Psychometric Evaluation and Developmental Validity of the Turkish Child Oral and Motor Proficiency Scale (ChOMPS)

BüşraKüka1

AymenBalikci2

SevdaAsqarova3

TeresaMay-Benson4

Department of Occupational Therapy, Graduate School of Health SciencesUskudar University34000Istanbul

Sense On Ltd34000Istanbul

Department of Occupational Therapy, Faculty of Health SciencesUskudar University34000Istanbul, Türkiye

4TMB Educational Enterprises, LLC19401NorristownPAUSA

Büşra Küka¹, Aymen Balikci², Sevda Asqarova³, Teresa May-Benson⁴

¹ Department of Occupational Therapy, Graduate School of Health Sciences, Uskudar University, Istanbul-34000

² Sense On Ltd., Istanbul-34000

³Department of Occupational Therapy, Faculty of Health Sciences, Uskudar University, Istanbul 34000, Türkiye

⁴TMB Educational Enterprises, LLC., Norristown, PA 19401, USA

Öz

Amaç:

Oral motor beceriler, beslenme, yutma ve konuşma için temel öneme sahiptir ve çocuğun beslenme ile iletişim becerilerinin temelini oluşturur. Bu becerilerin doğru değerlendirilmesi, gelişimsel gecikmelerin erken dönemde belirlenmesi ve uygun müdahalelerin planlanması açısından kritik öneme sahiptir. Ancak, erken çocukluk döneminde oral motor ve beslenme becerilerini değerlendirmeye yönelik Türkçe, psikometrik olarak güvenilir ve standart bir araç bulunmamaktadır. Bu nedenle, bu çalışma 6–72 ay arasındaki çocuklar için Çocuk Oral ve Motor Yeterlik Ölçeği’nin (ÇOMYÖ) Türkçe çevirisinin güvenirlik, geçerlik ve gelişimsel geçerliğini değerlendirerek klinik ve gelişimsel alanlarda kullanılabilecek güvenilir bir ölçüm aracı oluşturmayı amaçlamıştır.

Gereç ve Yöntem:

ÇOMYÖ ölçeği ileri–geri çeviri ve uzman görüşü yöntemiyle Türkçeye çevrilmiştir. İçerik geçerliği, on pediatrik rehabilitasyon uzmanının değerlendirmeleriyle, Madde Düzeyinde İçerik Geçerlik İndeksi (I-CVI) ve düzeltilmiş kappa katsayısı (k*) kullanılarak incelenmiştir. Psikometrik analizler, 162’si tipik gelişen ve 37’si serebral palsili olmak üzere toplam 199 çocukla gerçekleştirilmiştir. Analizlerde Cronbach alfa, madde–toplam korelasyonları, test–tekrar test güvenirliği (ICC), ROC analizi, bilinen grup geçerliği ve Gelişimsel Tarama Testi–Türkçe (ASQ-TR) ile gelişimsel geçerlik değerlendirilmiştir.

Bulgular:

Türkçe ÇOMYÖ mükemmel psikometrik özellikler göstermiştir. İç tutarlılık yüksek bulunmuştur (α_toplam = 0.987; alt ölçekler = 0.979–0.983) ve test–tekrar test güvenirliği zaman içi kararlılığı doğrulamıştır (ICC = 0.903–0.933). İçerik geçerliği mükemmeldir (Ave-CVI = 0.99; k* = 0.99). ROC analizi güçlü ayırt edicilik göstermiştir (AUC = 0.90, kesme noktası ≤71, duyarlılık = %97.3, özgüllük = %72.2). Ölçek, serebral palsili ve tipik gelişen çocukları anlamlı şekilde ayırt etmiştir (p < 0.001, Cohen d = 1.55–2.33) ve ASQ-TR alanlarına göre beklenen gelişimsel ilerlemeyi göstermiştir (p < 0.001).

Sonuç:

Türkçe ÇOMYÖ, erken çocukluk döneminde oral motor ve beslenme becerilerini değerlendirmek için güvenilir, geçerli ve gelişimsel olarak duyarlı bir ölçektir. Klinik tarama ve gelişimsel değerlendirme amaçlı olarak güvenle kullanılabilir.

Anahtar Kelimeler

ChOMPS, oral motor gelişim, beslenme değerlendirmesi, güvenirlik, geçerlik

Abstract

Aim:

Oral motor skills are vital for feeding, swallowing, and speech, forming the basis for a child’s nutrition and communication. Accurate assessment of these skills is essential for identifying developmental delays and planning early interventions. However, standardized and psychometrically sound tools in Turkish are limited. This study aimed to evaluate the reliability, validity, and developmental validity of the Turkish translation of the Children’s Oral and Motor Proficiency Scale (ChOMPS) for children aged 6 months to 6 years, providing a reliable tool for clinical and developmental use.

Material and Methods:

The ChOMPS was translated into Turkish using standardized forward–backward translation and expert review. Content validity was evaluated by ten pediatric rehabilitation specialists using the Item Content Validity Index (I-CVI) and modified kappa statistics. Psychometric analyses were conducted with 199 children (162 typically developing, 37 with cerebral palsy). Statistical analyses included Cronbach’s alpha, item–total correlations, test–retest reliability (intraclass correlation coefficients, ICC), receiver operating characteristic (ROC) analysis, known-group validity, and developmental validity based on the Ages and Stages Questionnaire–Turkish (ASQ-TR).

