Diagnostic Overshadowing

In PlainSpeak for the Lay Reader

Diagnostic overshadowing happens when doctors or healthcare workers focus so much on a person's autism that they miss other health problems the person might have. This can mean that other illnesses or conditions are not noticed or treated properly.

Key Points:

1. Mixing Up Symptoms: Sometimes, signs of other health problems are mistaken as just part of autism. For example, if an autistic person feels very anxious or has stomach pain, it might be seen as just them acting up due to autism instead of a separate issue.

2. Communication Barriers: Many autistic people find it hard to explain their feelings or symptoms and may have other communication challenges. This can make it harder for doctors to understand what's really going on.

3. Assumptions: Doctors might assume all problems are because of autism and not look for other causes. This can lead to missed diagnoses. Usually any acting up behaviors is redirected back to behavior therapy, when they actually needed different solutions.

4. Lack of Training: Not all doctors know how to spot other health problems in autistic people. They might need more training to do this well.

5. Poor Treatment: If other health issues are not found, the person might not get the right treatment. This can affect their immediate and long term health and well-being.

Examples:

• Mental Health: If an autistic person is feeling very sad or has depression, it might be ignored because it's thought to be just part of their autism.

• Physical Health: If an autistic person has pain in their stomach, it might be seen as just a behavior issue rather than a real medical problem.

How to Fix This:

1. Thorough Check-Ups: Doctors should look at the whole person and not just their autism. They should check for other health issues and underlying issues too.

2. Better Training: Doctors should learn more about how to spot other health problems in autistic people.

3. Clear Communication: Finding better ways for autistic people to share how they feel can help doctors understand their symptoms better.

4. Awareness: Helping everyone, including caregivers and educators, and professionals understand that autistic people can have other health problems too.

Versions of this post

Link Academic/Scientific Reader

Link PlainSpeak for the Lay Reader

 Link More Posts on this topic

Diagnostic Overshadowing

Diagnostic overshadowing in Autism occurs when the symptoms and behaviors associated with autism obscure or overshadow the presence of other mental or physical health conditions. This can lead to misdiagnosis, underdiagnosis, or delayed diagnosis of other conditions, ultimately impacting the individual's overall care and treatment outcomes.

Key Points

1. Misattribution of Symptoms: Symptoms that might indicate another disorder are often interpreted as part of the autism, leading to misattribution. For example, anxiety, depression, or gastrointestinal issues might be seen merely as behaviors or characteristics of autism.

2. Challenges in Communication: Communication challenges and Alexithymia faced by many autistics can make it harder for healthcare providers to identify additional conditions.

3. Biases and Assumptions: Healthcare providers may have implicit biases or assumptions about autism that lead them to overlook other conditions. They might assume that all behavioral issues or health complaints are related to autism without considering other potential causes.

4. Lack of Specialized Training: Not all healthcare providers are trained to recognize the complex interplay of autism and co-occurring conditions. This lack of specialized training can result in diagnostic overshadowing.

5. Impact on Quality of Care: Diagnostic overshadowing can result in inadequate treatment plans. If other conditions are not recognized, the autistic might not receive appropriate interventions or therapies that address their full range of health needs.

Examples 

• Mental Health: An autistic person might also have depression, but their low mood and social withdrawal may be seen as just part of their autism or obstinate or noncompliance, delaying the correct diagnosis and treatment of depression.

• Physical Health: An autistic experiencing pain or discomfort due to a medical condition like GI  issues might have their symptoms attributed to behavioral issues, leading to inadequate medical evaluation and treatment.

Addressing Diagnostic Overshadowing:

1. Comprehensive Assessments: Conducting thorough and holistic assessments that consider both autism and potential co-occurring conditions.
2. Training for Providers: Educating healthcare providers about the risks of diagnostic overshadowing and training them to recognize and differentiate symptoms.
3. Effective Communication: Developing better communication strategies to help autistics express their symptoms and concerns.
4. Awareness and Advocacy: Raising awareness among caregivers, educators, and clinicians about the importance of looking beyond autism to identify other health issues.

Versions of this post

Link Academic/Scientific Reader

Link PlainSpeak for the Lay Reader

Link More Posts on this topic

The Social Responsiveness Scale SRS

What is it? 

The Social Responsiveness Scale (SRS) is a tool primarily used for quantitative measurement of autism symptoms in the general population, including individuals who do not have a clinical autism diagnosis. 

It measures the severity of autism spectrum symptoms as they occur in natural social settings [1]. Although it is not a diagnostic tool for autism, it provides a clear picture of functioning in areas that could be impacted in autism.

There is both a child version filled out by caregivers and an adult self-report measure. 

Five Subscales

1. Social Awareness: Recognition of social cues 
2. Social Cognition: Interpretation of social cues 
3. Social Communication: Conveyance of appropriate responses to social cues 
4. Social Motivation: The extent to which a respondent is generally motivated to engage in social-interpersonal behavior. 
5. Autistic Mannerisms: Stereotypical behaviors and highly restricted interests characteristic of autism [2].

