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Autism Resources:
Assessment Procedures


Taken from APPENDIX B of:

Best Practices for Designing and Delivering Effective Programs for Individuals with Autistic Spectrum Disorders: Recommendations of the Collaborative Work Group on Autistic Spectrum Disorders

Sponsored by the California Departments of Education and Developmental Services - July 1997

DIAGNOSTIC AND ASSESSMENT INSTRUMENTS APPROPRIATE FOR USE WITH CHILDREN WITH AUTISTIC SPECTRUM DISORDERS

The following instruments are used by educators, clinicians, and researchers to assess children suspected of, or previously diagnosed with, a pervasive developmental disorder. The instruments were selected for this list because they are used to measure specific dimensions of a child's development, environment, or family. The instruments listed provide measures of development in different domains of functioning. Rate of change in those domains is sometimes used as a baseline or as a follow-up measure of developmental progress or response to educational programming. Some of the instruments listed below are critically reviewed in Burros' Mental Measurement Yearbook. References are available on each device listed.


Diagnostic Assessment

Autism Diagnostic Interview - Revised

The Autism Diagnostic Interview-Revised (ADI-R) is a semi-structured, investigator-based interview for caregivers of children and adults for whom autism or pervasive developmental disorders is a possible diagnosis. Two studies (Lord, Rutter, R LeCouteur, 1994; Lord, Storoschuk, Rutter, R Pickles, 1993) were conducted to assess the psychometric properties of the ADI-R. Reliability was tested among 10 autistic (mean age 48.9 months) and 10 mentally handicapped or language-impaired children (mean age 50.1 months), and validity was tested among an additional 15 autistic and 15 nonautistic children. Results indicated the ADI-R was a reliable and valid instrument for diagnosing autism in preschool children. Inter-rater reliability and internal consistency were good, and inter-class correlations were very high.

A standard diagnostic interview is conducted at home or in a clinic. The ADI-R is considered by some professionals in the field as a measure of high diagnostic accuracy. It takes several hours to administer and score. The ADI-R is recognized as one of the better standardized instruments currently available for establishing a diagnosis of autism. It is a semi-structured interview administered to subjects' caregivers which determines whether or not an individual meets the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) criteria for autism. The authors of the ADI-R plan to update the scoring procedure so it reflects DSM-IV criteria. The assessment begins with a home visit by a therapist who interviews the child's parents. A home visit provides a chance to meet the child and to get a sense of the parents' priorities. This interview may be scheduled as part of the in-clinic assessment (Rutter, Lord, & LeCouteur, 1990).

Prelinguistic Autism Diagnostic Observation Schedule

The Prelinguistic Autism Diagnostic Observation Schedule (PL-ADOS) (DiLavore, Lord, & Rutter, 1995) is a semi-structured observation scale for diagnosing children who are not yet using phrase speech and who are suspected of having autism. The scale is administered to the child with the help of a parent. This instrument provides an opportunity to observe specific aspects of the child's social behavior, such as joint attention, imitation, and sharing of affect with the examiner and parent. PL-ADOS scores are reported to discriminate between children with autism and children with nonautistic developmental disabilities. The resulting diagnostic algorithm is theoretically linked to diagnostic constructs associated with International Classification of Diseases (10th revision) and DSM-IV criteria for autism.

Childhood Autism Rating Scale

The Childhood Autism Rating Scale (CARS) was developed by the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) program staff in North Carolina to formalize observations of the child's behavior throughout the day. This 15-item behavior-rating scale helps to identify children with autism and to distinguish them from developmentally disabled children who are not autistic. Brief, convenient, and suitable for use with any child older than two years of age, the CARS makes it much easier for clinicians and educators to recognize and classify autistic children. Developed over a 15-year period, with more than 1,500 cases, CARS includes items drawn from five prominent systems for diagnosing autism. Each item covers a particular characteristic, ability, or behavior. After observing the child and examining relevant information from parent reports and other records, the examiner rates the child on each item. Using a seven-point scale, he or she indicates the degree to which the child's behavior deviates from that of a normal child of the same age. A total score is computed by summing the individual ratings on each of the 15 items. Children who score above a given point are categorized as autistic. In addition, scores falling within the autistic range can be divided into two categories: mild-to-moderate and severe. Professionals who have had only minimal exposure to autism can easily be trained to use CARS. Two training videos showing how to use and score the scale are available from Western Psychological Services (WPS) (Schopler, Reichler, DeVellis, & Daly, 1988; Schopler, Reichler, & Renner, 1986).

Autism Behavior Checklist

The Autism Behavior Checklist (ABC) is a general measure of autism. It is not as reliable as the CARS or ADI-R. Correlations between the ABC and CARS ranged from 0.16 to 0.73 in a study by Eaves and Milner (1993). The CARS correctly identified 98 percent of the autistic subjects; it identified 69 percent of the possibly autistic as autistic. The ABC correctly identified 88 percent of the autistic subjects, while it identified 48 percent of the possibly autistic as autistic. In two separate studies, teachers' ratings on the ABC failed to reveal a common set of characteristics of students with high functioning Autistic Disorder (Myles, Simpson, & Johnson, 1995) and Asperger's Disorder (Ghaziuddin, N., Metler, Ghaziuddin, M., Tsai, & Luke, 1993).

