Research in Developmental Disabilities 35 (2014) 75–86

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Research in Developmental Disabilities

Measuring quality of life in people with intellectual and

multiple disabilities: Validation of the San Martı́n scale
Miguel A. Verdugo a, Laura E. Gómez b,
*, Benito Arias c, Patricia Navas d,
Robert L. Schalock e
a
Institute on Community Integration (INICO), University of Salamanca, Avda. de la Merced, 109-131, 37005 Salamanca, Spain
b
Department of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
c
Department of Psychology, University of Valladolid, Paseo de Belén 1, Campus Miguel Delibes, 47011 Valladolid, Spain
d
Nisonger Center, The Ohio State University, 357F McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, United States
e
Hastings College, Nebraska, 710 Turner Avenue, Hastings, NE 68901, United States

A R T I C L E I N F O A B S T R A C T

Article history: Although there are numerous quality of life instruments in the, field of intellectual
Received 18 September 2013 disability, most of them are addressed to those, people with the highest levels of
Received in revised form 19 October 2013 functioning, while only a few are, suitable for people with the lowest levels (i.e., people
Accepted 21 October 2013 with profound, and severe intellectual disabilities, or people with intellectual and,
Available online developmental disabilities and other significant medical conditions or, disabilities). This
study provides reliability and validity evidence of, the San Martı́n Scale, a 95-item Likert
Keywords: scale questionnaire that is, completed by a third-party respondent. The validation sample
Profound intellectual and multiple disabil-
was composed, of 1770 people from Spain with intellectual and developmental,
ities
disabilities that showed extensive or pervasive support needs (8.7% had, mild intellectual
Intellectual, disability
Psychometric evaluation
disability, 28.25% moderate, 41.6% severe, and 21.4%, profound). The age of the
Validation participants ranged between 16 and 77 years old, (M = 7.78; SD = 12.32). The results
Reliability suggested that the eight quality of, life domains assessed on the scale are reliable
Measurement (Cronbach’s alpha ranging, from .821 to .933). Confirmatory Factor Analyses provided
Developmental disabilities construct, validity evidences related to the internal structure of the San Martı́n, Scale, and
indicated that the eight first-order factor solution provided, the best fit to the data over
unidimensional and hierarchical solutions. Implications of these findings and guidelines
for further research are, discussed.
ß 2013 Elsevier Ltd. All rights reserved.

1. Introduction

Personal outcomes are important measures in the fields of education, health care, and social services that are being used
not only for enhancing person well-being (Claes, van Hove, Vandevelde, van Loon, & Schalock, 2012; van Loon et al., 2013)
but also becoming very useful for assessing the effectiveness of intervention programs (Gómez, Verdugo, Arias, Navas, &
Schalock, 2013; Schalock, Verdugo, & Gómez, 2011; Schalock & Verdugo, 2012a, 2012b). Personal outcomes are typically
referenced to eight core quality of life domains that reflect an individual’s self-determination (SD), emotional well-being

* Corresponding author at: Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain. Tel.: +34 985 10 46 95.
E-mail addresses: verdugo@usal.es (M.A. Verdugo), gomezlaura@uniovi.es (L.E. Gómez), barias@psi.uva.es (B. Arias), patricia.navasmacho@osumc.edu
(P. Navas), rschalock@ultraplix.com (R.L. Schalock).

0891-4222/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ridd.2013.10.025
76 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86

(EW), physical well-being (PW), material well-being (MW), personal development (PD), rights (RI), social inclusion (SI), and
interpersonal relationships (IR) (Schalock & Verdugo, 2002).
These domains can be assessed either through self-reports, reports from other people, or both. Self-report forms assess
the individual’s self-perception of his/her status on the respective personal outcome and reflect the values underlying the
quality of life concept (e.g., inclusion, empowerment, equity, and self-determination) as well as the principles underlying the
disability rights movement (Navas, Gómez, Verdugo, & Schalock, 2012; Verdugo, Navas, Gómez, & Schalock, 2012). The
report of others assesses the respondent’s perception about the person’s status on the respective personal outcome.
Though the most desirable measurement is that involving both kinds of reports (Beadle-Brown, Murphy, & DiTerlizzi,
2009; Schalock et al., 2002; van Loon, van Hove, Schalock, & Claes, 2008; Verdugo, Gómez, & Arias, 2007; Verdugo et al.,
2013), it is not always possible to get reliable and valid self-reports from those people with the lowest levels of functioning
(Finlay & Lyons, 2002; Kober & Eggleton, 2002; McGillivray, Lau, Cummins, & Davey, 2009) and highest support needs (Petry
& Maes, 2007; Petry, Maes, & Vlaskamp, 2010). For this reason, reports from others (such as relatives, professionals, or
caretakers) are frequently used (e.g., Sines, Hogard, & Ellis, 2012; Vos, De Cock, Petry, Van den Noortgate, & Maes, 2010;
Wong, Wong, Schalock, & Chou, 2011). Moreover, others who are close to people with severe and profound disabilities often
make major life decisions on their behalf. Therefore, it is important to know what the perceptions are of professionals,
relatives, and other significant people (i.e., those involved in providing supports), given that concordance between the
formers and the judgments of people with intellectual and developmental disabilities is often low to moderate (Claes et al.,
2012; Cummins, 2002; Golubovic & Škrbić, 2013; Janssen, Schuengel, & Stolk, 2005; Kane et al., 2005; Mcvilly, Burton-Smit, &
Davidson, 2000; Perry & Felce, 2002; Schmidt et al., 2010; Shipman, Sheldrick, & Perrin, 2011).
Although there are a very considerable number of instruments to assess quality of life for people with intellectual and
developmental disabilities, almost none of them are suitable for those with the lowest levels of functioning. This is due to
significant limitations in adaptive behavior (Arias, Verdugo, Navas, & Gómez, 2013; Belva & Matson, 2013; Matson, Dixon,
Matson, & Logan, 2005; Matson, Cooper, Malone, & Moskow, 2008; Navas, Verdugo, Arias, & Gómez, 2012; Schuchardt,
Maehler, & Hasselhorn, 2011; Tassé, 2013), or other significant conditions related to language limitation, significant motor
dysfunctions (Nakken & Vlaskamp, 2007), chronic and pain-related medical conditions (van der Putten & Vlaskamp, 2011),
challenging behaviors (Gerber et al., 2011; Matson & Boisjoli, 2007; Matson & Minshawi, 2007; Matson & Neal, 2009; Matson
et al., 2011; Poppes, van der Putten, & Vlaskamp, 2010), sensory impairments (Meule et al., 2013), or mental health problems
(Horovitz et al., 2011; Kozlowski, Matson, Sipes, Hattier, & Bamburg, 2011; Morisse, Vandemaele, Claes, Claes, & Vandevelde,
2013).
In addition to the lack of suitable scales to use for people with severe and profound limitations, a systematic review of
self-reported quality of life measures for people with intellectual disability (Li, Tsoi, Zhang, Chen, & Wang, 2013) identified
only nine instruments (in English) that measured domains or indicators that aligned with the quality of life construct
currently used widely in the field. Data with regard to internal consistency was available for the nine instruments but only
four of them had an excellent overall rating (lower when internal consistency was analyzed for every domain). None of the
instruments applied confirmatory factor analysis or more advanced measurement methods such as item response theory.
Another recent systematic review of the existent quality of life scales – also focused only on English available tools – showed
that only six were valued as psychometrically sound and none of them specifically assessed quality of life for those who
exhibit challenging behaviors (Townsend-White, Pham, & Vassos, 2012).
According to both reviews, it can be concluded that, although there is a wealth of instruments to assess quality of life for
people with intellectual disability, most of them are not well validated or not related to a clearly articulated quality of life
theory. In addition, few are suitable for use regarding to the assessment of people with the lowest levels of functioning
(Lyons, 2005; Petry, Maes, & Vlaskamp, 2009; Petry, Kuppens, Vos, & Maes, 2010; Ross & Oliver, 2003; Vos et al., 2010).
There are several quality of life instruments available in Spanish that have been recently developed specifically for people
with intellectual and developmental disabilities: (a) the INTEGRAL Scale (Gómez, Arias, Verdugo, & Navas, 2012), for those
who are able to communicate and self-report but with psychometric limitations that need to be solved (it includes both self-
report and report of others); (b) the INICO-FEAPS Scale (Verdugo et al., 2013), an instrument with the same goals and
addressed to the same target population than the previous one but overcoming its limitations (self-report and report of
others); (c) the GENCAT Scale (Verdugo, Arias, Gómez, & Schalock, 2010), addressed to social service recipients, including
people with intellectual disability (report of others); and (d) the FUMAT Scale (Gómez, Verdugo, Arias, & Navas, 2008),
focused on people with disabilities in aging process (i.e., over 45 years old), but its psychometric properties have been only
preliminary tested (report of others). According to professionals providing supports and services to those people with
intellectual and developmental disabilities in Spain, none of the former instruments is suitable for those with the lowest
levels of functioning who are frequently unable to communicate their feelings, thoughts, and preferences.
The San Martı́n Scale (Verdugo et al., in press) was developed with the goal of bridging this gap and satisfying the
demands of practitioners that are interested on the implementation of evidence based practices to improve the quality of life
of people through the provision of supports. Its development involved the suggested steps for creating multidimensional
quality of life instruments focused on the context (Verdugo, Schalock, Gómez, & Arias, 2007) and guidelines for the
construction and analysis of tests (AERA, APA, NCME, 1999; Brennan, 2006; Downing & Haladyna, 2006; Evers et al., 2013;
Wilson, 2005).
To develop the San Martin Scale, firstly, a pool of 276 items – organized around the eight domains (Schalock & Verdugo,
2002) – was developed after an exhaustive review of the scientific literature. With the goal of selecting the best items and
 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86 77

providing evidences based on the content of the scale, the items were evaluated by 12 experts on quality of life (among them,
directors of entities, academics and researchers, psychologists). Experts valued their applicability to people with profound
intellectual disability and people with extensive and pervasive support needs. We carried out a modified Delphi method in
which the panel of experts assessed not only the content but also the structure of the initial pool of items, as well as added
new items and reformulations. The best 118 items by suitability, importance, sensitivity, and observability according to the
experts were selected using qualitative and quantitative methods (Gómez, Arias, Verdugo, Tassé, & Brown, 2013).
Next, given that stakeholders must be involved in the selection of items, the resultant items of the Delphi study were
reviewed by a focus group formed by nine direct-care professionals that worked with the target population at Fundación
Obra San Martı́n – a Spanish agency that provides support and services to people with intellectual and developmental
disabilities. They assessed again the suitability, importance, sensitivity, and observability of the 118 items, as well as
valued if the items were assessing the domain in which they were included, and if there was any indicator or important
aspect not represented by the selected items. The participants in the focus group considered that all items were suitable,
important, sensible, and observable, as well as well located in the domain they had been assigned to. They also
reformulated some items, made some clarifications in order to facilitate the understanding of some items, and added two
items in the material well-being domain with the goal of assessing a missing indicator (i.e., conditions of the center
providing supports).
The above process resulted in a 120 items field-test version of the scale whose validation is the object of the present study.
Both reliability and validity evidences based on the internal structure of the scale will be provided. The evaluation of
reliability includes Cronbach’s alpha indexes and means of polychoric correlations, while Confirmatory Factor Analysis (CFA)
evaluated validity comparing the goodness-of-fit to the data of three alternative models that have been pointed out in the
recent literature (Gómez, Verdugo, Arias, & Arias, 2010): (a) a unidimensional model: quality of life is composed of only one
generic domain (although there is a broad consensus about the multidimensionality of the construct, the structure will be
checked since structural equation modeling emphasizes model parsimony) (Model I); (b) the hypothesized eight-correlated
factors (Schalock & Verdugo, 2002) that was on the basis of the development of the scale (Model II); and (c) a hierarchical
structure in which these eight domains are first-order factors with the existence of a second-order one representing a generic
quality of life domain (Wang, Schalock, Verdugo, & Jenaro, 2010) (Model III).

2. Method

2.1. Participants

Two selection criteria were employed. In reference to those providing information (i.e., report of others) informants could
be professionals, relatives or proxies who knew well the assessed person for at least three months, and had the recent
opportunity (i.e., within the last month) to observe him/her in different contexts and during prolonged periods of time (i.e.,
several hours a day). In reference to the person being assessed, this individual needed to: (a) show an intellectual or
developmental disability and extensive or pervasive support needs (i.e., people with intellectual disability and a low level of
functioning, for instance, due to a profound or severe intellectual disability, very significant limitations in adaptive behavior,
multiple disabilities, chronic and severe health conditions, or mental health problems); (b) be currently receiving supports
and services; and (c) be 16 years old or older and not currently engaged in the education system.
The field-test version of the San Martı́n Scale was applied to a convenience sample composed of 1770 people who
met the above criteria. The assessment was carried out by 399 people, most of whom (97.4%) were professionals
working at 99 agencies that provided support to people with intellectual and developmental disabilities located
throughout Spain. Other respondents were parents (n = 36; 2%), siblings (n = 6; 0.3%), and a guardian (0.1%). Each
respondent completed the instrument on an average of four people, and an average of 18 people was assessed at each
agency. People that completed the assessment had known the person for more than two years in most of the cases
(85.1%), more than a half (54.2%) knew the person for more than five years, and 30.9% for between two and five years.
Professionals who knew the person for between six months and a year answered the scale for 6.4% of the participants,
while those for 3–6 months evaluated only 1.4% of the cases. The great majority (92.8%) had a frequency of contact with
the assessed person of several times per week.
With regard to the people with intellectual and developmental disabilities assessed, the number of men (n = 993; 56.1%)
was lightly higher than the number of women (n = 777; 43.9%). The age of the participants ranged between 16 and 77 years
old (M = 37.78; SD = 12.32). The analysis of the Pearson standardized residuals showed that the proportions of men and
women by age groups were equiprobable with the only exception of a slight underrepresentation of those women under 28
(x2ð3Þ ¼ 14:658; p = .002).
All clients in the sample required extensive (45.3%) or pervasive (54.7%) support needs. Although there was no specific
measurement of intellectual and adaptive functioning available for most of the people, respondents estimated that 8.7% had
mild intellectual disability, 28.25% moderate, 41.6% severe, and 21.4% profound. In addition, 91.6% had other associated
verified conditions, such as epilepsy, physical disability or challenging behaviors (see Fig. 1). A third (34.3%) of participants
had only one associated condition, 16% had two concurrent associated conditions, 16% showed three conditions, 6%
presented four, and the rest of the sample had between five and seven (M = 1.85; SD = 1.25). Most of them (74.2%) were taking
medication, especially antiepileptic/anti-seizures and anxiolytics.
[(Fig._1)TD$IG]
78 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86

