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BRIEF COMMUNICATION
Brazilian version of the Cognitive Failures Questionnaire
(CFQ): cross-cultural adaptation and evidence of validity
and reliability
Jonas J. de Paula,
1,2,3
Danielle S. Costa,
1,3
De
´bora M. de Miranda,
1,4
Marco A. Romano-Silva
1,5
1
Programa de Po
´s-Graduac¸a
˜o, Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte,
MG, Brazil.
2
Departamento de Psicologia, Faculdade de Cie
ˆncias Me
´dicas de Minas Gerais (FCM-MG), Belo Horizonte, MG, Brazil.
3
Laborato
´rio de Ensino e Pesquisa em Neuropsicologia, Belo Horizonte, MG, Brazil.
4
Departamento de Pediatria, Faculdade de Medicina,
UFMG, Belo Horizonte, MG, Brazil.
5
Departamento de Sau
´de Mental, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil.
Objective: Cognitive failures are simple mistakes in routine activities, such as forgetting commitments
and experiencing difficulty concentrating. The Cognitive Failures Questionnaire (CFQ) was designed
to assess the frequency of these errors in everyday life. Although widely used in psychiatry and psychology,
both in clinical and research settings, it has not been adapted for use in Brazil. Our objective was to perform
cross-cultural adaptation of the CFQ for the Brazilian reality and assess its validity and reliability.
Methods: The original version of the CFQ was translated into Brazilian Portuguese by two indepen-
dent researchers, analyzed by a multidisciplinary board of experts, and back-translated into English.
The final version was administered to 225 adults. Validity was assessed by correlation with the Self
Reporting Questionnaire-20 (SRQ-20) and the Adult Attention Deficit/Hyperactivity Disorder Self-
Report Scale (ASRS-18). Reliability was analyzed by calculating internal consistency and test-retest
stability.
Results: The adapted version of the CFQ showed significant correlations with SRQ-20 (r = -0.311),
ASRS-18 inattention (r = 0.696), and hyperactivity/impulsivity (r = 0.405) scores. Reliability analysis
suggests high internal consistency (0.906) and temporal stability (0.813).
Conclusion: The Brazilian Portuguese version of the CFQ showed moderate correlations with other
measures of mental health, as well as adequate reliability.
Keywords: Cognitive neuroscience; diagnosis and classification; memory; occupational psychiatry;
psychometric tests/interviews
Introduction
Cognitive failures are defined as simple mistakes in routine
activities, such as forgetting commitments, discarding
materials improperly, and difficulties in financial planning,
among others.
1,2
These mistakes appear to be represen-
tative of ecological cognitive functioning and are regarded
as an outcome of cognitive processing and other psycho-
logical factors, including psychopathology and personality.
2
Although they seem harmless, self-perception of cognitive
failures is strongly associated with mental disorders.
1-5
One of the measures most widely used to assess such
failures is the Cognitive Failures Questionnaire (CFQ),
1
which consists of 25 questions designed to represent cogni-
tive errors in daily life. These questions reflect different aspects
of cognitive functioning, including attention (‘‘Do you fail to
notice signposts on the road?’’), perception (‘‘Do you fail
to see what you want in a supermarket (although it’s
there)?’’), memory (‘‘Do you find you forget appointments?’’),
impulsivity (‘‘Do you say something and realize afterwards
that it might be taken as insulting?’’), and language (‘‘Do you
find yourself suddenly wondering whether you’ve used a
word correctly?’’). Each question is answered on a frequency
scale, ranging from never (0 points) to very often (4 points).
The total scale ranges from 0 to 100 points.
The CFQ is widely used in psychiatric and psychological
research. Performance on this scale has been related to
affective symptoms,
3,5
dissociative states,
4
learning disabil-
ities,
6
stress, and anxiety,
7
among other aspects of psycho-
pathology and psychological functioning.
2,8
CFQ scores
have also been associated with objective cognitive perfor-
mance, especially on measures of executive attention,
9
although its association with objective tests is inconsis-
tent.
