The Validity and Reliability Test of The Mini-Mental State Pediatric Examination (MMSPE) As A Screening Instrument for Cognitive Function In Indonesian-speaking Children

The Validity and Reliability Test of The Mini-Mental State Pediatric Examination (MMSPE) As A Screening Instrument for Cognitive Function In Indonesian-speaking Children | 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 Validity and Reliability Test of The Mini-Mental State Pediatric Examination (MMSPE) As A Screening Instrument for Cognitive Function In Indonesian-speaking Children R. A. Setyo Handryastuti, Nenden Nursyamsi Agustina, Rini Sekartini, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5982684/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Oct, 2025 Read the published version in BMC Pediatrics → Version 1 posted 18 You are reading this latest preprint version Abstract Background: Cognitive function is one of the important aspects in the period of a child’s development. Cognitive dysfunction can be a risk factor of neuropsychological development disorders. The Mini-Mental State Pediatric Examination (MMSPE) is one of the instruments for early detection of cognitive dysfunction in children. The adaptation of MMSPE into Bahasa Indonesia version is currently not available. There are no cognitive function screening instruments that assess higher functions or executive functions as tested in MMSPE. Objective: This study aimed to adapt the MMSPE into Indonesia version and prove the validity and reliability of the instrument. Methods: This was a cross-sectional study that recruited 90 children aged 6-14 years who attended elementary and junior high schools. The research was conducted at Public Elementary School and Public Junior High School in Jakarta, Indonesia, from May to October 2024. The sampling method was carried out using stratified random sampling. The translation process of the instrument consists of forward and back translation. It was carried out by two pairs of certified translators. Content validity was assessed by five related experts and presented in the form of content validity index for items (I-CVI) and content validity index for scale (S-CVI) values. Reliability a was assessed by the Cronbach's alpha value. Results: The Indonesia version of the MMSPE instrument has an average score of I-CVI, S-CVI/Ave (average), and S-CVI/UA (universal agreement) of 1. All items of the Indonesia version of the MMSPE instrument had calculated r > r table with a Cronbach's alpha values of 0.754 and 0.760 respectively at the first and second examination. Conclusion: Indonesia version of MMSPE is a valid and reliable instrument for screening of cognitive function in Indonesian children aged 6-14 years old. validity reliability MMSPE cognitive function Introduction Cognitive function is one of the important aspects during a child's development period. This function includes the ability to process information involved in learning, thinking, reasoning, remembering, communicating, problem-solving, and decision-making. These abilities are crucial for children to adapt, especially in achieving educational success, succeeding in their careers, innovating, and developing interpersonal relationships. 1 Cognitive dysfunction can affect the neuropsychological development of children, potentially diminishing their optimal future potential. 2 The prevalence of cognitive dysfunction in children is 8.56% and in several other studies it is estimated to be between 7–14%. 3,4 Genetic, perinatal, maternal, and environmental factors may serve as risk factors for the occurrence of cognitive dysfunction. Cognitive dysfunction occurring during childhood is associated with an increased risk of mental health disorders, substance abuse, unemployment, and antisocial or criminal behavior in adulthood. 5 Cognitive deficits carry the risk of long-term impairments in educational attainment, employment opportunities, and overall quality of life. 6 Early detection of cognitive dysfunction helps identify children at high risk of experiencing neuropsychological developmental disorders. Several assessment tools are available for evaluating cognitive function, many of which are commonly used in adult patients, such as the Mini-Mental State Examination (MMSE). 7 The MMSE is designed for screening cognitive dysfunction. 8 Cognitive function screening using the MMSE is widely employed for assessing age-related cognitive decline, but it is still rarely utilized for screening developmental delays in childhood. 9 MMSE was modified into pediatric version because it reflected developmental stage of cognitive domain. The use of the MMSE in children can contribute to early cognitive function assessment by pediatricians. 10 The screening assessment of cognitive function in children in developing countries faces challenges due to the lack of valid diagnostic instruments at the individual, group, and population levels. 6 Currently, recommended cognitive screening tools for children based on international consensus are not available. 7 , 11 Some countries have modified adult cognitive function screening tests into child versions. Scarpa et al. have created a standardized modified version of the MMSE for application in children in Italy, called the Mini-Mental State Pediatric Examination (MMSPE). 12 This pediatric screening version retains the basic structure of the MMSE test while exploring orientation (space and time), verbal production and comprehension, metaphonological skills (writing, reading, and arithmetic), memory, constructive abilities, and executive function. 9 , 13 Cognitive function domains include perception, memory, learning, attention, decision-making, and language abilities. These functions are closely related to the mechanisms of learning, remembering, problem-solving, and paying attention to things. 14 , 15 Systematic and brief cognitive function screening can assist doctors in detecting the risk of cognitive developmental delays or cognitive impairment. Cognitive function screening test is very useful for monitoring a child's cognitive profile, especially when a complete neuropsychological test battery cannot be easily administered, such as when a child exhibits difficulty concentrating, which can hinder the reliability of a comprehensive neuropsychological evaluation. This can provide relevant information to be considered in relation to the evaluation of academic skills, behavioral traits, and contextual factors in detecting learning difficulties or disabilities. 7 , 16 Research adapting the MMSPE into Indonesian version has not yet been conducted. There is no previous research about the use of MMSPE in Indonesia. Additionally, there are no cognitive function screening instruments that assess higher functions or executive functions. This study aims to adapt such a questionnaire to enhance the quality of healthcare services for children and adolescents so that it can be implemented in daily practice for cognitive function screening. Methods This study was a combination of qualitative methods in the instrument translation phase and quantitative methods in assessing the instrument's validity and reliability. A cross-sectional study design was used to test the validity and reliability of the Indonesian version of the MMSPE for cognitive function screening in children. The research was conducted at one model of Public Elementary School and Public Junior High School in Jakarta, Indonesia, from May to October 2024. The subjects were included to the study if the children and their parent or caregiver were able to read and write, speak Indonesian, and willing to participate in the study, as evidenced by an informed consent form signed by the parent, guardian, or other caregiver. However, children who had been formally diagnosed with intellectual disabilities, children with special needs, and children who were ill at the time of the examination were excluded from the study. This study adhered to the Declaration of Helsinki. Ethical approval for this study was obtained from the Health Research Ethics Committee, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo National Hospital, Jakarta, Indonesia (reference no.: KET-584/UN2.F1/ETIK/PPM.00.02/2024). All legal guardians of the subjects provided their consent for participation. The original version of Mini-Mental State Pediatric Examination (MMSPE) was developed by Scarpa, Toraldo, Peviani, and Bottini in 2017. The study conducted for screening cognitive function in the Italian pediatric population. The cut-off point of normal value was assessed according to child’s age and parents’ mean education. The initial stage of translation was forward translation, involving translating the instrument from English to Indonesian. The translation was performed by two certified translators, one with a medical background and the other with a non-medical background. One Italian translator was available as a reference. The expert committee compared the translation results to examine medical and non-medical perspectives on the instrument's content after the forward translation process. The expert committee consisted of a pediatric neurology consultant, a developmental and social pediatrics consultant, a psychologist, a linguist, and a general pediatrician. The expert committee also assessed the suitability of the translation results with the original MMSPE and made the necessary adaptation. The MMSPE instrument that had been translated into Indonesian was then translated back into English (back translation) by two translators who were not involved in the forward translation. One translator was a native speaker with a non-medical background, and the other was an Indonesian translator with a medical background. The results of the back translation into English were compared and reassessed by the expert committee, as in the previous forward translation process. If the back translation results were satisfactory, they would be sent to the questionnaire developer for input and approval. The assessment of content validity was performed using the content validity index (CVI) method. Content validity presented in the form of content validity index for items (I-CVI) and content validity index for scale (S-CVI) values. The I-CVI assessed the validity of the index for each statement in the questionnaire, while S-CVI was used to assess the overall scale validity. The assessment was conducted by five experts, consisting of one expert each from the fields of pediatric neurology, developmental and social pediatrics, psychology, linguistics, and general pediatrics. Each expert was asked to assess the suitability of the statements on a scale of 1–4, where 1 (not relevant), 2 (somewhat relevant), 3 (quite relevant), and 4 (very relevant). A score of 1 was given for questions rated on a scale of 3 or 4, while a score of 0 was given for questions rated on a scale of 1 or 2. The I-CVI score was obtained by dividing the number of experts who stated that the question on the questionnaire was relevant (score 1) by the total number of experts. The mean I-CVI score was obtained by summing all I-CVI scores for all questions and dividing by the number of experts, which was five. The S-CVI score is the number of questions that received a score of 1 (scale 3 or 4) divided by the total number of questions (18). The S-CVI score was then assessed using two methods: Scale-Level Content Validity Index based on the Average method (S-CVI/Ave) and Scale-Level Content Validity Index based on universal agreement (S-CVI/UA). S-CVI/Ave is a measure used to assess the content validity of a scale or instrument. It is calculated as the average of the Item-Level Content Validity Indexes (I-CVI) for all items on the scale. The S-CVI/Ave score is the total S-CVI score divided by the number of experts, while the S-CVI/UA score is the total universal agreement (UA) score for each question divided by the number of questions. The UA value is calculated by assigning a 1 to questions that received 100% agreement from the experts (all experts gave a scale of 3 or 4), while a 0 is given to questions that were not unanimously agreed upon. The accepted CVI value for a team of five experts is 0.99. The content