Reproducibility and validity of the Functional Communication Classification System for young children with cerebral palsy

Abstract

Aim To examine interrater agreement and validity of the Functional Communication Classification System (FCCS) for young children with cerebral palsy (CP) aged 2 or 3 years. Method Speech‐language pathologist (SLP) and parent FCCS ratings for 31 children with CP (aged 2y, n=16; aged 3y, n=15; 18 males, 13 females) were examined for interrater agreement using a weighted Cohen’s kappa statistic. Relationships between FCCS (SLP) ratings and: (1) concurrent validity with the Language Use Inventory, a standardized pragmatic assessment for children aged 18 to 47 months, (2) gross motor and fine motor function, (3) associated impairments (visual and intellectual), and (4) primary expressive communication mode were examined using Spearman’s correlation coefficients. Results Almost perfect interrater agreement between SLP and parent FCCS ratings were found (kw=0.94). Correlations with FCCS (SLP) were excellent for pragmatic function (rs=−0.83, p<0.001), intellectual function (rs=0.89, p<0.001), and primary expressive communication mode (rs=0.92, p<0.001). Correlations were good for gross motor function (rs=0.72, p<0.001) and visual impairment (rs=0.70, p<0.001) and fair for fine motor function (rs=0.53, p<0.002). Analysis was unwarranted for epilepsy (n=1 out of 31) and hearing‐associated impairments (n=0 out of 31). Interpretation The FCCS has excellent interrater agreement and validity for communication classification of children with CP aged 2 or 3 years and is highly suitable for surveillance and research purposes. The Functional Communication Classification System (FCCS) is a valid instrument for children with cerebral palsy (CP) aged 2 or 3 years. Excellent agreement exists between speech‐language pathologist and parent FCCS ratings. The FCCS has excellent correlation with intelligence, pragmatic function, and primary expressive mode. Stronger correlations with the Gross Motor Function Classification System and vision exist for children aged 2 or 3 years. Weaker correlations with manual ability exist when compared to older children with CP.

Assessing pragmatics in early childhood with the Language Use Inventory across seven languages

“…Additionally, children who scored below an empirically derived cut-off on the LUI at ages 24-47 months were 27 times more likely to display language difficulties at ages 5-6 than children scoring above the cutoff. Children's LUI scores also concur with direct measures such as the Communication and Symbolic Behavior Scales (O'Neill, 2009), observations of language use in laboratory settings (Abbot-Smith et al, 2015), and an SLP-and parent-report measure, the Functional Communication Classification System (Caynes et al, 2021). The LUI also has high test-retest reliability (O'Neill, 2007(O'Neill, , 2009.…”