Checklist for Autism in Toddlers

The Checklist for Autism in Toddlers (CHAT) is a screening instrument designed to detect core autistic features to enable treatment as early as eighteen months. The most effective treatment currently available for autism is early educational intervention, beginning as soon as possible after a child's diagnosis. Unfortunately, intervention rarely begins before the age of three years because few autistic children are diagnosed before they reach preschool age. CHAT offers physicians a means of diagnosing autism in infancy so that educational programs can be started months or even years before most symptoms become obvious. According to the authors, "We stress that the CHAT should not be used as a diagnostic instrument, but it can alert the primary health professional to the need for an expert... referral."

This first study (Baron-Cohen, Allen, & Gillberg, 1992) using the CHAT re- vealed that key psychological predictors of autism at thirty months are showing two or more of the following at eighteen months: (a) lack of pretend play, (b) lack of protodeclarative pointing, (c) lack of social interest, (d) lack of social play, and (e) lack of joint-attention. The CHAT detected all four cases of autism in a total sample of 91 eighteen-month-old children. The authors recommend that if a child lacks any combination of these key types of behavior on examination at eighteen months, it makes good clinical sense to refer him or her for a diagnostic assessment by a specialist with experhse m auQsm.

A second study (Baron-Cohen, Cox, Baird, Swettenham, Nightingale, Morgan, Drew, & Charman, 1996) concluded that "consistent failure of three key items from the CHAT at eighteen months of age carries an 83.3 percent risk of autism, and this pattern of risk indicator is specific to autism when compared to other forms of developmental delay." In the second study, research data on 16,000 children suggested that children who failed three items on the CHAT are at high risk of being autistic. The items include protodeclarative pointing (pointing at an object to direct another person's attention to it – not to obtain the item, but simply to share an interest in it); gaze monitoring (turning to look in the same direction as an adult is looking); and pretend play. The false positive rate for detection of autism using the CHAT is estimated at 16.6 percent.

Real Life Rating Scale

The Real Life Rating Scale (RLRS) (Freeman, Ritvo, Yokota, & Ritvo, 1986) is a scale used to assess the effects of treatment on 47 behaviors in the motor, social, affective, language, and sensory domains among autistic persons. The RLRS is applicable in natural settings by nonprofessional raters, is rapidly scored by hand, and can be repeated frequently without affecting inter-observer agreement. Data are presented on inter-rater agreement among novice and experienced observers. Instructions for the scale, target behaviors, and definitions are appended to the journal article.

Pervasive Developmental Disorder Screening Test

The Pervasive Developmental Disorder Screening Test (PDDST) (Siegel, 1996) is designed to be administered in settings where concerns about possible autistic spectrum disorders arise. Different "stages" of the PDDST correspond to representative populations in (a) primary care clinics; (b) developmental clinics; and (c) autism clinics. The PDDST is designed as a screening test and is a parent report measure. As such, it does not constitute a full clinical description of early signs of autism but does reflect those early signs that have been found to be reportable by parents and correlated with later clinical diagnosis.

Autism Screening Instrument for Educational Planning (2nd ed.)

The Autism Screening Instrument for Educational Planning (2nd ed.) (ASIEP- 2) (Krug, Arick, & Almond, 1993) is a major revision of one of the most popular individual assessment instruments available for evaluating and planning for subjects with autistic behavior characteristics. Standardized and researched in diagnostic centers throughout the world, ASIEP-2 uses five components to provide data on five unique aspects of behavior with individuals from eighteen months through adult- hood. The components of the ASIEP examine behavior in five areas: Sensory, Relating, Body Concept, Language, and Social Self-Help. The ASIEP-2 samples vocal behavior, assesses interactions and communication, and determines learning rate. In combination, ASIEP-2 subtests provide a profile of abilities in spontaneous verbal behavior, social interaction, educational level, and learning characteristics. Revisions to the ASIEP-2 include a new decision matrix, a new norming table section, and simplified administration of the Prognosis of Learning Rate Subtest. The author reports a strong intercorrelation among the ASIEP-2 subtests and the utility of the battery to distinguish among groups of subjects with a variety of disabilities. ASIEP-2 components have been normed individually. Percentiles and standard scores are provided for the five subtests.

Diagnostic Checklist for Behavior-Disturbed Children (Form E-2)

The Form E-2 Diagnostic Checklist (Rimland, 1971), developed at the Institute for Child Behavior Research, was proposed as an assessment instrument that differentiates between cases of "classical" autism and a broader range of children with "autistic-like" features. Questions on Form E-2 reference behaviors in children between birth and age six years. This questionnaire is completed by the child's parents. The form is intended to be used to identify autism for "biological research." Rimland is clear that Form E-2 is not designed to determine whether or not a child is autistic for the purposes of being admitted to an educational or rehabilitative program.

Gilliam Autism Rating Scale

Designed for use by teachers, parents, and professionals, the Gilliam Autism Rating Scale (GARS) (Gilliam & Janes, 1995) helps to identify and diagnose autism in individuals ages three through twenty-two years and to estimate the severity of the problem. Items on the GARS are based on the definitions of autism adopted by the DSM-IV. The items are grouped into four subtests: stereotyped behaviors, communication, social interaction, and developmental disturbances. The GARS has three core subtests that describe specific and measurable behaviors.

An optional subtest (Developmental Disturbances) allows parents to con- tribute data about their child's development during the first three years of life. Validity and reliability of the instrument are high. Coefficients of reliability (internal consistency, test-retest, and inter-scorer) for the subtests are all in the 0.80s and 0.90s. Behaviors are assessed using objective, frequency-based ratings. The entire scale can be completed in five to ten minutes by persons who have knowledge of the child's behavior or the greatest opportunity to observe him or her. Standard scores and percentiles are provided.

