Reliability and Factor Structure of the Parent Effort Scale Home Version (PES-H)

Background: The ability to participate in common daily activities can have a profound impact on the development of young children. Participation occurs most extensively within the context of the family. Both the child and family respond to participation restrictions through an interactional relationship in which parents provide supports to facilitate participation resulting in various amounts of parental effort. Although all parents describe effort required to support participation, research with families of children with Autism Spectrum Disorders (ASD) have described high levels of parental effort to accommodate their child’s special needs^1-2. There are few if any instruments that consider the impact of parent effort on child participation and none specifically for parents of children with ASD. The Parent Effort Scale – Home Version (PES-H) was developed to fill this need, although requires further psychometric examination.

Objectives: The purpose of this study was to examine internal consistency, factor structure, test-retest reliability, and scale distribution of the PES-H in children between the ages of 3 and 5. Additionally, this study examined differences in parental effort between children with and without Autism Spectrum Disorders.

Methods: A cross sectional design was used to collect data for psychometric analyses. Participants were 304 parents of children with and without ASD between the ages of 3 and 5 years old. Recruitment occurred nationally through social media, ASD community groups, private preschools, and school districts. Participants completed the PES-H, the Gilliam Autism Rating Scale to confirm ASD diagnosis, and a demographic questionnaire either through Qualtrics Survey software. All data was downloaded or inputted into excel and converted for STATA prior to analysis. One hundred and twenty-eight of the participants completed the PES-H two weeks later to evaluate test re-test reliability. Cronbach’s alpha was used to calculate internal consistency and intraclass correlation coefficients to calculate test re-test reliability (n=304)³. A confirmatory factor analysis to evaluate the model fit was completed using Stata software. The frequency of response options was calculated to examine scale distribution. A Cohen’s d effect size estimate was used to examine known group comparisons between scores of parent’s rating of children with (n=176) and without ASD (n=137)³.

Results: Confirmatory factor analysis identified the best fit as a four-factor model (CFI = 0.99, TLI = 0.99, RMSEA = 0.09). The four factors represented dressing, hygiene, sleep and social scales based on item content. Internal consistency was high for all four scales with Cronbach’s alpha ranging between .61 to .73 and very high for the total scale at .78. Total test-retest reliability was moderate for all items and scales (ICC = .51-.71). The PES-H had reasonable distributions for the whole sample. Negative effect sizes on Cohen’s d also indicated that parents of children with ASD when compared to children without ASD had higher effort scores on all subscales and the total scale.

Conclusions: The results of this study identify the underlying factor structure and provide initial reliability for a unique measure to assess parent effort to support participation in the community for young children with and without ASD.