Evaluating the CSAPPA subscales as potential screening instruments for developmental coordination disorder.
ABSTRACT In this study, we assess the potential of three subscales of the Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity (CSAPPA), a measure of generalised self-efficacy, as possible screens for developmental coordination disorder (DCD).
We used the Bruininks-Oseretsky Test of Motor Proficiency short form (BOTMP-SF) to identify probable cases of DCD. We administered the BOTMP-SF and the CSAPPA to 590 children in grades 4-8 from four schools in the Niagara region of Ontario, Canada. We used receiver operator characteristic (ROC) analysis to assess and compare the performance of the subscales and the full instrument.
The area under the receiving operating characteristic curve (AUC), a measure of the overall performance of the test against a diagnostic standard, was good for the full CSAPPA (AUC = 0.81, 95% CI 0.75 to 0.87). The adequacy (AUC = 0.79, 95% CI 0.73 to 0.85) and predilection (AUC = 0.80, 95% CI 0.74 to 0.87) subscales had performance statistically equivalent to the full scale. Since the adequacy subscale is shorter and has good content validity with respect to DCD, we ran additional analyses on this measure. A cut-point of 24 on this subscale gives a sensitivity of 0.86 (95% CI 0.76 to 0.97) and a specificity of 0.47 (95% CI 0.43 to 0.51).
The adequacy subscale of the CSAPPA appears to be equivalent to the full measure for the purposes of screening for DCD. Further research should explore the possibility of adding further criteria to improve the CSAPPA's modest specificity in this role.
- SourceAvailable from: Brent Faught[show abstract] [hide abstract]
ABSTRACT: To validate the Children's Self-Perceptions of Adequacy in, and Predilection for Physical Activity (CSAPPA) scale as a proxy for the BOTMP test in diagnosing DCD. A sample of 209 children (M = 121; F = 87) consented to the BOTMP test, CSAPPA scale, Participation Questionnaire, Léger 20-meter Shuttle Run, and body fat using bioelectric impedance. Receiver Operating Characteristic (ROC) curve analysis and Kappa statistic were used to validate the CSAPPA scale as a predictor for significant clumsiness on the BOTMP test. Prevalence of DCD was.09 +/-.03 of both males and females, all previously undiagnosed. A positive cutoff of < 47 and < 53 for DCD on the CSAPPA scale was identified in male and females, respectively. Both gender cut-offs demonstrated significant agreement (p <.01) with a positive BOTMP test. Males' results indicated a sensitivity and specificity values of.90 (CI =.18) and.89 (CI =.22). Likewise, the female subject cutoff demonstrated high sensitivity [.88 (CI =.05)] and specificity [75 (CI =.09)]. Gender specific analysis of variance (ANOVA) indicated that students identified as clumsy were not significantly different in age or height from their peers, but demonstrated significantly (p <.01) lower self-efficacy, aerobic fitness, and had significantly (p <.01) higher relative body fat. These results held true for both genders. These findings are consistent with the characteristics of children with DCD. These results suggest that the CSAPPA scale is a promising instrument for use in screening children for developmental coordination disorder.Journal of Adolescent Health 05/2004; 34(4):308-13. · 2.97 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Physical activity (PA) is compromised in children and adolescents with Developmental Coordination Disorder (DCD). The purpose of this study was to test a theoretical model linking DCD with 2 factors associated with increased risk for coronary vascular disease: (1) cardio-respiratory fitness (CF), and (2) relative body fat (BF), through physical activity. A cross-sectional design was implemented using 571 elementary school students (313 males, 258 females). Evaluation of body fat using bioelectric impedance, cardio-respiratory fitness using Léger 20-meter Shuttle Run, and physical activity level was determined using the Participation Questionnaire. The short-form version Bruininks-Oseretsky Test of Motor Proficiency was used to verify DCD. We tested to see how much of the association between DCD and factors associated with increased risk for coronary vascular disease (percentage body fat and cardio-respiratory fitness) using multivariate ordinary least squares regression