Adaptation and psychometric properties of the Head-Toes-Knees-Shoulders task in young Iranian children.

Abstract

Executive functions (EF) lay the foundation for healthy development. However, few reliable and valid measures of EF have been developed among children in less developed countries such as Iran. The present study addressed this gap by examining the factor structure, score variation, and psychometric properties of a short EF task, the Head-Toes-Knees-Shoulders (HTKS), among children from two metropolitan cities (Isfahan and Tehran) in Iran. Participants (N = 693; 58% male; M_age = 5.88 years) were recruited through a convenience sampling approach and tested with the HTKS along with other performance-based EF measures and parent reports of EF difficulties. Confirmatory factor analyses showed that both one-factor and two-factor structures were acceptable and that a one-factor solution was optimal. Results demonstrated significant variability in scores and age-related differences in EF skills, with higher scores observed in older children. The task indicated acceptable internal consistency, interrater agreement, and test-retest stability. For construct validity, the HTKS was significantly related to other performance-based measures of EF, tapping into working memory, cognitive flexibility, and planning skills after controlling for child's age, gender, parental education, and city. Together, these findings underscore the promise of the HTKS task as a brief, economical, and easily administered EF task that reliably and validly captures variation in EF skills among Iranian children.