Reliability of Subtle (Soft) Neurological Signs in Children

BENEDETTO VITIELLO, ALEXANDER J. RICCIUTI, DAVID M. STOFF, DAVID BEHAR, MARTHA B. DENCKLA

Research output: Contribution to journalArticlepeer-review

Abstract

Reliability and stability of neurological “subtle” (“soft”) signs were assessed in 54 psychiatric patients and 25 normal children, aged 5–17 years, using the revised Neurological Examination for Subtle Signs (NESS). Acceptable interrater reliability (kappa ≥ 0.50, or intraclass correlation coefficient ≥ 0.70) was found for 40 of the 64 items tested. Test-retest reliability at 2 weeks was unsatisfactory for most of the categorically scored items, including some “classic” subtle signs such as overflows or dysrhythmias. Continuous items, such as time needed to perform 20 consecutive movements, remained mostly stable at retest. A practicing effect was evident only in the graphesthesia test. Overall internal consistency was good (Cronbach's alpha = 0.74). Given the poor stability of overflows and dysrhythmias, researchers and clinicians should rely more on subtle signs that can be assessed on continuous scales.

Original languageEnglish (US)
Pages (from-to)749-753
Number of pages5
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume28
Issue number5
DOIs
StatePublished - 1989

Keywords

  • reliability
  • soft signs
  • stability
  • subtle signs

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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