The Turkish adaptation of the Child Occupational Self Assessment Scale (COSA) and its psychometric properties in children with attention-deficit/hyperactivity disorder

The Turkish adaptation of the Child Occupational Self Assessment Scale (COSA) and its psychometric properties in children with attention-deficit/hyperactivity disorder | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Turkish adaptation of the Child Occupational Self Assessment Scale (COSA) and its psychometric properties in children with attention-deficit/hyperactivity disorder Damla Ece Irmak¹, Gonca Bumin¹ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8369939/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Mar, 2026 Read the published version in BMC Psychology → Version 1 posted 11 You are reading this latest preprint version Abstract Background Occupational therapy practices are expanding in Turkey; however, rehabilitation professionals face a scarcity of validated Turkish-language assessment instruments. Consequently, the objective of the present study is to address this gap by validating the Turkish adaptation of the Child Occupational Self-Assessment (COSA) and evaluating its psychometric properties. Methods 101 children aged 7–11 with attention deficit hyperactivity disorder (ADHD) were included in the study. Pearson analysis was used for criterion validity, principal component analysis (PCA) was used for construct validity, and Rash analysis was used to measure reliability. Results Pearson analysis found a moderately positive association scales (p = 0.00, r = 0.675). Variance was found to be high among COSA principal components (%70.17). Internal consistency was found to be quite high (0.86 and 0.77). Conclusions The Turkish COSA was found to be a valid and reliable measurement tool to measure the perceived and importance of children with ADHD in performing daily occupations. Attention Deficit and Hyperactivity Disorder Daily Occupations Validity Reliability Figures Figure 1 Figure 2 Introduction Occupational performance refers to an individual's ability to select, organize, and engage in meaningful occupations based on age and culture. Childhood occupations are essential for a child's participation in daily life, social, and productive skills. Client-centered assessment tools help determine children's occupational performance from their perspectives ( 1 ). Several tools evaluate occupational performance from this approach, including the Canadian Occupational Performance Measure ( 2 ) and the Goal Attainment Scale ( 3 ). Additionally, tools like the Children’s Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC) assess children’s participation in and preferences for activities ( 4 , 5 ). The Children's Occupational Self-Assessment (COSA) is a self-assessment tool based on the Model of Human Occupation (MOHO), designed to involve children in occupational therapy intervention planning and goal-setting ( 6 , 7 ). MOHO provides an occupation-based, client-centered approach that actively engages individuals in the treatment process ( 8 – 11 ). Understanding a child's expectations is essential for developing an appropriate intervention program, as client-centered assessments are fundamental to the therapist-client collaboration ( 12 ). COSA uses self-reports to assess perceived competence and importance levels for daily occupations ( 10 ). Occupational perceived competence refers to an individual's ability to engage meaningfully in occupations that reflect their identity and roles, while the level of importance reflects the physical and material resources involved in these occupations ( 10 ). The prevalence of ADHD in Turkey is reported to be steadily increasing ( 13 ). ADHD is now one of the most common diagnostic groups treated by occupational therapists. It is associated with challenges in academic performance, social relationships, and overall quality of life, which negatively impact children’s ability to engage in daily occupations such as school tasks, play, and social interactions ( 14 ). Enhancing occupational performance in children with ADHD is crucial for improving health and well-being, with client-centered interventions being vital in occupational therapy ( 15 ). Incorporating children’s priorities in assessment and intervention planning ensures best practices and highlights the importance of focusing on these elements for children with ADHD ( 9 ). Consequently, this study selected children with ADHD for the Turkish adaptation and validity-reliability study of COSA. Various studies have adapted the COSA to different cultures: the 2.0 version to Spanish, the 2.1 version to Persian, Dutch, Italian, German, and Finnish, and the 2.2 version to Hungarian, Japanese, and Bulgarian ( 7 , 16 – 19 ). However, no Turkish version of COSA exists. This study aimed to adapt COSA 2.2 into Turkish. This version, developed with increased cultural sensitivity and a broader age range, is updated to accommodate various diagnoses, such as cerebral palsy, learning disabilities, motor development disorders, and sensory processing disorders, enhancing its reliability and universal applicability ( 6 ). Cultural adaptation and validity studies are essential to ensure the effectiveness of assessment tools across diverse populations ( 20 ). Since childhood occupations vary across cultures, understanding how children with ADHD perceive their abilities and participation in daily occupations can provide valuable insights for occupational therapists ( 1 ). This study’s goal was to adapt COSA 2.2 into Turkish and evaluate its psychometric properties for children with ADHD, aiming to improve the accuracy and applicability of client-centered assessments in pediatric occupational therapy. It was hypothesized that the Turkish version of the COSA would demonstrate validity and reliability for children with ADHD, good adaptability as an assessment tool, and no need for major revisions. This manuscript was prepared following the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist ( 21 ). Methods The Turkish adaptation, validity, and reliability of the COSA In this study, Beaton's translation procedure was used ( 22 ). The cross-cultural adaptation of COSA Version 2.2 into Turkish and its psychometric evaluation were conducted in two distinct phases. (Phase I: Translation and cross-cultural adaptation Phase II: Evaluation of reliability and validity). The two phases are described in detail below: Phase 1: Translation and Cross-Cultural Adaptation The English version of COSA 2.2 was translated into Turkish. Two native Turkish-speaking therapists, fluent in English and familiar with the scale’s terminology, performed the forward translation. The Turkish version was then independently back-translated into English by two native English speakers. The back-translations were reviewed for consistency with the original English version, resulting in a preliminary Turkish version of COSA. No modifications were made based on the forward and backward translations or expert reviews, as no culturally inappropriate meanings were identified. A pilot test with 20 children with ADHD confirmed that the items were culturally appropriate and understandable in Turkish, leading to the creation of the final version without any changes. Phase 2: Evaluation of Reliability and Validity Participants : Participants were selected using purposive sampling from children receiving occupational therapy at the Pediatric Rehabilitation Department of [institution name removed for blinding purposes]. Children diagnosed with ADHD according to DSM-5 criteria by child psychiatry were included. The required sample size was determined through power analysis using the G*Power 2 program, resulting in a target of 80 participants, with 80% power, a 5% margin of error, and a 95% confidence interval. To account for potential participant loss, the target was set at 100, and 150 children were assessed. A total of 101 children met the inclusion criteria and participated. Inclusion criteria were: (a) diagnosed with ADHD based on DSM-5, (b) aged 7 to 11, (c) voluntary participation, (d) no other diagnoses, and (e) at least 3 months of ADHD medication use. Exclusion criteria included inability to provide informed consent and the presence of additional neurological or psychiatric