The Internet is valid and reliable for child-report: An example using the Activities Scale for Kids (ASK) and the Pediatric Quality of Life Inventory (PedsQL) Nancy L. Young a,b, * , James W. Varni c , Laurie Snider d , Anna McCormick e , Bonita Sawatzky f , Marjorie Scott g , Gillian King h,i , Ross Hetherington b , Ellen Sears a , David Nicholas b a School of Rural and Northern Health, Laurentian University, Sudbury, Ontario, Canada b Child Health Evaluative Sciences, SickKids, Toronto, Ontario, Canada c Department of Landscape Architecture and Urban Planning, Texas A & M University, College Station, TX, USA d School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada e Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada f Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada g Janeway Children’s Health and Rehabilitation Centre, Eastern Health, St. John’s, Newfoundland & Labrador, Canada h Bloorview Research Institute, Bloorview Kids Rehab, Toronto, Ontario, Canada i Research Program, Thames Valley Children’s Centre, London, Ontario, Canada Accepted 27 June 2008 Abstract Objective: This study tested the impact of web administration on well-established measures of children’s physical function and quality of life. Study Design and Setting: Participants were recruited from clinics at six hospitals. They completed the Activities Scale for Kids (ASK ) and the Pediatric Quality of Life Inventory (PedsQL) questionnaires twice, in a crossover design that used paper and web-based modes of administration. Intraclass correlation coefficients were used to assess the validity of the new web formats relative to the original paper formats and their testeretest reliability. Results: Sixty-nine children ranging in age from 8.0 to 13.4 years (mean 5 11.0 years) completed the study. The sample included chil- dren with cerebral palsy (19), spina bifida (23), and cystic fibrosis (27). The mean ASK score was 77.5 and the mean PedsQL score was 69.1. The intermethod intraclass correlation coefficients were 0.98 (lower limit 0.94) for the ASK and 0.64 (lower limit 0.35) for the PedsQL. These compare to intraclass correlation coefficients of 0.99 and 0.94, respectively, for traditional paper formats. Conclusion: The web ASK was valid in comparison to the original paper format. Consistency in mode of administration may be more important when using the PedsQL. Both measures were highly reliable on paper and on the web. Ó 2008 Elsevier Inc. All rights reserved. Keywords: Child; Adolescent; Online surveys; Disability; Evaluation; Quality of life 1. Introduction In the past two decades there has been increasing em- phasis on the collection of health and health-related quality of life (HRQoL) outcomes in clinical research [1,2]. Tradi- tionally, this information is collected on paper question- naires. Mail administration of questionnaires has also been shown to be a valid and effective method for reaching research participants at a distance. Online questionnaire completion is an emerging method for measuring health outcomes [3]. This technique has been applied in adult pop- ulations [4,5], where the concordance between paper for- mats and Internet formats has been reported [6,7]. Internet-based data collection is now beginning to be ap- plied in teenage populations [8]. However, there is insuffi- cient information on the impact of the Internet on the validity and reliability of the data obtained from children. There is growing evidence that the medium of the Inter- net may change the social construction of self (e.g., how one presents oneself to the world) [9]. Divergence in portrayal of self has been reported to take the form of dis- inhibition, intensified communication, and selective * Corresponding author. School of Rural and Northern Health, Lauren- tian University, 935 Ramsey Lake Road, Sudbury, Ontario P3E 2C6, Can- ada. Tel.: 705-675-1151 ext. 4014; fax: 705-671-6603. E-mail address: nyoung@laurentian.ca (N.L. Young). 0895-4356/09/$ e see front matter Ó 2008 Elsevier Inc. All rights reserved. doi: 10.1016/j.jclinepi.2008.06.011 Journal of Clinical Epidemiology 62 (2009) 314e320