Assessment in Developmental Disabilities: Tools

Assessment in Developmental Disabilities
A Lecture for NSP Special Topics Course NRSC 7670 OV1 (Course Director:  K. Gardiner)
February 5 & 7, 2013

Presented by Susan Hepburn, Ph.D.
Licensed Clinical Psychologist/Associate Professor
Departments of Psychiatry & Pediatrics/JFK Partners/University of Colorado
 

 

DEVELOPMENTAL/INTELLECTUAL ASSESSMENT TOOLS
(sequenced developmentally)

1.  The Ages and Stages Questionnaire (ASQ) (Bricker & Squires, 1995) is a standardized screener for developmental concerns in children from 4 to 60 months of age. Nineteen different questionnaires cover designated age intervals. Each questionnaire covers fine motor, gross motor, problem solving, communication, and personal social areas of development. Each sub-section is scored on a pass/fail basis.  Pediatric practices use this tool to learn about general development.

Bricker, D., Squires, J. (1995). Ages and Stages Questionnaire: A parent-completed child monitoring system (2nd ed.) Baltimore, MD: Brookes.

2.  The Mullen Scales of Early Learning (MSEL; Mullen, 1995)
The MSEL is a standardized, comprehensive measure of development for infants and preschool children from birth to 68 months.  It includes five subscales: visual reception (i.e., solving problems without language), gross and fine motor, receptive and expressive language. The MSEL can be administered in a playful fashion.  Items can be administered in any order, allowing for the examiner to adjust to the interests and motivation of the child being tested.  The MSEL provides estimates of verbal and nonverbal problem-solving abilities.  It is widely used in studies of young children with developmental disabilities.  The MSEL demonstrates strong concurrent validity with other well-known developmental tests of motor, language, and cognitive development.  Mullen, E. M. (1995). Mullen scales of early learning (AGS ed.). Los Angeles: Western Psychological.

3.  Bayley Scales of Infant Development –II and II I(Bayley, 1993; 2005).  The Bayley is a standardized developmental assessment for young children (1-42 months) that requires approximately 45-60 minutes to administer.  The Bayley provides a Mental Development Index (MDI) and a Psychomotor Development Index (PDI).  The direct assessment also includes additional checklists for parents to complete.  Psychometric characteristics are strong and the materials are child-friendly.  Administration requires training for fluent, standardized use.  Perhaps more appealing to young children than the MSEL (in my opinion), it can be harder to tease apart verbal and nonverbal problem-solving on the Bayley than on the MSEL.

Bayley, N. (1993). The Bayley scales of infant development (2nd ed.). San Antonio, TX: Harcourt Brace. Bayley, N. (2005).  The Bayley scales of infant development (3rd ed.). San Antonio, TX: Harcourt Brace.

4.  Differential Abilities Scale (DAS; Eliot, 1990)
The DAS is a standardized test of intelligence with versions suitable for children from ages 2 ½ to 18 years that provides age equivalents and standard scores.  The DAS can be administered to children who are not verbal and it is expected that most children will obtain basal scores on the DAS – if not on the school-age version, then on the preschool version.   The School-Age Version is comprised of six core subtests which yield summary scores for: verbal performance, nonverbal performance, and spatial performance, as well as an overall score termed the General Conceptual Ability (GCA). 

While subtests provide T scores (M = 50, SD = 10), the verbal, nonverbal, spatial, and GCA scores are reported as standard scores, with a mean of 100 and standard deviation of 15. Ability scores, T-scores, and age-equivalent scores are computer for each subtest and standard scores are provided for the three composites and the General Conceptual Ability Score.  Verbal performance and Nonverbal performance are usually used to reflect a child’s profile of cognitive functioning.  In terms of its psychometrics, the DAS manual reports good to excellent properties in terms of both validity and reliability and shows acceptable convergent reliability with both the WISC-IV and WASI (Eliot, 1990). Eliot, 1990.  Manual for the Differential Ability Scales.  Austin, TX:  Psychological Corporation. 

5.  Wechsler Preschool and Primary Scale of Intelligence- Revised (WPPSI-R) (Wechsler, 1989).  The WPPSI-R is a standardized assessment of intellectual potential designed for children ages 3 – 7 years.  It contains 12 subtests, which load on either a Verbal Composite or a Performance Composite.  It also provides a Full IQ estimate. Wechsler, D. /Psychological Corporation (1989.)  Manual for the Wechsler Preschool and Primary Scale of Intelligence- Revised.  Austin, TX:  Harcourt.

