Asperger Syndrome
Spring 2012
by
Samantha Bensavage
Samantha Jansson
Amanda Pavalko
Janelle Strickler
Table of Contents
Background
2
Asperger Syndrome Characteristics
2
Prevalence & Incidence
3
Cause
4
Diagnostics
5
Misdiagnosis & Underdiagnoses
8
Co-Occurring Disorders
9
Medications
9
Impact on Family
11
Parents
11
Siblings
11
Assessments
12
Campbell (2005) Diagnostic Article
12
Standard Assessments
16
Pragmatics Language Skills Inventory (PLSI)
16
Social Emotional Evaluation (SEE)
21
Children’s Communication Checklist-2 (CCC-2)
23
Autism Screening Instrument for Educational Planning-Second Edition (ASIEP-2)
Gilliam Autism Rating Scale (GARS)
Criterion-Referenced
Clinical Evaluation of Language Fundamanetals-4 (CELF-4)
Treatment
Overview of treatment
Strategies & Research
Social Competence Intervention
LEGO Therapy & Social Use of Language Programme (SULP)
Video Modeling
Parent Training
Computerized Intervention
New Research
Toolbox Skill Set & Camp Campus Pilot Study
ILAUGH
Group
Resources
Parents/Caregivers
Teachers
Appendix A
Psychometric Properties
References
1
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29
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33
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47
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67
Background
In 1944, an Austrian pediatrician, Hans Asperger, observed four
children, with symptoms he characterized as “autistic psychopathy”
(Koegler & Koegler, 2006). The individuals exhibited extremely formal
speech, inappropriate social behaviors, narrowed interests, and motor
clumsiness. Though appearing cognitively and linguistically typical,
deficits in social difficulties and social isolation were prominent (Elder,
L., Caterino, L., Chao, J., Shacknai, D., &, DeSimone, G., 2006). In 1981, a
researcher, Lorna Wing, “coined” the term Asperger Syndrome (AS).
She reviewed Hans’s original work and added other elements of her own
research, proposing “formal diagnostic criteria be developed to support
a number of clinical accounts” of AS (Elder et al., 2006). In 1994, the
Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition
(DSM-IV) recognized the term AP as a Pervasive Developmental
Disorder (PDD) (Elder et al., 2006).
Asperger Syndrome Characteristics
AS, a developmental disorder, is commonly used interchangeably with the term with High
Functioning Autism (HFA) (Winters, 2003). Dr. Tony Attwood, a clinical researcher, imparts a
significant amount of knowledge on the topic of AS and HFA. He delineates that children or
individuals with HFA are classically autistic (i.e., significant language delay, early intervention, etc.)
during preschool years and younger. Contrasting this, individuals with AS, are not considered
classically autistic within their preschool years. The signs may be present, however, not substantial
enough to alert parents/caregivers, educators, speech language pathologists (SLP), etc. to intervene
and refer for a diagnoses (Yai Network, 2009). Signs and symptoms of AS become prominent when
children are of school-age resulting in a later diagnosis of AS. Dr. Attwood indicates that when
children with HFA and AS are around the age(s) of 8-10, they tend to be the similar in terms of
needs, friendships, learning profiles, emotional management, motor coordination, and
sensory/sensitivity. Further, the differences are prevalent at a younger age (Yai Network, 2009).
The chart below lists the specific characteristics exhibited by individuals with AS outlined by Dr.
Attwood.
–
–
–
–
Impairment in social interaction
Difficulty developing appropriate friendships with peers
Difficulty with the use of non-verbal behavior (i.e., eye gaze,
facial expression and body language)
Lack social/emotional reciprocity and empathy.
Difficulty identifying social cues and conventions
2
–
–
–
–
–
–
–
–
–
–
–
–
Impairment in communication skills:
Difficulties with conversation skills
“Pedantic” speech
Unusual prosody
Literal interpretation
Explaining thoughts/ideas via speech
Limited Interests
Constantly focused on a specific topic/interest
Preference for routine and consistency
Characteristics may also include
Motor clumsiness
Difficulty with handwriting
Hypersensitive to specific auditory and tactile sensations
Difficulties with organizational/time management skills
Source: Derived from information from Oasis (2005)
It is important to note, signs and characteristics are unique to every individual and will be
different in the extent and/or manner in which they are displayed. Symptoms become more
apparent when an individual is stressed, has anxiety or is exhausted.
It is important for a speech language pathologist who is working with an individual with AS
to consider the various deficits these individuals exhibit in the areas of pragmatics and social
competence. The deficits, outlined by Koegler & Koegler (2006), are listed below:
–
–
Pragmatic deficits:
o Use of prosodic features
o Monotone pitch
o Extremely formal speech
o Expressing & interpreting nonverbal cues
Conversational deficits:
o Introducing new topics
o Transitioning between topics
o Making relevant comments regarding another’s story
Because communication styles of individuals with AS are distinctly characterized by
loquaciousness (i.e., tending to talk a great deal) regarding fixation on topics of interest, this tends
to interfere or obstruct the way in which these individuals interact socially. Further, they become
immersed and attend fully to their own interest, rather than engaging in reciprocal social
exchanges. Therefore, it is crucial to recognize and assess the deficits within these areas that are
specific to the individual (Elder et al., 2006).
Prevalence & Incidence
Regarding prevalence, or the total number of cases in the population at a given time, it is
estimated to occur in as many as 48 per 10,000 individuals, being more common among the male
population compared to the female population (i.e., 8:1 according to the World Health Organization,
2004). Though incidence (i.e., the number of new cases that develop during a specific time period)
3
is not well established referring to this population specifically, it is important to note that AS is
increasing in the number of diagnoses. Males are 3 to 4 times as likely to be diagnosed with AS.
Further, AS is most prevalent in children, however, it is a lifelong condition that stabilizes overtime
(Elder et al., 2006).
Cause
Technology has played a critical role in determining the cause of AS. Currently, research
targets “brain abnormalities” as the cause of AS. Through the use of technology and brain imaging
techniques, researchers have been able to detect various “functional and structural differences” in
the brain of individuals diagnosed with AS as compared to individuals who are typically developing
( NINDS, 2012). The NINDS (2012) indicates the cause to be an “Abnormal migration of embryonic
cells during fetal development that affects brain structure and “wiring,” which further “affects the
circuits controlling thought and behavior.”
Research proves that AS Syndrome, as well as other disorders identified within Autism
Spectrum Disorder (ASD), have a genetic component, where the disorders tend to run in families.
The NINDS (2012) reports, however, that a gene specific to AS has not been identified within
current research. According to Griffin, et. al. (2006), “genes regulating glutamate, serotonin, and
gama-aminobutiric acid and their interactions may relate to possible causative factors.”
4
Diagnostics
According to Morris (2008), diagnosis of AS is typically made in school age children who range
from four to eleven years of age and done so by taking into consideration input from various
members of a multidisciplinary team. The multidisciplinary team consists of any individual who has
interacted with and/or observed the individual multiple times over various settings, or has
background knowledge of the evident characteristics and symptoms in those with AS. The
multidisciplinary team may include:
o
o
o
o
o
o
o
o
Speech Language Pathologists
Psychologists
Psychiatrists
Medical Personnel
Social Workers
Educators
Family members
Other Professionals
Although observations are an important component of the evaluation of an individual for a
potential diagnosis of AS, other neurological assessments are needed. These assessments are listed
in a later portion of our manual, however it is important to understand that the final diagnosis is
confirmed by the child’s pediatrician after all of these areas have been taken into consideration. The
pediatrician will also consult the Diagnostic and Statistical manual of Mental Disorders.
The American Psychiatric Association (APA) has published the Diagnostic and Statistical
Manual of Mental Disorders since 1952. The information published in the very first manual
consisted of statistic and census information gathered from a psychiatric hospital. The original
publication contained pertinent information in regards to all existing mental health disorders for
both children and adults at that time. Since then there have been seven revisions and publications
of manuals which have changed as our knowledge of mental disorders has expanded.
