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. 

Low Crohbach's Alpha

[Concepts in Research Statistical Analysis] 

In psychological and social sciences research, Cronbach's alpha is often used as a measure of internal consistency, which reflects how closely related a set of items are as a group. 

The alpha coefficient ranges in value from 0 to 1 and can be used to describe the reliability of factors extracted from dichotomous (that is, questions with two possible answers) and/or multi-point formatted questionnaires or scales. 

A high value of alpha (usually 0.7 or above) is taken as an indication that the items measure an underlying (or latent) construct. In other words, it indicates that the scale or test has good internal consistency and that the items within the scale reliably measure the same construct. 

If the Cronbach's alpha is low (below 0.7, and especially below 0.6), it suggests that the items in the scale may not be measuring the same construct; they could be disparate and not well related. For instance, if you have a low alpha for the specific subscale, it suggests that the questions intended to measure that subscale may not be working well together to accurately and reliably assess extraversion in your sample. 

However, a low alpha doesn't necessarily mean your measure is "bad." It could be that your measure is multidimensional (i.e., measuring multiple factors) rather than unidimensional. In addition, alpha is sensitive to the number of items in a scale; scales with fewer items can result in a lower alpha. Further, sometimes scales designed to cover a broad concept may naturally have a lower alpha. 

ie, a low alpha can be an indicator to check your scale or test more thoroughly to understand whether all items are appropriate for your construct and your population. It may also signal the need for additional scales or tests to ensure you're capturing all aspects of a construct.

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 vs RDoc
• DSM vs ICD: DSM is used in the US, ICD is used internationally [more...]

Screening for Autism

• ADOS , DSM vs ADOS:
• 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 
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Communication and Behavior

• SCQ - Social Communication Questionnaire

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

Behavioral /Developmental

• 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 

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.

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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.

Task Load Index

[See posts on other Screening/Assessment Tools, Psychological Measures]

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

DSM v 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 valuable 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.

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.

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. 

SCQ - Social Communication Questionnaire

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.