Psychometric Properties of the Cognitive and Linguistic Scale: A Follow-Up Study

Objective: In a pediatric rehabilitation setting, monitoring recovery of cognitive skills is challenging due to diversity in age and brain injury severity. The Cognitive and Linguistic Scale (CALS) is a measure with promising psychometric properties that was designed for inpatient pediatric rehabilitation care. This study re-examines the reliability and validity of the CALS in a larger, independent sample. Method: Two hundred fifty-eight children (2-21 years) who were consecutively admitted to an inpatient brain injury facility between 2008 and 2014 for a first inpatient rehabilitation admission following a traumatic or acquired brain injury were included. Both CALS and Functional Independence Measure for Children (WeeFIM) were examined at admission and discharge. CALS scores by age groups (preschool-aged, school-aged, adolescents, or young adults), gender, and etiology (acquired vs. traumatic brain injury) and in two subgroups. Results: The internal consistency of the CALS was high. Total CALS score and individual item scores improved significantly between admission and discharge for children of all age groups, both genders, both traumatic and acquired etiologies, and in subgroups with limited responsiveness and no change on the WeeFIM cognitive domain. No age group had a floor or ceiling effect. Correlations with the WeeFIM were high. Factor analysis revealed 2 factors (basic responding and higher-level cognitive skills). Conclusions: The CALS has strong psychometric properties across a wide range of ages, brain injury etiologies, and cognitive severity. The CALS can be used to track cognitive and linguistic recovery in children, adolescents, and young adults with brain injury during inpatient rehabilitation. Impact and Implications A preliminary study found that the Cognitive and Linguistic Scale (CALS) had adequate psychometric properties. This follow up study explores the psychometric properties of the CALS in a larger, independent sample. This study confirms that the psychometric properties of the CALS are strong even with preschool-aged children and those with a range of cognitive severity following traumatic or acquired brain injury. Psychologists working in an inpatient pediatric rehabilitation facility should consider using the CALS as a tool to assess and track cognitive recovery over time.