Results:

The Turkish ChOMPS demonstrated excellent psychometric properties. Internal consistency was high (α_total = 0.987; subscales = 0.979–0.983), and test–retest reliability confirmed temporal stability (ICC = 0.903–0.933). Content validity was excellent (Ave-CVI = 0.99; k* = 0.99). ROC analysis showed strong diagnostic accuracy (AUC = 0.90, cut-off ≤ 71, sensitivity = 97.3%, specificity = 72.2%). The scale differentiated children with cerebral palsy from typically developing peers (p < 0.001, Cohen’s d = 1.55–2.33) and showed developmental progression across ASQ-TR domains (p < 0.001).

Conclusion:

The Turkish ChOMPS is a reliable, valid, and developmentally sensitive tool for assessing oral motor and feeding proficiency in early childhood. It can be effectively used for clinical screening and developmental evaluation.

Keywords:

ChOMPS

oral motor development

feeding evaluation

reliability

validity

Introduction

Early childhood represents a dynamic period of human development in which rapid neural, motor, and behavioral growth occurs through continuous interaction between biological and environmental systems (Gabbard, 2013; Kalhoff et al., 2024). Theories of motor development emphasize that maturation alone cannot explain skill acquisition; rather, it emerges from complex interactions between the child’s neural organization, sensory input, environmental affordances, and task demands (Gabbard, 2013).

Within this system, oral-motor abilities constitute an essential domain of sensorimotor development, enabling the coordination of functions such as sucking, swallowing, chewing, and speech (Sampallo-Pedroza et al., 2014). These foundational skills support a child’s participation in everyday routines and are interlinked with broader cognitive, social, and motor domains (Hurtado-Almonacid et al., 2024; Kalhoff et al., 2024).

From a developmental perspective, oral-motor competence reflects the integrity of the neuromotor system and its capacity for coordination and control (Sampallo-Pedroza et al., 2014). This process begins prenatally and rapidly evolves during infancy, paralleling the refinement of postural stability and motor learning. As infants progress from reflexive to voluntary oral actions, integration across sensory and motor systems becomes critical for efficient feeding and communication (Kalhoff et al., 2024). Disturbances in this process—stemming from prematurity, neurological immaturity, or environmental deprivation—may disrupt not only feeding efficiency but also language development, cognitive growth, and social engagement (Esmaeili et al., 2024; Erol et al., 2023). Consequently, oral-motor performance serves as an indicator of both functional competence and developmental health.

Empirical research underscores the close relationship between oral-motor and general motor development. Erol et al. (2023) demonstrated significant correlations between oral feeding skills and gross motor milestones in preterm and term infants, suggesting shared neurophysiological mechanisms. Similar findings have been observed in children with cerebral palsy, where deficits in oral-motor control are associated with impaired speech and communication (Esmaeili et al., 2024; Pados, 2019). These interconnections affirm that oral-motor proficiency is not an isolated domain but part of a multidimensional developmental continuum that extends across motor, sensory, and cognitive systems (Gabbard, 2013). Furthermore, inadequate oral-motor function can negatively impact nutritional intake, growth, and participation in daily activities—key determinants of overall developmental outcomes (Kalhoff et al., 2024; Tunçeli & Zembat, 2017).

The functional relevance of oral-motor skills has been further demonstrated through intervention studies. Meta-analyses of oral-motor stimulation programs, such as the Premature Infant Oral Motor Intervention (PIOMI) and prefeeding oral stimulation, have shown significant improvements in independent oral feeding, weight gain, and reduced hospital stays among preterm infants (Mahmoodabadi et al., 2024; Wilson et al., 2021). These interventions rely on enhancing sensorimotor feedback, coordination, and neuromuscular control, highlighting the potential plasticity of the oral-motor system in early life. Accordingly, early evaluation of oral-motor proficiency is not only diagnostically important but also essential for designing effective, developmentally appropriate interventions (Tunçeli & Zembat, 2017).

To support this goal, standardized assessment tools are needed to identify oral-motor challenges and monitor progress in young children. The Child Oral and Motor Proficiency Scale (ChOMPS) was developed as a parent-report measure to evaluate oral-motor behaviors in children aged 6 months to 7 years, focusing on functions such as chewing, swallowing, and speech-related movements (Pados et al., 2019). The instrument addresses a crucial gap in developmental assessment by capturing observable oral-motor behaviors within everyday contexts (Park et al.,2019).

Accurate and sensitive assessment of oral-motor proficiency has broad implications for developmental screening and clinical practice. Psychometrically robust and linguistically equivalent instruments are essential to ensure that evaluations capture genuine developmental differences rather than linguistic or contextual bias (Behr, 2023; ISPOR Task Force, 2005). In this context, validating a Turkish version of the Child Oral and Motor Proficiency Scale (ChOMPS) offers an opportunity to strengthen evidence-based assessment in early childhood. The present study therefore aimed to evaluate the psychometric properties and developmental validity of the Turkish Child Oral and Motor Proficiency Scale (ChOMPS) in both typically developing children and those with cerebral palsy, providing empirical support for its reliability and applicability in developmental and clinical contexts.

