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Noncommunicating Children's Pain Checklist-Revised (NCCPC-R)
Please visit this website for more information about the instrument: Noncommunicating Children's Pain Checklist-Revised
The NCCPC-R may be freely copied for clinical use or use in research funded by not-for-profit agencies. For-profit agencies should contact Lynn Breau: Pediatric Pain Research, IWK Health Centre, 5850 University Avenue, Halifax, Nova Scotia Canada, B3J 3G9
Supplemental: Cerebral Palsy (CP)
Short Description of Instrument
The Noncommunicating Children's Pain Checklist-Revised (NCCPC-R) is designed for parents or caregivers to assess pain during daily life for children, aged 3 to 18 years who are unable to speak because of cognitive (mental/intellectual) impairments or disabilities (Breau et al., 2000). It is a revised version of the scale initially developed by McGrath et al. (1998). It can be used whether a child has physical impairments or disabilities. The NCCPC-R consists of 30 items regarding vocal, social, facial, activity, body and limb movements physiological status and eating/sleeping parameters. There is also a post-operative version that has been assessed for measuring acute post-operative pain.
Comments/Special Instructions
CP-specific Pain Category: Pain Behavior
CP-specific ICF Domains: Body Functions, Body Structures, Activity and Participation (World health Organization, 2001)
Scoring and Psychometric Properties
Scoring: 30 items - ordinal ratings of the frequency provided by observers (occurred: not at all, just a little, fairly often, very often).
0 = Not present at all during the observation period. (Note: if the item is not present because the child is not capable of performing that act, it should be scored as "NA").
1 = Seen or heard rarely (hardly at all) but is present.
2 = Seen or heard a number of times, but not continuous (not all the time).
3 = Seen or heard often, almost continuous (almost all the time); anyone would easily notice this if they saw the child for a few moments during the observation time.
NA = Not applicable. This child is not capable of performing this action.
Total score 0 - 90. A total score of 7 or more indicates a child has pain (Breau et al., 2002).
Psychometric Properties: The NCCPC-R has excellent internal consistency, and scores are consistent over time (Breau et al., 2002). The NCCPC-R can also discriminate between the presence and absence of pain, with 7 items in this measure having 85% sensitivity and 89% specificity for distinguishing between presence and absence of pain (Breau et al., 2001).
The NCCPC-R had excellent internal reliability (Cronbach's a = .93) across differing pain episodes in the same individual. It also displays concurrent validity with the Numeric Pain Rating Scale (NPRS) across differing pain episodes with the subscales of vocal and physiological signs more consistent in correlation than facial signs.
Pain behavior did not differ significantly across pain episodes or overtime for each child. Behavior was different when examined at a time a child was not in a pain episode. Total scores for each child remained consistent across pain episodes for most children tested.
Using Receiver Operating Characteristic (ROC) curves, a total NCCPC-R score of 7 had an 84% sensitivity and 68% specificity for pain.
Strengths: Psychometrically rigorous validation of pain measures in a population of children in which pain is difficult to assess and may be missed by providers and caregivers. Children with cerebral palsy were specifically included in this study and children of a large age range were also included. This measure has been validated for both acute and chronic pain.
Weaknesses: As this population is nonverbal, the caregivers had to assess when they thought their child was in pain, since the child is not able to state this. Children often displayed dissimilar pain behaviors or combination of pain behaviors, which necessitated inclusion of 30 items.
Key References:
Breau LM, Camfield C, McGrath PJ, Rosmus C, Finley GA. Measuring pain accurately in children with cognitive impairments: refinement of a caregiver scale. J Pediatr. 2001 May;138(5):721-721.
Breau LM, McGrath PJ, Camfield CS, Finley GA. Psychometric properties of the non-communicating children's pain checklist-revised. Pain. 2002 Sep;99(1-2):349-57.
Breau LM, McGrath PJ, Camfield C, Rosmus C, Finley GA. Preliminary validation of an observational pain checklist for persons with cognitive impairments and inability to communicate verbally. Dev Med Child Neurol. 2000;42(9):609-616.
McGrath PJ, Rosmus C, Canfield C, Campbell MA, Hennigar A. Behaviours caregivers use to determine pain in non-verbal, cognitively impaired individuals. Dev Med Child Neurol. 1998 May;40(5):340-3.
Additional References:
Breau LM, Camfield CS, Symons FJ, Bodfish JW, Mackay A, Finley GA, McGrath PJ. Relation between pain and self-injurious behavior in nonverbal children with severe cognitive impairments. J Pediatr. 2003 May;142(5):498-503.
Murgia M, Izzo R, Bettinelli A, Di Maggio C, De Angelis M, Mangone M, Paoloni M, Bernetti A, Torquati A, Leuzzi V, Santilli V. Validity and reliability of Italian version of the Non-Communicating Children's Pain Checklist: revised version. Eur J Phys Rehabil Med. 2019 Feb;55(1):89-94.
World health Organization (2001). International Classification of Functioning, Disability and Health (ICF) Retrieved 19August2021
Cerebral Palsy-specific:
Giray E, Simsek HI, Aydogduoglu M, Kangal Aç, çelik A, Kurt C, Karadag Saygi E. Pain evaluation in a sample of Turkish children with cerebral palsy and its association with dependency level, verbal abilities, and the quality of life of patients and sociodemographic status, depression, and quality of life of their caregivers. Turk J Phys Med Rehabil. 2018 Feb 23;64(3):222-229.
Document last updated August 2022