing Authors
Jessica Kramer PhD, OTR/L
Pengsheng Ni MD
Tian Feng MS
Ying-Chia Kao, MA, OT
Larry H. Ludlow PhD
Please note that this manual is updated regularly @ http://www.pedicat.com.
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PEDI-CAT
Version 1.3.6
Development, Standardization and Administration

Manual
October, 2012
Sponsoring Institution: Health and Disability Research Institute, Boston University School of
Public Health, Boston University Medical Center, Boston, MA
Funded by: STTR Phase I (R41HD052318) and II (R42HD052318) awards and an Independent
Scientist Award (K02 HD45354) to Dr. Haley from National Institutes of Health, The Eunice
Kennedy Shriver National Institute of Child Health and Human Development, National Center for
Medical Rehabilitation Research.
© 2011, Trustees of Boston University, under license to CREcare, LLC. All rights reserved.
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About the Authors
Dr. Haley received a B.S. in Psychology and a Certificate Degree in Physical Therapy at Ohio
State University, a Master of Science Degree in Education at the University of Kentucky, and a
Ph.D. in Educational Psychology at the University of Washington. Prior to work conducted at
Boston University, Dr. Haley served as a Research Associate Professor at New England Medical
Center Hospitals/ Tufts University School of Medicine, where he developed the original Pediatric
Evaluation of Disability Inventory (PEDI). Dr. Haley was also a contributing author to the School
Function Assessment, the Late Life Function and Disability Instrument, and the Activity Measure
for Post-acute Care (AM-PAC). In his role of Director of Research of the Center for Children with
Special Health Care Needs at Boston’s Franciscan Hospital for Children, he was active in the
development and application of rehabilitation outcome measures in research and clinical practice.
More recently, Awards and honors include: Research Award, Section on Pediatrics, American
Physical Therapy Association (1992), Golden Pen Award, American Physical Therapy Association
(1993), Helen J. Hislop Award for Outstanding Contributions to the Physical Therapy Professional
Literature (2006), and was named a Catherine Worthingham Fellow of the American Physical
Therapy Association in 2009. Dr. Haley had been active for years in applying Item Response
Theory methodology to functional assessments using a computerized-adaptive testing approach.
The PEDI-CAT was developed during Dr. Haley’s tenure as Professor, Department of Health
Policy and Management, School of Public Health, Boston University Medical Center, and
Associate Director, Health and Disability Research. Dr. Haley passed away July 16, 2011 after a
long and courageous battle against leukemia. Dr. Haley leaves a legacy as a colleague, mentor,
and friend to pediatric rehabilitation researchers, educators, and practitioners across the globe.
Dr. Coster is Professor and Chair, Department of Occupational Therapy at Boston University
College of Health and Rehabilitation Sciences (Sargent College). Dr. Coster received her Master
of Science in Occupational Therapy from Boston University and a PhD in Psychology from
Harvard University. Before beginning her academic career, she was involved in clinical practice
in schools and other community programs serving children and youth with emotional, behavioral,
and cognitive disabilities. For the past two decades her primary research focus has been the
development of assessments to guide service planning and evaluation for individuals with
disabilities and to support outcomes research. She was co-author of the original Pediatric
Evaluation of Disability Inventory (PEDI) and subsequently led the development of the School
Function Assessment (SFA), which is now widely used in schools throughout the United States.
She also participated with Dr. Haley in development of the Late-Life Function and Disability
Inventory; and the Activity Measures for Post-Acute Care (AM-PAC). Most recently Dr. Coster led
the project to develop the Participation and Environment Measure for Children and Youth, a
parent-report survey suitable for use in population surveys of young people with and without
disabilities. Currently she is completing a project to develop and test a version of the PEDI-CAT
that is appropriate for children and adolescents with an autism spectrum disorder. Dr. Coster has
received a number of awards and recognitions for her work, including selection to the American
Occupational Therapy Association Roster of Fellows (1993) and the American Occupational
Therapy Foundation Academy of Research (1997), as well as the A. Jean Ayres Research Award
(2001) and the Eleanor Clarke Slagle Lectureship (2007).
Helene M. Dumas PT, MS is the Manager of The Research Center for Children with Special
Health Care Needs at Franciscan Hospital for Children (FHC), Boston, MA. Ms. Dumas received
her Bachelor of Science Degree in Physical Therapy from Sargent College of Allied Health
Professions at Boston University, Boston, MA. Ms. Dumas received a Master of Science Degree
in Human Services Administration with a concentration in Human Services Program Evaluation
from the University of Massachusetts, Boston. Ms. Dumas’ employment history includes clinical,
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supervisory and administrative roles with infants, children, adolescents and adults with disabilities
in various clinical settings including early intervention, public and private schools, home health
and post-acute hospital care. Ms. Dumas has presented on clinical topics and research findings
for local and national audiences and has academic teaching experience in pediatric,
neuromuscular and cardiopulmonary physical therapy at two universities. Ms. Dumas has
participated in the development and use of functional outcomes measures for children with
disabilities as well as in evaluating outcomes of care for children with physical disabilities,
particularly those receiving inpatient post-acute rehabilitation. Ms. Dumas has published
numerous articles examining functional outcomes for children following acquired and traumatic
brain injury, predicting the recovery of ambulation following traumatic brain injury, and
investigating functional outcomes for children following botulinum toxin injections. Ms. Dumas has
conducted research in inpatient hospital, outpatient and community-based settings using the
original PEDI and has conducted studies using the PEDI to examine inpatient rehabilitation
outcomes, to ascertain the impact of specific interventions, and to determine the Minimal
Important Difference for the PEDI.
Maria A. Fragala-Pinkham, PT, DPT, MS is a Physical Therapist and Clinical Researcher in The
Research Center for Children with Special Health Care Needs at Franciscan Hospital for Children
(FHC), Boston, MA. Dr. Fragala-Pinkham received her Bachelor of Science Degree in Physical
Therapy from Northeastern University, Boston, MA, a Master of Science Degree in Human
Movement Science from the University of North Carolina - Chapel Hill and a Doctor of Physical
Therapy Degree from Massachusetts General Hospital Institute of Health Professions in Boston,
MA. She has worked in a variety of clinical pediatric settings including early intervention, schools,
home care and hospital inpatient and outpatient programs. In addition, she has developed
community-based adapted sports and fitness programs for children including an adapted ice
skating program and an aquatic exercise and swimming program. Dr. Fragala-Pinkham has
published articles on the topics of pediatric outcome measures, effectiveness of therapeutic
interventions and fitness for children with disabilities.
Richard Moed has over 25 years of experience in health care. He has served as chief operating
officer of both community and academic medical centers. Most recently, he led the operations at
Saint Francis Hospital and Medical Center in Hartford, Connecticut. He has also served as an
executive and/or board member of several health care services companies including CompCare,
an occupational medicine company, CLS, a clinical laboratory company and AMG, a physician
management company. Mr. Moed is experienced in developing and implementing research
collaboratives and has done so in numerous settings. Along with Drs. Jette and Haley, Mr. Moed
is a co-founder of CREcare LLC and serves as its president and CEO.
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Acknowledgements
Completion of this version of the PEDI-CAT was possible through the efforts of many people. We
thank the expert reviewers who suggested initial items to include in the item pool: Dr. Mary
Gannotti, Dr. Marie Berg, Dr. Eva Nordmark, Dr. Marisa Mancini, Dr. Nancy Flinn, Erin Simunds,
Dr. Missy Windsor, Dr. Gary Bedell, Dr. Mary Beth Kadlec, Dr. Mary Khetani.
Many clinicians and parents participated in the focus groups and cognitive testing and provided
valuable input to the initial item pool. We also appreciate the time and effort spent by parents
who participated in the nationwide calibration study.
We want to thank our two clinical sites and their staff and therapists: Franciscan Hospital for
Children (FHC), Boston, MA and Courage Center, Minneapolis, MN- therapists/staff and parents
who participated in data collection.
The art work was skillfully accomplished by Reed Gauthier.
The PEDI-CAT Spanish Translation was reviewed and edited by Angela Suescun-Lampe,
Director, Linguistic & Cultural Services, FHC, Julia Rifkin, MS, CCC/SLP, Speech-Language
Pathologist, FHC, and M. Veronica Llerena, MS, OTR/L
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TABLE OF CONTENTS
PART I. INTRODUCTION, ADMINISTRATION, AND SCORING

Chapter 1 PEDI-CAT Introduction and Administration……………………………………..7-12
 Intended Population
 Applications, Features and Versions
 Administration: Qualifications and Training
 Administration: Instructions for Windows and iPad Versions
Chapter 2 PEDI-CAT Scoring………………………………………………………………….13-16
 Score Reports
 Interpreting PEDI-CAT Scores
 Exporting Score Report Data
 Linking of the Old PEDI to the New PEDI-CAT
PART II. DEVELOPMENT OF THE PEDI-CAT
Chapter 3 Conceptual Model of the PEDI-CAT……………………………………………..17-19
 Conceptual Model
 Relation between the PEDI-CAT and Measures of Adaptive Behavior
Chapter 4 PEDI-CAT Content Development………………………………………………...20-61
 PEDI-CAT Domains: Daily Activities, Mobility, Social/Cognitive and Responsibility
 Methodology
 Final Item Banks and Response Scales
PART III. STANDARDIZATION AND TECHNICAL DATA
Chapter 5 Normative Standardization Sample…………………………………………….62-75
 Sampling Method and Demographic Data
 Normative Scores by Domain and Age Groups
 Reference (Age) Curves
Chapter 6 Disability Sample…………………………………………………………………..76-78
 Sampling Method and Demographic Data
 Scores by Domain and Age Groups
 Difference from Normative Data Age Curves
Chapter 7 PEDI-CAT Scales…………………………………………………………………..79-97
 Overall Scaling Approach
 Final Item Calibration Data
 Item Maps
 Correlations across PEDI-CAT domains
Chapter 8 Psychometric Properties of the PEDI-CAT…………………………………..98-109
 Calibration Data Simulations: Accuracy, Precision and Discriminant Validity
 Prospective Field Study: Discriminant Validity, Test-Retest Reliability and Efficiency
ADDITIONAL APPENDICES:
Case Examples using the PEDI-CAT
Spanish Translations of the PEDI-CAT Items
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PART I. INTRODUCTION, ADMINISTRATION, AND SCORING
Chapter 1 Introduction and Administration
Introduction
The Pediatric Evaluation of Disability Inventory (PEDI),1 originally published in 1992, has been
revised as a computer adaptive test (CAT), the PEDI-CAT. The components of the PEDI-CAT
include this manual and the software used to administer and score the items.
The original version of the PEDI, a paper/pencil functional assessment instrument, was designed
to examine key functional capabilities and performance in children ages 6 months to 7.5 years.
The PEDI’s three Functional Skills scales measure self-care, mobility and social function
capability in daily activities with 197 items. The PEDI’s Caregiver Assistance scale includes 20
items that measure the amount of caregiver assistance provided when the child is performing
multi-step self-care, mobility or social function tasks.
The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) is a clinical
assessment for children and youth that can be used across all diagnoses, conditions and settings.
The PEDI-CAT is comprised of a comprehensive item bank of 276 functional activities acquired
throughout infancy, childhood and young adulthood. It can be completed by parent/caregiver
report or professional judgment of clinicians or educators who are familiar with the child. The
PEDI-CAT is recommended for use with children approaching 1 year of age and up to 21 years of
age.
The PEDI-CAT measures function in four domains: (1) Daily Activities; (2) Mobility; (3)
Social/Cognitive, and (4) Responsibility. The PEDI-CAT items were selected based on their
relevance for children’s engagement in daily life tasks. This feature of the PEDI-CAT will enable
clinicians to construct a description of a child’s current functional status or progress in acquiring
functional skills that are part of everyday life. The PEDI-CAT combines elements of adaptive
behavior measures used in early intervention, developmental disabilities and special education
programs with functional assessments used in pediatric rehabilitation.
Computer adaptive testing methodology uses a computer interface to administer an assessment

individualized to each child. CAT uses a computer algorithm to pre-select the items that will be
administered to a specific person based on responses to previous items. Thus, the basic notion of
an adaptive test is to mimic what an experienced clinician would do. A clinician learns most when
assessment items are directed at the child’s approximate level of functional ability. In practice, this
approach minimizes the number of items that are administered for a child to obtain an estimate of
functioning in any particular content area. Items that are not relevant for a particular child are
filtered out. For example, children who use wheelchairs exclusively would not receive ambulation
items, and young children would not receive advanced grooming items such as shaving that are
not applicable for their age.
CAT-based instruments have the advantages of reducing test burden while increasing test
precision because test items are selected to match the person’s functional ability level, minimize
the number of irrelevant test items administered and thus, increase efficiency. In the future CATs
may link with electronic transmission of clinical data and allow easy use with current
1
Haley SM, Coster WJ, Ludlow LH, Haltiwanger J, Andrellos P. Pediatric Evaluation of Disability Inventory
(PEDI): Development, Standardization and Administration Manual. Boston, MA: Trustees of Boston
University; 1992.
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documentation systems. CATs can provide efficient and reliable data entry, analysis and
management as assessments are stored in a database on a local computer or server.
Intended Population
The PEDI-CAT is designed for use with infants, children and youth (birth up through 20 years of
age) with a variety of physical, cognitive, and/or behavioral conditions. As much as possible,
items were written to focus on the outcome of activity performance and allow a variety of methods
to be used For example, mobility items were designed to incorporate basic skills and alternative
methods often used by children with physical disabilities to accomplish mobility tasks, such as
using walking devices or wheelchairs. In the Social/Cognitive domain, communication items allow
use of alternative methods such as picture vocabulary or sign language. The items in the
Responsibility domain require children to use several functional skills in combination to carry out
life tasks. For this reason, this is a more difficult domain and is estimated to assess children and
youth beginning at the age of 3 years and extending up through the age of 20 years.
Applications
Specific clinical uses of the PEDI-CAT include:
 Detection and identification of the extent of functional delay
 Evaluation and monitoring of group progress in randomized clinical trials or program
evaluation
 Examination of individual child change
Features
 Normative standard scores, provided as age percentiles and T-scores based on the
normative standardization sample are available for 21 age groups (intervals of one
year).
 Scaled (criterion) scores are based on data from the normative and disability samples.
 Each PEDI-CAT domain is self-contained and can be used separately or along with the
other domains.
 Age, gender and mobility device filters prevent irrelevant items from being presented.
 Items focus on the child’s ability to perform each functional activity in a manner that is
effective given their abilities and challenges. Items do not require the child to perform the
activity in a standardized manner for credit.
 Items are worded using everyday language and clear examples.
 Illustrations of Daily Activities and Mobility items are included to facilitate understanding
of the item intent.
Versions of the PEDI-CAT

There are currently two versions of the PEDI-CAT:
1) Speedy (“Precision”) CAT: this is the most efficient CAT as it is the quickest way to get a
precise score estimate while administering only 5-15 items per domain. The score report
for the Speedy CAT includes a percentile score, a T-score, a scaled score on a 20-80
metric, and a list of the answers to all PEDI-CAT items administered.
2) Content-Balanced (“Comprehensive”) CAT: Approximately 30 items per domain are
administered for a score to be generated, which includes a balance of items from each of
the content areas within each domain. The score report for the Comprehensive CAT
includes a percentile score, a T-score, a scaled score on a 20-80 metric, a list of the
answers to all PEDI-CAT items administered and an item map showing the location of the
responses on functional continuum of that domain. The Comprehensive CAT is most
useful when the CAT is administered for individual program planning.
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The PEDI-CAT is an ideal measure for assessing current level of function, developing individual
client goals and examining functional outcomes over a period of time for individual children and
for programs. The PEDI-CAT can identify challenges that limit a child’s everyday activities.
Following administration and scoring, therapists can identify individualized and program goals
based on the results.
Administration of the PEDI-CAT

The PEDI-CAT does not require any special environment, materials or activities to administer
other than a computer and CAT software. The PEDI-CAT can be completed independently by the
child’s caregiver(s), through structured interview, or by professional judgment. The assessment
focuses on typical performance at the present time, thus the child’s parent(s) or professionals who
currently provide services for the child are the most likely respondents. The PEDI-CAT can be
completed on multiple occasions for the same child (e.g. intake, interim assessment, discharge
and follow-up) and there is no minimum time that must pass between assessments.
Qualifications of the Interviewer/Examiner

Although parents/caregivers can complete the PEDI-CAT independently, results should be
interpreted by a professional with a background in education, early childhood education,
pediatrics and/or rehabilitation. The professional should also have an understanding of functional
assessments and scoring to be able to understand and explain the intent of the individual items
and meaning of different types of scores.
Training in PEDI-CAT Administration

A review of the PEDI-CAT Manual prior to administration is essential for professionals to
familiarize themselves with the administration procedures, instrument content, item intent,
response scales and score interpretation.
Instructions for Administration of the PEDI-CAT – Windows Version

1. After downloading the program to your computer’s hard drive, the PEDI-CAT for Windows
program can be found in the Program menu. Once selected, the PEDI-CAT software opens with a
title screen and a ‘Start’ button. Click on the ‘Start’ button to begin the assessment.
2. Enter an identification number for the child/youth being assessed. (This is a combination of
numbers and/or letters that you determine and will use to identify this particular child for the
current and all future PEDI-CAT assessments). Select “Next” to continue.
3. Select domains (Daily Activities, Mobility, Social/Cognitive and/or Responsibility) and type of
PEDI-CAT (Speedy or Content-Balanced) to be used for the assessment. All domains do not
need to be administered using the same type of PEDI-CAT. Select “Next” to continue.
4. Complete the demographic information – select child’s gender; select respondent’s language
for administration (English or Spanish); enter complete date of birth; select type of walking device
and wheelchair, if applicable.
Note: If walking device is selected, the PEDI-CAT will include items specific to walking
aids in the Mobility domain.
Note: If manual wheelchair is selected, the respondent will be asked if the child is able to
propel a manual wheelchair. If this question is answered “yes”, the PEDI-CAT will include items
specific to manual wheelchair use as a separate short scale within the Mobility domain.
Select “Next” to continue.
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5. The first domain chosen for administration will now appear. The introductory statement below
will be on the screen and can be used to instruct respondents on how to complete the PEDI-CAT
for the three Functional Skill domains (Daily Activities, Mobility and Social/Cognitive):
“Please choose which response best describes your child’s ability in the following activities”.
Items in the Daily Activities, Mobility and Social/Cognitive domains ask about how much difficulty
the child has with specific activities.
For example, for this item from the PEDI-CAT Mobility domain:
Stands up from an adult-size chair.

Select ‘Unable’ if the child can’t do, doesn’t know how or is too young.
Select ‘Hard’ if the child does with a lot of help, extra time, or effort.
Select ‘A little hard’ if the child does with a little help, extra time or effort.
Select ‘Easy’ if the child does with no help, extra time or effort, or child’s skills are past this
level.
Select ‘I don’t know’ if respondent reports not knowing.
To complete the PEDI-CAT Responsibility domain, respondents answer the following for each
item, “How much responsibility does your child take for the following activities?”
For example, for this item from the Responsibility domain:
Getting ready in the morning on time

Includes: Getting up; Getting dressed; Grooming and hygiene activities; Eating breakfast;
Completing on time
Select ‘Adult/caregiver has full responsibility if the child does not take any responsibility’
Select ‘Adult/caregiver has most responsibility and child takes a little responsibility’
Select ‘Adult/caregiver and child share responsibility about equally’
Select ‘Child has most responsibility with a little direction, supervision or guidance from an
adult/caregiver’
Select ‘Child takes full responsibility without any direction, supervision or guidance from an
adult/caregiver’
6. Respondents should continue to select a response for each item and then click on the “Next”
button to advance to the next item.
Note: A response must be provided for each item or the PEDI-CAT will not let the
respondent advance to the next screen. In addition, there is a “Previous” button that may be used
if the respondent would like to go back to a previous item.
7. Items will continue to appear in the domain being assessed until the appropriate stopping rule
(test precision) has been determined to be met by the PEDI-CAT program.
Note: When the Mobility Domain is completed using the content-balanced method, the
response to the initial question is used as a screening to determine how many content
areas (1, 2 or 4) should be included. If the child has very limited mobility, content areas
with more advanced skills will not be administered.
8. If more than one domain was chosen to be administered, the next domain will appear
immediately after the conclusion of the previous domain.
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9. When all chosen domains have been completed, select a response for “Person Completing this
Assessment”. Response choices include “Parent”, “Other Caregiver” or “Clinician”. If “Parent” or
“Other Caregiver” is chosen, the responses will be saved and the program will close. If “Clinician”
is chosen, a screen asking which score report is desired will appear.
Note: Using the “PEDICAT Reports” tab from your computer’s program menu, score
reports can be accessed at any time.
Instructions for Administration of the PEDI-CAT – iPad Application

1. Download the PEDI-CAT iPad App from the iTunes store (search “Pedi-Cat”). Once selected,
the PEDI-CAT opens with a title screen and a ‘Start’ button. Click on the ‘Start’ button to begin the
assessment.
2. Enter an identification number for the child/youth being assessed. (This is a combination of
numbers and/or letters that you determine and will use to identify this particular child for the
current and all future PEDI-CAT assessments). Select “Next” to continue.
3. Select domains (Daily Activities, Mobility, Social/Cognitive and/or Responsibility) and type of
PEDI-CAT (Speedy or Content-Balanced) to be used for the assessment. All domains do not
need to be administered using the same type of PEDI-CAT. Select “Next” to continue.
4. Complete the demographic information – select respondent’s language for administration

(English or Spanish); select child’s gender; enter complete date of birth; select type of walking
device and wheelchair, if applicable.
Note: If a walking device is selected, the PEDI-CAT will include items specific to walking
aids in the Mobility domain.
Note: If “manual wheelchair, propels self” is chosen, the PEDI-CAT will include items
specific to manual wheelchair use as a separate short scale within the Mobility domain.
Select “Next” to continue.
5. The first domain chosen for administration will now appear. The introductory statement below
will be on the screen and can be used to instruct respondents on how to complete the PEDI-CAT
for the three Functional Skill domains (Daily Activities, Mobility and Social/Cognitive):
“Please choose which response best describes your child’s ability in the following activities”.
Items in the Daily Activities, Mobility and Social/Cognitive domains ask about how much difficulty
the child has with specific activities.
For example, for this item from the PEDI-CAT Mobility domain:
Stands up from an adult-size chair.