 

Developmental Assessment

Psychoeducational Profile-Revised

The Psychoeducational Profile-Revised (PEP-R) (Schopler, Reichler, Bashford, Lansing, & Marcus, 1990) offers a developmental approach to the assessment of children with autism or related developmental disorders. It is an inventory of behaviors and skills designed to identify uneven and idiosyncratic learning patterns. The test is most appropriately used with children functioning at or below the preschool range and within the chronological age range of six months to seven years. The PEP-R provides information on developmental functioning in imitation, perception, fine motor, gross motor, eye-hand integration, cognitive performance, and cognitive verbal areas. The PEP-R also identifies degrees of behavioral abnormality in relating and affect (cooperation and human interest), play and interest in materials, sensory responses, and language.

The PEP-R kit consists of a set of toys and learning materials that are presented to a child within structured play activities. The examiner observes, evaluates, and records the child's responses during the test. There are 131 developmental and 43 behavioral items on the PEP-R. The total time required to administer and score these items varies From 45 minutes to 1.5 hours. Because it is not a test of speed, variations in total testing time depend on the child's levels of functioning and any behavior management problems that arise during the testing situation. At the end of the session, the child's scores are distributed among seven developmental and four behavioral areas. The resulting profiles depict a child's relative strengths and weaknesses in different areas of development and behavior. The Developmental Scale tells where a child is functioning relative to peers. The items on the Behavioral Scale have the separate, but related, assessment function of identifying responses and behaviors consistent with a diagnosis of autism. The PEP-R provides a third and unique score called emerging. A response scored "emerging" is one that indicates some knowledge of what is required to complete a task, but not the full understanding or skill necessary to do so successfully.

The Adolescent and Adult Psychoeducational Profile (AAPEP) extends the PEP- R to meet the needs of adolescents and adults.

Southern California Ordinal Scales of Development

The Southern California Ordinal Scales of Development (SCOSD), which is available from Western Psychological Services, was developed by the California Department of Education, Diagnostic Center in Southern California (1985). The developmental scales of cognition, communication, social affective behavior, practical abilities, gross motor, and fine motor abilities are based on two fundamental principles. First, they draw extensively on the developmental theories of Jean Piaget. Each scale is divided according to the levels and stages that Piaget describes in his writings on human development. Second, the SCOSD incorporates assessment techniques that aim to minimize the constraints of traditional, standardized ability testing. When possible, the examiner is encouraged to observe the child in his or her natural environment, using materials that are readily available and familiar. In interpreting the results of assessment, the examiner arrives at a total picture of the child's abilities in terms of the particular developmental scale.

The SCOSD is criterion-referenced rather than norm-referenced. Assessment procedures are flexible, rather than fixed, and the scoring system takes into account the quality as well as the quantity of responses.

Developmental Play Assessment Instrument

The Developmental Play Assessment Instrument (Lifter, Sulzer-Azaroff, Ander- son, R Edwards-Cowdery, 1993) is an instrument used to assess the play develop- ment of children with disabilities relative to the play of nondisabled children. The developmental quality of toy play is evaluated according to the level of pretend play and the frequency and variety of play activities within the level identified.

Brigance Inventory of Early Development

The Brigance Inventory (Brigance, 1978) is criterion-referenced rather than norm-referenced. While useful for assessment purposes, its value is in identifying instructional objectives, serving as a guide for measuring those objectives, and providing an ongoing tracking system. The Brigance Inventory is intended for informal assessment of several aspects of child development and is for children functioning at developmental levels from birth to seven years of age. Major areas assessed include general knowledge and comprehension, speech and language, preacademics, self-help, and psychomotor skills. Within these major areas, there are 98 subtests of sequenced developmental skills.

The Brigance Inventory permits different administrations to be used, such as observation, direct testing of the child, or reports from caretakers, child-care workers, or teachers. To elicit the child's maximum performance, clinicians are encouraged to allow children to respond in any possible fashion, such as pointing, eye localizations, or verbalizing. Clinicians are encouraged to adapt materials to best meet the needs of the child to get a response.

Reliability and validity measures of the Brigance Inventory are limited, as is true of most criterion-referenced instruments. There is no reported reliability or validity data in the manual.

The value of the Brigance Inventory lies in its ability to identify a child's pattern of strengths and weaknesses in several areas. The items are representative of a curriculum appropriate for an early childhood program and thus are easily linked to instructional planning and intervention (Bagnato, 1985). Another benefit of relating items to teaching and planning is that repeated assessments with the Brigance Inventory can pinpoint areas of gains and losses. The obvious caution here is to avoid teaching to the test since the items are so very specific. (See an article by Gory, 1985, for a review of the Brigance Inventory.)

Adaptive Assessment

Vineland Adaptive Behavior Scales

The Vineland Adaptive Behavior Scales (VABS) (Sparrow, Balla, & Cicchetti, 1984) comes in three forms varying in degree of detail and proposed setting. There is the Survey Form, the Expanded Form, and the Classroom Edition. The VABS is administered by interviewing the child's parents, teachers, or care providers. The scales range in age from birth to nineteen years. Raw scores from communication, daily living skills, socialization, motor skills, and maladaptive behaviors are converted to standard scores with a mean of 100 and a standard deviation of 15. The Adaptive Behavior composite score includes the domains noted above and reflects overall adaptive ability.