The most current version of this manual is the Diagnostic and Statistical Manual-Fourth
Edition-Text Revision (DSM-IV-TR). The organization of this manual is based on a five-part
multidimensional system geared toward the diagnosis. This multidimensional approach covers five
areas of mental disorders:
o
o
o
o
o
Clinical Syndromes
Developmental & Personality Disorders
Physical Conditions
Severity of Psychosocial Stressors
Highest Level of Function
The DSM-IV-TR was published in July of 2000 and contains all empirical literature up until
1992. The purpose of the revision was to make corrections to the diagnostic codes and various sets
5
of diagnostic criteria which were published in the original DSM-IV. Listed below is the criteria
needed for a differential diagnosis of AS according to the criteria set in the DSM-IV-TR:
Criteria for Diagnosis of Asperger’s Disorder:
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
(1)
marked impairment in the use of multiple nonverbal behaviors such as eye-toeye gaze, facial expression, body postures, and gestures to regulate social
interaction
(2)
failure to develop peer relationships appropriate to developmental level
(3)
a lack of spontaneous seeking to share enjoyment, interests, or achievements
with other people (e.g., by a lack of showing, bringing, or pointing out objects of
interest to other people)
(4)
lack of social or emotional reciprocity
B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as
manifested by at least one of the following:
(1)
encompassing preoccupation with one or more stereotyped and restricted
patterns of
interest that is abnormal either in intensity or focus
(2)
apparently inflexible adherence to specific, nonfunctional routines or rituals
(3)
stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or
twisting, or complex whole-body movements)
(4)
persistent preoccupation with parts of objects
C. The disturbance causes clinically significant impairment in social, occupational, or other
important areas of functioning.
D. There is no clinically significant general delay in language (e.g., single words used by age 2
years, communicative phrases used by age 3 years).
E. There is no clinically significant delay in cognitive development or in the development of ageappropriate self-help skills, adaptive behavior (other than in social interaction), and
curiosity about the environment in childhood.
F. Criteria are not met for another specific Pervasive Developmental Disorder or
Schizophrenia.
Source: Chart adapted from APA, 2000
6
Currently the APA is in the process of releasing a new manual in May of 2013. Upon the
release of the new manual, the label of “Asperger Syndrome” will be removed from the DSM-5 and
replaced with the term “Social Communication Disorder,” which will fall under the heading of
autism spectrum disorder. Listed below is the criteria needed for a differential diagnosis of AS
according to the criteria set in the DSM-IV-TR:
Criteria for Diagnosis of Autism Spectrum Disorder
Must meet criteria A, B, C, and D:
A. Persistent deficits in social communication and social interaction across contexts, not
accounted for by general developmental delays, and manifest by all 3 of the following:
(1) Deficits in social-emotional reciprocity; ranging from abnormal social approach and
failure of normal back and forth conversation through reduced sharing of interests,
emotions, and affect and response to total lack of initiation of social interaction,
(2) Deficits in nonverbal communicative behaviors used for social interaction; ranging from
poorly integrated- verbal and nonverbal communication, through abnormalities in eye
contact and body-language, or deficits in understanding and use of nonverbal
communication, to total lack of facial expression or gestures.
(3) Deficits in developing and maintaining relationships, appropriate to developmental
level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit
different social contexts through difficulties in sharing imaginative play and in making
friends to an apparent absence of interest in people
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least
two of the following:
(1) Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple
motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
(2) Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or
excessive resistance to change; (such as motoric rituals, insistence on same route or
food, repetitive questioning or extreme distress at small changes).
(3) Highly restricted, fixated interests that are abnormal in intensity or focus; (such as
strong attachment to or preoccupation with unusual objects, excessively circumscribed
or perseverative interests).
(4) Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of
environment; (such as apparent indifference to pain/heat/cold, adverse response to
specific sounds or textures, excessive smelling or touching of objects, fascination with
lights or spinning objects).
C. Symptoms must be present in early childhood (but may not become fully manifest until
social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning.
Source: Chart adapted from APA, 2012
The rationale provided by the APA in 2012 is based on the empirical findings of recent
research. One of the key findings of this research in regards to the diagnosis of AS, is that the
diagnosis has been used “loosely.” This means that individuals have been diagnosed with AS when
they have been unable to meet the criteria for Autism Disorder. This research has also suggested
7
new criteria for the diagnosis of AS. The two current viewpoints the APA has discovered through
the findings of this research are listed as follows (APA, 2012):
o
o
“AS is not substantially different from other forms of ‘high functioning’ autism”
“AS is distinct from other subgroups within the autism spectrum therefore a more stringent
approach is needed to consider onset patterns and early language”
The main differentiating factor however is intelligence quotient (IQ) level. Research conducted by
the APA has determined that there is “little evidence that AS is distinct with current IQ being the
differentiating factor” (APA, 2012).
Although the label of “Asperger syndrome” will be removed from the DSM-5, this does not
mean that speech and language pathologists will not work with individual’s exhibiting the various
characteristics and symptoms listed in this manual. When discussing the concern for maintenance
for those with the diagnosis, the APA has set forth the following statement:
“Language impairment/delay is not a necessary criterion for diagnosis of ASD, and thus
anyone who shows the Asperger type pattern of good language and IQ but significantly
impaired social-communication and repetitive/restricted behavior and interests, who might
previously have been given the Asperger disorder diagnosis, should now meet criteria for
ASD, and be described dimensionally.” (APA, 2012)
Essentially it is important for a speech and language pathologist to understand the most
common characteristics of AS which include social/communication impairments,
repetitive/restricted behaviors and interests, as well as the IQ level and language abilities of these
individuals. Considering all of these factors will aid in the delivery of the most beneficial therapy to
an individual who will now be considered the ‘Asperger-type’ but, however, will not have this
diagnosis.
Misdiagnosis & Underdiagnosis
Arriving at the definitive diagnosis of AS for an individual patient is often a challenge for
pediatricians. Although information gathered via assessments, observations, consultation of the
DSM, and input from the multidisciplinary team is taken into consideration, other disorders can
present with similar symptoms. Misdiagnoses and under-diagnoses of AS are inevitable when
considering the various extraneous variables taken into consideration by the pediatrician when
diagnosing AS. Although there is potential for both misdiagnoses and under-diagnoses to occur, it
does not take away from the traumatic effects felt by not only the individual, but by family members
as well. Misdiagnosis also can lead to the use of medications can worsen or amplify the behaviors
exhibited in and individual with AS (Morris, 2008). The most common disorders diagnosed in the
place of AS include:
o
Other Autism Spectrum Disorders
o
Schizophrenia Spectrum
8
o
ADHD
o
Obsessive Compulsive Disorder
o
Depression
o
Semantic Pragmatic Disorder
o
Nonverbal Learning Disorder
o
Tourette Syndrome
o
Stereotypic Movement Disorder
o
Bipolar Disorder
Co-Occurring Disorders
Secondary diagnoses of disorders may occur in a child with AS. Co-occurring disorders may require
medications or other treatment methods. Advocacy groups claim the measles-mumps-rubella (MMR)
vaccine causes Asperger's and autism. Numerous studies, however, have not found a link between cooccurring conditions and the vaccine (NINDS, 2012). Typical disorders that co-exist with AS include:
o
Attention Deficit Hyperactivity Disorder
o
Bipolar Disorder in Children and Teens
o
Depression in Children and Teens
o
Nonverbal Learning Disorder
o
Obsessive-Compulsive Disorder
o
Social Anxiety Disorder
(NINDS, 2012)
Medications
There is no medication specifically for AS; however, medications are available for the co-occuring
symptoms and diagnoses. These medications may improve symptoms such as irritability,
hyperactivity and inattention, depression, and repetitive behaviors that can all be associated with
AS (Mayo Clinic, 2011). The Mayo Clinic, supported by ASHA, lists medications for individuals with
AS that may include but are not limited to:
o
Aripiprazole (Abilify) may be prescribed for irritability.
9
o
Guanfacine (Intuniv) may be prescribed for hyperactivity and inattention.
o
Selective Serotonin Reuptake Inhibitors (SSRIs) such as Fluvoxamine (Luvox) may be
prescribed for depression or to help control repetitive behaviors.
o
Risperidone (Risperdal) may be prescribed for agitation and irritability.
o
Olanzapine (Zyprexa) may be prescribed for reduction of repetitive behaviors.
o
Naltrexone (Revia) may be prescribed for reduction of some repetitive behaviors.