6.  Wechsler Intelligence Scales for Children-IV (WISC-IV) (Wechsler, 2003).  The WISC-IV is a standardized test of intelligence for children ages 6-16.  It examines both verbal and nonverbal intelligence performance and provides age equivalents and standard scores for each. The WISC-IV generally demonstrates good psychometric properties and shows acceptable convergent reliability with both the WASI and DAS (Wechsler, 2003). Wechsler, D./Psychological Corporation (2003).  Manual for the Wechsler Intelligence Scales for Children.  Austin, TX:  Harcourt.

7. Wechsler Abbreviated Scales of Intelligence (WASI) (Wechsler, 2002). This IQ screener provides an estimate of the child’s verbal and nonverbal abilities in a relatively brief period of time. The WASI contains four subtests (Vocabulary, Similarities, Block Design, and Matrices), takes approximately 30 minutes to administer, and is appropriate for children and adults older than 6 years.  The WASI has been shown to provide scores that are reliable with a full battery (i.e., WISC-IV) in samples of children with autism spectrum disorders.  The WASI also shows acceptable convergent reliability with both the WISC-IV and DAS in population-based samples (Wechsler, 2002). Wechsler, D./Psychological Corporation (2002).  Manual for the Wechsler Abbreviated Scales of Intelligence.  Austin, TX:  Harcourt.

8.  Stanford-Binet – Fifth Edition (SB-5) (Thorndike, Hagen & Sattler, 1986/2005).  The SB-5 is a standardized intelligence test designed for age 2-through older adulthood.  It provides composite scores and overall IQ estimates and has excellent psychometric properties.  The SB-5 has a brief IQ battery that is useful in research protocols.  Thorndike, Hagen & Sattler, 1986/Riverside, 2005.  The manual for the Stanford-Binet Intelligence Scales.  Los Angeles:  Riverside.

Developmental Assessments to Try if Person is Nonverbal or Difficult to Engage in Standardized Testing

1.  Child Development Inventory (CDI; Ireton, 1992).  The Ireton CDI is a 270-item parent/caregiver checklist that covers 8 areas of development (social, self-help, gross motor, fine motor, expressive language, language comprehension, letters, and numbers) and is suggested to be used for persons whose overall developmental level is approximately 6 years or less.  Norms are available for chronologically young children and age equivalent scores can be derived for older individuals who are developmentally impaired.  The CDI provides developmental estimates that are roughly equivalent to the results of standardized assessments of overall development.  Common practice in research and clinical protocols is usually to attempt standardized assessment before moving to the CDI as the tool of choice. Ireton, H. (1992).  Child Development Inventory Manual.  Minneapolis, MN:  Behavior Science Systems.

2.  Leiter International Performance Scale-Revised (Leiter-R; Roid & Miller, 1997). The Leiter-R is a standardized nonverbal measure of intelligence, often used to estimate the nonverbal problem-solving potential of individuals who do not use speech.  Several summary scores can be derived; most studies in autism research use the ‘‘Brief IQ’’, which can be obtained in less than an hour and is based on four subtests (Repeated Patterns, Sequential Order, Figure-Ground, and Form Completion).  Convergent validity varies, but the Leiter may produce elevated scores, relative to the Wechsler tests. Roid, G. H., & Miller, L. J. (1997). Leiter international performance scale revised. Wood Dale, IL: Stoelting Co.  J Autism Dev Disord (2007) 37:49–61

3.  Peabody Picture Vocabulary Test – III (PPVT; Dunn & Dunn, 1981; 1997).  See “Tools for Learning about a Student’s Communication, Speech & Language Skills.”

Tools for Learning about a Student’s Communication, Speech & Language Skills

1.  MacArthur-Bates Communicative Development Inventories:  Words & Gestures (CGI-WG). The MacArthur-Bates Communicative Development Inventories:  Words & Gestures (CGI-WG; Fenson et al, 1993; 2003) is a 4-page inventory of specific words and nonverbal acts that are important in the development of communication in young children.  The parent or educator/interventionist who knows the child indicate which of the words/behaviors on this rather long list the child is currently expressing, as well as those the child appears to understand.  The result is a developmentally informed snapshot of the child's current communicative profile (including both nonverbal and verbal acts of sending and receiving messages).  The MacArthur CGI has been shown to be sensitive to treatment effects - it could be used as part of an IEP objective to measure a child's nonverbal communication before and after a year in school, for example.