Questions have been raised about the scales' standardization and the accuracy of standard scores across the age range. One problem is lack of uniformity of scores across various ages. Depending upon the child's age, means and standard deviations differ. Thus, comparing the same child's performance on reassessment is compromised, as is the accuracy of any composite score. Differences among domain scores may be more apparent than real because of variable scores. There is considerable over- lap among the various domains with both communication and daily living domains containing questions about the child's language ability.

 

Communication Assessment

Sequenced Inventory of Communication Development (Rev. ed.)

The Sequenced Inventory of Communication Development (Rev. ed.) (SICD- R) (Hedrick, Prather, R Tobin 1984) tests a variety of early communication skills, giving a broad perspective of the semantic, syntactic, and pragmatic aspects of a child's receptive and expressive language. It combines parental report items with behavioral items that incorporate materials and methods to keep children's attention. The test provides for assignment of communication ages and for determining initial goals in communication programming. (Available from University of Washington Press, Seattle, Wash.)

The Nonspeech Test for Receptive/Expressive Language

The Nonspeech Test (Huer, 1988) is designed to provide a systematic way for observing, recording, and summarizing the variety of means in which an individual may communicate. This tool determines a person's skills as a communicator, whether speech or nonverbal means are used for communication. It allows for easy development of IEP objectives from the test response forms. (Available from Don Johnston Developmental Equipment, Inc.)

Assessing Semantic Skills Through Everyday Themes

The Assessing Semantic Skills Through Everyday Themes (ASSET) (Barrett, Zachman, & Huisingh, 1988) is a test of receptive and expressive semantics for pre- school and early elementary children. It is built around six common themes, which represent aspects of everyday life that are familiar and important to preschool and early elementary children. Test items emphasize vocabulary that is meaningful and relevant to the experiences of young children. There are five receptive and five expressive subtests, which are designed to elicit responses by questions or directions from the examiner, that refer to the illustrations in the picture stimuli book. Nonverbal performances on receptive vocabulary tasks can be compared to verbal responses on the expressive subtests. This evaluation instrument provides standardized analyses of receptive, expressive, and overall vocabulary abilities. (Available from LinguiSystems, Inc., Moline, Ill.)

Expressive One-Word Picture Vocabulary Test CRev. ed.)

The Expressive One-Word Picture Vocabulary Test (Rev. ed.) (Gardner, 1990) measures the child's ability to verbally label objects and people. The child must identify, by word, a single object or a group of objects on the basis of a single concept. This is a standardized test that provides age equivalents, standard scores, scaled scores, percentile ranks, and stanines. (Available 6om Academic Therapy Publications, Novato, Calif.)

Receptive One-Word Picture Vocabulary Test (Rev. ed.)

The Receptive One-Word Picture Vocabulary Test (Rev. ed.) (Gardner, 1990) obtains an estimate of a child's one-word hearing vocabulary based on what the child has learned from home and school. It provides information about the child's ability to understand language. This is a standardized test that provides age equivalents, stan- dard scores, scaled scores, percentile ranks, and stanines. (Available from Academic Therapy Publications, Novato, Calif.)

Clinical Evaluation of Language Fundamentals – Preschool

The Clinical Evaluation of Language Fundamentals – Preschool (CELF-P) (Wiig, Secord, R Semel, 1992) is a tool for identifying, diagnosing, and performing follow-up evaluations of language de6cits in preschool children. It assesses receptive and expressive language ability, including semantics, morphology, syntax, and auditory memory. It is standardized for ages three years and zero months through six years and eleven months. (Available from The Psychological Corporation, San Diego, Calif.)

ECOScales

The ECOScales Manual (MacDonald, Gillette, R Hutchinson, 1989) provides a model for evaluating the interactive and communication skills of preconversational children and their caregivers. The model is designed for both program planning and progress monitoring as well as for determining the child's performance. The ECOScales assessment approach assumes the adult is an active participant in the child learning to communicate. The ECOScales is an interactive approach which charts development from early play to conversations. Five levels of interactive development and delays are considered. The ECOScales Manual identifies disorders, not in terms of linguistic performance alone, but in terms of interaction skills and their role in fostering communication.

Peabody Picture Vocabulary Test (III)

The Peabody Picture Vocabulary Test (III) (PPVT-III) (Dunn & Dunn, 1981) measures an individual's receptive vocabulary for standard American English. It measures one facet of general intelligence: vocabulary. It takes a relatively short period of time to administer and may be used as an initial screening device. (Available from American Guidance Service, Circle Pines, Minn.)

Reynell Developmental Language Scales

The Reynell Developmental Language Scales (Reynell, 1987) is a language test for children from one to seven years. The Reynell measures comprehension (receptive language) and expressive language and is widely used with language-delayed children. This test will be given to all subjects at intake, at 12 months into treatment, at 24 months into treatment, and at follow-up to provide an index of the rate of growth in language functioning.

Preschool Language Scale (3rd ed.)

The Preschool Language Scale (3rd ed.) (PLS-III) (Zimmerman, Steiner, & Pond, 1992) has two standardized subscales, Auditory Comprehension and Expressive Communication, which allows evaluation of a child's relative ability in receptive and expressive language. When comparing scores, one can determine whether deficiencies are primarily receptive or expressive in nature or whether they reflect a delay or disorder in communication. Precursors of receptive skills (with a focus on attention abilities) and precursors to expressive skills (with a focus on social communication and vocal development) are also assessed. Supplemental measures include the Articulation Screener, the Language Sample Checklist, and the Family Information and Suggestions Form. (Available from The Psychological Corporation, San Diego, Calif.)