Scoring and Interpretation

The SRS is a 65-item rating scale, with responses ranging from "not true" to "almost always true." Scores are computed for each subscale as well as a total score that measures severity along the autism spectrum.

• Scores of 76 or higher: severe
• Scores of 60-75: mild-moderate, indicates presence of some autism symptoms
• Scores below 59: considered within typical limits, indicating no significant issues with social responsiveness [2]

History

The SRS was first developed by John N. Constantino and Christian P. Gruber, who published it in 2005. It was designed to be a quantitative measure of autism traits in the general population, including individuals who do not necessarily have an ASD diagnosis [3]. The child version was filled out by caregivers. The SRS for adults was designed to extend the applicability of the SRS to adults, addressing the need for a quantitative measure of autistic traits across the lifespan [3].

Psychometrics

The SRS demonstrates good psychometric properties. It has high internal consistency (Cronbach's alpha = .97) and test-retest reliability (Intraclass correlation = .88) [4]. The inter-rater reliability is also good, ranging from .76 to .95 [5].

For related posts on other measures

References: 

[1] Constantino, J.N., & Gruber, C.P. (2012). Social Responsiveness Scale, Second Edition (SRS-2). Torrance, CA: Western Psychological Services.
[2] Constantino, J.N., & Gruber, C.P. (2012). Social Responsiveness Scale (SRS). Torrance, CA: Western Psychological Services.
[3] Constantino, J.N., & Gruber, C.P. (2005). The Social Responsiveness Scale. Los Angeles: Western Psychological Services.
[4] Constantino, J. N., Davis, S. A., Todd, R. D., Schindler, M. K., Gross, M. M., Brophy, S. L., et al. (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, 427–433.
[5] Bölte, S., Poustka, F., & Constantino, J. N. (2008). Assessing autistic traits: cross-cultural validation of the social responsiveness scale (SRS). Autism Research, 1(6), 354-363.ckles, A., Kreiger, A., Buja, A.,

ADOS-2 Training

ADOS-2 Training Certificate

Related Posts

• Screening & Diagnostic Measures
• Related Posts on ADOS

 

Cognitive dissonance on ADOS

I was in an ADOS training this week. I can kind of get at the intended usefulness of this instrument. Its a screening and diagnostic measure that is widely used for Autism.

But disappointed at a few things that caused a lot of cognitive dissonance for me.

Video of kid who repeated back 2-3 words of one question of the clinician before responding - behavior marked as “echolalia”. But NT folks do this all the time, eg: common tactic in interviews as it buys you time to think. In the NT world this is called "active listening" Yet given as a negative label of echolalia in an autistic child instead of useful social strategy.

"Severe autism has reduced in the last 40 years." Not accurate!! It's just that autism includes many other dx since DSM-V and expanded to accommodate all ages, resulting in a bigger pool, so obviously that %severe looks smaller.

The type of ADOS module used depends on the oral level of the child. Module 1 is the one used for non-verbal/ minimally verbal kids.  Seemed to imply that oral communication mandatory for ADOS, cannot be coded if child uses AAC.

Justification given is that use of AAC means

• "It changes nature of eye contact." 
• "Are they modulating eye contact in some way"
• "It changes the nature of what is happening." 
• They are not making eye contact when they are looking at device.
• They are not doing social engagement with you while looking at device
• There may be some pre-made phrases on device they are making use of

Seems like a fundamental problem if you run the module 1 on a child but say , oh by the way, you can’t communicate unless you can talk with your mouth. 

So my question was whether ADOS then is not applicable to the 20-30% of autistics who have no to little spoken language.

Apparently ‘gestures’ are allowed but how much can you communicate with gestures unless you are fluent with ASL. And it is likely that kids with oral communication issues usually also have motor apraxia so their gesturing ability will not good as well.

Related Posts

• Screening & Diagnostic Measures
• Related Posts on ADOS

Racial Bias in Autism

Correll et al. (2002), points to societal judgements made about the Black community; that they are somehow less deserving. Goff et al. (2014) highlights racial bias in that Black children are thought to be less innocent than their White counterparts. What this racial bias translates to is substantial delays in the diagnosis of ASD for Black children, after the parents initially expressed concerns about the child’s development, despite the parents having health insurance (Costantino et al., 2020)

Read on here.....[link]

Can CATI be used to measure autistic inertia

Can CATI be used to measure Autistic Inertia. 

Autistic inertia refers to the challenges autistics may face in initiating, switching, or stopping activities, which can significantly impact various aspects of their lives, from daily routines to employment and social interactions. It manifests in numerous ways, including difficulties with time management, adjusting to changes, motivation, and focusing on tasks. Support strategiesinclude providing structure, teaching time management, organizing activities around energy levels, using visual reminders, establishing routines, breaking tasks down into manageable steps, and offering prompts or assistance with task initiation. [More on autistic inertia here].

