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The Italian Version of the Drooling Impact Scale: Translation and Psychometric Validation in Children with
Federica Pauciulo1, Marco Tofani1,2, Giulia Stella1
1Management and Diagnostic Innovations & Clinical Pathways Research Area, Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Background/Objectives:
Drooling is a common and clinically relevant issue in children with neurodevelopmental conditions, with important consequences for daily functioning, social participation, and caregiver burden. The lack of validated tools in Italian makes it difficult to quantify the impact of drooling on daily life, support appropriate care pathways, and evaluate the effectiveness of interventions. The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Italian version of the Drooling Impact Scale (DIS) in a pediatric population.
Methods:
The DIS is a 10-item caregiver-reported outcome measure, with each item rated on an ordinal 0-10 scale, designed to assess the functional and psychosocial impact of drooling. It was translated using a standard forward-backward procedure, followed by expert review and cognitive debriefing with caregivers. Caregivers of children aged ≥2 years with heterogeneous neurodevelopmental conditions and feeding/swallowing impairments were consecutively recruited from a tertiary pediatric hospital. Psychometric properties were assessed in line with COSMIN recommendations, including internal consistency (Cronbach's α), structural validity through exploratory factor analysis, inter-rater and test-retest reliability (intraclass correlation coefficients, ICC), measurement error (standard error of measurement, SEM; smallest detectable change, SDC), and construct validity through correlation with the Pediatric Quality of Life Inventory (PedsQL).
Results:
The Italian DIS was completed by caregivers of 126 children. It showed excellent internal consistency (Cronbach's α = 0.92). Factor analysis indicated a clear dominant factor, explaining 56.5% of the variance, while additional factors contributed only marginally. Agreement between caregivers was excellent (ICC = 0.94), and test-retest reliability was good (ICC = 0.85). Measurement error analysis yielded SEM = 8.66, SDC_individual = 24.00, and SDC_group = 2.14. As expected, DIS scores were associated with health-related quality of life.
Conclusions:
The Italian version of the DIS appears to be a reliable and structurally sound instrument for assessing the impact of drooling in children with neurodevelopmental conditions. It may be useful in both clinical practice and research, although further studies are needed to explore its responsiveness and confirm these findings in different settings.