2. Methods

2.1. Study Design and Ethical Considerations

This methodological study aimed to evaluate the psychometric properties and developmental validity of the Turkish version of the Child Oral and Motor Proficiency Scale (ChOMPS). The research was conducted in two consecutive phases: (1) translation and content validation, and (2) psychometric evaluation. At the time the study was initiated, no Turkish version of the ChOMPS was available; therefore, an independent translation of the original English version was conducted with permission from one of the original authors.

Ethical approval was obtained from the Üsküdar University Non-Interventional Research Ethics Committee (61351342/020–895, February 2025).

All participants provided informed consent, and the study was carried out in accordance with the principles of voluntariness, confidentiality, and data protection.

2.2. Phase 1: Translation and Content Validation

2.2.1. Process

The translation and content validation of the Child Oral and Motor Proficiency Scale (ChOMPS) (Pados et al., 2019) followed internationally accepted guidelines for cross-linguistic instrument translation (Cruchinho et al., 2024; Schuster et al., 2010). Two professional medical translators independently performed forward translations of the original English version. These translations were synthesized by a multidisciplinary review team comprising a pediatric physiotherapist, a speech and language therapist, and an occupational therapist. Two linguistic experts subsequently reviewed the consensus version for grammatical accuracy and semantic consistency.

The synthesized Turkish version was then back-translated into English by two independent translators who were blinded to the original version. The back-translated version was compared with the source instrument by the synthesis team and one of the original developers of the scale to ensure conceptual and linguistic equivalence.

An expert panel of ten pediatric rehabilitation professionals (seven occupational therapists, two physiotherapists, and one speech and language therapist) participated in an online meeting to evaluate the clarity, linguistic precision, and conceptual consistency of the Turkish version. Experts rated each item on a four-point Likert scale, and Item-Level Content Validity Index (I-CVI), Average Content Validity Index (Ave-CVI), and modified kappa coefficient (k*) were calculated to quantify agreement and adjust for chance; k* ≥ 0.75 was interpreted as excellent content validity (Almanasreh et al., 2019; Bodner, 2025).

In the final stage, pre-testing was conducted with parents from the target population. The Turkish draft and feedback forms were distributed electronically as PDF files. Parents reviewed the items, annotated their feedback directly on the forms, and returned them via email. Each parent subsequently participated in a one-on-one online interview with the research team to discuss item comprehension and linguistic clarity. Feedback from these interviews informed the final revisions, resulting in the finalized Turkish version of the ChOMPS (Özdemir et al.,2025).

2.2.2. Participants

Phase 1 involved multiple participant groups. Four professional translators (two forward, two backward), each with over ten years of medical translation experience, contributed to the translation process.

The synthesis team included a pediatric physiotherapist, a speech and language therapist, and an occupational therapist, who collaborated during the back-translation review to ensure conceptual fidelity. Two linguists—a Turkish language and literature expert and an educational scientist—reviewed the translated text for grammatical and linguistic accuracy.

The expert panel comprised ten pediatric rehabilitation specialists (seven occupational therapists, two physiotherapists, and one speech and language therapist) who participated in the content-validation session. The pre-testing group consisted of ten mothers of children aged between 12 months and 5 years (one aged 12 months, one aged 18 months, one aged 27 months, five aged 4 years, and two aged 5 years). Parents received the Turkish version and feedback forms by email, provided written responses on the PDFs, and later participated in individual online interviews to discuss clarity and comprehensibility. Feedback obtained in this phase contributed to the refinement of the final Turkish version.

2.3. Phase 2: Psychometric Evaluation

2.3.1. Process

Following the translation and content validation phase, the psychometric properties and developmental validity of the Turkish Child Oral and Motor Proficiency Scale (ChOMPS) were examined. Data were collected between February and August 2025 from families residing in the Marmara region of Türkiye.

The analyses focused on assessing internal consistency, test–retest reliability, discriminant validity, and developmental validity through correlations with the Ages and Stages Questionnaire – Turkish Version (ASQ) (Kapcı et al., 2015). Internal consistency was evaluated using Cronbach’s alpha and corrected item–total correlations. Discriminant validity was tested by comparing ChOMPS scores between typically developing children and those with cerebral palsy (CP). Developmental validity was assessed by examining the relationships between ChOMPS total and subscale scores and corresponding ASQ domains (communication, gross motor, fine motor, problem-solving, and personal–social).

2.3.2. Participants

The psychometric phase included a total of 199 parents of children aged 6 months to 6 years, comprising 162 parents of typically developing children and 37 parents of children diagnosed with cerebral palsy (CP) by a pediatric neurologist. For typically developing children, inclusion criteria were being aged between 6 months and 6 years, having no medical, genetic, or developmental disorders, and no neurological, structural, or sensory conditions affecting feeding.

Children were excluded if they were outside the target age range or had any disorder likely to interfere with oral–motor function or feeding. For the CP group, inclusion criteria included a confirmed diagnosis of cerebral palsy, the ability to feed orally without severe orofacial deformity or aspiration risk, and parental ability to reliably report feeding and oral–motor behaviors. Children were excluded if they had a tracheostomy, persistent sedation, or any condition preventing safe oral feeding. Participants were recruited via social media announcements and pediatric rehabilitation clinics across the Marmara region.

All parents participated voluntarily and provided written informed consent before data collection.

