Validating the Repetitive Behavior Scale-Revised in Young Children with Autism Spectrum Disorder

This study examined the factor structure of the Repetitive Behavior Scale-Revised (RBS-R) in a sample of 287 preschool-aged children with autism spectrum disorder (ASD). A confirmatory factor analysis was used to examine six competing structural models. Spearman’s rank order correlations were calculated to examine the associations between factor scores and variables of interest. The 3- and 5-factor models were selected as preferable on the basis of fit statistics and parsimony. For both models, the strongest correlations were with problem behavior scores on the Child Behavior Checklist and repetitive behavior scores on the ADI-R. Developmental index standard scores were not correlated with factors in either model. The results confirm the utility of the RBS-R as a measure of repetitive behaviors in young children with ASD.     

Daily living skills in children with autism spectrum disorder and intellectual disability: A comparative study from Turkey

BackgroundBetter daily living skills (DLS) are associated with increased independence and positive functional outcomes in Autism Spectrum Disorder (ASD).MethodThe present study aimed to investigate daily living skills (DLS) and the associated factors in 51 children with ASD and intellectual disability (ASD group) and 51 age- and gender-matched controls with intellectual disability (ID group). The severity of the autistic symptoms was measured with the clinician-rated Childhood Autism Rating Scale and the parent-reported Autism Behavior Checklist (ABC) in all children. The mothers also completed the Pediatric Quality of Life Inventory and the Basic DLS Questionnaire.ResultsThe ASD group scored lower than the comparison group in the total DLS score, personal hygiene, dressing, safety and interpersonal skills, despite being comparable in the parent-reported quality of life. Regression analysis of the whole sample demonstrated that the child’s age, intellectual level, speech level, autism symptom severity and the monthly household income were independent correlates of the total DLS. Exploratory analyses for each group revealed differential effects of these variables: in the ASD group; a higher speech level and monthly income, while in the ID group; an older age, a higher intellectual level and monthly income and a lower ABC score emerged as significant predictors of higher DLS.ConclusionsDeficient DLS in Turkish children with ASD, given their IQ, suggest that lower level of adaptive skills is inherent in ASD, rather than culture-specific to US and Western Europe.     

Psychometric Properties of the Norwegian Aberrant Behavior Checklist and Diagnostic Relationships in a Neuro-Pediatric Sample

ABSTRACT

Introduction: Although the Aberrant Behavior Checklist (ABC) is one of the most widely used behavioral rating scales among people with developmental disabilities, very few studies have examined the factor structure of the non-English versions.Methods: The construct validity of the Norwegian ABC was examined in a clinical sample of children and adolescents with neurological and neurodevelopmental disorders (N = 339). Diagnoses were obtained from direct interdisciplinary assessments in our neuro-pediatric clinics. Results: In an exploratory factor analysis, 46 of the 58 items (79%) loaded most heavily on four of the five original factors in the English version. Confirmatory factor analysis revealed less-than-optimal fit indices for the five-factor solution. Internal consistency was adequate to excellent for all subscales (α range = .76–.95). The ABC showed meaningful overlap and differentiation with the Strengths and Difficulties Questionnaire, the Behavior Rating Inventory of Executive Function, the Vineland Adaptive Behavior Scales, and full scale IQ. There were positive correlations between several of the ABC subscales and diagnoses of attention deficit/hyperactivity disorder, autism spectrum disorder, oppositional defiant disorder, and emotional disorder Conclusion: Satisfactory psychometric properties were found for the ABC, with the exception of the Inappropriate Speech factor, in a mixed sample of higher functioning children and adolescents with neurodevelopmental and neurological disorders.     

Early Indicators of Autism Spectrum Disorders in the Second Year of Life

Three groups of 18 children were selected for this study, one group with autism spectrum disorders (ASD), one group with developmental delays in which ASD was ruled out (DD), and one group with typical development (TD), from a pool of 3026 children who were screened with the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP, Wetherby & Prizant, 2002) Infant-Toddler Checklist under 24 months of age. The CSBS DP Behavior Sample was videotaped on selected children as a second-level evaluation during the second year of life. The Infant-Toddler Checklist had a sensitivity and specificity of 88.9% for this sample of children. Significant group differences were found on the Infant-Toddler Checklist and the Behavior Sample, however, these differences did not distinguish children with ASD and DD with high accuracy. The videotapes of the Behavior Sample were reanalyzed to identify red flags of ASD. Nine red flags differentiated children in the ASD group from both the DD and TD groups and four red flags differentiated children in the ASD Group from the TD group but not the DD group. These 13 red flags were found to discriminate the three groups with a correct classification rate of 94.4%.     

Validity of the Aberrant Behavior Checklist in a Clinical Sample of Toddlers

We investigated the congruent and criterion validity of the Aberrant Behavior Checklist (ABC) in a clinical sample of toddlers seen over 1 year in Turkey. All consecutive patients (N = 93), 14–43 months old (mean, 30.6 mos.), in a child psychiatry outpatient clinic were included. The ABC, Autism Behavior Checklist (AuBC), and Child Behavior Checklist 2/3 (CBCL) were completed by the children’s parents. Internal consistency for ABC subscales was moderate to high. The total ABC score, which is interdependent with subscales (e.g., Irritability, Social Withdrawal) of the ABC, was significantly correlated with the CBCL-total (r = .73) and AuBC-total (r = .71) scores. Subscales of the ABC revealed significant differences between diagnostic groups. ABC Total, and the Irritability and Hyperactivity subscale scores, were significantly higher in children with externalizing disorders; the Lethargy/Social Withdrawal and Stereotypic Behavior subscale scores were significantly higher in toddlers with autism. The ABC appears to be capable of discriminating several syndromes, such as disruptive behavior disorders and autism in early childhood.     

Language and communication skills in preschool children with autism spectrum disorders: contribution of cognition, severity of autism symptoms, and adaptive functioning to the variability

This study examined the contribution of cognitive function, severity of autism, and adaptive functioning to the variability in language and communication skills in 129 preschool children (aged 24-63 months) with autism spectrum disorder (ASD). Participants were selected from a representative research cohort of 208 preschool children on the basis of caregiver completion of the MacArthur-Bates Communicative Development Inventories (CDI). The children were classified into three cognitive groups: (a) Normal intelligence; (b) Developmental delay; and (c) Intellectual disability. Autism symptom severity was measured by the Autistic Behavior Checklist (ABC), and adaptive functioning by the Daily Living Skills (DLS) and Socialization (Soc) subscales from the Vineland Adaptive Behavior Scales. For each of five CDI variables (Phrases understood, Words understood, Words produced, Gestures and actions, and Language use), the contribution of cognition, severity of autism symptoms, and adaptive functioning to the variability was examined. Cognition and age explained about half or more of the variance in the four verbal language CDI variables, but only about one fourth of the variance in the non-verbal communication variable Gestures and actions. Severity of autism symptoms and the two adaptive measures (DLS and Soc) each only accounted for a few percent more of the variance in the four CDI language variables; however, for Gestures and actions, an additional 11-21% of the variance was accounted for. In conclusion, for children with ASD, receptive and expressive language is mainly related to cognitive level, whereas non-verbal communication skills seem to also be related to severity of autism symptoms and adaptive functioning.     

A comparison of the Aberrant Behavior Checklist and the GAF among adults with mental retardation and mental illness

Psychiatric assessment among individuals with a diagnosis of both mental retardation and mental illness presents a clinical challenge. This retrospective study compared two rating scales--the Aberrant Behavior Checklist (ABC) and the Global Assessment of Functioning (GAF)--to determine the scales' utility in a partial hospital setting. Although ABC and GAF ratings were weakly correlated, the ABC revealed symptom patterns consistent with recognizable features of psychiatric syndromes and differential improvement in symptoms within and between diagnostic subgroups. The ABC provided a more useful measure of treatment response than the GAF in this patient population.     

An Initial Psychometric Evaluation of the CBCL 6-18 in a Sample of Youth with Autism Spectrum Disorders

Individuals with an autism spectrum disorder (ASD) often present with co-occurring emotional and behavioral disorders (EBD). The Child Behavior Checklist 6-18 (CBCL; Achenbach & Rescorla, 2001) is an EBD measure that contains several norm-referenced scales derived through factor analysis of data from the general pediatric population. The psychometric properties of this widely used and well-researched measure have not been evaluated in samples of youth with ASD. This study evaluated the CBCL's internal structure, scale reliability, criterion-related validity, and diagnostic accuracy using archival data from a well-characterized sample of youth with ASD (N = 122). Confirmatory factor analyses supported the unidimensionality of the CBCL's syndrome scales and its internalizing-externalizing factor structure. Significance tests indicated that many scales discriminated between two subgroups: a group of individuals with ASD + EBD and a group with ASD alone. Diagnostic accuracy analyses indicated that the CBCL had good sensitivity but low specificity for detecting co-occurring disorders. Results supported the use of the CBCL in conjunction with other clinical data when assessing for EBD in youth with ASD.     

Gastrointestinal Problems in Children with Autism,Developmental Delays or Typical Development

To compare gastrointestinal (GI) problems among children with: (1) autism spectrum disorder (ASD), (2) developmental delay (DD) and (3) typical development (TD), GI symptom frequencies were obtained for 960 children from the CHildhood Autism Risks from Genetics and Environment (CHARGE) study. We also examined scores on five Aberrant Behavior Checklist (ABC) subscales comparing ASD children with high versus low frequency GI symptoms. Compared to TD children, those with ASD [aOR 7.92 (4.89–12.85)] and DD [aOR 4.55 (2.51–8.24)] were more likely to have at least one frequent GI symptom. Restricting to ASD children, those with frequent abdominal pain, gaseousness, diarrhea, constipation or pain on stooling scored worse on irritability, social withdrawal, stereotypy, and hyperactivity compared with children having no frequent GI symptoms. Frequent GI problems affect young children with ASD and DD more commonly than those with TD. Maladaptive behaviors correlate with GI problems, suggesting these comorbidities require attention.     

Factor validity and norms for the Aberrant Behavior Checklist in a community sample of children with mental retardation

The Aberrant Behavior Checklist (ABC) is a 58-item rating scale that was developed primarily to measure the effects of pharmacological intervention in individuals living in residential facilities. This study investigated the use of the ABC in a sample of community children with mental retardation. Teacher ratings on the ABC were collected on 666 students attending special classes. The data were factor analyzed and compared with other studies using the ABC. In addition, subscales were analyzed as a function of age, sex, and classroom placement, and preliminary norms were derived. A four-factor solution of the ABC was obtained. Congruence between the four derived factors and corresponding factors from the original ABC was high (congruence coefficients ranged between .87 and .96). Classroom placement and age had significant effects on subscale scores, whereas sex failed to affect ratings. The current results are sufficiently close to the original factor solution that the original scoring method can be used with community samples, although further studies are needed to look at this in more detail.Work on this paper was supported by a research project grant from the National Institute of Mental Health (Grant MH 44122) to M. G. Aman. The authors thank the departments of special education within public school districts, the county boards of MR/DD, and the numerous teachers in central and northern Ohio who participated in this study.     

Are Aberrant Behavioral patterns associated with the adaptive behavior trajectories of teenagers with Autism Spectrum Disorders?

This study aims to identify Aberrant Behavioral (AB) patterns in adolescents with Autism Spectrum Disorders (ASD) and to examine if these patterns are associated to their adaptive behavior trajectories. The Aberrant Behavior Checklist (ABC) was used to assess problems behaviors in a sample of 152 adolescents with ASD, whose adaptive behavior trajectories were described based on the Vineland communication and socialization scores. Clustering analyses were performed to identify AB patterns and univariate analyses to evaluate the association between AB patterns and adaptive behavior trajectories. We identified four clusters or AB patterns: (1) low scores in the ABC four domains, (2) high scores in irritability and hyperactivity, (3) medium scores in the four domains, and (4) medium level of irritability and high scores in stereotypy, lethargy and hyperactivity. These patterns were significantly linked to the adolescents’ adaptive behavior trajectories. Most adolescents with a high trajectory (87%) were found in clusters 1 and 3, whereas adolescents with a low trajectory were equally distributed in the four clusters. Results suggest that while a high trajectory seems associated with a low level of AB, low trajectory is not necessarily associated with a high level of AB. Study limitations and clinical implications are discussed.     

The psychometric properties of the Norwegian version of the social responsiveness scale in a neuropediatric sample

BackgroundThe current study is an examination of the psychometric properties of the Norwegian Social Responsiveness Scale (SRS), a measure of deficits in social behavior, in a neuropediatric outpatient sample of children and adolescents with neurological and neurodevelopmental disorders.MethodThe internal consistency of the SRS, the convergent validity of the SRS with the Vineland Adaptive Behavior Scale-II (VABS-II), the Strengths and Difficulties Questionnaire (SDQ), and the Aberrant Behavior Checklist (ABC) were examined, in addition to four different factor models of the SRS (i.e., a one-factor, the original five-factor, a second-order five-factor model, and a 16-item one-factor model) using confirmatory factor analyses.ResultsThere was satisfactory internal consistency on all subscales, except for the Social Awareness subscale. The SRS showed a somewhat meaningful overlap with parts of the related scales on the VABS-II, the SDQ, and the ABC. Model fit indices were mixed for evaluating the four different factor models. Overall, however, the model fit was rather poor.ConclusionsThe original SRS subscales showed adequate internal consistency and satisfactory convergent validity on some of the subscales. The construct validity in terms of factor structure was not acceptable. Future research should examine the psychometric properties of an improved version of the SRS, especially in terms of improving the scale’s construct validity.     

Evaluation of retinal nerve fiber layer thickness in children with autism spectrum disorders

BackgroundThe study compared retinal nerve fiber layer (RNFL) thickness, macular thickness, and macular volume of children with autism spectrum disorder (ASD) to those of healthy control group and correlated the RNFL thickness with symptom severity in children with ASD.MethodForty children between the ages of 7 and 12 with normal intelligence levels and who were diagnosed with ASD as per DSM-5 were included in the ASD group. The control group consisted of healthy children, who were matched with subjects in the ASD group in terms of age and gender. The Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS) were used to evaluate the severity of the disease in the cases diagnosed with ASD. The RNFL, macular thickness, and macular volume of all participants were measured optical coherence tomography (OCT).ResultsThe temporal, temporal superior, nasal superior, temporal inferior, and global RNFL thicknesses were significantly lower in the ASD group than in the control group. There was no correlation between the RNFL thickness and ASD symptom severity. The macular thickness and volume were not significantly different between the groups.ConclusionOur data suggest that lower RNFL thickness may relate to atypical brain development in the ASD, and this can be measured in the retina.     

Adaptive functioning and behaviour problems in relation to level of education in children and adolescents with intellectual disability

Background The interrelationship between adaptive functioning, behaviour problems and level of special education was studied in 186 children with IQs ranging from 61 to 70. The objective was to increase the insight into the contribution of adaptive functioning and general and autistic behaviour problems to the level of education in children with intellectual disability (ID). Methods Children from two levels of special education in the Netherlands were compared with respect to adaptive functioning [Vineland Adaptive Behavior Scales (VABS)], general behaviour problems [Child Behavior Checklist (CBCL)] and autistic behaviour problems [Autism Behavior Checklist (ABC)]. The effect of behaviour problems on adaptive functioning, and the causal relationships between behaviour problems, adaptive functioning and level of education were investigated. Results Children in schools for mild learning problems had higher VABS scores, and lower CBCL and ABC scores. The ABC had a significant effect on the total age equivalent of the VABS in schools for severe learning problems, the CBCL in schools for mild learning problems. A direct effect of the ABC and CBCL total scores on the VABS age equivalent was found, together with a direct effect of the VABS age equivalent on level of education and therefore an indirect effect of ABC and CBCL on level of education. Conclusions In the children with the highest level of mild ID, adaptive functioning seems to be the most important factor that directly influences the level of education that a child attends. Autistic and general behaviour problems directly influence the level of adaptive functioning. Especially, autistic problems seem to have such a restrictive effect on the level of adaptive functioning that children do not reach the level of education that would be expected based on IQ. Clinical implications are discussed.     

The Aberrant Behavior Checklist and the Behavior Problems Inventory: convergent and divergent validity

This study was designed to compare and cross-validate two rating instruments [the Aberrant Behavior Checklist (ABC) and the Behavior Problems Inventory (BPI)] for assessing maladaptive behavior. The BPI assesses three types of behavior problems: Self-Injurious Behavior (SIB), Stereotyped Behavior and Aggressive/Destructive Behavior. The ABC assesses five domains including these three. We collected data on 226 adults, mostly with severe or profound mental retardation, from a medium-sized developmental center. Individuals with elevated BPI scores generally had higher ABC scores; however, the extent of covariation differed across subscales. Similarly, multiple regression analyses showed that BPI subscales significantly but selectively predicted ABC subscale scores. Measures of differential diagnostic value (positive and negative predictive power, sensitivity, specificity and overall correct diagnostic efficiency) confirmed the anticipated partial overlap between instruments. Both instruments were used to rate participants with and without a Diagnosis of Stereotyped Movement Disorder. BPI, SIB and Stereotypy subscale composite had stronger positive predictive power than the ABC Stereotypy scale, while the ABC had higher negative predictive power and greater overall diagnostic efficiency. Thus, the ABC and the BPI cross-validated one another where expected, and they diverged for subscales thought to have little relationship.     

Repetitive behaviors in autism: relationships with associated clinical features

Relationships between repetitive behaviors (RBs) and associated clinical features (i.e., cognitive and adaptive functioning levels, sleep problems, medication use, and other behavioral problems) were examined in two groups (High nonverbal IQ > or = 97 versus Low nonverbal IQ < or = 56) of children with autism spectrum disorders (n = 14; mean age = 10 years, 7 months). For the group as a whole, nonverbal cognitive ability (NVIQ) (as measured by the Leiter-R), adaptive functioning level, the presence of sleep problems, and three scales of the Aberrant Behavior Checklist (ABC) (Irritability, Lethargy, and Hyperactivity) were highly correlated with total RB scores on the Repetitive Behavior Scale-Revised (RBS-R). After controlling for NVIQ, adaptive level, sleep problems, and two scales of the ABC (Irritability and Lethargy) were not significantly associated with RB scores. However, there remained a significant positive correlation between the presence of RBs and the Hyperactivity scale of the ABC. Parent ratings of their stress levels and the presence of RBs in their children were highly correlated. The relationship between RBs and associated clinical features in autism is complex and future studies should control for cognitive ability when examining the direct and indirect relationships of these variables with RBs.     

Factor Analysis of the Aberrant Behavior Checklist in Individuals with Autism Spectrum Disorders

Exploratory factor analysis (varimax and promax rotations) of the aberrant behavior checklist-community version (ABC) in 275 individuals with Autism spectrum disorder (ASD) identified four- and five-factor solutions which accounted for >70% of the variance. Confirmatory factor analysis (Lisrel 8.7) revealed indices of moderate fit for the five-factor solution. Our results suggest that the factor structure of the ABC is robust within an ASD sample. Both solutions yielded a three items self-injury factor. Stratifying on this factor, we identified significant differences between the high- and low-self injury groups on ABC subscales. The emergence of a self-injury factor, while not suggestive of a new subscale, warrants further exploration as a tool that could help dissect relevant neurobiobehavioral groups in ASD.     

Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC) Correspondence and Conflicts with DSM-IV Criteria in Diagnosis of Autism

Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC) are tests widely used for screening and diagnosis of autism. This study verified their correspondence and conflict with a diagnosis made with DSM-IV criteria. The sample consisted of 65 children, aged 18 months to 11 years. We found complete agreement between DSM-IV and CARS. We show that ABC does not distinguish individuals with autistic disorders from other cases of developmental disorders as well as CARS: the number of false negatives is high (46%) with ABC as opposed to 0% with CARS.     

A Head-to-Head Comparison of Aripiprazole and Risperidone for Safety and Treating Autistic Disorders,a Randomized Double Blind Clinical Trial

Aripiprazole and risperidone are the only FDA approved medications for treating irritability in autistic disorder, however there are no head-to-head data comparing these agents. This is the first prospective randomized clinical trial comparing the safety and efficacy of these two medications in patients with autism spectrum disorders. Fifty nine children and adolescents with autism spectrum disorders were randomized to receive either aripiprazole or risperidone for 2 months. The primary outcome measure was change in Aberrant Behavior Checklist (ABC) scores. Adverse events were assessed. Aripiprazole as well as risperidone lowered ABC scores during 2 months. The rates of adverse effects were not significantly different between the two groups. The safety and efficacy of aripiprazole (mean dose 5.5 mg/day) and risperidone (mean dose 1.12 mg/day) were comparable. The choice between these two medications should be on the basis of clinical equipoise considering the patient’s preference and clinical profile.     

Disruptive Behavior Disorders in Adolescents With ASD: Comparisons to Youth With Intellectual Disability or Typical Cognitive Development

Dual diagnosis of autism spectrum disorder (ASD) and behavior problems and/or mental disorders has become increasingly recognized and studied. Reported rates in samples of mixed-age youth with ASD are often above 70%, making this comorbidity more the rule than the exception. The present study compared rates of disruptive behavior disorder diagnosis in a sample of 13-year-old adolescents with ASD (n = 58), intellectual disability (ID; n = 40), or typical cognitive development (TD; n = 100). In youth without ASD, there was a high negative correlation between IQ and disruptive behavior disorders, assessed with the Child Behavior Checklist (CBCL) and the Diagnostic Interview Schedule for Children (DISC). In youth with ASD, however, the presence of a comorbid disruptive behavior disorder was unrelated to IQ, indicating that higher intelligence was not a protective factor for disruptive behavior disorders (DBDs) in ASD. On four CBCL scales and two DISC scales examined, youth with ASD had significantly higher rates than TD youth, though not generally higher than youth with ID. The most commonly diagnosed comorbid disorder in the early adolescents with ASD was attention-deficit/hyperactivity disorder. This has implications for planning school-based interventions, particularly for high-functioning children with ASD who are more likely to be fully included in general education.