Table 3 –

Examples of candidate items before and after cognitive interview-based refinement.

Original item	Notes from cognitive interview	Broad theme of concern	Final item
My child used a single word with meaning.	• Seems too young for child; my child is able to currently speak in paragraphs; sparse out questions for age	Item age-appropriateness	My child used a single word with meaning.
My child made sounds like ‘ga,’ ‘ma,’ or ‘ba’.	• Same age issue; child more articulate because ofage • Babbling and baby talk; is the child babbling/trying to communicate	Item age-appropriateness	My child made sounds like ‘ga,’ ‘ma,’ or ‘ba’.
My child used a lot of new words.	• Child is acquiringnewwords; Suggestion to take out “a lot” • My child is developing a vocabulary; Have I noticed my child using new words?; “A lot” makes it hard to respond to this. • “A lot” is subjective; Not sure if we should quantify; Depending on the child and development ofthe child, there could be a delay; Child has a growing vocabulary	Use of qualifier language	My child used new words.
My child worried a lot or was very serious.	• Not sure about “very serious”; Makes more sense for parent if it was my child worried a lot; Worried and serious do not go hand and hand; “Serious” could be interpreted as focused, or concentrating; Does not view “serious” as a bad thing • Anxious; Maybe more important to a parentwho has an anxious child	Use of qualifier language	My child was worried.
My child hurt animals on purpose.	• Pretty straightforward; Aggressive question; A bit startling; Even if (my) child did hurt animals, I would answer never	Extreme behaviors	Candidate item removed from psychological functioning item pool.
My child could say words like “feet” for more than one foot and “men” for more than one man.	• Suggestion to not use “feet” as an example • Child understands “feet” as an actual body part	Semantic meaning issues	My child could say words like “men” for more than one man.
My child copied the gestures of others.	• Confused by copying gestures; I don’t understand what you’re getting at; Gesture could be waving — maybe my child waved back at someone who waved to him/her • Is this talking about good or bad gestures?; This would change my response; Suggestion to put it more in the middle	Semantic meaning issues	My child copied the gestures of others- like waving back to someone.