(Mayo Clinic, 2011)
10
Impact on Family
Parents
Parents and caregivers of a child with AS can experience some negative emotions after their child is
diagnosed. They may feel overwhelmed and not sure what to do or where to turn next. They might
feel guilty and have thoughts such as “did I do something to cause this?” They may also become
stressed and confused with the unexpected and unfamiliar situation. Some parents might feel
angry after hearing that their child has AS. Depression might be seen in parents or frustration if
they are having a hard time understanding why this is happening or what is expected of them as
parents. They may also be frustrated if they feel like other people don’t understand their situation.
Lastly, they might feel a sense of loss after their child has been diagnosed with AS. There are some
ways for parents to cope with these feelings. These include counseling and support groups.
Another coping strategy is the utilization of an Asperger’s internet forum. These forums are a
positive resource where parents can talk to other parents about the way that they feel or the
struggles that they face with their child (Morris, 2008).
Siblings
Siblings of a child with Asperger’s may also be affected after their brother or sister is diagnosed
with AS. Since a child with Asperger’s may require more help or attention, siblings can feel jealous,
resentful, or they may feel ignored. Siblings may have trouble adjusting to the behaviors or unique
communication style of an individual with Aspergers. Some siblings may also feel embarrassed of
their brother or sister with Asperger’s. Another feeling that may be experienced by siblings is
concern. This leads to overprotective actions towards their brother or sister with AS, even if the
typically developing sibling is younger. Siblings of children with AS may also experience the same
emotions that parents experience. An effective way that siblings can cope with these feelings is by
talking about them. For this reason, it is important for parents to encourage their children to talk
about their feelings or even write them down (Morris, 2008).
11
Assessments
Evaluation and observation of any disorder must take place across a range of
settings and in a variety of contexts in order to determine an individual’s abilities in a
specific area, i.e., language, speech, social skills, pragmatics. Strategies including
standardized tests, naturalistic play environments, informal probing, and
parent/caregiver input are all specific ways to gather the information necessary to
make a correct and further adequate diagnosis. Specific to Asperger’s and challenges in
language, deficits exist in pragmatics, or the way language is used in social contexts,
social interactions, including eye contact, turn taking, conversational reciprocity, and
the way in which they adapt in these situations. A number of assessments exist that can
be used to detect and further identify these characteristics of AS. These assessments
have been identified, explained and critiqued below to provide a further understanding
of the intended purposes and psychometric properties of each test. It is important to
note, psychometric properties are defined in Appendix A of this manual. The tests listed
below are available in the Bloomsburg Speech, Language & Hearing Clinic.
Diagnostic Article
1. Campbell, J.M. (2005). Diagnostic assessment of Asperger’s Disorder: A review of five
third-party rating scales. Journal of Autism and Developmental Disorders, 35 (1), 25-35.


To establish consistency, the author utilizes AD as the abbreviation for Asperger
Disorder. Throughout this document, we have used AS referring to Asperger
syndrome. For the purposes of the article below, both are assumed to mean the
same.
Purpose
o The purpose of this article was to evaluate five screening procedures, i.e.,
three published screening assessments and two research instruments, to
evaluate and assess the detection of Asperger syndrome AS.
o This article completes an analysis targeting the intended purposes of each of
the five rating scales and further analyzes the psychometric properties of
each, contributing to the standardization, validity, and reliability measures to
aid in the detection of AS.

Method: Five rating scales
o Three published measures available including:
 The Asperger Syndrome Diagnostic Scale (ASDS)
 Gilliam Asperger’s Disorder Scale (GADS)
 Krug Asperger Disorder Index (KADI)
o Two research instruments were also utilized including:
 The Autism Spectrum Screening Questionnaire (ASSQ)
 The Childhood Asperger’s Screening (CAST)
12


Procedure:
o The examiner’s manual for each rating scale was used to examine
psychometric properties in regards to each rating scales adequacy in the
standardization process.
o The criteria established for psychometric properties was accessed from a
study completed by Bracken (1987) which determined:
 Psychometric Criteria
 Internal consistency must result in a value of 0.90 or greater
 Median subtests must have an internal consistency value of
0.80 or greater
 Total test temporal stability value must be 0.90 or greater
 Standard/Scaled Scores
 Test scores and floors must be at least 2 standard deviations
beyond normative data
 Average subtest scaled score floors and ceilings must be at
least 2 standard deviations and beyond normative data
 Item Gradients
 Average item gradients should be no steeper than 1/3 of a
standard deviation for a total standard score or an average
subtest scaled score
 Validity Data
 Presence of validity data was required by each of the rating
scales
o The criteria established for additional research measures considered in this
study was accessed from a study completed by Streiner (1993) which
determined:
 Readability Measures
 Flesh Reading Ease (FRE)
o This measure rates text on a 100 point rating scale with
higher scores indicating easier comprehension
 Flesh-Kincaid Grade Level (F-KG)
o This measure rates texts on a grade-based level
 E.g., score of 7.0 indicates the text is
comprehensible for the average 7th grader
Conclusions
o Consistent limitations are presented throughout the article regarding the
norm-referenced samples for the standardization process of three rating
scales including: ASDS, GADS and KADI
o Surveys were mailed to participants in this study and thus, there is not sure
way of knowing what definition of AS each child was diagnosed or if each had
a definitive diagnosis of AS.
o Of the published measures, Campbell reports the KADI demonstrated the
strongest psychometric properties, where as ASDS consistently showed the
weakest properties
13
o Considering the research measures, the ASSQ demonstrates positive
reliability outcomes; however, less convincing validity. The CAST
demonstrates strong validation; however, the authors do not report or
publish records of reliability.
o Campbell (2005) states, “All scales should be used with caution when
evaluating the presence of AS, especially differentiating between HFA and
AS.”
o Additionally, a larger sampling populations must be included when
differentiating between and diagnosing HFA and AS.

Discussion
o Campbell (2005) describes the diagnostic challenges, present when assessing
and evaluating psychometric properties, as difficult considering the everchanging diagnostic criteria of Asperger’s syndrome and further,
discriminating Asperger syndrome from High Functioning Autism.
o The author presents the fact that literature does exist discriminating HFA
and AS, however much of it is contradictory.
o Concluding Campbell’s argument (2005), any instrument that claims to
definitively diagnosis AS, must be able to differentiate between HFA and AS.

The charts below were compiled from this article and explain the intended
purposes and psychometric properties of each rating scale.
This chart describes the intended purposes of each rating scale, e.g., utilized to screen,
diagnostic scale, generate IEP goals, presents the number of items on the test, gives the age
range for each test, and lists the subtests for each rating scale. Additionally the readability
measures are presented in this table. The definitions are listed above.
Description of Third-Party Rating Scales & Intended Purposes
Purpose
ASDS
-
ASSQ
CAST
GADS
-
Diagnostic
and monitor
behavior
Generate IEP
Goals
Research
Screener
Research
Screener
Research
Diagnostic aid
Assess unique
behavior
Monitor
behavior
Age
Items on Test
Subscales
5-18
50-item
-
Language
Social
Maladaptive
Cognitive
Sensorimotor
6-17
27-item
-
Overall Score
4-11
37-item
-
Overall score
3-22
32-item
-
Social
interaction
Restricted
behaviors
Cognitive
-
14
Readability
(defined above)
FRE=40.5
F-KG=9.9
FRE=46.3
F-KG=8.7
FRE=74.9
F-KG=4.1
FRE=55.7
F-KG=8.1
-
KADI
-
Generate IEP
patterns
goals
- Pragmatic
Research
skills
Screener
6-21
32-item
- Overall score
Generate IEP
Goals
Research
Source: Chart derived from information from Campbell (2005)
FRE=51.2
F-KG=8.2
This chart displays the psychometric property, reliability for each rating scale. The criterion is listed
above. The ASSQ and CAST do not report internal consistency measures. The ASSQ displays positive
test-retest reliability. The KADI demonstrates strong measures of reliability, i.e., > 0.90. The ASDS and
the GADS present with moderate reliability. Inter-rater results indicate moderate to strong
reliability measures, except for the CAST which does not report on this measure.