analysis. Regression modeling demonstrated that DCD was associated with increased body fat and low cardio-respiratory fitness. Physical activity was a significant mediator in the DCD-CF relationship. Physical activity was also a mediating factor in the DCD-BF relationship, albeit to a lesser extent. Developmental coordination disorder is related with factors associated with increased risk for coronary vascular disease, including decreased cardio-respiratory fitness and increased body fat through the mediating influence of physical activity in children.Journal of Adolescent Health 12/2005; 37(5):376-80. · 2.97 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: The concept of DAMP (deficits in attention, motor control, and perception) has been in clinical use in Scandinavia for about 20 years. DAMP is diagnosed on the basis of concomitant attention deficit/hyperactivity disorder and developmental coordination disorder in children who do not have severe learning disability or cerebral palsy. In clinically severe form it affects about 1.5% of the general population of school age children; another few per cent are affected by more moderate variants. Boys are overrepresented; girls are currently probably underdiagnosed. There are many comorbid problems/overlapping conditions, including conduct disorder, depression/anxiety, and academic failure. There is a strong link with autism spectrum disorders in severe DAMP. Familial factors and pre- and perinatal risk factors account for much of the variance. Psychosocial risk factors appear to increase the risk of marked psychiatric abnormality in DAMP. Outcome in early adult age was psychosocially poor in one study in almost 60% of unmedicated cases. There are effective interventions available for many of the problems encountered in DAMP.Archives of Disease in Childhood 11/2003; 88(10):904-10. · 3.05 Impact Factor
2007;92;987-991; originally published online 15 Jun 2007; Arch. Dis. Child.
and John Hay
John Cairney, Scott Veldhuizen, Paul Kurdyak, Cheryl Missiuna, Brent E Faught
screening instruments for developmental
Evaluating the CSAPPA subscales as potential
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on 20 October 2009
Evaluating the CSAPPA subscales as potential screening
instruments for developmental coordination disorder
John Cairney, Scott Veldhuizen, Paul Kurdyak, Cheryl Missiuna, Brent E Faught, John Hay
............................................................... ............................................................... .....
See end of article for
Dr John Cairney, Centre for
Addiction and Mental
Health, Health Systems
Research and Consulting
Unit, 33 Russell Street,
Canada M5S 2S1;
Accepted 28 May 2007
Published Online First
15 June 2007
Arch Dis Child 2007;92:987–991. doi: 10.1136/adc.2006.115097
Objective: In this study, we assess the potential of three subscales of the Children’s Self-Perceptions of
Adequacy in and Predilection for Physical Activity (CSAPPA), a measure of generalised self-efficacy, as
possible screens for developmental coordination disorder (DCD).
Design: We used the Bruininks-Oseretsky Test of Motor Proficiency short form (BOTMP-SF) to identify
probable cases of DCD. We administered the BOTMP-SF and the CSAPPA to 590 children in grades 4–8
from four schools in the Niagara region of Ontario, Canada. We used receiver operator characteristic (ROC)
analysis to assess and compare the performance of the subscales and the full instrument.
Results: The area under the receiving operating characteristic curve (AUC), a measure of the overall
performance of the test against a diagnostic standard, was good for the full CSAPPA (AUC=0.81, 95% CI
0.75 to 0.87). The adequacy (AUC=0.79, 95% CI 0.73 to 0.85) and predilection (AUC=0.80, 95% CI 0.74
to 0.87) subscales had performance statistically equivalent to the full scale. Since the adequacy subscale is
shorter and has good content validity with respect to DCD, we ran additional analyses on this measure. A cut-
point of 24 on this subscale gives a sensitivity of 0.86 (95% CI 0.76 to 0.97) and a specificity of 0.47 (95% CI
0.43 to 0.51).
Conclusion: The adequacy subscale of the CSAPPA appears to be equivalent to the full measure for the
purposes of screening for DCD. Further research should explore the possibility of adding further criteria to
improve the CSAPPA’s modest specificity in this role.
