Malay translation, adaptation, and validation of the pediatric Khalfa Hyperacusis Questionnaire for children with autism spectrum disorder.

Abstract

Objective: Hyperacusis is characterized by an intolerance to loud sounds, causing discomfort, fear, and facial pain. Its evaluation often includes self-report questionnaires. A recent study in 2023 introduced the pediatric parent-report version of the Khalfa Hyperacusis Questionnaire (P-HQ) for children with autism spectrum disorder (ASD), but no Malay version currently exists, creating a barrier for non-English-speaking parents in Malaysia. This study aimed to translate, culturally adapt, and validate the P-HQ into Malay to improve the understanding of hyperacusis among Malay-speaking populations.

Materials and methods: The study consisted of six stages: (1) forward and backward translation by five independent translators, (2) content validation by six experts, (3) face validity assessments (n = 11), (4) assessment of internal consistency (n = 54), (5) validation of test-retest reliability (n = 23), and (6) assessment of concurrent validity (n = 54) with parents of children with ASD. Participants were purposively recruited from a community autism center located on the east coast of Malaysia.

Results: The translation process was successful, with experts confirming high relevance and agreement (item-level content validity index = 1.0, modified kappa = 1.0). One item was removed due to low item impact, resulting in a 10-item Malay version of the P-HQ (M-P-HQ). The M-P-HQ demonstrated good internal consistency (Cronbach's alpha = 0.884) and moderate to excellent test-retest reliability, with the intraclass correlation coefficient ranging from 0.62 to 0.96. A strong negative Spearman's rank correlation (rs = -0.648) with the auditory filtering subtest of the Malay version of the Short Sensory Profile supported the concurrent validity of the M-P-HQ.

Conclusion: The M-P-HQ is a valid, reliable, and culturally appropriate tool for assessing hyperacusis among Malay-speaking parents of children with ASD.