Psychometric Properties: Reliability
ASDS
ASSQ
CAST
GADS
KADI
Internal Consistency
- Cronbach’s
Coefficient 0.83
- Subscale score
Coefficient 0.640.83
- Not reported
Test Retest
- Not reported
Inter-rater Reliability
- 0.93 (parent-teacher
agreement)
0.94 (teacher
- 0.77 (parent-teacher
ratings)
agreement)
- 0.96 (parent
ratings)
- Not reported
- Not reported
- Not reported
- Cronbach’s
- 0.71-0.77 for
- 0.89 (parent teacher
Coefficient 0.87
GADS
agreement)
- Subscale score
subscales
coefficient
- Temporal
range 0.70-0.81
stability
reliability 0.93
for ADQ
- Cronbach’s
- Temporal
- 90% agreement reported
Coefficient 0.93
stability 0.98
for pairs of raters
Source: Chart derived from information from Campbell (2005)
-
Regarding validity, the author denotes that measures diagnosing AS, must be able to differentiate
between HFA and AS. Content validity measures the importance of the sample population or
whether or not the sample is representative of the population as a whole being targeted
within each rating scale. The criterion, as to how each test defines the sample population, is
listed under the content potion of this chart. Criterion validity refers to comparing the rating
scale to an external measure or a standard assessment measuring the same population.
Under the criterion potion of this chart, the author displayed what each rating scale
differentiates between and what measures were used to compare results. Construct validity
15
considers what is already known, and requires the correlations be evaluated regarding the
variables that are related to the measure, e.g., age, gender.
Psychometric Properties: Validity
Content
Criterion
Construct
ASDS
DSM-IV, ICD-10,
Asperger’s 1944
article, literature
review spanning
1975-1999
Differentiates between
Asperger’s, autism, LD, ADHD,
behavior disorders—correlates
with GARS
Scores not dependent on age.
Scale items correlate with total
ASSQ
Literature review
spanning Asperger’s
articles 1944-1989
Differentiates between ASD,
attention/behavior disorders
Not reported
CAST
DSM-IV, ICD-10,
ASSQ items, PDD-Q
items
Differentiates between ASD
and typical children in pilot
and community samples
Not reported
Differentiates between AD,
autism, other disability groups,
and non-disabled peers.
Correlates with GARS.
Scores not dependent on age
or gender. Items correlate with
total GADS scores
Differentiates between AD,
HFA, and typical peers.
Sensitivity, specificity, and
positive productive validity
Scores not dependent on age
or gender. Items correlate with
total KADI scores
GADS DSM-IV, ICD-10,-TR,
ICD-10; Literature
Review, other
measures of
Asperger’s
reviewed, e.g., ASSQ
KADI Pool of items from
ASIEP and other
measures, literature
review, e.g., Wing’s
(1981) description
of AD
Source: Chart derived from information from Campbell (2005)
Standardized Assessments
Pragmatic Language Skills Inventory (PLSI)
•
•
Age Range
– 5;0-12;0
Purpose
– The overall purpose of the PLSI is to assess an individual’s pragmatic and
language abilities.
16
The PLSI has four primary purposes:
• To identify pragmatic language disorders in an individual student.
• We using any assessment, the purpose is to identify students
with a specific disorder. Objective measures should be
provided. This will allow examiners to differentiate between
students who are or are not likely to have a pragmatic
language disorder. The PLSI provides strong reliability and
validity scores for this exact purpose.
• To document the individual students progress in pragmatic language
ability.
• This is extremely important in regards to accountability
purposes, program planning, decision making, and educational
placement within a school setting.
• To target pragmatic language goals that can be used for an
Individualized Education Program (IEP) and Section 504 plans.
• This is useful in determining the strengths and weaknesses of
specific pragmatic areas for individual students. Results
determined from the PLSI can be used to identify pragmatic
language problems, creating goals, and identifying targets for
instruction and intervention.
• To collect data for research.
• With strong scores in validity and reliability, the PLSI is an
encouraging instrument for researchers.
Subtests
– Classroom Interaction Skills
– Social Interaction Skills
– Personal Interaction Skills
–
•
•
What do the subtests measure?
– Classroom Interaction Skills assess an individual’s ability to:
• use and understand figurative language
• maintain a topic during conversation
• explain how things work
• write a good story
• use slang appropriately
– Social Interaction Skills assess an individual’s ability to:
• Know when to talk and when to listen
• Understand classroom rules
• Take turns in conversations
• Predict consequences for one’s behavior
– Personal Interaction Skills assess an individual’s ability to:
• Initiate conversations
• Ask for help
• Participate in verbal games
• Use appropriate nonverbal communicative gestures (e.g., eye gaze,
facial expressions)
17
Subtest
•
Median
Range
Classroom Interaction
.88 (High)
.74-.90
Social Interaction
.86 (Moderate to High)
.81-.90
Personal Interaction
.82 (Moderate)
.77-.87
Psychometric Properties
– Validity
• Content-Description Validity
• This was demonstrated in a discussion of how the content of
the PLSI is consistent with current theories on pragmatic
language. It also discussed how conventional item analysis
was used to validate the items.
• As seen in the following chart, the median discrimination
coefficients for boys, girls, and a cumulative total ranged from
.82 to .88. These help to provide quantitative evidence that the
PLSI has a strong validity factor.
• All the correlations were found to have significance with a
p<.01.
• It can be determined that the PLSI subscales are measuring
similar characteristics of pragmatic language.
(Gilliam et al. 2006)
•
Concurrent Criterion-Related Validity
• To examine the PLSI’s concurrent validity, it was correlated
with the standard scores of the Test of Pragmatic Language
(TOPL). There were two different samples of children used.
• The TOPL also identifies pragmatic language disorders in
children.
• The results can be seen in the following chart:
(Gilliam et al. 2006)
18
Correlation of the PLSI Standard Scores with the TOPL
PLSI Values
Mean
SD
TOPL Quotient
r
El Paso Study (N=12)
Classroom Interaction
12
3
112
.51*
Social Interaction
11
3
112
.71**
Personal Interaction
12
3
112
.50**
PLI
109
15
112
.82**
Albuquerque Study
(N=30)
Classroom Interaction
7
4
93
.86**
Social Interaction
8
3
93
.67**
Personal Interaction
7
3
93
.70**
PLI
87
16
93
.81**
*p<.05 **p<.01
• All the correlation coefficients found for the standard score
while doing this study were significant with a p<.01.
• The correlation between the PLSI and the TOPL Quotient were
also considered very high.
• The results from this study indicated a strong relationship
between the standard scores of the PLSI and the TOPL. Since
these two measurements were found to be very large, this is an
indication that the 2 tests are measuring the similar constructs.
In this case, they are looking at pragmatic language.
•
Construct-Identification Validity
• Interrelationship Among PLSI Subscales:
• The following table examines the relationships between
the PLSI subscales. The following table displays the
results of the correlations of the PLSI subscales. The
correlations were found to be significant with a p<.01.
As seen in the chart, the subscales are all measuring
pragmatic language skills.
Intercorrelation of PLSI Subscale Standard Scores
Classroom Interaction Social Interaction Personal Interaction
---
Subscale
Classroom
Interaction
Social Interaction
Personal Interaction
*p<.01
.75*
.82*
•
.79*
--(Gilliam et al. 2006)
Relationship of Subscale Standard Scores to the Pragmatic
Language Index
• The Pragmatic Language Index (PLI) is a combination of
standard scores of the PLSI subscales. This looks into
19
Subgroup
Classroom
Interaction
Social
Interaction
Personal
Interaction
Pragmatic
Language Index
Males
Females
.98 (High)
.98 (High)
.98 (High)
.97 (High)
.96 (High)
.97 (High)
.99 (High)
.99 (High)
Students with
Disabilities
Total Sample
.98 (High)
.96 (High)
.96 (High)
.98 (High)
.98 (High)
.98 (High)
.97 (High)
.99 (High)
•
the characteristics of pragmatic language behaviors on
the PLSI.