Select ‘Unable’ if the child can’t do, doesn’t know how or is too young.
Select ‘Hard’ if the child does with a lot of help, extra time, or effort.
Select ‘A little hard’ if the child does with a little help, extra time or effort.
Select ‘Easy’ if the child does with no help, extra time or effort, or child’s skills are past this
level.
Select ‘I don’t know’ if respondent reports not knowing.
To complete the PEDI-CAT Responsibility domain, respondents answer the following for each
item, “How much responsibility does your child take for the following activities?”
For example, for this item from the Responsibility domain:
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Getting ready in the morning on time
Includes: Getting up; Getting dressed; Grooming and hygiene activities; Eating breakfast;
Completing on time
Select ‘Adult/caregiver has full responsibility if the child does not take any responsibility’
Select ‘Adult/caregiver has most responsibility and child takes a little responsibility’
Select ‘Adult/caregiver and child share responsibility about equally’
Select ‘Child has most responsibility with a little direction, supervision or guidance from an
adult/caregiver’
Select ‘Child takes full responsibility without any direction, supervision or guidance from an
adult/caregiver’
6. Respondents should continue to select a response for each item and then click on the “Next”
button to advance to the next item.
Note: A response must be provided for each item or the PEDI-CAT will not let the
respondent advance to the next screen. In addition, there is a “Previous” button that may be used
if the respondent would like to go back to a previous item.
7. Items will continue to appear in the domain being assessed until the appropriate stopping rule
(test precision) has been determined to be met by the PEDI-CAT program.
Note: When the Mobility Domain is completed using the content-balanced method, the
response to the initial question is used as a screening to determine how many content
areas (1, 2 or 4) should be included. If the child has very limited mobility, content areas
with more advanced skills will not be administered.
8. If more than one domain was chosen to be administered, the next domain will appear
immediately after the conclusion of the previous domain.
9. When all chosen domains have been completed, select a response for “Person Completing this
Assessment”. Response choices include “Parent”, “Other Caregiver” or “Clinician”. If “Parent” or
“Other Caregiver” is chosen, the responses will be saved and the program will close. If “Clinician”
is chosen, a screen asking which score report is desired will appear.
Note: Score reports can be accessed at any time by opening and starting the PEDI-CAT
and choosing an existing identification number.
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Chapter 2 PEDI-CAT Scoring
Score Reports
After completion of the PEDI-CAT, score reports are available for each assessment date and for
each domain administered. Score reports may be viewed immediately after completion of the
PEDI-CAT or by opening the PEDI-CAT program and entering the appropriate child/youth
identification number. Score reports can be printed or exported to the user’s computer.
A Summary Report is available that provides:

 child/youth’s identification number
 child/youth’s date of birth
 child’s gender
 date of assessment
 domains administered
 scaled score(s) with standard error
 normative score(s) (given as a T-score and age percentile range)
 fit score(s)
 number of items per domain
 type of PEDI-CAT administered
A Detailed Assessment Report is also available that provides:

 child/youth’s identification number
 child/youth’s date of birth
 child’s gender
 date of assessment
 domains administered
 scaled score(s) (with standard error)
 normative score(s) (given as a T-score and age percentile range)
 fit score(s)
 number of items per domain
 proxy (respondent)
 use and type of walking aid and/or wheelchair (if applicable)
 type of PEDI-CAT administered
 list of all items and responses for each domain administered
If a Content-Balanced PEDI-CAT was completed the option for an item map (see Chapter 7) can
be selected prior to viewing the report(s).
Examples of score reports are provided with the case examples in the appendices.
Interpretation of PEDI-CAT Scores

Similar to the original PEDI (1992) the PEDI-CAT provides two types of transformed summary
scores: normative scores and scaled scores. Separate summary scores are calculated for each of
the four domains and for a small set of manual wheelchair items, if applicable. There is no total
score that sums across all four domains. A Fit score is also generated by the program.
Normative Scores (T-scores and percentile ranges)

Normative scores describe the child’s performance in comparison to other children of the same
age (by one year intervals). They were derived from the standardization sample of 2,205 typically-
developing children described in Chapter 5 and reflect the general U.S. pediatric population. The
normative scores are presented as T-scores in which the mean for each age group is 50, with a
10/7/2012 13
standard deviation of 10. (Users of the original PEDI will recognize that this T-score is the same
format used for normative scores in the earlier version). Typically scores between 30 and 70 (i.e.,
mean + 2 standard deviations) are considered within the expected range for age however
individual programs or institutions may set their own criterion for identifying developmental delay.
Users should keep in mind that the T-score of 50 on the PEDI-CAT represents the average for a
particular age group. Therefore the pattern of item performance represented by a score of 50 will
differ considerably across age groups.
Professionals using PEDI-CAT T-scores for important decisions such as determining eligibility for
services are strongly encouraged to use the standard error of measurement (SEm) to set
confidence intervals around the obtained T-score. The SEm reflects the degree of imprecision
(measurement error) to be expected in the obtained score. The child’s actual score is expected to
be within the confidence intervals set using + 2 SEm (for 95% accuracy) or + 3 (for 98%
accuracy). The table below provides the SEm estimates for the PEDI-CAT T-scores calculated
using the retest reliability estimates reported in chapter 8.
PEDI-CAT Domain Reliability SEm

Mobility .986 1.18
Daily Activities .997 0.55
Social/Cognitive .979 1.45
Responsibility .958 2.05
The percentile ranges were also derived from the standardization sample and are another means
of representing how the child performed relative to same age peers. The percentile indicates the
percentage of children of the same age group (year interval) whose scores were as high as or
higher than the child being assessed.
The percentile ranges were developed using a different methodology than that used to derive the
T-scores, i.e. growth curve analysis (see Chapter 5), therefore there may be occasions when the
two types of scores do not correspond exactly. When using PEDI-CAT scores for service eligibility
decisions, we strongly recommend that the child should be identified as eligible if EITHER the
T-score OR the percentile range is below the criterion.
Scaled Scores
Scaled scores are not age-related. They represent the child’s current status along the continuum
of function represented by the items in the domain being assessed. An increase in score means
that the child’s or adolescent’s performance of skills or level of responsibility has increased. In this
sense, differences in scaled scores represent the absolute amount of change that has occurred
from one assessment occasion to another. Scaled scores are particularly recommended to track
functional progress in children and youth with developmental delay who are not expected to catch
up to same age peers because the T-scores of these children might show no change or even a
decrease over time.
Wheelchair score
The Wheelchair Score is a separate scaled (criterion) score that represents current skills in self-
propelling a manual wheelchair. It is also expressed on a 20-80 continuum like the other domain
scores and is interpreted in the same way as the other scaled scores.
Fit score
The person fit score is unique to assessments developed using IRT methods. The fit score
provides information about whether responses to questions were close to expected. The CAT
10/7/2012 14
program computes a standardized log-likelihood statistic ( l z ) for polytomous items to test the
person fit for each scaled score. If the pattern of scores is highly unexpected, then the fit score
will become large. A fit score above +2.00 (empirical distribution is reasonably close to the
standardized normal distribution) indicates a “misfitting” pattern of responses and therefore the
scaled score for this domain should be interpreted with caution. In this situation it is
recommended that users review the item map provided with the score report (if the assessment
used the content-balanced format) or use copies of the item maps in Chapter 5 to create their
own display of obtained responses. Items whose responses deviate substantially from the pattern
expected for that scaled score are likely those responsible for the misfit. Inspection of those items
may suggest unique challenges or supports that affected the child’s performance. (See Chapter
7).
Exporting Score Report Data

Instructions for Exporting Score Report Data to Excel – Windows Version
Score report data may be exported to a Microsoft Excel file for further analysis using these steps:
-From the PEDI-CAT Reports screen, select type of report and then select Export All Data.
-Choose “Save as type: Text Files” and where to save the file from the “Save As” menu.
-Open Microsoft Excel and chose File → Open, choose “All files” and select the report text file.
-“Text Import Wizard” will appear (Delimited should be chosen as the file type) and then click
“Next”.
-On the next screen, click on the “Delimiters” titled “Tab” and “Comma”; click “Next” and then
“Finish”.
-In the Excel file, the data will be displayed in columns. Row 1 of the Excel file will have all of the
score report headings including demographic information (e.g. Subject ID #, Date, Age, Device
Use, Gender); Domain Name, Item Description, Response Choice (1=Unable, 2=Hard, 3=A Little
Hard, 4=Easy); and Scoring information (e.g. Scaled Score, Normative Score, Percentile, Fit,
Standard Error). Final scaled scores and normative scores can be found in the last row for each
domain assessed (e.g. Daily Activities, Social Cognitive) in the appropriate columns.
Instructions for Exporting Score Report Data to Excel – iPad Application

The PEDI-CAT application allows you to download data for analysis. This is done by writing files
to the iPad that can be recovered through iTunes. To export data, at the end of an assessment,
choose “Export all data to file”. A box will appear indicating “Export saved”. Data exported to file
“pedicatexport_date,number.txt”. After you have exported the files, you can see them by
connecting your iPad to iTunes and following these instructions:
1. Locate your device in the “Devices” section of iTunes.
2. Click on “Apps” to see app-specific features.
3. Scroll down to see the “File Sharing” section.
4. Find the PEDI-CAT app in the File Sharing section.
5. Locate your generated documents.
6. Click “Save to…” to save your files to your hard drive.
10/7/2012 15
Linking original PEDI scores to new PEDI-CAT scores
The PEDI-CAT scaled score is based on a 20 to 80 point scale, whereas the original PEDI was
based on a scale of zero to 100. Equations have been developed to link previous Functional Skill
Self-care, Mobility and Social Function scores from the original PEDI to the PEDI-CAT. Note that
there is no conversion for the Caregiver Assistance Scale as it has been replaced with the
Responsibility domain. The equations are as follows:
Original PEDI Functional PEDI-CAT Functional Equation

Skills Domain Skills Domain
Self-care Daily Activities New DA=0.417 * Old SC + 25.01
Mobility Mobility New MB= 0.416 * Old MB + 21.91
Social Function Social/Cognitive New SC=0.458 * Old SF + 31.12
None Responsibility N/A
The following is an example of how to convert a previous PEDI Functional Skills Self-care scaled
score to a PEDI-CAT Functional Skills Daily Activities score. If a child previously received a self-
care raw score of 25 and a scaled score of 45.2, the conversion would be done as follows:
New DA=0.417 * Old SC + 25.01
New DA=0.417 * 45.2 + 25.01
New DA score = 29.3
10/7/2012 16
PART II. DEVELOPMENT OF THE PEDI-CAT
Chapter 3 Conceptual Model and Relation to Measures of Adaptive Behavior
Conceptual Model
In the time since the first version of the PEDI was published, the field has seen considerable
advances in the conceptualization and measurement of function and disablement. One major
development was the 2001 publication of the World Health Organization (WHO) International
Classification of Functioning, Disability and Health (ICF)1 and its companion version for children
and youth, ICF-CY.2 The ICF was designed to provide a common framework and terminology for
describing function and disability and its application has been particularly notable in measurement
development. The PEDI-CAT was designed to be consistent with this framework.
The ICF proposes that health and disability are complex, multi-dimensional constructs. The
framework describes three dimensions of functioning that could be used to describe outcomes:
Body Function/Body Structure, Activity, and Participation. Although hierarchical in their degree of
complexity, the model asserts that the relation between these dimensions is not necessarily linear
or pre-determined. In particular the dimensions of Activity and Participation are affected by two
other factors: personal characteristics and features of the environment.
The three functional skills domains of the PEDI-CAT (Daily Activities, Mobility and
Social/Cognitive) address the Activity dimension, defined as the performance of discrete tasks.
The fourth domain, Responsibility, examines one aspect of Participation, which is defined as
engagement in life situations. Participation involves engagement in complex sets of culturally
typical activities and some degree of autonomy or personal choice. Accordingly, the
Responsibility domain items seek to capture the extent to which the young person is beginning to
take control over organizing and managing major life tasks.
The ‘Environment’ dimension is not measured separately in the PEDI-CAT. Instead we have 1)
specified that the assessment should reflect the child or youth’s performance in his or her typical
daily environment, including use of whatever adaptations or modifications are routinely available
to him or her, and 2) tried to define the relevant context of performance within each item. As
described in the ICF, the environment is assumed to involve a variety of factors that may facilitate
or impede the person’s activity performance and participation, including physical, attitudinal, and
social features of the daily environment.
For several reasons, we chose not to use the chapter structure of the ICF to organize the
domains of the PEDI-CAT. First, the chapter structure of the ICF was organized as a classification
scheme and is not built from empirical evidence. Second, our experience with the original PEDI
has supported the value of retaining a distinction between activities that depend heavily on gross
physical movement capacities (Mobility), activities that require more discrete use of hands and
upper limbs within the context of everyday life (Daily Activities), and activities that depend heavily
on social, communication, and behavioral competencies (Social/Cognitive). Scales constructed
with this structure provide a well-fitting model of the configuration of function across diverse
groups of children and youth with disabilities.
The Responsibility domain replaces the Caregiver Assistance scale in the original PEDI. The
definition of this construct draws on current developmental literature that describes the process of
“guided participation”3 through which adult caregivers support the young person to learn and then
take over the management of the important tasks of daily living. This construct better captures
progress of children and youth toward the desired outcome of full autonomy and independent
living. The emphasis on management of key tasks reflects the fact that independent living is often
10/7/2012 17
achieved with a variety of supports. Thus the most important aspect to measure is the extent to
which the person can organize and orchestrate these supports to meet his or her needs. Figure 1
illustrates the different aspects of the PEDI-CAT conceptual model.
Relation Between the PEDI-CAT and Measures of Adaptive Behavior

Professionals working with children with disabilities may be familiar with several well-known
measures of adaptive behavior such as the Vineland Adaptive Behavior Scales (VABS-II)4 and
the Scales of Independent Behavior (SIB-R)5, which also assess performance of daily activities.
Therefore the question may be asked: how are these measures similar or different from one
another?
Measures of adaptive behavior were developed primarily to assess the daily task performance of
children and adults with intellectual disabilities. Currently, demonstration of deficits in adaptive
behavior, concurrent with sub-average measured intelligence, is required for a diagnosis of
intellectual disability to be made. The content of the instruments is largely based on perceived
practical relevance of specific items rather than a clearly stated conceptual model. Factor
analyses have varied in the number of underlying factors in the construct of “adaptive behavior”.
Two factors that have emerged with some consistency have been described as “personal
independence”, which generally encompasses the performance of activities such as self-care and
care of one’s living space, and “social responsibility” or social competence, which generally
encompasses positive social interaction and ability to meet community expectations for
performance and behavior These two general factors roughly correspond to the PEDI-CAT
functional skills (Daily Activities, Mobility and Social/Cognitive) and some aspects of the
Responsibility domain.
The PEDI-CAT shares some of the strengths of adaptive behavior measures. Like the VABS-II4
and SIB-R,5 the PEDI-CAT is standardized on a national sample. It also encompasses almost all
of the content of the adaptive behavior measures, with additional content related to mobility skills
and more advanced instrumental and social/cognitive skills. However, the scales of the PEDI-CAT
offer important advantages compared to other measures of adaptive behavior.
 Meaningful assessment: PEDI–CAT items make an important distinction between the
performance of discrete activities and the ability to manage important life tasks.
 Assessment of a child’s optimal performance: Items on the VABS-II and SIB-R often
require a child to complete an activity in a certain way or require a particular (“typical”)
method of performance. In contrast, the items on the PEDI were carefully worded to allow
children to complete activities using alternative methods. This lessens the extent to which
children and youth with physical or communication difficulties are penalized in scoring due
to use of adaptations or technology, such as augmentative communication devices or
wheelchairs.
 Time efficient: Most commonly used adaptive behavior instruments are administered via
interview, which can be time and resource consuming. The PEDI-CAT offers a sound
alternative that minimizes both examiner and respondent time while still yielding precise
estimates of a child or youth’s current daily function.
10/7/2012 18
Figure 1. PEDI-CAT Conceptual Model
Body function/ Activity Participation

body structure
ICF
Framework
Environment: Home
and Community
Cultural practices and

expectations for different
Developmental age groups
Framework
Time
Changes in underlying
abilities and other personal
characteristics
Measurement Performance of Management of

Construct discrete activities important tasks of
of daily life daily life
PEDI-CAT Functional Responsibility

Scale Skills
References
1. World Health Organization. ICF: International Classification of Functioning, Disability and
Health. Geneva, Switzerland 2001.
2. World Health Organization. ICF: International Classification of Functioning, Disability and
Health: Children and Youth. Geneva, Switzerland 2008.
3. Rogoff B. The cultural nature of human development. NY: Oxford University Press 2003.
4. Sparrow SS, Domenic V. Cicchetti DV, Balla DA. Vineland Adaptive Behavior Scales, Second
Edition (Vineland-II). San Antonio, TX: Pearson Corp 2009.
5. Bruininks RH, Woodcock RW, Weatherman RF, Hill Bk. Scales of Independent Behavior-
Revised (SIB-R). Rolling Meadows, IL: Riverside Publishing 1996.
10/7/2012 19
Chapter 4 PEDI-CAT Content Development
PEDI-CAT Domains
The PEDI-CAT examines a set of functional activities that are likely to be encountered by children
and youth within the context of their daily lives. Functional activity is multidimensional, thus, the
PEDI-CAT is comprised of four independent content domains:
Daily Activities is the ability of a child to carry out daily living skills such as eating, dressing, and
grooming activities. The Daily Activities domain also includes items related to household
maintenance and the operation of electronic devices. Often, these items require coordination and
discrete movements of the hands and arms to complete the activities.
Mobility is the ability of a child to move in different environments such as in the home (getting in
and out of own bed) or in the community (getting on and off a public bus or school bus). Mobility
items range from foundational motor skills of rolling over and sitting unsupported to more
advanced skills of jumping, running, or carrying heavy objects. The use of mobility equipment
such as a wheelchair or walking devices is also included in this domain.
Social/Cognitive is the ability to interact with others in a community and participate in one’s
family and culture. This domain includes skills needed for effective social exchange and to
function safely. Social/Cognitive items address communication, interaction, safety, behavior, play,
attention, and problem-solving.
Responsibility is the extent to which a young person is managing life tasks which are important
for the transition to adulthood and independent living. The items in this domain require the child or
youth to use several functional skills assessed in the other domains in combination with each
other in order to carry out life tasks (e.g. fixing a meal, planning and following a weekly schedule).
This domain also contains content assessing health management and literacy, citizenship, safety,
and community mobility.
Methodology
The initial item pools for the PEDI-CAT were developed through a comprehensive review of
existing performance-based and functional standardized and non-standardized pediatric
measures, the published literature on the functional outcomes of children and youth in hospital-
based and community settings and user feedback since the original PEDI’s publication in 1992.
An expanded set of items for an extended age range (0 through 20 years of age) in each of the
original PEDI’s existing three functional domains (Self-care, Mobility and Social Function) and
items for the new Responsibility domain were compiled. Table 4 - 1 provides the initial number of
items (total =2615) considered and the published sources used for item development.
Focus groups were held with physical therapy, occupational therapy and speech-language
clinicians and parents of children with disabilities to provide feedback on the expanded set of
items and response scales. Participants were asked if there was additional content that should be
added to the domains and whether the items were written clearly for parents to understand and
respond to. For the response scales, participants were asked if rating scale point definitions were
clear and reflective of meaningful distinctions in management of daily life tasks.
The expanded set of items and response scales were also sent to a group of physical and
occupational therapy clinicians with expertise in child development, measurement of children’s
daily activities in home and community contexts, and instrument design, validation, and score
construction. In addition, these experts were experienced national and international users of the
10/7/2012 20
PEDI. Feedback regarding content coverage, content relevance, and item clarity was compiled
and reviewed and used to identify content or items that should be added, deleted or reworded.
Following the additions and revisions to the pool of items, cognitive interviews 1 were conducted to
finalize the items for calibration. These structured individual interviews were used to provide
insights into respondents’ thought processes as they read and responded to previously developed
assessment items. This information enabled us to determine whether or not the respondents
understood the items consistently, easily and as intended. Following the first round of interviews,
all feedback and items were reviewed by the project team and all items (including newly added
line drawings for the Daily Activities and Mobility items) were re-tested in a second set of
interviews before finalizing the items for calibration.
Two hundred ninety eight items were calibrated (76 Daily Activities, 105 Mobility, 64
Social/Cognitive and 53 Responsibility) using a normative sample of 2,205 infants, children and
youth. Following calibration, some additional items were eliminated (see Chapter 5 for explanation
and specific items). The final PEDI-CAT item banks are detailed in Tables 4-2 through 4-5.
Table 4-1. Initial Number of Items and Sources used for Item Development
Domain Published Sources
(Initial # of Items)
Daily Activities  Abilihand Questionnaire2
(771)  Activity Measure for Post-Acute Care (AM-PAC)3
 Arthritis Impact Measurement Scale (AIMS2) 4
 Assessment of Life Habits (Life- H) 5
 Barthel Index6
 Capabilities of Upper Extremity (CUE) 7
 Child Oral Health Quality of Life Questionnaire8
 Children's Assessment of Participation and Enjoyment (CAPE)9
 Community Integration Questionnaire10
 Craig Handicap Assessment and Reporting Technique (CHART)11
 Disabilities of the Arm, Shoulder and Hand (DASH) 12
 Frenchay Activities Index (FAI) 13
 Functioning After Brain Injury (FABI) 14
 Functional Independence Measure (FIM) 15
 Functional Status Questionnaire (FSQ) 16
 Generic Lifestyle Assessment Questionnaire (LAQ-G) 17
 Hawaii Early Learning Profile (HELP) 18
 Health Assessment Questionnaire (HAQ) 19
 Juvenile Arthritis Functional Assessment Report (JAFAR) 20
 Juvenile Arthritis Quality of Life Questionnaire (JAQQ) 21
 Juvenile Arthritis Status Index (JASI) 22
 Klein Bell ADL Scale23
 Neuro-QOL Adult Physical Function Measure24
 Neuro-QOL Pediatric Physical Function Measure25
 Pediatric Evaluation of Disability Inventory (PEDI) 26
 Pediatric Evaluation of Disability inventory-Multidimensional Computer
Adaptive Test (PEDI-MCAT) 27
 Pediatric Outcomes Data Collection Instrument (PODCI) 28
10/7/2012 21
 Pediatric Quality of Life Inventory (PedsQL) 29
 Rivermead Activities of Daily Living Scales30
 The Rotterdam 9-Item Handicap Scale31
Daily Activities  Shriners Cerebral Palsy Computer Adaptive Test (CP-CAT) 32
(continued)  Shriners Spinal Cord Injury Computer Adaptive Test (SCI-CAT) 33
 Spinal Cord Independence Measure (SCIM) 34
 Tetraplegia Hand Activity Questionnaire (THAQ)35
 Upper Extremity Functional Skills (UEFS)36
 Valutazione Funzionale Mielolesi (VFM)37
 Vineland Adaptive Behavior Scales (VABS)38
 Wee-Functional Independence Measure (Wee-FIM)39
10/7/2012 22
Mobility  Activities Scale for Kids (ASK)40
(987)  Activity Measure for Post-Acute Care (AM-PAC)3
 Arthritis Impact Measurement Scale (AIMS2)4
 Assessment of Life Habits (Life-H)5
 Barthel Index6
 Children's Assessment of Participation and Enjoyment (CAPE)9
 Disabilities of the Arm, Shoulder and Hand (DASH)12
 Functioning After Brain Injury (FABI)14
 Functional Assessment Questionnaire (FAQ)41
 Functional Independence Measure (FIM)15
 Functional Status Questionnaire (FSQ)16
 Generic Lifestyle Assessment Questionnaire (LAQ-G)17
 Hawaii Early Learning Profile (HELP) 18
 Health Assessment Questionnaire (HAQ)19
 Juvenile Arthritis Functional Assessment Report (JAFAR)20
 Juvenile Arthritis Status Index (JASI)22
 Klein Bell ADL Scale23
 Lifestyle Assessment Questionnaire (LAQ)17
 Lower Extremity Functional Scale (LEFS)42
 Neuro-QOL Adult Physical Function Measure24
 Neuro-QOL Pediatric Physical Function Measure25
 Pediatric Evaluation of Disability Inventory (PEDI)26
 Pediatric Evaluation of Disability inventory-Multidimensional Computer
Adaptive Test (PEDI-MCAT)27
 Pediatric Outcomes Data Collection Instrument (PODCI)28
 Pediatric Quality of Life Inventory (PedsQL)29
 Physical Activity Scale for Persons with Disabilities (PASIPD)43
 Osteoarthritis Computer Adaptive Test (OA-CAT)44
 Rivermead Mobility Index (RMI)45
 The Rotterdam 9-Item Handicap Scale31
 Shriners Cerebral Palsy Computer Adaptive Test (CP-CAT)32
 Shriners Spinal Cord Injury Computer Adaptive Test (SCI-CAT)33
 Spinal Cord Independence Measure (SCIM)34
 Test of Gross Motor Development (TGMD-2)46
 Valutazione Funzionale Mielolesi (VFM)37
 Wee-Functional Independence Measure (Wee-FIM)39
10/7/2012 23
Social/Cognitive  Adaptive Behavior Scales-School, 2nd ed.(ABS-2)47
(774)  Ansell-Casey Life Skills Assessment (ACLSA)48
 Assessment of Life Habits (Life-H) 4
 Caregiver Priorities and Child Health Index of Life with Disabilities (CP
CHILD)49
 Community Integration Questionnaire10
 Craig Hospital Assessment and Reporting Technique (CHART)11
 Disabilities of the Arm, Shoulder and Hand (DASH)12
 Frenchay Activities Index (FAI)13
 Functional Independence Measure (FIM)15
 Functioning After Brain Injury (FABI)14
 Generic Lifestyle Assessment Questionnaire (LAQ-G)17
 Handicap Scale for Children (HSC)50
 Juvenile Arthritis Status Index (JASI)22
 Pediatric Evaluation of Disability Inventory (PEDI)26
 Pediatric Quality of Life Inventory (PedsQL)29
 Scales of Independent Behavior Revised (SIB-R)51
 Shriners Spinal Cord Injury Computer Adaptive Test (SCI-CAT)33
Responsibility  Adaptive Behavior Scales-School, 2nd ed.(ABS-2)47

(83)  Ansell-Casey Life Skills Assessment (ACLSA)48
 Responsibility and Independence Scale for Adolescents (RISA)52
 Scales of Independent Behavior Revised (SIB-R)51
 Social Skills Questionnaire-Parent Form-Secondary Level (Grades 7-
12)53
10/7/2012 24
PEDI-CAT Final Item Banks
Table 4-2. Daily Activities (DA) Items

