Middle Eastern Journal of Disability Studies

Background and Objective: Toddlers’ language abilities are difficult to assess using either standard testsor through language sampling.Parents’ report is a valid alternative way of assessment which is broadly applicable for clinical and research purposes. MacArthur-Bates Communicative Development Inventories (MCDI) is one of the most widespread questionnaires applying for this reason. The current study aims to investigate the content validity and reliability of the grammar section of MCDI-Toddler form in 16 to 30 months old Persian-speaking children in Isfahan.
Methods: After adapting the grammar section ofMCDI-Toddler form intoPersian, its content validity was essayed using content validity ratio (CVR). The inventory, then, was sent out to the parents of 50 typically developing children in order to determine the internal consistency of the form. The sample subjects were randomly selected from 10 health centres in Isfahan city. Test-retest reliability was calculated for 20 children with a two-week’s time interval between test and retest phases.  Cronbach’s alpha and Pearson correlation coefficient were used to determine internal consistency and test-retest reliability, respectively.
Results: Calculated CVR was acceptable for more than half of the items. Consequently, those items with lower CVR were modified according to the experts’ opinions. All modified sub-sections but one showed high internal consistency (over 0.72) and high test-retest reliability (0.79 and over).
Conclusion: Grammar section of Persian MCDI-Toddler form is valid and reliable enough to be assayed in further phases of diagnostic studies including normalizing and diagnostic accuracy studies.

Abstract
Objective: Attitudes reflect our feelings about the world phenomena. Researchers believe that the attitudes of people who stutter are a main part of disorder as their motor speech failures, and should be addressed in the assessment and treatment. The Communication Attitude Test for Adults (BigCAT) is an instrument that assesses speech related attitudes in adults who stutter. The purpose of this study was to investigate the quality of translation, validity and reliability of the Persian version of the BigCAT.
Methods: This study was carried out on 17 adults who stutter involving 13 males and 4 females (mean age=25.5, SD=4.07). After the translation of the test and its equalization to Persian Language, content validity was determined by the opinions of experts. Then the criterion validity with S24’s test of communication attitude was determined in people who stuttered. The reliability was examined using Cronbach’s alpha and test-retest reliability.
Results: All BigCAT’s items had a good and suitable translation and good content validity (CVR<0.75). There was a high correlation between BigCAT and S24 (r=0.84, P<0.001). The Cronbach’s alpha for BigCAT’s items was 0.86. The single measure ICC for test-retest reliability was 0.89 with a 95% confidence interval from 0.730 to 0.960.
Conclusion: The results of this study confirm that the Persian version of the BigCAT is a reliable and internally consistent measure of the speech-associated attitude that Persian People who stutter have about their speech competences.
 

Abstract
Background and objective: The aim of this study is to determine the validity and reliability of the gestures section of the MacArthur–Bates Communicative Development Inventory-infant form for 8 to 16 month old Persian-speaking infants in Isfahan-Iran.
Methods: This is a validation study to determine content validity, internal consistency and test-retest reliability of the gestures section. Ten speech language pathologists were asked to comment and score the clarity, simplicity and relevance of the items. Lawshe’s method was used to analyze their scores to determine their content validity ratio (CVR). The administration limits and internal consistency were studied by asking 11 and 115 parents randomly selected, respectively to complete the revised checklist. To determine test-retest reliability the checklist was re-completed by 30 parents within a 15-30 days interval between test and retest phases.
Results: The calculated CVR for the gestures section is 0.91.Chronbach’s alpha shows %962 internal consistency between all items and the test-retest reliability is %925.
Conclusions: All psychometric features are highly acceptable which document the appropriate content validity, internal consistency and test-retest reliability of the gestures section of the infant form of CDI.
 

Abstract
Background & Objective: Many people suffer from chronic nonspecific low back pain among other musculoskeletal disorders during their life time. There is a close relationship between low back pain and one’s physical activity type. Therefore, it is important to have a satisfactory measurement tool to identify and measure the type and rate of physical activity and give some information about type and rate of physical activity to patients and therapists. The aim of this research was to investigate the face validity and test-retest reliability of Persian translation of "Baeck physical activity questionnaire" in patients with chronic nonspecific low back pain.
Methods: Baeck Physical Activity Questionnaire was translated to Persian in accordance with the standards set by the International Quality of Life Assessment (IQOLA) translation protocol with the help of an expert panel. Face validity of the final translation was investigated by both qualitative and quantitative methods. Pearson’s correlation and ICC were used to measure the test retest reliability of the test.
Results: Experts’ opinions were sought as to the wording and clarity of each statement in the instrument. In addition, the opinions of the target population (N=20) was asked as to the face validity of each item. A reliability of 0.85 calculated through ICC and 0.90 calculated through Pearson Correlation Coefficient confirmed the test-retest reliability of the instrument.
Conclusion: Persian translation of Baeck Physical Activity Questionnaire enjoys an acceptable face validity and test-retest reliability in patients with Low Back Pain.
 

