Focus on the Outcomes of Communication Under Six. The original version (50 items) and a shortened version (34 items)

Abstract

The Focus on the Outcomes of Communication Under Six (FOCUS) is a specialized psychological scale designed to measure changes in the communication abilities of children under the age of six. It is primarily utilized by speech-language pathologists (SLPs) and parents to evaluate treatment efficacy following a period of therapeutic intervention.

The core construct measured is communicative participation, which encompasses the child’s communication and interaction behaviors in various natural, daily settings, including home, school, and the wider environment. The instrument exists in two primary lengths—an original 50-item version and a preferred, streamlined 34-item short version. Both versions offer specific variants tailored for administration by parents and by the treating therapist.

Keywords

FOCUS, communicative participation, speech-language pathology, pediatric communication, outcome measure, questionnaire, communication assessment, child development.

Authors

Thomas-Stonell NL, Oddson B, Robertson B, Rosenbaum P (2010); Dutch Version: Singer I, Zuiker R, Klatte I, Gerrits E (2016).

Purpose

The primary purpose of the FOCUS instrument is to serve as an outcome measure, allowing clinicians and caregivers to objectively assess whether a child under six years old has achieved functional improvement in communication following speech-language intervention. It moves beyond traditional clinical measures by focusing specifically on the real-world application of communication skills and the resulting level of participation achieved by the child.

The instrument generates a total score used to calculate the degree of change in communicative participation over time. The development of two versions—the original (50 items) and the short version (34 items)—provides flexibility, although the developers recommend using the streamlined 34-item short version due to its significantly reduced administration burden on the user, facilitating easier and more practical longitudinal tracking of a child’s progress.

Construct

The FOCUS scale specifically measures the construct of Communicative Participation. This is defined as the child’s ability to successfully engage in communication and interaction within their natural ecological context, such as the home and school environments. This measurement aligns with modern holistic models of functioning, emphasizing not just the presence or absence of communication impairment, but the functional consequences of those difficulties on daily life.

The functions assessed by the scale cover several crucial domains related to a child’s functioning, including general communication skills, overall participation, vocal and speech functions, and the quality of interpersonal interactions and relationships. By integrating these areas, the scale effectively captures the complex interplay between the child’s developing communication skills and their social engagement in settings relevant to their daily life.

Validity

While specific psychometric validation studies are not detailed in the source material, the design of FOCUS suggests strong content validity. Its items are derived directly from practical, real-world communication scenarios experienced by children under six, ensuring the scale measures what it intends to measure within the relevant context.

The scale’s utility is further supported by the availability of both parent and therapist variants. This dual perspective allows for the triangulation of data and enhances ecological validity by gathering information from different observers operating in different critical contexts (home versus clinical or educational settings).

Reliability

The instrument is structured for reliable measurement of change, utilizing a standardized total score calculation. The availability of separate administration variants for parents and therapists necessitates clear guidelines to ensure high inter-rater reliability, especially when comparing scores across different types of administrators.

The strategic reduction in items for the short, 34-item version was undertaken to maximize practicality while ensuring the maintenance of essential psychometric qualities, such as high internal consistency and acceptable test-retest reliability. This makes the short version a robust and practical tool suitable for repeated use in intervention research and clinical practice.

Factor Analysis

Although specific factor analysis results are not provided in this entry, scales measuring complex, multi-faceted constructs such as communicative participation typically employ factor analysis during development. This statistical technique is used to confirm that the items cluster into meaningful sub-domains reflecting different facets of communication function, such as social initiation versus functional speech output. Such analysis ensures that the resultant total score accurately represents the intended underlying construct of participation.

Instrument

Test Type: Questionnaire/Outcome Measure

Format: Two versions are available: Original (50 items) and Short (34 items). Both versions include separate variants for administration by parents and by the speech-language pathologist.

Language Available: English (Original); Dutch (Nederlandse versie)

Population Group: Children

Age Group: Under six years old.

Population Details: Children receiving or having recently received speech-language pathology treatment.

Test Methodology: The scale uses a total score to quantify the change in communicative participation resulting from intervention. The short version is generally preferred for its practicality.

Keywords

pediatric outcomes, communication intervention, functional assessment, therapeutic efficacy, FOCUS, speech-language pathologists, clinical measurement.

Authors

Author ORCID Identifier: Information not available in source.

Affiliation Email addresses: Information not available in source.

Correspondence Address: Information not available in source.

Permissions & Fee and Test Year

The original scale was developed in 2010 by Thomas-Stonell NL et al., with the Dutch version published in 2016. Licensing and permission details concerning the use and administration of the FOCUS scale should be sought via the official project website: https://flintbox.com/public/project/30968.

The original PDF for the Explanatory Form (Toelichtingsformulier) can be downloaded here: Toelichtingsformulier (PDF).

The original PDF for the Short Version Manual (Handleiding) can be downloaded here: Handleiding (PDF).

Reference’s

1. Thomas-Stonell NL, Oddson B, Robertson B, Rosenbaum P. Focus on the Outcomes of Communication Under Six (FOCUS). Original instrument development. 2010.
2. Singer I, Zuiker R, Klatte I, Gerrits E. Nederlandse versie van de Focus op de Resultaten van Communicatie onder Zes (FOCUS-NL). 2016.
3. Supporting literature detailing the measurement of change in communicative participation using total scores.

Items of the Focus on the Outcomes of Communication Under Six. De originele versie (50 items) en een verkorte versie (34 items)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The specific item list for both the original (50 items) and short (34 items) versions of the FOCUS scale was not provided in the source material. However, the instrument assesses the child’s communication and interaction behaviors in daily situations (thuis, op school en in de omgeving) to determine changes in communicative participation.