Who it’s best for:  Developed and normed on children who are between 8 and 16 months old, the CGI can provide helpful qualitative information for students who are not yet effective communicators - either verbally or nonverbally, at just about any age.  Because the tool is geared to early childhood, if you want to use it for a student who is older than 3 years old, I would recommend asking the parent questions in order to fill out the form instead of giving it directly to them, as you will want to skip some sections that are not developmentally appropriate for an older, nonverbal student. 

Fenson et al. (1993; 2003).  MacArthur Communicative Development Inventories.  San Diego:  Singular Thompson Learning. 

2.  Peabody Picture Vocabulary Test – III (PPVT) (Dunn & Dunn, 1981; 1997).  The PPVT-III is a commonly used standardized assessment of receptive language skills, and is frequently used as a proxy for overall intellectual functioning when assessing individuals with speech/language impairments (including articulation difficulties).  It can be used across the lifespan and provides norm-referenced scores.  Training is minimal and the PPVT can be administered by someone with basic training in standardized testing. Dunn, L. & Dunn, L. (1981; 1997).  Peabody Picture Vocabulary Test=III.  Circle Pines, MN:  AGS Publishing.

3.  Clinical Evaluation of Language Fundamentals-4 (CELF-4)  (Semel, Wiig, & Secord, 2003).  The CELF-4 is a standardized comprehensive assessment of expressive and receptive language skills.   Norms are available for children 5-17, although there is a companion measure for preschoolers.  Two slightly different versions are administered to children aged 9-12 and 13-21.  The CELF-4 is widely used in educational and clinical settings and generally demonstrates good psychometric properties.  It is usually administered by a speech-language pathologist in clinical settings, but may be administered by a trained master’s level clinician for research studies. Semel, Wiig, & Secord, 2003.  Manual for the Clinical Evaluation of Language Fundamentals – 4.  Austin, TX:  Psychological Corporation.

4.  Children’s Communication Checklist-2 (CCC-2) (Bishop, 2003).  The CCC-2 is a 70-item checklist used to measure pragmatics (i.e., social-communication) that is completed by an adult who knows the child well (e.g., parent, therapist, teacher).  It’s been used in studies of autism, language impairment, and intellectual/developmental disabilities.  The CCC provides at total Scaled score and ten normed subscales:  “A-Speech (i.e., intelligibility); B-Semantics (i.e., word finding/vocabulary access); C-Syntax (i.e, grammar); D-Coherence (e.g.,  making sense in conversation through the proper referencing and sequencing of events); E-Inappropriate Initiation* (e.g.,  indiscriminate, talks too much, doesn’t initiate topics about reciprocal interests, repetitive initiating); F-Stereotyped Language* (e.g.,  overuse of “learned chunks” in conversations;  being “precise” in communications); G-Use of Context* (e.g.,  use and understanding of the social rules governing communication, including politeness, sarcasm, and humor;  ability to correctly interpret others, including abstract language concepts); H-Nonverbal Communication* (e.g.,  understanding and using nonverbal conversational cues including both gestures and affect); I-Social Relations (i.e.,  regard for and relationships with peers); and J-Interests (i.e.,  restricted and/or repetitive interests and flexibility).” [Bishop, 2003] A summary variable, The Social Interaction Deviance Composite (SIDC), may be derived from the Scaled Scores to consider whether or not a child is evidencing primarily structural or pragmatic language difficulties.

ASSOCIATED FEATURES:  MEASURES OF ASPECTS OF FUNCTIONING THAT TEND TO BE PROBLEMATIC IN SPECIFIC DEVELOPMENTAL DISABILITIES ; CAN ALSO BE USEFUL AS A WAY OF QUANTIFYING SOURCES OF INDIVIDUAL DIFFERENCES/REDUCING HETEROGENEITY (e.g., executive function, sensory responses, metal health issues, problem behaviors)

1.  Behavior Rating Inventory of Executive Functions (BRIEF): Preschool Version:  Gioia, Espy, & Isquith, 2003; School-Age Version:  Gioia, Isquith, Guy, & Kenworthy, 2000).  The BRIEF is an assessment system designed to gather information about how a person’s executive function skills impact functioning at home, in school and in the community.  Two different versions (Preschool and School-Age) allow for developmentally sensitive items across relevant areas of attention and self-regulation. 

