Screening Accuracy of Level 2 Autism Spectrum Disorder Rating Scales. A Review of Selected Instruments
Autism
Norris, M., & Lecavalier, L. (2010).
Autism, 14(4), 263-284.
This review investigates the accuracy of commonly-used caregiver-completed rating scales for autism screening in individuals, 3-years and older. This review included the following scales: the Social Communication Questionnaire (SCQ), the Gilliam Autism Rating Scale/Gilliam Autism Rating Scale
–Second Edition (GARS/GARS-2), the Social Responsiveness Scale (SRS), the Autism Spectrum Screening Questionnaire (ASSQ), and the Asperger Syndrome Diagnostic Scale (ASDS).
Not stated
1993- December 2008
Peer-reviewed studies (not further specified)
20 (see Table 1)
"The [Social Communication Questionnaire] should be considered a strong choice for professionals aiming to screen for [autism] ... in children and adolescents functioning above the moderate range of [intellectual disability]. The [Social Responsiveness Scale] and [Autism Spectrum Screening Questionnaire] are promising but are in need of additional examination. The GARS [Gilliam Autism Rating Scale] and ASDS [Asperger Syndrome Diagnostic Scale] both have demonstrated inadequate psychometric properties to support level 2 screening ..., and are thus not recommended based on currently available data" (pp. 280-281).
<p>The Asperger Syndrome Diagnostic Scale (ASDS):</p>
<ul>
<li>is comprised of 50 yes/no items arranged on the following five subscales:
<ul>
<li>language,</li>
<li>social,</li>
<li>maladaptive,</li>
<li>cognitive,</li>
<li>sensorimotor</li>
</ul>
</li>
<li>did not have any available sensitivity, specificity, positive predictive power, or negative predictive power data at the time of this study</li>
<li>was based on a normative sample which did not contain confirmed diagnoses of AS; only one study examined the ASDS (no sensitivity or specificity data were reported), and concerns have been raised regarding the ASDS (p. 278).</li>
</ul>
The Australian Scale for Asperger Syndrome (ASAS), the Gilliam Asperger Disorder Scale (GADS), and the Krug Asperger's Disorder Index (KADI) were not included in this review since they have not been subjected to peer-reviewed study.
<p>The Autism Spectrum Screening Questionnaire (ASSQ) was designed for individuals functioning at or above the borderline range of intellectual disability and has been used to differentially diagnose autism from other disorders, such as learning disorders. The following diagnostic validity characteristics were reported:</p>
<ul>
<li>sensitivity (.62-.82)</li>
<li>specificity (.90-.91).</li>
</ul>
<p>The Social Responsiveness Scale (SRS) requires more research to determine how well it differentiates children on the autism spectrum with diagnoses commonly mistaken for autism (e.g., language disorders) as well as those with intellectual disability. The following diagnostic validity characteristics were reported:</p>
<ul>
<li>sensitivity (.75-.78),</li>
<li>specificity (.77-.95),</li>
<li>positive predictive value (.63), and</li>
<li>negative predictive value (.67-.94).</li>
</ul>
The Children's Social Behavior Questionnaire (CSBQ) was excluded due to "its lack of an established cut-off score or published diagnostic validity evidence" (p. 279).
<p>The Social Communication Questionnaire (SCQ; formerly called the Autism Screening Questionnaire) was developed for individuals who are four years and older and have a mental age of two years and has the following diagnostic validity characteristics:</p>
<ul>
<li>sensitivity (.45-.96),</li>
<li>specificity (.52-.92),</li>
<li>positive predictive value (.47-.93), and</li>
<li>negative predictive value (.67-.94).</li>
</ul>
<p>The SCQ has "usefulness as a screening instrument, though the cut-off scores may need to be adjusted depending upon the population" (p. 271) and it is not optimal when used with children aged two to three years old.</p>