conditions affecting daily occupations. Informed consent was obtained from both the children and their parents prior to participation. The flow chart is shown in Fig. 1 . Procedure The demographic information of the children was recorded. While the COSA was filled out by the children, the Short Child Occupational Profile (SCOPE), which is used for the criterion validity of the test, was administered by the therapist through feedback received from the parents and teachers of the children. Assessments were conducted by interviewing the children face-to-face and individually. The assessments took 20–30 minutes for each child. Sociodemographic information This included age, sex, class level, primary caregiver's age, medication usage, and getting occupational therapy services. Child Occupational Self-Assessment Scale (COSA 2.2.) The COSA ( 9 ) is a self-assessment tool based on MOHO ( 10 ) that measures the perceived competence and importance of daily occupations in children with special needs. It consists of 25 statements describing various occupations, where children rate their performance and the importance of each activity ( 17 , 23 ). The scale includes two 4-point rating scales: one for competence (ranging from “I have a big problem doing this” to “I am really good at doing this”) and one for importance (ranging from “Not really important” to “Most important”). Unlike other standardized tests, COSA does not provide a total score or subscale scores but uses Likert scale responses as a qualitative tool to guide therapy by understanding how children perceive their performance and competence. While it is not a quantitative measure, some therapists may analyze the responses quantitatively ( 23 ). Kramer demonstrated that COSA possesses strong content, structural, and substantive validity, as shown by item and child fit statistics and the evaluation of unidimensionality ( 24 ). Data Analysis IBM SPSS Version 25 and R software (version 3.6.2, 2019-12-12- CRAN) were used for statistical analysis of the data. Validity Analysis The criterion validity of the COSA Scale was evaluation using the SCOPE, which had previously been adapted to Turkish and whose validity and reliability had been established. The SCOPE ( 25 ) evaluates the individual's performance in areas based on MOHO sub-parameters (volition, habituation, occupational performance and environment). It consists of 25 items. Additionally, a four-point rating scale is used to explain how the child's volition, habituation, and skills affect occupational participation. Each item has specific descriptors that guide the selection of an appropriate rating ( 26 ). The relationship between the COSA and SCOPE was examined using Pearson correlation coefficients, with statistical significance accepted at p < 0.05. Before conducting the Pearson correlation test, the Shapiro-Wilk test was performed, and it was determined that the data followed a normal distribution. The construct validity of COSA was evaluated using Principal Component Analysis (PCA). PCA is a technique that reduces a data set with multiple variables to a smaller number of new components. In this way, the basic structural components of the scale were more clearly identified. Eigenvalues were calculated for each component, and the variance ratios of components with eigenvalues greater than 1 were determined. This analysis is used to measure the contribution of each component to the total variance. Components with eigenvalues greater than 1 represent the fundamental building blocks of the scale, while the variance ratios of the components indicate whether the scale has a valid and consistent structure (27,28). Reliability Analysis For internal consistency, partial credit Rasch analysis based on item response theory (IRT) was performed. The relationship between the difficulty of the items and the ability of the children was visualized with the Wright map and item characteristic curves. The reliability index in Rasch analysis should be between 0 and 1, and it is recommended to be greater than 0.70 ( 29 , 30 ). Inter-item consistency was evaluated using Cronbach's alpha coefficients. Cronbach's alpha value indicates the following: unreliable in the range of 0.00 < α < 0.40, low reliability in the range of 0.40 < α < 0.60, quite reliable in the range of 0.60 < α < 0.80, and highly reliable in the range of 0.80 < α < 1.00. For item analysis, when each item was deleted, the mean of the scale, variance, Cronbach's α values, and item-total correlation were examined ( 30 ). Results Participants One hundred one children with ADHD were included in the study. The average age of the participants was 8.57 ± 1.22 years (ranging from 7 to 11 years). Of the participants, 67.3% (n = 68) were males, and 32.6% (n = 33) were females (Table 1 ). Table 1 Descriptive statistics of individuals (n = 101) Variables Category n (%) Gender Male 68 (67.3) Age (Year) 7 28 (27.72) 8 24 (23.76) 9 32 (31.63) 10 15 (14.85) 11 7 (6.93) Class Level 2nd grade 21 ( 20.79) 3rd grade 24 ( 23.76) 4th grade 22 ( 21.78) 5th grade 20 ( 19.80) 6th grade 14 ( 13.86) Primary Caregiver’s Age Below 30–35 25 (24.75) 36–40 38 (57.43) 41–45 16 (15.84) 45+ 2 (1.98) Usage Medication 101 (100) Getting Occupational Therapy Services 101 (100) Validity Criterion Validity The criterion validity method was used Pearson correlation analysis, and the analysis results indicated a moderate, significant relationship between COSA and SCOPE (p = 0.00, r = 0.675) (Table 2 ). Table 2 Criterion validity analysis of Child Occupational Self Assessment (COSA) with reference test Short Child Occupational Profile (SCOPE) COSA (Perceived Proficiency Level) COSA (Importance Level) KÇAPP COSA (Perceived Competence Level) r 1 0.221* 0.607** p 0.026 0.000 COSA (Importance Level) r 0.221* 1 0.675** p 0.026 0.003 * The correlation is significant at the 0.05 level. ** The correlation is significant at the 0.01 level. Construct validity The 25 items in the COSA were reduced to seven main components using the PCA method. These seven components were identified, measured, and named. The variance explained by these components was determined, and Table 3 presents their names, eigenvalues, variances, and cumulative variance. The total variance explained by the seven components exceeded 70%, which is considered high in terms of explaining the variables ( 29 ). Table 3 Nomenclature, eigenvalues, variances and cumulative variance rates of the 7 components of COSA Main Components Eigenvalue Variance(%) Cumulative Variance%) 1.Communication Skills 6.273 25.120 25.120 2. Executive Functions 3.014 12.250 37.37 3. Motor Functions 2.486 9.950 47.32 4. School Functions 1.889 7.655 54.975 5. Self Regulation Skilss 1.626 6.510 61.485 6. Assistive Daily Living Activities 1.083 4.335 65.82 7. Daily Living Activities 1.063 4.355 70.175 Reliability Internal consistency Item analysis As a result of the analyses conducted to assess the internal consistency of COSA (perceived competence level), the Cronbach's α value was found to be 0.86. Thus, all items of COSA (perceived compentence level) were determined to be highly reliable. Item analysis data for COSA (perceived competence level) were examined, and the Cronbach's α value for the internal consistency of the COSA (importance level) was found to be 0.77. Therefore, all items of COSA demonstrated an acceptable level of reliability. When the reliability coefficients for the perceived competence level and importance level of the COSA were examined, these values were 0.86 and 0.77, respectively. These findings indicate that COSA is highly reliable. Based on this result, it was concluded that the data collection tools were reliable and suitable for use in the analysis. Partially Credited Rasch Analysis To assess the internal consistency of the COSA, partial credit Rasch analysis was performed. The reliability of the weighted likelihood estimation (WLE) value for the items was found to be 0.868. Based on this result, the data collection tool was determined to be reliable, with no obstacles to its use in the analysis. Visualization with Wright Map Method Item difficulties follow a normal distribution. When examining the bar graphs on the left side of these figures, the graph appears to shift to the left (Fig. 2 ). Considering that items below 0 