Fig. 1. Percent of persons with other associated conditions.

2.2. Instrument

The field-test version of the San Martı́n Scale was a self-administered questionnaire in which a third-party respondent
(i.e., staff, relative, proxy, etc. who knows well and has opportunities to observe the person assessed) must answer questions
about the person’s quality of life. Administration time varied from 20 and 40 min. It was composed of eight subscales that
correspond to the eight quality of life domains by Schalock and Verdugo, and a total of 120 items (SD = 12; EW = 16; PW = 14;
MW = 17; RI = 16; PD = 16; SI = 11; IR = 18). All items were formulated as third person declarative statements and random
organized by domains. All items had positive valence with the only exception of five (i.e., EW15, EW20, EW22, RI63, and RI73).
The answer format was a frequency scale with four options (never, sometimes, often, and always). An English version of the
items is available via e-mail on request.

2.3. Procedure

Initially, an e-mail was sent to a large number of agencies providing services to people with intellectual and
developmental disabilities throughout Spain. In the e-mail, we indicated the goals of the study and asked for collaboration.
This procedure was augmented by explaining the study to participants of a number of different conferences and workshops
addressed to people interested on intellectual disability. Also a recruitment form was posted on Institute on Community
Integration (INICO)’s website.
People expressing interest answered a survey in which they provided their contact data and the potential number of
people that they might assess. We obtained a positive response from 147 agencies that were willing to potentially evaluate
4017 people. Consequently, the actual participation was 43.49% of the potential people to be assessed and 63.35% of the
interested agencies. Among the reasons they used to drop out of the study were the unexpected work overload, participating
in another study or assessment at that moment, and the loss of staff due to cutbacks in social service spending in Spain.
Next, the research team e-mailed information to these 147 agencies providing them more detailed information about the
study, as well as the way to gain access to the online version of the San Martı́n Scale, its administration manual with all the
needed instructions, and the informed consent sheet that should be completed for each person prior the evaluation. In this
way, informed consents were collected for all participants and the assessment was carried out guaranteeing the anonymity
and confidentiality of the collected data. The Ethics Committee of the University of Salamanca granted ethical approval.
Phone and e-mail contact was kept all along the process in case there were doubts or suggestions. Both were also used to
remind people about deadlines when it was necessary.

3. Results

3.1. Reliability

Reliability was analyzed in terms of internal consistency using corrected homogeneity index (CHI), Cronbach’s alpha, and
polychoric correlations. Only five among the 120 items showed CHI below .200, and they were eliminated. Among the
remaining 115 items, those 12 with the highest CHI values for each domain were retained for the final version of the scale,
 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86 79

Table 1
Cronbach’s alpha coefficients by level of intellectual functioning.

SD EW PW MW RI PD SI IR N

Total .884 .863 .821 .858 .832 .933 .904 .866 1770
Mild .882 .834 .846 .872 .840 .931 .892 .860 154
Moderate .890 .866 .823 .860 .835 .936 .906 .889 500
Severe .886 .866 .811 .855 .837 .932 .902 .889 738
Profound .870 .863 .823 .852 .810 .932 .908 .884 378
x2(3) 2.934 2.698 2.690 1.253 3.059 0.538 1.488 3.215 –
p .402 .441 .442 .740 .383 .911 .685 .340 –

Note: SD = self-determination; EW = emotional wellbeing; PW = Physical wellbeing; MW = material wellbeing; RI = rights; PD = personal development;
SI = social inclusion; IR = interpersonal relationships.

with the only exception of social inclusion that retained only 11. In this way, the final version of the San Martı́n Scale kept 95
items, with CHI values ranging from .332 to .676 (all of them had positive valence).
The mean polychoric correlations among the items composing each domain ranged between .444 and .650, while
Cronbach’s alpha fluctuated between .821 (physical well-being) and .933 (personal development). The Cronbach’s alpha
coefficient for the total scale (i.e., 95 items) was .974.
Given that the target population of this scale was those people with intellectual and developmental disabilities with
lowest levels of functioning and, as it was aforementioned in the description of the sample, some of the people assessed were
considered by the observers as showing mild or moderate intellectual disability, reliability was also analyzed taking into
account the intellectual disability level with the goal of checking if there were significant differences between the internal
consistency coefficients found for the different groups (i.e., mild, moderate, severe, profound). The results of the test of
significance of the differences between independent coefficient alphas (Hakstian & Whalen, 1976) showed that internal
consistency differences among groups were very small and non-significant (Table 1).

