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Rehab Measures: Child Occupational Self Assessment v 2.2

Link to instrument

Link to Instrument Order Form 

Title of Assessment

Child Occupational Self Assessment v 2.2 



Instrument Reviewer(s)

Initially reviewed by Kayla Smith, BA, Daiva Ragas, BA, Adam Kaltenhauser, BA, Occupational Therapy students at the University of Illinois at Chicago in April 2015.

Summary Date



The Child Occupational Self Assessment (COSA) is a self-report of occupational competence and value for everyday activities influenced by components of the Model of Human Occupation (MOHO). The COSA measures how competently children feel engaging in and completing activities and the values associated with these activities (Kramer, Kielhofner, & Smith 2010).


The COSA can be administered in one of three ways, depending on each child’s abilities: (1) a youth rating form with pictures (2) youth rating form without pictures (3) a card sort . Children are reminded to that there is no right or wrong answer and to pick the best choice for how they feel.

There is no “score” for the COSA. Therapists may use MOHO theory to interpret the COSA and select the most appropriate way to share this interpretation with others. (Kramer et al., 2014).

Area of Assessment

Communication; Motivation; Occupational Performance; Self-Efficacy 

Body Part

Not Applicable 

ICF Domain




Assessment Type

Patient Reported Outcomes 

Length of Test

06 to 30 Minutes 

Time to Administer

Average administration time is 25 minutes.

Number of Items


Equipment Required

Paper & Pencil; Stimulus card for the Card-sort Administration

Training Required

Practitioners are encouraged to be familiar with the Model of Human Occupation (MOHO) framework prior to interpretation.  

Type of training required

Reading an Article/Manual 


Not Free 

Actual Cost


Age Range

Child: 6-12 years; Adolescent: 13-17 years 

Administration Mode




Populations Tested

Pediatric: (Keller & Kielhoffner, 2005; n= 43; Mean Age = 12.21)
  • Diagnosis:
    • 48.8% developmental delay
    • 18.6% neurological
    • 16.3% mental/psychological
Pediatric: (Kramer, 2010; n= 502; Mean Age= 11.73)
  • Diagnosis:
    • 64.3% Developmental Delay
    • 17.5% Neurological
    • 46% Mental health
    • 3.0% Unknown/Other
    • Children with diagnosed disabilities receiving OT in U.S., U.K. Switzerland, Germany and Iceland

Pediatric: (Ten Velden, et al., 2012; n= 6; Mean Age = 9.16)

  • Diagnosis:
    • 16.7% Attention Deficit Hyperactivity Disorder
    • 16.7% Mild Hemiplegia [left]
    • 16.7% Congenital Limb Deficiencies [Bilateral UE and hands]
    • 16.7% Spina Bifida
    • 16.7% Arthrogryposis Multiplex Congenital
    • 16.7% Attention Deficit Disorder)

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Applicable

Cut-Off Scores

Not Established

Normative Data

Not Established

Test-retest Reliability

Not Established

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Pediatric: (Keller & Kielhofner, 2005)

  • Competence Items: Excellent (Cronbach's Alpha= .085)
  • Competence Scale: Excellent (Cronbach's Alpha= 0.88)
  • Values Items: Excellent (Cronbach's Alpha= 0.82)
  • Values Scale: Excellent (Cronbach's Alpha= 0.91)

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Not Established

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Pediatric: (Keller & Kielhofner, 2005)

  • Excellent: no floor/ceiling effects


Not Established

Professional Association Recommendations



The following factors should be considered:

  • Age
  • Appropriateness of item context
  • Appropriateness of rating scale structure given youth’s abilities
  • Youth’s capacity to identify interest and reflect on performance.
  • Youth must be able to identify interests and reflect on performance; consider acuity level
  • Therapist should consider if content of items is appropriate for therapy context (e.g. most items cover everyday activities of a school-aged youth). Items may not facilitate addressing specific fine motor or vocational skills (Kramer et al., 2014); consider level of care and setting
  • Some translation inaccuracies were identified in the Dutch version of the COSA


Kramer, J. M., Kielhofner, G., & Smith, E. V. (2010). Validity evidence for the Child Occupational Self Assessment. American Journal of Occupational Therapy, 64(4), 621-632.

Kramer, J., Ten Velden, M., Kafkes, A., Basu S., Federico J., and Kielhorner G. (2014). Child Occupational Self-Assessment (COSA) Version 2.2. Chicago, IL: The Model of Human Occupation Clearinghouse.

Keller, J., & Kielhofner, G. (2005). Psychometric characteristics of the Child Occupational Self-Assessment (COSA), part two: Refining the psychometric properties. Scandinavian Journal of Occupational Therapy, 12(4), 147-158.

Ten Velden, M., Couldrick, L., Kinébanian, A., & Sadlo, G. (2012). Dutch children’s perspectives on the constructs of the Child Occupational Self-Assessment (COSA). OTJR: Occupation, Participation, and Health, 33 (1), 50-58.

Year published

Original Version Published in 1999; COSA v2.2 Published in 2014 

Instrument in PDF Format

Approval Status Approved 
Created at 5/20/2015 1:31 PM  by Jason Raad 
Last modified at 6/5/2015 3:58 PM  by Jason Raad