# Italian Coma Recovery Scale for Pediatrics (CRS-P): Preliminary Validation in a Sample of Young Children with Typical Development

## TL;DR

This study evaluates the Italian Coma Recovery Scale for Pediatrics (CRS-P) in typically developing children to determine its effectiveness in diagnosing disorders of consciousness in young children.

## Contribution

The study provides preliminary validation of the CRS-P in typically developing children, highlighting age-related performance thresholds and suggesting modifications for improved diagnostic accuracy.

## Key findings

- Inter-rater reliability for the CRS-P was high, ranging from 0.95 to 1.
- Children aged ≥34 months reached the CRS-P ceiling, while those ≥14 months met criteria for functional object use.
- Behaviors distinguishing VS and MCS were observed in children as young as 3 months in the Visual and Motor subscales.

## Abstract

Background/Objectives: Guidelines for the diagnosis of children with disorder of consciousness (DoC) in pediatric age have not been defined yet. Assessment tools designed for adults have generally not been standardized for pediatrics, which could lead to misdiagnosis due to the limited behavioral repertoire of children. This study aims at examining the basic psychometric properties of the Italian Coma Recovery Scale for Pediatrics (CRS-P) in typically developing children. Methods: A total of 64 typically developing children aged 3 months to 5:7 years were administered the CRS-P. Performance was examined across the age range, and for the two behaviors indicating emergence to a conscious state, namely functional object use (FOU) and functional communication (FC). Results: Inter-rater reliability ranged from 0.95 to 1 for subscale and total scores. All children aged ≥34 months scored at the CRS-P ceiling. All children ≥ 14 months met the criteria for FOU and all children ≥ 34 months met those for FC. Children as early as 3 months of age displayed behaviors discriminating between vegetative state (VS) and minimally conscious state (MCS) in the Visual and Motor subscales. Language-based behaviors of MCS in other subscales were consistently displayed by older children. Conclusions: Typically developing children met the criteria for all items of the Italian CRS-P by 34 months, which suggests caution in adopting the scale at a younger age. However, the features of the distinct stages of DoC could be captured earlier, based on the various subscales. Modifications should be made to some items to improve diagnostic accuracy.