Purpose: To evaluate the differences among the major subjective scales used to rate drooling in children with neurological disorders.

Patient and Methods: Children with neurological disorders of broad aetiologies were recruited and three different subjective scales were administered: the Drooling Impact Scale (DIS), the modified Teachers' Drooling Scale (mTDS), and the Drooling Severity and Frequency Scale (DSFS). Participants were then divided into 2 groups (A and B) according to the score obtained on the DSFS scale. The Mann-Whitney U test was applied to verify and quantify the difference between the DIS scores obtained in the two groups. The Pearson's correlation was used to verify the correlation between the DSFS score and the DIS total (DIS-tot) score, the DSFS score and DIS (domain 1 to 5) score, and the DSFS score and the mTDS score. Moreover, we analyzed the correlation between age and DSFS/DIS-tot scores, and age and the mTDS score.

Results: 31 children (mean age: 7.3 ± 4.5 years) were enrolled. Group A included 11 (35%) patients with a DSFS score of 2-5; group B included 20 (65%) patients with a DSFS score of 6-9. The Mann-Whitney test highlighted a significant difference between group A and group B with a DIS-tot score of p = 5 × 10−5. We obtained a strong correlation between DSFS and DIS-tot (r = 0.86), between DSFS and mTDS (r = 0.88), and between DIS-tot and mTDS (r = 0.87). No correlation was found between age and DSFS (r = 0.12).

Conclusion: The DIS, DSFS, and mTDS scales are effective in rating drooling, both in terms of severity and frequency. A subjective illustrative approach should, however, include an adequate assessment of the patient as a whole. In light of the impact that drooling has on the quality of life of these patients, the development of a comprehensive method to assess this condition is essential in the future.

Drooling affects up to 58% of children with severe neurological disorders and greatly influences the patient’s Quality of Life (QoL). Drooling recognition and therapeutic management represent a fundamental step in the care of both the patient and his caregivers. Nowadays, novel treatments for pediatric drooling are facing the market, although the methods to assess their clinical utility and efficacy are not experimentally grounded and lack uniformity. The lack of reliable metrics to assess efficacy and safety outcomes in drooling limits researchers from identifying the best patient-suitable treatment. Furthermore, existing objective assessment methods do not consider the overall patient’s quality of life, which is a fundamental parameter in evaluating treatments’ effectiveness. Therefore, the application of subjective scales is suggested. The main goal is to develop a unique and validated technique to rate drooling, which will allow a reliable and safe assessment, and to carry out a detailed analysis of the effectiveness of the specific anti-drooling treatment. Therefore, a key enabler for new efficient therapies stands in the introduction of accurate and robust scales to measure their effects on drooling. An accurate approach must study the severity, frequency, and all the physical and psychological complications to improve the quality of life of the patients and their families. Sforza and collaborators reviewed the scales used for a comprehensive assessment of drooling; however, they underlined the need for more data to determine validity, reliability, and responsiveness. We performed a pilot experimental study on a group of Italian paediatric patients with neurological disorders of broad aetiologies, to evaluate the adequacy and differences between the three most used subjective scales (DIS, mTDS, and DSFS) in rating drooling.