The use of Likert scales with children.

OBJECTIVE We investigated elementary school children's ability to use a variety of Likert response formats to respond to concrete and abstract items. METHODS 111 children, aged 6-13 years, responded to 2 physical tasks that required them to make objectively verifiable judgments, using a 5-point response format. Then, using 25 items, we ascertained the consistency between responses using a "gold standard" yes/no format and responses using 5-point Likert formats including numeric values, as well as word-based frequencies, similarities to self, and agreeability. RESULTS All groups responded similarly to the physical tasks. For the 25 items, the use of numbers to signify agreement yielded low concordance with the yes/no answer format across age-groups. Formats based on words provided higher, but not perfect, concordance for all groups. CONCLUSIONS Researchers and clinicians need to be aware of the limited understanding that children have of Likert response formats.