2.4. Instruments

2.4.1. Child Oral and Motor Proficiency Scale (ChOMPS)-Translated Turkish Version

The ChOMPS is a 63-item parent-report instrument designed to assess oral and motor competencies related to feeding in children aged 6 months–7 years (Pados et al., 2018; 2019). Items are rated on a three-point scale (“yes,” “sometimes,” “not yet”), with higher scores indicating greater oral–motor proficiency. The instrument evaluates feeding-related behaviors encompassing complex and basic movement patterns, oral–motor coordination, and foundational oral–motor abilities. Although not diagnostic, it provides a structured quantitative assessment useful for both clinical and research purposes. Previous studies have reported excellent internal consistency (Cronbach’s α = 0.97), strong test–retest reliability (r = 0.98), and robust convergent and known-groups validity (Park et al., 2019).

2.4.2. Ages and Stages Questionnaire (ASQ) – Turkish Version

The ASQ is a standardized, parent-completed developmental screening tool for children aged 3–72 months. It assesses communication, gross motor, fine motor, problem-solving, and personal–social domains. Parents rate items as “yes,” “sometimes,” or “not yet,” scored 10, 5, and 0 points respectively. The ASQ – Turkish Version shows high sensitivity (94%), specificity (85%), and reliability (Cronbach’s α = 0.963; test–retest = 0.82; interrater = 0.87) (Kapcı, Küçüker, & Uslu, 2015). Its robust psychometric properties support its use as the criterion measure for concurrent validation of the Turkish ChOMPS.

2.5. Data Analysis

Data were analyzed using SPSS 22 and MedCalc 18.11.3. Descriptive statistics (mean, standard deviation, frequency, percentage) summarized participant characteristics. Internal consistency was examined using Cronbach’s alpha, and corrected item–total correlations were calculated. Discriminant validity was tested by comparing upper and lower 27% score groups, while criterion validity was examined through correlations between ChOMPS and ASQ scores. Statistical significance was set at p < 0.05. For the content validation phase, the Item-Level Content Validity Index (I-CVI), Average Content Validity Index (Ave-CVI), and modified kappa coefficient (k*) were calculated to quantify expert agreement and adjust for chance. Values of I-CVI ≥ 0.78, Ave-CVI ≥ 0.90, and k* ≥ 0.75 were interpreted as indicators of excellent content validity.

3. Results

3.1. Translation

The translation and content validation of the Child Oral and Motor Proficiency Scale (ChOMPS) into Turkish were completed following internationally accepted cross-linguistic adaptation standards. Two bilingual experts independently translated the original English version, after which a multidisciplinary synthesis team (including a pediatric physiotherapist, a speech and language therapist, and an occupational therapist) reconciled the translations into a single Turkish draft. Two linguists reviewed the synthesized version for grammatical and stylistic accuracy. Minor linguistic refinements were made to ensure punctuation consistency, adjust verb forms for clarity (e.g., “aktarabilir”), and improve overall readability through simplified wording and brief explanatory phrases when necessary.

During the back-translation phase, the Turkish version and its English back-translation were compared with the original scale to assess conceptual and semantic equivalence. One of the authors of the original instrument, confirmed high semantic consistency and offered minor suggestions to enhance the clarity of developmental terms and instructions—particularly for distinguishing between “Not Yet” responses that reflect developmental immaturity versus skill absence. Minor linguistic revisions were also implemented to ensure natural Turkish phrasing in certain items, such as rewording “drink from an open cup” and “take a bite of hard, crunchy food.”

Cognitive interviews were conducted with ten parents from diverse sociocultural backgrounds. Most participants found the items clear and developmentally appropriate for their children. Some suggested clarifying response options (e.g., “Not Yet”), specifying the respondent’s role, and differentiating between similar items. Quantitative feedback indicated that 90–100% of parents rated the language and structure as clear and comprehensible, although 20% noted that the overall scale length could be optimized.

Feedback from ten clinical experts (occupational, physical, and speech therapists) supported the linguistic accuracy and conceptual consistency of the Turkish version. They recommended minor refinements, such as simplifying redundant instructions and providing brief section-level guidance.

Quantitative analysis of expert evaluations demonstrated strong agreement: 90–100% rated the scale as linguistically appropriate, clinically relevant, and clear for use with Turkish parents and practitioners.

3.2. Content Validity

Content validity was evaluated using the Item-Level Content Validity Index (I-CVI) and modified kappa coefficient (k*), based on ten experts’ ratings of all 63 items on a four-point relevance scale (1 = not relevant to 4 = highly relevant). Sixty-one items achieved an I-CVI of 1.00, while two items (9 and 18) obtained 0.80, indicating slightly lower expert agreement. Corresponding k* values were 1.00 for most items and 0.79 for these two items. The average scale-level I-CVI (Ave-CVI) and k* were both approximately 0.99, reflecting excellent expert consensus. According to accepted benchmarks (I-CVI ≥ 0.78; k* ≥ 0.75), these findings confirm that the Turkish ChOMPS demonstrates strong content validity, high conceptual equivalence, and linguistic clarity, supporting its suitability for use in clinical and research settings as a psychometrically sound tool.

3.2. Validity and Reliability Findings of the Turkish Version of CHOMPS

3.2.1. Descriptive Characteristics

Among participating children, the largest proportion (24.6%) were aged 5–6 years, followed by 4–5 years (19.1%) and 3–4 years (16.1%). Younger age groups represented smaller proportions (2.5–7.5%). Slightly more than half were boys (52.8%), and most had no diagnosed condition (81.4%). Nearly all parents were married (97.0%), and over half held a university degree (50.3%), with 52.8% employed. Most children (75.4%) began complementary feeding between 0–6 months (Table 1). Developmental screening with the ASQ indicated variable rates of children requiring follow-up, highest in fine motor skills (30.2%), followed by gross motor (23.1%), personal-social (22.1%), problem-solving (16.6%), and communication (16.1%) (Table 2).