The Daily Activities domain includes items in four content areas: Getting Dressed, Keeping Clean,
Home Tasks, and Eating & Mealtime. Sixty-eight items address basic self care and instrumental
activities of daily living such as eating, grooming, dressing, and household maintenance.
Item Content Area Item Illustration
Number
DA002 Eating & Mealtime Swallows pureed/ blended/

strained foods
DA003 Eating & Mealtime Finger feeds small or bite-size

pieces of food
DA004 Eating & Mealtime Holds and drinks from an open

cup or glass
DA006 Eating & Mealtime Holds and eats a sandwich or

burger
DA007 Eating & Mealtime Feeds self with spoon (minimal

spilling)
DA008 Eating & Mealtime Drinks liquids using a straw
10/7/2012 25
DA009 Eating & Mealtime Feeds self with fork (minimal
spilling)
DA010 Eating & Mealtime Uses a knife to butter bread

and spread jam
DA011 Eating & Mealtime Cuts vegetables or meat with a

fork and table knife
DA012 Eating & Mealtime Inserts a straw into a juice box
DA013 Eating & Mealtime Pours liquid from a large carton

into a glass
DA014 Eating & Mealtime Stirs to mix ingredients
DA015 Eating & Mealtime Empties food from mixing bowl

to baking pan
10/7/2012 26
DA016 Eating & Mealtime Pulls open a sealed bag of
snack food
DA019 Eating & Mealtime Removes lid from plastic food

containers
DA020 Eating & Mealtime Opens sealed cardboard food

boxes
DA021 Home Tasks Cuts with scissors to open hard

plastic packaging
DA022 Eating & Mealtime Closes a bottle with a twist-off

cap
DA025 Eating & Mealtime Peels foods such as potatoes

or carrots
DA026 Eating & Mealtime Chops or slices hard fruits or

vegetables
10/7/2012 27
DA027 Eating & Mealtime Uses a can opener to open a
can
DA028 Keeping Clean Rubs hands together to clean
DA030 Keeping Clean Wipes nose thoroughly with

tissue
DA031 Keeping Clean Turns the water on and off at

sink
DA034 Keeping Clean Puts toothpaste on brush and

brushes teeth thoroughly
DA036 Keeping Clean Trims fingernails on both hands
DA039 Getting Dressed Fastens hairclips or barrettes
10/7/2012 28
DA040 Getting Dressed Puts hair up in a ponytail
DA044 Keeping Clean Shaves face using electric or

safety razor
DA046 Getting Dressed Fastens watch band
DA047 Getting Dressed Fastens a necklace or chain
DA049 Keeping Clean Trims toenails on both feet
DA051 Keeping Clean Cleans body thoroughly in bath

or shower
DA052 Keeping Clean Dries hair with a towel
10/7/2012 29
DA054 Keeping Clean Obtains shampoo, washes and
rinses hair
DA055 Keeping Clean Dries hair with a hair dryer
DA057 Getting Dressed Removes socks
DA058 Getting Dressed Takes off a t-shirt
DA060 Getting Dressed Puts on a t-shirt
DA061 Getting Dressed Puts on and buttons a front-

buttoning shirt
DA062 Getting Dressed Removes pants with elastic

waist
10/7/2012 30
DA064 Getting Dressed Puts on and fastens pants
DA065 Getting Dressed Fastens belt buckle
DA066 Getting Dressed Tucks in shirt or blouse
DA067 Getting Dressed Puts on socks
DA068 Getting Dressed Puts on slip-on shoes
DA069 Getting Dressed Connects and zips zippers that

are not fastened at the bottom
DA070 Getting Dressed Ties shoelaces
10/7/2012 31
DA072 Getting Dressed Inserts laces into sneakers or
boots
DA073 Getting Dressed Puts on winter, sport, or work

gloves
DA074 Getting Dressed Puts on bra and fastens in front

or back
DA075 Getting Dressed Puts on tights or pantyhose
DA079 Keeping Clean Wipes self with toilet paper after

a bowel movement
DA081 Keeping Clean Opens, closes and latches

public bathroom stall doors
DA083 Home Tasks Uses a TV remote control
10/7/2012 32
DA084 Home Tasks Operates a video game
controller
DA086 Home Tasks Uses a computer mouse to click

on icons or links
DA087 Home Tasks Uses a computer keyboard to

type
DA089 Home Tasks Wipes a counter or table
DA091 Home Tasks Stacks breakable plates or cups
DA092 Home Tasks Opens door lock using key
DA093 Home Tasks Changes pillow case on pillow
10/7/2012 33
DA094 Home Tasks Replaces (unscrews and
screws) the bulb in a table lamp
DA095 Home Tasks Tightens loose screws using a

screwdriver
DA096 Home Tasks Puts a bandage on a small cut

on hand
DA097 Home Tasks Opens childproof medicine or

vitamin containers
DA098 Home Tasks Presses buttons to operate a

key-pad such as phone or ATM
DA100 Home Tasks Removes a single bill from

wallet
10/7/2012 34
Table 4-3. Mobility (MB) Items
The PEDI-CAT Mobility domain addresses five content areas: Basic Movement and Transfers,
Standing and Walking, Steps & Inclines, Running and Playing, and Wheelchair. Seventy-five
items address early mobility and physical functioning activities such as head control, transfers,
walking, climbing stairs, and playground skills, while an additional 12 items are specifically for
children who use walking aids (canes, crutches, walkers). A separate domain addresses
functional mobility using a wheelchair.

Number
MB002 Basic Movement & When lying on

Transfers belly, turns head
to both sides

Transfers back, turns head
to both sides

Transfers back, reaches
for toy

Transfers belly, pushes up
on elbows

Transfers belly, pushes up
on hands
MB009 Basic Movement & Gets onto hands

Transfers and knees
10/7/2012 35
MB012 Basic Movement & Sits on floor with
Transfers pillow for
support
MB014 Basic Movement & Lifts one arm

Transfers overhead and
reaches for a
small toy while
sitting on floor
MB016 Basic Movement & Sits on floor

Transfers without support
of pillow or
couch
MB017 Basic Movement & Stands up from

Transfers an adult-size
chair
MB019 Basic Movement & Sits in an adult-

Transfers size chair with a
back
MB022 Basic Movement & Rolls over in bed

Transfers or crib
MB024 Basic Movement & Gets in and out

Transfers of own bed
10/7/2012 36
MB025 Basic Movement & Gets under
Transfers sheet or blanket
and arranges
pillows for
comfort in bed
MB027 Basic Movement & Stands up from

Transfers the middle of the
floor
MB030 Standing & Walking Stands for a few

minutes
MB031 Standing & Walking Stands on

tiptoes to reach
for something

Transfers of bathtub
MB033 Basic Movement & Steps in and out

Transfers of shower stall
MB034 Basic Movement & Gets on and off

Transfers an adult-sized
toilet
10/7/2012 37
MB035 Standing & Walking While standing,
bends over and
picks up
something from
the floor
MB036 Standing & Walking Squats down

and then stands
back up
MB037 Standing & Walking Walks while

holding onto
furniture or walls
MB038 Standing & Walking Walks from

room to room in
home (no stairs)
MB041 Standing & Walking Walks in

between a row
of auditorium or
movie theater
seats
MB042 Standing & Walking Opens and

closes door to
enter and exit
home
MB044 Standing & Walking Walks on wet,

indoor
slippery surfaces
10/7/2012 38
MB045 Standing & Walking Walks and
carries a full
glass without
spilling

wearing a light
backpack

wearing a heavy
backpack
MB048 Standing & Walking Pulls heavy

wagon filled with
toys or small
child

carries a food
tray

carries a full
shopping bag
with handles
MB051 Standing & Walking Pushes adult-

size shopping
cart
10/7/2012 39
MB053 Standing & Walking Walks outdoors
on grass, mulch
or gravel
MB054 Steps & Inclines Steps up and

down curbs
MB055 Steps & Inclines Walks on a

raised narrow
surface
(curb/low wall)
MB056 Steps & Inclines Walks up and

down ramp
MB057 Steps & Inclines Hikes up hill 2-3

miles/3-5
kilometers
MB058 Standing & Walking Walks several

hours at family
or school outing
such as zoo,
amusement park
or fair
MB059 Standing & Walking Walks fast

enough to cross
two-lane street
safely
10/7/2012 40
MB060 Running & Playing When running, is
able to go
around people
and objects
MB065 Running & Playing Moves forward

on ride-on toys
without pedals
MB066 Running & Playing Rides tricycle
MB067 Running & Playing Rides bicycle

without training
wheels

Transfers of a car
MB069 Steps & Inclines Gets on and off

a public bus or
school bus

Transfers of van, truck or
sport utility
vehicle
10/7/2012 41
MB071 Standing & Walking Stands while
holding on in a
moving vehicle
(bus, train,
trolley,
boat/ferry)
MB072 Steps &Inclines Goes up and

down stairs by
crawling or
scooting on
bottom
MB074 Steps & Inclines Walks up a flight

of stairs without
holding onto
handrail
MB075 Steps & Inclines Goes up and

down an
escalator
MB076 Steps & Inclines Walks up and

down bleacher
steps in gym or
stadium
MB077 Steps & Inclines Walks up a flight

of stairs holding
onto handrail
MB078 Steps & Inclines Walks down a

flight of stairs
holding onto
handrail
10/7/2012 42
MB079 Steps & Inclines Walks down a
flight of stairs
without holding
onto handrail
MB083 Steps & Inclines Carries full

laundry basket
with 2 hands up
a flight of stairs
MB085 Running & Playing Kicks a rolling

ball while
standing
MB086 Steps & Inclines Jumps down off

a single step
MB088 Running & Playing Jumps 10 times

in a row with a
jump rope
MB090 Basic Movement & Sits on infant

Transfers playground
swing while
swing is pushed
MB092 Running & Playing Pumps legs and

swings on
playground
swing
10/7/2012 43
MB095 Running & Playing Climbs up ladder
of a slide
MB096 Running & Playing Climbs on and

off a climbing
structure
MB097 Running & Playing Moves across

monkey bars
MB098 Steps & Inclines Climbs indoor

step ladder
MB099 Running & Playing Climbs out of

swimming pool
using pool
ladder
MB100 Running & Playing Pulls self out of

swimming pool
not using ladder
MB125 Basic Movement & Climbs onto

Transfers couch or adult-
size chair
10/7/2012 44
MB126 Standing & Walking When walking, is
able to go
around people
and objects
MB127 Steps & Inclines Climbs over 2

foot high
obstacle such as
a baby gate
MB128 Steps & Inclines Climbs step

ladder to put a
heavy box on a
high shelf
MB129 Standing & Walking Walks 3 miles/5

kilometers
MB130 Standing & Walking Walks 50 feet/15

meters while
carrying 25
pound/11
kilogram bag
MB132 Steps & Inclines Runs up 2 flights

of stairs
MB102D Standing & Walking Walks with

walking aid (e.g.
cane, crutches,
walker) from
room to room in
home (no stairs)
10/7/2012 45
MB104D Standing & Walking with walking aid (e.g.
Walking cane, crutches, walker), keeps
place in a line of moving people
MB107D Standing & Walks with walking aid (e.g.

Walking cane, crutches, walker) on wet,
indoor slippery surfaces

Walking cane, crutches, walker) on
grass, mulch or gravel
MB109D Steps & Steps up and down curbs using

Inclines walking aid (e.g. cane,
crutches, walker)
MB111D Steps & Walks with walking aid (e.g.

Inclines cane, crutches, walker) up and
down ramp

Walking cane, crutches, walker) several
hours at family or school outing
such as zoo, amusement park
or fair
MB113D Wheelchair Uses manual wheelchair to

move from room to room in
home
MB115D Wheelchair Keeps place in a line of moving

people while using manual
wheelchair
10/7/2012 46
MB116D Wheelchair Opens and closes door to enter
and exit home while using
manual wheelchair
MB119D Wheelchair Uses manual wheelchair

outdoors on grass, mulch or
gravel
MB120D Wheelchair Goes up and down curbs with

manual wheelchair
MB121D Wheelchair Goes up and down ramp with

manual wheelchair
MB124D Wheelchair Pushes manual wheelchair for

several hours at family or
school outing such as zoo,
amusement park or fair
MB133D Steps & Walks up a flight of stairs with a

Inclines walking aid (e.g. cane,
crutches, walker)
MB134D Steps & Using walking aid (e.g. cane,

Inclines crutches, walker), gets on and
off a public bus or school bus
10/7/2012 47
MB135D Steps & Walks down a flight of stairs
Inclines with walking aid (e.g. cane,
crutches, walker)
MB138D Wheelchair Moves from manual wheelchair

to adult size chair
MB139D Wheelchair Uses manual wheelchair to

move quickly indoors to answer
a telephone or doorbell
MB140D Wheelchair Fastens manual wheelchair

seat belt
MB141D Wheelchair Puts manual wheelchair brakes

on and off
MB142D Wheelchair Gets into manual wheelchair

from floor
10/7/2012 48
Table 4-4. Social/Cognitive Items
The PEDI CAT Social/Cognitive domain includes 60 items that address communication,
interaction, safety, behavior, play with toys and games, attention, and problem-solving in the four
content areas of Interaction, Communication, Everyday Cognition, and Self Management.
Item Content Area Item

Number
SC001 Communication Uses words, gestures or signs to ask for something
SC002 Communication Uses several words or signs together such as "go home now"
and "daddy go"
SC004 Communication Uses words or signs to ask questions such as "Where's
Mommy?" or "What's that?"
SC005 Interaction Carries on a conversation with a familiar person by listening
and responding appropriately
SC008 Communication Teaches another person a new game or activity by giving
examples and explanations
SC010 Interaction Greets new people appropriately when introduced
SC011 Everyday Cognition Follows directions given by adult leader of a small group (4-5
children or teenagers)
SC012 Interaction Asks permission before using someone else's property
SC013 Everyday Cognition Attends to and follows direction given by a coach or teacher
while in a large group (20-30 children or teenagers)
SC014 Interaction Uses language appropriate to the situation such as formal
language at a job interview or informal language when
hanging out with friends
SC016 Interaction Asks for a change in plans or responsibilities in a respectful
way such as asking a teacher to extend a deadline
SC018 Interaction Follows gaze of another person to look at the same place or
object
SC019 Interaction Plays peek-a-boo or pat-a-cake
SC020 Interaction Interacts briefly with a peer during play
SC021 Interaction Asks one or more peers to play using words or gestures
SC022 Interaction Takes turns sharing a favorite toy with peers
SC023 Interaction Participates in role-playing activities such as playing school

or acting out famous characters
SC024 Interaction Plays with one or more children of the same age for several
hours on their own
SC025 Interaction Takes turns and follows rules while playing simple board,
card, or video games
10/7/2012 49
SC026 Interaction Uses strategy and follows strict rules while playing complex
board, card, or video games
SC028 Interaction Shows positive reactions to friends' success such as
congratulating a peer for scoring a goal or doing well on a
test
SC029 Interaction Works with friends to reach an agreement when they have
different ideas
SC030 Interaction Maintains friendships that involve give-and-take,
compromises and loyalty
SC031 Interaction Tries to resolve a conflict with friends or classmates
SC032 Everyday Cognition Recognizes his/her printed name
SC033 Everyday Cognition Prints first and last name legibly
SC035 Everyday Cognition Writes a legible 3-4 item list
SC036 Communication Writes short notes or sends text messages or email
SC037 Everyday Cognition Communicates ideas in a 2-3 page written assignment or

report
SC038 Everyday Cognition Recognizes numbers such as on a clock or phone
SC039 Everyday Cognition Counts out the correct coins to pay for an item that costs $1
or less
SC040 Everyday Cognition Understands signs in the community such as Restrooms or
EXIT
SC041 Everyday Cognition Counts out the correct amount of bills and/or coins to pay for
an item costing $20-$40
SC042 Everyday Cognition Uses a map to plan a route to a new place
SC043 Everyday Cognition Finds a phone number or address using the phone book or
computer
SC044 Everyday Cognition Follows written directions of 2-3 steps
SC045 Everyday Cognition Follows complex written instructions such as to set up new
computer software or complete a school project
SC047 Communication Uses the words yesterday/ tomorrow/ today correctly
SC048 Everyday Cognition Associates days of the week with their typical activities such
as football practice on Tuesday, chores on Saturday
SC049 Everyday Cognition Associates a specific time with a specific activity such as a
favorite TV show starting at 3 pm
SC051 Everyday Cognition Uses a watch or clock to be ready for an activity such as
catching school bus or watching TV show
10/7/2012 50
SC056 Self-Management Accepts the need to wait an hour or two before a request can
be met
SC057 Self-Management When upset, responds without punching, hitting, or biting
SC058 Self-Management Accepts advice or feedback from a teacher, coach, or boss

without losing temper
SC059 Self-Management Keeps unsafe objects and household materials out of mouth
SC060 Self-Management Behaves safely when falling is possible, such as on a

playground slide or near stairs
SC063 Everyday Cognition Checks traffic in both directions and knows when to cross
street
SC064 Everyday Cognition Shows interest in objects held close by looking, touching, or
listening
SC065 Everyday Cognition Tries to make toys work by pressing, pushing, or squeezing
SC066 Everyday Cognition Puts together an unfamiliar 5-10 piece puzzle with
interlocking pieces
SC067 Everyday Cognition Uses toys in simple pretend play such as putting doll to bed
or driving a toy truck
SC068 Everyday Cognition Builds simple structures from objects such as building a tower
or a house from blocks
SC071 Communication Uses single words, gestures or signs to show what he/she
wants
SC072 Communication Describes what help is needed to solve a problem such as
approaching store staff to locate item or asking a friend to
borrow a book needed for homework
SC073 Everyday Cognition Tries to do things a different way when not successful such
as turning a puzzle piece in a different direction or trying a
different route in a video game
SC074 Everyday Cognition Uses a calendar or datebook to record and keep track of
appointments, assignment or events
SC076 Communication Explains reasons behind actions or such as why he/she spent
money on a particular item
SC077 Self-Management Stays quiet in public places when expected
SC078 Communication Provides own address and telephone number when asked
SC079 Self-Management Transitions from one familiar activity to another such as

playground to classroom, bath time to bed time
10/7/2012 51
Functional Skills Response Scale: Rating Scale for Daily Activities, Mobility, and
Social/Cognitive Domains
The two-point (Unable/Capable) response scale in the original PEDI was modified to a 4-point
Difficulty scale for the expanded PEDI-CAT Functional Skills Domains:
Please choose which response below best describes your child’s ability in the following:
□ Unable = Can’t do, doesn’t know how or is too young.
□ Hard = Does with a lot of help, extra time, or effort.
□ A little hard = Does with a little help, extra time or effort.
□ Easy = Does with no help, extra time or effort, or child’s skills are past this
level.
□ I don’t know.
10/7/2012 52
Table 4-5. Responsibility (RS) Items
The PEDI-CAT Responsibility Domain includes 51 items that assess the extent to which a young
person is managing life tasks that enable independent living with items that address daily
schedules and planning, health and hygiene, and cooking and nutrition. The items are organized
into the following four content domains: Organization & Planning, Taking Care of Daily Needs,
Health Management, and Staying Safe. The items in the Responsibility Domain require children
to use several functional skills in combination to carry out life tasks. For this reason, this is a
more difficult domain and is estimated to assess children and youth beginning at the age of 3
years and extending up to the age of 21 years.
Item Content Area Item Includes

Number
RS001 Organization & Getting ready in the Getting up; Getting dressed;
Planning morning on time Grooming and hygiene activities;
Eating breakfast; Completing on
time
RS002 Organization & Keeping track of time Arriving on time to scheduled
Planning throughout the day activities or appointments;
Coming back home at planned
time; Ending an activity on time to
stay on schedule
RS004 Organization & Planning and following a Identifying what needs to be done
Planning weekly schedule so all during a week; Determining how
activities get done when much time each activity will need
needed and when it should be done;
Carrying out plan; Making
necessary adjustments due to
unexpected delays or events
RS005 Organization & Having all items that will Determining what will be needed
Planning be needed before leaving (e.g. money, homework, cell
home for the day phone, lunch); Checking to make
sure those things are in
backpack, purse, etc.
RS006 Health Managing routine health Making and keeping
Management appointments and related appointments with doctors or
activities dentists; Refilling prescriptions
RS007 Taking Care of Eating and drinking Avoiding undernourishment, over-
Daily Needs appropriate foods to eating and dehydration; Selecting
maintain health and a variety of foods
energy
RS008 Health Following health and Taking prescribed medication as
Management medical treatment directed; Following dietary
requirements restrictions; Adhering to exercise
or other treatment routines
RS009 Health Taking care of minor Caring for minor cuts and burns;
Management health needs Taking over the counter
medication for fever, cold, and flu
when appropriate
10/7/2012 53
RS010 Health Seeking medical help for Recognizing when medical help is
Management serious illness or injury required; Contacting appropriate
when needed professionals; Knowing
emergency phone numbers
RS011 Staying Safe Staying safe in a familiar Avoiding strangers, objects,
location that is known to behavior or situations that may be
be safe such as friend's dangerous
home or local park
RS012 Staying Safe Determining the safety of Identifying and avoiding
a new location such as an potentially dangerous situations
unfamiliar neighborhood (e.g., dark street, construction
or a large event with site, crowded concert); Judging
many people, and the safety of a person before
responding appropriately seeking assistance (e.g.
to stay safe policeman, store owner)
RS013 Organization & Choosing and arranging Planning and getting together
Planning own social interactions with friends; Accepting invitations
to social events or inviting others;
Incorporating social plans into
schedule; Arranging
transportation
RS014 Taking Care of Fixing simple meals that Identifying what is available to
Daily Needs do not involve cooking eat; Selecting the needed food
such as cereal or a and utensils; Preparing by mixing,
sandwich pouring, etc.
RS015 Taking Care of Following a recipe or Identifying and obtaining the
Daily Needs cooking instructions that needed ingredients in the correct
includes 3-4 ingredients amounts; Assembling the recipe
and steps such as in correct order; Timing the steps
macaroni and cheese or appropriately
brownies
RS016 Taking Care of Managing kitchen Using precautions around hot
Daily Needs appliances such as stove, surfaces or electricity; Monitoring
microwave, or dishwasher appliances when in use;
safely Identifying potentially unsafe
situations and adjusting behavior
accordingly
RS017 Taking Care of Using utensils such as a Using precautions around sharp
Daily Needs knife or grater safely objects; Avoiding cuts; Identifying
during food preparation potentially unsafe situations and
adjusting behavior accordingly
RS018 Taking Care of Managing food needs for Obtaining food at grocery stores
Daily Needs the entire week or restaurants; Fixing meals as
needed
RS019 Taking Care of Using safe food handling Washing hands and cleaning
Daily Needs practices in the kitchen surfaces, dishes, and utensils
thoroughly; Disposing of expired
or rotten foods
10/7/2012 54
RS020 Taking Care of Maintaining cleanliness Cleaning spills and wiping up
Daily Needs and upkeep of living food crumbs; Scrubbing sink and
space tub; Emptying trash; Replacing or
repairing broken fixtures or
objects
RS022 Organization & Putting items and objects Knowing where objects are
Planning away after use stored; Organizing belongings
and objects so they can be found
when needed
RS023 Taking Care of Selecting clothing that is Identifying dress codes or
Daily Needs appropriate given the expectations for different events;
weather, daily schedule, Seeking information about
and activities weather for the day
RS025 Taking Care of Recognizing when Cleaning dirt, food, and other
Daily Needs appearance or hygiene stains off body, face, and
needs attention and clothing; Managing odor by
taking steps to correct washing, brushing teeth, using
deodorant, and wearing clean
clothes; Maintaining appearance
by smoothing hair, tucking in
shirt, arranging clothing after
using the bathroom
RS026 Taking Care of Cleaning and caring for Determining when clothes need
Daily Needs clothes to be cleaned; Washing clothing
according to the fabric care
instructions; Ironing clothes when
needed; Ensuring clean clothes
are available when needed
RS027 Organization & Developing and following Identifying a goal; Planning out
Planning a plan to reach a specific small steps needed to reach the
goal (e.g. buying a bike, goal; Carrying out plan and
earning a place on a adjusting plan as needed
team)
RS028 Organization & Prioritizing and
Planning coordinating multiple
goals at the same time
such as keeping up
grades as well as after
school activities
RS029 Staying Safe Supervising or caring for Ensuring another person's safety
another person (e.g., and well being; Providing
sibling or other child, assistance to another person
grandparent) when needed
RS030 Taking Care of Managing bowel and Avoiding accidents by using toilet
Daily Needs bladder through the night or incontinence products
RS031 Taking Care of Managing bowel and Avoiding accidents by using toilet
Daily Needs bladder through the day or incontinence products
10/7/2012 55
RS033 Taking Care of Managing menstrual cycle Having available or buying
Daily Needs feminine hygiene products; Using
feminine hygiene products in a
safe and hygienic manner
RS034 Health Taking precautions to Abstaining from sexual activity;
Management avoid sexually transmitted Using contraceptives; Seeking
diseases and/or unwanted information from a health
pregnancies professional
RS036 Organization & Tracking spending and Remembering or recording
Planning managing money money spent; Planning a budget;
Saving or putting aside money for
expenses; Recognizing when
budget is exceeded and adjusting
spending accordingly
RS037 Organization & Paying bills and other Using check, cash, money order,
Planning accounts on time or online payment; Identifying due
date and making payment on time
RS038 Organization & Managing daily expenses Anticipating events or needs for
Planning the day and their costs; Obtaining
needed money from bank or
ATM; Paying with cash, debit or
credit card
RS039 Organization & Completing legal and/or Applying for a license or permit;
Planning other personal paperwork Completing employment or
insurance application
RS040 Staying Safe Taking precautions to Providing personal information
protect the privacy of (e.g. social security number,
personal information address) only when appropriate
RS041 Organization & Locating needed services Identifying need; Contacting
Planning or supports (e.g. finding a person or organization that could
community program or meet that need
repair business)
RS042 Organization & Resolving errors in Identifying and contacting
Planning personal business such appropriate persons;
as billing, registration and Communicating effectively to
other accounts explain problem
RS043 Organization & Organizing important Recognizing which papers need
Planning papers and information to be saved (e.g. completed tax
and finding them when form, contracts, passport); Storing
needed in a secure location
RS045 Staying Safe Traveling safely within the Identifying and following a safe
community route; Using available methods of
transportation (e.g. walking,
driving, public transportation)
RS047 Staying Safe Eating safely without Chewing food adequately; Taking
choking or burning self appropriate-sized bites; Testing
temperature; Pacing self
10/7/2012 56
RS048 Taking Care of Packing all the items Determining what will be needed
Daily Needs needed for an overnight (e.g. toothbrush, clothing for the
stay next day); Checking to make sure
those things are in luggage, bag,
etc.
RS049 Taking Care of Buying clothing at a store, Purchasing clothing, including
Daily Needs from a catalog or online outerwear and undergarments
RS050 Organization & Keeping personal Having devices charged and