ing and is not the result of another psychiatric, neurological or
other medical condition.1DCD is common, with prevalence
estimated at 5–6%.1 2The specific manifestations of the disorder
are varied and pervasive, and include gross and/or fine motor
skill impairment. These problems make day-to-day activities
such as tying shoelaces, writing and participating in activities
such as skipping or basketball extremely difficult. It is not
surprising, therefore, that children with DCD tend to participate
less in social activities than other children, as social activities in
childhood often involve physical activity.3
Despite its relatively high prevalence, most children with
DCD are never diagnosed.3Rather, teachers typically describe
these children as clumsy, awkward or lazy.4However, DCD is
strongly associated with behavioural and emotional pro-
blems,5 6low self-worth,7–9poor perceived competence,9anxi-
ety,9 10depression,11 12bullying8and obesity.13Cairney et al13
recently demonstrated that children with DCD tend not to
participate in physical activities, increasing the likelihood of
overweight/obesity and poor cardiorespiratory fitness.14
If identified early, the physical health and academic and
emotional needs of affected children can be addressed and
negative experiences prevented.15 16The potential for improved
quality of life justifies efforts to screen for and identify children
with DCD in non-clinical settings.17However, existing screening
measures are based either on parent18or teacher19reporting of
motor coordination difficulties. To date, child self-report
measures have not been available.
Previous work has examined the possibility that the
Children’s Self-Perceptions of Adequacy in and Predilection
for Physical Activity scale (CSAPPA) may be useful as a
screening instrument for DCD in children aged 9–14.3 17When
evelopmental coordination disorder (DCD) is charac-
terised by poor motor proficiency that results in a
significant impairment in social and academic function-
Bruininks-Oseretsky Test of Motor Proficiency short form
(BOTMP-SF),20sensitivity and specificity for boys (0.90 and
0.89, respectively) and girls (0.88 and 0.75, respectively) on the
CSAPPA were moderate to high. The advantages of the CSAPPA
over motor testing are: i) it can be administered to children in
groups in 15–20 min (unlike motor testing, which is adminis-
tered individually); ii) it is easy to score; and iii) it can be
administered by teachers or research personnel. However, there
are instances where the 19-item CSAPPA measure is too
demanding and a shorter screening instrument is required. In
clinical settings, brief and effective screening instruments are
preferable. Moreover, in population-based studies, where
multiple measures are being administered in a single survey,
a premium is placed on shorter instruments that require little
time to complete.
The 19-item CSAPPA is composed of three subscales: i)
perceived adequacy (seven items); ii) predilection toward
physical activity (nine items); and iii) enjoyment of physical
education class (three items).21The purpose of this study was to
compare the CSAPPA with a standardised measure of motor
proficiency which is often used to identify children with DCD
and to evaluate the three CSAPPA subscales as possible short-
form screens for DCD.
The study involved a cross-sectional investigation of students in
grades 4–8 from five elementary schools in the Niagara region
of Ontario, Canada. Data collection within the school board was
not randomised, but attention was given to the selection of
Abbreviations: AUC, area under the curve; BOTMP-SF, Bruininks-
Oseretsky Test of Motor Proficiency short form; CSAPPA, Children’s Self-
Perceptions of Adequacy in and Predilection for Physical Activity; DCD,
developmental coordination disorder; ROC, receiver operator
on 20 October 2009
schools to ensure that the participants represented the socio-
economic, ethnic and urban/rural mix that occurs in the general
Canadian population.22Eighteen children with pre-existing
physical limitations and eight children with learning disorders
were excluded from all analyses. From a potential 929 students,
590 children (322 males, 268 females; 63.6% response)
provided informed consent and participated in the study.
Following a listwise deletion of cases with missing values, the
total sample size was 546. Both the Brock University Research
Ethics Board and the District School Board of Niagara Research
Ethics Committee approved the protocol for this study.
Informed consent was obtained from the parents of each child.