validity ratio (CVR) value is calculated using the formula: $$\:CVR=\frac{ne-N/2}{N/2}$$ Note • ne: number of experts who indicated that the question was appropriate and important (scale 3 or 4) • N: number of experts who assessed The MMSPE instrument was pilot-tested on 30 subjects different from the research participants before being administered to research subjects. The sample size for testing the validity of the research instrument is based on the literature that the minimum sample size were 30 subjects. The instrument adaptation process continued with the validation of the questionnaire on the research subjects. A total of 90 subjects were recruited for the study, distinct from the 30 subjects involved in the pilot testing phase of the Indonesian version of the MMSPE instrument. Sample size was measure using the formula. According to the formula, minimal sample size for each group was 30 subjects. These subjects were divided into three groups of 30 based on grade level: 30 subjects from grades 1–2 of elementary school, 30 subjects from grades 3–6 of elementary school, and 30 subjects from grades 1–3 of junior high school. The sampling method was carried out using stratified random sampling until the required number of research samples was met and divided into each age group within the research period. Subject selection was conducted using an age stratification approach to adjust the difficulty of question items with age range and developmental spectrum, as well as to add statements describing the assessment of executive function. Data collection was carried out by examining the research sample using the Indonesian version of the MMSPE questionnaire. All examination results were processed and analyzed in SPSS tables. The validity of the MMSPE instrument was assessed using the correlation coefficient (r). The results were considered valid if the calculated r-value > r-table value. Reliability, as reflected through internal consistency, was assessed using Cronbach's alpha, which has a value range from 0 to 1. A value of 0.6–0.8 is considered reliable, while a value above 0.8 indicates very reliable. Results The content validity of the MMSPE instrument was assessed for 18 questions, involving agreement among the expert committee regarding the translation results and quantitative measurement based on the relevance of each statement. The content validity assessment used content validity index for items (I-CVI) analysis to assess the validity of the index for each statement in the questionnaire, and the validity index for scales (S-CVI) to assess the overall scale validity (Table 1 ). Table 1 Content Validity of the Indonesian Version of the MMSPE Instrument Expert 1 Expert 2 Expert 3 Expert 4 Expert 5 UA I-CVI CVR Question 1 4 4 4 4 4 1 1 1 Question 2 4 4 4 4 4 1 1 1 Question 3 4 4 4 4 4 1 1 1 Question 4 4 4 4 3 3 1 1 1 Question 5 4 4 4 3 3 1 1 1 Question 6 4 4 4 4 4 1 1 1 Question 7 4 4 4 4 4 1 1 1 Question 8 4 4 4 4 4 1 1 1 Question 9 3 4 4 3 3 1 1 1 Question 10 4 4 4 4 4 1 1 1 Question 11 3 4 4 4 3 1 1 1 Question 12 4 4 4 3 4 1 1 1 Question 13 4 4 4 4 3 1 1 1 Question 14 4 4 4 4 3 1 1 1 Question 15 4 4 4 3 3 1 1 1 Question 16 4 4 4 4 4 1 1 1 Question 17 4 4 4 4 4 1 1 1 Question 18 3 4 4 4 3 1 1 1 S-CVI 1 1 1 1 1 Rerata I-CVI 1 S-CVI/UA 1 S-CVI/Ave 1 This study showed that the mean values of I-CVI, S-CVI/Ave, S-CVI/UA, and CVR are 1. This indicated an excellent level of content validity. All experts stated that the MMSPE instrument is highly relevant or quite relevant in screening for cognitive function. The MMSPE instrument was then pilot-tested on 30 child subjects aged 6–14 years after obtaining consent from the parents or guardians of the students (Table 2 ). Table 2 Validity Test Results of pilot-testing of the Indonesian Version of the MMSPE Instrument Questions the item-total correlation (r-calculated value) r-table validity* Cronbach’s Alpha 1 0,385 0,361 Valid 0,825 2 0,362 0,361 Valid 3 0,676 0,361 Valid 4 0,460 0,361 Valid 5 0,387 0,361 Valid 6 0,560 0,361 Valid 7 0,506 0,361 Valid 8 0,363 0,361 Valid 9 0,377 0,361 Valid 10.A 0,395 0,361 Valid 10.B 0,388 0,361 Valid 11 0,616 0,361 Valid 12 0,431 0,361 Valid 13 0,369 0,361 Valid 14 0,418 0,361 Valid 15 0,373 0,361 Valid 16 0,419 0,361 Valid 17 0,387 0,361 Valid 18 0,412 0,361 Valid *note: Valid if the calculated r-value > r-table value. Table 2 showed that all question items on the MMSPE instrument were valid because the item-total correlation values of each question item (calculated r-value) > r-table value (0.361). The reliability test results of the MMSPE instrument that was pilot-tested were reliable because the Cronbach's Alpha value was 0.825. The Indonesian version of the MMSPE instrument was then tested to 90 subjects different from those in the pilot testing phase to assess the validity and reliability of the instrument. The characteristics of the research subjects are shown in Table 3 . Table 3 Characteristics of subjects Characteristics of subjects N = 90 (%) Mean ± SD Median (min – max) Age, n (%) 10,26 ± 2,66 10 (6–14,67) School’grade, n (%) 1–2 Elementary school 30 (33.3) 3–6 Elementary school 30 (33,3) 1–3 Junior high school 30 (33,3) Sex, n (%) : Male 45 (50,0) Female 45 (50,0) Birth weight, n (%) Normal 81 (96,4) Low birth weight 3 (3,3) Excessive birth weight 0 (0,0) Nutritional status, n (%) Good 63 (70,0) Undernutrition 9 (10,0) Overweight 7 (7,8) Obesity 11 (12,2) Economic status : below the minimum wage 38 (42,2) Equal to or above the minimum wage 52 (57,8) Father’s education, n (%) Elementary School 1 (1,1) Junior High School 3 (3,3) Senior High School 54 (60,0) Higher education 32 (35,6) Mother’s education, n (%) Elementary School 0 (0,0) Junior High School 4 (4,9) Senior High School 48 (59,3) Higher education 29 (35,8) Suspected cognitive dysfunction, n (%) Yes 9 (10,0) No 81 (90,0) IQ Categories based on WISC, n (%) 9 (10%) Average 3 (33,3) Below Average 3 (33,3) Boderline 2 (22,2) Intellectual Disability 1 (11,1) Duration of examination 15,26 ± 4,09 15,24 (0,25–22,68) Cooperation with examiner 9,48 ± 0,59 10 (8–10) Ability to maintain attention during examination 9,29 ± 0,64 9 (8–10) Relationship/interaction with the examiner 9,37 ± 0,59 9 (8–10) Ability to maintain position 9,24 ± 0,69 9 (8–10) There were nine (10%) subjects with MMSPE scores below the cut-off value. They were then tested using Wechsler Intelligence Scale for Children (WISC) for Intelligence Quotient (IQ) category. The WISC is a gold standard diagnostic instrument for assessing cognitive dysfunction. Of the nine subjects, there were 3 (33.3%) subjects with average IQ, 3 (33.3%) subjects with below average IQ, 2 (22.2%) subjects with borderline IQ, and 1 (11.1%) subject with Intellectual Disability IQ. Table 4 showed the factor analysis using Kaiser-Meyer-Olkin (KMO) and Bartletts Test. Table 4 Kaiser-Meyer-Olkin (KMO) and Bartletts Test KMO and Bartletts Test KMO Measure of Sampling Adequacy 0,607 Bartlett's Test of Sphericity Approx. Chi-square 180,525 Sig < 0,001 Based on the results of the factor analysis, the KMO value was found to be greater than 0.05, indicating that the factor analysis can be proceeded (Table 5 ). Table 5 Correlation matrix of the factors in the Confirmatory Factor Analysis (CFA) model. Cognitive domain Anti Image Correlation Measures of Sampling Adequacy (MSA) Spatial and temporal orientation 0,831 MSA > 0,500 (fulfilled) Productive language 0,607 Praxis 0,545 Reading and writing prerequisite skills 0,680 Number knowledge 0,560 Verbal short- and long- term memory 0,555 Executive functions 0,737 The MSA value in Table 5 showed > 0.5. It indicated that the variable can be well predicted by other variables in the model. The fulfillment of the MSA criterion indicated that the relationship among variables were sufficiently strong and relevant, ensuring that factor analysis can yield valid and reliable results. Component matrix analysis showed in Table 6 . The indicators used have a factor loading value greater than 0.60 (n = 90) and cluster within a particular factor; therefore, it can be concluded that the indicators used were consistent in the variable. Table 6 Component Matrix Cognitive domain Component 1 2 3 Spatial and temporal orientation 0,605 Productive language 0,795 Praxis 0,854 Reading and writing prerequisite skills 0,820 Number knowledge 0,946 Verbal short- and long- term memory 0,950 Executive functions 0,698 The validity test of the Indonesian version of the MMSPE instrument showed that both the first and second assessments revealed that the item-total correlation (r-calculated value) > r-table (0.175). The reliability test results of the MMSPE instrument were reliable because the Cronbach's Alpha value were 0,754 and 0,760 respectively (Table 7 ). Table 7 The Validity and Reliability Tests of the Indonesian Version of the MMSPE Instrument Cognitive Domain the item-total correlation (r-calculated value) 1st Test r-tabel Cronbach’s alpha 1 the item-total correlation (r-calculated value) 1st Test r-tabel Cronbach’s alpha 2 Spatial and temporal orientation 0,448 0,175 0,754 0,422 0,175 0.760 Productive language 0.298 0,175 0,176 0,175 Praxis 0,203 0,175 0,220 0,175 Reading and writing prerequisite skills 0,582 0,175 0,629 0,175 Numnber knowledge 0.604 0,175 0,685 0,175 Verbal short- and long-term memory 0,558 0,175 0,582 0,175 Executive function 0,573 0,175 0,590 0,175 r hitung > r table (0,175)→Valid All subjects underwent a retest of the Indonesian version of MMSPE instrument, which involved the test twice with a 1-week interval to assess the consistency of the answers provided. These results were then assessed using intraclass correlation coefficients (ICC). The ICC result in this study was 0.879, which indicates good reliability (Table 8 ). Table 8 Retest of the Indonesiaon version of MMSPE Instrument MMPSE Mean (SD) ICC (IK 95%) Test 1 31,87 (3,519) 0,879 (0,816-0,920) Test 2 33,04 (3,097) Discussion The MMSPE instrument was developed in Italy in 2017 by adapting the MMSE instrument 11 . The MMSPE instrument explores orientation in space and time, along with the collection of personal data, verbal production and comprehension, writing, reading, arithmetic, working and verbal memory, logical sequencing skills, constructive abilities, shape and color recognition, awareness of body schema, and executive functions 11 .The MMSPE instrument also observes the level of cooperation, interaction with the examiner, sustained attention, and maintenance of the whole component arrangement, qualitatively and quantitatively assessed by the examiner 17 . This study is the first research in Indonesia that aims to assess the validity and reliability of the Indonesian version of the MMSPE instrument as a screening tool for cognitive function disorders in children. The average age of subjects in this study was 10.26 years. The adaptation of the MMSPE instrument can screen for cognitive function disorders in three different education groups: elementary school grades 1–2, 3–6, and junior high school grades 1-3. 13 A total of 81 subjects (96.4%) had a normal birth weight history, and 63 subjects (70%) had good nutritional status. Low birth weight (LBW) can increase the risk of cognitive function disorders in children, as can nutritional status. A systematic review concluded that low birth weight and low parental education levels are significant predictors of global cognitive impairment in children. The review also showed that the influence of perinatal risk factors decreases over time as other environmental and social factors become more influential in a child's cognitive development. 17 The highest education level of fathers and mothers was high school graduates, with 54 subjects (60%) and 48 subjects (59.3%), respectively. The education level in this study is better compared to the education level of Indonesian men and women. Data from the Central Statistics Agency (BPS) in 2023 shows that 42.62% of Indonesian men and 37.6% of Indonesian women have a high school education or equivalent. Parental education has a significant effect on global cognitive scores in all age groups on the MMSPE examination. 