While there are no current scales to measure autistic inertia, we could perhaps use one of the measures like CATI (Comprehensive Autistic Trait Inventory) [post on CATI] which covers a broad range of autistic traits, and has subscales may indirectly relate to behaviors and experiences that could be associated with autistic inertia; specifically - social interactions (SOC), communication (COM), social camouflage (CAM), repetitive behaviors (REP), cognitive rigidity (RIG), and sensory sensitivity (SEN).

• Cognitive Rigidity (RIG) could relate to difficulties with changing activities or adapting to new tasks, as it may measure aspects of flexibility in thinking and behavior.
• Repetitive Behaviors (REP) might also have connections to autistic inertia, given that a preference for sameness and routine or repetitive actions could impact the ability to start or stop activities.
• Sensory Sensitivity (SEN) could influence autistic inertia by affecting how sensory inputs are processed, potentially making transitions between activities more challenging.
• Social Interactions (SOC): Difficulties in understanding and engaging in social interactions could exacerbate feelings of inertia by increasing anxiety or reluctance to transition into social activities or contexts, impacting the ability to initiate or change social engagements.
• Communication (COM): Challenges with verbal and non-verbal communication may contribute to autistic inertia by making the prospect of initiating or adapting to communicative tasks more daunting, leading to delays or avoidance of these activities.
• Social Camouflage (CAM): The effort required to mask autistic traits in social situations could lead to increased inertia, as the mental and emotional resources expended on camouflaging may reduce the capacity to engage with new tasks or changes.

While these subscales can provide insights into traits that might influence or correlate with autistic inertia, it's important to note that autistic inertia as a specific construct might require more targeted assessment tools or approaches to fully understand and measure its impact on autistics. The CATI provides a broad overview of autistic traits within the general population and is not designed to diagnose autism or directly measure autistic inertia. 

DSM v ADOS

Lexicon [Measures] DSM, ADOS

DSM-5-TR (latest version of DSM) and ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition)  are two distinct tools used in assessment and dx of autism.

DSM-5-TR 

• Diagnostic manual that outlines the criteria for diagnosing ASD, including the presence of social communication deficits and RRB. 
• Serves as a reference for clinicians and researchers in making diagnostic decisions and ensures consistency in the diagnosis of ASD.

ADOS-2 

• Standardized observational assessment tool designed to aid in the diagnosis of ASD. 
• Administered by a trained professional and involves direct interaction with the individual  
• consists of a series of activities and social scenarios that allow the examiner to observe and evaluate the individual's communication skills, social interaction, play, and RRB. 
• It helps in determining whether an individual meets the diagnostic criteria for ASD and provides information to inform intervention and treatment planning.

ADOS-2 can be utilized as part of the diagnostic process, providing information to support the dx under DSM-5. Both tools are commonly used together to aid in the assessment and diagnosis of Autism Spectrum Disorder.

Related Posts: [DSM],[ADOS],[Measures]

Screening / Diagnostic / Psychological Measures

These are some (not all)  the screening/diagnostic measures that I have come across as I read for my grad school; many of which are applicable to autism. Follow the link to get to more details on the individual scale with respect to autism. 

Clinical Dx

• DSM-V-TR  provides dx  criteria and guidelines for autism
• DSM is used in the US, ICD is used internationally

Screening for Autism

• 
  
• ADOS, DSM 
• ADI-R - Autism Diagnostic Interview 
• AQ - Autism Quotient 
• BAPQ - Broad Autism Phenotype Questionnaire 
• CARS - Childhood Autism Rating Scale 
• CATI - Comprehensive Autism Traits Inventory
• GARS - Gillian Autism Rating Scale
• M-CHAT-R: Modified Checklist for Autism in Toddlers
• SRS - Social Responsiveness Scale
• STAT - Screening Tool for Autism in Toddlers and Young Children

IQ Tests

• Why IQ Testing is especially problematic in the Autistic Population
• WASI II 
• WISC-V - Wechsler Intelligence Scale for Children 
• WAIS IV -  Wechsler Adult Intelligence Scale 

Communication and Behavior

• SCQ - Social Communication Questionnaire

• CSBS - Communication and Symbolic Behavior Scale 
• EOWPVT: Expressive One-Word Picture Vocabulary Test 

Behavioral /Developmental

• ABC - Aberrant Behavior Checklist
• ASQ: Ages and Stages Questionnaires
• ABAS-3 - Adaptive Behavior Assessment System 
• ASEBA - Achenbach System of Empirically Based Assessment 
• IPASE - Psychotic-Like Anomalous Self-Experiences 

ADHD

• SWAN - Strengths and Weaknesses of ADHD Symptoms and Normal Behavior  

Tests of Empathy

• TASIT: The Awareness of Social Inference Test 

Sensorimotor Domain 

• SSTPQ - The Self, Space, and Time Perception Questionnaire 
• GSQ - Glasgow Sensory Questionnaire

Other

•  NASA-TLX (Task Load Index)

Post is in progress. 