Background & Objectives: Based on the evidence, motor skills in children with Down syndrome usually develop similarly to normal children, but at a slower rate and with some delay. People with Down syndrome show some setbacks in developing motor skills and balance, which is evident during childhood and adolescence. Postural stability plays an essential role in daily activities and motor independence. Compared to the general population and other people with intellectual disabilities, people with Down syndrome gain lower scores in equilibrium tests. Various tests have been used in different studies to assess the balance in Down syndrome subjects, and few studies have been conducted to measure the balance using functional tests. One of the benefits of functional tests is their generalization ability compared to laboratory tests. This study aimed to investigate the inter–class and intra–class reliability of the motor performance tests of static and dynamic balance in people with Down syndrome in Tehran.
Methods: The present research used a descriptive survey method. The study participants were 50 people (both genders, 24.4±1.6 years old, IQ=76.8±3.2) with Down syndrome who were purposefully selected with an available sampling method after applying the inclusion and exclusion criteria. The inclusion criteria included the ability to walk without assistance and follow at least three unrelated instructions, with an IQ range of 60 to 85, without severe visual, cognitive, behavioral, or language problems, no vestibular and hearing impairments, or ear infections. Also, they should not have used drugs related to muscle function and systems involved in maintaining balance in the last six months, with no lower limb fractures, lower limb injuries, or movement problems. All samples were checked through their medical records. The exclusion criteria were dissatisfaction with continuing the study, performing physical activities outside the care plan, and not performing correctly in two test measurements. The study motor performance tests of the static and dynamic balance were the Balance Error Scoring System (BESS), Romberg, Sharpened Romberg, Stork Stand, Timed Up and Go (TUG), and tandem walk. Each participant should perform two attempts in each test and has 15 seconds of rest after each trial. The timing of both correct attempts in each session was recorded with a timer. Those who did not perform the test correctly should repeat it. All tests were taken within seven consecutive days by all participants, and one week after taking the test from the last sample, the next testing round was performed in the same manner and with the same testers. The order of the tests was the same for all participants. Inter–class and intra–class correlation coefficients were used to verify the tests' reliabilities. All statistical tests were performed in SPSS–23 software at a significant level of α=0.05. 
Results: The reliabilities of balance performance tests by examining the inter–class correlation (in one session) and intra–class correlation (between the sessions; between two measurements with an interval of one week) were confirmed (p<0.05) in the BESS test, double–leg stance on a firm surface ( 0.950 and 0.857, respectively), the BESS test, single–leg stance on a foam surface ( 0.962 and 0.785, respectively), tandem stance on a firm surface (0.938 and 0.823, respectively), double–leg stance on a foam surface (0.936 and 0.863, respectively), single–leg stance on a foam surface (0.968 and 0.777, respectively), tandem stance on a foam surface ( 0.932 and 0.787, respectively), Romberg test (0.739 and 0.724, respectively), Sharpened Romberg test (0.941 and 0.643, respectively), Stork test (0.779 and 0.839, respectively), Timed Up and Go (TUG) test (0.904 and 0.700, respectively) and tandem walk test (0.878 and 0.634, respectively).
Conclusion: According to the research findings, motor performance tests for the balance of BESS, Romberg, Sharpened Romberg, Stork, TUG, and tandem walk are reliable tests for adults with Down syndrome.