Planning electronic devices in available when needed; Updating
working order (e.g., cell software
phone, computer)
RS051 Health Coping with stress, worry, Evaluating current emotional
Management or anger state; Identifying and using
coping strategies (e.g. taking a
deep breath, taking a break)
RS052 Health Communicating health Identifying questions for health
Management needs and seeking professionals; Understanding
information and services basic health terms; Identifying
as needed problems and potential solutions
RS053 Health Making healthy choices to Exercising regularly; Avoiding
Management maintain health and well- substance abuse or exposure to
being environmental hazards
RS054 Organization & Seeking out and joining a Finding available groups;
Planning club, community Selecting and joining groups or
organization, or other organizations that match interests
social group for fun,
leisure, and social
networking
RS055 Organization & Voting in local and Identifying correct polling location;
Planning national elections Understanding the voting process
and rights; Requesting absentee
ballots as needed
RS057 Staying Safe Using the internet safely Recognizing scams and
inappropriate approaches from
strangers; Avoiding posting
inappropriate images; Evaluating
safety of files before downloading
RS058 Staying Safe Testing and adjusting Ensuring water is a comfortable
water temperature before temperature; Avoiding contact
taking a shower or bath with very hot water
RS059 Organization & Informing home, school, Requesting schedule changes in
Planning or work when he or she advance; Anticipating what
will be late or absent contact information would be
needed in case of emergencies
10/7/2012 57
Responsibility Response Scale:
Respondents are asked to choose one of the following responses for the Responsibility Domain
items.
How much responsibility does your child take for the following activities?
□ Adult/caregiver has full responsibility; the child does not take any responsibility.
□ Adult/caregiver has most responsibility and child takes a little responsibility.
□ Adult/caregiver and child share responsibility about equally.
□ Child has most responsibility with a little direction, supervision or guidance from an
adult/caregiver.
□ Child takes full responsibility without any direction, supervision or guidance from an
adult/caregiver.
10/7/2012 58
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Questionnaire (THAQ): the development, assessment of arm–hand function-related activities in
tetraplegic patients with a spinal cord injury. Spinal Cord. 2004;42:294–301.
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37. Taricco M, Apolone G, Colombo C, Filardo G, Telaro E, Liberati A, for Gruppo Interdisciplinare
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standardized measurement scale. Arch Phys Med Rehabil 2000;81:1173-1180.
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(WeeFIM). Conceptual basis and pilot use in children with developmental disabilities. Clin Pediatr
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40. Young NL, Williams JI, Yoshida KK, Wright JG. Measurement properties of the Activities
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41. Novacheck TF, Stout JL, Tervo R. Reliability and validity of the Gillette Functional
Assessment Questionnaire as an outcome measure in children with walking disabilities. J Pediatr
Orthop. 2000;20:75-81.
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42. Binkley JM Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS):
Scale development measurement properties and clinical application. Phys Ther. 1999;79:371-
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43. Washburn RA, Zhu W, McAuley E, Frogley, M, Figoni SF. The Physical Activity Scale for
Individuals with Physical Disabilities: development and evaluation. Arch Phys Med Rehabil.
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44. Jette AM, McDonough CM, Haley SM, et al. A computer-adaptive disability instrument for
lower extremity osteoarthritis research demonstrated promising breadth, precision, and reliability.
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45. Collen FM Wade DT, Robb GF, Bradshaw CM. The Rivermead Mobility Index: a further
development of the Rivermead Motor Assessment. Int Disabil Studies. 1991;13:50-54.
46. Ulrich D. Test of Gross Motor Development, 2nd Edition. Austin, TX: Pro-ed; 2000.
47. Lambert N, Nihira K, Leland H. AAMR Adaptive Behavior Scale-School (2nd ed.). Austin, TX:
PRO-ED; 1993.
48. Nollan KA, Horn M, Downs AC, Pecora PJ, Bressani RV. Ansell-Casey Life Skills Assessment
(ACLSA) and Life Skills Guidebook Manual. Seattle, WA: Casey Family Programs; 2001.
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Validation of the Caregiver Priorities and Child Health Index of Life with Disabilities. Dev Med
Child Neurol. 2006;48:804–812.
50. Detmar SB, Hosli EJ, Chorus AM, et al. The development and validation of a handicap
questionnaire for children with a chronic illness. Clin Rehabil. 2005;19:73-80.
51. Bruininks RH, Woodcock RW, Weatherman RF, Hill Bk. Scales of Independent Behavior-
Revised (SIB-R). Rolling Meadows, IL: Riverside Publishing; 1996.
52. Sylvia J, Neisworth J, Schmidt M. Responsibility and Independence Scale for Adolescents.
Allen, TX: DLM Inc: 1990.
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10/7/2012 61
PART III. STANDARDIZATION AND TECHNICAL DATA
Chapter 5 Normative Sample
Sampling Method and Demographic Data

Normative data for the PEDI-CAT were collected through the internet. An online panel
(n=115,000) from YouGovPolimetrix (www.polimetrix.com), (Palo Alto, CA) was the sample
source for a sample of 2,205 parents. YouGovPolimetrix operates PollingPoint panel, a panel of
over one million respondents who have provided YouGovPolimetrix with their names, street
addresses, email addresses, and other information, and who regularly participate in online
surveys. Panel members receive modest compensation when they participate in on-line surveys.
The targeted population of interest for the PEDI-CAT was civilian households in the contiguous
United States with children under 21 years of age. Eligibility for participation was determined by
the initial screening questions as detailed below. Children were not eligible for the normative
sample if parents said yes to any of the following:
Ages Birth to 2 years-Compared to other children at the same age, is your child limited in the
kind or amount of play or recreation that he/she can do because of a physical, mental, or
emotional problem? Does your child receive Early Intervention Services because of a physical,
mental, or emotional problem?
Ages 3 to 17 years-Compared to other children at the same age, is your child limited in the kind
or amount of play or recreation that he/she can do because of a physical, mental, or emotional
problem? Does your child receive Special Education Services because of a physical, mental, or
emotional problem? Is your child limited in personal care activities such as eating, bathing,
dressing or getting around inside the home because of a physical, mental, or emotional problem?
Is your child limited in any of the following areas: emotional control, concentration, behavior,
communication, remembering, or being able to get along with people because of a physical,
mental or emotional problem?
Ages 18-20 years-Compared to other children at the same age, is your child limited in the kind or
amount of play or recreation that he/she can do because of a physical, mental, or emotional
problem? Is your child limited in personal care activities such as eating, bathing, dressing or
getting around inside the home because of a physical, mental, or emotional problem? Is your child
limited in any of the following areas: emotional control, concentration, behavior, communication,
remembering, or being able to get along with people because of a physical, mental or emotional
problem? Is your child limited in handing routine needs such as everyday household chores,
doing necessary business, shopping, or getting around for other purposes?
Once eligibility was determined and participation consent obtained, quota sampling based on age
was used to ensure that sufficient cases were collected within each of the PEDI age-based strata
(100 cases in each of the 21 PEDI age strata). Within each age group, equal proportions of
gender were selected and efforts were made to assure that subjects were representative of the
racial and ethnic distribution of the US according to the Year 2000 Census Bureau data. See
Tables 5-1 and 5-2 for specific details on age, gender and demographics of the normative
sample.
A common-item non-equivalent design was used to gather calibration data for the general
population sample (n=2,205). Seventy-six Daily Activities items, 78 Mobility items, 27 Mobility-
device items, 64 Social/Cognitive items and 53 Responsibility Items were tested. Blocks of items
were created to populate 12 parallel on-line survey forms that included: a) 1/3 of the PEDI-CAT
10/7/2012 62
items divided by predicted item difficulty; b) overlapping items across item difficulty splits; and c)
approximately 30 original PEDI items. Each of the forms was also intended for one of three age
groups (0-7 years, 8-14 years, 15-21 years), so that children at the younger and older ages
typically received developmentally appropriate items. No participant responded to more than 175
items, thus reducing respondent burden and ‘domain fatigue’ that may occur when a respondent
is asked too many questions or too many questions about the same concept.
A unique set of cases (n=512, 25% of sample) completed all items from one domain. Table 5-3
presents normative scores for each domain by age year on the 20- 80 criterion scale.
Table 5–1. Normative Sample (n=2205) by Age Year and Gender

Mean Age in Years (SD); Age Range 10.12 (6.07); 0 to 20 years
Age Groups Male n (%) Female n (%) Total

<1 year 48 (46%) 56 (54%) 104
1-2 years 49 (47%) 55 (53%) 104
2-3 years 47 (45%) 57 (55%) 104
3-4 years 56 (54%) 47 (46%) 103
4-5 years 52 (50%) 52 (50%) 104
5-6 years 57 (55%) 46 (45%) 103
6-7 years 49 (49%) 52 (51%) 101
7-8 years 48 (48%) 52 (52%) 100
8-9 years 49 (48%) 54 (52%) 103
9-10 years 54 (52%) 49 (48%) 103
10-11 years 48 (47%) 54 (53% 102
11-12 years 58 (57%) 43 (43%) 101
12-13 years 46 (46%) 54 (54%) 100
13-14 years 47 (47% 53 (53%) 100
14-15 years 68 (53%) 61 (47%) 129
15-16 years 60 (59%) 41 (41%) 101
16-17 years 47 (44%) 59 (56%) 106
17-18 years 71 (61%) 46 (39%) 117
18-19years 60 (54%) 52 (46%) 112
19-20 years 57 (53%) 51 (47%) 108
20-21 years 55 (55%) 45 (45%) 100
1126 (51%) 1079 (49%) 2205
10/7/2012 63
Table 5–2. Normative Sample Demographics (n=2,205)
Child Race* n (%)
White 1438 (65.2)
Black 241 (10.9)
Hispanic 207 (9.4)
Asian 30 (1.4)
Native American 13 (0.6)
Mixed 222 (10.1)
Other 49 (2.2)
Middle Eastern 4 (0.2)
Child Language at home* n (%) English 2145 (97.3)
Child’s Current Placement in School n (%)
Preschool/Early Childhood Program/Kindergarten 294 (13.3)
Elementary/middle/high school 1236 (56.1)
Ungraded 20 (0.9)
Undergraduate/College 196 (8.9)
Not in school 459 (20.8)
Parent/Respondent Education Level* n (%)
No High School 47 (2.1)
High school Graduate 392 (17.8)
Some College 846 (38.4)
College Graduate 573 (26)
Post-Graduate 346 (15.7)
Family income n (%)
< $49,999 743 (33.7)
$50,000 - $99,999 833 (37.8)
≥ $100,000 463 (21)
Prefer not to say 166 (7.5)
*Missing data for one case
10/7/2012 64
Table 5-3. Mean Scaled Scores for Normative Sample by Domain and Age Groups
Daily Activities (DA)

Domain Age Group (years) N Mean SD Minimum Maximum
DA <1 99 36.15 5.45 29.77 45.96
DA >1 and < 2 97 45.67 3.74 36.24 53.84
DA >2 and < 3 100 50.39 4.38 34.39 60.16
DA >3 and < 4 102 53.67 2.74 47.88 60.93
DA > 4 and < 5 99 55.85 3.48 39.22 63.46
DA > 5 and < 6 99 56.54 4.02 41.21 62.98
DA > 6 and < 7 100 58.96 3.65 49.00 70.76
DA > 7 and < 8 99 59.79 4.18 46.88 71.64
DA > 8 and < 9 102 62.10 3.00 56.08 68.61
DA > 9 and < 10 103 63.67 2.93 57.73 70.66
DA > 10 and < 11 102 64.00 3.43 54.73 70.66
DA > 11 and < 12 101 64.93 3.20 57.62 71.64
DA > 12 and < 13 99 66.16 2.79 57.42 71.64
DA > 13 and < 14 99 67.25 2.62 60.27 71.64
DA > 14 and < 15 128 66.66 2.76 59.94 71.64
DA > 15 and < 16 98 67.58 1.83 62.92 71.64
DA > 16 and < 17 104 68.06 1.94 62.60 71.64
DA > 17 and < 18 115 68.03 1.85 62.03 71.64
DA > 18 and < 19 111 68.45 1.80 64.84 71.64
DA > 19 and < 20 107 68.08 1.78 63.96 71.64
DA > 20 and ≤ 21 100 68.21 1.86 63.94 71.64
Mobility (MB)
Domain Age group (years) N Mean SD Minimum Maximum
MB <1 99 44.63 8.28 24.69 55.55
MB >1 and < 2 96 56.21 3.48 42.54 61.97
MB >2 and < 3 99 60.54 3.48 42.06 66.63
MB >3 and < 4 101 63.84 1.84 57.69 68.80
MB > 4 and < 5 97 65.44 2.51 56.88 71.77
MB > 5 and < 6 100 66.71 3.76 55.16 76.76
MB > 6 and < 7 100 68.46 2.94 60.67 74.95
MB > 7 and < 8 98 69.77 3.99 55.19 76.77
MB > 8 and < 9 103 71.34 2.46 66.51 76.77
MB > 9 and < 10 102 72.11 2.12 66.24 76.77
MB > 10 and < 11 101 72.66 2.33 65.28 76.77
MB > 11 and < 12 101 72.80 2.32 66.03 76.77
MB > 12 and < 13 99 73.42 1.93 68.18 76.77
MB > 13 and < 14 98 73.88 1.49 69.96 76.77
MB > 14 and < 15 128 73.64 1.98 66.90 76.77
MB > 15 and < 16 97 75.13 1.31 69.98 76.77
MB > 16 and < 17 102 75.36 1.36 69.61 76.77
MB > 17 and < 18 115 75.15 1.32 70.52 76.77
MB > 18 and < 19 109 75.51 0.85 72.45 76.77
MB > 19 and < 20 106 75.27 1.33 70.07 76.77
MB > 20 and ≤ 21 99 75.09 1.43 69.89 76.77
10/7/2012 65
Social Cognitive (SC)
SC <1 99 44.29 5.71 33.40 56.03
SC >1 and < 2 98 53.17 4.60 36.68 61.28
SC >2 and < 3 100 58.15 4.42 38.64 63.89
SC >3 and < 4 99 62.19 2.16 57.15 66.97
SC > 4 and < 5 99 64.20 2.82 51.84 71.32
SC > 5 and < 6 100 65.52 4.47 47.90 74.01
SC > 6 and < 7 99 68.18 3.23 58.92 77.31
SC > 7 and < 8 97 68.66 4.32 50.24 77.31
SC > 8 and < 9 103 70.39 2.88 65.14 77.31
SC > 9 and < 10 103 71.95 2.60 66.29 77.31
SC > 10 and < 11 101 72.26 2.95 63.71 77.31
SC > 11 and < 12 101 72.75 2.73 66.89 77.31
SC > 12 and < 13 100 73.46 2.85 65.75 77.31
SC > 13 and < 14 100 74.63 2.20 69.09 77.31
SC > 14 and < 15 128 74.34 2.66 65.62 77.31
SC > 15 and < 16 97 74.94 2.08 68.40 77.31
SC > 16 and < 17 103 75.52 1.92 68.90 77.31
SC > 17 and < 18 113 75.55 1.56 71.36 77.31
SC > 18 and < 19 110 75.87 1.46 70.86 77.31
SC > 19 and < 20 107 75.59 1.65 70.02 77.31
SC > 20 and ≤ 21 99 75.67 1.73 69.50 77.31
Responsibility (RS)
RS <1 98 30.41 3.61 24.53 38.20
RS >1 and < 2 101 33.23 4.53 24.53 45.16
RS >2 and < 3 101 37.88 5.31 24.53 47.89
RS >3 and < 4 101 41.60 4.47 29.20 51.08
RS > 4 and < 5 98 44.09 4.15 31.77 53.94
RS > 5 and < 6 101 45.43 4.77 29.22 56.75
RS > 6 and < 7 101 47.47 4.09 32.77 54.56
RS > 7 and < 8 98 48.99 6.71 29.22 75.83
RS > 8 and < 9 102 52.66 3.78 45.63 62.73
RS > 9 and < 10 101 53.26 4.38 40.94 65.18
RS > 10 and < 11 99 54.83 3.99 45.65 65.71
RS > 11 and < 12 99 55.04 3.68 43.18 63.92
RS > 12 and < 13 97 55.99 4.05 45.78 65.96
RS > 13 and < 14 98 58.43 4.10 48.85 68.04
RS > 14 and < 15 126 59.27 5.08 47.72 76.52
RS > 15 and < 16 100 62.09 5.10 50.48 78.57
RS > 16 and < 17 106 64.88 5.45 54.43 78.60
RS > 17 and < 18 117 66.60 6.10 55.30 78.60
RS > 18 and < 19 112 68.99 6.01 54.81 78.60
RS > 19 and < 20 107 70.48 5.25 57.53 78.60
RS > 20 and ≤ 21 100 71.43 4.92 60.46 78.60
10/7/2012 66
Normative Standard Scores (T-scores)
T-scores were derived from the normative sample data by first converting the scores for each age
group into z-scores and then transforming z-scores onto a T-scale with a mean of 50 and a
standard deviation of 10. On this T-scale, approximately 95% of the population is expected to
score between ± 2 SD, or between 30 and 70.
Users of the original PEDI will recognize that this T-score is the same format used for normative
scores in that version.
Reference (Age) Curves

Reference curves for the assessment of age-appropriate function in children were developed
using data from the normative sample (n=2,205). These curves cover a wide age span and are
based on a racially representative sample within the United States. These curves are the source
of the age percentile calculations.
Reference curves for each of the four PEDI-CAT domains were calculated from the quantile
regression model.2 To construct the reference curves, we modeled 7 quantile regression models
(95th, 90th, 75th, 50th, 25th, 10th, and 5th) across four domains separately by gender. As seen in the
following normed reference curve figures, each child’s age percentile is based on the year of age
and gender. Scores are presented in the PEDI-CAT score reports in ranges of <5th percentile, 5th-
25th percentile, 25th-50th percentile, 50-75th percentile, 75th-100th percentile
2
Koenker, R. and Bassett, G. W. (1978), “Regression Quantiles,” Econometrica, 46, 33–50.
10/7/2012 67
Daily Activities-Male
80
70
60
50
Scale Scores
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age(years)
10/7/2012 68
Daily Activities-Female
80
70
60
50
Scale Scores
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age(years)
10/7/2012 69
Mobility-Male
90
80
70
60
Scale Scores
50
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age(years)
10/7/2012 70
Mobility-Female
90
80
70
60
Scale Scores
50
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age(years)
10/7/2012 71
Social/Cognitive-Male
90
80
70
60
Scale Scores
50
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age(years)
10/7/2012 72
Social/Cognitive-Female
90
80
70
60
Scale Scores
50
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age(years)
10/7/2012 73
Responsibility-Male
90
80
70
60
Scale Scores
50
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age(years)
10/7/2012 74
Responsibility-Female
90
80
70
60
Scale Scores
50
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age(years)
10/7/2012 75
Chapter 6 Disability Sample
Sampling Method and Demographic Data

In addition to the national panel of children without disabilities Polimetrix collected data for 617
children with disabilities using the screening questions. If parents reported “yes” to any of the
screening questions, they were placed into the disability sample. (See Chapter 5 for screening
questions). The same opt-in methods were used as for the panel of children without disabilities.
Seventy-six Daily Activities items, 105 Mobility items, 64 Social/Cognitive items and 53
Responsibility items were tested. Participants responded to approximately 25% of all items from
each domain. No more than 175 items were answered by any one respondent.
To further increase the sample size and to create a diverse sample of children with physical
impairments and limitations in mobility, additional participants were recruited through Courage
Centers, Minneapolis, MN and Franciscan Hospital for Children (FHC), Boston, MA (n=86).
Parent respondents from Courage completed the on-line survey using a laptop computer while
their children were receiving outpatient services. Parent respondents from FHC were provided
with a one-time use password to access the survey on-line from a personal computer. De-
identified demographic data and all 105 Mobility item responses were collected and combined
with the responses generated by the Polimetrix sample. (Tables 6-1 through 6-4).
Table 6–1. PEDI-CAT Disability Sample Demographics (n=703, unless specified)

Child Limited in Kind or Amount of Play or Recreation n (% Yes) 350 (49.8)
Child in Special Education or Early Intervention n=590; (% Yes) 379 (64.2)
Child Limited in Personal Care Activities n (%) n=657; (%Yes) 158 (24.0)
Child Limited in Emotional Control, Concentration, etc. n (%) n=662 515 (77.8)
Child Limited in Handing Routine Needs n=80; (% Yes) 40 (50)
Child Race n (%)
White 491 (69.8)
Black 63 (9.0)
Hispanic 63 (9.0)
Asian 13 (1.8)
Native American 7 (1.0)
Mixed 57 (8.1)
Other 7 (1.0)
Middle Eastern 2 (0.3)
Child’s Current Placement in School n (%)
Preschool/Early Childhood Program/Kindergarten 132(13.8)
Elementary/Middle/High school 475 (67.6)
Ungraded 20 (2.8)
Undergraduate/College 20 (2.8)
Type of Class Child Attends at School n (%)
A regular classroom 317 (45.1)
Both regular and special classroom 232 (33.0)
Only special education class 83 (11.8)
Parent/Respondent Education Level n (%)
No High School 58 (8.3)
High School Graduate 141 (20.1)
10/7/2012 76
Some College 260 (37.0)
College Graduate 142 (20.2)
Post-Graduate 97 (13.8)
Family income n (%)
< $49,999 324 (46.1)
$50,000 - $99,999 217 (30.9)
≥ $100,000 116 (16.5)
Prefer not to say 46 (6.5)
Child Language at Home n (%) English 659 (93.7)
Table 6–2. Disability Sample by Age Groups and Gender (n=703)