12 Content validity assessment in this study was carried out by assessing the I-CVI, S-CVI, and CVR scores. The study showed that the average values of I-CVI, S-CVI/Ave, S-CVI/UA, and CVR were 1. This indicates that the Indonesian version of the MMSPE instrument has excellent content validity. This assessment is important to ensure that the adapted instrument is representative, relevant, and can function well as a screening tool for cognitive function in children. Cainelli et al.'s study obtained the following parameters from the MMSPE diagnostic performance evaluation in neuropsychological disorders: negative predictive value (NPV) 0.81, positive predictive value (PPV) 0.87, specificity 0.91 (95% CI 0.81–1.00), sensitivity 0.74 (95% CI 0.57–0.90), and overall accuracy 0.83 (95% CI 0.64–0.91), p < 0.001. The MMSPE instrument has proven to have good prognostic ability in predicting neuropsychological problems in the context of various neurological diseases in children, especially in identifying high-risk children. 18 The validity of the Indonesian version of the MMSPE instrument was assessed by comparing the item-total correlation (r-calculated) to the r-table value, and it was found that all items of the Indonesian version of the MMSPE instrument were valid because r-calculated > r-table. This is consistent with Fakhri et al.'s research, which concluded that the Iranian version of the MMSPE in Persian has good validity. Validity in that study was based on an independent t-test with a 95% confidence level, which showed a significant difference between the normal group and the group with cognitive impairment. 19 The Indonesian version of the MMSPE instrument has a Cronbach's alpha value of 0.754 in the first assessment and 0.760 in the second assessment. This indicates that the MMSPE instrument has good reliability. A retest of the MMSPE instrument, which was administered twice with a 1-week interval to each research subject, was also conducted to assess the consistency of the answers provided. The ICC result in this study was 0.879, which means there was good consistency in the answers between the first and second assessments. This result is consistent with other studies that assessed the reliability of the MMSPE instrument. Fakhri et al. stated that the Cronbach's alpha value for the Persian (Iran) version of the instrument was excellent, at 0.92. 19 This study found nine subjects (10%) who likely have cognitive impairment based on the cut-off value of the total MMSPE score, according to Scarpa et al.'s research. 7 This is not much different from the figures reported by Donald KA et al., nor from the incidence of cognitive impairment reported in other literature, which is around 7–14%. 4 Each subject who had an MMSPE score below the normal value, the researcher contacted and provided education, and advised parents to have their child examined by a child psychologist to confirm the presence of cognitive function disorder. This study has several strengths and limitations. This is the first study to adapt the MMSPE for the child population in Indonesia. This research was conducted in public schools, so the subjects recruited encompassed a variety of demographics representing the conditions of children in Indonesia. This study did not compare with a gold standard instrument on all research subjects to compare the diagnostic test of the Indonesian version of the MMSPE instrument. The gold standard examination with WISC in this study was only performed on research subjects who had an MMSPE score below the cut-off value. Conclusion The Indonesian version of the MMSPE instrument has good content validity with an average I-CVI, S-CVI/Ave, and S-CVI/UA score of 1. The Indonesian version of the MMSPE instrument is valid because all items have a total item correlation value (r calculated) > r table. The Indonesian version of the MMSPE instrument has good instrument reliability with a Cronbach's alpha value of 0.754 in the first assessment and 0.760 in the second assessment. Comparison of the Indonesian version of the MMSPE instrument with a gold standard test for all research subjects is necessary so that the Indonesian version of the MMSPE instrument can be widely used as a screening instrument for cognitive function disorders in children. Further research is needed to determine the sensitivity and specificity values in the diagnostic test of the Indonesian version of the MMSPE instrument with a larger sample size in the child population in Indonesia. Abbreviations MMSPE :The Mini-Mental State Pediatric Examination MMSE : the Mini-Mental State Examination I-CVI : content validity index for items S-CVI : the validity index for scales UA : universal agreement CVR : content validity ratio KMO : Kaiser-Meyer-Olkin CFA : Confirmatory Factor Analysis MSA : Measures of Sampling Adequacy Declarations The Indonesian version of MMSPE used in this study has not previously been published elsewhere. Ethics Approval and Consent to Participate Ethical considerations were diligently addressed in the planning and execution of this study. This study adhered to the Declaration of Helsinki. Ethical approval for this study was obtained from the Health Research Ethics Committee, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo National Hospital, Jakarta, Indonesia (reference no.: KET-584/UN2.F1/ETIK/PPM.00.02/2024). All legal guardians of the subjects participated in the study provided informed consent before participating in the study. All legal guardians of the subjects provided their consent for participation. Consent for Publication The confidentiality and privacy of the participants in this study have been paramount. All legal guardians of individuals included in this research were assured of the anonymity of their data. Informed written consent was obtained from each legal guardians, emphasizing that no personal identifiers, such as names or affiliations, would be disclosed in any publications resulting from this study. There is no financial benefit from company regarding the submission or publication of this manuscript. Availability of Data and Materials The data and materials supporting the findings of this study are available upon reasonable request from corresponding author (Nenden Nursyamsi Agustina, Pediatric Neurology Division, Department of Pediatric, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Hospital, Jakarta, Indonesia. E-mail: [email protected] ). Competing Interests The authors declare that they have no competing interests relevant to the content of this manuscript. All authors had read and agree to submit the manuscript. Funding Declaration This research was funded through the researcher’s personal resources and received no external funding. Authors' Contributions R.A.S.H : Conceptualization, data analysis and interpretation, and writing original draft preparation N.N.A : Investigation, data analysis, software, and writing original draft, preparation R.S : data curation, validation, reviewing, and editing T.T.S : Methodology, data analysis, reviewing, and editing I.M : Supervision, validation, and editing B.T : Data analysis, supervision, and editing A.N.L.S : Supervision, validation, reviewing final manuscript B.K: Supervision, validation, reviewing final manuscript Acknowledgement We would like to express our sincere gratitude to Valeria Peviani, P. Scarpa, A. Toraldo, and G. Bottini, the developers of MMSPE, for granting permission to adapt the MMSPE instrument into an Indonesian language version. References Zelazo PD, Lourenco SF, Frank MC, Elison JT, Heaton RK, Wellman HM, et al. Measurement of cognition for The National Children’s Study. Front Pediatr. 2021;9:1–18. Sätilä H, Jolma LM, Meriläinen-Nipuli M, Koivu-Jolma M. Challenges and neuropsychological functioning in children and adolescents with borderline intellectual functioning. Children. 2022;9:1–13. Zablotsky B, Ng AE, Black LI, Blumberg SJ. Diagnosed developmental disabilities in children aged 3–17 years: United States, 2019–2021.2023;473:1–7. Riskesdas. 2021. Riset Kesehatan Dasar, Badan Penelitian dan Pengembangan Kesehatan Departemen Kesehatan Republik Indonesia, Jakarta. 2021;70–9. Donald KA, Wedderburn CJ, Barnett W, Nhapi RT, Rehman AM, Stadler JAM. dkk. Risk and protective factors for child development: An observational South African birth cohort. PLoS Med. 2019;16:1–20. Di Cesare F, Di Cesare L, Di Carlo C. Development of a cognitive ability assessment tool for a pediatric school-aged population. Innov Clin Neurosci. 2021;18:30–7. Scarpa P, Piazzini A, Pesenti G, Brovedani P, Toraldo A, Turner K. dkk. Italian neuropsychological instruments to assess memory, attention and frontal functions for developmental age. Neurol Sci. 2006;27:381–96. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98. Peviani V, Scarpa P, Vedovelli S, Bottini G. Mini-Mental State Pediatric Examination (MMSPE) standardization and normative data on Italian children aged 36 to 72 months. Appl Neuropsychol Child. 2020;9:92–6. Moura R, Andrade PMO, Fontes PLB, Ferreira FO, Salvador LS, Carvalho MRS. dkk. Mini-mental state exam for children (MMC) in children with hemiplegic cerebral palsy. Dement Neuropsychol. 2017;11:287–96. El Din EMS, Rabah TM, Metwally AM, Nassar MS, Elabd MA, Shalaan A. dkk. Potential risk factors of developmental cognitive delay in the first two years of life. Open access Maced J Med Sci. 2019;7:2024–30. Scarpa P, Toraldo A, Peviani V, Bottini G. Let’s cut it short: Italian standardization of the MMSPE (Mini-Mental State Pediatric Examination), a brief cognitive screening tool for school-age children. Neurol Sci. 2017;38:157–62. Peviani VC, Scarpa P, Bottini G. The Mini-Mental State Pediatric Examination: a cognitive screening test for Italian children. In: Preedy VR, Rajendram R, editors. Diagnosis, management, and modeling of neurodevelopmental disorders. Dalam: CR Martin; 2021. pp. 345–54. Boy GA. Cognitive function analysis for human-centered automation of safety-critical systems. Dalam: Proceedings of the SIGCHI conference on human factors in Computing Systems.; 1998:265 – 72. Driscoll LL. Cognitive function. Compr Toxicol. 2017;6:376–92. Hardy KK, Olson K, Cox SM, Kennedy T, Walsh KS. Systematic review: A prevention-based model of neuropsychological assessment for children with medical illness. J Pediatr Psychol. 2017;42:815–22. Saputra HE, Handryastuti S, Mangunatmadja I, Widodo DP, Pardede SO. Ouvrier’s modified mini mental state examination as a screening test for cognitive impairment in school-aged children with epilepsy. Paediatr Indones. 2020;60:137–41. Jain M, Passi GR. Assessment of a modified Mini-Mental Scale for cognitive functions in children. Indian Pediatr. 2005;42:907–12. Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic factors for poor cognitive development in children born very preterm or with very low birth weight: a systematic review. JAMA Pediatr. 2015;169:1162–72. Cainelli E, Di Giacomo DL, Mantegazza G, Vedovelli L, Favaro J, Boniver C. Prognostic role of mini-mental state pediatric examination (MMSPE) on neuropsychological functioning. Neurol Sci. 2020;41:619–23. Fakhri Z, Zare H, Alipour A, Sharif-Alhoseini M. Reliability of the Iranian version of Mini-Mental State Pediatric Examination (MMSPE): children’s cognitive screening tool. Soc Cogn. 2022;11:1–9. Zelazo PD, Lourenco SF, Frank MC, Elison JT, Heaton RK, Wellman HM, et al. Measurement of cognition for The National Children’s Study. Front Pediatr. 2021;9:1–18. Sätilä H, Jolma LM, Meriläinen-Nipuli M, Koivu-Jolma M. Challenges and neuropsychological functioning in children and adolescents with borderline intellectual functioning. Children. 2022;9:1–13. Zablotsky B, Ng AE, Black LI, Blumberg SJ. Diagnosed developmental disabilities in children aged 3–17 years: United States, 2019–2021.2023;473:1–7. Donald KA, Wedderburn CJ, Barnett W, Nhapi RT, Rehman AM, Stadler JAM. dkk. Risk and protective factors for child development: An observational South African birth cohort. PLoS Med. 2019;16:1–20. Di Cesare F, Di Cesare L, Di Carlo C. Development of a cognitive ability assessment tool for a pediatric school-aged population. Innov Clin Neurosci. 2021;18:30–7. Scarpa P, Piazzini A, Pesenti G, Brovedani P, Toraldo A, Turner K. dkk. Italian neuropsychological instruments to assess memory, attention and frontal functions for developmental age. Neurol Sci. 2006;27:381–96. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98. Peviani V, Scarpa P, Vedovelli S, Bottini G. Mini-Mental State Pediatric Examination (MMSPE) standardization and normative data on Italian children aged 36 to 72 months. Appl Neuropsychol Child. 2020;9:92–6. Moura R, Andrade PMO, Fontes PLB, Ferreira FO, Salvador LS, Carvalho MRS. dkk. Mini-mental state exam for children (MMC) in children with hemiplegic cerebral palsy. Dement Neuropsychol. 2017;11:287–96. El Din EMS, Rabah TM, Metwally AM, Nassar MS, Elabd MA, Shalaan A. dkk. Potential risk factors of developmental cognitive delay in the first two years of life. Open access Maced J Med Sci. 2019;7:2024–30. Scarpa P, Toraldo A, Peviani V, Bottini G. Let’s cut it short: Italian standardization of the MMSPE (Mini-Mental State Pediatric Examination), a brief cognitive screening tool for school-age children. Neurol Sci. 2017;38:157–62. Peviani VC, Scarpa P, Bottini G. The Mini-Mental State Pediatric Examination: a cognitive screening test for Italian children. In: Preedy VR, Rajendram R, editors. Diagnosis, management, and modeling of neurodevelopmental disorders. Dalam: CR Martin; 2021. pp. 345–54. Boy GA. Cognitive function analysis for human-centered automation of safety-critical systems. Dalam: Proceedings of the SIGCHI conference on human factors in Computing Systems.; 1998:265 – 72. Driscoll LL. Cognitive function. Compr Toxicol. 2017;6:376–92. Hardy KK, Olson K, Cox SM, Kennedy T, Walsh KS. Systematic review: A prevention-based model of neuropsychological assessment for children with medical illness. J Pediatr Psychol. 2017;42:815–22. Saputra HE, Handryastuti S, Mangunatmadja I, Widodo DP, Pardede SO. Ouvrier’s modified mini mental state examination as a screening test for cognitive impairment in school-aged children with epilepsy. Paediatr Indones. 2020;60:137–41. Jain M, Passi GR. Assessment of a modified Mini-Mental Scale for cognitive functions in children. Indian Pediatr. 2005;42:907–12. Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic factors for poor cognitive development in children born very preterm or with very low birth weight: a systematic review. JAMA Pediatr. 2015;169:1162–72. Cainelli E, Di Giacomo DL, Mantegazza G, Vedovelli L, Favaro J, Boniver C. Prognostic role of mini-mental state pediatric examination (MMSPE) on neuropsychological functioning. Neurol Sci. 2020;41:619–23. Fakhri Z, Zare H, Alipour A, Sharif-Alhoseini M. Reliability of the Iranian version of Mini-Mental State Pediatric Examination (MMSPE): children’s cognitive screening tool. Soc Cogn. 2022;11:1–9. Additional Declarations No competing interests reported. Supplementary Files BackTranslationMMSPEIndonesianversion.pdf IndonesianVersionofMMSPE.pdf Cite Share Download PDF Status: Published Journal Publication published 28 Oct, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 08 Apr, 2025 Reviews received at journal 08 Apr, 2025 Reviewers agreed at journal 08 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviewers agreed at journal 06 Apr, 2025 Reviewers agreed at journal 04 Apr, 2025 Reviewers agreed at journal 04 Apr, 2025 Reviewers agreed at journal 04 Apr, 2025 Reviewers agreed at journal 04 Apr, 2025 Reviewers agreed at journal 02 Apr, 2025 Reviewers agreed at journal 02 Apr, 2025 Reviews received at journal 01 Apr, 2025 Reviewers agreed at journal 30 Mar, 2025 Reviewers invited by journal 29 Mar, 2025 Submission checks completed at journal 24 Mar, 2025 First submitted to journal 18 Mar, 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5982684","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436637762,"identity":"b1943bae-84eb-4404-bb25-1abb33380405","order_by":0,"name":"R. A. Setyo Handryastuti","email":"","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"R.","middleName":"A. Setyo","lastName":"Handryastuti","suffix":""},{"id":436637763,"identity":"45b9e67e-180a-42ac-97fb-407bc1a76ef1","order_by":1,"name":"Nenden Nursyamsi Agustina","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYDCCA8jsD0CCjZ0ULQdngLQwk6KFmQdMEtDBd/sA22PePXWJ/dOOPzxs82ubPB8zA+OHjzm4tUieS2A35nl2OHHG7RyDw7l9tw3bmBmYJWduw63F4AwDmzTPgQOJDbdzGA7n9txmBGphY+YlrKUucf7t9AeHLXtu2xOrhTlxw+0Eg8MMP24nEtQieYaxTXLOgcPGG4F+OdjbcDu5jZmxGa9f+M4wH5N4c6BOdt7t9Mcffvy5bTu/vfngh494tDAwMDaASEcwydiGECEI7CHUH6IUj4JRMApGwQgDAE0GVcMO2eZxAAAAAElFTkSuQmCC","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":true,"prefix":"","firstName":"Nenden","middleName":"Nursyamsi","lastName":"Agustina","suffix":""},{"id":436637764,"identity":"7c550b35-92bf-4313-8660-5cfa9501c39b","order_by":2,"name":"Rini Sekartini","email":"","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Rini","middleName":"","lastName":"Sekartini","suffix":""},{"id":436637765,"identity":"0b23d794-8815-4dfe-b859-b8098598e79b","order_by":3,"name":"Teny Tjitra Sari","email":"","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Teny","middleName":"Tjitra","lastName":"Sari","suffix":""},{"id":436637766,"identity":"418d0cc2-13d9-4989-882d-ccfb7851fcab","order_by":4,"name":"Irawan Mangunatmadja","email":"","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Irawan","middleName":"","lastName":"Mangunatmadja","suffix":""},{"id":436637767,"identity":"de8e92c7-ef3c-400b-a7d1-e75d60889a48","order_by":5,"name":"Bambang Tridjaja","email":"","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Bambang","middleName":"","lastName":"Tridjaja","suffix":""},{"id":436637770,"identity":"6c47ab20-0237-41bf-a8a3-e87ce097994d","order_by":6,"name":"Ali Nina Liche Seniati","email":"","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Nina Liche","lastName":"Seniati","suffix":""},{"id":436637771,"identity":"5382047c-9f45-4496-87f4-660e28802464","order_by":7,"name":"Bernadette Kushartanti","email":"","orcid":"","institution":"Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Bernadette","middleName":"","lastName":"Kushartanti","suffix":""}],"badges":[],"createdAt":"2025-02-07 16:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5982684/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5982684/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-025-06021-9","type":"published","date":"2025-10-28T15:58:44+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":95040522,"identity":"1a6130ee-0e46-4564-b742-1b5499f04444","added_by":"auto","created_at":"2025-11-03 16:09:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1105789,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5982684/v1/e3e36aac-f1a5-4b8c-b3d4-0845b6f73d9f.pdf"},{"id":79761237,"identity":"a1e24fd1-a5b2-4a39-9c2a-e3c11c2d5eca","added_by":"auto","created_at":"2025-04-02 11:22:00","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":2401330,"visible":true,"origin":"","legend":"","description":"","filename":"BackTranslationMMSPEIndonesianversion.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5982684/v1/2c3e1b8884a97af75b0812ca.pdf"},{"id":79761233,"identity":"8af53a60-225f-4e5a-a4d0-4a4ccaae34f7","added_by":"auto","created_at":"2025-04-02 11:22:00","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":429570,"visible":true,"origin":"","legend":"","description":"","filename":"IndonesianVersionofMMSPE.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5982684/v1/048cfce61450f30aabadc92c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Validity and Reliability Test of The Mini-Mental State Pediatric Examination (MMSPE) As A Screening Instrument for Cognitive Function In Indonesian-speaking Children","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCognitive function is one of the important aspects during a child's development period. This function includes the ability to process information involved in learning, thinking, reasoning, remembering, communicating, problem-solving, and decision-making. These abilities are crucial for children to adapt, especially in achieving educational success, succeeding in their careers, innovating, and developing interpersonal relationships.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCognitive dysfunction can affect the neuropsychological development of children, potentially diminishing their optimal future potential.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The prevalence of cognitive dysfunction in children is 8.56% and in several other studies it is estimated to be between 7\u0026ndash;14%.\u003csup\u003e3,4\u003c/sup\u003e Genetic, perinatal, maternal, and environmental factors may serve as risk factors for the occurrence of cognitive dysfunction. Cognitive dysfunction occurring during childhood is associated with an increased risk of mental health disorders, substance abuse, unemployment, and antisocial or criminal behavior in adulthood.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Cognitive deficits carry the risk of long-term impairments in educational attainment, employment opportunities, and overall quality of life.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEarly detection of cognitive dysfunction helps identify children at high risk of experiencing neuropsychological developmental disorders. Several assessment tools are available for evaluating cognitive function, many of which are commonly used in adult patients, such as the Mini-Mental State Examination (MMSE).\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e The MMSE is designed for screening cognitive dysfunction.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Cognitive function screening using the MMSE is widely employed for assessing age-related cognitive decline, but it is still rarely utilized for screening developmental delays in childhood.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e MMSE was modified into pediatric version because it reflected developmental stage of cognitive domain. The use of the MMSE in children can contribute to early cognitive function assessment by pediatricians.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe screening assessment of cognitive function in children in developing countries faces challenges due to the lack of valid diagnostic instruments at the individual, group, and population levels.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Currently, recommended cognitive screening tools for children based on international consensus are not available. \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Some countries have modified adult cognitive function screening tests into child versions. Scarpa et al. have created a standardized modified version of the MMSE for application in children in Italy, called the Mini-Mental State Pediatric Examination (MMSPE).\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e This pediatric screening version retains the basic structure of the MMSE test while exploring orientation (space and time), verbal production and comprehension, metaphonological skills (writing, reading, and arithmetic), memory, constructive abilities, and executive function.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Cognitive function domains include perception, memory, learning, attention, decision-making, and language abilities. These functions are closely related to the mechanisms of learning, remembering, problem-solving, and paying attention to things.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSystematic and brief cognitive function screening can assist doctors in detecting the risk of cognitive developmental delays or cognitive impairment. Cognitive function screening test is very useful for monitoring a child's cognitive profile, especially when a complete neuropsychological test battery cannot be easily administered, such as when a child exhibits difficulty concentrating, which can hinder the reliability of a comprehensive neuropsychological evaluation. This can provide relevant information to be considered in relation to the evaluation of academic skills, behavioral traits, and contextual factors in detecting learning difficulties or disabilities.