Developmental coordination disorder (DCD)
Children’s motor proficiency was evaluated using the BOTMP-
SF.20This test examines the full scope of motor proficiency
using selected items from the full scale. The short form takes
30 min to complete, as opposed to 2 h for the full version, and
has been validated against the full scale, with correlations of
between 0.90 and 0.91 for children in the 8–14-year age range.20
While not providing an in-depth analysis of each aspect of
motor proficiency, it provides an assessment of general motor
functioning.23 24In this study, the BOTMP-SF was individually
administered by a trained research assistant to each consenting
child behind a curtained barrier in the school’s gymnasium. The
BOTMP-SF examiner was blind to the results of the CSAPPA
scale. A BOTMP-SF standard score (age adjusted) below 38,
which is at or below the 10th percentile rank on the BOTMP-
SF, was used to identify cases of ‘‘probable DCD’’. We use the
term probable DCD as no formal diagnosis was established by a
physician. Table 1 outlines the complete DSM-IV case
identification criteria for DCD and the assessment protocol
used in this study. This assessment protocol for probable DCD
(pDCD) has been used in previous studies.13 23 25–28
The CSAPPA is a 19-item scale designed to measure children’s
perceptions of their adequacy in performing, and their like-
lihood of selecting, physically active games or sports.21The scale
employs a structured alternative choice format. Children are
asked to choose the option that best describes them from pairs
of statements such as ‘‘some kids are among the last to be
chosen for active games’’ and ‘‘other kids are usually picked to
play first’’ by indicating whether the selected sentence was
either ‘‘sort of true for me’’ or ‘‘really true for me’’. Hay21 29
designed the CSAPPA scale for 9–16-year-old children; it has
demonstrated a high test–retest reliability (r=0.84–0.90) as
well as strong predictive and construct validity.17 21 29With
regard to construct validity, the CSAPPA is significantly
correlated with aerobic fitness, physical activity, anthropometry
and motor proficiency.21 29 30The internal consistencies for each
factor are: adequacy, a=0.83; predilection, a=0.83; and
enjoyment, a=0.86. The CSAPPA and its component scales
are scored such that higher scores reflect greater self-efficacy
Receiver operator characteristic (ROC) curve techniques were
used to assess performance of the CSAPPA and its three
subscales (fig 1). In a medical context, ROC curves provide a
graphical and numerical means of assessing the ability of a test
to discriminate between people with and without a condition of
interest. The larger the area under the ROC curve (AUC), the
more potent the diagnostic ability of the test. The AUC is equal
to the probability that a randomly selected case will have a
higher score than a randomly selected non-case. The accuracy
of tests with AUCs of between 0.50 and 0.70 is considered low;
between 0.70 and 0.90, moderate; and over 0.90, high.31
In the first stage of the analysis, we plotted ROC curves for
the full CSAPPA and each of its three subscales, and calculated
AUCs for each. Given previous evidence of gender differences in
DCD,17 26we then tested for differential performance in male
and females subsamples by comparing AUCs calculated for
each group separately. To determine whether the performance
of each subscale differed from that of the full CSAPPA, we then
performed pairwise tests comparing the AUC of each subscale
to that of the full instrument. On the evidence of the preceding
analyses, we selected the adequacy subscale as the best
candidate for a short-form DCD screen and calculated
sensitivity, specificity, and positive and negative predictive
values for each of its potential cut-points. Because some
confidence intervals would otherwise have overlapped 0 or 1,
these were calculated using the Wilson score method.32We then
identified a cut-point suitable for screening purposes; as the
first aim of a screen should be to retain true positives for further
assessment, we gave most weight to sensitivity in making this
selection. All analyses were performed using the roctab,
roccomp, rocfit and rocgold procedures in Stata 8.0.33
A total of 590 students participated in this study (table 2). The
proportion of students scoring below our cut-point for probable
DCD was 7.5% (95% CI 5.4% to 9.6%). Although somewhat
more common among females (9.4%, 95% CI 5.9% to 13.0%)
than males (5.9%, 95% CI 3.3% to 8.5%) in this sample, this
difference was not significant (x22.6, df=1, p=0.11). Age did
not differ significantly between students with and without
probable DCD (t=0.09, df=584, p=0.93).
AUC values (table 3) were in the moderate range for the full
CSAPPA and for the predilection and adequacy subscales, while
that for the enjoyment factor was considerably lower. Formal
tests for differences between the AUCs revealed that this
difference was significant, while performance of the other three
scales was equivalent.
Since the use of the empirical method of ROC analysis may
bias the performance of short instruments downwards, we also
fit an ROC curve for the enjoyment subscale (which includes
only three items) using the binormal method.34This approach
DSM-IV case identification criteria for developmental disorder
DSM-IV criteriaAssessment protocols
A. Significant motor impairment below the age-expected norms
B. Motor impairment must significantly interfere with academic achievement or activities
of daily living
C. The condition cannot be due to other known conditions (eg, cerebral palsy,
muscular dystrophy, hemiplegia or pervasive developmental delay)
D. If mental disability is present, motor impairments must be below the norm
(age appropriate) expected for these children
BOTMP-SF used to screen for significant motor impairment
Not assessed in this study, which is common in DCD literature
Children with known disabilities were excluded from analyses
No children with mental disability were present in the sample
988 Cairney, Veldhuizen, Kurdyak, et al
on 20 October 2009
resulted in an estimated AUC of 0.71, which, while marginally
higher than the original estimate, is still well below those of the
other subscales and the full instrument.
