title: Reliability and the measurement of activity limitations (ADLs) for children with special health care needs (CSHCN) living in the community.
abstract: OBJECTIVE
  Meeting the personal care challenges of children with special health care needs (CSHCN) living in the community demands a reliable assessment of their abilities to perform activities of daily living (ADLs). This research investigates factors affecting the inter-rater reliability of functional assessments of CSHCN conducted in the home.
  
  
  METHODS
  Dual-standardised assessments were conducted with 236 community-dwelling CSHCN seeking or receiving Medicaid Personal Care Services (PCS) in a single state in USA.
  
  
  RESULTS
  Analyses revealed that assessments of CSHCN with the greatest or least amount of activity limitations exhibited the greatest agreement. The greatest disagreement occurred when assessors faced children with moderate to moderately severe activity limitations. Specific ADLs, where the greatest and least agreements occurred, varied by the level of the child's overall activity limitation.
  
  
  CONCLUSIONS
  These results imply that the most serious challenges to the reliability of home-based assessment of ADLs among CSHCN occur in cases of children with moderate or moderately severe activity limitations.
authors.affiliation: School of Rural Public Health, Texas A&M Health Science Centre, Texas, USA. phillipscd@srph.tamhsc.edu
authors.forename: Charles D
authors.initials: CD
authors.lastname: Phillips
authors.forename: Ashweeta
authors.initials: A
authors.lastname: Patnaik
authors.forename: James A
authors.initials: JA
authors.lastname: Dyer
authors.forename: Emily
authors.initials: E
authors.lastname: Naiser
authors.forename: Catherine
authors.initials: C
authors.lastname: Hawes
authors.forename: Constance J
authors.initials: CJ
authors.lastname: Fournier
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Elliott
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008484:Medicaid; D009043:Motor Activity; D020380:Needs Assessment; D015203:Reproducibility of Results; D012111:Residence Characteristics; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult