Autism Spectrum Rating - Sam Goldstein
Autism Spectrum RatingScales (ASRS ) Product OverviewSam Goldstein, Ph.D. & Jack A. Naglieri, Ph.D.Please Note: All data presented in this overview are subject to change. Copyright 2009, 2010 Multi-Health Systems Inc. All rights reserved.No part of this document may be reproduced by any means without permission from the publisher.USA: P.O. Box 950, North Tonawanda, NY, 14120-0950Tel: 1.800.456.3003, Fax: 1.888.540.4484CAN: 3770 Victoria Park Avenue, Toronto, Ontario, M2H 3M6Tel: 1.800.268.6001, Fax: 1.888.540.4484Website: www.mhs.com Email: customerservice@mhs.comTMA S S E S S M E N T SAutism Spectrum Rating Scales (ASRS )2
OverviewThe Autism Spectrum Rating Scales (ASRS ) aredesigned to measure behaviors associated with theAutism Spectrum Disorder (ASD) for children and youthaged 2 through 18 years, as reported by parents and/or teachers or childcare providers.1 As recognition andprevalence of the ASD increase, risk of over- and underdiagnosis increase in parallel. The need for a valid,reliable, and carefully crafted tool for assessment becomesparamount; the ASRS was developed to meet this need.The ASRS can help guide diagnostic decisions and can beused during treatment planning, ongoing monitoring ofresponse to intervention, and program evaluation.ASRS Components and Scale StructureAs illustrated in Figure 1, the ASRS has full-length andshort forms for young children aged 2 to 5 years, and forolder children and adolescents aged 6 to 18 years.The Full-Length ASRS Form: The full-length ASRS(2 5 Years) comprises 70 items, and the full-length ASRS(6 18 Years) consists of 71 items. There are separateparent (ASRS Parent Ratings) and teacher (ASRS TeacherRatings) rating forms for each age group. This form isthe most comprehensive and offers the most completeassessment information, including the Total Score, theASRS Scales, the DSM Scale, and the Treatment Scales.The full-length form is recommended for use in initialevaluations and full re-evaluations.The ASRS Short Form: The ASRS Short Form wasdeveloped by selecting items that best differentiatednonclinical youth from youth diagnosed with an ASD.The ASRS Short Form (2–5 Years) and ASRS Short Form(6–18 Years) both contain 15 items, and parents andteachers complete the same form. This form providesone Short Form total score, and can be used as a screenerto determine which youth are most likely to requireadditional evaluation or services for an ASD andrelated issues. The Short Form may be most suitable formonitoring treatment/intervention.Figure 1. Overview of the ASRS FormsNote. Reading Level determined by the Flesch-Kincaid Grade Level.For the ASRS (2–5 Years) both teachers and/or childcare providers cancomplete the form. For ease of presentation, this group of raters is referredto as “teacher” herein.1Autism Spectrum Rating Scales (ASRS )3
Administration andScoring OptionsAll of the forms can be administered via paper-and-pencilor using the ASRS Online Asssessment Center. TheASRS can be scored via paper-and-pencil, the ASRSScoring Software, or the ASRS Online AsssessmentCenter. Figure 2 outlines the various combinations ofadministration and scoring options.Scoring OptionsThe following two scoring options are available for the MHSOnline Assessment Center and the MHS Scoring Software: The standard scoring method which can be continuedto be used for individuals without limited speech. An alternative scoring method for individuals whodo not speak or speak infrequently.Figure 2. Overview of Administration and Scoring OptionsReport OptionsASRS reports can be obtained by using the ASRS Scoring Software or the ASRS Online Assessment Center. There arethree report types:(1) the Interpretive Report provides detailed results from one administration,(2) the Comparative Report provides a multi-rater perspective by combining results from up to five different raters, and(3) the Progress Monitoring Report provides an overview of change over time by combining resultsof up to four administrations from the same rater.Normative andClinical SamplesData collection took place between October, 2006 andOctober, 2008. Over 6,000 assessments were collectedwhich included normative data, clinical data, as wellas reliability and validity research data. Of theseassessments, 2,560 were included in the normativesample (320 ASRS [2 5 Years] Parent Ratings, 320 ASRS[2 5 Years] Teacher/Childcare Provider Ratings, 960 ASRS[6 18 Years] Parent Ratings, and 960 ASRS [6 18 Years]Teacher Ratings). The ASRS normative samples areproportioned evenly in terms of age and gender(see Table 1) and are highly similar to the most recent U.S.Census in terms of race/ethnicity (see Table 2). While theAutism Spectrum Rating Scales (ASRS )normative samples primarily include ratings of nonclinicalchildren, 7.6% of the normative sample includes ratingsof children with an educational classification or clinicaldiagnosis. These cases were included in the normativesample in order to reflect the actual U.S. general population,which includes both children with and without clinicalconditions.In addition to the clinical data that were collected forinclusion in the normative sample, ratings from over1,600 youth with a clinical diagnosis were collected in orderto create clinical samples; see Table 3 for the diagnosticmakeup of these samples.4
Table 1. Age x Gender Distribution: ASRS Normative SamplesParent RatingsAgeTeacher 340408040408044040804040805404080404080ASRS (2 5 Years) 0804040801640408040408017/18404080404080ASRS (6 18 Years) Table 2. Race/Ethnicity Distribution: ASRS Normative SamplesParent RatingsASRS(2 5 Years)ASRS(6 18 Years)Teacher RatingsTotalU.S.CensusASRS(2 5 Years)ASRS(6 18 TotalNote: Census figures are based on the 2000 U.S. Census Report.Table 3. Primary Diagnosis: ASRS Clinical SamplesParent RatingsASRS(2 5Years)ASRS(6 18Years)Autism Spectrum Disorder135214ADHDN/AAnxiety/Mood DisordersN/ACommunication Disorders35Delayed Cognitive Development41DiagnosisOtherTotalTeacher RatingsTotalASRS(2 5Years)ASRS(6 alASRS(2 5Years)ASRS(6 292694997682745608345431,0591,602Note. N/A Not Applicable.Autism Spectrum Rating Scales (ASRS )5
ReliabilityTest-Retest Reliability refers to the stability of test scoreswhen an assessment is administered on two or moreoccasions. Test-retest reliability scores were computed forthe ASRS scores over a 2- to 4-week interval (see Table 5).Overall, the test-retest values indicate excellent test-retestreliability.Internal Consistency refers to the extent to which all itemson the same scale consistently or reliably measure the samecontent, and is commonly assessed by an examination ofCronbach’s alpha statistic, which ranges from 0.0 to 1.0(Cronbach, 1951). The internal consistency of the ASRS wasassessed, and the scales were found to demonstrate highlevels of internal consistency (see Table 4).Table 4. Internal Consistency Coefficients (Cronbach’s Alpha)Parent Ratings6 11 Years12 18 YearsASRS(2 5 Years)6 11 Years12 18 Years.97.97.97.97.97.97.96.95.94.97.95.94Unusual 3N/A.94.92Total ScoreSocial/CommunicationDSM-IV-TR ScaleTreatmentScalesASRS (6 18 Years)ASRS(2 5 Years)ScaleASRSScalesTeacher RatingsASRS (6 18 Years).95.96.95.95.95.95Peer Socialization.89.88.88.91.87.87Adult Socialization.77.77.78.82.81.77Social/Emotional Reciprocity.91.90.90.93.91.91Atypical 3.77Behavioral Rigidity.90.91.91.90.92.92Sensory 2.92.92.93.91.92Short FormNote. N/A Not Applicable.Table 5. Test-Retest Reliability Coefficients (Pearson’s r)Parent RatingsASRS(2 5 Years)ASRS(6 18 Years)ASRS(2 5 Years)ASRS(6 18 Unusual 1.91.87.78Peer Socialization.79.87.92.78Adult Socialization.88.90.83.79Social/Emotional Reciprocity.86.88.90.70Atypical al Rigidity.85.90.87.81Sensory l ScoreASRSScalesDSM-IV-TR ScaleTreatmentScalesTeacher RatingsNAutism Spectrum Rating Scales (ASRS )6
ValidityDiscriminative Validity pertains to an instrument’sability to distinguish between relevant participant groups(i.e., the ability of the ASRS to differentiate betweenAutism Spectrum Disorder group membership andGeneral Population or Other Clinical group membership).Autism Spectrum Disorders. These other measuresincluded the Gilliam Autism Rating Scale Second Edition(GARS-2 ; Gilliam, 2006), the Gilliam Asperger’s DisorderScale (GADS ; Gilliam, 2001), and the Childhood AutismRating Scale (CARS ; Schopler, Reichler, & RochenRenner, 1986).A series of discriminant function analyses wereconducted in order to determine the ability of the scoresto predict group membership into the Autism SpectrumDisorder or General Population group. Table 6 displaysthe classification accuracy of both the ASRS full-lengthand ASRS Short Form Total Scores. On average, the scaleswere able to very accurately predict group membership,with a mean overall correct classification rate of 92.10%.The correlations (both obtained and corrected for rangeinstability), as well as means and standard deviations,are provided in Table 7. Examination of these values mustbe made with recognition of the different metrics usedfor the different rating scales, and the fact that the CARSonly provides a raw score. The mean scores obtainedon the GARS and GADS are based on a comparison toatypical samples so that a score of 100 indicates averageperformance in relation to individuals on the AutismSpectrum. For children rated on both the ASRS and theGARS, the ASRS means by rater and age varied from 69.3to 75.3 and the GARS values ranged from 88.6 to 100.9.The results for the 6–18 year olds rated by parents andteachers were particularly important because the GARSmeans were less than 100, yet the ASRS means were about70 (two standard deviations above the normative mean forthe general population). Similar findings were obtainedfor the GADS, illustrating the importance of having ageneral population reference group.Furthermore, Figures 3 to 6 reveal that for virtuallyevery scale, the Autism Spectrum Disorder group wasrated higher than both the General Population and theOther Clinical groups. Results from a series of Analysesof Covariance revealed that these differences werestatistically significant for every scale (with mostlylarge effect sizes; 2 mean Cohen’s d 1.60), with theexception of the Attention scale on the ASRS (6 18Years) Teacher form, where scores between the AutismSpectrum Disorder and Other Clinical groups did notdiffer significantly from each other (this result is notunexpected due to the fact that the Other Clinical groupin the ASRS [6 18 Years] sample includes a large ADHDsample).The ASRS Total Score was moderately correlated with theGARS Autism Index and the GADS Asperger’s DisorderQuotient. The correlations between the ASRS Total Scoreand the CARS Total Score were somewhat lower. Thelow ASRS–CARS correlations could be due to the factthat different raters completed the forms (i.e., scoresfrom parent- and teacher-completed ASRS forms werecompared to clinician-completed CARS scores) and/or theCARS only yields a raw score.Convergent Validity is established if results from themeasure of interest are correlated with results fromtheoretically-related measures (Anastasi & Urbina, 1997).In an attempt to provide evidence for the convergentvalidity of the ASRS, a sample of parents and teacherscompleted the ASRS forms along with at least one othermeasure of childhood psychopathology that assessesTable 6. Classification Statistics of the ASRS Total ScoresFull-Length Total ScoreParent RatingsClassification StatisticASRS(2 5Years)ASRS(6 18Years)Short Form Total ScoreTeacher RatingsASRS(2 5Years)Parent RatingsASRS(6 18Years)ASRS(2 5Years)Teacher RatingsASRS(6 18Years)ASRS(2 5Years)ASRS(6 18Years)94.9Overall Correct Classification (%)90.091.389.491.494.293.488.4Sensitivity (%)89.890.390.292.193.992.792.695.4Specificity (%)90.392.288.690.794.594.184.394.3Positive Predictive Power (%)91.391.888.690.394.694.185.594.1Negative Predictive Power (%)88.790.890.292.593.892.791.995.6False Positive Rate (%)9.77.811.49.35.55.915.75.7False Negative Rate 0.90.90Autism Spectrum Disorder (N)126183114206129202131219General Population (N)115196112212128207111228Rough rules of thumb for interpreting effect size in clinical/educationalpsychology have been provided by Cohen (1988): small effect size .2;medium effect size .5; large effect size .8.2Autism Spectrum Rating Scales (ASRS )7
Figure 3. Mean T-Scores by Group: ASRS (2 5 Years) Parent RatingsFigure 4. Mean T-Scores by Group: ASRS (2 5 Years) Teacher RatingsTOT Total ScoreAS Adult SocializationBR Behavioral RigiditySC Social/CommunicationSER Social/Emotional ReciprocitySS Sensory SensitivityUB Unusual BehaviorsAL Atypical LanguageASR Attention/Self-RegulationDSM DSM-IV-TR ScaleST StereotypyShort Short FormPS Peer SocializationAutism Spectrum Rating Scales (ASRS )8
Figure 5. Mean T-Scores by Group: ASRS (6 18 Years) Parent RatingsFigure 6. Mean T-Scores by Group: ASRS (6 18 Years) Teacher RatingsTOT Total ScorePS Peer SocializationBR Behavioral RigiditySC Social/CommunicationAS Adult SocializationSS Sensory SensitivityUB Unusual BehaviorsSER Social/Emotional ReciprocityAT AttentionSR Self-RegulationAL Atypical LanguageShort Short FormDSM DSM-IV-TR ScaleST StereotypyAutism Spectrum Rating Scales (ASRS )9
Table 7. Correlations Between the ASRS Total Score and Other MeasuresGARS, GADS, or CARSOther MeasuresGARSAutism IndexGADS Asperger’sDisorder QuotientCARSTotal Raw ScoreASRSRaterAgesObtained rCorrected rNMSDMSDParent2–5 Years.83.6178100.925.774.511.4Teacher2–5 Years.76.4153100.130.575.312.7Parent6–18 Years.80.6310493.924.469.310.0Teacher6–18 Years.82.6811688.623.369.810.0Parent2–5 Years.63.497896.919.374.511.4Teacher2–5 Years.76.565298.320.875.612.6Parent6–18 Years.70.548392.321.668.110.7Teacher6–18 Years.74.618291.521.667.710.0Teacher2–5 Years.50.663436.89.776.76.6Parent2–5 Years.06.063636.910.378.410.1Teacher6–18 Years.35.4010935.310.569.58.7Parent6–18 Years.50.5112235.710.871.39.9Note. ASRS T-scores (normative sample M 50, SD 10) were correlated with: GARS-2 and GADS Standard Scores (reference sample M 100, SD 15), andCARS raw scores. All correlations significant, p .01, except for the ASRS (2–5 Years) Teacher correlation with the CARS (ns). Pair-wise deletion of missingcases was used.ReferencesAnastasi, A., & Urbina S. (1997). Psychological testing(7th ed.). Upper Saddle River, NJ: Prentice Hall.Cohen, J. (1988). Statistical power analysis for behaviouralsciences (2nd ed.). Hillsdale, NJ: Erlbaum Associates.Cronbach, L. J. (1951). Coefficient alpha and the internalstructure of tests. Psychometrika, 16, 297–335.Gilliam, J. E. (2001). Gilliam Asperger’s Disorder Scaleexaminer’s manual. Austin, TX: PRO-ED.Gilliam, J. E. (2006). Gilliam Autism Rating Scale SecondEdition examiner’s manual. Austin, TX: PRO-ED, Inc.Schopler, E., Reichler, R. J., & Rochen Renner, B. (1986).Childhood Autism Rating Scale. Los Angeles: WesternPsychological Services.Autism Spectrum Rating Scales (ASRS )10
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Autism Spectrum Rating Scales . (ASRS Parent Ratings) and teacher (ASRS Teacher Ratings) rating forms for each age group. This form is the most comprehensive and offers the most complete . the Progress Monitoring Report provides an overview of change over time by combining results
Autism spectrum disorder encompasses disorders previously referred to as early infantile autism, childhood autism, Kanner’s autism, high-functioning autism, atypical autism, pervasive developmental disorder not otherwise specified, childhood disintegrative disorder, and Asperger’s disorder
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