The results found were significant with a p<.01. This
supports the validity of the test. The results are
indicated below:
Correlation of PLSI Subscales with Pragmatic Language Index
Value
Classroom Interaction Social Interaction
Personal Interaction
Pragmatic Language
.83
.81
.86
Index
*p<.01
(Gilliam et al. 2006)
- Specificity and sensitivity were not specifically discussed within the PLSI
manual.
- Reliability
• Coefficient Alpha’s were used within the PLSI.
• This demonstrates the extent to which items within the PLSI
correlate with one another. Coefficient Alpha’s were computed
for all subscales of the PLSI. The participants in the normative
sample were all used.
• The acceptable criterion for reliability is .80 and .90 would be
considered optimal. When looking at the following chart, we
can determine that all of the PLSI’s alphas exceed the criteria.
This identifies the PLSI’s strong reliability.
•
•
Test Retest
• Classroom Interaction– correlation of 0.90– high test-retest
reliability
• Social Interaction– correlation of 0.91– high test-retest
reliability
• Personal Interaction– correlation of 0.78– moderate testretest reliability
• Pragmatic Language Index- correlation of .89- high test-retest
reliability
Inter-Examiner Reliability: Rated by 2 different teachers
20
•
•
•
•
Classroom Interaction– correlation of .87- high interexaminer reliability
Social Interaction- correlation of .90- high inter-examiner
reliability
Personal Interaction- correlation of .85- moderate interexaminer reliability
Pragmatic Language Index- correlation of .85- moderate
inter-examiner reliability
Social Emotional Evaluation (SEE)
by Elisabeth Wiig, Ph.D.
Rationale: Communication functions, whether that be initiating, establishing, and maintaining
human relationships, is dependent on adequate social competence and pragmatic skills. Individuals
with AS have primary deficits in these two key areas, thus supporting why the test is a sufficient
measure for this population.
•
Age Range
– 6;0-12;11
•
Purpose
– The SEE is a criterion referenced assessment and is designed to evaluate
various aspects of social and emotions awareness. The aspects assessed are
those defined by social emotional competence.
•
Subtests
– Supplemental Subtest: Recognizing Facial Expressions
– Four Core Subtests
• Identifying Common Emotions
• Identifying Emotional Reactions
• Understanding Social Gaffes
• Understanding Conflicting Messages
– The Social Emotional Questionnaire
•
What do the subtests measure?
– Supplemental Subtest: Recognizing Facial Expressions
• Evaluates a student’s ability to recognize people with the same facial
expression among 6 categories, i.e., happy, sad, anger, surprise, fear,
and disgust.
– Core Subtest: Identifying Common Emotions
• Given a choice of 4, the client is required to discriminate between
happy, sad, angry, etc.
– Core Subtest: Identifying Emotional Reactions
• Requires student to identify a reasonable or rational cause of an
emotional reaction after being shown an illustration (Receptive task)
21
–
–
–
•
• Name/label the emotion (Expressive task)
Core Subtest: Understanding Social Gaffes (Social blunder/mistake)
• After being shown an illustration, identify everyone in the picture
doing the right thing (Receptive Task)
• If identified, the student is then asked who is doing the wrong thing
(Expressive Task)
Core Subtest: Understanding Conflicting Messages
• After listening to an auditory stimulus the student is asked if he/she
thinks the speaker means what they are saying.
• The student is then required to identify the underlying message.
The Social Emotional Questionnaire
• A comparison of perceptions of the student’s social emotional
competence from parent/caregiver and educator/specialist (i.e., home
vs. school). Thus the parent is required to complete the questionnaire
and return the form to the evaluator so that he/she can assess the
perceptions in the home environment to that of the environment of
the evaluator.
Psychometric Properties
– Validity
• Internal Consistency
• The range for age groups is 0.76-0.88, indicating moderate to
high validity
• Concurrent Validity
• Concluded that no other test measures or assessments were
comparable to the SEE
• Authors decided to compare the results of the assessment to
the results of the SEE Social Emotional Questionnaires–
Pearson Chi-Square correlation indicated an association
between the scores
• Expressive (One standard deviation cutoff)
• Specificity– 95% were correctly identified– high specificity
• Sensitivity– 100% were correctly identified– high sensitivity
• Receptive (One standard deviation cutoff)
• Specificity– 95% were correctly identified– high specificity
• Sensitivity– 95% were correctly identified– high sensitivity
• Total Accuracy Measures
• Specificity– 100% were correctly identified– high specificity
• Sensitivity– 100% were correctly identified– high sensitivity
– Reliability
• Test Retest
• Receptive Raw Scores– correlation of 0.89– high test-retest
reliability
• Expressive Raw Scores– correlation of 0.88– high test-retest
reliability
22
Total Raw Scores– correlation of 0.93– high test-retest
reliability
Inter-Examiner Reliability: Computed for 3 trained diagnosticians
• Receptive– Pearson's r raw scores ranged from 0.99-1.00 and
Spearman’s rho ranged from 0.94-0.97– examiner highly
reliable in recording responses
• Expressive– Pearson’s– Pearson's r raw scores ranged from
0.96-0.98 and Spearman’s rho was greater than 0.99–
examiner highly reliable in recording responses
• Total Raw Scores– Pearson's r raw scores ranged from 0.980.99 and Spearman’s rho ranged from 0.97-0.99– examiner
highly reliable in recording responses
Inter-Examiner Reliability: Test Administration
• Ranged from 0.94-1.00– strong evidence that test examiners
are able to duplicate administration and scoring procedures
•
•
•
Children’s Communication Checklist – 2

Age range:
- 4;0-16;11
-
Purpose:
-
-
Norm-referenced assessment
Evaluates children in various domains of communication including pragmatics, syntax,
morphology, semantics, and speech.
Identifies children with pragmatic language impairment, speech and language
impairment and assists in identification of those requiring further assessment of an
autistic spectrum disorder (ASD).
Tests & Scales
- Checklist
o Used for children who speak in sentences and who have a primary language of
English.
o Children must not have a hearing impairment.
o 70 items divided into 10 scales
o Each scale has 7 items (5 address difficulties, 2 focus on strengths)
o Scales A, B, C, & D assess articulation and phonology, language structure,
vocabulary and discourse
o Scales E, F, G & H address pragmatic aspects of communication
o Scales I & J assess behaviors commonly impaired in children with ASD
- Uses a Caregiver Response Form
o The adult, who has regular contact with the child, is given the response form to
complete.
23
- Psychometric Properties
-
Validity
 The source of the data was taken from three sample populations:
• Children with SLI
• Children with PLI
• Children with ASD
 The children were matched to a typically developing control group on age,
gender, race/ethnicity and parent education.
 Supports strong evidence for clinical use—strong validity
-
Reliability
o Test-Retest
• First administration: This assessment was administered to 98
participants and was divided into 3 specific age ranges including:
 4:0-6:11
 7:0-9:1
 10:0-16:11
• Second administration was within 1 to 28 days
• Reliability coefficients ranged from 0.86-0.96—strong reliability
• Reliability ranges:
 All scales by age ranged from 0.47-0.85—moderate to
strong reliability
 Scales averaged across all ages ranged from 0.65-0.79—
moderate reliability
 GCC reliability ranged from0 .94 to .96—strong reliability
Autism Screening Instrument Screening Instrument for Educational
Planning–Second Edition (ASIEP-2)
by David A. Krug, Joel R. Arick, & Patricia J. Almond
Rationale: The ASIEP-2 was designed to aid professionals in the educational setting in the
identification of individuals with autism as well as provide an appropriate education plan for that
student. According to the manual, the ASIEP-2 provides the range and sensitivity to reliably identify
those with high-functioning autism (HFA). In regard to Asperger Syndrome, this information is
beneficial since AS is considered to be a form of HFA.
*This assessment is broken into five subtests which are then scored and plotted on the Interpreting
Across Subtests (IAS): Autism Profile. This profile then allows the clinician to see how the client
compares to the normative sample.

Ages – Several discrepancies:
–
First, the manual does not provide a definitive age group for which the AISEP is
appropriate. The only population the manual says to target includes those who are
24
“functioning at a language and social age between 3 months and 49 months” (ASIEP2, 1993).