Mean Age in Years (SD); Age Range 11.67 (4.70); 0 – 20 years
Age Groups (years) Male n (%) Female n (%) Total
<1 year 1 (0.2%) 0 (0%) 1 (0.1%)
1-2 years 2 (0.5%) 4 (1.5%) 6 (0.8%)
2-3 years 5 (1.1%) 10 (3.7%) 15 (2.1%)
3-4 years 4 (0.9%) 7 (2.6%) 11 (1.6%)
4-5 years 13 (3.0%) 11 (4.1%) 24 (3.4%)
5-6 years 14 (3.2%) 7 (2.6%) 21 (3.0%)
6-7 years 20 (4.6%) 12 (4.5%) 32 (4.6%)
7-8 years 20 4.6(%) 13 (4.9%) 33 (4.7%)
8-9 years 35 (8.0%) 9 (3.4%) 44 (6.3%)
9-10 years 31 (7.1%) 17 (6.3%) 48 (6.8%)
10-11 years 34 (7.8%) 20 (7.5%) 54 (7.7%)
11-12 years 29 (6.7%) 14 (5.2%) 43 (6.1%)
12-13 years 36 (8.3%) 20 (7.5%) 56 (8.0%)
13-14 years 36 (8.3%) 21 (7.8%) 57 (8.1%)
14-15 years 28 (6.4%) 8 (3.0%) 36 (5.1%)
15-16 years 32 (7.3%) 19 (7.1%) 51 (7.3%)
16-17 years 28 (6.4%) 17 (6.3%) 45 (6.4%)
17-18 years 32 (7.3%) 17 (6.3%) 49 (7.0%)
18-19years 14 (3.2%) 18 (6.7%) 32 (4.6%)
19-20 years 2 (2.1%) 10 (3.7%) 12 (1.7%)
20-21 years 20 (4.7%) 14 (5.2%) 34 (4.8%)
435 268 703
10/7/2012 77
Table 6–3. PEDI-CAT Disability Sample - Disability as reported by parent respondents
(n=703, >100% due to multiple option selection by respondents)
Developmental delay n (% Yes) 271 (38.5)
Intellectual disability n (% Yes) 73 (10.4)
Hearing impairment n (% Yes) 36 (10.8)
Speech/Language Impairment n (% Yes) 212 (30.2)
Vision impairment n (% Yes) 59 (8.4)
Serious Emotional Disturbance n (% Yes) 91 (12.9)
Orthopedic/Movement Impairment n (% Yes) 68 (9.7)
Autism Spectrum disorder n (% Yes) 114 (16.2)
Attention Deficit Disorder (ADD) n (% Yes) 284 (40.4)
Traumatic Brain Injury n (% Yes) 20 (2.8)
Specific Learning Disability n (% Yes) 92 (13.1)
Health impairment n (% Yes) 80 (11.4)
Multiple Disabilities n (% Yes) 63 (9.0)
Other Impairments/Problem n (% Yes) 125 (17.8)
None of these n (% Yes) 78 (12.6)
Scaled Scores
As in the original Pediatric Evaluation of Disability Inventory (PEDI) criterion-based (scaled)
scores are available for children not expected to exhibit or regain normative levels of functioning.
The scaled scores are based on an estimate of the placement of an individual child along the
hierarchical scale within each domain. The PEDI-CAT scaled scores are currently on a 20 to 80
scale metric. This will allow new items to be added and calibrated to enlarge the item bank and
improve the psychometric properties of the items.
10/7/2012 78
Chapter 7 PEDI-CAT Scales
Overall Scaling Approach

We conducted confirmatory factor analyses (CFA) to check the unidimensionality and local
independence of each of the four PEDI-CAT content domains based on the normative data.
Table 7-1 displays the fit results of the CFAs. Comparative Fit index (CFI), Tucker–Lewis Index
(TLI) and Root Mean Square Error Approximation (RMSEA) were used. CFI and TLI compare the
model to a baseline null model; possible values range from 0 to 1; 0.95 or higher suggests
acceptable fit. RMSEA assesses misfit per degree of freedom; values less than 0.08 suggest an
acceptable fit, whereas values less than 0.05 suggest very good fit.1,2 The results of the CFA
indicate that the PEDI-CAT has four distinct content domains
Table 7–1. Confirmatory Factor Analysis Results

Scale # of items CFI TLI RMSEA
DA 68 .999 .999 .059
MB 75 .988 .992 .088
SC 60 .999 .999 .078
RS 48 .995 .995 .057
PEDI-CAT Final Item Calibration

We combined the normative and disability sample data into a combined set and assessed for Item
Response Theory (IRT) item fit and differential item functioning (DIF) using the two-parameter
logistic Graded Response Model (GRM) with PARSCALE. To test for item fit, we used likelihood
ratio chi-square statistics to test each item based on the comparison of the expected and
observed value across the distribution of the latent variable; a p value less than 0.05 indicated
misfit.3 We also used Residual-Plot program to assess item fit as it provided the item and
category fit plots. We identified item misfit based on whether both the residual plots and chi-
square statistics exceeded standards.4
We examined DIF based on the logistic regression model, and were particularly interested in DIF
between the normative and disability samples. Based on feedback from our content experts, we
retained a few items with DIF between samples or item misfit in cases in which removal of the
item would increase floor or ceiling effect, or the content was felt to be critical to the overall scale.
The Calibration Tables (Tables 7 – 2 through 7 – 5) identify those items retained in the scale with
item misfit or DIF (as indicated by a significant p-value). The final item difficulty calibrations are
presented in order of difficulty (hard item - easy item).
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Table 7-2. Daily Activities
Item No Item Content Difficulty DIF p
DA044 Shaves face using electric or safety razor 0.54 0
DA074 Puts on bra and fastens in front or back 0.011
DA036 Trims fingernails on both hands -0.097 0
DA047 Fastens a necklace or chain -0.098
DA027 Uses a can opener to open a can -0.103
DA049 Trims toenails on both feet -0.119
Opens childproof medicine or vitamin
DA097 containers -0.158
DA026 Chops or slices hard fruits or vegetables -0.165
Replaces (unscrews and screws) the bulb in a
DA094 table lamp -0.177
DA025 Peels foods such as potatoes or carrots -0.192
DA046 Fastens watch band -0.226
DA055 Dries hair with a hair dryer -0.233
DA095 Tightens loose screws using a screwdriver -0.31
DA040 Puts hair up in a ponytail -0.323
DA072 Inserts laces into sneakers or boots -0.424
Cuts with scissors to open hard plastic
DA021 packaging -0.444
DA070 Ties shoelaces -0.452
DA093 Changes pillow case on pillow -0.455
DA075 Puts on tights or pantyhose -0.549
Cuts vegetables or meat with a fork and table
DA011 knife -0.569
DA092 Opens door lock using key -0.626
DA015 Empties food from mixing bowl to baking pan -0.682
DA039 Fastens hairclips or barrettes -0.695
DA013 Pours liquid from a large carton into a glass -0.72
DA096 Puts a bandage on a small cut on hand -0.728
DA054 Obtains shampoo, washes and rinses hair -0.744
DA087 Uses a computer keyboard to type -0.752
DA065 Fastens belt buckle -0.755
DA061 Puts on and buttons a front-buttoning shirt -0.781
Connects and zips zippers that are not
DA069 fastened at the bottom -0.783
DA091 Stacks breakable plates or cups -0.814
DA066 Tucks in shirt or blouse -0.821
DA010 Uses a knife to butter bread and spread jam -0.835
DA064 Puts on and fastens pants -0.861
Wipes self with toilet paper after a bowel
DA079 movement -0.903
DA073 Puts on winter, sport, or work gloves -0.919
DA016 Pulls open a sealed bag of snack food -0.923
DA020 Opens sealed cardboard food boxes -0.945
DA014 Stirs to mix ingredients -0.983
DA084 Operates a video game controller -1.014
DA052 Dries hair with a towel -1.019
DA081 Opens, closes and latches public bathroom -1.021
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stall doors
Puts toothpaste on brush and brushes teeth
DA034 thoroughly -1.023
DA051 Cleans body thoroughly in bath or shower -1.023
DA100 Removes a single bill from wallet -1.035
DA012 Inserts a straw into a juice box -1.094
DA022 Closes a bottle with a twist-off cap -1.107
Uses a computer mouse to click on icons or
DA086 links -1.109
Presses buttons to operate a key-pad such as
DA098 phone or ATM -1.124
DA067 Puts on socks -1.138
DA089 Wipes a counter or table -1.174
DA060 Puts on a t-shirt -1.195
DA083 Uses a TV remote control -1.207
DA019 Removes lid from plastic food containers -1.245
DA030 Wipes nose thoroughly with tissue -1.257
DA031 Turns the water on and off at sink -1.298
DA068 Puts on slip-on shoes -1.344
DA058 Takes off a t-shirt -1.348
DA062 Removes pants with elastic waist -1.524
DA028 Rubs hands together to clean -1.536
DA009 Feeds self with fork (minimal spilling) -1.569
DA006 Holds and eats a sandwich or burger -1.596
DA007 Feeds self with spoon (minimal spilling) -1.686
DA004 Holds and drinks from an open cup or glass -1.759
DA057 Removes socks -1.872
DA008 Drinks liquids using a straw -1.89 0.008
DA003 Finger feeds small or bite-size pieces of food -2.39 0.005
DA002 Swallows pureed/ blended/ strained foods -2.801 0
: Removed Items: DA001, Drinks from bottle or spout cup (held by self or someone else)
DA017, Squeezes plastic bottles to obtain ketchup, syrup, etc.
DA023, Pulls open the tab on a soft drink can
DA024, Unscrews the lid on a tight or new jar
DA041, Shaves legs and underarms using either electric or safety razor
DA48, Puts on deodorant
DA063, Puts on sunglasses or glasses
DA076, Puts on and ties a tie
: Differential Item Function across normative and disability samples. There is no item with DIF in
this domain.
: Item fit: p-value less than 0.05 indicates misfit, otherwise item fit is acceptable.
10/7/2012 81
Table 7-3. Mobility
Walks 50 feet/15 meters while carrying 25
MB130 pound/11 kilogram bag -0.308
MB067 Rides bicycle without training wheels -0.322
Climbs step ladder to put a heavy box on a
MB128 high shelf -0.352
Carries full laundry basket with 2 hands up a
MB083 flight of stairs -0.413 1
MB129 Walks 3 miles/5 kilometers -0.468 0
MB057 Hikes up hill 2-3 miles/3-5 kilometers -0.475
MB097 Moves across monkey bars -0.487 0.006
MB088 Jumps 10 times in a row with a jump rope -0.504
MB132 Runs up 2 flights of stairs -0.613
MB100 Pulls self out of swimming pool not using ladder -0.632 0
MB069 Gets on and off a public bus or school bus -0.715
MB092 Pumps legs and swings on playground swing -0.8
Climbs over 2 foot high obstacle such as a
MB127 baby gate -0.837
MB051 Pushes adult-size shopping cart -0.848
MB099 Climbs out of swimming pool using pool ladder -0.852
Walks and carries a full shopping bag with
MB050 handles -0.863
MB071 Stands while holding on in a moving vehicle -0.867
Walks fast enough to cross two-lane street
MB059 safely -0.882
MB047 Walks while wearing a heavy backpack -0.903
Walks with walking aid several hours at family
or school outing such as zoo, amusement park
MB112D or fair -0.952
Walks several hours at outing such as zoo,
MB058 amusement park or fair -0.988
MB096 Climbs on and off a climbing structure -1.026
Walks down a flight of stairs without holding
MB079 onto handrail -1.028
Walks up and down bleacher steps in gym or
MB076 stadium -1.032
Gets in and out of van, truck or sport utility
MB070 vehicle -1.039
Walks up a flight of stairs without holding onto
MB074 handrail -1.048
MB049 Walks and carries a food tray -1.067
MB098 Climbs indoor step ladder -1.074
MB034 Gets on and off an adult-sized toilet -1.076
MB075 Goes up and down an escalator -1.089
MB135D Walks down a flight of stairs with walking aid -1.12
MB045 Walks and carries a full glass without spilling -1.125
MB066 Rides tricycle -1.138
Using walking aid, gets on and off a public bus
MB134D or school bus -1.151
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MB068 Gets in and out of a car -1.182
MB095 Climbs up ladder of a slide -1.206
MB048 Pulls heavy wagon filled with toys or small child -1.218
MB086 Jumps down off a single step -1.23
MB133D Walks up flight of stairs with a walking aid -1.233
MB120D Goes up and down curbs with wheelchair -1.246
MB042 Opens and closes door to enter and exit home -1.274
MB032 Gets in and out of bathtub -1.278
MB044 Walks on wet, indoor slippery surfaces -1.298
Walks with walking aid on wet, indoor slippery
M107D surfaces -1.302
M046 Walks while wearing a light backpack -1.314
Walks on a raised narrow surface (curb/low
MB055 wall) -1.321
Walks down a flight of stairs holding onto
MB078 handrail -1.33
MB033 Steps in and out of shower stall -1.342
MB017 Stands up from an adult-size chair -1.352
Walks in between a row of auditorium or movie
MB041 theater seats -1.36
MB085 Kicks a rolling ball while standing -1.382
MB077 Walks up a flight of stairs holding onto handrail -1.4
When running, is able to go around people and
MB060 objects -1.437
Gets under sheet or blanket and arranges
MB025 pillows for comfort in bed -1.461 0.045
MB124D Pushes wheelchair for several hours at outing -1.47
MB142D Gets into wheelchair from floor -1.48
MB056 Walks up and down ramp -1.486
MB109D Steps up and down curbs using walking aid -1.516
MB024 Gets in and out of own bed -1.522
MB065 Moves forward on ride-on toys without pedals -1.59
MB138D Moves from wheelchair to adult size chair -1.622
MB054 Steps up and down curbs -1.634
MB019 Sits in an adult-size chair with a back -1.673
MB125 Climbs onto couch or adult-size chair -1.675
Opens and closes door to enter and exit home
MB116D while using wheelchair -1.74
Goes up and down stairs by crawling or
MB072 scooting on bottom -1.746
MB140D Fastens wheelchair seat belt -1.759
When walking, is able to go around people and
MB126 objects -1.791
MB053 Walks outdoors on grass, mulch or gravel -1.795
Walking with walking aid, keeps place in a line
MB104D of moving people -1.819
Walks with walking aid on grass, mulch or
MB108D gravel -1.827
MB031 Stands on tiptoes to reach for something -1.845
MB027 Stands up from the middle of the floor -1.866
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MB038 Walks from room to room in home (no stairs) -1.871
While standing, bends over and picks up
MB035 something from the floor -1.881
MB139D Uses wheelchair to move quickly indoors -1.888
MB036 Squats down and then stands back up -1.924
Uses wheelchair outdoors on grass, mulch or
MB119D gravel -1.965
MB111D Walks with walking aid up and down ramp -2.046
MB141D Puts wheelchair brakes on and off -2.046
MB030 Stands for a few minutes -2.048
MB121D Goes up and down ramp with wheelchair -2.198
MB037 Walks while holding onto furniture or walls -2.3 0
Sits on infant playground swing while swing is
MB090 pushed -2.459
MB009 Gets onto hands and knees -2.489 1
Keeps place in a line of moving people while
MB115D using wheelchair -2.508
Walks with walking aid from room to room in
MB102D home (no stairs) -2.701
Uses wheelchair to move from room to room in
MB113D home -2.732
Lifts one arm overhead and reaches for toy
MB014 while sitting on floor -2.756 1
MB016 Sits on floor without support of pillow or couch. -2.848 1
MB008 When lying on belly, pushes up on hands -2.849 1 0.014
MB012 Sits on floor with pillow for support -3.015
MB006 When lying on back, reaches for toy -3.141 1
MB007 When lying on belly, pushes up on elbows -3.153
MB022 Rolls over in bed or crib -3.282 1
: Removed items: MB63, Length of time child can run
MB04, When lying on belly, holds head up
MB011, Crawls across room with belly not touching floor
MB105D, Opens/closes door to enter/exit home, while walking with walking
aid
MB106D, Using walking aid, walks quickly indoors
MB123D, Tolerates sitting in wheelchair for several hours at family or
school outing such as at zoo, amusement park or fair
MB136D, With walking aid, walks fast enough to cross two-lane street
safely
MB143D, Positions feet on wheelchair footrests
: Differential Item Function across normative and disability samples,’1’ indicates significant DIF.,
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Table 7-4. Social/Cognitive
SC042 Uses a map to plan a route to a new place 0.022
SC045 Follows complex written instructions -0.018
Communicates ideas in a 2-3 page written
SC037 assignment or report -0.073
SC074 Uses a calendar or datebook -0.093
Finds a phone number or address using the
SC043 phone book or computer -0.141
Counts out correct amount of bill/coins to
SC041 pay for a $20-$40 item -0.253
Asks for a change in plans or responsibilities
SC016 in a respectful way -0.265
Writes short notes or sends text messages
SC036 or email -0.304
Uses strategy and follows strict rules while
SC026 playing complex games -0.328
SC014 Uses language appropriate to the situation -0.35 0
Counts out the correct coins to pay for an
SC039 item that costs $1 or less -0.372
SC044 Follows written directions of 2-3 steps -0.391
Uses a watch or clock to be ready for an
SC051 activity -0.402
SC035 Writes a legible 3-4 item list -0.417
SC072 Describes help needed to solve a problem -0.495
Tries to resolve a conflict with friends or
SC031 classmates -0.496
SC076 Explains reasons behind actions -0.504
Provides own address and telephone
SC078 number when asked -0.504
SC033 Prints first and last name legibly -0.525
Maintains friendships that involve give-and-
SC030 take/compromises/loyalty -0.562
SC058 Accepts advice without losing temper -0.575
Works with friends to reach an agreement
SC029 when have different ideas -0.601
Teaches another person a new game or
Understands signs in the community such as
SC040 Restrooms or EXIT -0.674
Attends to/follows direction given by teacher
SC013 while in a group -0.675
Associates days of the week with their
SC048 typical activities -0.676
Checks traffic in both directions and knows
SC063 when to cross street -0.691
Accepts the need to wait an hour or two
SC056 before a request can be met -0.758
Associates a specific time with a specific
SC025 Takes turns and follows rules while playing -0.813
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simple games
Uses the words yesterday/ tomorrow/ today
SC047 correctly -0.819
Asks permission before using someone
SC012 else's property -0.856
SC028 Shows positive reactions to friends' success -0.861 0
Recognizes numbers such as on a clock or
SC038 phone -0.906
SC032 Recognizes his/her printed name -0.994
SC077 Stays quiet in public places when expected -0.995 0.001
SC023 Participates in role-playing activities -1.014
Tries to do things a different way when not
SC073 successful -1.099
Puts together an unfamiliar 5-10 piece
SC066 puzzle -1.104
Follows directions given by adult leader of a
SC011 small group -1.219
Carries on a conversation with a familiar
SC005 person -1.276 1 0
Keeps unsafe objects and household
SC059 materials out of mouth -1.328
SC060 Behaves safely when falling is possible -1.356
Greets new people appropriately when
SC010 introduced -1.358
When upset, responds without punching,
SC057 hitting, or biting -1.373 0.008
Plays with one or more children of the same
SC024 age for several hours -1.397
Asks one or more peers to play using words
SC021 or gestures -1.422 0.032
SC022 Takes turns sharing a favorite toy with peers -1.435
SC002 Uses several words or signs together -1.473
SC004 Uses words or signs to ask questions -1.483
SC068 Builds simple structures from objects -1.513
SC067 Uses toys in simple pretend play -1.654
Transitions from one familiar activity to
SC079 another -1.766
Uses words, gestures or signs to ask for
SC001 something -1.889
Uses single words, gestures or signs to
SC071 show what he/she wants -1.919
SC020 Interacts briefly with a peer during play -2.356 1
SC019 Plays peek-a-boo or pat-a-cake -2.418
Tries to make toys work by pressing,
SC065 pushing, or squeezing -2.54
Follows gaze of another person to look at
SC018 the same place or object -2.6 1
Shows interest in objects held close by
SC064 looking/touching/listening -3.147
: Removed items: SC003, Uses words, gestures, or signs to express feelings
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SC017, Turns head toward familiar people in response to
voice/sight/touch
SC054, Handles stimulating situations for 1-2 hours without losing control
SC055, Accepts changes in routine without losing temper and crying
: Differential Item Function across normative and disability samples: ’1’ indicates significant DIF.
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Table 7-5. Responsibility
Item No Item Difficulty DIF p
RS042 Resolving errors in personal business 0.979
RS037 Paying bills and other accounts on time 0.968
Completing legal and/or other personal
RS039 paperwork 0.912
Organizing important papers and information
RS043 and finding when needed 0.89
RS041 Locating needed services or supports 0.874
Managing routine health appointments and
RS006 related activities 0.754
RS018 Managing food needs for the entire week 0.747
RS055 Voting in local and national elections 0.743
Informing home, school, or work when he or
RS059 she will be late or absent 0.688
Communicating health needs and seeking
RS052 information and services 0.667
Taking precautions to protect the privacy of
RS040 personal information 0.649
Buying clothing at a store, from a catalog or
RS049 online 0.604
RS038 Managing daily expenses 0.497
Taking precautions to avoid STDs and/or
RS034 unwanted pregnancies 0.44 0.02
RS026 Cleaning and caring for clothes 0.425
RS054 Seeking out and joining a social group 0.41
Seeking medical help for serious illness or
RS010 injury when needed 0.362
RS036 Tracking spending and managing money 0.347
Making healthy choices to maintain health
RS053 and well-being 0.33
RS045 Traveling safely within the community 0.319
Using safe food handling practices in the
RS019 kitchen 0.313
Following health and medical treatment
RS008 requirements 0.291
RS009 Taking care of minor health needs 0.22
RS012 Determining the safety of a new location 0.217
RS029 Supervising or caring for another person 0.199 0
RS057 Using the internet safely 0.163
Eating and drinking appropriate foods to
RS007 maintain health and energy 0.16
Planning/following weekly schedule so all
RS004 activities get done 0.152
Choosing and arranging own social
RS013 interactions 0.137
Following recipe instructions that include 3-4
RS015 ingredients/steps 0.127
RS016 Managing kitchen appliances safely 0.089
RS050 Keeping personal electronic devices in 0.068
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working order
Maintaining cleanliness and upkeep of living
RS020 space 0.042
Prioritizing and coordinating multiple goals at
RS028 the same time 0.033 0.03
Developing and following a plan to reach a
RS027 specific goal 0.007
RS033 Managing menstrual cycle 0.003
Using utensils such as knife or grater safely
RS017 during food preparation -0.047
RS002 Keeping track of time throughout the day -0.052
Having all items that will be needed before
RS005 leaving home for the day -0.098
RS051 Coping with stress, worry, or anger -0.163
Packing all the items needed for an overnight
RS048 stay -0.168 0.014
Fixing simple meals that do not involve
RS014 cooking -0.24
RS023 Selecting clothing that is appropriate -0.323
Staying safe in a familiar location that is
RS011 known to be safe -0.336 0
Recognizing when appearance or hygiene
RS025 needs attention -0.342
Testing and adjusting water temperature
RS058 before taking a shower/bath -0.404
RS022 Putting items and objects away after use -0.474
RS001 Getting ready in the morning on time -0.481 0
Managing bowel and bladder through the
RS030 night -1.027 0
RS047 Eating safely without choking or burning self -1.04
RS031 Managing bowel and bladder through the day -1.157 0.003
: Removed items: RS003, Washing hands after using the bathroom
RS044, Length child can be left home alone safely
: Differential Item Function across normative and disability samples. There were no items with
significant DIF item in this domain.
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Item Maps
Item maps provide a convenient method of interpreting a PEDI-CAT score with respect to the
expected level of difficulty of activity items or the child’s amount of responsibility. Each item map
represents a sequential pattern of functional skills consistent with children’s development and
recovery of function and transfer of responsibility from adult to child throughout childhood and
young adulthood.
The item maps represent the location of item ratings along the continuum of difficulty measured in
that domain. Scaled scores are estimates of the placement of an individual child along this
continuum. By drawing a vertical line through the map to the scaled score, one can identify which
item rating the child receiving that score would be expected to obtain. This process is aided by
placing confidence intervals around the individual score: the most likely rating on a particular item
is that falling within the boundaries of the confidence interval or closest to the lower boundary.
When you print the item maps from the Content-Balanced PEDI-CAT, this vertical line is drawn in
the map for you, and the confidence interval around the line is shaded gray.
The following item maps are based on combined data from the normative and disability samples.
Each domain has its own item map with all items presented in hierarchical order along the Y-axis,
though all items may not be answered by the respondent when completing the PEDI-CAT. The
scaled score is along the x-axis while the ratings of 1-4 (Functional Skills item maps) and 1-5
(Responsibility item map) represent the respondent’s response or rating. Item maps are arranged
by content areas within each of the PEDI-CAT domains.
See Appendices for case examples and score reports with completed item maps.
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Daily Activities Item Map
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Mobility Item Map
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Mobility Device Item Map
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Social/Cognitive Item Map
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Responsibility Item Map
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Correlations across PEDI-CAT Domain Scores
Correlations among domain scores of the PEDI-CAT for the total normative sample and the total
sample of children with disabilities are displayed in tables 7-6 and 7-7. As noted in Table 7-6,
there is a high degree of correspondence in the full normative sample across the domains. The
strongest relationship for this sample is between the Daily Activities and Mobility domain scores
while the weakest relationship is that between the Mobility and Responsibility domain scores.
While the correlations for the total disability sample are not as strong as for the normative sample,
they are still moderate to high across all scales. As with the normative sample, the strongest
relationship is between the Daily Activities and Mobility scales, while the weakest relationship is
between the Mobility and Responsibility scales. We know that the Mobility scale encompasses
many skills acquired at a young age, while the Responsibility scale encompasses many items for
older children and young adults.
Table 7-6. Correlations among PEDI-CAT domain scores for the Normative Sample
Daily Social/ Responsibility
Activities Cognitive
Mobility Pearson Correlation .927** .912** .814**
Sig. (2-tailed) .000 .000 .000
N 2198 2197 2198
Daily Pearson Correlation .922** .861**
Activities Sig. (2-tailed) .000 .000
N 2197 2198
Social/ Pearson Correlation .851**
Cognitive Sig. (2-tailed) .000
N 2197
**Correlation is significant at the 0.01 level (2-tailed)
Table 7-7. Correlations among PEDI-CAT domain scores for the Disability Sample
Daily Social/ Responsibility
Activities Cognitive
Mobility Pearson Correlation .809** .685** .596**
Sig. (2-tailed) .000 .000 .000
N 617 617 617
Daily Pearson Correlation .782** .732**
Activities Sig. (2-tailed) .000 .000
N 617 617
Social/ Pearson Correlation .718**
Cognitive Sig. (2-tailed) .000
N 617
**Correlation is significant at the 0.01 level (2-tailed)
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References
1. Cook K, Kallen M, Amtmann D. Having a fit: impact of number of items and distribution of data
on traditional criteria for assessing IRT’s unidimensionality assumption. Qual Life Res.
2009;18:447-460.
2. Reeve BB, Hays RD, Bjorner JB, Cook KF, Crane PK, Teresi JA et al. Psychometric evaluation
and calibration of health-related quality of life item banks: plans for the Patient-Reported
Outcomes Measurement Information System (PROMIS). Med Care 2007;45:S22-31.
3. Muraki E, Bock RD. PARSCALE: IRT Item Analysis and Test Scoring for Rating--Scale Data.
Chicago: Scientific Software International; 1997.
4. Liang T, Han K, Hambleton R. User’s guide for ResidPlots-2: Computer Software for IRT
Graphical Residual Analyses, Version 2.0. Amherst, MA: University of Massachusetts, Center for
Educational Assessment; 2008.
5. Swanson DB, Clauser BE, Case SM, Nungester RJ, Featherman C. Analysis of differential item
functioning (DIF) using hierarchical logistic regression models. J Educ Behav Stat. 2002;27:53-75.
10/7/2012 97
Chapter 8 Psychometric Properties of the PEDI-CAT
Overview of the PEDI-CAT Research Program