Autistic Traits in the General NT Population

 I'm somewhat conflicted on this research. We have hardly gotten around to understanding and finding solutions for the vast heterogeneity that is autism today. Frankly its one hot mess right now.

Are we adding to the confusion with studies like this which are going about investigating the general NT population to see if they too have "autistic traits." Its almost like trying to prove, everyone has some autistic traits which is all nice for a coffee chit chat, but is distracting us from focus on research based solutions that many of the more impacted autistics desperately need. Because if everyone has autism, then no further action is needed.

======

Article 1

Palmer CJ, Paton B, Enticott PG, Hohwy J. 2015. “Subtypes” in the presentation of autistic traits in the general adult population. J. Autism Dev. Disord. 45:1291–301 

Key Takeaways.

• The study examined the presentation of autistic traits in a large adult population sample using the Autism-Spectrum Quotient (AQ).
• Cluster analysis was used to identify two subgroups with distinguishable trait profiles related to autism.
• The first subgroup (n = 1,059) reported significantly higher scores on the AQ subscales related to social difficulties (Social Skills and Communication) and significantly lower scores on the Detail Orientation subscale.
• The second subgroup (n = 1,284) reported significantly higher scores on the Detail Orientation subscale and significantly lower scores on the Social Skills subscale.
• The study also found that the AQ had a three-factor solution, with two related social-themed factors (Sociability and Mentalising) and a third non-social factor that varied independently (Detail Orientation).
• These findings suggest that there is significant variability in the presentation of autistic traits in the general adult population, and that different profiles of autistic characteristics tend to occur in nonclinical populations.

Article 2

Austin EJ. 2005. Personality correlates of the broader autism phenotype as assessed by the Autism Spectrum Quotient (AQ). Personal. Individ. Differ. 38:451–60

Key Takeaways

• There is evidence to suggest the existence of a broader autism phenotype, with non-autistic relatives of autistic individuals showing similar traits and characteristics.
• The study aimed to characterize the five-factor personality model profile of the broader autism phenotype as assessed by the Autism Spectrum Quotient (AQ) which has shown to be a valid tool for assessing autism traits in the general population. 
• The AQ and personality scale were completed by 201 undergraduates and a second group of 136 adults completed the personality scale and the Asperger screening measure.
• High scores on both 'autism' measures were associated with high neuroticism and low extraversion and agreeableness.
• Three of the five proposed sub-scales of the AQ emerged from the factor analysis.
• Males had higher AQ scores than females, 'hard' science students had higher scores than other students, and students with parent(s) in a scientific occupation had higher scores.
• The AQ and sub-scales had satisfactory or near-satisfactory reliabilities.
• Male participants, science students, and individuals from a scientific family background tend to have higher scores on the AQ, indicating a higher likelihood of autistic traits.

This study explored the broader autism phenotype and its association with personality traits using the Autism Spectrum Quotient (AQ). The study found correlations between AQ scores and personality traits, suggesting that the broader autism phenotype is associated with high Neuroticism and possibly Conscientiousness, as well as low Extraversion. The factor structure of the AQ was also examined, and group differences in AQ scores were observed. The study also compared the results from the student group with a screening instrument for Asperger syndrome in an older adult group. Overall, the AQ was found to have good psychometric properties and provided valuable insights into the broader autism phenotype.

Article 3: 

Ruzich E, Allison C, Smith P, Watson P, Auyeung B, et al. 2015. Measuring autistic traits in the general population: a systematic review of the Autism-Spectrum Quotient.  

Key Takeaways:

• The study reports a comprehensive systematic review of the literature to estimate a reliable mean AQ score in individuals without a diagnosis of an autism, in order to establish a reference norm for future studies.
• Mean AQ score for the nonclinical population was 16.94 (95% CI 11.6, 20.0), while mean AQ score for the clinical population with ASC was found to be 35.19 (95% CI 27.6, 41.1).
• In the nonclinical population, a sex difference in autistic traits was found, although no sex difference in AQ score was seen in the clinical ASC population.

A Simple Guide to the DSM and Autism

Lexicon [Measures] - DSM

PlainSpeak. In Plain Language for the Lay Reader

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a big book that doctors and mental health professionals use to diagnose and understand mental health conditions. 

Here’s a quick history of the DSM, focusing on how it has changed its understanding of autism over the years.

The Early Years: DSM-I and DSM-II

• DSM-I (1952): The first edition of the DSM didn’t include autism. Back then, people didn’t really know about autism.
• DSM-II (1968): The second edition mentioned “schizophrenic reaction, childhood type,” because people thought autism was related to childhood schizophrenia.

