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Development of a Symbol Cancellation Test to Evaluate Attention in a School-aged Zambian Population
Franco di Cesare1, Cristiana di Carlo1, Leonardo di Cesare2
1Drs. F. Di Cesare and Di Carlo are with Leoben Research srl in Rome, Italy.
Insights
The Zambia Symbol Cancellation Test (ZSCT) effectively measures selective attention in children, showing good reliability and validity for assessing cognitive development and health impacts in pediatric populations.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatric Health
Background:
- Assessing child cognitive health in developing countries is challenging due to limited diagnostic tools.
- Selective attention is a key cognitive function impacting development and learning.
- Valid psychometric instruments are needed for pediatric populations in Sub-Saharan Africa.
Purpose of the Study:
- To develop and validate the Zambia Symbol Cancellation Test (ZSCT).
- To evaluate selective attention in school-aged children in Zambia.
- To assess the test's reliability and clinical utility.
Main Methods:
- The Zambia Symbol Cancellation Test (ZSCT) was developed and administered to 409 children aged 5-17 years.
- Test-retest reliability was assessed using the intraclass correlation coefficient (ICC).
- The visuomotor processing index (VMPI) was analyzed for associations with age and health status.
Main Results:
- The ZSCT demonstrated adequate test-retest reliability (ICC: 0.79).
- Age significantly affected VMPI scores (r=-0.62, p=0.000).
- Impaired VMPI was associated with poorer health status and chronic conditions.
Conclusions:
- The ZSCT is a reliable and valid tool for assessing cognitive development and attention in children.
- The test shows clinical utility in evaluating the impact of health conditions on attention.
- Further research is recommended to validate ZSCT in diverse healthcare and clinical settings.
Objective:
The assessment of child cognitive health in Sub-Saharan developing countries poses significant challenges, including the paucity of valid diagnostic tools. We report the development and the initial validation of the Zambia Symbol Cancellation Test (ZSCT), a psychometric test to evaluate selective attention in a pediatric, school-aged population.
Design:
ZSCT reliability and validity were assessed in a field trial. A total of 409 children, aged 5 to 17 years, were recruited at multiple Zambian clinical sites and schools. The ZSCT provides a visuomotor processing index (VMPI), a measure of effortful processing to deliver accurate task response.
Results:
The VMPI reliability estimate at test-retest was found to be adequate for a clinical use (intraclass correlation coefficient [ICC]: 0.79, ICC-95% confidence interval [CI]: 0.69-0.86). Age showed a large effect on VMPI (n=323, r=-0.62, p=0.000). Impaired visuo-perceptual-motor processing, as measured by VMPI, was associated with poor health status (i.e., chronic neurologic or medical disease or prolonged exposure to psychosocial stress and deprivation). A two-way ANOVA found significant and small health status and age group effects [F (7, 408): 33.24, p=0.0000, η2=0.367]; the main effect of health status [F (1, 408): 37.79, p=0.000, η2=0.09], age group [F (3, 408): 35.06, p=0.000, η2=0.21], and their interaction was not significant (p=0.364).
Conclusion:
Study findings indicate that the ZSCT has satisfactory reliability, validity, and clinical utility to evaluate cognitive development and the effect of health conditions on attention. Study results warrant further research to validate its use in healthcare and clinical research settings.