CAT procedures aim to achieve a critical balance between the need for score precision (often
achieved by long fixed-length tests) and administration efficiency (often achieved by short
variable-length tests). This balance is particularly difficult to achieve in a single instrument
intended to cover the wide range of skill levels observed across childhood and adolescence. The
adaptive format of a CAT allows a large set of items to be available during the assessment, which
supports greater precision and content coverage, however only the subset of items most
appropriate for the child’s skill level is actually used.1
When we embarked on creating the PEDI-CAT, we undertook a research program to develop

psychometrically sound (highly reliable and valid) item banks and implementation procedures,
and to establish the comparability, and subsequent advantages, of CAT scoring compared to
traditional fixed-length scoring procedures. The initial development of a CAT requires: (1) a large
set of items examining the functional domain of interest; (2) items that scale consistently on a
single dimension from low to high functional achievement; and (3) rules to guide starting,
stopping, and scoring. The items are usually identified through review of similar instruments and
related literature, as well as through discussion with clinicians and families. Based on the
judgment of clinicians and researchers and cognitive testing results, the pool of items is then
reduced to some manageable level prior to pilot testing. In this phase of CAT development an
item may be removed if the wording is ambiguous, has similar content to other items, is biased
against a particular group, or is not relevant to all children.2
IRT methods are used to create hierarchically structured item pools, after which software
algorithms select the items to be administered. In our work all respondents answer the same first
question, which has been selected a priori based on its broad coverage of the range of function.
The response to the first question is used to estimate an initial score and confidence interval (CI)
and guides selection of the second item within the estimated range. The response to this second
item is used to re-estimate the score and the CI. The process continues in an iterative fashion
until the computer algorithm determines that the stopping rule has been satisfied (either a preset
number of items or a minimum CI).
Although appealing in terms of reduced respondent burden, CATs must also meet satisfactory
reliability and validity standards for acceptance in clinical and research applications. Therefore we
undertook studies to examine the score agreement, validity, precision, and response burden of
the CAT tailored approach compared to a full-length assessment format. Two of our earliest
studies of the PEDI self-care, social function and mobility domains established that the CAT
approach offers a valid and viable solution to the long-standing conflict between the need for
accuracy in clinical assessment and the equal need for practicality of administration.3,4
Item Response Theory

Item response theory (IRT) is a family of statistical modeling techniques that permit a detailed
analysis of responses to individual items and how those items relate to one another in a particular
functional domain. In addition IRT provides a means to design assessments with the flexibility of
using all items in an item pool or any subset of items to estimate the performance of individuals
along a functional scale. Item Response Theory methods were used to develop and refine the
item pools for our PEDI-CAT programs.
Item Response Theory and CAT methods assume certain strong measurement properties of item
sets. These include the assumptions of unidimensionality (items measure a single trait) and local
independence (success on one item is not dependent on success on a different item), and item
10/7/2012 98
parameter invariance across groups (e.g., sex or diagnosis). Item sets that violate these
assumptions may be less effective in modeling the latent variable (i.e. the functional construct of
interest) and may limit the accuracy and precision of the score estimates generated by a CAT
assessment.
Unidimensionality
We tested the latent factor structure of items through exploratory (EFA) and confirmatory factor
analysis (CFA) procedures. To maximize the unique variance of common factors, we used the
principal axis method of EFA which is then typically followed by orthogonal and oblique factor
rotations. We also used weighted least squares and variance-adjusted estimation methods for
CFA (using Mplus software), which are more precise when analyzing small to moderate-size
samples with skewed data. Four pieces of evidence were reviewed to determine the extent to
which a unidimensional model adequately represented a construct defining one of the four PEDI
scale domains: (1) the magnitude of the item loadings on the primary factor, the percentage of
variance attributed to the first factor, and the ratio of eigenvalues between the first and second
factors; (2) results from the overall model fit tests; (3) residual correlations between all possible
pairs of items within a construct; and (4) the patterns of inter-item correlations among items. We
retained items with factor loadings greater than 0.4. Item pairs with residual correlations greater
than 0.2 were considered to be locally dependent. Model fit was assessed with the Comparative
Fit Index (CFI), the Tucker-Lewis Index (TLI), and Root Mean Square Error Approximation
(RMSE).1,6
Item calibration, fit, and score estimates

The item parameter calibrations stored within the CAT system were estimated using the two-
parameter IRT Graded Response Model (GRM) but we restricted the slope parameter to a single
fixed constant. This model was selected because of the observation that most of the items had
high, but similar, point-biserial correlations, suggesting that discrimination (i.e. the slope
parameter) did not vary much across items. The item parameter estimates were calculated using
the Parscale software package, which is based on marginal maximum likelihood estimation. We
evaluated item fit using residual plots from the Residual-Plot software and both the likelihood ratio
chi-square statistic from Parscale and the information-weighted mean (the so-called infit statistic)
from the Winsteps software package. A range in infit values of 0.7 to 1.4 is generally deemed
acceptable but investigator experience always plays a role in its interpretation. Individual scale
scores were standardized to a mean of 50 and standard deviation of 10 (T-scale).1
In our efforts to employ the most powerful and sensitive ways to model and report the PEDI data
(both fixed-length and uni-dimensional and multi-dimensional CAT variations), we have employed
numerous variations of Rasch one-parameter unidimensional and multidimensional models and
IRT multi-parameter models, including: one-parameter dichotomous, polytomous rating scale and
partial credit Rasch models; two-parameter dichotomous and polytomous IRT models including
two-parameter Graded Response Model IRT models. In addition we have used various IRT and
statistical analysis software packages including: SPSS, Mplus, WinSteps, Parscale, ConQuest,
Residual-Plot, and our own proprietary code.
Item Invariance
The assumption of item invariance is routinely tested through a differential item function (DIF)
analysis using logistic regression. The criterion variable is the item score and the predictor
variables include background variables (such as diagnosis, age, or sex), the ability level (total test
score), and the background-by-ability interaction. The analytic strategy is to successively add
ability level, background variables, and interaction terms into the model. The model comparisons
are based on the likelihood ratio test. Bonferroni corrected p-values are used for significance
testing and pseudo-R2 change is used to quantify the DIF effect size.5
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Item independence
Local item dependence is determined by calculating the residual correlation between item pairs
after partialling out the variance accounted for by the trait estimate. For each respondent, the
expected value of each item is calculated and then the residual is calculated as the difference
between the observed value and the expected value on each item. The residual correlation then
is the correlation between pairs of item-level residuals across the respondents. Local dependence
is then defined as a residual correlation between item pairs greater than 0.2. 5
Based on the CFAs, the item fit tests and the DIF analyses, we concluded that the final sets of
items are sufficiently unidimensional to meet the assumptions of IRT modeling. To achieve this
result it was necessary to remove a number of items with large misfit from the item bank. For
example, “social dancing” can be accomplished, at a very basic level, by children in wheelchairs,
yet children with high levels of physical functioning may choose not to take part in dancing
activities due to lack of peer acceptance or dislike of the activity. We did keep a few items in the
item bank that exceeded the typical threshold used to highlight DIF or misfit problems. These
items were retained mainly for content. To remove items purely on a statistical basis without
assessing the impact on the content validity and coverage of the scale is, in our view,
undesirable. In the final analysis, our decision to retain items was made both on content and
statistical criteria.1,5
CAT Data Simulations

We based the PEDI-CAT algorithms on software developed at the Health and Disability Research
Institute (HDRI), Boston, Massachusetts. The CAT software includes options for item selection,
score estimation using weighted likelihood procedures, and item administration stop rules based
on either the number of items, level of precision, or both. We used a real data simulation
approach to investigate the merits of CAT. In this approach the complete set of actual item
responses is used to estimate ability, and this estimate then serves as the criterion against which
scores from the CAT are compared. As items are selected for administration in the simulation,
responses are taken from the actual data set. After each response, an estimated score based on
all administered items to that point in the simulation and the score’s associated standard error is
calculated. The selection of the next item is based on the item that can provide the greatest
information at the estimated score. We established specific stop rules based on the number of
items (5, 10, or 15) and did not use precision as the criterion for stop rule decisions. 1
The validity of this real data simulation approach for studying CAT estimated scores assumes that
people respond in much the same way to items regardless of their context; that is, whether items
proceed or follow one another, or whether short or long forms are administered would not
influence a person’s responses to the items. Basically, this is the assumption of independence of
item responses that is made with all common IRT models. In our studies we developed 3 CAT
scores in the simulations to reflect the 3 stop rules based on the number of items (CAT-5, CAT-
10, and CAT-15). These simulated scores were compared with the “gold standard” (i.e., the actual
score estimated by the full item bank).1
In a second series of CAT simulations we conducted Monte Carlo simulations based only on the
item parameters. In this procedure we simulated 100 subjects at each 0.5 logit step from -4 to 4.
We then converted the IRT logit metric to the more conventional PEDI-CAT scoring metric of 20-
80. As in the real data simulations, we contrasted 5-, 10- and 15-item stop-rule versions of the
PEDI-CAT. Using the full-bank score as the reference, we chose the following as evaluation
criteria: the average standard error (level of measurement precision defined as the reciprocal of
the information function), bias (difference between the score estimated from the CAT and the full
item bank), absolute bias (absolute difference of the scores estimated from the CAT and the full
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item bank) and root mean square error (RMSE) (square root of the mean square difference
between the scores estimated from the CAT and the full item bank) at each simulated logit level
We assessed concurrent and discriminant validity to determine whether the score estimates from
the full item bank and the 3 CAT versions produced interchangeable interpretable scores. The
ability of the full item bank and each CAT version (5-, 10-, and 15-item stop rules) to discriminate
between groups of children based on levels of cerebral palsy severity was established by
comparing average scores using one-way analysis-of-variance tests with post hoc comparisons.
Statistically significant Pearson correlations established the concurrent validity between the full
item bank scores and the WeeFIM motor score, and the PedsQL-CP daily activity and school
activity subscales.1
Results
Using real data simulations, the correlations between the three versions of CAT scores and the
true score (score based on all the items) were all 0.95 or higher, even with the 5-item CAT (Table
8-1). The results suggest that although the 15-item CAT was closer to the full item bank scores in
all instances, the differences in correlations between the 10-and 5-item CATs and the full item
banks are relatively small.
Using simulations based on the item parameter estimates with 100 replications, we found that as
the number of administered items increased in the CAT, accuracy and precision improved. In
addition, Figure 8-1 shows that measurement precision is much better, as expected, in the mid-
range of each scale than in the extremes.
We used the simulation study data to assess the extent to which the parents of children in the
normative sample responded differently from parents of children in the disability sample. These
differences were checked at six different age levels for all four domains. Independent means t-
tests were conducted at the alpha =0.05 level of statistical significance.
Differences between the normative and disability groups at all age levels based on the real-data
simulated PEDI-CAT exercises were significant at p < .05 in 22 out of 24 comparisons. (Table 8-
2) It should be noted that the disability sample had relatively few children identified with significant
physical disabilities, which may account for the lack of difference between groups in the youngest
age group on the Mobility scale. Because of the relatively smaller n’s in the younger age groups in
the disability sample, it is also possible that data from subgroups of children with less significant
disability influenced the results.
Results from this particular set of simulations should be interpreted as preliminary evidence of the
discriminant validity of the PEDI-CAT. The results from the prospective field-test study reported in
the next section provide stronger evidence of the sensitivity of the PEDI-CAT to detect known (i.e.
expected) differences between children with and without disabilities as reported by their parents.
In summary, these analyses demonstrated that the newly revised PEDI-CAT has good
unidimensionality and IRT fit; all CATs were accurate and showed small bias except for the 5-item
PEDI-CAT; and the CATs provided extremely good measurement in the middle ranges of all four
dimensions. These findings suggest that the PEDI-CAT, and the 15-item version in particular, can
be used as an accurate measure of function in clinical outcome measurement and clinical trials,
reducing the burden typically placed on both parent respondents and research protocols when full
item banks are administered.
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Table 8-1 Accuracy of the PEDI-CAT Using Simulations
Real Data Simulation Simulations on 100

Random Replications
Correlation Average Average Average Average Diff.

from CAT Diff. Diff. Bias Diff. RMSE vs. All
scores vs. Std Error vs. All Absolute Items
All Items vs. Items Bias vs. All
All Items Items
Daily Activities
5-CAT 0.97 0.25 0.09 0.15 0.09
10-CAT 0.99 0.22 -0.01 0.04 0.01
15-CAT 0.99 0.20 -0.00 0.02 0.00
Mobility
5-CAT 0.95 0.21 0.07 0.14 0.09
10-CAT 0.98 0.19 0.008 0.04 0.02
15-CAT 0.99 0.17 -0.001 0.02 0.01
Social/Cognitive
5-CAT 0.96 0.24 0.18 0.18 0.16
10-CAT 0.98 0.22 -0.01 0.06 0.04
15-CAT 0.99 0.19 0.00 0.03 0.01
Responsibility
5-CAT 0.98 0.31 0.06 0.19 0.21
10-CAT 0.99 0.28 -0.01 0.04 0.03
15-CAT 0.99 0.26 -0.01 0.03 0.01
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Figure 8-1 Comparison of Full Item Bank and RMSE Conditioned on PEDI-CAT Scores
Daily Activities
0.8
0.7
0.6
0.5
RMSE
0.4
0.3
0.2
0.1
0
-3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5
CAT-5 CAT-10 CAT-15 Full item bank
Mobility
0.5
0.4
0.3
RMSE
0.2
0.1
0
-3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1
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Social/Cognitive
1.2
0.8
RMSE
0.6
0.4
0.2
0
-3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5
Responsibility
1.4
1.2
1
RMSE
0.8
0.6
0.4
0.2
0
-3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5 2 2.5 3
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Table 8-2 Discriminant Validity across Age Groups Using Simulated PEDI-CAT Data
Normative Sample Disability Sample
Domain Age Group-years n Mean SD n Mean SD t p
DA 0≤3 413 42.04 9.48 27 46.45 8.82 2.50 0.01
DA 4≤6 308 53.17 6.17 68 51.63 6.17 1.92 0.05
DA 7 ≤ 10 408 60.67 6.06 161 56.70 7.16 6.69 0.00
DA 11 ≤ 13 301 66.51 5.51 137 61.99 7.16 7.22 0.00
DA 14 ≤ 17 332 69.48 4.52 109 63.75 8.38 9.02 0.00
DA 17 ≤ 21 433 71.36 2.27 115 65.80 9.15 11.58 0.00
MB 0≤3 413 48.37 8.38 36 51.92 8.47 0.13 0.20
MB 4≤6 308 58.72 5.91 76 57.04 6.21 2.09 0.04
MB 7 ≤ 10 408 65.71 5.71 178 62.66 7.29 5.29 0.00
MB 11 ≤ 13 301 69.55 4.43 156 62.36 10.64 10.24 0.00
MB 14 ≤ 17 333 71.13 3.94 124 63.74 9.85 11.41 0.00
MB 17 ≤ 21 433 72.21 2.86 130 64.43 11.23 13.16 0.00
SC 0≤3 413 45.71 8.55 27 49.05 9.39 1.98 0.05
SC 4 ≤6 308 57.29 6.26 68 54.99 7.61 2.57 0.01
SC 7 ≤10 408 63.65 5.95 161 59.27 6.68 7.63 0.00
SC 11 ≤ 13 301 68.34 5.11 137 62.29 5.84 11.07 0.00
SC 14 ≤17 336 70.64 5.22 109 64.07 7.72 10.12 0.00
SC 17 ≤ 21 437 72.38 3.33 115 64.48 7.30 16.83 0.00
RS 0≤3 413 34.43 6.29 27 37.73 8.35 2.52 0.01
RS 4≤6 308 43.09 5.15 68 42.68 6.29 0.55 0.58
RS 7 ≤ 10 408 49.79 5.87 161 47.42 7.42 4.01 0.00
RS 11 ≤ 13 301 53.39 4.74 137 51.85 7.11 2.76 0.01
RS 14 ≤ 17 333 58.44 5.77 109 53.91 7.93 6.52 0.00
RS 17 ≤ 21 433 65.45 6.29 115 56.90 8.14 12.13 0.00
Prospective Field Study of the PEDI-CAT

In this final study we assessed discriminant validity (the ability to discriminate between children
with and without disabilities), test-retest reliability, efficiency (administration time), and feasibility
of the four 15-item PEDI-CAT dimensions.9
Sample
A sample of 102 parents (50 children with disabilities and 52 children without disabilities)
participated in this prospective field study. The PEDI-CAT was completed by parents either in the
clinic or at their home on a laptop computer. The time to complete the PEDI-CAT was recorded
internally by the computer. A brief questionnaire asked parents about their perceptions of the
utility and acceptance of the PEDI-CAT immediately following completion of the assessment. A
study coordinator was present to answer any questions. A 25% convenience sub-sample (n=25)
repeated the PEDI-CAT one week to one month later. Parent demographic information is
presented in Table 8-3.
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Table 8-3 Description of Participants in Prospective Field Study
Total Sample Parents/Children Parents/Children Retest
(n=102) with Disabilities* without Sample
(n=50) Disabilities* (n=25)
(n=52)
Respondent Relationship to
Child (n, % mother) 94 (92%) 45 (90%) 49 (94%) 23 (92%)
Respondent Highest Level of
Education:
Some High School 6 (6%) 2 (4%) 4 (8%) 0 (0%)
High School Graduate 8 (8%) 7 (14%) 1 (2%) 2 (8%)
Some College 20 (20%) 11 (22%) 9 (17%) 6 (24%)
College Graduate 47 (46%) 18 (36%) 29 (56%) 10 (40%)
Graduate School 21 (21%) 12 (24%) 9 (17%) 7 (28%)
Respondent Race:
White 81 (79%) 41 (82%) 40 (77%) 19 (76%)
Black/African-American 7 (7%) 1 (2%) 6 (12%) 3 (12%)
Hispanic 5 (5%) 1 (2%) 4 (8%) 2 (8%)
Asian 2 (2%) 0 (0%) 2 (4%)
Native American 1 (1%) 1 (2%) 0 (0%) 0 (0%)
Mixed 2 (2%) 2 (4%) 0 (0%) 0 (0%)
Middle Eastern 4 (4%) 4 (8%) 0 (0%) 0 (0%)
1 (4%)
Child’s Gender (n, % Male) 60 (59%) 34 (68%) 28 (54%) 15 (60%)
Child’s Race:
White 79 (78%) 39 (78%) 38 (76%) 19 (76%)
Black/African-American 7 (7%) 1 (2%) 6 (12%) 3 (12%)
Hispanic 5 (5%) 1 (2%) 4 (8%) 2 (8%)
Asian 3 (3%) 1 (2%) 2 (4%)
Native American 1 (1%) 1 (2%) 0 (0%) 0 (0%)
Mixed 3 (3%) 3 (6%) 0 (0%) 0 (0%)
Middle Eastern 4 (4%) 4 (8%) 0 (0%) 0 (0%)
1 (4%)
Children’s Ages (years) 10.30 (4.64) 10.68 (4.34) 10.44 (4.96) 10.68 (5.16)
(mean, SD) range =3 to range = 3 to 20 range = 3 to 20 range= 3 to
20 years years years 20 years
Children’s Age Groups
(years)
3-5 years 16 (16%) 8 (16%) 8 (15%) 4 (16%)
6-9 years 30 (29%) 14 (28%) 16 (31%) 7 (28%)
10-13 years 28 (28%) 16 (32%) 12 (23%) 6 (24%)
14-17 years 18 (18%) 7 (14%) 11 (21%) 3 (12%)
18-20 years 10 (10%) 5 (10%) 5 (10%) 5 (20%)
Diagnostic Groups:
ADHD N/A 3 (6%) N/A 11 (44%)
Autism Spectrum Disorders 9 (18%)
Cerebral Palsy
Other Genetic/ 27 (54%)
Neuromuscular Disorders 11 (22%)
*No differences between groups.
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Discriminant (Known-Group) Validity
The discriminant validity of PEDI-CAT domains was assessed by comparing the average scores
of children with (N=50) and without (N=52) disabilities. Independent means t-tests with checks on
variance assumptions were performed. The results reported in Table 8-4 show that children with
disabilities had statistically significant lower scores in all four domains than children without
disabilities. This finding is particularly encouraging in the Mobility domain because the number of
children with more severe physical disabilities was small.
Table 8-4 Discriminant (Known-Group) Validity

Normative Group Disability Group t p
Daily Activities 51.2 (6.1) 40.8 (8.4) 7.16 (89.4) <.0001*
Mobility 50.1 (4.7) 37.4 (10.8) 7.64 (66.2) <.0001*
Social/Cognitive 50.9 (4.8) 43.9 (7.7) 5.48 (81.6) <.0001*
Responsibility 50.9 (8.7) 43.2 (7.9) 4.70 (100) <.0001
*: Unequal variance and using Satterthwaite’s approximation to degrees of freedom
Test-Retest Reliability
Test-retest reliability was assessed via intraclass correlations (ICCs) of survey responses
collected one week to one month apart. The average number of days between the initial
assessment and the re-test was 14.92 (SD=7.69). Reliability estimates were very high for all four
domains of the PEDI-CAT (see Table 8-5). These results provide evidence that the PEDI-CAT
scores are stable over time. Thus, there is little measurement error when the PEDI-CAT is
completed by the same respondent within one month. These ICC estimates are also useful
because they may be used to help define Minimal Detectable Changes (MDCs) 10 in our future
work to examine sensitivity and responsiveness.
Table 8-5 Test-Retest Reliability (n=25)