–
The publisher of this assessment, Pro-Ed Incorporated, state that the target
population are those from 2;0 to 13;11.
–
Finally, The American Speech, Language and Hearing Association (ASHA) states that
this test can be given to individuals 1;6-Adult (ASHA, 2012).
–
Considering the amount of conflicting information, it may be best for the clinician to
utilize his/her clinical knowledge when choosing this test for a particular client.
•
Administration Time: Varies
•
Subtests:
–
Autism Behavior Checklist (ABC)
•
Purpose:
•
•
•
The ABC is a checklist of non-adaptive behaviors which allows the
professional to quantify behavioral characteristics of an individual.
Results of this checklist provide the professional with a picture of
how the client “looks” in comparison to others. The behaviors
observed fall into the categories of sensory, relating, body and object
use, language, and social and self-help skills.
Validity
•
Content Validity – All 57 behavior descriptors were significant
predictors (p<.001) of the diagnosis of autism
•
Concurrent Validity – F-ratios to compare five diagnostic groups are
provided. Mean score for the autism population is significantly
higher (p<.001) then other four groups.
•
Criterion-Related Validity – 86% of this sample had ABC scores
within 1 SD of the mean of the ABC profile
Reliability
•
Intra-rater
•
Based on split-half reliability was r=0.87
•
Full test – r=0.94
25
•
Inter-rater
•
–
42 independent raters of 14 children was 95%
Sample of Vocal Behavior
•
Purpose:
•
•
Criterion-Related Validity
•
•
•
This is subtest is most relevant to clinicians because it is the results
of this subtest that will most likely help us differentiate AS from
other forms of autism. This subtest evaluates expressive speech at
the preverbal & emerging language levels and does so by focusing on
four specific characteristics. These characteristics include
repetitiveness (stereotypy), non-communication (social relating),
intelligibility (expressive delay and deviance), and babbling (nonmeaningful vocalization).
Autistic Speech Characteristics:
•
Noncommunicative – School age: p<.001
•
Repetitive – School age: p<.05
•
Unintelligible – not reported
•
Babbling - School age: p<.001
•
Multiple regression procedure – autistic speech
characteristics account for 24% of the variance in the ABC
Language Age Equivalents – concurrent validity with the Sequenced
Inventory of Communication Development (SICD) –found a significant
correlation, r=.81
Reliability
•
Test-Retest – Correlations for each of 5 areas (range .85-.94)
•
Split-Half – r(59)=.974, p<.001
•
Interobserver
•
“Reliability of each of the Autistic Speech Characteristics was
found at 90% mean agreement.”
26
–
Interaction Assessment
•
Purpose:
•
•
This subtest elicits and measures an individual’s social response
which include both spontaneous social responses as well as and
individual’s reaction to requests.
Standardization – Validity was not documented for this subtest however
the authors did report methods of data collection, sample and data analysis
to provide standardization to this subtest.
•
Data collection – 60 professionals attended a 30-min training
workshop
•
•
•
Sample – 115 randomly selected students with autism or other
severe disabilities were administered subtest
•
Data analysis: (F-Ratio & Significance Level)
•
Interaction p<.001; Aggressive Negative p<.01
•
Independent Play & No Response – not significant
Reliability
•
–
Focus on videotape reliability & scoring procedures –
achieved 95% agreement
The Kuder-Richardson test of item reliability r=.857
Educational Assessment
•
Purpose:
•
•
Information gathered from this subtest is directly pertinent the
student’s performance in the classroom. The subtest probes adaptive
language concepts which include knowledge gained from
environment as well as from classroom instruction. Probes the areas
of staying in seat, receptive language, expressive language, body
concept and speech imitation.
Validity
•
Content Validity – Items were compared to various assessments
•
Cross-Validity – analysis of subtest 4 with Sequenced Inventory of
Communication Development (SICD) found a significant positive
relationship at r=.75, p<.01.
27
•
–
Reliability
•
Test-Retest – range of agreement was 84%-100%
•
Interobserver – agreement of the scoring procedure across 18
scorers found 100% accuracy
Prognosis of Learning Rate
•
This subtest is new and does not require previous knowledge. It has been
developed from previous investigations of the learning acquisition rate of
children with autism conducted by Arick & Krug (1978). The subtest
examines an individual’s learning acquisition rate in terms of responses
required to learn a two-step black-white sequencing task. Results of this
subtest help a professional identify the learning characteristics of a student.
•
Standardization – Validity was not documented for this subtest however
the authors did report methods of data collection, sample and data analysis
to provide standardization to this subtest.
•
–
Correlations & Levels of Significance:
•
Subject’s language age and their total responses r=.91,
p<.000001
•
Educational Assessment subtest and the Learning Rate
subtest at r=.78, p<.0001
Interpretation Across Subtests (IAS): Autism Profile
•
•
After obtaining an autistic total score for each subtest, a profile can be
developed based on the percentile charts. The profile is completing the
following steps:
•
Fill in the 6 column chart by circling either the percentile rank or the
raw score
•
Connect the circle numbers to establish a profile
•
By plotting findings, the client will fall within a range from low to
high level of autistic behaviors
•
Solid line – mean scores
•
Dotted line – 1 standard deviation higher than the mean
It is important to remember that results from the IAS: Autism Profile allow
the clinician to observe how a given individual compares with the
standardized sample.
28
Gilliam Autism Rating Scale (GARS)
By James E. Gilliam
•
Age: 3-22 years
•
Purpose:
–
•
Evaluates:
–
•
The purpose of this test is to identify individuals with autism spectrum disorders,
determine progress throughout intervention, determine possible goals for
intervention, and provide a measurement for use by teachers and parents.
The GARS evaluates typical behaviors associated with Autism Spectrum Disorders,
including Asperger's Syndrome
Subtests:
–
Stereotyped Behaviors
•
–
Communication
•
–
E.g., Is unaffectionate, Becomes upset when routines change
Developmental Disturbances
•
•
E.g., Repeats words or phrases over and over, Uses pronouns
inappropriately
Social Interaction
•
–
E.g., Avoids establishing eye contact, Flaps hands and fingers
E.g., Did they walk within first 15 months?, Did they follow simple
commands?
Validity:
–
Content validity:
•
Items were derived from the definition of autism from the Autism Society of
America (ASA) and DSM-IV and split into checklists (Stereotyped behaviors,
Communication, Social interaction, and Developmental disturbances).
•
Item discrimination- Each item was correlated to the total score.
•
The method for choosing each item involved required a correlation
coefficient of > .35; this is a relatively low coefficient in comparison to
typically accepted coefficients.
•
Stereotyped behaviors: .61; Social interaction: .69; developmental
disturbances: .61; Communication: .65
29
•
–
Criterion-Related Validity:
•
•
–
These coefficients are relatively low, which suggests that content validity of
the GARS is no more than moderate.
Correlation to the Autism Behavior Checklist (ABC)
•
Stereotyped behaviors: .81; Communication: .65; Social interaction:
.65; Developmental disturbances: .19
•
These coefficients range from very low (developmental
disturbances) to high (stereotyped behaviors). This suggests that
correlation to the ABC varies for each subtest.
Discrimination between autism and other diagnoses related to negative
behaviors
•
A sample of individuals with known autism spectrum disorders was
compared to sample with other diagnoses and a percentage was
obtained showing individuals correctly classified.
•
Stereotyped behaviors: 71%; Communication: 70%; Social
interaction: 78; Developmental disturbances: 80%
•
The coefficients suggest a moderate to high ability to correctly
identify individuals with Autism Spectrum Disorders.
Construct Validity:
•
•
Effect of age on results- Theoretically, age should not have an effect on
results of the test.
•
Coefficients were derived from the normative sample.
•
Stereotyped behaviors: -.13; Communication: .06; Social interaction:
-.10; Developmental disturbances: .10; Total: .00
•
These results indicate that scores and age are not related.
Intercorrelation between subtests
•
All subtests are designed to test autistic behaviors and theoretically
should be highly correlated.