 

Infant/Toddler Assessment

Bayley Scales of Infant Development (2nd ed.)

New norms were recently developed for the Bayley Scales of Infant Development (2nd ed.) (BSID-II) (Bayley, 1993). The BSID-II allows diagnostic assessment at an earlier age. The BSID-II was designed to identify children who have a cognitive or motor delay and suggests needed forms of intervention. The BSID-II has been renormed on a stratified random sample of 1,700 children (850 boys and 850 girls) ages one month to forty-two months, grouped at one-month to three-month intervals, closely paralleling the 1988 U.S. Census statistics on the variables of age, sex, region, race and ethnicity, and parental education. The Behavior Rating Scale (formerly the Infant Behavior Record) was revised in both structure and content. The Mental Scale yields a normalized standard score called the Mental Development Index, evaluating a variety of abilities, including sensory-perceptual acuities, discriminations, and response acquisition of object constancy memory, learning, and problem solving, vocalization, beginning verbal communication, mental mapping, complex language and mathematical concept formation. The Motor Scale assesses degree of body control, large-muscle coordination, fine motor manipulatory skills, postural imitation, and motor quality.

The Behavior Rating Scale provides information to supplement the Mental and Motor scales. The 30-item scale rates the child's relevant test-taking behaviors and measures attention, arousal, orientation, engagement, and emotional regulation.

Mullen Scales of Early Learning

The Mullen Scales of Early Learning (MSEL) (AGS Edition, 1997) assesses early cognitive ability and motor development. This new standardized version of the MSEL combines the old Infant Mullen and the Preschool Mullen into one instrument that allows comprehensive assessment of language, motor, and perceptual abilities for children of all ability levels. Test ages range from birth to five years, eight months. This revised and updated version includes five additional scales, including Gross Motor, Visual Reception, Fine Motor, Expressive Language, and Receptive Language. Test scores provide an objective foundation for intervention planning and serve as baseline data for a continuum of appropriate teaching methods and interactions. The MSEL evaluates visual and language abilities at both receptive and expressive levels and provides a framework in which to examine infant development and interactional patterns. This test identifies uneven learning patterns and children who need support (visual and auditory) for weaknesses in reception and memory and indicates when input should be reduced because of sensory overload. The scale helps facilitate appropriate parent/child interactions, and assists in identifying the instructional approach, which links the ISP to the IFSP.

The publisher reports that it takes 15 minutes to assess a one-year-old using all five scales; 25-35 minutes to assess a three-year-old; and 40-60 minutes to assess a five-year-old. Mullen ASSIST computer software is available for scoring and report writing. (Available from American Guidance Service, Circle Pines, Minn.)

Early Coping Inventory

Early Coping Inventory (Zeitlin, Williamson, & Szczepanski, 1988) is an observation instrument to assess the coping behaviors that are used by infants and toddlers in everyday living. Analysis of a child's scores provides information about level of coping effectiveness, style, and strengths and weaknesses. The inventory has 48 items divided into three categories: sensorimotor organization, reactive behavior, and self- initiated behavior. It is designed to be used for children between ages four to thirty-six months, or for older children who function within this developmental range. (Avail- able from Scholastic Testing Service, Inc., Bensenville, Ill.)

 

Standardized Tests of Intelligence

Wechsler Preschool and Primary Scale of Intelligence (Rev. ed.)

The Wechsler Preschool and Primary Scale of Intelligence (Rev. ed.) (WPPSI- R) (Wechsler, 1989) is a frequently used intelligence test for children from three to seven years of age. It represents the gold standard for assessment for a multitude of situations. In addition, use of the WPPSI-R during preschool years dovetails smoothly with use of the Wechsler Intelligence Scale for Children (Rev. ed.) as children enter school and require reassessment.

The WPPSI-R contains the 11 original WPPSI subtests and an additional performance subtest, Object Assembly, which consists of colorful, appealing puzzles. Animal Pegs (formerly Animal House) and Sentences are now optional subtests. A design-recognition task was added to the Geometric Design subtest so that it now has two parts: Visual Recognition/Discrimination for younger children and Drawing of Geometric Figures for older children. The WPPSI-R provides norms for 17 age groups divided by three-month intervals from three years through seven years, three months. The norms are based on a standardization sample of 1,700 children stratified by age, race, sex, geographic region, parents' education, and parents' occupation. Subtest scaled scores are expressed as standard scores with a mean of 10 and standard deviation of 3.

Wechsler Intelligence Scale for Children (3rd ed.)

While retaining the basic structure and content of the revised edition, the Wechsler Intelligence Scale for Children – Third Edition (WISC-III) (Wechslgr, 1991) has up- dated normative data, improved items and design, and an added optional subtest. The WISC-III includes numerous additional statistical tables and relevant validity information. The WISC-III continues Wechsler's concept of intelligence as a global but multifaceted entity that can be inferred from a child's performance on a series of tasks. It is valuable for psychoeducational assessment, diagnosis, placement, and planning. WISC-III can be used to diagnose exceptionality among school-aged children and has a strong place in clinical and neuropsychological assessment and in research. Like the WPPSI-R, the WISC-III is widely used and generally regarded as the best standardized measure of intelligence. (Available from The Psychological Corporation, San Diego, Calif.)