Norms are provided for each of 9 subscales, as well as for a set of developmentally relevant factors that are thought to reflect global functioning.  For preschoolers, the BRIEF provides subscale scores for Inhibit, Shift, Emotional Control, Working Memory, Plan/Organize and composite scores for Global Executive Composite, Inhibitory Self-Contol Index, Emergent Metacognition Index, and Flexibility Index.

For school-aged children, the BRIEF provides subscale scores for Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor.  Composite scores are computed for a Global Executive Index, Behavioral Regulation Index, and a Metacognition Index.  The BRIEF has been used in many studies of executive function in special populations, including autism, fragile X syndrome and Down syndrome. Gioia et al, (2003).  Manual for the Preschool Version of the Behavior Rating Inventory of Executive Functions.  Lutz, Florida:  Psychological Assessment Resources.  Gioia et al, (2000).  Manual for the School-age Version of the Behavior Rating Inventory of Executive Functions.  Lutz, Florida:  Psychological Assessment Resources. 

2.  Emotion Regulation Checklist (ERC) (Shields & Cicchetti, 1997) is a brief (24-item) parent/teacher report measure that provides information regarding a child’s typical responses to emotionally intense experiences.  The instrument has good reliability and validity across adult informants and provides indices regarding the child’s ability to modulate and express affect in a manner that is context-appropriate.  The ERC has been shown to be sensitive to change in effectiveness studies of CBT protocols with anxious youth (Suveg, Kendall, Comer, & Robin, 2006). Shields, A., & Cicchetti, D. (1997).  Emotion-regulation among school-age children:  The development and validation of a new Q-sort scale.  Developmental Psychology, 33, 906-917.

Suveg, C., Kendall, P.C., Comer, J.S., & Robin, J. (2006).  Emotion-focused cognitive-behavioral therapy for anxious youth:  A multiple baseline evaluation.  Journal of Contemporary Psychotherapy, 36, 77-85.

3.  Short Sensory Profile (SSP) (MacIntosh, Miller, Shyu & Dunn, 1999).  The SSP is a 38-item parent questionnaire designed to provide information about a child’s sensory responses in daily life. Norming procedures for the SSP included a national US sample of 117 children and the measure shows high internal reliability (.91). The SSP is a brief version of the more extensive 125 item Sensory Profile assessment measure, and includes the domains: Tactile Sensitivity, Taste/Smell Sensitivity, Movement Sensitivity, Underresponsive/Seeks sensation, Auditory Filtering, Low Energy/Weak, and Visual/Auditory Sensitivity. McIntosh, D.N., Miller L. J., Shyu, V., & Dunn, W.. The Sensory Profile: Examiner’s Manual, 1999.

4.  The Multidimensional Anxiety Scale for Children (MASC) (March, 1998) is a 39-item, 4-point Likert-type scale of anxiety symptoms, designed for youth 8-19 years.  It has a youth self-report and a parent report version.  The MASC has strong psychometric properties (March, Parker, Sullivan, Stallings, & Conners, 1997) and preliminary evidence suggests it may also perform well in ASD samples (Bellini, 2004).  The MASC measures the frequency (e.g., often true) of 39 thoughts, feelings or actions related to anxiety.  The questionnaire should take approximately 15 minutes for the child to complete.

Bellini, S. (2006).  The development of social anxiety in high-functioning adolescents with autism spectrum disorders.  Focus on Autism and Other Developmental Disabilities, 2, 138-145. 

March, J.S. (1998). Multidimensional anxiety scale for children. North Tonawanda, NY: Multi-Health Systems.

Scale for Children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 554–565.

5.  Children’s Depression Inventory (CDI) (Kovacs, 1981) is a brief, 27-item self-report screening tool for depression in youth (7 -19 years).  A score of 13 or higher is indicative of significant risk of depression.  Psychometric properties (internal consistency, test-retest reliability) are strong.  Requires functional language ability of approximately 8 years to be valid.  Kovacs, M. (1981).  Rating scales to assess depression in school-aged children.  Acta Paedopsychiatrica, 46, 305-315.

