Head-Toes for Neurodiverse Learners: Adapting an Existing Behavioral Self-regulation Assessment

Abstract Background Direct assessments of self-regulation are rare for neurodiverse learners, irewhose skills are typically assessed with observer reports. Objective In this mixed-methods study, we refined an existing behavioral self-regulation assessment (Head-Toes-Knees-Shoulders [HTKS]), originally created for typically developing children, into a new version that we piloted and tested with children ages 5 to 7 classified with moderate to severe developmental disabilities. Methods The study occurred in the Northeastern U. S., with n = 47 children (74% male; 64% White) whose families consented for them to participate in a Randomized Control Trial of a yoga intervention targeting self-regulation. Data consisted of qualitative administration notes and individual children’s scores on the structured observational assessment at two time points (T1 and T2). Results We found that (a) items on the new measure, the Head-Toes for Neurodiverse Learners (HTNL) demonstrated strong internal validity and inter-rater reliability; and (b) composite scores of children’s overall performance correlated positively with teacher ratings on both social-emotional learning (SEL) using the Devereux Strengths and Skills Assessment (DESSA) and with classroom self-regulation items from the Child Behavior Rating Scale (CBRS). Finally, examining both quantitative and qualitative data, we found (c) there was heterogeneity within this sample on HTNL scores. Specifically, three qualitative groups were identified, distinguished by whether the HTNL captured meaningful variation in self-regulation and/or was easy to administer. Conclusions Results indicate that self-regulation in some neurodiverse learners can be assessed directly and meaningfully, while highlighting the need to determine assessment appropriateness on an individual basis in this population.