3.2. Construct validity

3.2.1. Based on the internal structure

With the goal of providing evidences of validity based on the internal structure of the scale, a Confirmatory Factor
Analysis (CFA) was used to evaluate the goodness-of-fit for three measurement models. Model I was unidimensional. Model
II contained the eight inter-correlated factors proposed by Schalock and Verdugo. Model III hypothesized a hierarchical
structure with eight first-order domains (the ones proposed by Schalock and Verdugo) and a second-order one (i.e., quality of
life). Given the nature of the data, the CFA was performed implementing DWLS (Diagonally Weighted Least Squares)
estimation method with the covariance and asymptotic variance–covariance matrices. LISREL 9.1 was the software used.
In spite of the use of parcels is considered by some authors as a controversial practice (Little, Cunningham, Shahar, &
Widaman, 2002), among the reasons to use them stand out that parcels are closer to multivariate normality than the original
set of item scores and reduce models complexity (Bandalos, 2002; Bandalos & Finney, 2001; Hall, Snell, & Singer Foust, 1999).
Given the high number of items in each domain, three parcels composed of four items (i.e., a total of 24 parcels) were used as
indicators of the latent constructs for each quality of life domain by combining individual items and using them as the
observed variables. The items were assigned to each parcel depending on their opposite skew (Temperaal, Schim, &
Gijselaers, 2007) (i.e., the most and less asymmetric items were assigned to the first parcel; the next most and less
asymmetric were allocated in the second one, and so on), a recommended practice with continuous or ordered categorical
items (Holt, 2004).
Given that item parceling should only be carried out if a clearly defined unidimensional structure has been identified
(Bandalos & Finney, 2001; Little et al., 2002), unidimensionality of each parcel was guaranteed through Exploratory Factor
Analysis (EFA) and Horn’s Parallel Analysis – one of the most recommendable rules for determining the number of
components to retain that compares the observed eigenvalues with those obtained from uncorrelated normal variables
using a Monte-Carlo simulation method. A factor is retained if the associated eigenvalue is larger than the 95th of the
distribution of eigenvalues derived from the random data. In Fig. 2, it can be seen that first empirical eigenvalues were bigger
than the random ones for the 24 parcels, and the second empirical eigenvalues were lower than those random generated.
Parcels were also considered unidimensional because: (a) the eigenvalue for the first factor was large relative to the
eigenvalue of the second factor (Reise, Moore, & Haviland, 2010), ratios ranged between 1.914 (parcel 1 in physical well-
being) to 5.379 (parcel 1 in social inclusion); and (b) the proportion of variance explained by the first factor was greater than
40% (range from 42.62% to 69.26%). As it is shown in Table 2, all these criteria were fulfilled and supported the
appropriateness of conducting CFA.
Finally, another required condition for a model to be estimated is that there are more observations than parameters to be
estimated, so measured variables were identified and it was confirmed that the three models (Models I, II, and III) were over-
identified (df = 252, 224, and 244, respectively).
According to the recommendations of Hu and Bentler (1999) and addressing the limitations of Chi-square test (x2) (e.g., it
is greatly affected by sample size), model fit was evaluated using a combination of absolute and incremental goodness-of-fit
[(Fig._2)TD$IG]
80 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86

Fig. 2. Parallel analysis results with empirical and random eigenvalues.

Table 2
Parcel unidimensionality.

Domain Parcel Eig1 Eig2 E1/E2 Dif_Eig1 Dif_Eig2 Var expl 18 Var expl 28 Dif_var

SD SD1 1.945 0.897 2.168 0.896 0.152 48.625 22.420 26.205

SD2 2.079 0.766 2.714 1.030 0.283 51.986 19.160 32.826
SD3 2.576 0.582 4.426 1.527 0.467 64.403 14.538 49.865
EW EW1 2.335 0.805 2.901 1.286 0.244 58.382 20.117 38.265
EW 2 1.992 0.868 2.295 0.943 0.181 49.793 21.690 28.103
EW 3 2.510 0.746 3.365 1.461 0.303 62.746 18.652 44.094
PW PW1 1.820 0.951 1.914 0.771 0.098 45.491 23.779 21.712
PW12 1.993 0.889 2.242 0.944 0.160 49.824 22.226 27.598
PW13 1.705 0.847 2.013 0.656 0.202 42.623 21.174 21.449
MW MW1 2.030 0.773 2.626 0.981 0.276 50.751 19.324 31.427
MW2 1.886 0.875 2.155 0.837 0.174 47.143 21.877 25.266
MW3 1.781 0.892 1.997 0.732 0.157 44.515 22.297 22.218
RI RI1 1.857 0.942 1.971 0.808 0.107 46.434 23.560 22.874
RI2 1.868 0.846 2.208 0.819 0.203 46.708 21.147 25.561
RI3 2.266 0.748 3.029 1.217 0.301 56.643 18.700 37.943
PD PD1 2.634 0.652 4.040 1.585 0.397 65.840 16.310 49.530
PD2 2.447 0.673 3.636 1.398 0.376 61.185 16.830 44.355
PD3 2.715 0.599 4.533 1.666 0.450 67.867 14.966 52.901
SI SI1 2.770 0.515 5.379 1.721 0.534 69.260 12.870 56.390
SI2 2.119 0.891 2.378 1.070 0.158 52.966 22.273 30.693
SI3 1.864 0.721 2.585 0.815 0.328 62.127 24.020 38.107
IR IR1 2.287 0.716 3.194 1.238 0.333 57.166 17.907 39.259
IR2 2.282 0.681 3.351 1.233 0.368 57.052 17.035 40.017
IR3 2.141 0.976 2.194 1.092 0.073 53.516 24.401 29.115

Note: SD = self-determination; EW = emotional wellbeing; PW = Physical wellbeing; MW = material wellbeing; RI = rights; PD = personal development;
SI = social inclusion; IR = interpersonal relationships; Dif_Eig1 = difference between the eigenvalue for the first factor and the first value random obtained;
Dif_Eig2 = difference between eigenvalue for the second factor and the first value random obtained.
 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86 81

Table 3
Goodness of fit indices.

Model I Model II Model III

2
S-Bx 7508.356 2676.694 5745.080
p .000 .000 .000
df 252 224 244
RMSEA .066 .054 .132
(90% CI) .064–.069 .051–.057 .130–.135
CFI .953 .984 .965
TLI .949 .981 .960
SRMR .087 .045 .253
McDonald’s Omega .971 .985 .964
Composite reliability .971 .986 .973
Average variance extracted .588 .740 .644

Note: S-Bx2 = Satorra–Bentler adjusted Chi-square; RMSEA = root mean square error of approximation; CFI = comparative fit index; TLI = Tucker–Lewis
index; SRMR = standardized root mean square residual.

Table 4
Correlations among the eight domains (Model II).

SD EM PW MW RI PD SI IR

SD 1.000
EW .823 1.000
PW .660 .848 1.000
MW .727 .832 .830 1.000
RI .682 .815 .706 .701 1.000
PD .802 .801 .663 .709 .657 1.000
SI .682 .650 .592 .636 .502 .732 1.000
IR .814 .887 .735 .821 .720 .887 .782 1.000

Note: SD = self-determination; EW = emotional wellbeing; PW = Physical wellbeing; MW = material wellbeing; RI = rights; PD = personal development;
SI = social inclusion; IR = interpersonal relationships.