Differential Ability Scales

The Differential Ability Scales (DAS) (Elliott, 1990) measures overall cognitive ability and specific abilities in children and adolescents. It is better suited for intellectually higher-functioning children with autism. The DAS assesses multidimensional abilities in children ages two years and six months to seventeen years and eleven months. It is administered individually and takes 45 to 65 minutes for the full cognitive battery. The achievement test takes 15 to 25 minutes to administer.

The seventeen cognitive and three achievement subtests yield an overall cognitive ability score and achievement scores. The three achievement subtests are Basic Number Skills, Spelling, and Word Reading. The DAS allows the examiner to explore differences among the various cognitive abilities as well as differences between cognitive abilities and academic achievement. Colorful, manipulative materials enhance the testing for preschoolers. The Preschool Level measures reasoning as well as verbal, perceptual, and memory abilities and is suitable for ages two years and six months to six years. The school-age level contains a variety of tasks suitable for children ages seven years to 17 years and 11 months.

Stanford-Binet Intelligence Scale (4th ed.)

The Stanford-Binet Intelligence Scale (4th ed.) (SBIS-IV) (Thorndike, Hagen, & Sattler, 1986) has a new format and scoring system, mostly new items, and a new national standardization. The SBIS-IV is for individuals ages two years to adult. It provides scores in four areas: Verbal Reasoning, Abstract and Visual Reasoning, Quantitative Reasoning, and Short-Term Memory; and a Composite Score that is equivalent to the Wechsler Scales Full Scale IQ. Standard scores with means of 100 and standard deviations of 16 are available for each of the four areas. The areas are composed of one or more subtests; the exact subtests administered depend on the individual's age and his or her performance. The subtests have a mean of 50 and standard deviation of 8.

 

Tests of Nonverbal Intelligence

Columbia Mental Maturity Scale (3rd ed.)

The Columbia Mental Maturity Scale (3rd ed.) (CMMS-III) (Burgemeister, Blum, & Lorge, 1972) is useful in evaluating children who have sensory or motor defects or who have difficulty speaking and, to some extent, reading. The test does not depend on reading skills. It provides age deviation scores (standard scores) for chronological ages between three years and six months and nine years and eleven months. The age deviation scores range from 50 to 150, with a mean of 100 and standard deviation of 16. A second score, the Maturity Index, indicates the standardization age group most similar to that of the child in terms of test performance.

The task is to have the child select the one drawing that is different from the others on each card. However, autistic children may have difficulty understanding the concept of pointing to the "one that does not belong." This untimed test usually takes 15 to 20 minutes to administer and is simple to score. The child is required to make perceptual discriminations involving color, shape, size, use, number, missing parts, and symbolic material. Tasks include simple perceptual classifications and abstract manipulation of symbolic concepts. The CMMS-III appears to measure general reasoning ability, although there is some evidence that it may be more of a test of the ability to form and use concepts than a test of general intelligence (Reuter & Mintz, 1970).

The scale provides a means for evaluating intelligence through the use of non- verbal stimuli. It can be useful as an aid in evaluating children with disabilities and may be less culturally loaded than some other intelligence tests. However, the scores obtained on the CMMS-III are not interchangeable with those on the SBIS-IV, WISC- R"or WPPSI-R.

Merrill-Palmer Scale of Mental Tests

The Merrill-Palmer Scale of Mental Tests (MPSMT) (Stutsman, 1931) is for children from one year and six months to six years. The MPSMT is widely used as a nonverbal test instrument for assessing visual-spatial skills (e.g., Howlin & Rutter, 1987) and can be used for young autistic children at the beginning of intervention, at 12 months, and at 24 months into the intervention. Visual-spatial skills are an area of strength for many children with autism. The MPSMT enables a more detailed assessment of visual-perceptual functioning than is provided by the BSID-II or WPPSI=R

Leiter International Performance Scale

The Leiter International Performance Scale (LIPS) (Leiter, 1948) measures intelligence independent of language ability for children age three years and older. Administration time is 30 to 45 minutes. Because directions are communicated by pantomime, the LIPS is widely used with non-English-speaking subjects, illiterate or disadvantaged individuals, and those with speech, hearing, or other medical disabilities. The LIPS provides activities which foster attention and allow observation of a student's approach to problem solving and his or her emotional reactions. The subject matches blocks with corresponding characteristic strips positioned in the sturdy wooden frame. Level of difficulty increases at each age level. The LIPS yields a Mental Age and IQ data. The LIPS scale has four tests at each year level. The scale has a number of limitations, including uneven item difficulty levels, outdated pictures, a small number of tests at each year level, and use of the ratio IQ. The most serious difficulties are the outdated norms, inadequate standardization, and lack of information about the reliability of the scale for various age levels. Because the norms underestimate the child's intelligence, Leiter (1959) recommended that five points be added to the IQ obtained on the scale.

While the LIPS has a number of limitations, it does merit consideration as an aid in clinical diagnosis (rather than as a measure of general intelligence), especially in testing language-handicapped children who cannot be evaluated by the SBIS-IV, WISC-III, or WPPSI-R. However, although the test may be less culturally loaded than some other intelligence tests, there is no evidence that it is a culture fair measure of intelligence.

Test of Nonverbal Intelligence (2nd ed.)

The Test of Nonverbal Intelligence (2nd ed.) (TONI-II) (Brown, Sherbenou, & Johnsen, 1990) is a language-free measure of cognitive ability. It measures abstract figural problem solving in children age five years and older. Administration time is 10 to 15 minutes. The TONI-II contains 55 problem-solving tasks that progressively increase in complexity and difficulty. Each item presents a set of figures where one or more of the items is missing. The child with autism must be able to examine the differences among the figures, identify problem solving rules that define the relationship, and select a correct response.