2
This may reflected the different demand involved in
controlled, usually simple objective cognitive tests when
compared to real-life situation, in which not only raw
cognitive abilities but also contextual and emotional factors
may affect the outcome.
2
In addition to the aforementioned
associations, CFQ shows robust psychometric prop-
erties, including high internal consistency and test-retest
stability
1,10,11
and multidimensional factor structure,
10
usually involving components of memory and attention.
Despite its widespread use and utility in psychiatric and
psychological research in several cultures, to the best of
Correspondence: Jonas J. de Paula, Universidade Federal de Minas
Gerais - Medicina Molecular, Av. Alfredo Balena, 190, CEP 30130-100,
Belo Horizonte, MG, Brazil.
E-mail: jonasjardim@gmail.com
Submitted Jan 15 2017, accepted Aug 07 2017.
Revista Brasileira de Psiquiatria. 2017;00:000–000
Associac¸a
˜o Brasileira de Psiquiatria
doi:10.1590/1516-4446-2017-2227
our knowledge, the CFQ has not been adapted for use
in Brazil. Thus, the objective of this study is to perform
translation and cross-cultural adaptation of the CFQ for
use in Brazil and analyze its validity and reliability in this
setting.
Methods
Translation and cross-cultural adaptation of the Cognitive
Failures Questionnaire (CFQ)
We obtained written authorization from one of the authors
of the original version of the CFQ, Professor Kathy Parkes,
to perform cross-cultural adaptation of the instrument into
Brazilian Portuguese. The translation was done by two
psychologists with expertise in cognitive functioning. Two
of the authors (JJdP and DSC) performed an initial transl-
ation of the CFQ, adapting some of the items for the
Brazilian context. A synthesis of this translation was then
sent to a panel of experts, composed of a researcher with
experience in neuropsychology (neuropsychologist, PhD),
a researcher with experience in functional evaluation
(occupational therapist, PhD), and another researcher
with experience in psychometrics (physical educator, PhD).
The reviewers’ feedback was summarized and implemen-
ted in a final version of the instrument, considering the
peculiarities of Brazilian culture and the necessary adapta-
tions. Finally, back-translation and reanalysis were per-
formed by a naı
¨ve professional and checked by the expert
translators. Table 1 presents the original and adapted
versions of the questionnaire.
Participants and procedures
We assessed 225 Brazilian adults in an online platform for
the present study. The mean (SD) age of participants was
29.21 (610.54) years. They were predominately female
(58%), white (52%), single (68%), with a high school educa-
tion (52%), and had studied in public schools (58%). None
of the participants had a history of psychiatric disorders,
neurological diseases, or current use of psychotropic drugs.
Beside the self-report CFQ, participants completed the
Self Reporting Questionnaire 20 (SRQ-20),
12
a screening
measure for non-psychotic psychiatric disorders, and the
Adult Attention Deficit/Hyperactivity Disorder (ADHD) Self-
Report Scale (ASRS-18)
13
for the assessment of ADHD
symptoms. The clinical cutoffs of both instruments (47
and 421, respectively) were used to identify participants
with higher probability of presenting psychiatric disorders,
and scores below these cutoffs were defined as inclusion
criteria.
The participants completed the CFQ on an online plat-
form, which has been previously used in other research.
14
To ensure the equivalence of online and pen-paper
versions of the QFC, we compared the scores of 60 parti-
cipants who completed the pen-paper version to those of
the 225 online questionnaires. Both samples were similar
in terms of age, education, and sex (p 40.10 for all
comparisons). An independent-samples t-test showed no
between-group difference in scores (t= -0.289, p = 0.773,
d= 0.08).
This study was conducted in accordance with the
Helsinki Declaration and was approved by the local ethics
committee (CAEE: 57378016.5.0000.5134). All subjects
gave consent for participation.
Analysis of psychometric properties
In this study, we assessed both the validity and the reli-
ability of the CFQ. For analysis of validity, we computed
Pearson correlations between CFQ total score and SRQ-20
and ASR-18 scales, since both internalizing and exter-
nalizing are associated with cognitive failures.