indices (McDonald & Ho, 2002). Regarding Chi-square analysis, it is recommended to examine its magnitude rather than its
level of significance (e.g., Barrett, 2007; Flora & Curran, 2004; Iacobucci, 2010; Kline, 2010). For this reason, Satorra–Bentler
scaled Chi-square (Satorra & Bentler, 2010) was used since it is a correction that allows data to more closely approximate the
Chi-square distribution. With regard to relative fit indexes, Root Mean Square Error of Approximation (RMSEA), Comparative
Fix Index (CFI), Tucker-Lewis Index (TLI), and Standardized Root Mean Square Residual (SRMR) measure the proportionate
improvement in fit by comparing a target model with a more restricted nested baseline model (a null model in which all the
observed variables are uncorrelated). Model fit is indicated by Chi-square small values and non-significant levels; RMSEA
values less than .060; CFI and TLI values above .950; and SRMR values less than .080 (Browne & Cudeck, 1993). On the other
hand, internal consistency of each model was calculated through McDonald’s Omega, composite reliability (rc) (also known
as construct reliability), and the average variance extracted (rv). McDonald’s Omega and composite reliability (rc) are similar
to Cronbach’s alpha coefficients with values greater than .700 signifying that indicators are a reliable measure of the latent
variable. The average variance extracted (rv), however, indicates the accuracy in which the construct is measured (i.e.,
validity). Hair, Ringle, and Sarstedt (2011) recommend values greater than .500.
As it is shown in Table 3, the goodness-of-fit indexes of the eight-factor model – the one hypothesized to provide the best
fit to the data (Model II) – were acceptable with the exception of x2. The eight-factor solution had much better indexes than
the unidimensional model (Model I) and the hierarchical model (Model III). Despite Model I and Model III obtained CFI and
TLI values that indicate a good model fit (Model I  .950; Model III  .960), all the values were smaller to the ones found for
Model II (>.980). On the other hand, both Model I and Model III showed an increase of SRMR and RMSEA: both values were
close to show a good model fit in the case of Model I (SRMR = .087; RMSEA = .066) but far in the case of Model III
(SRMR = .253; RMSEA = .244). In contrast, both RMSEA (<.060) and SRMR (<.080) indicate a good model fit for Model II.
Also, Model II showed higher reliability and validity according to McDonald’s Omega, composite reliability (rc), and the
average variance extracted (rv). Finally, the measurement errors (ranging between .142 and .433) and factor loadings (with
values grater than .753) supported the best fit to the data of the eight-factor solution (Fig. 3). Correlations among the eight
domains are presented in Table 4. In conclusion, the goodness-of-fit for the eight-factor model suggested that this model
provided a better fit to the data than the other solutions whose fit is poor in the case of Model I and very far from acceptable in
the case of Model III.

3.2.2. Convergent validity

With the goal of providing evidences related to convergent validity (i.e., the indicators of each domain should converge or
share a high proportion of variance), we checked for Model II (i.e., eight first order correlated domains) that: (a) all
[(Fig._3)TD$IG]
82 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86

Fig. 3. Model II. Eight-correlated factors. Standardized solution. SD = self-determination; EW = emotional wellbeing; PW = Physical wellbeing;
MW = material wellbeing; RI = rights; PD = personal development; SI = social inclusion; IR = interpersonal relationships.

standardized factor loadings were greater than .700 (ranged from .753 to .926) and statistically significant (p < .001); (b) the
average variance extracted values were greater than .500 for all domains (ranged between .657 and .852); (c) all composite
reliability values were greater than .700 (fluctuated from .851 to .945); and (d) McDonald’s Omega coefficients were greater
than .800 (varied from. 850 to .945).

3.2.3. Discriminant validity

Discriminant validity (i.e., evidence about every domain is unique and different to the others) was estimated through two
methods for Model II (i.e., eight first order correlated domains). The first method consisted of comparing the fit of Model II
with the fit of 28 new models [n(n  1)/2, where n is the number of domains]. For each one of these 28 models, the correlation
 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86 83

Table 5
Discriminant validity: average variance extracted values and squares of correlations (Model II).

SD EM PW MW RI PD SI IR

SD .749
EW .677 .657
PW .436 .719 .667
MW .529 .692 .689 .764
RI .465 .664 .498 .491 .671
PD .643 .642 .440 .503 .432 .852
SI .465 .423 .350 .404 .252 .536 .812
IR .663 .787 .540 .674 .518 .787 .612 .749

Note: SD = self-determination; EW = emotional wellbeing; PW = Physical wellbeing; MW = material wellbeing; RI = rights; PD = personal development;
SI = social inclusion; IR = interpersonal relationships; average variance extracted values (diagonal); squares of correlations (below diagonal).

between a pair of constructs was setting to 1.000. In all cases, the fit of Model II was the best in comparison to these 28
models including the pair of domains with r = 1.000. In consequence, it can be affirmed that the set of indicators represent
eight separated domains.
The second method consisted in comparing the average variance extracted (AVE) values for any two constructs with the
square of the correlation estimate between these two constructs. As it is shown in Table 5, most of the AVE values were
greater than the squares of the correlations. Emotional well-being and physical well-being were, however, the domains with
less discriminant validity.

4. Discussion

This study provided evidences about the reliability and the validity of the just recently developed San Martı́n Scale, a
quality of life instrument for people with intellectual and developmental disabilities with the lowest levels of functioning
and for whom there was not any adequate instrument in the Spanish context.
The study exhibited a number of strengths. First, the large size of the sample (N = 1770) overcomes the typical sample
size one finds in the field (Li et al., 2013). The high participation – voluntarily and without compensation – serves as
evidence of the urgent need of an instrument like this and the great demand existing from agencies providing supports and
services. Second, in contrast with the usual lack of advanced measurement methods in the validation of quality of life
instruments for people with intellectual and developmental disabilities (Li et al., 2013), we have not only used CFA to
provide validity and reliability evidences about the internal structure of the scale, but have also compared the fit of
different potential models derived from the scientific literature. Third, unlike similar studies (e.g., Bonham et al., 2004;
Petry et al., 2009; van Loon et al., 2008), we evaluated whether there were significant differences in internal consistency
coefficients depending on the individual’s level of intellectual functioning, and the results confirmed that the scale is
reliable independently of this variable. Fourth, all internal consistency coefficients, including the overall coefficient and the
ones for each and every one of the eight domains were adequate and overcomes the ones found for domains in previous
studies (Townsend-White et al., 2012). Finally, beyond the psychometric properties and given that the instrument offers
standard scores (M = 10; SD = 3) and percentiles, it is also possible to illustrate all scores on a profile that facilitates score
interpretation. In this regard, it should be stressed the utility that this tool may have utility for implementing evidence-
based practices (Schalock et al., 2011), enhancing personal outcomes (Claes et al., 2012; van Loon et al., 2013) and guiding
social and human policies (Gómez, Verdugo, et al., 2013). An English version of the instrument is also available and is about
to be validated in other countries.
Nevertheless, the study is not free of limitations. One of the most obvious is that there were no valid assessments of either
intellectual functioning (IQ) or adaptive behavior for participants. In this way, the classification of people into the labels of
mild, moderate, severe, and profound levels of intellectual disability was only a judgment provided by the respondents. The
second greatest limitation is the pending task of providing evidences about the inter-observer reliability. Likewise, further
research should be focused on facing the challenge of increasing the opportunities of self-reporting for this population, being
more simplistic in how items are phrased and more systematic in their explanation, and using more sophisticated and user-
friendly approaches (e.g., visual icons, controls, trained peer interviewers, response elicitation strategies). In addition, the
development and validation of a similar instrument suitable for adolescents and children is also an urgent necessity. In this
regard, a similar process of development and validation to the one described here has already been initiated with the KidsLife
Scale (Gómez, Arias, et al., 2013).