The TONI-II is a language-&ee measure of intelligence, aptitude, and reasoning. Because the subject does not have to read, write, speak, or listen during test administration, it is ideal for assessing (a) individuals with speech, language, or hearing impairments; (b) those who have suffered brain injury or have other academic handicaps; and (c) those who do not speak English. Two equivalent forms make the TONI-II ideal for situations where both pre- and postmeasures are desirable.

The TONI-II yields quotient scores and percentile ranks. It was normed on more than 2,500 subjects. Reliability and validity data are provided for normal, mentally retarded, learning disabled, deaf, and gifted subjects.

 

Academic Screening

Wide Range Achievement Test 3 (WRAT3)

The Wide Range Achievement Test 3 (WRAT3) measures reading, spelling, and arithmetic in persons from five to seventy-four years old. Two equivalent forms make pre- and post testing possible. The test takes 10 to 15 minutes to administer. The WRAT3 provides a good method for measuring basic academic skills in children who perform below their peers.

 

Behavior Assessment

Achenbach Child Behavior Checklist

The Achenbach Child Behavior Checklist (ACBC) is for children four to eighteen years old and is completed by an adult informant. It has two major scales – externalizing and internalizing behaviors – each of which has four subscales. It has been used as a follow-up measure. The child's primary caregiver (in most cases, the client's mother) serves as the informant. There is a separate version of this test developed for teachers, the Teacher Report Form (Achenbach, 1991).

Analysis of Sensory Behavior Inventory (Rev. ed.)

The Analysis of Sensory Behavior Inventory (Rev. ed.) (ASBI-R) (Morton & Wolford, 1994) is designed to collect information about an individual's behaviors as they are related to sensory stimuli. Six sensory modalities are assessed: vestibular, tactile, proprioceptive, auditory, visual, and gustatory-olfactory. Ratings can be made about both sensory-avoidance and sensory-seeking behaviors within each modality. Information obtained from this tool may be helpful in completing a functional analysis of behavior and in designing effective intervention strategies, including accommodations and reinforcers for the individual.

Sensory processing differences are frequently seen in persons with severe disabilities and problem behaviors. Analyzing these differences may assist in understanding puzzling behaviors which have proven difficult to change. Interventions which accommodate to individual differences frequently result in improved adaptive functioning. (Available from Skills with Occupational Therapy, Arcadia, Calif.)

 

Family Assessment

These measures focus primarily on aspects of the family. These instruments are used to determine pre- and posttest changes and are not specifically used to tailor the course of individual programming for a family or child.

Behavioral Vignettes Test

The Behavioral Vignettes Test (BVT) is a multiple-choice test (20 items) used to evaluate a parent's, school therapist's, or special education teacher's functional knowledge of behavioral principles. The BVT can be used as a pre- and posttest measure of change in persons undergoing training in teaching self-help, social, and play skills. (Baker, 1989)

Parenting Satisfaction Scale

The Parenting Satisfaction Scale (PSS) (Guidubaldi & Cleminshaw, 1996) facilitates clinical assessment of parent-child relationships. The PSS assists in identifying a troubled parent-child relationship and can be useful in assessing a parent's response to the effect of intervention and, if suggested, conducting family therapy. The PSS is a 45-item standardized assessment of parents' attitudes toward parenting. Scores derived from this scale allow a clinician or researcher to define, compare, and communicate levels of parenting satisfaction in three domains: (a) Satisfaction with the spouse's or ex-spouse's parenting performance in the parenting role; (b). The parent's satisfaction with the relationship with her or his own child; and (c) Satisfaction with the parent's own performance in the parenting role. To improve family communication and increase empathy toward family members, teachers may have a parent's spouse or children complete the scale as he or she believes the parent would respond. Information derived from family members can then be compared with the parent's own responses to identify areas of concordant or discordant perceptions and determine areas in which clinical intervention could improve relationships. The PSS can be completed for siblings of the child with autism. The PSS can be administered in 20 minutes.

Parenting Stress Index (3rd ed.)

The Parenting Stress Index (3rd ed.) (PSI-III) (Abidin, 1983) identifies stressful areas in parent-child interactions. It is administered individually and takes 20 to 30 minutes to complete. There is a short form that takes 10 minutes. This screening and diagnostic instrument assumes that the total stress a parent experiences is a function of child characteristics, parent characteristics, and situations that are directly related to the role of being a parent. Child characteristics are measured in six subscales: distractibility, hyperactivity, adaptability, reinforces parent, demandingness, mood, and acceptability.

The parent personality and situational variables component consists of seven subscales: competence, isolation, attachment, health, role restriction, depression, and spouse. The PSI is particularly helpful in assessing early identification of dysfunctional parent-child systems, prevention programs aimed at reducing stress, intervention and treatment planning in high stress areas, family functioning and parenting skills, and assessment of child-abuse risk.

The PSI Short Form is a derivative of the full-length test and consists of a 36- item, self-scoring questionnaire-profile. It yields a Total Stress score from three scales: parental distress, parent-child dysfunctional interaction, and difficult child.

