The Revised Children's Communication Checklist-2 (CCC-R): Factor Structure and Psychometric Evaluation.

Area of Science:

• Developmental Psychology
• Clinical Psychology
• Speech and Language Pathology

Background:

• The Children's Communication Checklist-2 (CCC-2) is widely used for pragmatic language impairment assessment, particularly in autism spectrum disorder (ASD).
• Previous research indicated limitations in the CCC-2's clinical applicability and inconsistent factor structure, necessitating a revised instrument.
• Pragmatic language difficulties are highly prevalent in ASD, intellectual disability (ID), and various mental health conditions (MHC).

Purpose of the Study:

• To develop a concise, simplified, and revised version of the CCC-2 (CCC-R) for assessing pragmatic language impairments.
• To validate the CCC-R in a large, diverse German-speaking sample including clinical and typically developing groups.
• To evaluate the CCC-R's factor structure and its ability to differentiate between clinical groups.

Main Methods:

• A large German-speaking sample of children and adolescents (ages 4-17) was recruited, comprising groups with ASD (n=195), ID (n=83), MHC (n=144), and typically developing controls (n=417).
• The original 70-item CCC-2 was reduced to a 39-item CCC-R based on item analysis, exploratory factor analysis, and exclusion of non-communication-related items.
• Reliability (Cronbach's alpha) and factor structure of the CCC-R were analyzed, and group differences in CCC-R scores were examined.

Main Results:

• The revised CCC-R demonstrated high internal consistency (α = 0.96) and comprised two distinct factors: pragmatic-language (α = 0.96) and grammatical-semantic-language (α = 0.93).
• All clinical groups (ASD, ID, MHC) exhibited significantly higher CCC-R total scores compared to the typically developing group, with neurodevelopmental disorders (ASD, ID) showing the highest scores.
• The CCC-R effectively distinguished ASD from other groups and revealed group-specific patterns, such as elevated pragmatic-language scores in ASD and grammatical-semantic scores in ID.

Conclusions:

• The CCC-R is a reliable, valid, and simplified caregiver questionnaire for assessing pragmatic language impairments in children and adolescents.
• The CCC-R overcomes the limitations of the original CCC-2, offering improved clinical utility for identifying communication difficulties across neurodevelopmental and mental health conditions.
• The two-factor structure (pragmatic and grammatical-semantic) provides a nuanced understanding of language challenges in clinical populations.