6.  Child Behavior Checklist (CBCL) (Achenbach, 1983; 1991). The CBCL is a standardized parent checklist that assesses behavior problems and social competencies in children 18 to 70 months of age. The CBCL was used to define child affective, anxiety, pervasive developmental, attention deficit/hyperactivity, and oppositional defiant problems.  Achenbach, T. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington, VT: University Medical Education Associates. Achenbach, T. M., & Edelbrock, C. S. (1983). Manual for the child behavior checklist and revised child behavior profile. Burlington, VT: University of Vermont Department of Psychiatry.

7.  The Developmental Behavioral Checklist (DBC) (Einfeld & Tonge, 1994) is a 96-item checklist (each item scored on a 3 point Likert scale) completed by parents or teachers to assess behavioral and emotional problems in children with a developmental disability. A Total Behavior Problem score is derived in addition to five subscale factor scores: Disruptive/Antisocial behavior, Self Absorbed Behavior, Communications Disturbance, Anxiety Problems and Social Relating Problems.  The DBC is considered to have good reliability and validity (Einfeld & Tonge, 1994) and is sometimes used in intervention effectiveness studies on children with developmental disabilities, including autism.  Two versions of the checklist are available: the Parent/Carer version (DBC-P) and the Teacher version (DBC-T).   

Einfeld, S. L., & Tonge, B. J. (1994). Manual for the developmental behaviour checklist. Clayton, Australia: Monash University Centre for Developmental Psychiatry and School of Psychiatry, University of New South Wales.

8.  Aberrant Behavior Checklist (ABC) (Aman & Singh, 1994).  The ABC is a brief parent/caregiver or teacher report checklist of externalizing and internalizing behaviors that is commonly used in studies of medication effectiveness.  There are versions that have been normed on special populations (e.g., Nisonger Child Report Form was normed on an institutionalized sample of adults with severe intellectual disabilities.)

Aman, M. G., & Singh, N. N. (1994). Supplement to the Aberrant Behavior Checklist. East Aurora, NY: Slosson Educational Publications.

Downloaded At: 22:35 16 February 2010 Risk Markers and Correlates in ID 93

9.  Behavior Assessment System for Children, 2nd ed. (Reynolds & Kamphaus, 2011).  The BASC-2 is a multi-informant assessment system that provides information concerning a child’s adaptive and maladaptive behaviors across settings.  Commonly used by school psychologists, the BASC is a developmentally sensitive instrument that provides standardized scores and estimates of significant risk across a range of internalizing and externalizing behaviors.  Psychometric properties are strong. Reynolds, C.R. & Kamphaus, R.W. (2011).  Behavior assessment system for children – Second edition.  San Antonio, TX:  Pearson Corporation.

TOOLS FOR ASSESSING AUTISM SYMPTOMS

SCREENING TOOLS

1.  Screening Tool for Autism in Two-Year Olds (STAT)
The STAT (Stone et al, 2000; 2004) is a brief interactive screening measure for use by early identification professionals.  It is designed for toddlers ages 12-23 months.  Comprised of a few play-based activities for screener to do with the child, accompanied by a very brief parent interview, the STAT has very strong psychometric characteristics.  Its been shown to be useful differentiating children at risk for ASD from those who are typically-developing, as well as those who are developmentally delayed or have language disorders.  Training and certification are necessary for responsible use.  The STAT has been successfully adopted in statewide Part C efforts in several states.  Stone, W.L., Coonrod, E.E. & Ousley, O.Y. (2000).  ‘Brief Report: Screening Tool for Autism in Two-Year-Olds (STAT): Development and Preliminary Data’, Journal of Autism and Developmental Disorders 30 (6): 607–12.

Stone, W.L., Coonrod, E.E., Turner, L.M., & Pozdol, S.L. (2004). Psychometric properties of the STAT for Early Autism Screening. Journal of Autism and Developmental Disorders, 34(6), 691-701.

