Preliminary validation of the coma recovery scale for pediatrics in typically developing young children

Objective: To examine the basic psychometric features of a modified version of the Coma Recovery Scale-Revised (CRS-R) for use in young children with disorders of consciousness (DoC). Method: The CRS-R was modified to create the Coma Recovery Scale for Pediatrics (CRS-P) and administered to 33 typically developing children (8–59 months). Total scores, subtest scores, and inter-rater reliability were evaluated. Performance on the two items representing emergence to conscious state (CS)–functional object use (FOU) and functional communication (FC) was examined across the age range. Results: Inter-rater reliability of CRS-P subscale scores was adequate (K_w =.87–1.00). All 4-year-olds, 75% of 3-year-olds, 10% of 2-year-olds, and 0% <2 years scored at the CRS-P ceiling. Total and subtest scores were strongly correlated with age as were the two behaviors representing emergence to CS (FOU, FC)–all children >12 months and none <12 months of age met criteria for FOU; all children ≥3 years, 20% between 2 and <3 years, and none <2 years met criteria for FC. Conclusions: The CRS-P is appropriate for use in children as young as 12 months of age, with a strong association between performance and age at administration. The CRS-P also captures emergence to CS, a key clinical milestone.