Cultural Adaptation and Norms Setting of a Childhood Intelligence Measure in a Rural District of Pakistan By Irum Gilani HEALTH SERVICES ACADEMY Faculty of Medicine, Quaid–i–Azam University, Islamabad April 2019 Cultural Adaptation and Norms Setting of a Childhood Intelligence Measure in a Rural District of Pakistan Submitted by Irum Gilani Thesis submitted to the Quaid–i–Azam University in the partial fulfillment of the degree of Doctor of Philosophy in Community Medicine and Public Health HEALTH SERVICES ACADEMY Faculty of Medicine, Quaid–i–Azam University April 2019 Dedicated to my child Abdullah Ziyad & all the children worldwide Contents Acknowledgme nt ________________________________________________________ i List of Figures _________________________________________________________ ii List of Tables __________________________________________________________ v List of Abbreviations __________________________________________________ vii List of Appendices _____________________________________________________ viii Chapter 1: Introduction 1) Introduction______________________________________________________ 1 Chapter 2: Literature Review 2.1) Introduction of the chapter ________________________________________ 3 2.2) Conceptualization of Intelligence ____________________________________ 3 2.3) Quantification of Intelligence ______________________________________ 6 2.3.1) Evolution of Intelligence Assessment _______________________________________ 7 2.3.2) Intelligence Testing & its Measures _________________________________________10 2.4) Significance of Cultural Adaptation_________________________________ 14 2.5) Broader Context of the Doctoral Research____________________________ 17 2.6) Contribution of the Doctoral Research ______________________________ 19 2.7). Subtests & age limits : from WPPSI to WPPSI–III _____________________ 21 2.8) Subtests & age limits of the WPPSI–IV ______________________________ 23 2.9) Composite scores of the WPPSI–IV _________________________________ 24 2.10) Process scores of the WPPSI–IV ___________________________________ 24 2.11) Test structure of the WPPSI–IV ___________________________________ 25 2.11.1) Test structure of the WPPSI–IV for ages 2:6–3:11 ____________________________25 2.11.2) Test structure of the WPPSI–IV for ages 4:0–7:7_____________________________26 2.12) Revision goals of the WPPSI–IV ___________________________________ 28 2.12.1) Update theoretical foundations __________________________________________28 2.12.2) Increase developmental appropriateness ___________________________________28 2.12.3) Increase user–friendliness ______________________________________________28 2.12.4) Improve psychometric properties_________________________________________28 2.12.5) Enhance clinical utility ________________________________________________29 2.13) Five research stages of the WPPSI–IV development ____________________ 29 2.13.1) Conceptual development _______________________________________________29 2.13.2) Pilot stage __________________________________________________________30 2.13.4) Standardization stage _________________________________________________31 2.13.5) Final assembly & evaluation ____________________________________________31 2.14) Norms development of the WPPSI–IV _______________________________ 31 2.14.1) Determining start points and discontinue rules _______________________________32 2.14.2) Deriving subtest scaled scores __________________________________________32 2.14.3) Deriving composite scores ______________________________________________32 2.14.4) Deriving age equivalents _______________________________________________33 2.15 WPPSI translation, standardization & adaptation outside the U.S. _________ 33 Chater 3: Aim and Objectives 3.1) Research Question__________________________________________________ _35 3.1) Aim _________________________________________________________ 35 3.2) Objectives ____________________________________________________ 35 3.3) Operational Definitions __________________________________________ 35 3.3.1) Cultural Adaptation of the WPPSI–IV _______________________________________36 a 3.3.2) Norms Setting _________________________________________________________36 Chapter 4: Subjects and Methods 4.1) Study Population & Sample Selection _______________________________ 37 4.1.1) Inclusion Criteria for the Child _____________________________________________37 4.1.2) Exclusion Criteria for the Ch ild ____________________________________________37 4.1.3) Exclusion Criterion for the Mother __________________________________________37 4.3) Study Settings _________________________________________________ 37 4.3.2) Pre–piloting and Piloting _________________________________________________37 4.3.2) Main Study Data Collection _______________________________________________38 4.3.3.) Description of the Study Area ___________________________________________38 4.4) Sampling Technique ____________________________________________ 40 4.4.1) Sampling Technique of 2005’s THP Study ____________________________________40 4.4.2) Sampling Technique of 2012’s Follow–up THP Study ___________________________42 4.4.3) Sampling Technique of the PhD Research Part _________________________________43 4.5) Sample Size Calculation__________________________________________ 43 4.6) Data Collection Tools & M ate rials __________________________________ 45 4.6.1) Data Co llect ion Tools ____________________________________________________45 4.6.2) Data Collection Materials _________________________________________________46 4.7) Kilifi approach for adaptation & piloting of the WPPSI–IV ______________ 47 4.8) Data Analysis Software & Plan ____________________________________ 48 4.8.1) Statistical Package for Social Sciences (SPSS), 16th version _______________________48 4.8.2) Analysis of Moment Structures (AMOS), 22nd version_____________________________49 4.9) Ethical Considerations ___________________________________________ 49 Chapter 5: Adaptation of the WPPSI-IV 5.1) Construct definition: Kilifi 1st stage _________________________________ 50 5.1.1) Relevant Literature Review________________________________________________51 5.1.2) Panel of Experts ________________________________________________________51 5.2) Item Pool Creation: Kilifi 2nd s tage _________________________________ 53 5.2.1) Urdu Translation _______________________________________________________53 5.2.2) Cultural Adaptation _____________________________________________________55 5.3) Developing the Procedure: Kilifi 3rd stage ____________________________ 56 5.3.1) Pre–piloting ___________________________________________________________56 5.4) Evaluation of the Adapted Schedule: Kilifi 4th s tage ____________________ 58 5.4.1) Piloting_______________________________________________________________58 Chapter 6: Piloting & Construct Validation 6.1) Visual Spatial Scale/Index ________________________________________ 61 6.1.1) Subtest Block Design (BD): time–bound subtest ________________________________61 6.1.2) Subtest Object Assembly (OA): time–bound subtest _____________________________68 6.2) Fluid Reasoning Scale/Index ______________________________________ 70 6.2.1) Subtest Matrix Reasoning (MR) ____________________________________________71 6.2.2) Subtest Picture Concepts (PC) _____________________________________________74 6.3) Working Memory Scale/Index _____________________________________ 76 6.3.1) Subtest Picture Memory (PM)______________________________________________76 6.3.2) Subtest Zoo Location (ZL) ________________________________________________78 6.4) Processing Speed Scale/Index______________________________________ 80 6.4.1) Subtest Bug Search (BS): time–bound subtest ___________________________________80 6.4.2) Subtest Cancellation (CA): time–bound subtest_________________________________82 b 6.4.3) Subtest Animal Coding (AC): time–bound subtest ______________________________85 6.5) Verbal Comprehension Scale/Index _________________________________ 87 6.5.1) Subtest Information (IN)__________________________________________________87 6.5.2) Subtest Similarities (SI) __________________________________________________89 6.5.3) Subtest Vocabulary (VC) _________________________________________________91 6.5.4) Subtest Comprehension (CO) ______________________________________________93 6.5.5) Receptive Vocabulary (RV) _______________________________________________95 6.5.6) Picture Naming (PN) ____________________________________________________97 6.6) Full Scale Intelligence Quotient (FSIQ) ______________________________ 99 6.6.1) Steps for FSIQ Computation on the Piloting Data ______________________________ 100 6.6.1.1) Calculating Individual Subtest Total Raw Score___________________________ 100 6.6.1.2) Sum of Raw Scores to Scaled Score Equiva lents __________________________ 100 6.6.2) Results of the FSIQ Computation of Piloting Data _____________________________ 103 6.6.3) Factor Analyses during WPPSI–IV Development ______________________________ 106 6.6.4) Construct Validation of the WPPSI–IV a priori Model __________________________ 108 6.6.4.1) Goodness of Fit Analyses on Piloting Data ______________________________ 109 6.6.5) Detail of Fit Indices in relation to Goodness of Fit Analyses ______________________ 111 6.6.5.1) CMIN/DF Index __________________________________________________ 111 6.6.5.2) Comparative fit indices _____________________________________________ 112 6.6.5.3) Parsimony adjusted fit indices ________________________________________ 112 6.6.5.4)