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eResearch adapting the MMSPE into Indonesian version has not yet been conducted. There is no previous research about the use of MMSPE in Indonesia. Additionally, there are no cognitive function screening instruments that assess higher functions or executive functions. This study aims to adapt such a questionnaire to enhance the quality of healthcare services for children and adolescents so that it can be implemented in daily practice for cognitive function screening.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was a combination of qualitative methods in the instrument translation phase and quantitative methods in assessing the instrument's validity and reliability. A cross-sectional study design was used to test the validity and reliability of the Indonesian version of the MMSPE for cognitive function screening in children. The research was conducted at one model of Public Elementary School and Public Junior High School in Jakarta, Indonesia, from May to October 2024. The subjects were included to the study if the children and their parent or caregiver were able to read and write, speak Indonesian, and willing to participate in the study, as evidenced by an informed consent form signed by the parent, guardian, or other caregiver. However, children who had been formally diagnosed with intellectual disabilities, children with special needs, and children who were ill at the time of the examination were excluded from the study.\u003c/p\u003e \u003cp\u003e This study adhered to the Declaration of Helsinki. Ethical approval for this study was obtained from the Health Research Ethics Committee, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo National Hospital, Jakarta, Indonesia (reference no.: KET-584/UN2.F1/ETIK/PPM.00.02/2024). All legal guardians of the subjects provided their consent for participation.\u003c/p\u003e \u003cp\u003eThe original version of Mini-Mental State Pediatric Examination (MMSPE) was developed by Scarpa, Toraldo, Peviani, and Bottini in 2017. The study conducted for screening cognitive function in the Italian pediatric population. The cut-off point of normal value was assessed according to child\u0026rsquo;s age and parents\u0026rsquo; mean education. The initial stage of translation was forward translation, involving translating the instrument from English to Indonesian. The translation was performed by two certified translators, one with a medical background and the other with a non-medical background. One Italian translator was available as a reference. The expert committee compared the translation results to examine medical and non-medical perspectives on the instrument's content after the forward translation process. The expert committee consisted of a pediatric neurology consultant, a developmental and social pediatrics consultant, a psychologist, a linguist, and a general pediatrician. The expert committee also assessed the suitability of the translation results with the original MMSPE and made the necessary adaptation.\u003c/p\u003e \u003cp\u003eThe MMSPE instrument that had been translated into Indonesian was then translated back into English (back translation) by two translators who were not involved in the forward translation. One translator was a native speaker with a non-medical background, and the other was an Indonesian translator with a medical background. The results of the back translation into English were compared and reassessed by the expert committee, as in the previous forward translation process. If the back translation results were satisfactory, they would be sent to the questionnaire developer for input and approval.\u003c/p\u003e \u003cp\u003eThe assessment of content validity was performed using the content validity index (CVI) method. Content validity presented in the form of content validity index for items (I-CVI) and content validity index for scale (S-CVI) values. The I-CVI assessed the validity of the index for each statement in the questionnaire, while S-CVI was used to assess the overall scale validity. The assessment was conducted by five experts, consisting of one expert each from the fields of pediatric neurology, developmental and social pediatrics, psychology, linguistics, and general pediatrics. Each expert was asked to assess the suitability of the statements on a scale of 1\u0026ndash;4, where 1 (not relevant), 2 (somewhat relevant), 3 (quite relevant), and 4 (very relevant). A score of 1 was given for questions rated on a scale of 3 or 4, while a score of 0 was given for questions rated on a scale of 1 or 2. The I-CVI score was obtained by dividing the number of experts who stated that the question on the questionnaire was relevant (score 1) by the total number of experts. The mean I-CVI score was obtained by summing all I-CVI scores for all questions and dividing by the number of experts, which was five. The S-CVI score is the number of questions that received a score of 1 (scale 3 or 4) divided by the total number of questions (18). The S-CVI score was then assessed using two methods: Scale-Level Content Validity Index based on the Average method (S-CVI/Ave) and Scale-Level Content Validity Index based on universal agreement (S-CVI/UA). S-CVI/Ave is a measure used to assess the content validity of a scale or instrument. It is calculated as the average of the Item-Level Content Validity Indexes (I-CVI) for all items on the scale. The S-CVI/Ave score is the total S-CVI score divided by the number of experts, while the S-CVI/UA score is the total universal agreement (UA) score for each question divided by the number of questions. The UA value is calculated by assigning a 1 to questions that received 100% agreement from the experts (all experts gave a scale of 3 or 4), while a 0 is given to questions that were not unanimously agreed upon. The accepted CVI value for a team of five experts is 0.99. The content validity ratio (CVR) value is calculated using the formula:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:CVR=\\frac{ne-N/2}{N/2}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNote\u003c/strong\u003e \u003cp\u003e\u0026bull; ne: number of experts who indicated that the question was appropriate and important (scale 3 or 4)\u003c/p\u003e \u003cp\u003e\u0026bull; N: number of experts who assessed\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe MMSPE instrument was pilot-tested on 30 subjects different from the research participants before being administered to research subjects. The sample size for testing the validity of the research instrument is based on the literature that the minimum sample size were 30 subjects. The instrument adaptation process continued with the validation of the questionnaire on the research subjects. A total of 90 subjects were recruited for the study, distinct from the 30 subjects involved in the pilot testing phase of the Indonesian version of the MMSPE instrument. Sample size was measure using the formula. According to the formula, minimal sample size for each group was 30 subjects. These subjects were divided into three groups of 30 based on grade level: 30 subjects from grades 1\u0026ndash;2 of elementary school, 30 subjects from grades 3\u0026ndash;6 of elementary school, and 30 subjects from grades 1\u0026ndash;3 of junior high school. The sampling method was carried out using stratified random sampling until the required number of research samples was met and divided into each age group within the research period. Subject selection was conducted using an age stratification approach to adjust the difficulty of question items with age range and developmental spectrum, as well as to add statements describing the assessment of executive function.\u003c/p\u003e \u003cp\u003eData collection was carried out by examining the research sample using the Indonesian version of the MMSPE questionnaire. All examination results were processed and analyzed in SPSS tables. The validity of the MMSPE instrument was assessed using the correlation coefficient (r). The results were considered valid if the calculated r-value\u0026thinsp;\u0026gt;\u0026thinsp;r-table value. Reliability, as reflected through internal consistency, was assessed using Cronbach's alpha, which has a value range from 0 to 1. A value of 0.6\u0026ndash;0.8 is considered reliable, while a value above 0.8 indicates very reliable.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe content validity of the MMSPE instrument was assessed for 18 questions, involving agreement among the expert committee regarding the translation results and quantitative measurement based on the relevance of each statement. The content validity assessment used content validity index for items (I-CVI) analysis to assess the validity of the index for each statement in the questionnaire, and the validity index for scales (S-CVI) to assess the overall scale validity (Table \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\u003eContent Validity of the Indonesian Version of the MMSPE Instrument\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExpert 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExpert 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExpert 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExpert 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eExpert 5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eUA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eI-CVI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS-CVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRerata I-CVI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS-CVI/UA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS-CVI/Ave\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis study showed that the mean values of I-CVI, S-CVI/Ave, S-CVI/UA, and CVR are 1. This indicated an excellent level of content validity. All experts stated that the MMSPE instrument is highly relevant or quite relevant in screening for cognitive function.\u003c/p\u003e \u003cp\u003eThe MMSPE instrument was then pilot-tested on 30 child subjects aged 6\u0026ndash;14 years after obtaining consent from the parents or guardians of the students (Table \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\u003eValidity Test Results of pilot-testing of the Indonesian Version of the MMSPE Instrument\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 \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ethe item-total correlation\u003c/p\u003e \u003cp\u003e(r-calculated value)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003er-table\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003evalidity*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCronbach\u0026rsquo;s Alpha\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,825\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*note: Valid if the calculated r-value\u0026thinsp;\u0026gt;\u0026thinsp;r-table value.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e showed that all question items on the MMSPE instrument were valid because the item-total correlation values of each question item (calculated r-value)\u0026thinsp;\u0026gt;\u0026thinsp;r-table value (0.361). The reliability test results of the MMSPE instrument that was pilot-tested were reliable because the Cronbach's Alpha value was 0.825.