PEDI-CAT Domain ICC(3,1) 95% CI
Daily Activities 0.997 (0.994,0.999)
Mobility 0.986 (0.968,0.994)
Social/Cognitive 0.979 (0.953,0.991)
Responsibility 0.958 (0.908,0.981)
Efficiency
Assessment efficiency was evaluated by examining the time it took parent respondents to
complete the 60 items (15 items in each of the four domains). In addition, we examined what
percentage of participants completed the PEDI-CAT in less than 10, less than 15, and less than
20 minutes. The mean time to complete the full PEDI-CAT for the full sample (n=102) was 12.66
minutes (SD=4.47). The least amount of time needed to complete the full PEDI-CAT was 3.96
minutes and the longest time was 26.68 minutes. The mean time for the re-test sample to
complete the PEDI-CAT a second time dropped slightly to 12.26 minutes (SD=4.65).
Closer examination of the data for each case indicated that the parent respondents with times
greater than the average were those parents who completed the PEDI-CAT in a clinic setting. In
addition, it was noted that some parents needed assistance in using a laptop computer, others
needed assistance reading or interpreting the items, and others chose to engage in conversation
with the study personnel while completing the assessment, which prolonged the completion time.
Feasibility
After they completed the PEDI-CAT, the study coordinator asked the participants four questions
as part of a User Evaluation Survey. Parent respondent feedback regarding item-relevance,
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provision of meaningful information about their own child, willingness to complete a CAT versus a
full-length paper-pencil assessment, and interest in completing a CAT online was collected and
summarized using percentages.
The majority of parent respondents indicated that they would be willing to answer questions about
their child using a CAT versus a paper-pencil assessment. Almost all parents indicated that they
felt they provided meaningful information about their child. However some individual items were
reported as irrelevant, which we believe was due to the forced use of 15 items selected by a
computer algorithm in this version of the PEDI-CAT that did not have an age filter (a modification
added to the final PEDI-CAT). Parents were highly enthusiastic about the Responsibility domain
reporting that the subtle distinctions in this area were particularly useful for older children and
teens.
In summary, the PEDI-CAT demonstrated strong evidence of known-group discriminant validity,

was stable in its score estimates over a month’s separation in re-testing, and was favorably
reviewed by parents who not only completed the computer interface quickly but also reported they
would prefer its use over a traditional fixed format paper-pencil assessment.
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References
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assess physical functioning in children with cerebral palsy I: Lower-extremity and mobility skills.
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Bilodeau N, Hambleton RK, Tucker CA. Evaluation of an item bank for a computerized
adaptive test of activity in children with cerebral palsy. Phys Ther. 2009;89(6):589-600.
3. Coster WJ, Haley SM, Ni P, Dumas HM, Fragala-Pinkham MA. (2008). Assessing self-care and
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Inventory. Arch Phys Med Rehabil. 2008;89:622-629.
4. Haley SM, Raczek AE, Coster WJ, Dumas HM, Fragala-Pinkham MA. (2005). Assessing
mobility in children using a computer adaptive testing version of the Pediatric Evaluation of
Disability Inventory. Arch Phys Med Rehabil. 2005;86:932-939.
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Moed R, Ludlow LH. (2011), Accuracy and precision of the Pediatric Evaluation of Disability
Inventory Computer Adaptive Tests (PEDI-CAT). Dev Med Child Neurol. 2011;53:1100-1106.
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Ludlow LH. Computer adaptive test performance in children with and without disabilities:
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Case Example 1
Fay is a 5 year old girl with cerebral palsy – spastic diplegia. She recently had botulinum toxin
injections (bilateral medial hamstrings, hip adductors and gastrocs) and was referred for
outpatient physical and occupational therapy services. Currently Fay walks with a posterior
rolling walker in her home and in her school classroom with some help and uses a wheelchair
for longer distance mobility. She requires more assistance for ambulation on stairs and on
uneven surfaces. Fay also needs assistance for dressing and self-care activities such as
brushing her teeth, combing her hair, and washing her hands. Fay’s mother feels that her
daughter could probably do more by herself but is not sure how to adapt self-care activities at
home. Her mother would also like her daughter to improve her walking skills. In addition to
recording Fay’s mobility and self-care capabilities in the outpatient hospital setting using
performance-based measures, the physical and occupational therapists are interested in
documenting what she is doing in her home, school and community settings. The therapists
selected the PEDI-CAT as part of the initial evaluation to determine baseline mobility and daily
activity skills and to use this as an outcome measure to look at progress over this episode of
outpatient therapy services. They note that her mobility can be classified as Level III on the
Gross Motor Function Classification System (Walk with a hand-held device on level surfaces
and climb stairs with the assistance of an adult) and her hand function can be classified as
Level II (Handles objects with difficulty; needs help to prepare and/or modify activities) on the
Manual Abilities Classification System. They decide to use the Content-Balanced option of the
PEDI-CAT so that they can use the information obtained on the item maps to assist with
program planning. The Content-Balanced version of the PEDI-CAT Daily Activities and Mobility
Scales administers a balance of items from each of the content areas in the Daily Activities and
Mobility Domain domains. Fay’s mother completed the PEDI-CAT Daily Activities and Mobility
Domains during her initial outpatient evaluation.
Case 1: Notes on Scoring and Interpretation

For normative scores on the Daily Activities Domain, Fay received a T score of 33 and a
percentile score of < 5th (exact percentile 3.7 as recorded on the excel download data file)
suggesting that her skills in the area of Daily Activities are in the low range of normal compared
to other children her age. For the normative scores on the Mobility Domain, Fay received a T
score of 13 and a percentile of <5 suggesting that her functional abilities are much lower than
most children her age. The therapists anticipated that her skills would be in the lower range
compared to other children her age due the effects of cerebral palsy on her upper and lower
extremity movement. The therapists are more interested in Fay’s scaled scores for evaluating
improvements after intervention. They will be using the scaled scores to compare her initial
evaluation scores to monthly retest scores to evaluate her progress. On the initial evaluation for
the Daily Activities Domain, Fay received a scaled score of 50 with a standard error of .59 on
the Content-Balanced version. For the Mobility Domain, she had a scaled score of 53 with a
standard error of .91. On a follow-up assessment, a scaled score of >55 would indicate
improvement in the Mobility Domain for this child. Fay received a Wheelchair scaled score of 52
with a standard error of 1.3 for the manual wheelchair items in the Mobility Domain. The
wheelchair items are scored separately from the other mobility items and normative scores are
not available for this subset of items. On a follow-up assessment, a scaled score of >55 would
indicate improvement on the Wheelchair Score for this child.
Case Example 2
Jim is a 14 year old adolescent with a diagnosis of Down syndrome. Jim was seen in the
outpatient developmental clinic 6 months ago by the developmental pediatrician, occupational
therapist, and speech and language pathologist. Several recommendations were made at that
time and he is being seen again today by the pediatrician and the speech language pathologist
to assess his progress and initiate speech and language outpatient therapy services to improve
his communication skills in his home and community settings. In addition, his parents are
concerned that Jim relies on them for most things and they would like him to start taking more
responsibility at home such as getting himself ready for school in the morning and keeping his
room clean. They request guidance on how to work towards this goal. Jim lives with his parents
and older brothers. He attends public school and has an Individualized Education Plan and
receives special education and related therapy services. He will be starting vocational skills
training in school this year.
The team would like to know more about Jim’s daily living skills such as eating, dressing, and
grooming activities and his ability to move in different environments and basic motor skills.
They decide to administer the Speedy option of the Daily Activities, Mobility Domains of the
PEDI-CAT for this purpose. In addition, the speech and language pathologist would like to know
more about his communication, interaction, safety, behavior, attention, and problem-solving
skills in the context of his home and community environments and the team is also interested in
how much responsibility Jim is taking for managing general life tasks. They ask Jim’s parents to
complete the Social/Cognitive and Responsibility Domains of the PEDI-CAT for this purpose.
The Content-Balanced option of the PEDI-CAT was selected to provide information on his
baseline skills in these two domains and to get a more detailed look at his abilities related to
specific tasks for program planning and goal setting.
Case 2: Notes on Scoring and Interpretation

For this case, the Content-Balanced and Speedy options for the Social/Cognitive and
Responsibility Domains were completed for comparison. For the Social/Cognitive Domain, the
scaled scores for both the Speedy (Scaled Score = 66, Standard Error (SE) = .51) and Content-
Balanced PEDI-CAT (Scaled Score = 66, SE = .78) were the same. The normative scores for
both the Social Cognitive and the Responsibility Domains are in the “less than 5th percentile” or
less than 30 for the T score indicating that his functional abilities are lower than most youth his
age. For the Responsibility Domain, Jim’s scaled score is 49 (SE = 1.18) for the Speedy option
and 47 (SE= .85) for the Content-Balanced option. Note that although the scores are not
identical they are very close and within the margin of error suggested by the standard error
score. In general, with more items, the standard error will decrease since it is easier to estimate
a score with more items. For the Speedy option, 9 items were administered for the
Social/Cognitive Domain and 10 items were administered for the Responsibility Domain. For
the Content-Balanced option, 30 items were administered for each of the domains.
Normative scores on the Daily Activities and Mobility Domains of the PEDI-CAT also indicate
that Jim’s skills in these domains are in the low range compared to other youth his age(T scores
of <30 and percentile <5th). The team will use this information to determine if limitations with
these skills are also impacting his ability to take more responsibility. This information will help
with establishing realistic goals and in determining whether additional services or
accommodations are needed. The scaled scores can also be used to record changes in these
domains that may result from intervention or maturation.
SPANISH TRANSLATION OF THE PEDI-CAT (content area translations)
The PEDI-CAT was translated and is available in Spanish. The Spanish translation was
completed by a translation service and reviewed and back-translated by a bi-lingual Speech-
Language Pathologist and a bi-lingual Occupational Therapist. The translations were then
finalized by a linguistic and cultural expert experienced in providing translation services for
children with disabilities and their families.
Daily Activities (DA) Items (Las Actividades Diarias)
The Daily Activities domain includes 68 items in four content areas: Getting Dressed, Keeping
Clean, Home Tasks, and Eating & Mealtime. Sixty-eight items address basic selfcare and
instrumental activities of daily living such as eating, grooming, dressing, and household
maintenance.

Number
DA002 Eating & Mealtime Traga alimentos en

puré/licuados/colados
DA003 Eating & Mealtime Come con los dedos alimentos

pequeños o del tamaño de un
bocado
DA004 Eating & Mealtime Sostiene y bebe de un vaso o

taza sin tapa
DA006 Eating & Mealtime Sostiene y come un sándwich o

hamburguesa
DA007 Eating & Mealtime Come independientemente con

tenedor (derrama
mínimamente)
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DA008 Eating & Mealtime Bebe líquidos con una
pajilla/sorbete/pitillo
DA009 Eating & Mealtime Come independientemente con

tenedor (derrama
mínimamente)
DA010 Eating & Mealtime Utiliza un cuchillo para untar

manteca y mermelada en el
pan
DA011 Eating & Mealtime Corta verduras o carne con un

tenedor y un cuchillo de mesa
DA012 Eating & Mealtime Coloca una pajilla/sorbete/pitillo

en una caja de jugo
DA013 Eating & Mealtime Vierte líquido de una caja de

cartón grande en un vaso
DA014 Eating & Mealtime Revuelve para mezclar los

ingredientes
9/25/2012 2
DA015 Eating & Mealtime Pasa los alimentos del
recipiente donde los mezcló a
una bandeja para hornear
DA016 Eating & Mealtime Puede abrir una bolsa sellada

de bocadillos/refrigerios
DA019 Eating & Mealtime Quita las tapas de los

recipientes de plástico para
alimentos
DA020 Eating & Mealtime Abre cajas de cartón de

alimentos sellados
DA021 Eating & Mealtime Utiliza tijeras para abrir

paquetes de plástico duro
DA022 Eating & Mealtime Cierra una botella con tapa a

rosca
DA025 Eating & Mealtime Pela alimentos como papas o

zanahorias
9/25/2012 3
DA026 Eating & Mealtime Corta frutas o verduras duras
en trozos pequeños o rodajas
DA027 Eating & Mealtime Utiliza un abrelatas para abrir

una lata
DA028 Keeping Clean Se frota las manos para

limpiarse
DA030 Keeping Clean Se limpia bien la nariz con un

pañuelo de papel
DA031 Keeping Clean Abre y cierra el grifo del

fregadero
DA034 Keeping Clean Coloca pasta dental en el

cepillo y se cepilla bien los
dientes
DA036 Keeping Clean Se corta las uñas de ambas

manos
9/25/2012 4
DA039 Getting Dressed Cierra horquillas/ hebillas o
broches para el cabello
DA040 Getting Dressed Se ata el cabello en una cola

de caballo
DA044 Keeping Clean Se afeita la cara con una

máquina de afeitar eléctrica o
una afeitadora desechable
DA046 Getting Dressed Cierra la correa del reloj de

pulsera
DA047 Getting Dressed Cierra un collar o cadena
DA049 Keeping Clean Se corta las uñas de ambos

pies
DA051 Keeping Clean Se lava el cuerpo

completamente en una bañera
o ducha
9/25/2012 5
DA052 Keeping Clean Se seca el cabello con una
toalla
DA054 Keeping Clean Coge el champú, se lava y

enjuaga el cabello
DA055 Keeping Clean Se seca el cabello con un

secador de cabello
DA057 Getting Dressed Se quita las medias/calcetines
DA058 Getting Dressed Se saca la camiseta.
DA060 Getting Dressed Se pone una camiseta
DA061 Getting Dressed Se pone una camisa con

botones en el frente y la
abotona
9/25/2012 6
DA062 Getting Dressed Se saca los pantalones con
cintura elástica
DA064 Getting Dressed Se pone los pantalones y se los

cierra/abrocha
DA065 Getting Dressed Se abrocha la hebilla del

cinturón
DA066 Getting Dressed Se coloca la camisa o blusa

dentro del pantalón
DA067 Getting Dressed Se pone las medias
DA068 Getting Dressed Se pone mocasines (zapatos

sin cordones)
DA069 Getting Dressed Conecta y cierra cremalleras

que no están fijas en la parte
inferior
9/25/2012 7
DA070 Getting Dressed Se ata los cordones
DA072 Getting Dressed Ensarta los cordones en los

tenis o botas
DA073 Getting Dressed Se pone guantes de invierno,

deportivos o de trabajo
DA074 Getting Dressed Se pone el sostén/brasier y lo

abrocha adelante o atrás
DA075 Getting Dressed Se pone mallas (medias

largas), tights o media pantalón
DA079 Keeping Clean Se limpia solo con papel

higiénico después de haber
evacuado
DA081 Keeping Clean Abre, cierra y traba con cerrojo

las puertas de los baños
públicos
9/25/2012 8
DA083 Home Tasks Utiliza el control remoto para
TV
DA084 Home Tasks Utiliza el teclado de la

computadora para escribir
DA086 Home Tasks Utiliza el mouse de la

computadora para hacer clic
sobre íconos o vínculos
DA087 Home Tasks Utiliza el teclado de la

computadora para escribir
DA089 Home Tasks Limpia un mostrador o mesa

con un paño
DA091 Home Tasks Apila platos y tazas frágiles
DA092 Home Tasks Abre la cerradura de una puerta

con una llave
9/25/2012 9
DA093 Home Tasks Cambia la funda de una
almohada
DA094 Home Tasks Cambia (enrosca y desenrosca)

la bombilla de una lámpara de
mesa
DA095 Home Tasks Ajusta los tornillos flojos con un

destornillador
DA096 Home Tasks Se pone una curita en un

corte/cortada pequeño en la
mano
DA097 Home Tasks Abre recipientes a prueba de

niños con vitaminas o
medicamentos
DA098 Home Tasks Oprime botones de teclados

numéricos, como en un
teléfono o ATM (cajero
automático)
DA100 Home Tasks Extrae un solo billete de la

billetera
9/25/2012 10
Mobility (Movilidad)
The PEDI-CAT Mobility domain addresses five content areas: Basic Movement and Transfers,
Stand and Walk, Steps & Inclines, Run and Play, and Wheelchair. Ninety-seven items address
early mobility and physical functioning activities such as head control, transfers, walking, climbing
stairs, and playground skills, with items specifically for children who use mobility devices such as
walking aids (canes, crutches, walkers) and/or wheelchairs.

Number
MB002 Basic Movement Cuando está acostado

& Transfers boca abajo, gira la
cabeza hacia ambos
lados

& Transfers boca arriba gira la
cabeza hacia ambos
lados

& Transfers boca arriba estira los
brazos para alcanzar
un juguete

& Transfers boca abajo, se levanta
empujando con los
antebrazos

& Transfers boca abajo, utiliza sus
manos para
incorporarse
9/25/2012 11
MB009 Basic Movement Se puede apoyar
& Transfers sobre las manos y
rodillas
MB012 Basic Movement Se sienta en el suelo

& Transfers con la ayuda de una
almohada como
soporte
MB014 Basic Movement Mientras está sentado

& Transfers en el suelo, levanta un
brazo por encima de
la cabeza para
alcanzar un juguete
pequeño
MB016 Basic Movement Se sienta en el suelo

& Transfers sin la ayuda de una
almohada como
soporte o sofá
MB017 Basic Movement Se levanta de una

& Transfers silla para adultos
MB019 Basic Movement Se sienta en una silla

& Transfers para adultos con
respaldo
9/25/2012 12
MB022 Basic Movement Se da vuelta en la
& Transfers cama o en la cuna
MB024 Basic Movement Se sube y baja de su

& Transfers propia cama
MB025 Basic Movement Se mete debajo de las

& Transfers sábanas o mantas y
acomoda la almohada
para estar más
cómodo en la cama
MB027 Basic Movement Se pone de pie en

& Transfers el medio del
suelo/piso
MB030 Standing & Se mantiene de pie

Walking durante unos minutos
MB031 Standing & Se para en puntillas

Walking para tratar de
alcanzar algo
9/25/2012 13
MB32 Basic Movement Entra y sale de la
& Transfers bañera
MB033 Basic Movement Entra y sale de la

& Transfers ducha
MB034 Basic Movement Se sienta y se levanta

& Transfers de un inodoro para
adultos
MB035 Standing & Mientras está de pie,

Walking se agacha y recoge
objetos del suelo
MB036 Standing & Se pone en cuclillas y

Walking luego se vuelve a
poner de pie
MB037 Standing & Camina

Walking sosteniéndose de
muebles o paredes
9/25/2012 14
MB038 Standing & Camina de habitación
Walking en habilitación en su
casa (no escaleras)
MB041 Standing & Camina entre las filas

Walking de un auditorio o entre
los asientos de un
cine
MB042 Standing & Abre y cierra la puerta

Walking para entrar y salir de
su casa
MB044 Standing & Camina sobre

Walking superficies interiores
húmedas y
resbaladizas
MB045 Standing & Camina llevando un

Walking vaso lleno sin
derramarlo
MB046 Standing & Camina llevando una

Walking mochila ligera
9/25/2012 15
Walking mochila pesada
MB048 Standing & Arrastra un carrito

Walking pesado lleno de
juguetes o con un
niño pequeño

Walking bandeja con alimentos
MB050 Standing & Camina cargando una

Walking bolsa con
asas/cargaderas llena
de compras
MB051 Standing & Empuja un carrito de

Walking compras para adultos
MB053 Standing & Camina sobre césped,

Walking mantillo o grava
9/25/2012 16
MB054 Steps & Inclines Sube y baja aceras
MB055 Steps & Inclines Camina sobre una

superficie estrecha y
elevada (acera/murito)
MB056 Steps & Inclines Sube y baja rampas
MB057 Steps & Inclines Sube colinas durante

2 y 3 millas/3 y 5
kilómetros
MB058 Standing & Walks several hours

Walking at family or school
outing such as zoo,
amusement park or
fair
MB059 Standing & Walks fast enough to

Walking cross two-lane street
safely
9/25/2012 17
MB060 Running & Cuando corre logra
Playing pasar alrededor de
personas y objetos
MB065 Running & Moves forward on

Playing ride-on toys without
pedals
MB066 Running & Anda en triciclo

Playing
MB067 Running & Anda en bicicleta sin

Playing ruedas de
entrenamiento
MB068 Basic Movement Sube y baja de un

& Transfers automóvil
MB069 Steps & Inclines Sube y baja de un

autobús público o del
autobús escolar
MB070 Basic Movement Se sube y baja de una

& Transfers furgoneta, camión o
camioneta
9/25/2012 18
MB071 Standing & Viaja de pié sosteniolo
Walking de algo en un vehiculo
en movimiento
(autobús, tren,
tranvía,
bote/transbordador)
MB072 Steps & Inclines Sube y baja escaleras

gateando o sentado
de cola/nalgas
MB074 Steps & Inclines Sube un tramo de

escaleras sin
sostenerse de la
baranda
MB075 Steps & Inclines Sube y baja escaleras

mecánicas
MB076 Steps & Inclines Sube y baja tribunas

en un gimnasio o
estadio

escaleras
sosteniéndose de la
baranda
9/25/2012 19
MB078 Steps & Inclines Baja un tramo de
escaleras
sosteniéndose de la
baranda
MB079 Steps & Inclines Baja un tramo de

escaleras sin
sostenerse de la
baranda

escaleras sosteniendo
con las 2 manos una
cesta llena de ropa
sucia
MB085 Running & Patea una pelota en

Playing movimiento mientras
se encuentra de pie
MB086 Steps & Inclines Salta de un escalón
MB088 Running & Salta la soga 10

Playing veces seguidas
9/25/2012 20
MB090 Basic Movement Se sienta en un
& Transfers columpio del parque
mientras alguien lo
empuja
MB092 Running & Se empuja con las

Playing piernas y se hamaca
en un columpio del
patio de juegos
MB095 Running & Sube la escalera de

Playing un tobogán
MB096 Running & Sube y baja de una

Playing estructura para
escalar
MB097 Running & Se desplaza por las

Playing estructura de barras
para trepar
MB098 Steps & Inclines Sube escaleras

portátiles para
interiores
9/25/2012 21
MB099 Running & Sale de una piscina
Playing utilizando la escalera
MB100 Running & Sale de una piscina

Playing sin utilizar la escalera
MB125 Basic Movement Se sube a un sofá o

& Transfers silla para adultos
MB126 Standing & Cuando camina, logra

Walking girar alrededor de
personas y objetos
MB127 Steps & Inclines Pasa por encima de

obstáculos de más de
2 pies de alto, como
una puerta para
bebés
MB128 Steps & Inclines Sube una escalera de

mano para colocar
una caja pesada en
un estante alto
9/25/2012 22
MB129 Standing & Camina 3 millas/5
Walking kilómetros
MB130 Standing & Camina 50 pies

Walking llevando una bolsa de
25 libras
MB132 Steps & Inclines Sube corriendo 2

tramos de escaleras
MB102D Standing & Camina asistido en

Walking casa (ejemplo,
bastón, muletas,
caminador/andador)
para desplazarse de
cuarto a cuarto (sin
escaleras)
MB104D Standing & Utiliza un dispositivo de
Walking ayuda para caminar
(ejemplo, bastón,
muletas, andador),
mantiene su lugar en una
fila de gente en
movimiento
MB107D Standing & Camina asistido sobre
Walking superficies interiores
húmedas y resbaladizas
(ejemplo, bastón,
muletas,
caminador/andador)
MB108D Standing & Camina asistido sobre el
Walking césped, mantillo o gravilla
(ejemplo, bastón,
muletas,
caminador/andador)
MB109D Steps & Sube y baja aceras

Inclines asistido (ejemplo,
bastón, muletas,
9/25/2012 23
caminador/andador)
MB111D Steps & Sube y baja rampas con

Inclines un dispositivo de ayuda
para caminar (ejemplo,
bastón, muletas,
andador)
MB112D Standing & Camina varias horas
Walking durante salidas familiares
o escolares, como visitas
al zoológico, parque de
diversiones o ferias, con
un dispositivo de ayuda
para caminar (ejemplo,
bastón, muletas,
andador)
MB113D Wheelchair Utiliza una silla de ruedas
para desplazarse de
habitación en habitación
en su casa
MB115D Wheelchair Conserva su lugar en una

fila de gente en
movimiento mientras
utiliza una silla de ruedas
MB116D Wheelchair Abre y cierra la puerta

para entrar y salir de su
casa mientras utiliza una
silla de ruedas
MB119D Wheelchair Se desplaza sobre

césped, mantillo o grava
con una silla de ruedas
MB120D Wheelchair Sube y baja aceras en la

silla de ruedas
9/25/2012 24
MB121D Wheelchair Sube y baja rampas con
una silla de ruedas
MB124D Wheelchair Empuja la silla de ruedas

varias horas durante
salidas familiares o
escolares, como visitas al
zoológico, parque de
diversiones o ferias
MB133D Steps & Sube un tramo de

Inclines escaleras con un
dispositivo de ayuda para
caminar (ejemplo, bastón,
muletas, andador)
MB134D Steps & Sube y baja de un