Background & Objectives: Social anxiety is defined as persistent and obvious fear of social and functional conditions. As a result, this belief occurs in the person who has acted shamefully and embarrassingly in this situation and others will judge him negatively. Prominent models of social anxiety emphasize the role of cognitive factors in creating this disorder. Cognitive models state that self-related beliefs are an essential factor in the persistence of social anxiety disorder. The Social Anxiety Questionnaire for Adults (SAQ-A30), originally designed to assess the social anxiety of Spanish students (12), is a self-report instrument that measures the level of social anxiety. This questionnaire is a multidimensional tool that measures social anxiety in people. One of the most important issues in the constructing questionnaires is that the measurement and test tools have desirable psychometric properties. Accordingly, the current study aimed to examine the psychometric properties (reliability and validity) and the standardization of SAQ-A30 among university students.
Methods: In terms of objectives and methodology, this research was applied and developmental research, respectively. Out of the statistical population, 389 students of the Islamic Azad University of Yazd City, Iran were selected by convenience sampling. Then, they completed the SAQ-A30 (Caballo et al., 2010) and the Social Phobia Inventory (SPIN) (Connor et al., 2000). For reliability assessment, using SPSS, the internal consistency method and the Cronbach α coefficient were employed. Additionally, for construct validity assessment, using LISREL, a confirmatory factor analysis was run. For convergent validity evaluation, the Pearson correlation coefficient was used at a significance level of 0.01. Initially, the English version of SAQ-A30, i.e., approved by the designers, was translated to Farsi. Then, the study questionnaires were distributed among the study samples. The instructions on responding to the questionnaires were explained to the study subjects. Besides, the respondents were assured that their collected information would remain confidential.
Results: The analysis data revealed that the Cronbach α coefficient for the whole SAQ-A30 was 0.88. The α values for the subscales of speaking in public; interaction with the opposite sex; assertive expression of annoyance, disgust, and displeasure; criticism and embarrassment; and interaction with strangers, were respectively obtained as 0.67, 0.74, 0.60, 0.72, and 0.68. The result of Confirmatory Factor Analysis (CFA) of the items of the SAQ-A30, using LISREL indicated that this scale has 5 factors with good fit indices. The fit indices were AGFI=0.86, RMSEA=0.05, CFI=0.96, NFI=0.91, and GFI=0.88. Furthermore, there was a significant difference between the components of speaking with people in authority (r=0.451, p=0.001), interactions with the opposite sex (r=0.614, p=0.001), assertive expression of annoyance, disgust, and displeasure (r=0.518, p=0.001), critique and embarrassment (r=0.489, p=0.001), and interactions with strangers (r=0.610, p=0.001), and the total scale (r=0.573, p=0.001) had a positive and significant relationship with Social Phobia Inventory (SPIN).
Conclusion: The present research findings support that SAQ-A30 is an appropriate diagnostic tool for identifying social anxiety among adults.

Background & Objectives: One of the fundamental concepts in psychotherapy is dysfunctional spiritual schemas. These schemas confuse and obscure people's relationship with God and destroy transparency. They create problems for the individual in order to adapt to the laws of God, society, and the environment and reduce the individual's adaptation. Dysfunctional spiritual schemas result in failure in doing jobs. Despite extensive search on popular Iranian and foreign websites, no standardized Persian or foreign scale was found to measure dysfunctional spiritual schemas. Considering the importance of a suitable tool for measuring dysfunctional spiritual schemas, we aimed to design a spiritual dysfunctional schema questionnaire and validate its psychometric properties.
Methods: The present research aims to design and validate a study instrument for measuring dysfunctional spiritual schemas. The study population comprised all staff working for Offshore Oil Company in 2019. A total of 200 individuals were selected by the purposive sampling method. The inclusion criteria included lacking a history of psychiatric disorder, not using specific drugs, giving informed consent to participate in the study, having avoidant and anxious attachment styles to God, and lacking physical limitations disrupting personal care. The exclusion criterion was lack of study cooperation. To design the questionnaire items, we reviewed the relevant texts and interviewed the experts and the target population. To check the content validity (content validity index and content validity ratio) and the face validity, 10 final users were used. Then, to evaluate the construct validity of the questionnaire, the exploratory factor analysis method was used. To evaluate the reliability of the questionnaire, the Cronbach alpha coefficient and test–retest method were used. Data analysis was performed using SPSS 24 at a significance level of 0.05.
Results: The results of the qualitative content validity of the instrument led to the removal of 19 items and revision of 6 items, and finally, a questionnaire with 51 items was prepared. The mean ± SD age of the participants was 45.71±9.45 years. Factor analysis identified ten factors with a specific value of more than one, which together explain 56.75% of the variance. In other words, the dysfunctional spiritual schema questionnaire consisted of ten factors. The results of data analysis showed that the first factor has the highest eigenvalue and the observation of factor loads and factor structure also confirmed this finding. The Cronbach alpha subscales of this questionnaire were as follows: emotional deprivation of God, 0.91; spiritual abandonment, 0.79; spiritual defectiveness and shame, 0.81; spiritual vulnerability, 0.79; spiritual self–immaturity, 0.89; spiritual obedience, 0.76; stubborn spiritual criteria, 0.83; entitlement/spiritual magnanimity, 0.78; negativity/pessimism, 0.85; infidelity and polytheism, 0.82; and total questionnaire, 0.86. To evaluate the instrument's reliability, a correlation coefficient of 0.78 was obtained between two tests with one week interval, indicating the appropriate reliability of the questionnaire. The correlation coefficient subscales of this questionnaire were as follows: emotional deprivation of God, 0.76; spiritual abandonment, 0.7; spiritual defectiveness and shame, 0.71; spiritual vulnerability, 0.71; spiritual self–immaturity, 0.75; spiritual obedience, 0.69; stubborn spiritual criteria, 0.74; entitlement/spiritual magnanimity, 0.68; negativity/pessimism, 0.74; infidelity and polytheism, 0.73; and total questionnaire, 0.78.
Conclusion: According to the study findings, the dysfunctional spiritual schemas questionnaire is a reliable and valid tool, and the components of this questionnaire accurately measure the various dimensions and aspects of dysfunctional spiritual schemas. So, it can be used in research and consulting departments.