\u003c/p\u003e \u003cp\u003eThe Indonesian version of the MMSPE instrument was then tested to 90 subjects different from those in the pilot testing phase to assess the validity and reliability of the instrument. The characteristics of the research subjects are shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\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\u003eCharacteristics of subjects\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\u003eCharacteristics of subjects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;90 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian (min \u0026ndash; max)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10,26\u0026thinsp;\u0026plusmn;\u0026thinsp;2,66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (6\u0026ndash;14,67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool\u0026rsquo;grade, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2 Elementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;6 Elementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (33,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;3 Junior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (33,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, n (%) : Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (50,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (50,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (96,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow birth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcessive birth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional status, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (70,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndernutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (10,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (7,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (12,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEconomic status\u0026nbsp;: below the minimum wage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (42,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEqual to or above the minimum wage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (57,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather\u0026rsquo;s education, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElementary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (60,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (35,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s education, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElementary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (4,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (59,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (35,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuspected cognitive dysfunction, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (10,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (90,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIQ Categories based on WISC, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (33,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow Average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (33,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoderline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (22,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntellectual Disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (11,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15,26\u0026thinsp;\u0026plusmn;\u0026thinsp;4,09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,24 (0,25\u0026ndash;22,68)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCooperation with examiner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,48\u0026thinsp;\u0026plusmn;\u0026thinsp;0,59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (8\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbility to maintain attention during examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,29\u0026thinsp;\u0026plusmn;\u0026thinsp;0,64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (8\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship/interaction with the examiner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,37\u0026thinsp;\u0026plusmn;\u0026thinsp;0,59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (8\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbility to maintain position\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9,24\u0026thinsp;\u0026plusmn;\u0026thinsp;0,69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (8\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were nine (10%) subjects with MMSPE scores below the cut-off value. They were then tested using Wechsler Intelligence Scale for Children (WISC) for Intelligence Quotient (IQ) category. The WISC is a gold standard diagnostic instrument for assessing cognitive dysfunction. Of the nine subjects, there were 3 (33.3%) subjects with average IQ, 3 (33.3%) subjects with below average IQ, 2 (22.2%) subjects with borderline IQ, and 1 (11.1%) subject with Intellectual Disability IQ.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e showed the factor analysis using Kaiser-Meyer-Olkin (KMO) and Bartletts Test.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKaiser-Meyer-Olkin (KMO) and Bartletts Test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKMO and Bartletts Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKMO Measure of Sampling Adequacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBartlett's Test of Sphericity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApprox. Chi-square 180,525\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\u003eSig\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on the results of the factor analysis, the KMO value was found to be greater than 0.05, indicating that the factor analysis can be proceeded (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation matrix of the factors in the Confirmatory Factor Analysis (CFA) model.\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\u003eCognitive domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnti Image Correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeasures of Sampling Adequacy (MSA)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpatial and temporal orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eMSA\u0026thinsp;\u0026gt;\u0026thinsp;0,500 (fulfilled)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProductive language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePraxis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReading and writing prerequisite skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,680\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVerbal short- and long- term memory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,555\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExecutive functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,737\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe MSA value in Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e showed\u0026thinsp;\u0026gt;\u0026thinsp;0.5. It indicated that the variable can be well predicted by other variables in the model. The fulfillment of the MSA criterion indicated that the relationship among variables were sufficiently strong and relevant, ensuring that factor analysis can yield valid and reliable results.\u003c/p\u003e \u003cp\u003eComponent matrix analysis showed in Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. The indicators used have a factor loading value greater than 0.60 (n\u0026thinsp;=\u0026thinsp;90) and cluster within a particular factor; therefore, it can be concluded that the indicators used were consistent in the variable.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComponent Matrix\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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCognitive domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eComponent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpatial and temporal orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProductive language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,795\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePraxis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,854\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReading and writing prerequisite skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVerbal short- and long- term memory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExecutive functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe validity test of the Indonesian version of the MMSPE instrument showed that both the first and second assessments revealed that the item-total correlation (r-calculated value)\u0026thinsp;\u0026gt;\u0026thinsp;r-table (0.175). The reliability test results of the MMSPE instrument were reliable because the Cronbach's Alpha value were 0,754 and 0,760 respectively (Table \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Validity and Reliability Tests of the Indonesian Version of the MMSPE Instrument\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ethe item-total correlation\u003c/p\u003e \u003cp\u003e(r-calculated value)\u003c/p\u003e \u003cp\u003e1st Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003er-tabel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eCronbach\u0026rsquo;s alpha\u003c/em\u003e 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ethe item-total correlation\u003c/p\u003e \u003cp\u003e(r-calculated value)\u003c/p\u003e \u003cp\u003e1st Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003er-tabel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eCronbach\u0026rsquo;s alpha\u003c/em\u003e 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpatial and temporal orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0,754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProductive language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePraxis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReading and writing prerequisite skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumnber knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVerbal short- and long-term memory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExecutive function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003er hitung\u0026thinsp;\u0026gt;\u0026thinsp;r table (0,175)\u0026rarr;Valid\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll subjects underwent a retest of the Indonesian version of MMSPE instrument, which involved the test twice with a 1-week interval to assess the consistency of the answers provided. These results were then assessed using intraclass correlation coefficients (ICC). The ICC result in this study was 0.879, which indicates good reliability (Table \u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRetest of the Indonesiaon version of MMSPE Instrument\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\u003eMMPSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICC (IK 95%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31,87 (3,519)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,879 (0,816-0,920)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33,04 (3,097)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe MMSPE instrument was developed in Italy in 2017 by adapting the MMSE instrument\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. The MMSPE instrument explores orientation in space and time, along with the collection of personal data, verbal production and comprehension, writing, reading, arithmetic, working and verbal memory, logical sequencing skills, constructive abilities, shape and color recognition, awareness of body schema, and executive functions\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.The MMSPE instrument also observes the level of cooperation, interaction with the examiner, sustained attention, and maintenance of the whole component arrangement, qualitatively and quantitatively assessed by the examiner\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. This study is the first research in Indonesia that aims to assess the validity and reliability of the Indonesian version of the MMSPE instrument as a screening tool for cognitive function disorders in children.\u003c/p\u003e \u003cp\u003eThe average age of subjects in this study was 10.26 years. The adaptation of the MMSPE instrument can screen for cognitive function disorders in three different education groups: elementary school grades 1\u0026ndash;2, 3\u0026ndash;6, and junior high school grades 1-3.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA total of 81 subjects (96.4%) had a normal birth weight history, and 63 subjects (70%) had good nutritional status. Low birth weight (LBW) can increase the risk of cognitive function disorders in children, as can nutritional status. A systematic review concluded that low birth weight and low parental education levels are significant predictors of global cognitive impairment in children. The review also showed that the influence of perinatal risk factors decreases over time as other environmental and social factors become more influential in a child's cognitive development.