Inclines autobús público o del
autobús escolar con un
muletas, andador)
MB135D Steps & Baja un tramo de
Inclines escaleras con un
muletas, andador)
MB138D Wheelchair Se pasa de la silla de

ruedas a una silla para
adultos
MB139D Wheelchair Usa la silla de ruedas

dentro de la casa para
desplazarse rápidamente
a responder el teléfono o
el timbre de la puerta
9/25/2012 25
MB140D Wheelchair Ajusta el cinturón de
seguridad de la silla de
ruedas
MB141D Wheelchair Pone y quita los frenos de

la silla de ruedas
MB142D Wheelchair Puede sentarse en la silla

de ruedas desde el suelo
9/25/2012 26
Social Cognitivo
The PEDI CAT Social/Cognitive domain includes 60 items that address communication,
interaction, safety, behavior, play with toys and games, attention, and problem-solving in the four
content areas of Interaction, Communication, Everyday Cognition, and Self Management.
Item Content Area Item

Number
SC001 Communication Utiliza palabras, gestos o señales para pedir algo
SC002 Communication Utiliza varias palabras o señales juntas, por ejemplo “váyase
a casa ahora mismo” y “váyase papi”
SC004 Communication Utiliza palabras o señales para hacer preguntas como
"¿Dónde está mi mamá?" o "¿Qué es eso?"
SC005 Interaction Mantiene una conversación con una persona conocida,
escucha y responde adecuadamente
SC008 Communication Le enseña a otra persona un juego o una actividad nueva por
medio de ejemplos y explicaciones
SC010 Interaction Saluda apropiadamente a las personas nuevas cuando se
las presentan
SC011 Everyday Cognition Sigue las instrucciones dadas por un líder adulto en un grupo
pequeño (de 4 a 5 niños o adolescentes)
SC012 Interaction Pide permiso antes de utilizar las pertenencias de otra
persona
SC013 Everyday Cognition Presta atención y sigue las instrucciones dadas por un
entrenador o maestro en un grupo grande (de 20 a 30 niños
o adolescentes)
SC014 Interaction Utiliza el lenguaje apropiado según la circunstancia, por
ejemplo, lenguaje formal en una entrevista de trabajo o
informal en una reunión con amigos
SC016 Interaction Pide un cambio de planes o de responsabilidades con
respeto, por ejemplo, pide a la maestra que extienda una
fecha límite
SC018 Interaction Sigue la mirada de otra persona para mirar al mismo lugar u
objeto
SC019 Interaction Juega al peek-a-boo (juego que consiste en esconderse y
reaparecer para hacer reír a un bebé) o a pat-a-cake (juego
que consiste en chocar palmas junto con el niño al compás
de una canción infantil)
SC020 Interaction Interactúa brevemente con un compañero durante un juego
SC021 Interaction Invita a uno o más compañeros a jugar mediante palabras o

gestos
SC022 Interaction Se turna con sus compañeros para compartir un juguete
favorito
SC023 Interaction Participa en actividades de roles como jugar a la escuela o
jugar a ser un personaje famoso
9/25/2012 27
SC024 Interaction Juega independientemente con niños de su misma edad
durante varias horas
SC025 Interaction Se turna y sigue las reglas de juegos simples de mesa, de
cartas o video juegos
SC026 Interaction Utiliza estrategias y sigue reglas estrictas de juegos
complejos de mesa, de cartas o video juegos
SC028 Interaction Muestra una reacción positiva ante el logro de un amigo, por
ejemplo, felicita a un compañero por anotar un gol o aprobar
un examen
SC029 Interaction Trabaja con amigos para llegar a un acuerdo cuando tienen
ideas diferentes
SC030 Interaction Mantiene amistades que implican dar y recibir,
comprometerse y ser leal
SC031 Interaction Trata de resolver un conflicto con amigos o compañeros
SC032 Everyday Cognition Reconoce su nombre en letra imprenta
SC033 Everyday Cognition Escribe su nombre y apellido en letra imprenta de manera

legible
SC035 Everyday Cognition Escribe una lista legible de 3 ó 4 elementos
SC036 Communication Escribe notas cortas o envía mensajes de texto o correos

electrónicos
SC037 Everyday Cognition Comunica ideas en una tarea o informe escrito de 2 ó 3
páginas
SC038 Everyday Cognition Reconoce números en un reloj o en un teléfono
SC039 Everyday Cognition Cuenta la cantidad correcta de monedas para pagar por una
compra de $1 o menos
SC040 Everyday Cognition Comprende letreros en la comunidad, por ejemplo, Baño o
SALIDA
SC041 Everyday Cognition Cuenta la cantidad correcta de billetes y/o monedas para
pagar por una compra de entre $20 y $40
SC042 Everyday Cognition Utiliza un mapa para planificar la ruta hacia un lugar nuevo
SC043 Everyday Cognition Busca un número de teléfono o dirección en un directorio

telefónico o en el computador
SC044 Everyday Cognition Sigue instrucciones escritas de 2 ó 3 pasos
SC045 Everyday Cognition Sigue instrucciones escritas complejas, por ejemplo, cómo
instalar un nuevo software en la computadora o terminar un
proyecto escolar
SC047 Communication Utiliza los términos ayer/mañana/hoy correctamente
9/25/2012 28
SC048 Everyday Cognition Asocia los días de la semana con las actividades típicas de
esos días, por ejemplo, práctica de fútbol el día martes,
tareas domésticas el día sábado
SC049 Everyday Cognition Asocia una hora específica con una actividad específica, por
ejemplo, un programa favorito de la tele que comienza a las
3 pm
SC051 Everyday Cognition Utiliza un reloj pulsera o un reloj de pared para prepararse
para una actividad, por ejemplo, para tomar el autobús
escolar o mirar un programa de TV
SC056 Self-Management Acepta el hecho de tener que esperar una o dos horas para
que un pedido pueda ser cumplido
SC057 Self-Management Cuando se enoja, responde sin dar puñetazos, golpear o
morder
SC058 Self-Management Acepta consejos u opiniones de un maestro, un entrenador o
un jefe de buena manera, sin perder la calma
SC059 Self-Management No se lleva objetos peligrosos o materiales de uso doméstico

a la boca
SC060 Self-Management Actúa de manera segura en situaciones con riesgo de
caídas, por ejemplo, en el tobogán del patio de juegos o
cerca de las escaleras
SC063 Everyday Cognition Se fija en el tráfico a ambos lados de la calle y sabe cuando
es apropiado cruzar
SC064 Everyday Cognition Muestra interés en objetos sostenidos cerca mirándolos,
tocándolos o escuchándolos
SC065 Everyday Cognition Presiona, empuja o aprieta los juguetes para que funcionen
SC066 Everyday Cognition Arma un rompecabezas de 5 ó 10 piezas que no ha armado

antes
SC067 Everyday Cognition Utiliza juguetes en juegos de personificación simples, por
ejemplo, acuesta a una muñeca o maneja un camión de
juguete
SC068 Everyday Cognition Construye estructuras simples con objetos, por ejemplo, una
torre o una casa hecha de bloques
SC071 Communication Utiliza palabras sueltas, gestos o señales para indicar lo que
quiere
SC072 Communication Describe qué tipo de ayuda necesita para resolver un
problema, por ejemplo, se acerca al personal de la tienda
para encontrar un artículo o le pide a un amigo que le preste
un libro que necesita para hacer los deberes/tareas
SC073 Everyday Cognition Cambia el modo de hacer las cosas cuando éstas no
resultan, por ejemplo, coloca la pieza del rompecabezas en
otra dirección o toma otro camino en un video juego
SC074 Everyday Cognition Utiliza un calendario o una agenda para registrar y estar al
tanto de citas, deberes o eventos
SC076 Communication Da explicaciones por lo que hace, por ejemplo, por qué gastó
dinero en un artículo en particular
9/25/2012 29
SC077 Self-Management Permanece quieto en lugares públicos cuando la situación
así lo exige
SC078 Communication Proporciona su dirección y su número de teléfono cuando se
le pregunta
SC079 Self-Management Cambia de una actividad familiar a otra, por ejemplo, del
patio de juegos al aula, del baño a la cama
Escala de Respuesta para las actividades diarias, movilidad, y social cognitivo.
Elija qué respuesta describe mejor la capacidad de su hijo para realizar las siguientes
actividades:
□ Le resulta imposible = No puede hacerlo, no sabe cómo hacerlo o es muy pequeño

para hacerlo.
□ Le resulta difícil = Logra hacerlo con mucha ayuda, tiempo o esfuerzo adicional.
□ Le resulta un poco difícil = Logra hacerlo con un poco de ayuda, tiempo o esfuerzo
adicional.
□ Le resulta fácil = Logra hacerlo sin ayuda, tiempo ni esfuerzo adicional, o bien, las
habilidades del niño superan este nivel.
□ No sé.
9/25/2012 30
Responsibility (Responsibilidad)
The PEDI-CAT Responsibility Scale includes 51 items that assess the extent to which a young
person is managing life tasks that enable independent living with items that address daily
schedules and planning, health and hygiene, and cooking and nutrition. The items are organized
into the following four content domains: Organization & Planning, Taking Care of Daily Needs,
Health Management, and Staying Safe.
Item Content Area Item Includes

Number
RS001 Organization & Se prepara en la mañana a Se levanta; se viste; desarolla

Planning tiempo actividades relacionadas con
el aseo personal y la higiene;
desayunar; terminar a tiempo
RS002 Organization & Mantiene noción del tiempo Llega a tiempo a las
Planning durante todo el día actividades y citas
programadas; vuelve a casa
a la hora planeada; termina
una actividad a tiempo para
seguir el horario
RS004 Organization & Planea y segue un programa Identifica qué actividades
Planning semanal a fin de realizar todas deben hacerse durante la
las actividades cuando sea semana; determina cuánto
necesario tiempo se necesitará para
realizar cada actividad y
cuándo se deberán realizar;
lleva a cabo un plan; hace
ajustes necesarios debido a
demoras o eventos
inesperados
RS005 Organization & Cuenta con todo lo que será Determina lo qué será
Planning necesario antes de salir de la necesario (ejemplo, dinero,
casa tareas, teléfono celular,
almuerzo); se asegura de
tener dentro de la mochila,
bolso, etc.
RS006 Health Gestiona citas médicas de rutina Hace y asiste a citas con
Management y actividades relacionadas médicos o dentistas; renueva
las recetas
RS007 Taking Care of Bebe y come alimentos Evita la mala alimentación, el
Daily Needs apropiados para mantenerse exceso de comida y la
saludable y con energía deshidratación; selecciona
alimentos variados
RS008 Health Sigue los requisitos de Toma los medicamentos
Management tratamientos médicos y de salud recetados según las
indicaciones; sigue
restricciones alimenticiass;
cumple con rutinas de
ejercicios y otras rutinas de
tratamiento
9/25/2012 31
RS009 Health Se ocupa de las necesidades Cuida cortes/cortadas y
Management pequeñas de salud quemaduras pequeñas; toma
medicinas de venta sin receta
para la fiebre, gripe y la
influenza cuando sea
necesario
RS010 Health Busca atención médica en caso Reconoce cuándo se
Management de enfermedad o lesiones necesita asistencia médica;
graves cuando sea necesario se comunica con los
profesionales adecuados;
sabe los números telefónicos
de emergencia
RS011 Staying Safe Permanece a salvo en una Evita el contacto con
ubicación familiar que es segura personas extrañas, objetos,
como la casa de un amigo o el comportamientos o
parque local situaciones que puedan ser
peligrosas
RS012 Staying Safe Determina el grado de seguridad Identifica y evita situaciones
de un lugar neuvo como un de posible peligro (ejemplo,
barrio desconocido o un gran calles oscuras, obras en
evento con muchas personas, y construcción, conciertos
responder de manera apropiada llenos de gente); evalúar la
para permanecer a salvo seguridad de una persona
antes de buscar asistencia
(ejemplo, un oficial de policía,
dueño de una tienda)
RS013 Organization & Elige y programar sus propias Planea y se reune con
Planning interacciones sociales amigos; acepta invitaciones a
eventos sociales o invitar a
otras personas; incorporar
planes de eventos sociales
en su horario; programar el
transporte
RS014 Taking Care of Prepara comidas sencillas que Identifica que hay para
Daily Needs no impliquen cocinar, como comer, selecciona los
cereales o un alimentos y utensilios
sándwich/sánduche/emparedado necesarios; en la preparación
de éstos mezcla, verte, etc.
RS015 Taking Care of Sigue una receta o instrucciones Identifica y obtiene los
Daily Needs para cocinar que incluyan entre ingredientes necesarios en
3 y 4 ingredientes y pasos, como las cantidades apropiadas;
los macarrones con queso o desarrolla la receta en el
brownies orden correcto; calcula el
tiempo adecuado para cada
paso
9/25/2012 32
RS016 Taking Care of Maneja en forma segura los Toma medidas de precaución
Daily Needs electrodomésticos como la al usar superficies calientes o
estufa, el microondas o el aparatos eléctricos; controla
lavaplatos automático los electrodomésticos cuando
los está usando; identifica
posibles situaciones de
inseguridad y responde de
manera apropiada a éstas
RS017 Taking Care of Utiliza utensilios como un Toma medidas de precaución
Daily Needs cuchillo o rallador de manera al encontrarse cerca de
segura durante la preparación objetos filosos; evita cortes;
de la comida identifica posibles situaciones
de inseguridad y responde de
manera apropiada a dichas
situaciones
RS018 Taking Care of Administra la necesidad de Compra alimentos en
Daily Needs alimentos para toda la semana supermercados/tiendas o
restaurantes; prepara
comidas cuando las necesita
RS019 Taking Care of Utiliza prácticas seguras de Se lava las manos y limpia
Daily Needs manipulación de alimentos en la bién las superficies, los platos
cocina y los utensilios; desecha
alimentos vencidos o en mal
estado
RS020 Taking Care of Mantene la limpieza y el orden Limpia líquidos derramados y
Daily Needs del espacio donde vive recoge restos de alimentos;
limpia el fregadero y la
bañera; saca la basura;
cambia o reparar artefactos u
objetos rotos
RS022 Organization & Guarda elementos y objetos Sabe dónde se guardan los
Planning después de utilizarlos objetos; organiza las
pertenencias y los objetos a
fin de poder encontrarlos
fácilmente cuando sea
necesario
RS023 Taking Care of Selecciona la vestimenta Identifica normas y
Daily Needs apropiada según el clima, el expectativas de vestimenta
programa diario y las actividades según el evento; busca
información sobre el
pronóstico del tiempo para el
día
9/25/2012 33
RS025 Taking Care of Reconoce cuando la apariencia Limpia las manchas de
Daily Needs o la higiene necesitan atención y suciedad, de comida, y de
toma medidas al respecto otro tipo del cuerpo, la cara y
la ropa; controla el olor
mediante el baño, el cepillado
de los dientes, el uso de
desodorantes y de ropa
limpia; se peina el cabello,
lleva la camisa dentro del
pantalón, arregla la ropa
después de salir del baño
para mantener una buena
apariencia
RS026 Taking Care of Lava y cuida la ropa Determina cuándo la ropa
Daily Needs está sucia; lava la ropa según
las instrucciones de cuidado
de las prendas; plancha la
ropa cuando sea necesario;
se aseguro de contar con
ropa limpia disponible cuando
sea necesario
RS027 Organization & Desarrolla y segue un plan para Identifica un objetivo;
Planning alcanzar un objetivo específico planifica pequeños pasos
(ejemplo, comprar una bicicleta, para conseguirlo; lleva a cabo
ganarse el lugar en un equipo) el plan y lo ajusta según las
necesidades
RS028 Organization & Da prioridad y coordina objetivos
Planning múltiples (ejemplo, mantener
buenas notas y al mismo tiempo
mantener actividades después
de la escuela
RS029 Staying Safe Supervisa o cuida a otra persona Garantiza la seguridad y el
(ejemplo, un hermano u otro bienestar de otra persona;
niño, un abuelo) brinda asistencia a otra
persona cuando sea
necesario
RS030 Taking Care of Controla los intestinos y la vejiga Utiliza el baño o productos
Daily Needs durante la noche para la incontinencia para
evitar accidentes
RS031 Taking Care of Controla los intestinos y la vejiga Utiliza el baño o productos
Daily Needs durante el día para la incontinencia para
evitar accidentes
RS033 Taking Care of Controla el ciclo menstrual Compra o tiene productos de
Daily Needs higiene femenina disponibles;
utiliza productos de higiene
femenina de manera segura
e higiénica
RS034 Health Toma medidas de precaución Se abstiene de mantener
Management para evitar enfermedades de actividad sexual; utiliza
transmisión sexual o embarazos anticonceptivos; consulta con
no deseados un profesional de la salud
9/25/2012 34
RS036 Organization & Hace un seguimiento de los Recuerda o registra el dinero
Planning gastos y administra el dinero gastado; programa un
presupuesto; ahorra dinero
para gastos; reconoce
cuando se ha excedido el
presupuesto y ajusta los
gastos de manera apropiada
RS037 Organization & Paga las facturas y otras Utiliza cheques, dinero en
Planning cuentas a tiempo efectivo, orden de pago o
realiza pagos por el
computador; identifica la
fecha de vencimiento y hace
el pago a tiempo
RS038 Organization & Administra los gastos diarios Prevee eventos o
Planning necesidades para el día y sus
costos; obtiene dinero de un
ATM (cajero automático);
paga con dinero en efectivo,
tarjeta de débito o de crédito
RS039 Organization & Completa trámites legales y/o Solicita una licencia o
Planning personales permiso; llena solicitudes de
seguro o de empleo
RS040 Staying Safe Toma precauciones para Otorga información personal
proteger la privacidad de la (ejemplo, número del Seguro
información personal Social, dirección) sólo cuando
sea apropiado
RS041 Organization & Localiza servicios o asistencia Identifica una necesidad; se
Planning necesarios (ejemplo, encontrar comunica con una persona u
un programa comunitario o una organización que pueda
tienda de reparación). satisfacer esa necesidad
RS042 Organization & Resuelve errores en asuntos Identifica y se comunica con
Planning personales como facturas, las personas adecuadas; se
inscripción y otras cuentas comunica de manera efectiva
para explicar un problema
RS043 Organization & Organiza documentos e Reconoce qué documentos
Planning información importantes y los deben ser guardados
encuentra cuando los necesita (ejemplo, formularios de
impuestos ya completos,
contratos, pasaporte); los
guarda en un lugar seguro
RS045 Staying Safe Viaja seguro dentro la Identifica y segue una ruta
comunidad segura; utilizar métodos de
transporte disponibles
(ejemplo, caminar, conducir,
transporte público)
RS047 Staying Safe Come de manera segura sin Mastica los alimentos de
ahogarse ni quemarse manera adecuada; toma
bocados del tamaño
apropiado; controla la
temperatura de los alimentos;
come despacio
9/25/2012 35
RS048 Taking Care of Empaca todos los elementos Determina qué elementos
Daily Needs necesarios para pasar la noche serán necesarios (ejemplo,
cepillo de dientes, ropa para
el día siguiente); se asegura
de que todos esos elementos
se encuentren dentro del
equipaje, bolso, etc.
RS049 Taking Care of Comprar ropa en una tienda, de Compra ropa, incluida tanto
Daily Needs un catálogo o en línea de calle como ropa interior
RS050 Organization & Mantiene los aparatos Mantiene los aparatos

Planning electrónicos personales en buen cargados y disponibles
estado de funcionamiento cuando sea necesario;
(ejemplo, teléfono celular, actualiza el software
computadora)
RS051 Health Sobrelleva el estrés, las Evalua su estado emocional
Management preocupaciones o la ira actual; identifica y utiliza
estrategias de enfrentamiento
(ejemplo, respirar hondo,
tomar un descanso)
RS052 Health Comunica las necesidades de Identifica preguntas para
Management salud, al igual que busca hacerle al profesional de la
información y servicios según salud; entiende términos
sea necesario básicos de salud; identifica
problemas y posibles
soluciones
RS053 Health Toma decisiones saludables Hace ejercicios con
Management para mantener el bienestar y la regularidad; evita el abuso de
salud drogas o estar expuesto a
peligros del medio ambiente
RS054 Organization & Busca y se inscribe un club, una Encuentra grupos
Planning organización comunitaria u otros disponibles; selecciona y se
grupos sociales, para diversión, une a grupos u
recreación y socialización organizaciones que sean de
su interés
RS055 Organization & Vota en las elecciones locales y Identifica cuál es el lugar
Planning nacionales correcto de votación;
comprende el proceso y los
derechos electorales; solicita
el voto a distancia cuando
sea necesario
RS057 Staying Safe Utiliza Internet de manera Reconoce estafas y
segura acercamientos inadecuados
de parte de personas
extrañas; evita publicar
imágenes inapropiadas;
evalua la seguridad de los
archivos antes de bajarlos
RS058 Staying Safe Prueba y regula la temperatura Se asegra de que el agua
del agua antes de darse una esté a una temperatura
ducha o tomar un baño adecuada; evita el contacto
con agua muy caliente
9/25/2012 36
RS059 Organization & Informa a la familia, la escuela o Solicita cambios en el
Planning al trabajo cuando esté por llegar programa por adelantado;
tarde o no vaya a asistir prevee qué información de
los contactos será necesaria
en caso de emergencia
Responsibilidad:
¿En qué medida su hijo es responsable en las siguientes actividades?
□ El adulto o persona a cargo de su cuidado tiene toda la responsabilidad; el niño no tiene

ninguna responsabilidad.
□ El adulto o persona a cargo de su cuidado tiene la mayor parte de la responsabilidad y el
niño tiene sólo un poco de responsabilidad.
□ Tanto el adulto o persona a cargo de su cuidado como el niño comparten la misma
responsabilidad.
□ El niño tiene la mayor parte de la responsabilidad pero con un poco de instrucción,
supervisión o guía del adulto o persona a cargo de su cuidado.
□ El niño tiene toda la responsabilidad sin ningún tipo de instrucción, supervisión o guía del
adulto o persona a cargo de su cuidado.
9/25/2012 37

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What is the purpose of the PEDI-CAT manual?

What is the purpose of the PEDI-CAT manual?

What are some of the credentials and accomplishments of Dr. Haley?

What are some of the credentials and accomplishments of Dr. Haley?

Senior Authors

Stephen M. Haley PhD, PT, FAPTA

Please note that this manual is updated regularly @ http://www.pedicat.com.

Development, Standardization and Administration

The art work was skillfully accomplished by Reed Gauthier.

PART I. INTRODUCTION, ADMINISTRATION, AND SCORING

Chapter 1 Introduction and Administration

Computer adaptive testing methodology uses a computer interface to administer an assessment

Versions of the PEDI-CAT

Administration of the PEDI-CAT

Qualifications of the Interviewer/Examiner

Training in PEDI-CAT Administration

Instructions for Administration of the PEDI-CAT – Windows Version

Stands up from an adult-size chair.

For example, for this item from the Responsibility domain:

Getting ready in the morning on time

Instructions for Administration of the PEDI-CAT – iPad Application

4. Complete the demographic information – select respondent’s language for administration

Stands up from an adult-size chair.

A Summary Report is available that provides:

A Detailed Assessment Report is also available that provides:

Interpretation of PEDI-CAT Scores

Normative Scores (T-scores and percentile ranges)

PEDI-CAT Domain Reliability SEm

Exporting Score Report Data

Instructions for Exporting Score Report Data to Excel – iPad Application

Original PEDI Functional PEDI-CAT Functional Equation

Mobility Mobility New MB= 0.416 * Old MB + 21.91

Social Function Social/Cognitive New SC=0.458 * Old SF + 31.12

None Responsibility N/A

Chapter 3 Conceptual Model and Relation to Measures of Adaptive Behavior

Relation Between the PEDI-CAT and Measures of Adaptive Behavior

Body function/ Activity Participation

Cultural practices and

Measurement Performance of Management of

PEDI-CAT Functional Responsibility

Responsibility  Adaptive Behavior Scales-School, 2nd ed.(ABS-2)47

Table 4-2. Daily Activities (DA) Items

DA002 Eating & Mealtime Swallows pureed/ blended/

DA003 Eating & Mealtime Finger feeds small or bite-size

DA004 Eating & Mealtime Holds and drinks from an open

DA006 Eating & Mealtime Holds and eats a sandwich or

DA007 Eating & Mealtime Feeds self with spoon (minimal

DA008 Eating & Mealtime Drinks liquids using a straw

DA010 Eating & Mealtime Uses a knife to butter bread

DA011 Eating & Mealtime Cuts vegetables or meat with a

DA012 Eating & Mealtime Inserts a straw into a juice box

DA013 Eating & Mealtime Pours liquid from a large carton

DA014 Eating & Mealtime Stirs to mix ingredients

DA015 Eating & Mealtime Empties food from mixing bowl

DA019 Eating & Mealtime Removes lid from plastic food

DA020 Eating & Mealtime Opens sealed cardboard food

DA021 Home Tasks Cuts with scissors to open hard

DA022 Eating & Mealtime Closes a bottle with a twist-off

DA025 Eating & Mealtime Peels foods such as potatoes