Development and validation of the children's voice handicap index-10 (CVHI-10)

Objective/hypothesis: To develop and validate the self-administered Voice Handicap Index-10 for children (CVHI-10) in Italian and evaluate its internal consistency and reliability in normal and disordered children's voices. Study design: Cross-sectional survey study. Methods: CVHI-10 was developed after a series of individual interviews with 20 children, aged 8-14 years to discuss the phrasing and wording of the original VHI-10. Subsequently, 66 dysphonic children (group 1) provided input to test internal consistency, external validity, and clinical validity. The voices of group 1 children were rated using the grade, roughness, and breathiness parameters of the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. The test-retest results of 30 children (group 2) who successfully underwent voice treatment were also analyzed for test-retest reliability and responsiveness to treatment. Children of group 2 completed CVHI-10 twice, with an interval of 2 weeks. Additionally, 40 children without voice disorders (group 3) were included as a control group to obtain clinical validity. Each child included in the study completed CVHI-10 autonomously. Results: Internal consistency measured with the Cronbach α coefficient was .85; test-retest reliability was 0.84. CVHI-10 positively correlated with G (r=0.62) and B (r=0.34) parameters of the GRBAS scale on Spearman rho test. The mean CVHI-10 score for group 2 was 12.4±2.8 before treatment and 3.6±1.6 after treatment; the difference was significant using the Wilcoxon sign test (P=0.0001). The difference between CVHI-10 scores in groups 1 and 3 was significant using the Mann-Whitney U test (P=0.0001). Conclusions: CVHI-10 is easily administered, highly reproducible, exhibits good clinical validity, and responsiveness to treatment.