Cross-cultural adaptation to the Brazilian Portuguese language of the Waisman Activities of Daily Living (W-ADL) for adolescents and adults with developmental disabilities

  • Renata Machado Teixeira
  • Eveline Torres Pereira
  • Matthew J. Maenner
  • Maicon Rodrigues Albuquerque
Original Article


Waisman Activities of Daily Living (W-ADL) is a free and brief measure of activities daily living (ADL) for adolescents and adults with developmental disabilities. However, its use is limited in non-English-speaking countries. For this reason, translation, cross-cultural adaptation, and validation for other languages are needed. Thus, this study aimed to perform a translation and cross-cultural adaptation and validation of the W-ADL from English to Portuguese language. We used a rigorous approach for translating and adapting the scale, which included a committee of six experts to assess content validity. We also conducted interviews with 62 caregivers of people with a medical diagnosis of Autism spectrum disorder (ASD) or Down syndrome (DS) with different age groups who responded about the person with ASD or DS in their care. Our results include all steps from the translation and cross-cultural adaptation process. Item Content Validity Index showed that items 5 and 16 showed values not acceptable in “relevance” and “theoretical dimension”. On the other hand, the scale content validity index indicated acceptable value. Furthermore, our results showed that our version had acceptable reliability, did not presented floor and ceiling effects, and was able to discriminate subjects from different age groups, as expected. In conclusion, the two versions of the Portuguese version of the W-ADL Scale (15 items and 17 items) demonstrated the acceptable validity and reliability measurement to evaluate ADL for adolescents and adults with developmental disabilities. However, the 15-item version seems to be the best option for Portuguese language speakers.


Activities of daily living Scale Developmental disabilities Adolescents Adults Validation 



The authors would also like to thank the caregivers and the six experts who assisted with the scale analysis.

Compliance with ethical standards

Conflict of interest

There are no potential conflicts of interest.

Ethical approval

The study was approved by the local ethical committee of the Institutional Review Board (protocol number: 43853215.6.0000.5153).

Informed consent

Participants signed an informed consent after receiving a full explanation of the study.