Autism Emerges: DSM-III and DSM-III-R

• DSM-III (1980): This edition was a big deal because it introduced "Infantile Autism" as its own category. This was the first time autism was seen as different from schizophrenia.
• DSM-III-R (1987): The revised edition changed the name to "Autistic Disorder" and provided more detailed criteria for diagnosing it, recognizing a wider range of symptoms.

Refining the Diagnosis: DSM-IV and DSM-IV-TR

• DSM-IV (1994): This edition added more details. Autism was now part of a group called Pervasive Developmental Disorders (PDD), which included:

  • Autistic Disorder
  • Asperger’s Disorder
  • Rett’s Disorder
  • Childhood Disintegrative Disorder
  • Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

  This allowed doctors to better identify different types of autism.

• DSM-IV-TR (2000): This version didn’t change much but updated and clarified the existing information.

The Modern Era: DSM-5

• DSM-5 (2013): The most recent edition made major changes to how autism is diagnosed:
  • Autism Spectrum Disorder (ASD): The DSM-5 combined all the previous types of autism into one diagnosis called Autism Spectrum Disorder (ASD). This reflects the idea that autism is a single condition with different levels of severity.
  • Two Domains: The criteria for diagnosing ASD are now based on two main areas:
    1. Social Communication and Interaction: Problems with social communication and interaction in different situations.
    2. Restricted, Repetitive Behaviors: Repetitive movements, strict routines, very focused interests, and unusual reactions to sensory experiences.
  • Severity Levels: The DSM-5 includes levels to show how much support someone with ASD might need:
    • Level 1: Requires support
    • Level 2: Requires substantial support
    • Level 3: Requires very substantial support
  • Specifiers and Comorbidities: Doctors can add more details about a person’s ASD, like if they have intellectual or language difficulties. The DSM-5 also recognizes that people with ASD often have other conditions like anxiety, depression, or ADHD.

Summary

The DSM has changed a lot over the years to better understand and diagnose autism. From not recognizing autism at all to seeing it as a broad spectrum of conditions, these updates help doctors and families understand and support people with autism better.

Related Posts: [DSM], [Diagnosis],[Measures]

Task Load Index

The NASA-TLX (Task Load Index) questionnaire is a tool developed by NASA to assess the workload and subjective workload experienced by individuals performing a task. Though initially designed for pilots, it is widely used across various industries including autism research 

The questionnaire has 6 subscales/submeasures, that assess different dimensions of workload. 

• Mental Demand: mental effort and cognitive load required to perform the task.
• Physical Demand: physical effort and exertion involved in performing the task.
• Temporal Demand: perceived time pressure and the amount of time available to complete the task.
• Performance: individual's perception of their own performance during the task.
• Effort: perceived level of effort and energy expenditure required to complete the task.
• Frustration: degree of annoyance, stress, and dissatisfaction experienced during the task.

Scoring and Interpretation

Participants rate each submeasure on a scale of 0 to 100. Scoring and interpretation vary depending on the specific study or context. Generally, higher scores indicate a higher perceived workload in the respective submeasure. 

Researchers often analyze the individual submeasure scores and the overall workload score to gain insights into the specific dimensions of workload that are most significant in a given task or situation. The questionnaire can help identify areas where workload can be optimized or where additional support or resources may be required.

Examples of use in Autism Research in evaluating workload and cognitive demands 

Study: "Task load and verbal responses to questions in children with autism spectrum disorder"Citation: Nishida, T., Yuhi, T., Kaneoke, Y., Kurosawa, K., & Dan, I. (2014). Task load and verbal responses to questions in children with autism spectrum disorder. Frontiers in Human Neuroscience, 8, 937.
Link: https://doi.org/10.3389/fnhum.2014.00937

Study: "Measurement of cognitive workload in individuals with high-functioning autism spectrum disorder using a virtual reality task"Citation: Park, S. M., Chong, S. C., Lim, S. L., Kim, J. S., & Kim, J. S. (2020). Measurement of cognitive workload in individuals with high-functioning autism spectrum disorder using a virtual reality task. Applied Sciences, 10(2), 581.
Link: https://doi.org/10.3390/app10020581

SCQ - Social Communication Questionnaire

Lexicon [Measures] - SCQ 

The Social Communication Questionnaire (SCQ) is a caregiver-reported questionnaire that evaluates social communication and interaction patterns in individuals suspected of being autistic. It was derived from the Autism Diagnostic Interview-Revised (ADI-R). It is designed for use with children and adults who have a mental age [see post on why "mental age" is problematic] of at least 2 years and 6 months. It is often used as a screening tool in clinical and research settings. [See posts on other Screening/Diagnostic Measures].

