Translation of the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale into an African Language: An Exploratory Study

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is commonly perceived as a cultural construct due to its disproportionate global representation, however limited data is available from Africa. Standardisation of screening tools in epidemiological studies is essential for global prevalence comparison, but tools such as the Adult ADHD Self-Report Scale (ASRS) have not been translated into African languages. Objective: To assess the translation process followed in attempting to adapt the ASRS into an indigenous African language widely spoken within South Africa for cross-cultural research. Method: Xhosa was selected as an appropriate target language for translation. An exploratory approach was used to assess linguistic considerations for adaptation of the ASRS. Blind translation was applied by two independent bilingual translators. A translational studies expert translated the ASRS into Xhosa. The translated document was back-translated into English by a bilingual pharmacist. Key findings: Side-by-side comparison of the original and back-translated English versions revealed 13 content queries. Each query was discussed with the back translator, revealing common themes which complicated the effective Xhosa ASRS translation. Appropriate contextualisation of questions and removal or explanation of idiomatic terms were identified as key requirements to improve properties for Xhosa translation. Conclusion: Suitability of the original instrument for Xhosa translation was problematic and further investigation into appropriate cross-cultural translation techniques is needed to improve ASRS translation properties and assess its Xhosa translation. Development of a suitable Xhosa version of the ASRS is considered to be an important step towards broadening the scope of ADHD research in South Africa.