on the Logit axis are easier and those above 0 are more difficult, the questions tend to be closer to the easy range. Dıscussion The aim of this study was to adapt COSA 2.2 into Turkish and evaluate its psychometric properties. Beaton’s procedures were followed during the cross-cultural adaptation and translation, with no modifications made as there were no inconsistencies or misunderstandings within the Turkish cultural context. To ensure psychometric and clinical validity and reliability for practitioners and clients, criterion validity, construct validity, and internal consistency analyses were conducted. The findings suggest that the Turkish version of COSA is a valid and reliable tool for assessing the perceived competence and importance of occupational tasks for Turkish children with ADHD. Several assessment tools for measuring children's occupational performance include COPM ( 31 ), GAS ( 3 ), and CAPE/PAC ( 4 , 5 ), all of which are valid and reliable in Turkish. However, COSA offers an advantage over COPM and GAS by identifying specific areas where children may struggle, which is particularly useful for children with ADHD and executive function challenges. Furthermore, while CAPE and PAC require 45 to 60 minutes to administer, COSA’s shorter administration time and clarity make it a more suitable tool for children with attention difficulties ( 32 , 33 ), offering a valuable contribution to occupational therapists' assessments. Sturgess, Rodger, and Ozanne ( 34 ) identified potential issues related to how questions are conveyed to children in their study examining self-assessment tools for children. In this study, to ensure consistency, One person read aloud the COSA instructions according to the guidelines in the manual and explained it to the children. However, due to differences in the children's cognitive capacities and levels of task participation, inevitable variations occurred in how the message was conveyed. The original COSA provides a guide on how the items can be explained to children, and the researchers in this study followed this guide when reading and explaining the questions to the children ( 6 ). The translation of words that do not have direct equivalents between languages and the presence of items that are not suitable for the target culture are obstacles encountered during the cultural adaptation of assessment tools ( 35 ). However, in our study, no difficulties were encountered during the translation stages. These findings further demonstrate that the COSA 2.2 version is suitable for cultural adaptation ( 6 ). The results of the study are also supported by the fact that MOHO and its assessments have been studied in many countries, and their theories consider concepts such as "culturally defined occupational forms for each client" ( 36 ). Criterion validity can be assessed using a reference test ( 37 ). In this context, the reference test method was used in our study, and the relationship between COSA and SCOPE was examined using Pearson’s correlation coefficients. A moderately positive correlation was found between COSA and SCOPE ( p = .00, r = .675). This moderate correlation indicates that while the two tests are related, they are not identical, supporting the decision to use COSA and SCOPE as reference measures ( 37 ). The SCOPE describes how the sub-parameters of the MOHO influence an individual’s occupational participation and identifies strengths and weaknesses in occupational performance ( 25 , 38 ). The SCOPE assessment is conducted by therapists through direct observation of the child and by gathering feedback from the multidisciplinary team ( 26 ). In contrast, COSA is a self-report scale completed by the child ( 9 ). Results indicated that a strong positive correlation between the perceived competence level of COSA and SCOPE ( r = .607, p = .00), suggesting that the children in our study demonstrated high self-awareness. Conducting factor analysis to assess construct validity in our study, PCA method was applied using Varimax rotation. A previous study on the psychometric properties of COSA, which used factor analysis for construct validity, found that COSA had a three-dimensional structure, with the total variance explained by the three dimensions being 47.86% ( 16 ). In our study, using PCA as part of factor analysis, we found that COSA consists of a seven-dimensional structure, with the explained variance ratio for the seven components being 71.17%. Since a higher variance ratio strengthens the scale’s structural validity to the same extent ( 30 ), these findings indicate that the construct validity of the Turkish COSA is stronger than that reported in other studies in the literature. The Hungarian adaptation study of COSA reported a Cronbach’s alpha of .87 ( 16 ). In the present study, Cronbach’s alpha values were similarly high, with .86 for the perceived competence level and .77 for the importance level, indicating strong reliability. Additionally, the partial credit Rasch analysis method, based on item response theory, was used to assess internal consistency. The reliability index from this analysis was .86, surpassing the recommended threshold of .70 ( 39 ), confirming the alignment between item difficulties and individual abilities. With a sample of 101 participants, the consistency between item and person measures for all items, along with the absence of items requiring removal, further supports the high internal reliability and methodological strength of the Turkish version of COSA for children with ADHD. This study used a person-item map to determine the difficulty hierarchy of items on the performance scale. Unlike Kramer et al. ( 24 ), where participants’ abilities were one standard deviation above item difficulty, this study found overlap between children’s abilities and item difficulties. This discrepancy may arise from diagnostic differences, as children with ADHD may exhibit higher functional abilities than those with autism, language delays, cerebral palsy, spina bifida, or intellectual disabilities. In line with Keller et al. ( 9 ) and Romero Ayuso and Kramer ( 17 ), the easiest tasks in this study involved communication and social interaction. However, the Iranian adaptation study found these areas most difficult, likely due to cultural and familial norms restricting children’s independence, such as not allowing them to shop alone. The results of our study are consistent with the existing literature that highlights the challenges faced by children with ADHD in occupations requiring executive functions, such as maintaining attention, organizing, emotional regulation, and completing academic tasks like homework. Studies have consistently shown that children with ADHD struggle with tasks requiring sustained effort and responsibility ( 32 , 33 ). Our findings also indicate that the children in our sample faced difficulties with executive function-based tasks, such as completing homework, following classroom rules, calming themselves when upset, continuing tasks even when they became more challenging, taking care of their belongings, and finishing tasks on time. These challenges are consistent with findings from the Spanish version of the COSA ( 17 ), further supporting the tool's validity in assessing ADHD-related difficulties. The inclusion of evaluations regarding areas where children demonstrate weaker performance in the Turkish version of the COSA is crucial for intervention planning. Identifying these weaknesses allows therapists to design intervention programs that are tailored to the specific needs of children with ADHD. Understanding how children perceive their daily occupations is crucial for developing intervention plans in therapy. When children feel inadequate, their motivation for challenging occupations decreases, and they require more support during these tasks ( 10 ). Our study involved the Turkish adaptation of the COSA, and aimed to investigate its validity and reliability in children with ADHD. It is important to introduce a client-centered assessment to the literature, as well as to children's occupational identity, to inform therapists about perceived performance competence, expectations from therapy, and the creation of client-centered intervention programs ( 17 , 40 ). As a result, the Turkish version of