Limitations:

• The SCQ is a screening tool and should not be used as a standalone diagnostic instrument. A comprehensive evaluation by a trained clinician using multiple assessment methods is necessary for a formal autism diagnosis.
• Co-occurring Conditions: Many individuals with ASD may have co-occurring conditions such as intellectual disabilities, language impairments, ADHD, anxiety, or sensory processing difficulties. The SCQ focuses specifically on social communication and interaction and may not fully capture the range of challenges associated with co-occurring conditions such as language challenges, ADHD, anxiety or sensory processing.
• Caregiver reports are subject to biases and inaccuracies, as they rely on the caregiver's observations and interpretations of the individual's behaviors.
• Caregivers' ability to accurately report on specific social communication behaviors and experiences of nonspeaking autistics may be limited.
• The SCQ is not designed to assess other developmental disabilities apart from ASD.

Comparing the ABC and CATI Autism Measures

Autism Assessments & Measures 

The Aberrant Behavior Checklist (ABC) and the Comprehensive Autistic Trait Inventory (CATI) are both tools used to assess behaviors and traits associated with autism, but they differ in their specific focus, structure, and use cases. Here’s a comparison to highlight the differences between the two:

[Posts on other Assessment Tools and Diagnostic Measures] 

Aberrant Behavior Checklist (ABC)

Purpose: Designed to assess the presence and severity of problem behaviors in individuals with developmental disabilities, including autism.

Structure: Consists of 58 items divided into five subscales:

• 1. Irritability
  2. Lethargy/Social Withdrawal
  3. Stereotypic Behavior
  4. Hyperactivity/Noncompliance
  5. Inappropriate Speech

Administration:

• Completed by caregivers, teachers, or clinicians who are familiar with the individual's behavior.
• Uses a Likert scale (0-3) to rate the severity of each behavior.

Focus:

• Measures the severity and frequency of specific problem behaviors.
• Used to track changes over time and assess treatment effectiveness.

Advantages:

• Provides detailed information about specific behavioral issues.
• Useful for treatment planning and monitoring progress.

Limitations:

• Subjective responses from raters.
• Does not provide a comprehensive assessment of autism traits.

Comprehensive Autistic Trait Inventory (CATI)

Purpose: Designed to provide a detailed assessment of the range of autistic traits across various domains, specifically for research and clinical purposes.

Structure: The exact structure may vary, but typically includes multiple domains that cover:

• 1. Social Interaction
  2. Communication
  3. Restricted and Repetitive Behaviors
  4. Sensory Sensitivities
  5. Cognitive Traits
  6. Emotional Regulation

Administration:

• Can be completed by individuals with autism (self-report), parents, or clinicians, depending on the version.
• Uses a comprehensive rating scale to assess the frequency and intensity of various autistic traits.

Focus:

• Provides a broad and detailed overview of autistic traits across multiple domains.
• Aims to capture the full spectrum of autism-related characteristics for both diagnostic and research purposes.

Advantages:

• Offers a comprehensive assessment of a wide range of autistic traits.
• Useful for identifying strengths and areas of need in individuals with autism.

Limitations:

• Can be more time-consuming due to its comprehensive nature.
• May require detailed knowledge of the individual’s behaviors and traits.

Key Differences

1. Focus:

   • ABC: Focuses on assessing and quantifying specific problem behaviors.
   • CATI: Focuses on providing a comprehensive assessment of a wide range of autistic traits across multiple domains.

2. Structure:

   • ABC: 58 items across five subscales related to problem behaviors.
   • CATI: Multiple domains covering social interaction, communication, repetitive behaviors, sensory sensitivities, cognitive traits, and emotional regulation.

3. Administration:

   • ABC: Typically completed by caregivers or teachers.
   • CATI: Can be completed by individuals with autism, parents, or clinicians, depending on the version.

4. Purpose:

   • ABC: Used for identifying problem behaviors, planning treatment, and monitoring changes over time.
   • CATI: Used for a detailed assessment of autistic traits for both diagnostic and research purposes.

5. Rating Scale:

   • ABC: Uses a Likert scale (0-3) to rate the severity of each behavior.
   • CATI: Uses a comprehensive rating scale to assess the frequency and intensity of various autistic traits.

In Essence, while the ABC is focused on problem behaviors and is useful for clinical treatment planning, the CATI provides a broad and detailed assessment of the full range of autistic traits, making it valuable for both clinical and research applications.

For Related Posts on other Measures in Autism

Posts on Aberrant Behavior Checklist (ABC)

Posts on Comprehensive Autistic Trait Inventory (CATI) 

CATI - Comprehensive Autism Trait Inventory

 

• The Comprehensive Autism Trait Inventory (CATI) is a new measure of autistic traits that reflects our current understanding of autism and includes subscales for social camouflage and sensory sensitivity.
• The 42 items are divided into 6 subscales of "Social Interactions,” “Communication,” "Social Camouflage,” "Cognitive Rigidity,” "Repetitive Behaviours,” and "Sensory Sensitivity” (each with 7 items).
• It is free to use. 