2.  Infant-Toddler Checklist (ITC)
The Infant-Toddler Checklist (ITC; Wetherby & Prizant, 2002) is a 25-item checklist that was developed out of the SCERTS model of autism intervention and is very well attuned to the communicative aspects of ASD in young children.  Designed and validated in a large community sample of children between 6 and 24 months, there is evidence for its effectiveness in screening children for overall developmental delay, as well as differentiating ASD from developmental delay (without autism).  It is a highly sensitive tool (i.e., won't miss many children), but may over-identify ASD in some cases.  Wetherby, A., & Prizant, B. (2002). Communication and Symbolic Behavior Scales Developmental Profile–First Normed Edition. Baltimore: Paul H. Brookes.Wetherby & Prizant, 2002.

Wetherby, A.M., Brosnan-Maddox, S., Peace, V., & Newton, L. (2008). Validation of the infant-toddler checklist as a broadbrand screener for autism spectrum disorders from 9 to 24 months of age. Autism,12 (5), 487-511.

www.autismspeaks.org/videoglossary:  provides a library of videos of young children with and without high risk of ASD to illustrate behaviors they are looking for.

3.  Modified Checklist for Autism in Toddlers (M-CHAT)
The M-CHAT (Robins et al, 2001) is a 23-item checklist designed for caregivers to complete and then discuss with the examiner.  The goal of the tool is to try to differentiate between autism and general developmental delays in young children.  Best for children under the age of 3 years, the M-CHAT may also be helpful in screening children with known developmental disabilities as old as 10 years. 

The M-CHAT can be administered over the telephone, in a brief in-person meeting, or as a self-report measure with the screener asking follow-up questions, as needed. The American Academy of Pediatrics recommends that the M-CHAT be administered in well-child visits by pediatricians (see AAP.org).  It is also recommended that if the parent completes the checklist independently, it is best for someone to call the parent and ask a few follow-up or clarifying questions. 

How it is scored:  Scoring instructions are available in the websites listed below.  The M-CHAT provides a total score (ranging from 0 to 23), and scores above a certain score indicate that the child is “at risk” for ASD and is referred for further evaluation.  There is also a set of items designated as “critical,” meaning that if a parent or caregiver endorses 3 or more of these 7 items, then the child is also deemed “at risk” for ASD and is referred for further testing.

How much training it requires:  None, just some time to get familiar with the questions/behaviors of interest, and identify the critical items.

How to get it:  The M-CHAT is available for free responsible use at:  www.firstsigns.org or www.gsu.edu/~wwwpsy/faculty/robins.htm or for a nice version of the M-CHAT with scoring guide:  https://www.m-chat.org/_references/mchatdotorg.pdf.

Colleagues at JFK Partners worked with the M-CHAT developer and created an iPhone app for parents or clinicians to use.  For more information, contact:  deb.efird@ucdenver.edu.

Robins, D. L., & Dumont-Mathieu, T. M. (2006). Early screening for autism spectrum disorders: Update on the Modified Checklist for Autism in Toddlers and other measures. Journal of Developmental and Behavioral Pediatrics, 27(Supplement 2), S111–S119.

Robins, D. L., Fein, D., Barton, M. L., Greene, J. A. (2001). The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31, 131–144.

www.firstsigns.org

www.aap.org

4.  Social Communication Questionnaire (SCQ)
The SCQ (Berument et al, 1999; Rutter, Bailey & Lord, 2003) is a 41-item yes/no parent/caregiver checklist that has very strong scientific support as a screening tool for school-aged children.  The SCQ was derived from a well-respected interview -- the Autism Diagnostic Interview- Revised; Lord et al, 1999).   Although the ADI-R is thought to be part of a “gold standard” clinical/research evaluation for ASD, it is not thought to be an efficient tool for use in community settings.  The SCQ doesn’t provide as comprehensive a view of the child’s developmental history or current functioning as the ADI-R; however, the SCQ requires about 1/8th the time to administer (20 minutes vs 2 hours) and does not require special training.  Parents can complete it independently; however, follow-up discussion of items endorsed is recommended to be sure that the intent of the items was understood by the respondent.