•
Social interaction-Communication: .60; Social interactionstereotyped behaviors: .74; Communication-Stereotyped behaviors:
.49; Developmental disturbances-stereotyped behaviors: .54;
Developmental disturbances-Communication: .34; Developmental
disturbances-Social interaction: .58
•
Some correlations are relatively low, specifically the correlation
between developmental disturbances and communication. This
suggests that the subtests of the GARS are not equally effective at
identifying someone with an Autism Spectrum Disorder.
30
•
Item Validity of Subtests
•
Correlation of subtest items to subtest topics
•
Median correlations of subtest items:
•
•
•
The manual claims that results indicate a strong correlation of
subtest items to each subtest; however, these values are not
indicative of a strong correlation when compared to typically
accepted coefficients.
Contrasting groups who are expected to obtain different measurements
•
Evaluators tested individuals from the "non-autistic" group and
obtained mean standard scores.
•
Stereotyped behaviors:
•
•
•
Mentally retarded: 7; Emotionally disturbed: 5; Learning
disabilities: 3; Speech handicapped: 5; Multihandicapped: 7;
Nonhandicapped: 2
Developmental Disturbances:
•
•
Mentally retarded: 7; Emotionally disturbed: 5; Learning
disabilities: 3; Speech handicapped: 7; Multihandicapped: 7;
Nonhandicapped: 2
Social Interaction:
•
•
Mentally retarded: 7; Emotionally disturbed: 5; Learning
disabilities: 3; Speech handicapped: 5; Multihandicapped: 8;
Nonhandicapped: 2
Communication:
•
•
Stereotyped behaviors: .61; Communication: .65; Social
interaction: .69; Developmental disturbances: .61
Mentally retarded: 9; Emotionally disturbed: 7; Learning
disabilities: 6; Speech handicapped: 8; Multihandicapped: 9;
Nonhandicapped: 5
As expected the typically developing group has pretty low scores, but
the scores for other diagnoses are relatively close. If groups in the
non-autistic group have similar scores, it makes it easier for us to
measure this group as a whole without having too many variations
because of differing diagnoses.
Reliability:
–
Internal Consistency:
•
This is the extent to which items correlate to test and subtest scores.
31
–
•
Stereotyped behaviors: .90; Communication: .89; Social interaction: .93;
Developmental disturbances: .88
•
The results indicate strong internal consistency.
Standard Error of Measurement:
•
–
–
Variance of error for standard scores
•
Stereotyped behaviors: .95; Communication: .99; Social Interaction:
.79; Developmental disturbances: 1.04
•
A low standard error of measurement for standard scores directly
correlates to a strong reliability for each subtest; therefore, these
values do not support strong reliability for the GARS.
Test-retest (Stability) Reliability
•
Evaluators determined whether scores were highly correlated 2-weeks later.
•
Stereotyped behavior: .82; Communication: .81; Social interaction: .86 (the
subtest for developmental disturbances was not given)
•
The high correlation between test scores indicates strong test-retest
reliability.
Interrater reliability:
•
Results from teachers and parents were compared to determine correlation.
•
Stereotyped behaviors: .82; Communication: .77; Social interaction: .73
(Teachers were not provided with the developmental disturbances subtest)
•
Results indicate a moderate to high correlation between individuals
administering the test to include teachers and parents.
32
Criterion Referenced Assessments
Clinical Evaluation of Language Fundamentals – 4 (CELF-4)

Age range:
- 5;0- 21;11 years

Purpose:
- Administered to evaluation language strengths and weaknesses
- Provides both expressive and receptive scores, as well as other composite scores in
the areas of semantics, memory, language structure and content.

Psychometric Properties
- Validity
 Sensitivity was 0.87 with data reported 2 standard deviations below the
mean—high sensitivity
 Specificity was 0.96 with data reported for 2 standard deviations below the
mean—high specificity
 Authors of the CELF-4 report strong validity on the basis of test content,
response processes, internal structure, relationships with other variables.
- Reliability
 Test-Retest
 Stability coefficients range from 0 .71 to 0.86 for subtests & from .88
to .92 for composite scores—high reliability
 Chronbach’s coefficient ranges from 0.69 to 0 .91 for subtests &
from 0.87 to 0.95 for composite scores—moderate to high
reliability
 Split-half reliability ranged from 0.71 to 0.92 for subtests & from
0.87 to 0.95 for composite scores—high reliability
 Inter scorer reliability ranged from 0.88-0.99—high reliability
Other Assessments
Other assessments not available in the Bloomsburg Speech, Language, & Hearing Clinic, which can
be helpful in identifying deficits in AS, include (ASHA, 2006):
• Test of Language Competence—Expanded Edition, Levels 1 and 2
• Vineland Adaptive Behavior Scales—Expanded Edition
• Vineland Adaptive Behavior Scales—Classroom Edition
• Damico Clinical Discourse Analysis
• The Pragmatic Rating Scale
33
Treatment
Overview of Treatment
There is currently no means of prevention or cure for AS; however, treatment is available to teach
strategies that will suppress socialization and communication difficulties. Goals are dependent upon the
skill level and needs of the individual client (Darretxe & Sepulveda, 2011). The following treatment goals
are examples of possible speech and language goals for a child with AS; however, it is important to note
that clients may have varying needs and therefore the following list may not be entirely applicable or
extensive:
o
o
Pragmatics
o John will identify emotions portrayed by facial expressions with 80% accuracy across
three therapy sessions.
o John will demonstrate eye contact with a communication partner no less than three
times during a two-minute conversation.
o John will appropriately initiate a conversation with 80% accuracy across three therapy
sessions.
o John will appropriately maintain a conversation for a minimum of three reciprocal turns
across three therapy sessions.
o John will demonstrate appropriate social proximity with no more than two verbal or
visual prompts across three therapy sessions.
Semantics
o John will identify meanings behind metaphors, synonyms & antonyms with 80%
accuracy across three therapy sessions.
o John will define age-appropriate vocabulary words with 80% accuracy across three
therapy sessions.
(Darretxe & Sepulveda, 2011)
34
Strategies & Research
Social Competence Intervention
•
Definition
–
•
•
Rationale
–
From an early age, deficits in social skills are of significant concern when targeting
the population of AS and HFA. According to research conducted by Strichter et al.
(2012), “children with HFA/AS present unique challenges relating to peers,
interpreting complex contextual cues, and transitioning across settings.”
–
Social competence intervention is a curriculum based intervention, specifically
focusing on the distinguishing characteristics of individuals with AS and how he/she
perceives emotions, and further understanding the difficulties each individual
experiences in areas including: theory of mind and executive functioning, that may
inhibit interactions with others (Strichter et al., 2010).
Previous Research
-
-
-
•
As defined by Stichter et al. (2012), “social competence refers to a person’s ability to
successfully and independently engage in social interactions, establish and maintain
relationships with others, and get needs and wants met across contexts.”
Previous research on intervention for individuals with Autism spectrum disorder is
said to be too specific and lacking generalization, thus the outcome as to how an
individualized intervention would work with others is too difficult to determine.
The author states that providing individuals with ongoing naturalistic environments
to practice skills, does not necessarily mean individuals will have a greater
maintenance of the skills.
Cognitive Behavioral Intervention (CBI) is a type of intervention, which research has
determined to provide better outcomes for individuals with AS, as it presents a
“framework for the integration between social cognitive processes and social
behavior” (Stricher et al., 2010).
Current Research
–
–
Challenges thinking through strategies including:
• Self-regulation, self-monitoring
• Meta-cognitive strategy
• Exposure and Response
Individuals with AS have significant difficulties with self-regulation, selfmonitoring, and meta-cognition, which all pertain to core deficits in social
35
competence including: 1) theory of mind, 2) emotional recognition, and 3)
executive functioning.
Social Competence
Theory of
Mind
Executive
Functioning
Emotional
Recognition
*HFA/AS is “marked” by a combination of these three core deficits, though
each can occur in other disorders (Stricher, 2010).
