Evidence That School-Age Children Can Self-Report on Their Health

doi:10.1367/A03-178R.1

Ambulatory Pediatrics

Volume 4, Issue 4, July–August 2004, Pages 371-376

https://doi.org/10.1367/A03-178R.1 Get rights and content

The value of obtaining children's reports about their health from questionnaires is a topic of considerable debate in clinical pediatrics and child health research. Evidence from the following areas can inform the debate: 1) studies of parent-child agreement or concordance about the child's health state, 2) basic research on the development of children's cognitive abilities, 3) cognitive interviewing studies of children's abilities to respond to questionnaires and of influences on their responses, 4) psychometric studies of child-report questionnaires, and 5) longitudinal research on the value of children's reports. This review makes a case for the utility of child rather than parent-proxy reports for many, though not all, applications. The review summarizes evidence in terms of the value and limitations of child questionnaire reports. Research demonstrates adequate understanding and reliability and validity of child reports of their health even at age 6, which increases after age 7 in general populations. The reliability of reports by children 8–11 years old is quite good on health questionnaires developed especially for this age group. Children's personal reports provide a viable means of monitoring internal experiences of health and distress during childhood and adolescence, which can enhance understanding about trajectories of health and development of illnesses.

Section snippets

REPORTERS, EXPERIENCES, SITUATIONS

All reporters are not equal. A child has unique awareness of his or her own experiences, whereas parents, teachers, and clinicians observe the child only in certain specific settings. Each has a perspective that a different type of reporter may not be able to duplicate.4, 5, 6 This is reflected in the child-proxy report literature. For example, in a meta-analysis of 119 studies, correlations between reporters in similar settings (parent-parent or teacher-teacher) averaged 0.60, but the average

STRENGTHS OF DIFFERENT REPORTERS

The face validity of reports of health and quality of life is much greater when individuals report their own perceptions.⁹ If the research questions focus on well-being, symptoms, and perceived strengths and needs, the person's own voice is needed. For longitudinal assessments, children are likely to be the most consistent reporters over time, and their reports of health in first grade have predictive validity into adolescence.¹⁰ When research focuses on the social competence and behavior of

SCHOOL-AGE CHILDREN IN CLINICAL SETTINGS

Twenty-five years ago, researchers began to demonstrate that elementary school children could effectively communicate their health-services needs. In an “adult-free,” school-based health clinic, children 5–12 years old were allowed to seek health care on their own and did so effectively.²⁰ Interestingly, when children initiated their own care, girls and poor children used more care, although parents bring boys into care more often than girls and, at the time, poor children used less health care

ADOLESCENT REPORTS OF HEALTH

Once children become adolescents, there is little question that their own health perspective is valuable. The more advanced cognitive development of adolescents and the obvious limitations of asking parents about health-risk behaviors, such as smoking, drinking, sexual activity, and aggression, further the argument for assessing adolescents directly. Cognitive science supports asking adolescents directly, too. Adolescents are as accurate about their own and their family's health and illness

Understanding Concordance Between Child and Parent or Other Proxy Reports

One of the most basic reasons for investing resources in child self-report health data is that parents are proxy respondents. As summarized above, their reports correlate poorly with those of their children, a reason often cited for not assessing children directly. Despite the increasing acceptance of self-reports of adolescents, their concordance with their parents' reports is not any better than that of parents and children.8, 25

A close look at the level and pattern of agreement between

DISCUSSION

In sum, there is good evidence from research on cognitive development, psychometric studies, cognitive interviewing research, and longitudinal research that children can successfully complete age-appropriate health questionnaires and provide valuable information about their own health. Reports of children as young as 6 years old can be used independently of those of their parents. Parent reports differ from those of children, but are nonetheless valuable in their own right, especially for

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Evidence That School-Age Children Can Self-Report on Their Health

Section snippets

REPORTERS, EXPERIENCES, SITUATIONS

STRENGTHS OF DIFFERENT REPORTERS

SCHOOL-AGE CHILDREN IN CLINICAL SETTINGS

ADOLESCENT REPORTS OF HEALTH

Understanding Concordance Between Child and Parent or Other Proxy Reports

DISCUSSION

Adult outcomes of childhood and adolescent depression: I. Psychiatric status

Arch Gen Psychiatry

Inclusion of children as participants in research involving human subjects

A person-oriented approach in research on developmental psychopathology

Dev Psychopathol

Parent and child contributions to diagnosis of mental disorder: are both informants always necessary?

J Acad Child Adolesc Psychiatry

Measurement effects in self vs. proxy responses to survey questions: an information-processing perspective

Child/Adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity

Psychol Bull

The measurement of quality of life in children: past and future perspectives

J Dev Behav Pediatr

Measuring health-related quality of life in children: the development of the TACQOL parent form

Qual Life Res

The distal impact of two first grade preventive interventions on conduct problems and disorder and mental health service need and utilization in early adolescence

J Em Behav Disord

Mental Health and Going to School. The Woodlawn Program of Assessment, Early Intervention and Evaluation

Agreement between CASA parent reports and provider records of children's ADHD services

J Behav Health Serv Res

Methodological challenges in assessing children's mental health services utilization

Ment Health Serv Res

Validity of parental report of a child's medical history in otitis media research

Am J Epidemiol

How reliable are maternal reports of their children's psychopathology? One-year recall of psychiatric diagnosis of ADHD children

J Am Acad Child Adolesc Psychiatry

How well they remember. The accuracy of parent reports

Arch Pediatr Adolesc Med

Parental reporting of children's coughing is biased

Eur J Epidemiol

The effect of maternal depression on maternal ratings of child behavior

Abnorm Child Psychol

Maternal ratings of child behavior improve with treatment of maternal depression

Fam Med

Child-initiated care: The use of school nursing services by children in an “adult-free” system

Pediatrics

Chronically ill children's concepts of their illness

Pediatrics

Guidelines for Child Health Supervision III

Adolescents' knowledge of medical terminology and family health history

Health Psychol

Agreement between adolescent self-report and parent reports of health and well-being: results of an epidemiological study

Child Care Health Dev

Problems in using health survey questionnaires in older patients with physical disabilities

Gerontology

Using proxies to evaluate quality of life: can they provide valid information about patients' health status and satisfaction with medical care

Med Care

Proxy reporting of quality of life using the EQ-5D

Med Care

The adolescent child health and illness profile: a population-based measure of health

Med Care

The proxy problem: child report versus parent report in health-related quality of life research

Qual Life Res

Quality of life predictors of outcome in pediatric abdominal pain patients: findings at initial assessment and 5-year follow-up

Elementary school-aged children's reports of their health: a cognitive interviewing study

Qual Life Res

Children's representations of ‘everyday’ aspects of health and illness

J Ped Psychol

Development of children's concepts of illness

Pediatrics