COSA was found to be a valid and reliable tool for children with ADHD. We recommend that this MOHO-based scale be used by Turkish pediatric occupational therapists in assessments to measure children's perceived competence in performing daily occupations and the level of importance they place on these occupations. A limitation of the study is that test-retest reliability was not performed to assess time-invariance reliability. Another limitation of the study is the lack of a control group. Conclusion It has been found that the Turkish version of COSA can be used as a self-assessment scale to measure the perceived competence and importance levels in daily occupations of children with ADHD in Turkey. Since this self-assessment scale will provide a valuable guideline for intervention planning for pediatric occupational therapists working with children with ADHD in Turkey, it is considered important to introduce it into the Turkish language within the context of our research. Declarations Ethics approval and consent to participate Before initiating the translation of COSA, the researchers obtained permission for the cross-cultural adaptation of COSA Version 2.2 and to evaluate its psychometric properties. Ethical approval was obtained from the 2019/20–36 decision of the Hacettepe University Non-interventional Clinical Research Ethics Committee.Written informed consent was obtained from all participants. The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors have declared that there are no potential conflicts of interest regarding the research, authorship, or publication of this article. Funding The author(s) did not receive any financial support for the research, authorship, or publication of this article. Author Contribution Conceptualization: DEI, GB. Formal Analysis: DEI, GB. Investigation: DEI, GB. Methodology: DEI, GB. Software: DEI. Supervision: GB. Writing – original draft: DEI. Writing review & editing: DEI and GB. All authors have read and agreed to the published version of the manuscript. Acknowledgements The authors would like to express their gratitude to all the research participants. Data Availability The data used in this study can be obtained from the corresponding author upon request. References Pekçetin S, Salar S, İnal Ö, Kayıhan H. 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OTJR: Occup Particip Health. 2003;23(3):99–106. 10.1177/153944920302300303 . Kashefimehr B, Kayihan H, Huri M. The effect of sensory integration therapy on occupational performance in children with autism. OTJR: Occup Particip Health. 2018;38(2):75–83. 10.1177/1539449217743456 . Uzunsakal E, Yıldız D. Alan araştirmalarinda güvenilirlik testlerinin karşilaştirilmasi ve tarimsal veriler üzerine bir uygulama. Uygulamalı Sosyal Bilimler Dergisi. 2018;2(1):14–28. Kafkes AR. Measurement properties of the Child Occupational Self-Assessment (COSA) [dissertation]. Chicago: University of Illinois at Chicago; 2003. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Mar, 2026 Read the published version in BMC Psychology → Version 1 posted Editorial decision: Revision requested 27 Jan, 2026 Reviewers agreed at journal 22 Jan, 2026 Reviews received at journal 16 Jan, 2026 Reviewers agreed at journal 16 Jan, 2026 Reviews received at journal 15 Jan, 2026 Reviewers agreed at journal 15 Jan, 2026 Reviewers invited by journal 15 Jan, 2026 Editor assigned by journal 15 Jan, 2026 Editor invited by journal 29 Dec, 2025 Submission checks completed at journal 21 Dec, 2025 First submitted to journal 21 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Irmak¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYBACNiBmbACSfGBuBRAzMzcQp4UNzD0D0sKIXwsDihbGNggfr3I+6dOJH2eU2UWzsR8++OHjvNpo/naglh8V23A7jC93s+SGc8m5bTxpyZIztx3PnXGYsYGx58xt3Fp4eDdIPmxjzm1jyDFj5t12LLcBqIWZsQ2vls0/H7bV57bxv//G/HfOsdz5RGjZJrmx7XBum0QOGzCsanI3EKPFcsa540Atz4wle44dyN0I1HIQn1/ke3g33+wpq87t509++OFHTV3uvPOHDz74UYFbCzo4DCYPEK0eCOpIUTwKRsEoGAUjBAAAWoZaBSBP1KsAAAAASUVORK5CYII=","orcid":"","institution":"Hacettepe University","correspondingAuthor":true,"prefix":"","firstName":"Damla","middleName":"Ece","lastName":"Irmak¹","suffix":""},{"id":575588338,"identity":"74664e59-46e7-4951-8142-f43a86e2ce78","order_by":1,"name":"Gonca Bumin¹","email":"","orcid":"","institution":"Hacettepe University","correspondingAuthor":false,"prefix":"","firstName":"Gonca","middleName":"","lastName":"Bumin¹","suffix":""}],"badges":[],"createdAt":"2025-12-15 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1","display":"","copyAsset":false,"role":"figure","size":16655,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8369939/v1/3862ec14585a5ee1bda5f55c.png"},{"id":100672666,"identity":"26d44943-6cb9-4e25-b585-df35e0b915a7","added_by":"auto","created_at":"2026-01-20 10:40:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20429,"visible":true,"origin":"","legend":"\u003cp\u003ePresentation of Wright Map”\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8369939/v1/d0fd9919226f37d2e553d770.png"},{"id":105224133,"identity":"a9d552dd-57de-4cee-96a7-6885e6012055","added_by":"auto","created_at":"2026-03-23 16:12:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1052697,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8369939/v1/88a4114f-d2ff-47c0-8f95-4637b35ba952.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Turkish adaptation of the Child Occupational Self Assessment Scale (COSA) and its psychometric properties in children with attention-deficit/hyperactivity disorder","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOccupational performance refers to an individual's ability to select, organize, and engage in meaningful occupations based on age and culture. Childhood occupations are essential for a child's participation in daily life, social, and productive skills. Client-centered assessment tools help determine children's occupational performance from their perspectives (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Several tools evaluate occupational performance from this approach, including the Canadian Occupational Performance Measure (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and the Goal Attainment Scale (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Additionally, tools like the Children\u0026rsquo;s Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC) assess children\u0026rsquo;s participation in and preferences for activities (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Children's Occupational Self-Assessment (COSA) is a self-assessment tool based on the Model of Human Occupation (MOHO), designed to involve children in occupational therapy intervention planning and goal-setting (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). MOHO provides an occupation-based, client-centered approach that actively engages individuals in the treatment process (\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Understanding a child's expectations is essential for developing an appropriate intervention program, as client-centered assessments are fundamental to the therapist-client collaboration (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). COSA uses self-reports to assess perceived competence and importance levels for daily occupations (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Occupational perceived competence refers to an individual's ability to engage meaningfully in occupations that reflect their identity and roles, while the level of importance reflects the physical and material resources involved in these occupations (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of ADHD in Turkey is reported to be steadily increasing (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). ADHD is now one of the most common diagnostic groups treated by occupational therapists. It is associated with challenges in academic performance, social relationships, and overall quality of life, which negatively impact children\u0026rsquo;s ability to engage in daily occupations such as school tasks, play, and social interactions (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Enhancing occupational performance in children with ADHD is crucial for improving health and well-being, with client-centered interventions being vital in occupational therapy (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Incorporating children\u0026rsquo;s priorities in assessment and intervention planning ensures best practices and highlights the importance of focusing on these elements for children with ADHD (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Consequently, this study selected children with ADHD for the Turkish adaptation and validity-reliability study of COSA.