The Parental Stress Scale

The Parental Stress Scale (PSS) (Berry R Jones, 1995) is a newly developed general measure of stress. Analyses of responses completed by 1,276 parents suggested that the PSS is reliable, both internally and over time. Initial evaluation of the PSS showed a stable consistency for assessing stress across parents of differing parental characteristics. The validity of PSS scores was supported by predicted correlations with measures of relevant emotions and role satisfaction and significant discrimination between 129 mothers of children in treatment for emotional-behavioral problems and developmental disabilities compared with mothers of children not receiving treatment. Factor analysis suggested a four-factor structure underlying responses to the PSS.

Questionnaire on Resources and Stress

The Questionnaire on Resources and Stress (QRS) (Holroyd, 1974; 1987) consists of 55 items on 11 scales: parental affliction, pessimism about child development, overprotection/dependency, anxiety about the future of the child, social isolation, burden for members of the family, financial problems, lack of family integration, intellectual incapacitation, physical incapacitation, and need for the care of the child. The QRS contains 285 items in 15 rational nonoverlapping scales. It was administered to parents of 43 individuals with disabilities four-sixteen years old evaluated in an outpatient psychiatry clinic. The QRS is used in research to assess ecological causes of stress and general levels of stress in families. There is a short form of the QRS (see Randall, Sexton, Thompson, & Wood, 1989). Holroyd (1988) reviewed studies that have used the QRS for families with members with disabilities to compare parents of clinical groups with normal controls, parents of children with different clinical conditions, and pre- and postintervention. These studies are examined in terms of the relationship of 15 QRS scales to child variables (e.g., age, degree of disability); parent variables (e.g., marital status, educational level); and family variables (e.g., nationality/culture). It is concluded that the QRS fulfills requirements for an acceptable level of validity.

Family Adaptability and Cohesion Evaluation Scales III

The Family Adaptability and Cohesion Evaluation Scale (FACES III and FACES IV) (Olson, 1986; 1994) provides measures of perceived cohesion and adaptability of families. This instrument is relatively well researched. It has been used to assess, for example, the differences between "the ideal and the real representation of family," as perceived by parents and adolescent children. FACES has been used to assess marital satisfaction. Combined with the Clinical Rating Scale, a related family assessment in- strument, these two assessment tools can be used for making a diagnosis of family functioning and for assessing changes over the course of treatment.

Family Assessment Interview

The Family Assessment Interview (FAI) (Koegel, Koegel & Dunlap, 1996) is a simple protocol for collecting information from families in preparation for selecting and designing an intervention plan. Items in this brief instrument are designed to enable a "good contextual fit" for the intervention strategy. Interview data based on family members' ideas and reactions to the function of problem behaviors, support strategies, and issues for implementation are actively solicited throughout the assessment and support plan development process. The family assessment interview focuses on information about the ways in which the family structures its daily patterns and routines. It helps identify the family's successful strategies for addressing problem behaviors. Sources of stress for the family are identified and discussed.

Child Improvement Locus of Control Scale

The Child Improvement Locus of Control Scale (CILC) (DeVellis, DeVellis, Revicki, Lurie, Runyan, & Bristol, 1985) assesses belief about a child's ability to improve. The instrument is based on two research studies to develop and validate the CILC scales. In the first study, 145 parents (average age 37.8 years) of autistic children completed a questionnaire tapping beliefs about their children's improvement. In Study 2, 175 parents of physically ill children were given the CILC items. The following relationships were observed: (a) parental beliefs in child influence increased with child age; (b) belief in external factors (chance and divine Influence) was greater among African American parents; and (c) belief in parent influence decreased with illness severity.

Family Environmental Scale

The Family Environmental Scale (FES) (Moos & Moos, 1981; Moos, 1974) is an inventory which assesses behavior patterns within the family on subscales, such as control, active-recreational orientation, intellectual cultural orientation, and cohesion. Norms are available on large national samples of distressed families as well as smaller samples of families with autistic children. The FES can be given to parents at the beginning and middle of the child's intervention program. It assesses family dynamics at key points during the intervention process. The questionnaire can be completed by both of the child's parents if both participate in the child's care.

 

Other Assessment Options

Standardized videotape assessment

A critical component of progress assessment is objective behavioral measurement documented by an ongoing videotaped database – a luxury afforded by school laboratory programs. Each child is videotaped daily for five minutes according to a systematic sampling procedure arranged to track children across different activities, times of day, and days of the week. The unique feature of the video database is that there are no contrived observational conditions; children are videotaped at preset times wherever they happen to be, doing whatever they happen to be doing. Video-tapes are scored by a highly trained intervention team to obtain objective, reliable measures of language, social, and engagement variables.

Videotaped formal and informal language samples are obtained; they are then evaluated by the speech pathologist to determine age appropriateness of communication in the area of social development.

Complete medical examination

A comprehensive neurological and physical examination with laboratory tests that include blood and urine screening, thyroid and liver function, and complete blood count (CBC) is recommended to rule out medical conditions that might interfere with a child's ability to learn. Tests used to detect debilitating medical conditions associated with ASD are electroencephalogram (EEG), electrocardiogram (EKG), imaging techniques, and chromosome studies where indicated.

Audiometric assessment

Impairments in auditory processing and hearing acuity should be ruled out before formal intervention procedures begin. Depending on the child's level of communication and awareness, audiological testing should be used to verify that hearing, especially in the speech range, is within normal limits. If the child's active participation in audiological testing is not possible, auditory evoked-response (AER) studies can be performed. Research has shown that in a subgroup of children with autism, AER studies detect significant deviations in auditory processing. In addition, the audiologist will interview the child's parents for information related to hearing ability.

 

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