The SCQ is best for children 4 years and older; works best if the child has a developmental age of 2 years or older.  May “miss” children who are very bright intellectually and have more subtle features; may also over-identify a child with significant developmental delays (and not autism).  There is some evidence it isn't as good a tool for assessing girls as boys.  Available in Spanish and English; however, the Spanish version has been criticized for its lack of cultural competence.  It is designed specifically for parents to complete, and although school staff can complete most items and provide qualitative information on the tool, it has not been validated for teacher report.  Berument, S.K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism Screening Questionnaire: Diagnostic validity. British Journal of Psychiatry,175, 444–451. Rutter, M.,Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles, CA: Western Psychological Services.

Allen, C.W., Silove, N.,Williams, K., & Hutchins, P. (2007) Validity of the Social Communication Questionnaire in assessing risk of autism in preschool children with developmental problems. Journal of Autism and Developmental Disorders, 37, 1272–1278.

Wiggins, L.D., Bakeman, R., Adamson, L.B., & Robins, D.L. (2007) The utility of the Social     Communication Questionnaire in screening for autism in children referred for early intervention. Focus on Autism and Developmental Disabilities, 22, 33–38.

Witwer, A.N., & Lecavalier, L. (2007) Autism screening tools: An evaluation of the Social Communication Questionnaire and the Developmental Behaviour Checklist-Autism Screening Algorithm. Journal of Intellectual and Developmental Disability, 32,179–182.

5.  Social Responsiveness Scale (SRS)
The SRS (Constantino et al, 2007) is a 65-item checklist that can be completed by parents or teachers of children 3 years and older.  Often used in genetics studies, the SRS was designed to try to tell the difference between autism and another psychiatric conditions.  The SRS frames questions that provide insight into how the child usually functions in natural settings.  It has been used in many genetic studies because it picks up on the "broader phenotype" - or characteristics of family members who don't present with full ASD, but have bits and pieces of the condition.  The SRS provides norm-based scores that help you to evaluate the person's risk for actually having an ASD and also allows for development of symptom lists.  There are separate tools for males and females.

The SRS is a good choice for a screening tool if the team is trying to differentiate autism from an emotional/behavioral disability.  Psychometrics are strongest in children 4-14 years and in samples of intellectually competent children.  It is also one of the only tools that uses different norms for boys and girls, making it potentially more sensitive and specific in evaluating females. Constantino, J.N., LaVesser, P.D., Zhang,Y., Abbacchi, A., Gray,T., & Todd, R.D. (2007). Rapid quantitative assessment of autistic social impairment by classroom teachers. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1668–1676.

Constantino, J.N.,& Gruber, C. P. (2005). The Social Responsiveness Scale Manual. Los Angeles: Western Psychological Services.

Constantino, J.N., Przybeck,T., Friesen, D., & Todd, R.D. (2000) Reciprocal social behavior in children with and without pervasive developmental disorders. Developmental and Behavioral Pediatrics, 21, 2–11.

Constantino, J.N., Davis, S.A., Todd, R.D., Schindler, M.K., Gross, M.M., Brophy, S.L.,Metzger, L.M., Shoushtari, C.S., Splinter, R., & Reich, W. (2003). Validation of a brief quantitative measure of autistic traits: Comparison of the social responsiveness scale with the autism diagnostic interview-revised. Journal of Autism and Developmental Disorders, 33(4), 427-433.

6.  Childhood Asperger Screening Test (CAST)
The CAST is a 37-item, parent report checklist that is currently being used in the educational identification process in Great Britain.  Originally designed for use in large epidemiological studies, the tool has been modified and tested in school settings, with promising results. 

Who it’s best for:  Elementary-middle, school-aged children in general education settings who have not been identified with a significant intellectual impairment.  It is not validated in children who are not using verbal speech.  Most of the normative samples have been Caucasian, but do represent a broad sample of socioeconomic status.  The CAST may be especially useful if there is concern about a differential between ASD and ADD/ADHD.  Although it is not clear yet if it is useful for high school students, my review of the tool suggests it would provide qualitative information that will be useful, however, it is not known if the scoring algorithms will work as well with older students.

How to get it:  The CAST is available for free through:  www.autismresearchcentre.com

Scott, F.J., Baron-Cohen, S., Bolton, P. & Brayne, C. (2002).  The CAST (Childhood Asperger Syndrome Test): Preliminary Development of a UK Screen for Mainstream Primary-School-Age Children’, Autism 6 (1): 9–31.