\u003c/p\u003e \u003cp\u003eVarious studies have adapted the COSA to different cultures: the 2.0 version to Spanish, the 2.1 version to Persian, Dutch, Italian, German, and Finnish, and the 2.2 version to Hungarian, Japanese, and Bulgarian (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). However, no Turkish version of COSA exists. This study aimed to adapt COSA 2.2 into Turkish. This version, developed with increased cultural sensitivity and a broader age range, is updated to accommodate various diagnoses, such as cerebral palsy, learning disabilities, motor development disorders, and sensory processing disorders, enhancing its reliability and universal applicability (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Cultural adaptation and validity studies are essential to ensure the effectiveness of assessment tools across diverse populations (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Since childhood occupations vary across cultures, understanding how children with ADHD perceive their abilities and participation in daily occupations can provide valuable insights for occupational therapists (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This study\u0026rsquo;s goal was to adapt COSA 2.2 into Turkish and evaluate its psychometric properties for children with ADHD, aiming to improve the accuracy and applicability of client-centered assessments in pediatric occupational therapy.\u003c/p\u003e \u003cp\u003eIt was hypothesized that the Turkish version of the COSA would demonstrate validity and reliability for children with ADHD, good adaptability as an assessment tool, and no need for major revisions. This manuscript was prepared following the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe Turkish adaptation, validity, and reliability of the COSA\u003c/h2\u003e \u003cp\u003eIn this study, Beaton's translation procedure was used (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The cross-cultural adaptation of COSA Version 2.2 into Turkish and its psychometric evaluation were conducted in two distinct phases. (Phase I: Translation and cross-cultural adaptation Phase II: Evaluation of reliability and validity). The two phases are described in detail below:\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePhase 1: Translation and Cross-Cultural Adaptation\u003c/h3\u003e\n\u003cp\u003eThe English version of COSA 2.2 was translated into Turkish. Two native Turkish-speaking therapists, fluent in English and familiar with the scale\u0026rsquo;s terminology, performed the forward translation. The Turkish version was then independently back-translated into English by two native English speakers. The back-translations were reviewed for consistency with the original English version, resulting in a preliminary Turkish version of COSA.\u003c/p\u003e \u003cp\u003eNo modifications were made based on the forward and backward translations or expert reviews, as no culturally inappropriate meanings were identified. A pilot test with 20 children with ADHD confirmed that the items were culturally appropriate and understandable in Turkish, leading to the creation of the final version without any changes.\u003c/p\u003e\n\u003ch3\u003ePhase 2: Evaluation of Reliability and Validity\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eParticipants\u003c/em\u003e: Participants were selected using purposive sampling from children receiving occupational therapy at the Pediatric Rehabilitation Department of [institution name removed for blinding purposes]. Children diagnosed with ADHD according to DSM-5 criteria by child psychiatry were included. The required sample size was determined through power analysis using the G*Power 2 program, resulting in a target of 80 participants, with 80% power, a 5% margin of error, and a 95% confidence interval. To account for potential participant loss, the target was set at 100, and 150 children were assessed. A total of 101 children met the inclusion criteria and participated. Inclusion criteria were: (a) diagnosed with ADHD based on DSM-5, (b) aged 7 to 11, (c) voluntary participation, (d) no other diagnoses, and (e) at least 3 months of ADHD medication use. Exclusion criteria included inability to provide informed consent and the presence of additional neurological or psychiatric conditions affecting daily occupations. Informed consent was obtained from both the children and their parents prior to participation. The flow chart is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThe demographic information of the children was recorded. While the COSA was filled out by the children, the Short Child Occupational Profile (SCOPE), which is used for the criterion validity of the test, was administered by the therapist through feedback received from the parents and teachers of the children. Assessments were conducted by interviewing the children face-to-face and individually. The assessments took 20\u0026ndash;30 minutes for each child.\u003c/p\u003e\n\u003ch3\u003eSociodemographic information\u003c/h3\u003e\n\u003cp\u003eThis included age, sex, class level, primary caregiver's age, medication usage, and getting occupational therapy services.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eChild Occupational Self-Assessment Scale (COSA 2.2.)\u003c/h2\u003e \u003cp\u003eThe COSA (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) is a self-assessment tool based on MOHO (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) that measures the perceived competence and importance of daily occupations in children with special needs. It consists of 25 statements describing various occupations, where children rate their performance and the importance of each activity (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The scale includes two 4-point rating scales: one for competence (ranging from \u0026ldquo;I have a big problem doing this\u0026rdquo; to \u0026ldquo;I am really good at doing this\u0026rdquo;) and one for importance (ranging from \u0026ldquo;Not really important\u0026rdquo; to \u0026ldquo;Most important\u0026rdquo;). Unlike other standardized tests, COSA does not provide a total score or subscale scores but uses Likert scale responses as a qualitative tool to guide therapy by understanding how children perceive their performance and competence. While it is not a quantitative measure, some therapists may analyze the responses quantitatively (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Kramer demonstrated that COSA possesses strong content, structural, and substantive validity, as shown by item and child fit statistics and the evaluation of unidimensionality (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eIBM SPSS Version 25 and R software (version 3.6.2, 2019-12-12- CRAN) were used for statistical analysis of the data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eValidity Analysis\u003c/h3\u003e\n\u003cp\u003eThe criterion validity of the COSA Scale was evaluation using the SCOPE, which had previously been adapted to Turkish and whose validity and reliability had been established. The SCOPE (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) evaluates the individual's performance in areas based on MOHO sub-parameters (volition, habituation, occupational performance and environment). It consists of 25 items. Additionally, a four-point rating scale is used to explain how the child's volition, habituation, and skills affect occupational participation. Each item has specific descriptors that guide the selection of an appropriate rating (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The relationship between the COSA and SCOPE was examined using Pearson correlation coefficients, with statistical significance accepted at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Before conducting the Pearson correlation test, the Shapiro-Wilk test was performed, and it was determined that the data followed a normal distribution.