To be consistent with previous work,17we also tested each of
the four scales for evidence of differential performance on male
and female subsamples by comparing AUCs calculated for each
group separately. Our examination of gender differences in
performance revealed no statistically significant differences for
any of the four scales.
As the performance of the predilection and adequacy factors
was very similar to that of the full scale, we selected the
adequacy subscale for further analyses. This decision was based
on its brevity (the adequacy scale includes seven items,
predilection includes nine) and on theoretical considerations,
self-reported adequacy in physical activity seeming more closely
related to possible movement disorder than predilection.
Sensitivity was reasonable (.0.80) for adequacy scores from
22 to 28. In this part of the scale, specificity ranges from 0.10 to
0.64 (table 4). Children scoring below 24 might be considered
for further testing, as this would eliminate 47% (specificity;
95% CI 0.43 to 0.51) of those without DCD while retaining 86%
(sensitivity; 95% CI 0.76 to 0.97) of those with it. Due to the
modest specificity and low prevalence, however, the positive
predictive value at this point of the scale is only 0.12 (95% CI
0.09 to 0.16).
Since there may be circumstances where a different trade-off
between sensitivity and specificity is preferable, the full range
of values is provided (table 4). For the full scale, a cut-off of 63
corresponds to a sensitivity of 0.91 (95% CI 0.78 to 0.96) and a
specificity of 0.53 (95% CI 0.49 to 0.57).
The ability of the CSAPPA and its subscales to detect cases of
DCD is moderate31when caseness criteria are set to include
children with mild to moderate impairment. While a higher
level of agreement would be desirable, DCD is difficult to detect,
in part due to its heterogeneous nature.35Until the clinical
criteria and nature of this condition are more clearly defined,
the development of highly accurate screening tools with
excellent sensitivity and specificity will be difficult. In light of
these considerations, the instrument’s ease of administration
and its usefulness for other purposes, the CSAPPA performs
well. Its ability to identify cases of DCD in a community setting
is comparable to that of the Developmental Coordination
Disorder Questionnaire, a dedicated parent report instrument.16
Results in the present study, however, are not wholly in
agreement with those previously reported17; in particular, our
estimates of sensitivity and specificity, and the optimal cut-
point on the scale, are different. This is surprising, since both
samples were derived from schools in the same geographical
area and the measures are identical to those used in the original
study. The likeliest explanation is that the relatively small
sample size in the previous study is responsible. After
stratification by gender, there appear to have been no more
than 11 cases of DCD in each group, which suggests large
confidence intervals for sensitivity. Thus, the difference
between the original estimate and the one in this study is
likely to be within the bounds of statistical error.
ROC curves for CSAPPA instrument and subscales.
Enjoyment of physical education
between the full instrument and each subscale
AUCs for all scales and tests for differences
AUC (95% CI)
0.81 (0.75 to 0.87)
0.79 (0.73 to 0.85)
0.69 (0.61 to 0.78)
0.80 (0.74 to 0.87)
CSAPPA subscales as potential screening instruments989
on 20 October 2009
The CSAPPA adequacy and predilection subscales appear to
be good candidates for short screening instruments. There is no
significant degradation of performance when either of these are
used instead of the full CSAPPA. However, on all scales,
specificity is modest at high levels of sensitivity. High sensitivity
and low or moderate specificity means that true cases will be
accompanied by a relatively high number of false positives. This
is typical for screening tools that are intended for use in a two-
stage detection process; their function is simply to exclude a
large proportion of the true negatives before the administration
of further assessment. As they are brief instruments with
reasonable sensitivity, subscales of the CSAPPA could be useful
in such a process. The second stage could involve a brief clinical
interview of parents, or follow-up with another instrument,
such as the DCD-Q,16 23to determine the impact of motor
coordination problems on everyday activities, followed by a
Assessment Battery for Children18or the BOTMP.20The high
proportion of false positives does, however, limit the usefulness
of the CSAPPA when used alone. At the cut-off we suggest only
12% of those screening positive will have DCD. While this
represents a considerable saving over testing all children, it also
indicates that a low CSAPPA or adequacy subscale score must
be supplemented by other evidence of movement disorder. In a
screening context, this is supplied by the second stage of case
ascertainment. In a clinical setting, however, the CSAPPA
should be considered as one piece of evidence among others;
when combined with a known prior probability in this way, it
will be considerably more informative.