Williams, J., Scott, F., Stott, C., Allison, C., Bolton, P., Baron-Cohen, S. & Brayne, C. (2005).  The CAST (Childhood Asperger Syndrome Test): Test Accuracy, Autism, 9 (1): 45–68.

7.  Asperger Syndrome Screening Questionnaire (ASSQ)
The ASSQ (Ehlers et al, 1999) is a teacher checklist of 27 items that was developed specifically for screening for high-functioning ASD in elementary & middle schools in Europe (Campbell, 2005; Posserud, Lundervold & Gillberg, 2006).  Psychometric data are strong.  For example, in an epidemiological study of the ASSQ in Sweden, all students with a medical diagnosis of Asperger syndrome obtained a score of 17 or higher on the ASSQ (Kadesjo et al, 1999).  Few children without an ASD obtained scores this high, although some children with attention deficit disorders (and not ASD) also obtained relatively high scores on the ASSQ.  As with all screening tools, further evaluation is necessary to differentiate an appropriate educational eligibility. Ehlers, S., Gillberg, C., & Wing, L. (1999). A screening questionnaire for Asperger syndrome and other high functioning autism spectrum disorders in school age children. Journal of Autism and Developmental Disorders, 29, 129–141.

Campbell, J. M. (2005). Diagnostic assessment of Asperger’s disorder: A review of five third-party rating scales. Journal of Autism and Developmental Disorders, 35(1), 25–35.

Kadesjo, C., Gillberg, C., & Hagberg, B. (1999). Autism and Asperger syndrome in 7-year old children: A total population study. Journal of Autism and Developmental Disorders, 29(4), 327–331.

Posserud, M., Lundervold, A.J., & Gillberg, C. (2006). Autistic features in a total population of 7–9 year old children assessed by the ASSQ. Journal of Child Psychology and Psychiatry, 47(2), 167–175.

EVALUATION TOOLS

Autism Diagnostic Interview-Revised (ADI-R; Rutter et al. 2003)
The ADI-R is a semi-structured parent interview that operationalizes DSM-IV and ICD-10 criteria for autism.  Trained interviewers assess domains of social interaction, communication, and restricted, repetitive behaviors/interests.  Onset status can be categorized well.  The interview consists of over 100 questions.  An algorithm has been established that differentiates autism from other developmental disorders at high levels of sensitivity and specificity (over .90 for both) for subjects with mental ages (MA) of 18 months and older.  The ADI-R was developed as the parent interview companion measure to the ADOS.  The ADI-R is used in research more than in clinical practice, due to the amount of time it requires to administer (as well as the amount of time required for clinicians to achieve certification). 

Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism diagnostic interview-revised. Los Angeles: Western Psychological Services.

Lord, C., Rutter, M. & LeCouteur, A. (1994).  ‘Autism Diagnostic Interview–Revised: A Revised Version of a Diagnostic Interview for Caregivers of Individuals with Possible Pervasive Developmental Disorders’, Journal of Autism and Developmental Disorders 24 (5): 659–85.

Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore, & Risi, 2002) is thought to be the “gold standard” tool for direct observation of autism symptoms.  Designed for research and now integrated into clinical practice, the ADOS is comprised of 4 modules, arranged by language level.  Administrators must complete training in administration and scoring before using.  Revised algorithms now include a severity score, in addition to suscale scores, organized by symptom cluster (e.g., social-communication, repetitive activities).

The reliability and validity of the ADOS are very strong (Lord, Rutter, DiLavore, & Risi, 2002; Risi et al, 2008), particularly when the person being evaluated has a nonverbal problem-solving developmental level of 12 months or higher.  (At lower levels, the ADOS is less specific in differentiating autism from intellectual impairment without autism.)

Gotham, K. et al. (2007).  The Autism Diagnostic Observational Schedule: Revised algorithms for improved diagnostic validity.  Journal of Autism and Developmental Disorders, 37, 613-627.

Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The Autism Diagnostic Observation Schedule–Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.

Lord, C., Rutter, M., DiLavore, P.C., & Risi, S. (2002). Autism Diagnostic Observation Schedule. Los Angeles: Western Psychological Services.

Lord, C., Leventhal, B. L., & Cook, E. H. (2001). Quantifying the phenotype in autism spectrum disorders. Neuropsychiatric Genetics, 105, 36–38.