Conflicts of interest

The authors report no conflicts of interest and are solely responsible for the content and, writing of this paper.
84 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86

Acknowledgments

Work on this research was funded by Fundación Obra San Martı́n (Cantabria, Spain) and the Ministry of Economy and
Competitiveness (R&D Projects, 2012) (PSI2012-33139 and PSI2012-36278).

References

American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, (1999). Standards for
educational and psychological testing. Washington, DC: American Psychological Association.
Arias, B., Verdugo, M. A., Navas, P., & Gómez, L. E. (2013). Analyzing the factor structure of adaptive behavior in children with and without intellectual disability.
International Journal of Clinical and Health Psychology, 13, 155–166.
Bandalos, D. L. (2002). The effects of item parceling on goodness-of-fit and parameter estimate bias in structural equation modeling. Structural Equation Modeling,
9, 78–102.
Bandalos, D. L., & Finney, S. J. (2001). Item parceling issues in structural equation modeling. In G. A. Marcoulides & R. E. Schumacker (Eds.), Advanced structural
equation modeling: New developments and techniques (pp. 269–296). Mahwah, NJ: Lawrence Erlbaum Associates Inc.
Barrett, P. (2007). Structural equation modeling: Adjudging model fit. Personality and Individual Differences, 42, 815–824.
Beadle-Brown, J., Murphy, G., & DiTerlizzi, M. (2009). Quality of life for the Camberwell Cohort. Journal of Applied Research in Intellectual Disabilities, 22, 380–390.
Belva, B. C., & Matson, J. L. (2013). An examination of specific daily living skills deficits in adults with profound intellectual disabilities. Research in Developmental
Disabilities, 34, 596–604.
Bonham, G. S., Basehart, S., Schalock, R. L., Marchan, C. B., Kirchner, N., & Rumenap, J. M. (2004). Consumer-based quality of life assessment: The Maryland Ask Me!
Project Mental Retardation, 42, 338–555.
Brennan, R. L. (Ed.). (2006). Educational measurement. Westport, CT: ACE/Praeger.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162).
Newbury Park, CA: Sage.
Claes, C., van Hove, G., Vandevelde, S., van Loon, J., & Schalock, R. L. (2012). The influence of supports strategies, environmental factors, and client characteristics on
quality of life-related personal outcomes. Research in Developmental Disabilities, 33, 96–103.
Cummins, R. A. (2002). Proxy responding for subjective well-being: A review. International Review of Research in Mental Retardation, 25, 183–207.
Downing, S. M., & Haladyna, T. M. (Eds.). (2006). Handbook of test development. Erlbaum: Hillsdale, NJ.
Evers, A., Muñiz, J., Hagemeister, C., Hstmælingen, A., Lindley, P., Sjöbergr, A., et al. (2013). Assessing the quality of tests: Revision of the EFPA review model.
Psicothema, 25(3), 283–291.
Finlay, W. M., & Lyons, E. (2002). Acquiescence in interviews with people who have mental retardation. Mental Retardation, 40, 14–29.
Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological
Methods, 9, 466–491.
Gerber, F., Bessero, S., Robbiani, B., Courvoisier, D. S., Baud, M. A., Traoré, P. B., et al. (2011). Comparing residential programmes for adults with autism spectrum
disorders and intellectual disability: Outcomes of challenging behaviour and quality of life. Journal of Intellectual Disability Research, 55, 918–932.
Golubovic, Š. , & Škrbić, R. (2013). Agreement in quality of life assessment between adolescents with intellectual disability and their parents. Research in
Developmental Disabilities, 34, 1863–1869.
Gómez, L. E., Arias, B., Verdugo, M. A., & Navas, P. (2012). Application of the Rasch Rating Scale Model to the assessment of quality of life of persons with intellectual
disability. Journal of Intellectual & Developmental Disability, 37(29), 141–150.
Gómez, L. E., Arias, B., Verdugo, M. A., Alcedo, M. A., Arias, V., Monsalve, A., et al. (2013). KidsLife: Assessment of quality of life for children and adolescents (in
preparation).
Gómez, L. E., Arias, B., Verdugo, M. A., Tassé, M. J., Brown, I. (2013). Quality of life for adults with multiple profound disabilities: A modified Delphi Method and
Facet Analysis (in preparation).
Gómez, L. E., Verdugo, M. A., Arias, B., & Navas, P. (2008). Evaluación de la calidad de vida en personas mayores y con discapacidad: La Escala FUMAT [Assessment
of quality of life in elderly people with disabilities: The FUMAT Scale]. Intervención Psicosocial, 17(2), 189–199.
Gómez, L. E., Verdugo, M. A., Arias, B., & Arias, V. (2010). A comparison of alternative models of individual quality of life for social service recipients. Social Indicators
Research, 101, 109–126.
Gómez, L. E., Verdugo, M. A., Arias, B., Navas, P., & Schalock, R. L. (2013). The development and use of provider profiles at the organization and systems level.
Evaluation & Program Planning, 40, 17–26.
Hair, C., Ringle, C. M., & Sarstedt, M. (2011). PLS-SEM: Indeed a silver bullet. Journal of Marketing Theory and Practice, 19, 139–151.
Hakstian, A. R., & Whalen, T. E. (1976). A k-sample significance test for independent alpha coefficients. Psychometrika, 41(2), 219–231.
Hall, R. J., Snell, A. F., & Singer Foust, M. (1999). Item parceling strategies in SEM: Investigating the subtle effects of unmodeled secondary constructs.
Organizational Research Methods, 2, 233–256.
Holt, J. K. (2004, October). Item parceling in structural equation models for optimum solutions. Paper presented at the 2004 annual meeting of the Mid-Western
Educational Research Association, Columbus, OH.
Horovitz, M., Matson, J. L., Sipes, M., Shoemaker, M., Belva, B., & Bamburg, J. W. (2011). Incidence and trends in psychopathology symptoms over time in adults
with severe to profound intellectual disability. Research in Developmental Disabilities, 32, 685–692.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation
Modeling, 6, 1–55.
Iacobucci, D. (2010). Structural equations modeling: Fit indices, sample size, and advanced topics. Journal of Consumer Psychology, 20, 90–98.
Janssen, C., Schuengel, C., & Stolk, J. (2005). Perspectives on quality of life of people with intellectual disabilities: The interpretation of discrepancies between
clients and caregivers. Quality of Life Research, 14(1), 55–69.
Kane, R. L., Kane, R. A., Bershadsky, B., Degenholtz, H., Kling, K., Totten, A., et al. (2005). Proxy sources for information on nursing home residents’ quality of life.
Journals of Gerontology Series B – Psychological Sciences and Social Sciences, 60, S318–S325.
Kline, R. B. (2010). Principles and practices of structural equation modeling (3rd ed.). New York: The Guilford Press.
Kober, R., & Eggleton, I. R. (2002). Factor stability of the Schalock and Keith (1993): Quality of life questionnaire. Mental Retardation, 40, 157–165.
Kozlowski, A. M., Matson, J. L., Sipes, M., Hattier, M. A., & Bamburg, J. W. (2011). The relationship between psychopathology symptom clusters and the presence of
comorbid psychopathology in individuals with severe to profound intellectual disability. Research in Developmental Disabilities, 32, 1610–1614.
Li, C., Tsoi, E. W. S., Zhang, A. L., Chen, S., & Wang, C. K. J. (2013). Psychometric properties of self-reported quality of life measures for people with intellectual
disabilities: A systematic review. Journal of Developmental and Physical Disabilities, 25, 253–270.
Little, T. D., Cunningham, W. A., Shahar, G., & Widaman, K. F. (2002). To parcel or not to parcel: Exploring the question, weighing the merits. Structural Equation
Modeling, 9, 151–173.
Lyons, G. (2005). The life satisfaction matrix: An instrument and procedure for assessing the subjective quality of life of individuals with profound multiple
disabilities. Journal of Intellectual Disability Research, 49, 766–769.
Matson, J. L., & Boisjoli, J. A. (2007). Multiple versus single maintaining factors of challenging behaviors as assessed by the QABF for adults with intellectual
disabilities. Journal of Intellectual and Developmental disability, 32, 39–44.
 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86 85