A strength of the CSAPPA is that it has uses beyond
screening for DCD. A child’s low self-assessment of adequacy in
physical activity is problematic in itself, and may be useful in
identifying other difficulties or risk factors for inactivity and
obesity. The CSAPPA as a whole can help identify children who
dislike physical activity, or think they are poor at it, and may
suggest interventions by providing information on specific
areas of difficulty.
Finally, it is important to note that, unlike false positives on
instruments intended to diagnose serious disorders such as
cancer or HIV, the burden associated with a false positive screen
for DCD, if reported appropriately, is likely to be minor, and is
unlikely to concern children or parents in the absence of other
evidence for movement problems. In contrast, missing cases of
DCD may have serious consequences. While the disorder is not
well understood, the symptoms are noticeable to those around
suchas the Movement
the child, and the consequences significant. Most children with
DCD, and their parents, are aware of their motor problems.36In
the absence of a diagnosis, parents are left with little leverage in
advocating for their child.36Lacking a diagnosis, children and
their parents may believe that the condition can be outgrown,
or alleviated by behavioural change (if the child just tries
harder or pays more attention to what he/she is doing), views
that are clearly erroneous.36Recognition of the daily struggles of
these children is critical to prevention of deterioration in self-
In clinics that handle referrals for paediatric developmental
problems, the full CSAPPA may actually be more useful than
the results presented here suggest, since the prevalence of DCD
in this population will be considerably higher than in the
general population. Positive predictive values are dependent on
the background prevalence of the disorder; when the disorder is
rare, most positive results are likely to be false.37–39In
populations where a larger number of positive cases are to be
expected, a larger proportion of children screening positive will
actually have the disorder. Alternate cut-offs may be required
for this purpose, however, since children in a clinical sample
would likely score lower on the scale than children from a
general population sample.
Further work in this area should also explore triangulation
methodologies, where more than one screening instrument is
used to maximise sensitivity and specificity. The DCD-Q, for
example, is a parent-completed questionnaire designed to
screen for DCD cases.16 23Using both the CSAPPA scales and
the DCD-Q for parents may significantly improve case detection
in a field setting. It would also be useful to compare the multi-
method approach across different samples (child versus
teacher-reported versus parent reported motor proficiency).
Finally, as with any study, there are limitations that need to
be considered when interpreting the results. Most notably, as
mentioned earlier, our cases of DCD are ‘‘probable’’ because we
did not use a clinical assessment using the full DSM-IV criteria1
to assess caseness. In the absence of a ‘‘gold standard’’
instrument for diagnosing DCD,19 23 40however, we believe the
BOTMP to be a reasonable choice, as it is widely used to detect
motor coordination problems in children.23 41–43Increasingly,
however, clinicians and researchers are using the Movement-
ABC18as the preferred instrument for identifying cases of DCD.
Work showing that the CSAPPA performs similarly with other
measures of motor impairment (such as the Movement-ABC)
would be reassuring.