[Related Posts on CATI]

Psychometrics

• (English et al., 2021) is a first validation paper that has included 3 separate studies.
• The CATI showed convergent validity and superior internal reliability compared to existing measures like the AQ and BAPQ
• The CATI provides a comprehensive assessment of trait dimensions associated with autism, potentially eliminating the need for multiple measures, and has the potential to improve research on autistic traits in the general population.

The English et al (2021) article discusses the need for a new measure of autistic traits that reflects our current understanding of autism. The article describes the development and validation of the CATI, comparing it to existing measures such as the Autism-Spectrum Quotient (AQ) and the Broad Autism Phenotype Questionnaire (BAPQ). The CATI demonstrates convergent validity, superior internal reliability, and greater predictive ability for classifying autism compared to the other measures. It is also the first measure to have dedicated subscales for social camouflage and sensory sensitivity. The authors conclude that the CATI provides a reliable and comprehensive assessment of autistic traits, addressing the limitations of existing measures

• (Meng & Xuan, 2023) - A Mandarin Chinese translation of CATI that was recently validated (although only 35 of the 42 items made it into that version, likely due to issues with the model fit of the translated measure). The Chinese group also derived a 24-item short form of the Chinese CATI which appears to have good psychometrics as well. 

References
English, M.C.W., Gignac, G.E., Visser, T.A.W. et al. The Comprehensive Autistic Trait Inventory (CATI): development and validation of a new measure of autistic traits in the general population. Molecular Autism 12, 37 (2021). https://doi.org/10.1186/s13229-021-00445-7

Meng F, Xuan B. Psychometric Properties of the Chinese Version of the Comprehensive Autistic Trait Inventory. Psychol Res Behav Manag. 2023 Jun 15;16:2213-2223. doi: 10.2147/PRBM.S411599. PMID: 37342828; PMCID: PMC10278863.

WASI-II Wechsler Abbreviated Scale of Intelligence

The WASI-II (Wechsler Abbreviated Scale of Intelligence) is an IQ test for ages 6-90.  It is a shorter and simpler measure based on the more comprehensive Wechsler Intelligence Scale for Children (WISC) and the Wechsler Adult Intelligence Scale (WAIS). 

WASI-II measures cognitive abilities across a range of domains and provides an estimate of a person's general intellectual ability (or Full Scale IQ - FSIQ). It is often used in research studies, and often used to screen for intellectual disability or giftedness, or to assess cognitive abilities in the context of neuropsychological evaluations or clinical diagnoses.

Uses in autistic population

• Assessment of Cognitive Abilities: believed to help identify cognitive strengths and weaknesses in verbal comprehension and perceptual reasoning, which can be informative for planning educational/ behavioral interventions.
• Research: frequently used in autism research studies as measure of cognitive ability.
• Diagnosis: While the WASI-II itself isn't a dx tool for autism, it can be part of a broader diagnostic assessment as it is believed that understanding an individual's cognitive functioning can perhaps provide context for other symptoms or behaviors.

Mental Age

The concept of "mental age" in assessments has been subject to criticism and limitations. Here are some reasons why

• Normative Bias: Mental age is based on comparing an individual's performance to the average performance of a specific age group. However, these age norms may not adequately account for cultural, linguistic, or socioeconomic differences. The concept assumes that all individuals progress at the same rate, which may not be true or fair across diverse populations.
• Arbitrary Cutoffs: Mental age relies on the notion of discrete age categories, which can lead to arbitrary cutoffs and potential misclassifications. Development is a continuous process, and individuals may display a range of abilities that do not neatly align with specific age groups.
• Lack of Sensitivity: The concept of mental age does not capture the full complexity and multidimensionality of human intelligence. It may oversimplify and overlook individual strengths, weaknesses, and variations in cognitive abilities across different domains.
• Limited Predictive Value: Mental age alone may not provide sufficient information about an individual's future development or functional outcomes. It does not account for the dynamic nature of cognitive abilities and the potential for growth and change over time.
• Reinforcement of Deficit-Based Approaches: The focus on mental age as a deficit-oriented measure may perpetuate stigmatization and negatively impact individuals' self-perception and opportunities for growth.

It is essential to approach assessments and diagnostic criteria with a comprehensive and nuanced perspective, considering multiple factors beyond a single measure like mental age to ensure a holistic understanding of an individual's abilities and needs.

EOWPVT - Expressive One-Word Picture Vocabulary Test

Lexicon [Measures] - EOWPVT 

The EOWPVT (Expressive One-Word Picture Vocabulary Test) is an assessment tool used to measure expressive vocabulary skills in individuals (ages 2.5 years - 90 years). It requires the examinee to identify and name pictures presented to them. It is commonly used in educational, clinical, and research settings to assess language development and vocabulary skills including in the autistic population.