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e The highest education level of fathers and mothers was high school graduates, with 54 subjects (60%) and 48 subjects (59.3%), respectively. The education level in this study is better compared to the education level of Indonesian men and women. Data from the Central Statistics Agency (BPS) in 2023 shows that 42.62% of Indonesian men and 37.6% of Indonesian women have a high school education or equivalent. Parental education has a significant effect on global cognitive scores in all age groups on the MMSPE examination.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eContent validity assessment in this study was carried out by assessing the I-CVI, S-CVI, and CVR scores. The study showed that the average values of I-CVI, S-CVI/Ave, S-CVI/UA, and CVR were 1. This indicates that the Indonesian version of the MMSPE instrument has excellent content validity. This assessment is important to ensure that the adapted instrument is representative, relevant, and can function well as a screening tool for cognitive function in children. Cainelli et al.'s study obtained the following parameters from the MMSPE diagnostic performance evaluation in neuropsychological disorders: negative predictive value (NPV) 0.81, positive predictive value (PPV) 0.87, specificity 0.91 (95% CI 0.81\u0026ndash;1.00), sensitivity 0.74 (95% CI 0.57\u0026ndash;0.90), and overall accuracy 0.83 (95% CI 0.64\u0026ndash;0.91), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. The MMSPE instrument has proven to have good prognostic ability in predicting neuropsychological problems in the context of various neurological diseases in children, especially in identifying high-risk children.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e The validity of the Indonesian version of the MMSPE instrument was assessed by comparing the item-total correlation (r-calculated) to the r-table value, and it was found that all items of the Indonesian version of the MMSPE instrument were valid because r-calculated\u0026thinsp;\u0026gt;\u0026thinsp;r-table. This is consistent with Fakhri et al.'s research, which concluded that the Iranian version of the MMSPE in Persian has good validity. Validity in that study was based on an independent t-test with a 95% confidence level, which showed a significant difference between the normal group and the group with cognitive impairment.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Indonesian version of the MMSPE instrument has a Cronbach's alpha value of 0.754 in the first assessment and 0.760 in the second assessment. This indicates that the MMSPE instrument has good reliability. A retest of the MMSPE instrument, which was administered twice with a 1-week interval to each research subject, was also conducted to assess the consistency of the answers provided. The ICC result in this study was 0.879, which means there was good consistency in the answers between the first and second assessments. This result is consistent with other studies that assessed the reliability of the MMSPE instrument. Fakhri et al. stated that the Cronbach's alpha value for the Persian (Iran) version of the instrument was excellent, at 0.92.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study found nine subjects (10%) who likely have cognitive impairment based on the cut-off value of the total MMSPE score, according to Scarpa et al.'s research.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e This is not much different from the figures reported by Donald KA et al., nor from the incidence of cognitive impairment reported in other literature, which is around 7\u0026ndash;14%.\u003csup\u003e4\u003c/sup\u003e Each subject who had an MMSPE score below the normal value, the researcher contacted and provided education, and advised parents to have their child examined by a child psychologist to confirm the presence of cognitive function disorder.\u003c/p\u003e \u003cp\u003eThis study has several strengths and limitations. This is the first study to adapt the MMSPE for the child population in Indonesia. This research was conducted in public schools, so the subjects recruited encompassed a variety of demographics representing the conditions of children in Indonesia. This study did not compare with a gold standard instrument on all research subjects to compare the diagnostic test of the Indonesian version of the MMSPE instrument. The gold standard examination with WISC in this study was only performed on research subjects who had an MMSPE score below the cut-off value.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Indonesian version of the MMSPE instrument has good content validity with an average I-CVI, S-CVI/Ave, and S-CVI/UA score of 1. The Indonesian version of the MMSPE instrument is valid because all items have a total item correlation value (r calculated)\u0026thinsp;\u0026gt;\u0026thinsp;r table. The Indonesian version of the MMSPE instrument has good instrument reliability with a Cronbach's alpha value of 0.754 in the first assessment and 0.760 in the second assessment. Comparison of the Indonesian version of the MMSPE instrument with a gold standard test for all research subjects is necessary so that the Indonesian version of the MMSPE instrument can be widely used as a screening instrument for cognitive function disorders in children. Further research is needed to determine the sensitivity and specificity values in the diagnostic test of the Indonesian version of the MMSPE instrument with a larger sample size in the child population in Indonesia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003eMMSPE \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;:The\u0026nbsp;Mini-Mental State Pediatric Examination\u003c/li\u003e\n \u003cli\u003eMMSE\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;: the Mini-Mental State Examination\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eI-CVI\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; :\u0026nbsp;content validity index for items\u003c/li\u003e\n \u003cli\u003eS-CVI\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; :\u0026nbsp;the validity index for scales\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;: universal agreement\u003c/li\u003e\n \u003cli\u003eCVR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;: content validity ratio\u003c/li\u003e\n \u003cli\u003eKMO\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;: Kaiser-Meyer-Olkin\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCFA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;: Confirmatory Factor Analysis\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMSA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; : Measures of Sampling Adequacy\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe Indonesian version of MMSPE used in this study has not previously been published elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical considerations were diligently addressed in the planning and execution of this study. This study adhered to the Declaration of Helsinki. Ethical approval for this study was obtained from the Health Research Ethics Committee, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo National Hospital, Jakarta, Indonesia (reference no.: KET-584/UN2.F1/ETIK/PPM.00.02/2024). All legal guardians of the subjects participated in the study provided informed consent before participating in the study. All legal guardians of the subjects provided their consent for participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe confidentiality and privacy of the participants in this study have been paramount. All legal guardians of individuals included in this research were assured of the anonymity of their data. Informed written consent was obtained from each legal guardians, emphasizing that no personal identifiers, such as names or affiliations, would be disclosed in any publications resulting from this study. There is no financial benefit from company regarding the submission or publication of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials supporting the findings of this study are available upon reasonable request from corresponding author (Nenden Nursyamsi Agustina, Pediatric Neurology Division, Department of Pediatric, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Hospital, Jakarta, Indonesia. E-mail: [email protected]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests relevant to the content of this manuscript. All authors had read and agree to submit the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded through the researcher\u0026rsquo;s personal resources and received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.A.S.H : Conceptualization, data analysis and interpretation, and writing original draft preparation \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eN.N.A : Investigation, data analysis, software, and writing original draft, preparation\u003c/p\u003e\n\u003cp\u003eR.S : data curation, validation, reviewing, and editing\u003c/p\u003e\n\u003cp\u003eT.T.S : Methodology, data analysis, reviewing, and editing\u003c/p\u003e\n\u003cp\u003eI.M : Supervision, validation, and editing\u003c/p\u003e\n\u003cp\u003eB.T : Data analysis, supervision, and editing\u003c/p\u003e\n\u003cp\u003eA.N.L.S : Supervision, validation, reviewing final manuscript\u003c/p\u003e\n\u003cp\u003eB.K: Supervision, validation, reviewing final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to Valeria Peviani, P. Scarpa, A. Toraldo, and G. Bottini, the developers of MMSPE, for granting permission to adapt the MMSPE instrument into an Indonesian language version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZelazo PD, Lourenco SF, Frank MC, Elison JT, Heaton RK, Wellman HM, et al. Measurement of cognition for The National Children\u0026rsquo;s Study. Front Pediatr. 2021;9:1\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026auml;til\u0026auml; H, Jolma LM, Meril\u0026auml;inen-Nipuli M, Koivu-Jolma M. Challenges and neuropsychological functioning in children and adolescents with borderline intellectual functioning. Children. 2022;9:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZablotsky B, Ng AE, Black LI, Blumberg SJ. Diagnosed developmental disabilities in children aged 3\u0026ndash;17 years: United States, 2019\u0026ndash;2021.2023;473:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiskesdas. 2021. Riset Kesehatan Dasar, Badan Penelitian dan Pengembangan Kesehatan Departemen Kesehatan Republik Indonesia, Jakarta. 2021;70\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonald KA, Wedderburn CJ, Barnett W, Nhapi RT, Rehman AM, Stadler JAM. dkk. Risk and protective factors for child development: An observational South African birth cohort. PLoS Med. 2019;16:1\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Cesare F, Di Cesare L, Di Carlo C. Development of a cognitive ability assessment tool for a pediatric school-aged population. Innov Clin Neurosci. 2021;18:30\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScarpa P, Piazzini A, Pesenti G, Brovedani P, Toraldo A, Turner K. dkk. Italian neuropsychological instruments to assess memory, attention and frontal functions for developmental age. Neurol Sci. 2006;27:381\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFolstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeviani V, Scarpa P, Vedovelli S, Bottini G. Mini-Mental State Pediatric Examination (MMSPE) standardization and normative data on Italian children aged 36 to 72 months. Appl Neuropsychol Child. 2020;9:92\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoura R, Andrade PMO, Fontes PLB, Ferreira FO, Salvador LS, Carvalho MRS. dkk. Mini-mental state exam for children (MMC) in children with hemiplegic cerebral palsy. Dement Neuropsychol. 