World Health Organisation Disability Assessment Schedule – Children and Youth version (WHODAS-Child)

This is the children and youth version of the WHODAS 2.0 for use by children aged 10 – 17 years of age and over. There is also versions for use with adults (aged 18 and over): a self-report version, a proxy version, which can be completed by a relative, carer, or friend, or an interviewer version, which can be completed by a clinician.

WHODAS-Child captures the level of functioning in six domains of life:

1. Cognition – understanding and communicating
2. Mobility – moving and getting around
3. Self-care – attending to one’s hygiene, dressing, eating and staying alone
4. Getting along – interacting with other people
5. Life activities – domestic responsibilities, leisure, work and school
6. Participation – joining in community activities, participating in society.

The WHODAS- Child provides a common metric of the impact of any health condition in terms of functioning. Being a generic measure, the instrument does not target a specific disease or condition – it can thus be used to compare disability due to different conditions. The WHODAS-Child can also facilitate the design and monitoring of health and health-related interventions. The instrument has proven useful for assessing health and disability levels in the general population and specific groups (e.g. people with a range of different mental and physical conditions). Furthermore, the WHODAS-Child can inform the design of health-related interventions and to monitor their impact on children.

Disability is a major health issue. When global assessments are made for the burden of disease, more than half of the burden of premature mortality is due to overall disability. In line with the WHODAS-Child condition agnostic approach, it is noted that people generally seek health services because a disease makes it difficult for them to do what is developmentally appropriate for their age (i.e. because they are disabled) rather than because they have a disease. Health-care providers consider a case to be clinically significant when it limits a child’s daily activities, and they use disability information as the basis of their evaluation and planning. The WHODAS is commonly used by disability services such as the NDIS to assess the level of need for support services.  

Example WHODAS-Child items:

There are two scoring methods used for the WHODAS-Child:
1. Score (and its percentile)
2. Average score (and its descriptor)

The score is calculated using a domain-weighted system. For the total score and the six domains, the WHODAS-Child is scored by estimating the percent of the maximum possible score observed for the total/domains. Each of these scores has a potential range from 0–100, where a higher score is indicative of greater levels of disability. It is important to note that the Life Activities domain of the WHODAS-Child includes five questions about impairments in school activities and participation. These items are optional for children not in school, and their score for that domain is the percent of the maximum possible score in that domain excluding the five school-related questions.

The average scores are comparable to the WHODAS 5-point scale, which allows the clinician to think of the individual’s disability in terms of none (0-0.49), mild (0.5-1.49), moderate (1.5-2.49), severe (2.5-3.49), or extreme (3.5-4). The average domain and general disability scores were found to be reliable, easy to use, and clinically useful to clinicians in the DSM-5 Field Trials of the WHODAS (APA, 2021). The average domain score is calculated by dividing the raw domain score by the number of items in the domain. The average general disability score is calculated by dividing the raw overall score by the number of items in the measure (i.e., 34 or 29 if the optional items are not completed).

The two scoring methods are used for the total score and each of the 6 domains:
1. Cognition (items 1-6)– Assesses communication and thinking activities; specific areas assessed include concentrating, remembering, problem-solving, learning, and communicating.
2. Mobility (items 7-11) – Assesses activities such as standing, moving around inside the home, getting out of the home, and walking a long distance.
3. Self-care (items 12-15) – Assesses hygiene, dressing, eating, and staying alone.
4. Getting along (items 16-20)– Assesses interactions with other people and difficulties that might be encountered with this life domain due to a health condition; in this context, “other people” includes those known intimately or well (e.g. spouse or partner, family members or close friends) and those not known well (e.g. strangers).
5. Life activities (items 21-29) – Assesses difficulty with day-to-day activities (i.e. those that people do on most days, including those associated with domestic responsibilities, leisure, work, and school).
6. Participation (items 30-34) – Assesses social dimensions, such as community activities; barriers and hindrances in the world around the respondent; and problems with other issues, such as maintaining personal dignity.

If there is excessive variability (i.e., some extreme responses) within a domain score on the WHODAS-Child, it will be noted in the interpretive text. In these cases, it is recommended that the domain score be de-emphasised in favour of an examination of individual items to determine the client’s strengths and weaknesses. Excessive variability that would render domain level scores difficult to interpret is defined as a difference between the maximum and minimum score within a domain of greater than 2. This would mean that a response within a domain would have to have a minimum score of 0 (“None”) and a maximum score of 3 (“Severe”) or a minimum score of 1 (“Mild”) and a maximum score of 4 (“Extreme”) within the same domain to be classified as showing too much variability for domain level interpretation.

Plots are displayed upon first administration that show the average scores for the total and domains. Upon multiple administrations of the WHODAS, longitudinal plots will be displayed for the total average score and for the domain average scores. This allows the practitioner to see if there has been any change in total and domain-level functioning for the client over time.

The WHODAS-Child’s test-retest and inter-rater reliability on a sample of 367 (59.1% male and 40.9% female) children has been reported to be high (r = .83 and ICC = .88). The distribution of WHODAS-Child scores is approximately normal, with a reported mean of 25.0 and a standard deviation of 14.57 in a Rwandan sample of children and youth (Scorza et al., 2013).

Confirmatory factor analysis validated a six-factor structure for the scale, echoing the WHODAS-Child scale (Scorza et al., 2013). With a high-reliability coefficient (α = .84), the scale exhibits convergent and divergent validity. Scores on the scale demonstrate moderate positive correlations with depression and post-traumatic stress disorder while showing moderate negative correlations with prosocial behaviours. WHODAS-Child scores have also been found to be significantly increased among youth diagnosed with a mental disorder compared to those without any disorder.

The average WHODAS-Child scores show no significant variance between boys and girls or across different age groups, irrespective of whether the assessment was provided by a parent or the child. Although there was a moderate correlation between parent and child-reported scores, parents tended to indicate less impairment compared to self-reports from children. WHODAS-Child scores derived from parent reports demonstrated a significantly weaker correlation with the diagnosis of major depressive episodes.

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