Table 1
Distribution of Participants According to Descriptive Characteristics
Groups	Frequency (n)	Percentage (%)
Age
6–9 months	13	6.5
9–12 months	15	7.5
12–15 months	6	3.0
15–18 months	5	2.5
18–24 months	13	6.5
24–30 months	14	7.0
30–36 months	14	7.0
3–4 years	32	16.1
4–5 years	38	19.1
5–6 years	49	24.6
Child’s Gender
Female	94	47.2
Male	105	52.8
Presence of Diagnosis
No	162	81.4
Yes	37	18.6
Parental Marital Status
Single	6	3.0
Married	193	97.0
Parental Education Level
Primary school	12	6.0
High school	44	22.1
Associate degree	28	14.1
Bachelor’s degree	100	50.3
Postgraduate	15	7.5
Parental Employment Status
Employed	105	52.8
Unemployed	94	47.2
Age of Introduction to Complementary Feeding
0–6 months	150	75.4
7–12 months	37	18.6
13 months and above	12	6.0

Table 2
Distribution According to ASQ Inventory
Developmental Domain	Monitoring Required (n, %)	Typical Development (n, %)
Communication	32 (16.1)	167 (83.9)
Gross Motor	46 (23.1)	153 (76.9)
Fine Motor	60 (30.2)	139 (69.8)
Problem Solving	33 (16.6)	166 (83.4)
Personal–Social	44 (22.1)	155 (77.9)

3.2.2. Reliability and Item Analysis

Reliability analyses revealed excellent internal consistency for the Turkish CHOMPS. Cronbach’s alpha values ranged from 0.979 to 0.983 across subscales and reached 0.987 for the total score, confirming high reliability. Corrected item–total correlations (0.475–0.871) showed that all items contributed meaningfully to the construct. The lowest correlations (Items 24, 29, 39, and 61) remained acceptable, and deleting any item did not improve alpha, supporting strong internal coherence and reliability (Table 3).

Table 3
Item Analysis of the ChOMPS
Item	CITC	CAID	Item	CITC	CAID	Item	CITC	CAID
CHOMPS1	0.842	0.987	CHOMPS22	0.815	0.987	CHOMPS43	0.805	0.987
CHOMPS2	0.811	0.987	CHOMPS23	0.756	0.987	CHOMPS44	0.847	0.987
CHOMPS3	0.778	0.987	CHOMPS24	0.512	0.987	CHOMPS45	0.819	0.987
CHOMPS4	0.700	0.987	CHOMPS25	0.839	0.987	CHOMPS46	0.867	0.987
CHOMPS5	0.728	0.987	CHOMPS26	0.768	0.987	CHOMPS47	0.794	0.987
CHOMPS6	0.794	0.987	CHOMPS27	0.793	0.987	CHOMPS48	0.810	0.987
CHOMPS7	0.698	0.987	CHOMPS28	0.634	0.987	CHOMPS49	0.738	0.987
CHOMPS8	0.729	0.987	CHOMPS29	0.475	0.987	CHOMPS50	0.829	0.987
CHOMPS9	0.722	0.987	CHOMPS30	0.607	0.987	CHOMPS51	0.677	0.987
CHOMPS10	0.839	0.987	CHOMPS31	0.675	0.987	CHOMPS52	0.702	0.987
CHOMPS11	0.844	0.987	CHOMPS32	0.722	0.987	CHOMPS53	0.769	0.987
CHOMPS12	0.754	0.987	CHOMPS33	0.762	0.987	CHOMPS54	0.791	0.987
CHOMPS13	0.792	0.987	CHOMPS34	0.723	0.987	CHOMPS55	0.720	0.987
CHOMPS14	0.853	0.987	CHOMPS35	0.630	0.987	CHOMPS56	0.795	0.987
CHOMPS15	0.845	0.987	CHOMPS36	0.782	0.987	CHOMPS57	0.800	0.987
CHOMPS16	0.796	0.987	CHOMPS37	0.677	0.987	CHOMPS58	0.728	0.987
CHOMPS17	0.817	0.987	CHOMPS38	0.699	0.987	CHOMPS59	0.844	0.987
CHOMPS18	0.789	0.987	CHOMPS39	0.555	0.987	CHOMPS60	0.606	0.987
CHOMPS19	0.836	0.987	CHOMPS40	0.653	0.987	CHOMPS61	0.517	0.987
CHOMPS20	0.846	0.987	CHOMPS41	0.826	0.987	CHOMPS62	0.871	0.987
CHOMPS21	0.831	0.987	CHOMPS42	0.869	0.987	CHOMPS63	0.716	0.987
CITC: Corrected Item–Total Correlation; Cronbach’s α if Item Deleted (CAID)

3.2.3. Discriminant Validity

Independent-sample t-tests comparing the upper and lower 27% groups revealed significant differences across all subscales and total scores (p < .001), with large effect sizes (Cohen’s d = 1.55–2.33), the largest observed in Complex Movement Patterns (d = 2.33). These findings demonstrate that CHOMPS effectively discriminates between high and low performance groups (Table 4).