2
ASRS-18
scores are particularly representative of cognitive pro-
blems, since they involve the inattention dimension of
ADHD. Assessment of reliability was done by the analysis
of internal consistency (McDonald’s omega, since latent
structure is multidimensional) and test-retest stability (intra-
class correlation coefficient). The latter was calculated in a
smaller subsample (n=22) with a 1-week interval. We also
computed correlations with sociodemographic data.
Results
The original items and final translation of each item are
shown in Table 1. We changed three items to better fit
contemporary issues, since the original questionnaire
was developed in 1982. The item ‘‘Do you forget where
you put something like a newspaper or a book?’’ was
changed to ‘‘Do you forget where you put something like a
newspaper, your cell phone or your keys?’’; the item
‘‘Do you find you accidentally throw away the thing you
want and keep what you meant to throw away – as in the
example of throwing away the matchbox and putting the
used match in your pocket?’’ was changed to ‘‘Do you find
you accidentally throw away the thing you want and keep
what you meant to throw away – as in the example of
throwing away candy and putting its wrapper in your
pocket?’’; and the item ‘‘Do you leave important letters
unanswered for days?’’ was changed to ‘‘Do you leave
important letters, messages, or e-mails unanswered for
days?.’’ The translated version is freely available at www.
labepneuro.com.
The mean CFQ score was 35.58 (standard devia-
tion, 12.14; range, 10-74). Most of the items showed
more frequent values in the intermediate categories
(very rarely, occasionally, quite often) when compared
to extreme responses (never, very often). Correlations
with sociodemographic measures suggest a weak asso-
ciation with age (r = -0.263, p o0.001) but no association
with formal education (r = -0.079, p = 0.237) and
socioeconomic status measured by the Brazilian Socio-
economic Classification Criteria (r = 0.005, p = 0.936). We
found no differences in scores between men and women
(z = -1.03, p = 0.301).
CFQ scores correlated significantly with SRQ-20 (r =
0.311, p o0.001, R
2
= 10%), ASRS-18 inattention (r =
0.696, p o0.001, R
2
= 48%), and ASRS-18 hyperactivity/
impulsivity (r = 0.405, p o0.001, R
2
= 16%) scores. Reli-
ability analysis suggests high internal consistency (0.909)
and temporal stability (0.813).
Rev Bras Psiquiatr. 2017;00(00)
2JJ de Paula et al.
Table 1 Translation of Cognitive Failures Questionnaire (CFQ) and descriptive statistics for each item
# Original Translated M SD N VR OC QO VO
1 Do you read something and find you haven’t been thinking about it
and must read it again?
Voce
ˆle
ˆalguma coisa, percebe que na
˜o estava prestando
atenc¸a
˜o e precisa le
ˆ-la novamente?
2.53 0.93 12% 40% 30% 18% 6%
2 Do you find you forget why you went from one part of the house to
the other?
Voce
ˆse esquece por que
ˆfoi de um co
ˆmodo a outro
dentro de casa?
2.01 1.01 5% 28% 34% 25% 7%
3 Do you fail to notice signposts on the road? Voce
ˆdeixa de notar placas de sinalizac¸a
˜o ao dirigir? 1.28 0.97 20% 46% 24% 6% 4%
4 Do you find you confuse right and left when giving directions? Voce
ˆconfunde esquerda e direita ao indicar o caminho
a algue
´m?
1.14 1.21 37% 36% 11% 10% 7%
5 Do you bump into people? Voce
ˆesbarra (‘‘tromba’’) em outras pessoas? 1.40 0.98 12% 54% 19% 10% 4%
6 Do you find you forget whether you’ve turned off a light or a fire or
locked the door?
Voce
ˆesquece se apagou a luz, a chama do foga
˜oouse
trancou a porta?
1.64 1.08 12% 40% 25% 17% 6%
7 Do you fail to listen to people’s names when you are meeting them? Voce
ˆna
˜o se atenta ao nome da pessoa quando ela esta
´
sendo apresentada a voce
ˆ?
1.58 1.15 17% 37% 24% 15% 7%
8 Do you say something and realize afterwards that it might be taken
as insulting?
