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JCPSLP Volume 15, Number 1 2013 29
psychometric properties such as reliability and validity are
needed. The Focus © is a new measure available for use by
SLPs ). This measure is
specific to evaluating communicative participation in young
children. To date, there have been a limited number of
measures available to evaluate this area of functioning. The
support provided for the FOCUS© by this study is timely
because it shows the reliability of a new measures designed
to evaluate real-world functioning for young children with
speech-language impairments.
Acknowledgements
The authors would like to thank the families, children,
speech pathologists, graduate-SLP students and research
assistants who made this research possible. The authors
especially thank Joan Walker, research assistant to the last
author. This study was funded by the Social Sciences and
Humanities Research Council (first author) and the
Canadian Institutes of Health Research (last author)
(Funding reference #: Grant numbers 86884 and 86573).
Peter Rosenbaum holds a Canada Research Chair from the
Canadian Institutes of Health Research. This research data
was collected for a postdoctoral project completed at the
Bloorview Research Institute and the Graduate Department
of Speech-Language Pathology, University of Toronto in
Toronto, Ontario, Canada.
References
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Enderby, P., & John, A. (1997). Therapy outcome
measures: Speech-language pathology technical manual.
London, UK: Singular Press.
Hidecker, M., Paneth, N., Rosenbaum, P., Kent, R.,
Lillie, J., Eulenberg J.,...Taylor, K. (2011). Developing and
validating the communication function classification system
(CFCS) for Individuals with cerebral palsy. Developmental
Medicine and Child Neurology, 53(8), 704–710.
Hinkle, D., Wiersma, W., & Jurs, S. (2003). Applied
statistics for the behavioral sciences . (5th ed.).
Independence, KY: Wadsworth Publishing.
Jette, A., & Haley, S. (2005). Contemporary measurement
techniques for rehabilitation outcomes assessment. Journal
of Rehabilitation Medicine , 37, 339–345.
John, A., & Enderby, P. (2000). Reliability of speech and
language therapists using therapy outcome measures.
International Journal of Language and Communication
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Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C.
(2000). Prevalence and natural history of primary speech
and language delay: Findings from a systematic review
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Communication Disorders , 35(2), 165–188.
McCabe, P. (2005). Social and behavioral correlates
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Psychology in Schools , 42(4), 373–387.
McLeod, S., & Harrison, L. (2009). Epidemiology
of speech and language impairment in a nationally
representative sample of 4- to 5-year-old children. Journal
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McLeod, S., & Threats, T. (2008). The ICF-CY and
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Results of the study indicated that SLPs’ administration
of the FOCUS© was reliable. Comparisons of the FOCUS©
for test-retest reliability were very high (r = .96), revealing
the same SLPs could reliably administer the FOCUS© within
a 1-month time interval. The very high test-retest reliability
estimates of the FOCUS© are in-line with impairment-
based measures of speech and language for young
children, such as the Clinical Evaluation of Language
Fundamentals-Preschool (CELF-P; Wiig, Secord, & Semel,
2004), MacArthur-Bates Communicative Developmental
Inventories – Second Edition (CDI-II; Fenson et al., 2007),
and the Preschool Language Scales – Fourth Edition (PLS-
4; Zimmerman, Steiner, & Pond, 2004). They are also in line
with other participation-based measures (e.g., the TOMS
and AusTOMs). The size of the correlation coefficients
is indicative of the strength of the relationship between
two variables (Hinkle et al., 2003). The very high values
observed in this study indicate there is consistency in the
administration of the FOCUS© by the same SLP, which
suggests that it is psychometrically sound.
This study also showed that the FOCUS© had high inter-
rater reliability. Thus, two SLPs could reliably administer
the FOCUS© for the same child with speech-language
impairments. The developers of the TOMs also found that
SLPs had high (>.80) inter-rater reliability for different test
domains (Enderby & John, 1997). In addition, the high inter-
rater reliability of the FOCUS© was consistent with values
found for impairment-based measures (e.g., CELF-P and
PLS-4). The difference between reliability scores obtained in
the previous study of FOCUS© reliability (Thomas-Stonell et
al., 2010) and the results from this study could be attributed
to the reliability procedures not being completed for children
receiving speech-language intervention, thus addressing a
possible confound in the initial study.
Measures that are valid, reliable, and reflective of the
most current theoretical framework are needed within the
rehabilitation sciences to quantify functional changes in
skills (Jette & Haley, 2005; Wade & de Jong, 2000; Yorkston
et al., 2001). The current findings support the consistency
and accuracy in FOCUS© ratings when administered by
SLPs. This new evidence for test-retest and inter-rater
reliability expands on the already established evidence for
parental administration and evidence of construct validity
for this measure.
Limitations and future directions
Larger samples are typically used in describing the reliability
of outcome measures. The sample used in this study was
relatively small and there may have been a selection bias
due to the convenience sample included. Thus, these
findings should be interpreted with caution. Further, the
sample of children may not be representative of all children
with speech and/or language impairment as a large
proportion was diagnosed with additional medical
diagnoses. That said, the FOCUS© was developed using
young children with medical diagnoses as well as those
with a variety of speech-language characteristics.
Consequently, the sample of children included in this study
is reflective of those with whom the FOCUS© can be used.
While there is evidence supporting the reliability of the
FOCUS© additional research should be undertaken with a
larger sample comprising a broader range of children with
speech-language impairments.
Clinical implications
To further the evidence-based delivery of speech-language
pathology services, clinical measures that have good