OBJECTIVE. We developed the Assessment of Children’s Hand Skills (ACHS) to evaluate hand skills using naturalistic observation and examined the assessment's interrater and test–retest reliability.

METHOD. We developed the hand skill framework, performed expert review, and pilot tested the ACHS. The ACHS's reliability was examined by recruiting 54 children (30 typically developing children and 24 children with disabilities).

RESULTS. The test–retest reliability for the ACHS was satisfactory at the individual item level (0.42 ≤ κ ≤ 0.79) and the total scale level (Spearman’s ρ = 0.78, p < .01). Moderate interrater agreement of the total scale scores was demonstrated (ρ = 0.63, p < .01), but individual items exhibited varied interrater agreement.

CONCLUSION. The ACHS demonstrated adequate content validity and preliminary reliability evidence and could be used to quantify children’s hand skill use. Construct validity should be established in a clinical setting.

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