Voce
ˆdiz alguma coisa e depois percebe que isso pode
ter sido interpretado como um insulto?
1.61 0.87 7% 43% 36% 12% 2%
9 Do you fail to hear people speaking to you when you are doing
something else?
Voce
ˆtem dificuldade em escutar as pessoas falando com
voce
ˆquando esta
´fazendo outra coisa?
2.07 1.03 4% 28% 33% 25% 9%
10 Do you lose your temper and regret it? Voce
ˆperde a calma e se arrepende? 1.63 1.07 9% 46% 26% 10% 8%
11 Do you leave important letters unanswered for days? Voce
ˆdeixa cartas, mensagens ou e-mails importantes
sem resposta por dias?
1.28 1.10 25% 42% 18% 9% 5%
12 Do you find you forget which way to turn on a road you know well but
rarely use?
Voce
ˆesquece aonde virar em um caminho que conhece
bem, mas usa pouco?
1.18 1.03 27% 43% 19% 8% 4%
13 Do you fail to see what you want in a supermarket (although it’s
there)?
Voce
ˆtem dificuldades em achar o que voce
ˆquer no
supermercado, embora o produto esteja por la
´?
1.40 0.91 13% 47% 27% 12% 1%
14 Do you find yourself suddenly wondering whether you’ve used a
word correctly?
Voce
ˆse encontra subitamente pensando se usou uma
palavra de forma correta?
1.88 1.07 9% 30% 32% 21% 7%
15 Do you have trouble making up your mind? Voce
ˆtem problemas em se decidir? 1.97 1.16 8% 32% 29% 17% 14%
16 Do you find you forget appointments? Voce
ˆesquece os seus compromissos? 1.29 1.00 20% 47% 23% 5% 5%
17 Do you forget where you put something like a newspaper or a book? Voce
ˆesquece onde colocou alguma coisa, como o jornal,
o celular ou suas chaves?
1.87 1.10 8% 36% 28% 20% 9%
18 Do you find you accidentally throw away the thing you want and
keep what you meant to throw away – as in the example of throwing
away the matchbox and putting the used match in your pocket?
Voce
ˆacidentalmente joga fora algo que queria guardar e
fica com aquilo que queria descartar (por exemplo, joga
fora uma bala e guarda seu papel no bolso)?
0.88 0.91 39% 41% 15% 4% 2%
19 Do you daydream when you ought to be listening to something? Voce
ˆ‘‘viaja’’ ou fica ‘‘no mundo da lua’’ quando deveria
estar ouvindo alguma coisa?
1.86 1.06 7% 35% 31% 19% 8%
20 Do you find you forget people’s names? Voce
ˆesquece o nome das pessoas? 1.91 1.06 7% 32% 32% 22% 8%
21 Do you start doing one thing at home and get distracted into doing
something else (unintentionally)?
Voce
ˆcomec¸a a fazer alguma coisa em casa e se distrai
fazendo algo diferente (sem querer)?
1.79 1.13 12% 31% 29% 19% 8%
22 Do you find you can’t quite remember something although it’s ‘‘on
the tip of your tongue’’?
Voce
ˆna
˜o consegue se lembrar de alguma coisa, mesmo
que esteja ‘‘na ponta da lı
´ngua’’?
1.95 0.89 1% 32% 42% 19% 6%
23 Do you find you forget what you came to the shops to buy? Voce
ˆse esquece do que saiu para comprar? 0.98 0.84 30% 48% 18% 3% 1%
24 Do you drop things? Voce
ˆdeixa as coisas caı
´rem (as derruba)? 1.51 1.13 18% 40% 22% 13% 7%
25 Do you find you can’t think of anything to say? Voce
ˆna
˜o consegue pensar em nada para dizer? 1.44 0.95 14% 44% 29% 10% 3%
M = mean; SD = standard deviation.
Rating: N = never (0 points); VR = very rarely (1 point); OC = occasionally (2 points); QO = quite often (3 points); VO = very often (4 points).
Descriptive data for the total score: M = 35.58, SD = 12.14.