The sub-measures of the EOWPVT include a basal level and a ceiling level, which determine the starting and stopping points of the assessment based on the individual's performance. The test presents a series of pictured items, and the examinee is asked to name each picture.

Scoring and interpretation of the EOWPVT involve calculating raw scores, standard scores, and percentile ranks. These scores provide an indication of the individual's expressive vocabulary skills compared to their peers.

Limitations re Autism

• Limited assessment of other language domains: Thought it focuses on expressive vocabulary skills, it does not comprehensively evaluate other language domains such as grammar, syntax, or pragmatics.
• Limited cultural and linguistic representation: The picture stimuli used may not be culturally or linguistically appropriate for all individuals, potentially impacting their performance and scores.
• Lack of context and functional language use: The test assesses isolated one-word responses and does not capture the individual's ability to use language in context or in functional communication situations.
• Potential reliance on rote memorization: Some autistics may excel at memorizing labels for pictures without fully grasping the meaning or generalizing the vocabulary to other contexts

IQ Testing

IQ is a measure designed to assess an individual's cognitive abilities and intellectual functioning; specifically it aims to assess various aspects of intelligence, including verbal comprehension, perceptual reasoning, working memory, processing speed, and problem-solving abilities. These tests typically cover domains such as language, math, spatial reasoning, and logical thinking.

IQ scores are derived by comparing an individual's performance on the test to a representative sample of the population. The scores are standardized and follow a bell curve distribution, with the average score set at 100. Scores above 100 indicate above-average intelligence, while scores below 100 indicate below-average intelligence. The standard deviation is typically 15 points, meaning that about 68% of the population falls within the range of 85-115.

Commonly used IQ tests in Autism 

• WAIS: Wechsler Adult Intelligence Scale (ages 16-90)
• WISC-V: Wechsler Intelligence Scale for Children (ages 6-16)
• KABC-II: Kaufman Assessment Battery for Children (ages 3-18)
• MSEL: The Mullen Scales of Early Learning (ages birth - 5)
• DAS: The Differential Ability Scales (ages 2-17)
• Leiter-R (ages 2-20+)
• RIAS (ages 3-94)
• CAS Cognitive Assessment System (ages 5-17)

See Post: Why is IQ Testing especially problematic in the Autistic Population

Other general problems and limitations of IQ Testing:

• Narrow Assessment: IQ tests primarily measure cognitive abilities related to academic success and may not capture the full range of human intelligence, such as creativity, emotional intelligence, or practical skills.
• Cultural Bias: IQ tests have been criticized for potential cultural bias, as they may reflect the experiences, values, and knowledge of specific cultural or socioeconomic groups. Some questions or tasks may be more familiar or relevant to individuals from certain backgrounds, leading to potential disparities in scores.
• Limited Contextualization: IQ tests provide a snapshot of an individual's abilities at a specific point in time and may not account for the influence of environmental or socio-economic factors, educational opportunities, or individual motivation on test performance.
• Interpretation Challenges: IQ scores are often misinterpreted or used as a sole indicator of an individual's worth or potential, neglecting the complexity of human intelligence and the importance of other factors such as motivation, personality traits, or social and emotional skills.

History: The concept of IQ testing dates back to the early 20th century. Alfred Binet and Theodore Simon developed the first modern intelligence test in 1905. Over time, numerous IQ tests have been developed, revised, and standardized. 

ADOS - Autism Diagnostic Observation Schedule

Lexicon [Measures] - ADOS

The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured assessment for diagnosing autism. It consists of various social and play-based activities designed to observe behaviors related to autism. [See posts on other Screening/Diagnostic Measures]

Limitations of ADOS as a dx tool

1. Not a Standalone Diagnostic Tool: It is intended to be part of a comprehensive evaluation, which should also include other assessments and detailed developmental history.
2. Snapshot in Time: ADOS provides a snapshot of an individual's behavior during the time of the assessment, which may not capture the full range of behavior or abilities.
3. Limited Scope: It primarily focuses on two areas: social interaction and communication, and restricted/repetitive behaviors. Other aspects of autism, such as sensory issues or co-occurring conditions, are not part of the primary scoring system.
4. Language and Age Constraints: While ADOS offers different modules for different developmental stages and language abilities, it may not be entirely suitable for all individuals, particularly those with complex profiles or co-occurring conditions.
5. Requires Specialized Training: to ensure accurate administration and interpretation of the results. This requirement can limit its accessibility and use.
6. Culture and Context: The ADOS was developed in English-speaking countries and may not fully account for cultural differences in behavior and communication. Translated versions are available, but they may not capture all nuances.
7. Reliability of Diagnosis over Time: Some studies have questioned the reliability of the ADOS over time, especially in younger children, where symptoms and behaviors can change significantly as the child grows and develops.