Table 4
Differences in CHOMPS T-Scores Between Lower 27% and Upper 27% Groups
Groups	Lower 27% (n = 54) Mean	Lower 27% SD	Upper 27% (n = 54) Mean	Upper 27% SD	t	df	p	d
Basic Movement Patterns T-Score	51.167	14.076	65.922	0.625	-8.383	116	0.000	1.549
Fundamental Oral-Motor Skills T-Score	45.370	10.396	57.781	1.228	-9.479	116	0.000	1.752
Oral-Motor Coordination T-Score	50.278	13.532	67.813	0.852	-10.350	116	0.000	1.913
Complex Movement Patterns T-Score	59.093	8.194	72.000	0.000	-12.612	116	0.000	2.330
ChOMPS Total T-Score	53.426	13.480	72.000	0.000	-11.032	116	0.000	2.038
Independent Samples t-Test; t, p: Significance; df: Degrees of Freedom; Cohen’s d: Effect Size

3.2.4. Diagnostic Accuracy and Test–Retest Reliability

ROC analysis indicated excellent diagnostic accuracy (AUC = 0.900, SE = 0.0252, 95% CI = 0.850–0.938; z = 15.898; p < .0001). The optimal cut-off score (≤ 71) yielded 97.3% sensitivity and 72.2% specificity (Youden Index = 0.6952) (Table 5).

Table 5
ROC Curve Analysis Results
Statistic	Value
Area under the ROC Curve (AUC)	0.900
Standard Error (SE)ᵃ	0.0252
95% Confidence Intervalᵇ	0.850–0.938
z Statistic	15.898
Significance Level (p)	< 0.0001
Youden Index (J)	0.6952
Cut-off Value (Criterion)	≤ 71
Sensitivity (%)	97.30
Specificity (%)	72.22

Test–retest analysis confirmed stability, showing no significant differences between administrations (p > .05) and high intraclass correlation coefficients (ICC = 0.903–0.933; p < .001). The total score achieved the highest reliability (ICC = 0.933), verifying temporal consistency (Table 6).

Table 6
Test–Retest Reliability Analysis
Measure	Test Mean	Test SD	Retest Mean	Retest SD	N	t	p	ICC
Fundamental Movement Patterns T-Score	53.933	14.213	54.433	14.488	30	-1.361	0.184	0.906
Basic Oral-Motor Skills T-Score	48.100	11.106	48.967	11.343	30	-1.439	0.161	0.912
Oral-Motor Coordination T-Score	53.500	15.204	54.433	15.301	30	-0.910	0.370	0.903
Complex Movement Patterns T-Score	62.100	10.952	62.533	11.144	30	-1.107	0.277	0.924
ChOMPS Total T-Score	57.267	16.530	57.967	16.823	30	-1.165	0.254	0.933
Paired Samples t-Test; ICC: Intraclass Correlation Coefficient

3.2.5. Diagnostic Group Differences

Children without diagnoses scored significantly higher than those with diagnoses across all subscales and total scores (p < .001; Cohen’s d = 1.61–1.90). The Complex Movement Patterns subscale again showed the largest difference (d = 1.90), supporting strong criterion validity (Table 7).

Table 7
Differences in CHOMPS T-Scores According to Diagnostic Status
Groups	No Diagnosis (n = 162) Mean	No Diagnosis SD	Diagnosis Present (n = 37) Mean	Diagnosis Present SD	t	df	p	d
Basic Movement Patterns T-Score	64.204	6.024	50.649	14.589	8.985	197	0.000	1.637
Fundamental Oral-Motor Skills T-Score	56.364	5.162	45.703	10.954	8.851	197	0.000	1.613
Oral-Motor Coordination T-Score	65.525	6.563	50.216	14.673	9.731	197	0.000	1.773
Complex Movement Patterns T-Score	70.136	3.782	59.378	10.602	10.399	197	0.000	1.895
CHOMPS Total T-Score	69.599	5.763	53.216	15.990	10.462	197	0.000	1.906
Independent Samples t-Test; t, p: Significance; df: Degrees of Freedom; Cohen’s d: Effect Size

3.2.6. Criterion Validity

To assess criterion validity, CHOMPS T-scores were compared between children identified as “monitoring required” and those with typical development according to the ASQ. Analyses revealed statistically significant differences across all developmental domains and CHOMPS subscales (p < .001).

Large effect sizes were observed for Basic Oral Motor Skills, Oral Motor Coordination, and Complex Movement Patterns (Cohen’s d = 1.72–2.33). In the gross motor domain, the normal group obtained significantly higher scores, with a strong effect size (d = 2.18). Differences in fine motor skills were smaller yet still meaningful (d = 1.07–1.28). For problem-solving and personal–social domains, children with typical development again scored significantly higher, showing very strong effects (d = 1.79–2.42). The largest overall difference was in total CHOMPS scores (t = − 12.684, p < .001, d = 2.42). These results confirm that the Turkish version of CHOMPS effectively distinguishes between children with typical and delayed development, providing strong evidence of criterion validity (Table 8).