Rev Bras Psiquiatr. 2017;00(00)
Brazilian version of the CFQ 3
Discussion
This paper reports on the translation and adaptation of the
CFQ into Brazilian Portuguese, as well as preliminary evi-
dence of its validity and reliability for use in the Brazilian
reality. Total CFQ scores showed a weak negative cor-
relation with age, and no correlation with formal educa-
tion, sex, or socioeconomic status. Regarding validity,
we found moderate correlation with SRQ-20 scores
(a measure of non-psychotic psychiatric symptoms), mode-
rate correlation with ASRS-18 hyperactivity-impulsivity
scores, and a strong correlation with ASRS-18 inattention
scores. The CFQ also showed high internal consistency
and test-retest reliability.
We found a small contribution (8%) of sociodemographic
factors on CFQ scores. The only measure correlated with
cognitive failures was age. However, the correlation was
inverse, suggesting that subjects tend to experience fewer
cognitive failures at older ages. This may occur due to the
multidimensional nature of the CFQ, in which dimensions
such as forgetfulness/memory may elicit worse scores in
older groups while distractibility/attention may improve, as
seen in other studies.
10
Futures studies should address
these points in larger and more heterogeneous samples.
The correlations with measures of mental health are
in accordance with other studies which adopted the
CFQ.
1,8,15
The associations were stronger in measures
more related to attention than those related to depression/
anxiety and hyperactivity/impulsivity, which mirrors its
stronger correlations with cognitive functions (executive-
attention), as also seen in objective cognitive tests.
9
The moderate-to-strong associations suggest dependency
between the measures, but higher unique than shared
variance, which provides evidence of construct validity.
The internal consistency of the CFQ in this study (0.909)
was similar to that reported in other studies, such as Bridger
et al.,
15
who reported internal consistencies of 0.92 and
0.93 at two time points. Other studies reported lower coeffi-
cients, but usually in the intermediate to high range, as in
Merckelbach et al.
11
(0.85). The test-retest stability values
found in our study seem consistent with those reported in the
original study by Broadbent et al.
1
In their study, reporting a
sample relatively like ours, coefficients of temporal stability
were 0.824 and 0.803, at intervals of 21 and 64 weeks
respectively. These values are higher than those reported by
Bridger et al.,
15
who reported only moderate stability (0.71),
albeit at a 2-year interval.
Our study has limitations which need to be addressed.
First, our sample was recruited through online advertise-
ments, and is not representative of the Brazilian popula-
tion. This may generate a selection effect, and hinders
the generalization of our results. Our sample is also not
adequate for a comprehensive assessment of the internal
structure of the CFQ (which would require exploratory and
confirmatory factor analysis), and the amount of mea-
sures used to test its convergent and divergent validity,
including objective cognitive measures, was limited. We
also lacked an ecological measure of cognitive function-
ing, such as simulated ‘‘real-life’’ tasks, to better evaluate
cognitive failures. These issues should be addressed in
future studies.
In conclusion, we have translated the CFQ into
Brazilian Portuguese and presented preliminary evidence
of its validity and reliability for use in Brazil. The test
showed moderate-to-strong correlations with other mea-
sures of mental health, as well as adequate reliability.
Acknowledgements
This study received financial support from Instituto
Nacional de Cie
ˆncia e Tecnologia - Medicina Molecular
(INCT-MM), Fundac¸a
˜o de Amparo a
`Pesquisa do Estado
de Minas Gerais (FAPEMIG; CBB-APQ-00075-09), Con-
selho Nacional de Desenvolvimento Cientı
´fico e Tecnolo
´gico
(CNPq; 573646/2008-2), and FAPEMIG (APQ-01972/12-10,
APQ-02755-10). We would like to thank the undergraduate
and graduate students who helped with data collection,
Professor Kathy Parkes for the authorization to adapt the
Cognitive Failures Questionnaire (CFQ), and Professors
Gabriel Coutinho, Luciana Assis Oliveira, and Maicon
Albuquerque for revising the translation.
Disclosure
The authors report no conflicts of interest.
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