2017;11:287\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Din EMS, Rabah TM, Metwally AM, Nassar MS, Elabd MA, Shalaan A. dkk. Potential risk factors of developmental cognitive delay in the first two years of life. Open access Maced J Med Sci. 2019;7:2024\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScarpa P, Toraldo A, Peviani V, Bottini G. Let\u0026rsquo;s cut it short: Italian standardization of the MMSPE (Mini-Mental State Pediatric Examination), a brief cognitive screening tool for school-age children. Neurol Sci. 2017;38:157\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeviani VC, Scarpa P, Bottini G. The Mini-Mental State Pediatric Examination: a cognitive screening test for Italian children. In: Preedy VR, Rajendram R, editors. Diagnosis, management, and modeling of neurodevelopmental disorders. Dalam: CR Martin; 2021. pp. 345\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoy GA. Cognitive function analysis for human-centered automation of safety-critical systems. Dalam: Proceedings of the SIGCHI conference on human factors in Computing Systems.; 1998:265\u0026thinsp;\u0026ndash;\u0026thinsp;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDriscoll LL. Cognitive function. Compr Toxicol. 2017;6:376\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHardy KK, Olson K, Cox SM, Kennedy T, Walsh KS. Systematic review: A prevention-based model of neuropsychological assessment for children with medical illness. J Pediatr Psychol. 2017;42:815\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaputra HE, Handryastuti S, Mangunatmadja I, Widodo DP, Pardede SO. Ouvrier\u0026rsquo;s modified mini mental state examination as a screening test for cognitive impairment in school-aged children with epilepsy. Paediatr Indones. 2020;60:137\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain M, Passi GR. Assessment of a modified Mini-Mental Scale for cognitive functions in children. Indian Pediatr. 2005;42:907\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLinsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic factors for poor cognitive development in children born very preterm or with very low birth weight: a systematic review. JAMA Pediatr. 2015;169:1162\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCainelli E, Di Giacomo DL, Mantegazza G, Vedovelli L, Favaro J, Boniver C. Prognostic role of mini-mental state pediatric examination (MMSPE) on neuropsychological functioning. Neurol Sci. 2020;41:619\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFakhri Z, Zare H, Alipour A, Sharif-Alhoseini M. Reliability of the Iranian version of Mini-Mental State Pediatric Examination (MMSPE): children\u0026rsquo;s cognitive screening tool. Soc Cogn. 2022;11:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZelazo PD, Lourenco SF, Frank MC, Elison JT, Heaton RK, Wellman HM, et al. Measurement of cognition for The National Children\u0026rsquo;s Study. Front Pediatr. 2021;9:1\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026auml;til\u0026auml; H, Jolma LM, Meril\u0026auml;inen-Nipuli M, Koivu-Jolma M. Challenges and neuropsychological functioning in children and adolescents with borderline intellectual functioning. Children. 2022;9:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZablotsky B, Ng AE, Black LI, Blumberg SJ. Diagnosed developmental disabilities in children aged 3\u0026ndash;17 years: United States, 2019\u0026ndash;2021.2023;473:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonald KA, Wedderburn CJ, Barnett W, Nhapi RT, Rehman AM, Stadler JAM. dkk. Risk and protective factors for child development: An observational South African birth cohort. PLoS Med. 2019;16:1\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Cesare F, Di Cesare L, Di Carlo C. Development of a cognitive ability assessment tool for a pediatric school-aged population. Innov Clin Neurosci. 2021;18:30\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScarpa P, Piazzini A, Pesenti G, Brovedani P, Toraldo A, Turner K. dkk. Italian neuropsychological instruments to assess memory, attention and frontal functions for developmental age. Neurol Sci. 2006;27:381\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFolstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeviani V, Scarpa P, Vedovelli S, Bottini G. Mini-Mental State Pediatric Examination (MMSPE) standardization and normative data on Italian children aged 36 to 72 months. Appl Neuropsychol Child. 2020;9:92\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoura R, Andrade PMO, Fontes PLB, Ferreira FO, Salvador LS, Carvalho MRS. dkk. Mini-mental state exam for children (MMC) in children with hemiplegic cerebral palsy. Dement Neuropsychol. 2017;11:287\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Din EMS, Rabah TM, Metwally AM, Nassar MS, Elabd MA, Shalaan A. dkk. Potential risk factors of developmental cognitive delay in the first two years of life. Open access Maced J Med Sci. 2019;7:2024\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScarpa P, Toraldo A, Peviani V, Bottini G. Let\u0026rsquo;s cut it short: Italian standardization of the MMSPE (Mini-Mental State Pediatric Examination), a brief cognitive screening tool for school-age children. Neurol Sci. 2017;38:157\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeviani VC, Scarpa P, Bottini G. The Mini-Mental State Pediatric Examination: a cognitive screening test for Italian children. In: Preedy VR, Rajendram R, editors. Diagnosis, management, and modeling of neurodevelopmental disorders. Dalam: CR Martin; 2021. pp. 345\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoy GA. Cognitive function analysis for human-centered automation of safety-critical systems. Dalam: Proceedings of the SIGCHI conference on human factors in Computing Systems.; 1998:265\u0026thinsp;\u0026ndash;\u0026thinsp;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDriscoll LL. Cognitive function. Compr Toxicol. 2017;6:376\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHardy KK, Olson K, Cox SM, Kennedy T, Walsh KS. Systematic review: A prevention-based model of neuropsychological assessment for children with medical illness. J Pediatr Psychol. 2017;42:815\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaputra HE, Handryastuti S, Mangunatmadja I, Widodo DP, Pardede SO. Ouvrier\u0026rsquo;s modified mini mental state examination as a screening test for cognitive impairment in school-aged children with epilepsy. Paediatr Indones. 2020;60:137\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain M, Passi GR. Assessment of a modified Mini-Mental Scale for cognitive functions in children. Indian Pediatr. 2005;42:907\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLinsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic factors for poor cognitive development in children born very preterm or with very low birth weight: a systematic review. JAMA Pediatr. 2015;169:1162\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCainelli E, Di Giacomo DL, Mantegazza G, Vedovelli L, Favaro J, Boniver C. Prognostic role of mini-mental state pediatric examination (MMSPE) on neuropsychological functioning. Neurol Sci. 2020;41:619\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFakhri Z, Zare H, Alipour A, Sharif-Alhoseini M. Reliability of the Iranian version of Mini-Mental State Pediatric Examination (MMSPE): children\u0026rsquo;s cognitive screening tool. Soc Cogn. 2022;11:1\u0026ndash;9.\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-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"validity, reliability, MMSPE, cognitive function","lastPublishedDoi":"10.21203/rs.3.rs-5982684/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5982684/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Cognitive function is one of the important aspects in the period of a child’s development. Cognitive dysfunction can be a risk factor of neuropsychological development disorders. The Mini-Mental State Pediatric Examination (MMSPE) is one of the instruments for early detection of cognitive dysfunction in children. The adaptation of MMSPE into Bahasa Indonesia version is currently not available. There are no cognitive function screening instruments that assess higher functions or executive functions as tested in MMSPE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aimed to adapt the MMSPE into Indonesia version and prove the validity and reliability of the instrument.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was a cross-sectional study that recruited 90 children aged 6-14 years who attended elementary and junior high schools. The research was conducted at Public Elementary School and Public Junior High School in Jakarta, Indonesia, from May to October 2024. The sampling method was carried out using stratified random sampling. The translation process of the instrument consists of forward and back translation. It \u0026nbsp;was carried out by two pairs of certified translators. Content validity was assessed by five related experts and presented in the form of content validity index for items (I-CVI) and content validity index for scale (S-CVI) values. Reliability a was assessed by the Cronbach's alpha value.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The Indonesia version of the MMSPE instrument has an average score of I-CVI, S-CVI/Ave (average), and S-CVI/UA (universal agreement) of 1. All items of the Indonesia version of the MMSPE instrument had calculated r \u0026gt; r table with a Cronbach's alpha values of 0.754 and 0.760 respectively at the first and second examination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Indonesia version of MMSPE is a valid and reliable instrument for screening of cognitive function in Indonesian children aged 6-14 years old.\u003c/p\u003e","manuscriptTitle":"The Validity and Reliability Test of The Mini-Mental State Pediatric Examination (MMSPE) As A Screening Instrument for Cognitive Function In Indonesian-speaking Children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-02 11:21:55","doi":"10.21203/rs.3.rs-5982684/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-08T07:15:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T06:37:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32434343936877455494219004694885265441","date":"2025-04-08T04:10:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12803563176908173517789954791205334914","date":"2025-04-08T01:26:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282206395917089508127762247637075110479","date":"2025-04-08T00:51:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156239913382504385530857164257896945576","date":"2025-04-07T14:55:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243720041231384651570350841510268655391","date":"2025-04-06T16:55:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164345346291772536952296562720879510718","date":"2025-04-05T00:45:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246603996698147041481408404434045478542","date":"2025-04-04T13:40:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280661817431195951374367316556444278600","date":"2025-04-04T12:16:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153248978267398705588494175357203424747","date":"2025-04-04T11:47:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37736177445905494342106789315536055586","date":"2025-04-02T12:25:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95623257036161878029446914484051698476","date":"2025-04-02T11:40:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-01T04:33:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332236553568258563783374578366633094652","date":"2025-03-30T14:43:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-30T01:48:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-24T09:47:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-03-18T21:14:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f83197df-9c19-44b3-b722-6ee00e08f721","owner":[],"postedDate":"April 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T16:05:59+00:00","versionOfRecord":{"articleIdentity":"rs-5982684","link":"https://doi.org/10.1186/s12887-025-06021-9","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-10-28 15:58:44","publishedOnDateReadable":"October 28th, 2025"},"versionCreatedAt":"2025-04-02 11:21:55","video":"","vorDoi":"10.1186/s12887-025-06021-9","vorDoiUrl":"https://doi.org/10.1186/s12887-025-06021-9","workflowStages":[]},"version":"v1","identity":"rs-5982684","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5982684","identity":"rs-5982684","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}