Sensitivity, specificity, and positive and negative predictive values (95% CIs) for all points on the Adequacy subscale
Sensitivity SpecificityPositive predictive value Negative predictive value
1.00 (0.92 to 1)
1.00 (0.92 to 1)
0.98 (0.88 to 1)
0.93 (0.82 to 0.98)
0.86 (0.73 to 0.94)
0.82 (0.68 to 0.9)
0.80 (0.65 to 0.89)
0.73 (0.58 to 0.84)
0.70 (0.56 to 0.82)
0.57 (0.42 to 0.7)
0.50 (0.36 to 0.64)
0.39 (0.26 to 0.53)
0.32 (0.20 to 0.47)
0.25 (0.15 to 0.39)
0.20 (0.11 to 0.35)
0.16 (0.08 to 0.29)
0.11 (0.05 to 0.24)
0.05 (0.01 to 0.15)
0 (0 to 0.08)
0.10 (0.08 to 0.13)
0.20 (0.17 to 0.24)
0.31 (0.27 to 0.35)
0.41 (0.37 to 0.45)
0.47 (0.43 to 0.51)
0.55 (0.51 to 0.59)
0.64 (0.60 to 0.68)
0.72 (0.68 to 0.76)
0.78 (0.74 to 0.81)
0.83 (0.80 to 0.86)
0.86 (0.83 to 0.89)
0.89 (0.86 to 0.91)
0.92 (0.89 to 0.94)
0.95 (0.92 to 0.96)
0.97 (0.96 to 0.98)
0.98 (0.97 to 0.99)
0.98 (0.97 to 0.99)
0.99 (0.98 to 1.00)
1.00 (0.99 to 1.00)
0.08 (0.06 to 0.11)
0.10 (0.07 to 0.13)
0.11 (0.08 to 0.14)
0.12 (0.09 to 0.15)
0.12 (0.09 to 0.16)
0.13 (0.10 to 0.18)
0.15 (0.11 to 0.21)
0.18 (0.13 to 0.24)
0.21 (0.15 to 0.28)
0.22 (0.16 to 0.31)
0.23 (0.16 to 0.33)
0.22 (0.14 to 0.33)
0.25 (0.15 to 0.37)
0.28 (0.17 to 0.44)
0.39 (0.22 to 0.59)
0.44 (0.23 to 0.67)
0.38 (0.18 to 0.64)
0.33 (0.10 to 0.70)
0 (0 to 0.79)
1.00 (0.93 to 1.00)
1.00 (0.97 to 1.00)
0.99 (0.97 to 1.00)
0.99 (0.96 to 1.00)
0.98 (0.95 to 0.99)
0.97 (0.95 to 0.99)
0.97 (0.95 to 0.99)
0.97 (0.95 to 0.98)
0.97 (0.95 to 0.98)
0.96 (0.94 to 0.97)
0.95 (0.93 to 0.97)
0.95 (0.92 to 0.96)
0.94 (0.92 to 0.96)
0.94 (0.91 to 0.96)
0.94 (0.91 to 0.95)
0.93 (0.91 to 0.95)
0.93 (0.91 to 0.95)
0.93 (0.90 to 0.94)
0.92 (0.90 to 0.94)
990Cairney, Veldhuizen, Kurdyak, et al
on 20 October 2009
To conclude, we have confirmed that the CSAPPA, a brief
scale intended to measure self-efficacy towards physical activity
in children, is a useful screen for motor difficulties in children.
Furthermore, the adequacy and predilection subscales perform
as well as the full instrument. Given its brevity (seven items)
and content (perceived adequacy toward physical activity), the
adequacy subscale appears to be a sufficient substitute for the
full CSAPPA, especially in situations where shorter instruments
are desired. The CSAPPA is an instrument that has the
possibility to be useful as both a clinical and research tool to
screen for children with DCD.
John Cairney, Scott Veldhuizen, Paul Kurdyak, Health Systems Research
and Consulting Unit, Centre for Addiction and Mental Health, Toronto,
Brent E Faught, John Hay, Department of Community Health Sciences,
Brock University, St. Catharines, ON, Canada
Cheryl Missiuna, School of Rehabilitation Science and CanChild, Centre
for Childhood Disability Research, McMaster University, Hamilton, ON,
Competing interests: None.
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What is already known on this topic
N There is increasing belief in the field that early interven-
tion for children with DCD can substantially improve their
social, psychological and physical functioning; however,
identification of these children is complicated by a lack of
short, self-report instruments to screen for the disorder.
N In a 2004 article in the Journal of Adolescent Health
2004;34:308–13, the CSAPPA, a 19-item measure of
child-reported generalised self-efficacy toward physical
activity, was shown by Hay et al to be a good screen for
What this study adds
N In this study, we test whether the three subscales of the
CSAPPA might be useful as brief screens in situations
where a shorter instrument is desirable.
N We conclude that the 7-item Adequacy subscale of the full
CSAPPA is a reasonable choice for DCD screening efforts.
N Apart from the CSAPPA, only one measure, the
Developmental Coordination Disorder Questionnaire
(DCD-Q), has been validated.
N The DCD-Q is a parent report instrument, however, while
the CSAPPA is administered directly with children,
making it practical for both clinical and school-based
CSAPPA subscales as potential screening instruments991
on 20 October 2009