Table 8
Comparison of ChOMPS T-Scores According to ASQ Subdomains
Developmental Domain	ChOMPS Subscale	Monitoring Required Mean ± SD	Typically Developing Mean ± SD	t	df	p	d
Communication	Basic Movement Patterns	49.41 ± 15.90	64.04 ± 5.73	-9.230	197	0.000	1.781
	Fundamental Oral-Motor Skills	44.41 ± 11.74	56.29 ± 4.89	-9.526	197	0.000	1.838
	Oral-Motor Coordination	49.88 ± 16.29	65.13 ± 6.62	-8.915	197	0.000	1.720
	Complex Movement Patterns	57.84 ± 10.94	70.11 ± 3.55	-11.717	197	0.000	2.261
	ChOMPS Total	50.91 ± 16.95	69.55 ± 5.14	-11.759	197	0.000	2.269
Gross Motor	Basic Movement Patterns	50.59 ± 14.36	65.02 ± 3.97	-11.151	197	0.000	1.875
	Fundamental Oral-Motor Skills	46.24 ± 10.50	56.83 ± 4.52	-9.843	197	0.000	1.655
	Oral-Motor Coordination	51.50 ± 15.21	66.04 ± 5.04	-10.160	197	0.000	1.708
	Complex Movement Patterns	59.44 ± 9.55	70.75 ± 2.81	-12.968	197	0.000	2.181
	ChOMPS Total	53.65 ± 15.10	70.43 ± 3.99	-12.439	197	0.000	2.092
Fine Motor	Basic Movement Patterns	55.12 ± 13.76	64.52 ± 5.49	-6.898	197	0.000	1.066
	Fundamental Oral-Motor Skills	48.55 ± 10.38	56.90 ± 4.47	-7.948	197	0.000	1.228
	Oral-Motor Coordination	54.75 ± 14.15	66.10 ± 5.74	-8.067	197	0.000	1.246
	Complex Movement Patterns	62.73 ± 9.90	70.47 ± 3.34	-8.209	197	0.000	1.268
	ChOMPS Total	58.30 ± 15.30	70.12 ± 4.64	-8.286	197	0.000	1.280
Problem Solving	Basic Movement Patterns	48.30 ± 15.57	64.34 ± 5.05	-10.803	197	0.000	2.059
	Fundamental Oral-Motor Skills	44.33 ± 11.49	56.38 ± 4.81	-9.894	197	0.000	1.886
	Oral-Motor Coordination	48.88 ± 16.36	65.42 ± 5.85	-10.220	197	0.000	1.948
	Complex Movement Patterns	57.91 ± 10.69	70.17 ± 3.52	-11.960	197	0.000	2.280
	ChOMPS Total	50.52 ± 16.62	69.74 ± 4.69	-12.684	197	0.000	2.417
Personal-Social	Basic Movement Patterns	50.68 ± 14.68	64.81 ± 4.37	-10.507	197	0.000	1.795
	Fundamental Oral-Motor Skills	45.59 ± 11.04	56.88 ± 3.97	-10.591	197	0.000	1.809
	Oral-Motor Coordination	50.23 ± 15.07	66.21 ± 4.58	-11.526	197	0.000	1.969
	Complex Movement Patterns	59.73 ± 10.05	70.52 ± 3.12	-11.606	197	0.000	1.982
	ChOMPS Total	53.27 ± 15.52	70.32 ± 3.88	-12.445	197	0.000	2.126
Independent Samples t-Test; t, p: Significance; df: Degrees of Freedom; Cohen’s d: Effect Size

3.2.7. Mean T-Score Results

Descriptive analyses of CHOMPS subscales and total scores indicated varying mean values across domains.

The highest mean was observed in Complex Movement Patterns (68.13 ± 7.04), followed by Oral Motor Coordination (62.67 ± 10.47), Basic Movement Patterns (61.68 ± 9.80), and Basic Oral Motor Skills (54.38 ± 7.79). The total T-score mean was 66.55 ± 10.69. Minimum–maximum values ranged from 27–66 for Basic Movement Patterns, 29–58 for Basic Oral Motor Skills, 27–68 for Oral Motor Coordination, and 37–72 for Complex Movement Patterns, with total scores spanning 28–72. These results indicate differences in subscale performance levels, with Complex Movement Patterns and total scores showing the strongest overall performance (Table 9).

Table 9
Mean T-Scores for ChOMPS Subscales and Total Score
	N	Mean	SD	Min.	Max.
Basic Movement Patterns T-Score	199	61.683	9.806	27.000	66.000
Fundemental Oral-Motor Skills T-Score	199	54.382	7.796	29.000	58.000
Oral-Motor Coordination T-Score	199	62.678	10.479	27.000	68.000
Complex Movement Patterns T-Score	199	68.136	7.048	37.000	72.000
ChOMPS Total T-Score	199	66.553	10.692	28.000	72.000

5. Discussion

This study examined the psychometric properties and developmental validity of the Turkish version of the Child Oral and Motor Proficiency Scale (ChOMPS). The findings demonstrated that the Turkish ChOMPS is a valid, reliable, and developmentally sensitive instrument for assessing oral–motor proficiency in children aged 6 months to 6 years. The results support its utility as a screening and research tool for identifying oral–motor difficulties in early childhood.

5.1. Translation and Content Validation

The translation and validation of the Turkish ChOMPS followed internationally accepted methodological standards for instrument translation and content evaluation (Behr, 2023; Cruchinho et al., 2024; Wild et al., 2005).