\u003c/p\u003e \u003cp\u003eThe construct validity of COSA was evaluated using Principal Component Analysis (PCA). PCA is a technique that reduces a data set with multiple variables to a smaller number of new components. In this way, the basic structural components of the scale were more clearly identified. Eigenvalues were calculated for each component, and the variance ratios of components with eigenvalues greater than 1 were determined. This analysis is used to measure the contribution of each component to the total variance. Components with eigenvalues greater than 1 represent the fundamental building blocks of the scale, while the variance ratios of the components indicate whether the scale has a valid and consistent structure (27,28).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eReliability Analysis\u003c/h2\u003e \u003cp\u003eFor internal consistency, partial credit Rasch analysis based on item response theory (IRT) was performed. The relationship between the difficulty of the items and the ability of the children was visualized with the Wright map and item characteristic curves. The reliability index in Rasch analysis should be between 0 and 1, and it is recommended to be greater than 0.70 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Inter-item consistency was evaluated using Cronbach's alpha coefficients. Cronbach's alpha value indicates the following: unreliable in the range of 0.00\u0026thinsp;\u0026lt;\u0026thinsp;α\u0026thinsp;\u0026lt;\u0026thinsp;0.40, low reliability in the range of 0.40\u0026thinsp;\u0026lt;\u0026thinsp;α\u0026thinsp;\u0026lt;\u0026thinsp;0.60, quite reliable in the range of 0.60\u0026thinsp;\u0026lt;\u0026thinsp;α\u0026thinsp;\u0026lt;\u0026thinsp;0.80, and highly reliable in the range of 0.80\u0026thinsp;\u0026lt;\u0026thinsp;α\u0026thinsp;\u0026lt;\u0026thinsp;1.00. For item analysis, when each item was deleted, the mean of the scale, variance, Cronbach's α values, and item-total correlation were examined (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eOne hundred one children with ADHD were included in the study. The average age of the participants was 8.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22 years (ranging from 7 to 11 years). Of the participants, 67.3% (n\u0026thinsp;=\u0026thinsp;68) were males, and 32.6% (n\u0026thinsp;=\u0026thinsp;33) were females (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of individuals (n\u0026thinsp;=\u0026thinsp;101)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (67.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (Year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (27.72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (23.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (31.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (14.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (6.93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eClass Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2nd grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 \u003cb\u003e(\u003c/b\u003e20.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 \u003cb\u003e(\u003c/b\u003e23.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 \u003cb\u003e(\u003c/b\u003e21.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 \u003cb\u003e(\u003c/b\u003e19.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6th grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 \u003cb\u003e(\u003c/b\u003e13.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ePrimary Caregiver\u0026rsquo;s Age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelow 30\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (24.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (57.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (15.84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUsage Medication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGetting Occupational Therapy Services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eValidity\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eCriterion Validity\u003c/h2\u003e \u003cp\u003eThe criterion validity method was used Pearson correlation analysis, and the analysis results indicated a moderate, significant relationship between COSA and SCOPE (p\u0026thinsp;=\u0026thinsp;0.00, r\u0026thinsp;=\u0026thinsp;0.675) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCriterion validity analysis of Child Occupational Self Assessment (COSA) with reference test Short Child Occupational Profile (SCOPE)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCOSA\u003c/p\u003e \u003cp\u003e(Perceived Proficiency Level)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCOSA\u003c/p\u003e \u003cp\u003e(Importance Level)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eK\u0026Ccedil;APP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOSA (Perceived Competence Level)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.221*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.607**\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOSA (Importance Level)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003er\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.221*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.675**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e* The correlation is significant at the 0.05 level.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e** The correlation is significant at the 0.01 level.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eConstruct validity\u003c/h2\u003e \u003cp\u003eThe 25 items in the COSA were reduced to seven main components using the PCA method. These seven components were identified, measured, and named. The variance explained by these components was determined, and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents their names, eigenvalues, variances, and cumulative variance. The total variance explained by the seven components exceeded 70%, which is considered high in terms of explaining the variables (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNomenclature, eigenvalues, variances and cumulative variance rates of the 7 components of COSA\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain Components\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEigenvalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVariance(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCumulative Variance%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1.Communication Skills\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Executive Functions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Motor Functions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. School Functions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5. Self Regulation Skilss\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.626\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.485\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6. Assistive Daily Living Activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7. Daily Living Activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eInternal consistency\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eItem analysis\u003c/strong\u003e \u003cp\u003eAs a result of the analyses conducted to assess the internal consistency of COSA (perceived competence level), the Cronbach's α value was found to be 0.86. Thus, all items of COSA (perceived compentence level) were determined to be highly reliable. Item analysis data for COSA (perceived competence level) were examined, and the Cronbach's α value for the internal consistency of the COSA (importance level) was found to be 0.77. Therefore, all items of COSA demonstrated an acceptable level of reliability. When the reliability coefficients for the perceived competence level and importance level of the COSA were examined, these values were 0.86 and 0.77, respectively. These findings indicate that COSA is highly reliable. Based on this result, it was concluded that the data collection tools were reliable and suitable for use in the analysis.