Matson, J. L., & Minshawi, N. F. (2007). Functional assessment of challenging behavior: Toward a strategy for applied settings. Research in Developmental
Disabilities, 28, 353–361.
Matson, J. L., & Neal, D. (2009). Psychotropic medication use for challenging behaviors in persons with intellectual disabilities: An overview. Research in
Developmental Disabilities, 30, 572–586.
Matson, J. L., Cooper, C., Malone, C. J., & Moskow, S. L. (2008). The relationship of self-injuries behavior and other maladaptive behaviors among individuals with
severe and profound intellectual disability. Research in Developmental Disabilities, 29, 141–148.
Matson, J. L., Dixon, D. R., Matson, M. L., & Logan, R. L. (2005). Classifying mental retardation and specific strength and deficit areas in severely and profoundly
mentally retarded persons with the MESSIER. Research in Developmental Disabilities, 26, 41–45.
Matson, J. L., Kozlowski, A. M., Worley, J. A., Shoemaker, M. E., Sipes, M., & Horovitz, M. (2011). What is the evidence for environmental causes of challenging
behaviors in persons with intellectual disabilities and autism spectrum disorders? Research in Developmental Disabilities, 32, 693–698.
McDonald, R. P., & Ho, M. H. R. (2002). Principles and practice in reporting statistical equation analyses. Psychological Methods, 7(1), 64–82.
McGillivray, J. A., Lau, A. L. D., Cummins, R. A., & Davey, G. (2009). The utility of the personal well-being index intellectual disability scale in an Australian sample.
Journal of Applied Research in Intellectual Disabilities, 22, 276–286.
Mcvilly, K. R., Burton-Smit, R. M., & Davidson, J. A. (2000). Concurrence between subject and proxy ratings; of quality of life for people with and without
intellectual disabilities. Journal of Intellectual & Developmental Disability, 25, 19–39.
Meule, A., Fath, K., Real, R. G. L., Sütterlin, S., Vögele, C., & Kübler, A. (2013). Quality of life, emotion regulation, and heart rate variability in individuals with
intellectual disabilities and concomitant impaired vision. Psychology of Well-Being: Theory, Research and Practice, 3, 1–14,. Available from http://www.psywb.-
com/content/3/1/1.
Morisse, F., Vandemaele, E., Claes, C., Claes, L., & Vandevelde, S. (2013). Quality of life in persons with intellectual disabilities and mental health problems: An
explorative study. The ScientificWorld Journal, 2013. Article ID 491918, 8 pages. http://dx.doi.org/10.1155/2013/491918. Available from http://www.hinda-
wi.com/journals/tswj/2013/491918/.
Nakken, H., & Vlaskamp, C. (2007). A need for a taxonomy for profound intellectual and multiple disabilities. Journal of Policy and Practice in Intellectual Disabilities,
4, 83–87.
Navas, P., Gómez, L. E., Verdugo, M. A., & Schalock, R. L. (2012). Derechos de las personas con discapacidad intelectual: Implicaciones de la Convención de Naciones
Unidas [Rights of persons with intellectual disability: Implications of United Nations Convention]. Siglo Cero, 43, 7–28.
Navas, P., Verdugo, M. A., Arias, B., & Gómez, L. E. (2012). Development of an instrument for diagnosing significant limitations in adaptive behavior in early
childhood. Research in Developmental Disabilities, 33, 1551–1559.
Perry, J., & Felce, D. (2002). Subjective and objective quality of life assessment: Responsiveness, response bias and resident: Proxy concordance. Mental Retardation,
40, 445–456.
Petry, K., & Maes, B. (2007). Description of the support needs of people with profound multiple disabilities using the 2002 AAMR system: An overview of literature.
Education and Training in Developmental Disabilities, 42(2), 130–143.
Petry, K., Kuppens, S., Vos, P., & Maes, B. (2010). Psychometric evaluation of the Dutch Version of the Mood, Interest and Pleasure Questionnaire (MIPQ). Research in
Developmental Disabilities, 31, 1652–1658.
Petry, K., Maes, B., & Vlaskamp, C. (2009). Psychometric evaluation of a questionnaire to measure the quality of life of people with profound multiple disabilities
(QOL-PMD). Research in Developmental Disabilities, 30, 1326–1336.
Petry, K., Maes, B., & Vlaskamp, C. (2010b). Support characteristics associated with the quality of life of people with profound intellectual and multiple disabilities:
The perspective of parents and direct support staff. Journal of Policy and Practice in Intellectual Disabilities, 4(2), 104–110.
Poppes, P., van der Putten, A. J. J., & Vlaskamp, C. (2010). Frequency and severity of challenging behaviour in people with profound intellectual and multiple
disabilities. Research in Developmental Disabilities, 31, 1269–1275.
Reise, S. P., Moore, T. M., & Haviland, M. G. (2010). Bifactor models and rotations: Exploring the extent to which multidimensional data yield univocal scale scores.
Journal of Personality Assessment, 92, 544–559.
Ross, E., & Oliver, C. (2003). Preliminary analysis of the psychometric properties of the Mood, Interest & Pleasure Questionnaire (MIPQ) for adults with severe and
profound learning disabilities. British Journal of Clinical Psychology, 42, 81.
Satorra, A., & Bentler, P. M. (2010). Ensuring positiveness of the scaled difference Chi-square test statistic. Psychometrika, 75, 243–248.
Schalock, R. L., Brown, I., Cummings, R. A., Felce, D., Matikka, L., & Keith, K. D. (2002). Conceptualization, measurement, and application of quality of life for persons
with intellectual disabilities: Report of an international panel of experts. Mental Retardation, 40, 457–470.
Schalock, R. L., & Verdugo, M. A. (2002). Handbook on quality of life for human service practitioners. Washington, DC: American Association on Mental Retardation.
Schalock, R. L., & Verdugo, M. A. (2012a). The transformation of disability organizations. Journal of Intellectual and Developmental Disabilities, 51, 273–286.
Schalock, R. L., & Verdugo, M. A. (2012b). A leadership guide for today’s disabilities organizations: Overcoming challenges and making change happen. Baltimore, MD:
Paul Brookes Publishing Co.
Schalock, R. L., Verdugo, M. A., & Gómez, L. E. (2011). Evidence-based practices in the field of intellectual and developmental disabilities: An international
consensus approach. Evaluation and Program Planning, 34, 273–282.
Schmidt, S., Power, M., Green, A., Lucas-Carrasco, R., Eser, E., Dragomirecka, E., et al. (2010). Self and proxy rating of quality of life in adults with intellectual
disabilities: Results from the DISQOL study. Research in Developmental Disabilities, 31, 1015–1026.
Schuchardt, K., Maehler, C., & Hasselhorn, M. (2011). Functional deficits in phonological working memory in children with intellectual disabilities. Research in
Developmental Disabilities, 32, 1934–1940.
Shipman, D. L., Sheldrick, R. C., & Perrin, E. C. (2011). Quality of life in adolescents with autism spectrum disorders: Reliability and validity of self-reports. Journal of
Developmental and Behavioral Pediatrics, 32(2), 85–89.
Sines, D., Hogard, E., & Ellis, R. (2012). Evaluating quality of life in adults with profound learning difficulties resettled from hospital to supported living in the
community. Journal of Intellectual Disabilities, 16(4), 247–263.
?
Tassé, M. J. (2013). Qué son las limitaciones significativas en conducta adaptativa en personas con discapacidades intelectuales y del desarrollo? [What are
significant limitations in adaptive behavior in people with intellectual and developmental disabilities?]. Siglo Cero, 44, 22–33.
Temperaal, D. T., Schim, S., & Gijselaers, W. H. (2007). A structural equation model analyzing the relationship of student’s attitudes toward statistics, prior
reasoning abilities and course performance. Statistics Education Research Journal, 6, 78–102.
Townsend-White, C., Pham, A. N. T., & Vassos, M. V. (2012). A systematic review of quality of life measures for people with intellectual disabilities and challenging
behaviours. Journal of Intellectual Disability Research, 56(3), 270–284.
van der Putten, A., & Vlaskamp, C. (2011). Pain assessment in people with profound intellectual and multiple disabilities; a pilot study into the use of the Pain
Behaviour Checklist in everyday practice. Research in Developmental Disabilities, 32, 1677–1684.
van Loon, J. H. M., Bonham, G. S., Peterson, D. D., Schalock, R. L., Claes, C., & Decramer, A. E. M. (2013). The use of evidence-based outcomes in systems and
organizations providing services and supports to persons with intellectual disability. Evaluation and Program Planning, 36, 80–87.
van Loon, J., van Hove, G., Schalock, R. L., & Claes, C. (2008). POS. Persoonlijke ondersteuningsuitkomsten schaal. individuele kwaliteit van bestaan. administration
manual. Antwerpen, Apeldoorn: Garant.
Verdugo, M. A., Arias, B., Gómez, L. E., & Schalock, R. L. (2010). Development of an objective instrument to assess quality of life in social services: Reliability and
validity in Spain. International Journal of Clinical and Health Psychology, 10(1), 105–123.
Verdugo, M. A., Gómez, L. E., & Arias, B. (2007). La Escala Integral de Calidad de Vida. Desarrollo y estudio preliminar de sus propiedades psicométricas [The
Integral quality of life scale: Development and preliminary study of its psychometric properties]. Siglo Cero, 38(4), 37–56.
Verdugo, M. A., Gómez, L. E., Arias, B., Santamarı́a, M., Clavero, D., & Tamarit, J. (2013). Evaluación de la calidad de vida en personas con intelectual o del desarrollo:
La escala INICO-FEAPS [Assessment of quality of life in people with intellectual o developmental disabilities: INICO-FEAPS Scale]. Siglo Cero, 44(3), 6–20.
Verdugo, M. A., Gómez, L. E., Arias, B., Santamarı́a, M., Navallas, E., Fernández, S., et al. Evaluación de la calidad de vida en personas con discapacidades
significativas: La escala San Martı́n [Assessment of quality of life in people with significant disabilities: San Martı́n Scale]. Siglo Cero (in press).
86 M.A. Verdugo et al. / Research in Developmental Disabilities 35 (2014) 75–86