Abstract
Background & Objectives: Some people with bipolar disorder regain psychosocial functioning upon symptomatic remission. The majority still suffer persistent functional difficulties, even though their core affective symptoms are controlled. Functional recovery is considered as important as symptomatic recovery, and assessing functional outcomes is increasingly recommended in clinical and research settings. Therefore, it seems quite necessary to make instruments with acceptable validity and reliability in different languages. A variety of measures are applied to evaluate functional impairments in bipolar disorder studies, but none of them are specifically designed for bipolar disorder. This instrument was developed for clinical evaluation of functional impairments presented by patients suffering from mental disorders (especially bipolar disorder). Functioning Assessment Short Test (FAST) is a brief instrument designed to assess the main functioning problems experienced by psychiatric patients, specifically bipolar patients. Here in this research we examined the psychometric properties of the Persian version of FAST.
Methods: This questionnaire development study was conducted in the Psychiatric Department of Imam–Reza Clinic, Shiraz City, Iran. Outpatients diagnosed with bipolar disorder type I and II (n=202) were recruited using convenience sampling. A psychiatrist diagnosed bipolar disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). All available information, including psychiatric records, was brought into consideration. Subjects diagnosed with borderline personality disorder, those in the acute phase of bipolar disorder, active drug abusers, and patients with comorbid mental retardation were excluded. The control group consisted of healthy subjects (n=202) recruited using convenience sampling and screened to have no first–degree relatives with bipolar disorder, current psychiatric comorbidity, schizophrenia, or other psychotic disorders. The control group was compared with the patient group regarding sex, age, marital status, and educational level. Based on the results of the Hamilton Depression Rating Scale and the Young Mania Rating Scale scores, patients were classified as euthymic (those with scores < 8) and symptomatic (those with scores ≥ 8). Bipolar disorder patients and the control group were assessed with FAST. The instrument was evaluated regarding face, construct, convergent, discriminant and concurrent validity. The Cronbach alpha and intra–class correlation coefficients were calculated to estimate internal consistency and test–retest reliability, respectively. Data were analyzed using SPSS 23 and Lisrel 22 at a significance level of 0.05.
Results: The control group and patients group had no significant differences regarding sex, age, marital status, and educational level (p>0.05). Face validity for all questions was acceptable with impact scores ≥ 4.9. FAST total scores were higher for the patient group (22.36±14.21) compared to the control group (4.49±2.03; p<0.001). Furthermore, FAST total scores showed a significant difference between the symptomatic and euthymic groups. FAST scores were lower for the euthymic group (13.80±9.06) compared to the symptomatic group (34.89±10.62; p<0.001). The FAST could successfully discriminate between patients and controls as well as euthymic and symptomatic patients. Confirmatory factor analysis also confirmed the selected model (X2/df=5.04; RMSEA=0.101; NFI=0.96; CFI=0.97; IFI=0.97; GFI=0.80). The FAST also showed acceptable convergent and discriminant validity. The findings showed that the scaling success rates for convergent and discriminant validity were 100% for all domains. Total FAST scores were strongly and negatively correlated with the Global Assessment of Functioning scores (rho= –0.9, p<0.001); therefore, FAST showed an acceptable concurrent validity. The Cronbach alpha coefficient and intra–class correlation coefficient in the Persian version of the FAST were above 0.7.
Conclusion: Based on the findings of this study, the Persian version of FAST has sufficient validity and reliability, making it an acceptable assessment for application in clinical trials and comparative studies.