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePartially Credited Rasch Analysis\u003c/strong\u003e \u003cp\u003eTo assess the internal consistency of the COSA, partial credit Rasch analysis was performed. The reliability of the weighted likelihood estimation (WLE) value for the items was found to be 0.868. Based on this result, the data collection tool was determined to be reliable, with no obstacles to its use in the analysis.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eVisualization with Wright Map Method\u003c/strong\u003e \u003cp\u003eItem difficulties follow a normal distribution. When examining the bar graphs on the left side of these figures, the graph appears to shift to the left (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Considering that items below 0 on the Logit axis are easier and those above 0 are more difficult, the questions tend to be closer to the easy range.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Dıscussion","content":"\u003cp\u003eThe aim of this study was to adapt COSA 2.2 into Turkish and evaluate its psychometric properties. Beaton\u0026rsquo;s procedures were followed during the cross-cultural adaptation and translation, with no modifications made as there were no inconsistencies or misunderstandings within the Turkish cultural context. To ensure psychometric and clinical validity and reliability for practitioners and clients, criterion validity, construct validity, and internal consistency analyses were conducted. The findings suggest that the Turkish version of COSA is a valid and reliable tool for assessing the perceived competence and importance of occupational tasks for Turkish children with ADHD.\u003c/p\u003e \u003cp\u003eSeveral assessment tools for measuring children's occupational performance include COPM (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), GAS (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), and CAPE/PAC (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), all of which are valid and reliable in Turkish. However, COSA offers an advantage over COPM and GAS by identifying specific areas where children may struggle, which is particularly useful for children with ADHD and executive function challenges. Furthermore, while CAPE and PAC require 45 to 60 minutes to administer, COSA\u0026rsquo;s shorter administration time and clarity make it a more suitable tool for children with attention difficulties (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), offering a valuable contribution to occupational therapists' assessments.\u003c/p\u003e \u003cp\u003eSturgess, Rodger, and Ozanne (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) identified potential issues related to how questions are conveyed to children in their study examining self-assessment tools for children. In this study, to ensure consistency, One person read aloud the COSA instructions according to the guidelines in the manual and explained it to the children. However, due to differences in the children's cognitive capacities and levels of task participation, inevitable variations occurred in how the message was conveyed. The original COSA provides a guide on how the items can be explained to children, and the researchers in this study followed this guide when reading and explaining the questions to the children (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe translation of words that do not have direct equivalents between languages and the presence of items that are not suitable for the target culture are obstacles encountered during the cultural adaptation of assessment tools (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). However, in our study, no difficulties were encountered during the translation stages. These findings further demonstrate that the COSA 2.2 version is suitable for cultural adaptation (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The results of the study are also supported by the fact that MOHO and its assessments have been studied in many countries, and their theories consider concepts such as \"culturally defined occupational forms for each client\" (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCriterion validity can be assessed using a reference test (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). In this context, the reference test method was used in our study, and the relationship between COSA and SCOPE was examined using Pearson\u0026rsquo;s correlation coefficients. A moderately positive correlation was found between COSA and SCOPE (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.00, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.675). This moderate correlation indicates that while the two tests are related, they are not identical, supporting the decision to use COSA and SCOPE as reference measures (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe SCOPE describes how the sub-parameters of the MOHO influence an individual\u0026rsquo;s occupational participation and identifies strengths and weaknesses in occupational performance (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The SCOPE assessment is conducted by therapists through direct observation of the child and by gathering feedback from the multidisciplinary team (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In contrast, COSA is a self-report scale completed by the child (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Results indicated that a strong positive correlation between the perceived competence level of COSA and SCOPE (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.607, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.00), suggesting that the children in our study demonstrated high self-awareness.\u003c/p\u003e \u003cp\u003eConducting factor analysis to assess construct validity in our study, PCA method was applied using Varimax rotation. A previous study on the psychometric properties of COSA, which used factor analysis for construct validity, found that COSA had a three-dimensional structure, with the total variance explained by the three dimensions being 47.86% (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In our study, using PCA as part of factor analysis, we found that COSA consists of a seven-dimensional structure, with the explained variance ratio for the seven components being 71.17%. Since a higher variance ratio strengthens the scale\u0026rsquo;s structural validity to the same extent (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), these findings indicate that the construct validity of the Turkish COSA is stronger than that reported in other studies in the literature.\u003c/p\u003e \u003cp\u003eThe Hungarian adaptation study of COSA reported a Cronbach\u0026rsquo;s alpha of .87 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In the present study, Cronbach\u0026rsquo;s alpha values were similarly high, with .86 for the perceived competence level and .77 for the importance level, indicating strong reliability. Additionally, the partial credit Rasch analysis method, based on item response theory, was used to assess internal consistency. The reliability index from this analysis was .86, surpassing the recommended threshold of .70 (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), confirming the alignment between item difficulties and individual abilities. With a sample of 101 participants, the consistency between item and person measures for all items, along with the absence of items requiring removal, further supports the high internal reliability and methodological strength of the Turkish version of COSA for children with ADHD.\u003c/p\u003e \u003cp\u003eThis study used a person-item map to determine the difficulty hierarchy of items on the performance scale. Unlike Kramer et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), where participants\u0026rsquo; abilities were one standard deviation above item difficulty, this study found overlap between children\u0026rsquo;s abilities and item difficulties. This discrepancy may arise from diagnostic differences, as children with ADHD may exhibit higher functional abilities than those with autism, language delays, cerebral palsy, spina bifida, or intellectual disabilities.\u003c/p\u003e \u003cp\u003eIn line with Keller et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and Romero Ayuso and Kramer (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), the easiest tasks in this study involved communication and social interaction. However, the Iranian adaptation study found these areas most difficult, likely due to cultural and familial norms restricting children\u0026rsquo;s independence, such as not allowing them to shop alone.