  1. 1.
    Brown KA, Patel DR (2005) Complementary and alternative medicine in developmental disabilities. Indian J Pediatr 72(11):949–952CrossRefPubMedGoogle Scholar
  2. 2.
    Durkin MS, Schneider H, Pathania VS, Nelson KB, Solarsh GC, Bellows N, Scheffler RM, Hofman KJ (2006) Learning and developmental disabilities. In: Jamison DT, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries, 2nd edn. The International Bank for Reconstruction and Development/The World Bank, Washington (DC)Google Scholar
  3. 3.
    Maenner MJ, Smith LE, Hong J, Makuch R, Greenberg JS, Mailick MR (2013) Evaluation of an activities of daily living scale for adolescents and adults with developmental disabilities. Disabil Health J 6(1):8–17. CrossRefPubMedGoogle Scholar
  4. 4.
    Brugha TS, McManus S, Bankart J, Scott F, Purdon S, Smith J, Bebbington P, Jenkins R, Meltzer H (2011) Epidemiology of autism spectrum disorders in adults in the community in England. Arch Gen Psychiatry 68(5):459–465. CrossRefPubMedGoogle Scholar
  5. 5.
    Srinivasan SM, Pescatello LS, Bhat AN (2014) Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders. Phys Ther 94(6):875–889. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Perry A, Flanagan HE, Dunn Geier J, Freeman NL (2009) Brief report: the Vineland adaptive behavior scales in young children with autism spectrum disorders at different cognitive levels. J Autism Dev Disord 39(7):1066–1078. CrossRefPubMedGoogle Scholar
  7. 7.
    Sikkes SA, de Lange-de Klerk ES, Pijnenburg YA, Scheltens P, Uitdehaag BM (2009) A systematic review of instrumental activities of daily living scales in dementia: room for improvement. J Neurol Neurosurg Psychiatry 80(1):7–12. CrossRefPubMedGoogle Scholar
  8. 8.
    Duncan AW, Bishop SL (2015) Understanding the gap between cognitive abilities and daily living skills in adolescents with autism spectrum disorders with average intelligence. Autism 19(1):64–72. CrossRefPubMedGoogle Scholar
  9. 9.
    Smith LE, Maenner MJ, Seltzer MM (2012) Developmental trajectories in adolescents and adults with autism: the case of daily living skills. J Am Acad Child Adolesc Psychiatry 51(6):622–631. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bigler ED, Duffield TC, Prigge MD, Froehlich AL, Lange N, Alexander AL, Lainhart JE, Woodman AC (2016) Contextual factors predict patterns of change in functioning over 10 years among adolescents and adults with autism spectrum disorders. Dev Sci 46(1):176–189. (10.1007/s10803-015-2561-z) Google Scholar
  11. 11.
    Minshew NJ, Mazefsky CA, Eack SM, Travers BG (2016) Longitudinal development of manual motor ability in autism spectrum disorder from childhood to mid-adulthood relates to adaptive daily living skills. J Autism Dev Disord. (10.1111/desc.12401) Google Scholar
  12. 12.
    Painter J, Trevithick L, Hastings RP (2016) Development and validation of the learning disabilities needs assessment tool (LDNAT), a HoNOS-based needs assessment tool for use with people with intellectual disability. J Intellect Disabil Res 60(12):1178–1188. CrossRefPubMedGoogle Scholar
  13. 13.
    Taylor JL, Henninger NA, Mailick MR (2015) Longitudinal patterns of employment and postsecondary education for adults with autism and average-range IQ. Autism 19(7):785–793. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Taylor JL, Mailick MR (2014) A longitudinal examination of 10-year change in vocational and educational activities for adults with autism spectrum disorders. Dev Psychol 50(3):699–708. (10.1037/a0034297) CrossRefPubMedGoogle Scholar
  15. 15.
    Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25(24):3186–3191CrossRefPubMedGoogle Scholar
  16. 16.
    Cha E-S, Kim KH, Erlen JA (2007) Translation of scales in cross-cultural research: issues and techniques. J Adv Nurs 58(4):386–395. CrossRefPubMedGoogle Scholar
  17. 17.
    Sperber AD (2004) Translation and validation of study instruments for cross-cultural research. Gastroenterology 126(1 Suppl 1):S124–S128CrossRefPubMedGoogle Scholar
  18. 18.
    Hambleton RK, Hambleton R, Merenda P, Spielberger C (2005) Issues, designs, and technical guidelines for adapting tests into multiple languages and cultures. Adapt Educ Psychol Tests Cross-Cult Assess 1:3–38Google Scholar
  19. 19.
    Guillemin F, Bombardier C, Beaton D (1993) Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46(12):1417–1432CrossRefPubMedGoogle Scholar
  20. 20.
    Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) 25(24):3186–3191CrossRefGoogle Scholar
  21. 21.
    Roberts P, Priest H (2006) Reliability and validity in research. Nurs Stand (Royal College of Nursing, Great Britain, 1987) 20(44):41–45. CrossRefGoogle Scholar
  22. 22.
    Lynn MR (1986) Determination and quantification of content validity. Nurs Res 35(6):382–385CrossRefPubMedGoogle Scholar
  23. 23.
    Zamanzadeh V, Jasemi M, Valizadeh L, Keogh B, Taleghani F (2015) Effective factors in providing holistic care: a qualitative study. Indian J Palliat Care 21(2):214–224. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Polit DF, Beck CT (2006) The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health 29(5):489–497. CrossRefPubMedGoogle Scholar
  25. 25.
    Wynd CA, Schmidt B, Schaefer MA (2003) Two quantitative approaches for estimating content validity. West J Nurs Res 25(5):508–518CrossRefPubMedGoogle Scholar
  26. 26.
    Costa DS, Bechara A, de Paula JJ, Romano-Silva MA, Correa H, Lage GM, Miranda DM, Malloy-Diniz LF (2016) Influence of COMT Val158Met polymorphism on emotional decision-making: a sex-dependent relationship? Psychiatry Res. PubMedGoogle Scholar
  27. 27.
    Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60(1):34–42. CrossRefPubMedGoogle Scholar
  28. 28.
    Hays RD, Anderson R, Revicki D (1993) Psychometric considerations in evaluating health-related quality of life measures. Qual Life Res 2(6):441–449CrossRefPubMedGoogle Scholar
  29. 29.
    Field A (2013) Discovering statistics using IBM SPSS statistics. SAGE Publications, New YorkGoogle Scholar
  30. 30.
    Andresen EM (2000) Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil 81(12 Suppl 2):S15–S20CrossRefPubMedGoogle Scholar
  31. 31.
    Wishart JG (1993) The development of learning difficulties in children with Down’s syndrome. J Intellect Disabil Res 37(4):389–403. CrossRefPubMedGoogle Scholar
  32. 32.
    Maneesriwongul W, Dixon JK (2004) Instrument translation process: a methods review. J Adv Nurs 48(2):175–186. CrossRefPubMedGoogle Scholar
  33. 33.
    Eremenco SL, Cella D, Arnold BJ (2005) A comprehensive method for the translation and cross-cultural validation of health status questionnaires. Eval Health Prof 28(2):212–232. CrossRefPubMedGoogle Scholar
  34. 34.
    Tanzer NK (2005) Developing tests for use in multiple languages and cultures: a plea for simultaneous development. In: Adapting educational and psychological tests for cross-cultural assessment, pp 235–263Google Scholar
  35. 35.
    de Paula JJ, Albuquerque MR, Lage GM, Bicalho MA, Romano-Silva MA, Malloy-Diniz LF (2016) Impairment of fine motor dexterity in mild cognitive impairment and Alzheimer s disease dementia: association with activities of daily living. Rev Bras Psiquiatr 38:235–238CrossRefPubMedGoogle Scholar
  36. 36.
    Hopkins WG (2000) Measures of reliability in sports medicine and science. Sports Med 30(1):1–15CrossRefPubMedGoogle Scholar
  37. 37.
    Tavakol M, Dennick R (2011) Making sense of Cronbach’s alpha. Int J Med Educ 2:53–55. CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    McHorney CA, Ware JE Jr, Raczek AE (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31(3):247–263CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Programa de Pós-Graduação em Educação FísicaUniversidade Federal de ViçosaViçosaBrazil
  2. 2.Departamento de Educação FísicaUniversidade Federal de ViçosaViçosaBrazil
  3. 3.AtlantaUSA
  4. 4.Departamento de Esporte, Escola de Educação Física, Fisioterapia e Terapia Ocupacional (EEFFTO)Universidade Federal de Minas GeraisBelo HorizonteBrazil

Personalised recommendations