The stepwise process—including forward–back translation, expert synthesis, linguistic review, and parent feedback—ensured conceptual equivalence and linguistic clarity between the Turkish and original English versions. Minor revisions, such as adding clarifying phrases (“a cup without a lid”) and simplifying long items, improved interpretability and consistency across respondents.

The back-translation review confirmed a high degree of semantic and conceptual correspondence, and the original author validated the Turkish version’s fluency and accuracy. Clarifications to response options (e.g., differentiating “Not Yet” as a developmental delay rather than absence of ability) further strengthened interpretability. Consistent with the literature (Behr, 2023; Sousa & Rojjanasrirat, 2011), these refinements enhanced content precision without altering construct meaning.

Parent interviews confirmed that the scale’s items were developmentally appropriate and easily understood. Expert evaluations indicated that the Turkish version preserved both the clinical intent and observational nature of the original scale. Quantitative findings demonstrated excellent consensus among experts. In Bodner’s (2025) Swedish validation study, the instrument achieved an overall Ave-CVI of 0.98, with 62 out of 63 items exceeding the 0.78 threshold, indicating excellent item-level content validity, while only one item showed moderate agreement. Similarly, in the original development of the ChOMPS, Pados et al. (2019) reported strong content validity results, with all items meeting acceptable standards in the second round of expert review and the scale-level CVI exceeding the 0.90 criterion. These results collectively confirm the conceptual clarity and representativeness of the ChOMPS items across different cultural and linguistic contexts. Accordingly, the present study’s I-CVI of 1.00 for most items, Ave-CVI of 0.99, and modified kappa of 0.99 are consistent with the robust evidence of content validity established in previous research. Such high indices underscore the strong conceptual alignment of the instrument with the developmental constructs it aims to measure and provide further cross-cultural support for the ChOMPS as a comprehensive and reliable measure of oral, fine, and gross motor feeding skills (Pados et al., 2019; Bodner, 2025).

5.2. Reliability and Developmental Validity

The Turkish ChOMPS exhibited excellent internal consistency, with Cronbach’s α = 0.987 for the total scale and 0.97–0.98 for subscales—comparable to the original validation study (Park et al., 2019). Such high reliability indicates that the translated version consistently measures oral–motor proficiency across domains. The slightly elevated α values may be attributed to enhanced clarity and homogeneity in the Turkish sample (Tavakol & Dennick, 2011; Zijlmans et al., 2018).

Discriminant validity results demonstrated that all subscales significantly differentiated between upper and lower 27% score groups (p < 0.001), with large Cohen’s d values (1.55–2.33), confirming strong sensitivity in distinguishing performance levels. These outcomes align with previous methodological literature emphasizing the role of known-group comparison in psychometric validation (Rönkkö & Cho, 2022). The largest effects emerged in the Complex Movement Patterns and total score subscales, indicating that these domains are particularly discriminative for detecting oral–motor deficits.

Developmental validity was supported by significant correlations with the Ages and Stages Questionnaire (ASQ). Children with typical development scored higher in communication, motor, and problem-solving domains than those requiring monitoring, consistent with developmental theory (Jewsbury, 2019; Indu et al., 2025; Mokkink et al., 2010). These findings confirm that the Turkish ChOMPS not only measures oral–motor performance reliably but also reflects broader developmental competencies.

The ROC analysis yielded an AUC = 0.90, indicating excellent diagnostic accuracy in identifying children at risk for oral–motor difficulties. This analysis, extending beyond the original validation, strengthens the scale’s clinical applicability in screening contexts. Test–retest reliability further confirmed temporal stability, suggesting that ChOMPS measures enduring traits rather than transient conditions (Aldridge et al., 2017; McCrae et al., 2011).

Additionally, significant group differences between children with cerebral palsy and typically developing peers support the scale’s clinical sensitivity and discriminant capacity. These outcomes parallel prior research documenting oral–motor challenges in neurodevelopmental disorders (Esmaeili et al., 2024; Parkes et al., 2010). The observed developmental progression—where more complex subscales yielded higher mean scores in older age groups—provides further evidence for the scale’s developmental validity and structural consistency with the original model (Pados et al., 2018).

Although limited by regional sampling and reliance on parent-report data, the study contributes strong psychometric and developmental evidence for the Turkish ChOMPS. The inclusion of diverse analyses—Cronbach’s α, item–total correlations, test–retest reliability, ROC, and known-group validity—ensures methodological rigor and replicability.

6. Conclusion and Recommendations

This study established the psychometric robustness and developmental validity of the Turkish Child Oral and Motor Proficiency Scale (ChOMPS). The findings confirmed high internal consistency, strong content and discriminant validity, and excellent diagnostic accuracy. The Turkish ChOMPS reliably differentiates developmental levels and effectively identifies children at risk for oral–motor difficulties.

By providing a linguistically accurate and developmentally sensitive measure, the Turkish ChOMPS offers a valuable resource for clinicians, therapists, and researchers in early childhood assessment. It enables comprehensive evaluation of oral–motor performance, supports early detection of feeding and speech-related difficulties, and contributes to evidence-based intervention planning.

Future research should employ larger and more geographically diverse samples to establish national norms and enhance generalizability. Studies combining clinician observations with parent-reported data could further strengthen convergent and predictive validity. Overall, the Turkish ChOMPS represents a psychometrically sound, developmentally grounded, and clinically applicable tool for assessing oral–motor proficiency in Turkish children.

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