\u003c/p\u003e \u003cp\u003eThe results of our study are consistent with the existing literature that highlights the challenges faced by children with ADHD in occupations requiring executive functions, such as maintaining attention, organizing, emotional regulation, and completing academic tasks like homework. Studies have consistently shown that children with ADHD struggle with tasks requiring sustained effort and responsibility (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Our findings also indicate that the children in our sample faced difficulties with executive function-based tasks, such as completing homework, following classroom rules, calming themselves when upset, continuing tasks even when they became more challenging, taking care of their belongings, and finishing tasks on time. These challenges are consistent with findings from the Spanish version of the COSA (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), further supporting the tool's validity in assessing ADHD-related difficulties. The inclusion of evaluations regarding areas where children demonstrate weaker performance in the Turkish version of the COSA is crucial for intervention planning. Identifying these weaknesses allows therapists to design intervention programs that are tailored to the specific needs of children with ADHD.\u003c/p\u003e \u003cp\u003eUnderstanding how children perceive their daily occupations is crucial for developing intervention plans in therapy. When children feel inadequate, their motivation for challenging occupations decreases, and they require more support during these tasks (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Our study involved the Turkish adaptation of the COSA, and aimed to investigate its validity and reliability in children with ADHD. It is important to introduce a client-centered assessment to the literature, as well as to children's occupational identity, to inform therapists about perceived performance competence, expectations from therapy, and the creation of client-centered intervention programs (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs a result, the Turkish version of COSA was found to be a valid and reliable tool for children with ADHD. We recommend that this MOHO-based scale be used by Turkish pediatric occupational therapists in assessments to measure children's perceived competence in performing daily occupations and the level of importance they place on these occupations. A limitation of the study is that test-retest reliability was not performed to assess time-invariance reliability. Another limitation of the study is the lack of a control group.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIt has been found that the Turkish version of COSA can be used as a self-assessment scale to measure the perceived competence and importance levels in daily occupations of children with ADHD in Turkey. Since this self-assessment scale will provide a valuable guideline for intervention planning for pediatric occupational therapists working with children with ADHD in Turkey, it is considered important to introduce it into the Turkish language within the context of our research.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eBefore initiating the translation of COSA, the researchers obtained permission for the cross-cultural adaptation of COSA Version 2.2 and to evaluate its psychometric properties. Ethical approval was obtained from the 2019/20\u0026ndash;36 decision of the Hacettepe University Non-interventional Clinical Research Ethics Committee.Written informed consent was obtained from all participants. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors have declared that there are no potential conflicts of interest regarding the research, authorship, or publication of this article.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe author(s) did not receive any financial support for the research, authorship, or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: DEI, GB. Formal Analysis: DEI, GB. Investigation: DEI, GB. Methodology: DEI, GB. Software: DEI. Supervision: GB. Writing \u0026ndash; original draft: DEI. Writing review \u0026amp; editing: DEI and GB. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors would like to express their gratitude to all the research participants.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003e The data used in this study can be obtained from the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePek\u0026ccedil;etin S, Salar S, İnal \u0026Ouml;, Kayıhan H. Validity of the Turkish occupational self assessment for elderly individuals. 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Chicago: University of Illinois at Chicago; 2003.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Attention Deficit and Hyperactivity Disorder, Daily Occupations, Validity, Reliability","lastPublishedDoi":"10.21203/rs.3.rs-8369939/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8369939/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOccupational therapy practices are expanding in Turkey; however, rehabilitation professionals face a scarcity of validated Turkish-language assessment instruments. Consequently, the objective of the present study is to address this gap by validating the Turkish adaptation of the Child Occupational Self-Assessment (COSA) and evaluating its psychometric properties.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e101 children aged 7\u0026ndash;11 with attention deficit hyperactivity disorder (ADHD) were included in the study. Pearson analysis was used for criterion validity, principal component analysis (PCA) was used for construct validity, and Rash analysis was used to measure reliability.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePearson analysis found a moderately positive association scales (p\u0026thinsp;=\u0026thinsp;0.00, r\u0026thinsp;=\u0026thinsp;0.675). Variance was found to be high among COSA principal components (%70.17). Internal consistency was found to be quite high (0.86 and 0.77).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe Turkish COSA was found to be a valid and reliable measurement tool to measure the perceived and importance of children with ADHD in performing daily occupations.\u003c/p\u003e","manuscriptTitle":"The Turkish adaptation of the Child Occupational Self Assessment Scale (COSA) and its psychometric properties in children with attention-deficit/hyperactivity disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 09:22:03","doi":"10.21203/rs.3.rs-8369939/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-27T07:22:01+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"42339761259347630378917069385923839428","date":"2026-01-22T08:59:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T11:50:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135520672948160677225545816260456666574","date":"2026-01-16T10:18:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-15T06:06:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258429979574852559755738208227760946139","date":"2026-01-15T05:41:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-15T05:34:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-15T05:25:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-29T13:17:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-21T18:49:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-12-21T18:44:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1184d5e4-c185-4a5e-89f5-847d2cbe10fd","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:09:05+00:00","versionOfRecord":{"articleIdentity":"rs-8369939","link":"https://doi.org/10.1186/s40359-026-04369-w","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2026-03-17 15:59:09","publishedOnDateReadable":"March 17th, 2026"},"versionCreatedAt":"2026-01-20 09:22:03","video":"","vorDoi":"10.1186/s40359-026-04369-w","vorDoiUrl":"https://doi.org/10.1186/s40359-026-04369-w","workflowStages":[]},"version":"v1","identity":"rs-8369939","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8369939","identity":"rs-8369939","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}