Verdugo, M. A., Navas, P., Gómez, L. E., & Schalock, R. L. (2012). The concept of quality of life and its role in enhancing human rights in the field of intellectual
disability. Journal of Intellectual Disability Research, 56(2), 1036–1045.
Verdugo, M. A., Schalock, R. L., Gómez, L. E., & Arias, B. (2007). Construcción de escalas de calidad de vida multidimensionales centradas en el contexto: La Escala
GENCAT [Development of quality of life scales focused on the context]. Siglo Cero, 38(4), 57–72.
Vos, P., De Cock, P., Petry, K., Van den Noortgate, W., & Maes, B. (2010). Do you know what I feel? A first step towards a non-interpretative measurement of the
subjective well-being of persons with profound intellectual and multiple disabilities. Journal of Applied Research in Intellectual Disabilities, 23, 366–378.
Wang, M., Schalock, R. L., Verdugo, M. A., & Jenaro, C. (2010). Examining the factor structure and hierarchical nature of the quality of life construct. American Journal
on Intellectual and Developmental Disabilities, 115(3), 218–233.
Wilson, M. (2005). Constructing measures: An item response Modeling approach. Mahwah, NJ: Erlbaum.
Wong, P. K. S., Wong, D. F. K., Schalock, R. L., & Chou, Y. C. (2011). Initial validation of the Chinese Quality of Life Questionnaire–Intellectual Disabilities (CQOL-ID):
A cultural perspective. Journal of Intellectual disability Research, 55, 572–580.