•
Core Deficits Defined (Stricher et al., 2010)
– Theory of Mind (ToM)
• Inability to understand thoughts, intentions & others feelings
• Difficulty with Perspective taking
– Emotional Recognition (ER)
• Identify, recognize & distinguish between various facial expressions of self &
others
• Able to understand basic emotions, however, display an inability to
understand or explain contexts that underlie emotional states
– Executive Functioning (EF)
• Poor impulse control, cognitive inflexibility, inability to produce multiple
problem solutions, poor planning, self-monitoring & self- regulation
1.
Stichter, J.P, Herzog, M.J., Visovsky, K., Schmidt, C., Randolph, J., Schultz, T., Gage, N. (2010).
Social competence intervention for youth with Asperger syndrome and high functioning
autism: An individual investigation. Journal of Autism and Developmental Disorders, 40,
1067-1079.
•
Purpose
– This study was designed with the purpose to introduce and outline the development
and initial administration of the Social Competence Intervention (SCI) targeting
social difficulties in 3 areas including theory of mind (ToM), executive functioning
(EF), and emotion recognition (ER).
Method
– University-affiliated interdisciplinary diagnostic and outpatient treatment center for
autism and neurodevelopment disorders
– Sample population included n=27, in age range from 11;0-14;0
•
36
N=27, 4 had ASD, 12 had AS, 7 had PDD-NOS and the remaining 4 were
noted by medical professionals to have ASD although specific diagnosis was
not identified.
– 10 weeks of intervention, 2 times a week (total 20 hours of intervention)
– Inclusion Criteria
Procedure
– SCI included 5 units (Four 1 hr. sessions for each unit)
– Consistent Structure
– Scaffold Approach
Targeted Skills (Stricher et al, 2010)
– Recognition of Facial Expressions or the ability to interpret facial expressions/cues,
and label each expression
– Sharing ideas with others ability to apply the roles of a speaker and listener in a
conversation (e.g., eye contact)
– Turn taking or the ability to apply rules conversational reciprocity
– Recognizing feelings and emotions or the ability to recognize or interpret contextual
cues from emotional recognition
– Problem solving or the ability to react appropriately to stress, and identify problem
situations and determine how to solve the problem through multiple ways
Measurements
– Social Abilities
• Social Responsiveness Scale (SRS)
– Theory of Mind (ToM)
• Sally Anne False Belief Task
• Smarties False Belief Task
• The Friends ABC Story
• Faux Pas
– Emotional Recognition
• The Diagnostic Analysis of Non-Verbal Accuracy-2, Child Facial Expressions
(DANVA-2-CF)
• The Reading Mind in Eyes test
– Executive Functioning
• The Behavior Rating Inventory of Executive Function (BRIEF)
• The Test of Problem Solving (TOPS-3)
Results
– Social Abilities
• Significant gains on pre vs. post test on all subscales of the SRS,
demonstrating the most improvement on social cognition
• Total scores also evidenced significant improvement
– Theory of Mind
• Results were mixed for pre vs. post assessment for the Friends ABC task
• Faux Pas story results indicated significant improvement
– Executive functioning
•
•
•
•
•
37
Significant improvements in participants abilities to self-regulate behaviors
and utilize cognitive resources
• Significant improvement with the ability to make inferences about the cause
of problems and ability to identify problem solutions
– Emotional recognition
• Greater ability to correctly identify emotional states
• Improvement in ability to accurately label emotion state
Strengths
– Initial results report positive outcomes for SCI and growth of the intervention for
future research for children with AS and HFA
– The intervention utilized CBI strategies in combination with remediating core
deficits, proved beneficial regarding outcomes for intervention.
– Scaffold Approach
– Targeted and assessed core deficits specific to those with HFA/AS
Limitations
– Impact of parent education was not assessed within the first 2 semesters of
intervention because it was not fully developed, thus some participant’s parents
were not educated on SCI.
– Parent Bias could potentially be a limitation of this study considering parents knew
the intervention their child was participating in.
– An inconsistent protocol for collecting data from teachers resulted considering it
was the main concern of intervention, thus data was missing for some participants
on the SRS measure.
– The intervention was delivered across 5 semesters. Considering this was an initial
investigation, the intervention process evolved over 5 semesters, as did methods of
SCI.
– Standardization of Emotional Recognition Tests do not exist for all of the constructs
the authors intended to measure, therefore a limitation of this study.
•
•
•
2. Stichter, J. P., O’Connor, K., Herzog, M., Lierheimer, K., & McGhee, S. (2012). Social
competence intervention for elementary students with Asperger’s syndrome and high
functioning autism. Journal of Autism Developmental Disorders, 42, 354-366.
•
•
Purpose
o “The purpose of this study was to expand on previous research regarding the
development of social competence intervention for children with HFA/AS. More
specifically, the existing Social Competence Intervention (SCI) described by Stichter
et al. (2010) was modified to respond to specific needs of these types of elementary
age children” (Stichter et al., 2012).
Method
o Consistent with SCI-A Intervention; however, this intervention process took place
across 3 semesters vs. 5 semesters
o Sample population for this intervention included n=20, age range 6;7-10;8
38
•
•
•
•
•
Adjustments & Adaptations of Content (SCI-A vs. SCI-E)
o Skills introduced with enhanced instruction for SCI-E considering children in
elementary have less experience developmentally as compared to adolescence SCIA.
o Supports to assist participant comprehension of lesson objects were introduced
 i.e., written products accompanying verbal descriptions used to promote
increased acquisition and generalization of skills
Adjustments & Adaptations of Delivery (SCI-A vs. SCI-E)
o Smaller group instruction
 Continued use of “centers,” however rotating allowed for more hands-on vs.
discussion based
o Greetings taught one-on-one since elementary had less experience vs. naturalistic
o Increased repetition done through activity based tasks for SCI-E vs. discussion SCI-A
o More naturalistic practice for SCI-E vs. lesson based SCI-A
Results
o Social Abilities
 Gains on pre vs. post test on all subscales of the SRS, demonstrating the most
improvement on social cognition and social communication
 Total scores also evidenced significant improvement
 Reports from parents and teachers also reported on social improvement as
well as social communication
o Theory of Mind
 Results were consistent with previous research for this measure
o Executive functioning
 Results evidenced strong gains in abilities to utilize cognitive resources and
an increased ability to regulate their own behaviors
 Participants evidenced a greater ability to determine the chronological order
of events
o Emotional recognition
 In contrast to prior research and contrary to the hypothesis (i.e.,
participants ability to identify and correctly label emotional states will
improve) did not improve significantly
Strengths
o Extends research
o Younger population with HFA/AS respond positively to SCI and modifications
o This study provides promising results in the area of SCI for elementary age students
with AS/HFA
o Shorter duration
Limitations
o Small Sample Size
o Replication and Generalization
39
o
o
o
Implementation fidelity refers to how well the intervention is implemented in
comparison to the original intervention. Regarding prior research previous fidelity
coding systems have no been designed, compared to in this study where these
systems have been implemented, thus this is a limitation.
The parents were not blind to the intervention
There is a need to find an improved ToM measurement for SCI.
Implementing Social Competence
Source: Stricher et al., 2010
3. Granader, Y., & Humphrey, A., Owens, G. (2008). LEGO® therapy and the social use of
language programme: An evaluation of two social skills interventions for children with high
functioning Autism and Asperger syndrome. Journal of Autism and Developmental Disorders,
38,1944-1957.
40
Social Skills Intervention

Importance of Social Skills:
- In order for an individual to form meaningful social relationships, social
communication skills play a major role. Appropriate social skills enable
people to be successful in everyday life. According to Owens et al. (2008),
successful social interaction requires a multitude of skills that typically
developing individuals learn without the need for direct teaching.
- Individuals that fall within the Autism Spectrum Disorders, have a difficult
time acquiring social skills that come naturally to typically developing
persons.
- Social skills have a great impact on all aspects of an individual’s life.
Therefore, when working with persons with a diagnosis of Asperger’s
Syndrome (or even within the Autism Spectrum), long term goals for these
individuals should include the development of appropriate social skills. This
is extremely important during the school age years.

Methods for Teaching Social Skills to Individuals with Asperger Syndrome
- Social Stories These are written stories that are created in order to teach social
rules and behaviors. This is done in a supportive and non-judgmental
way.
- Peer Mediated Behavioral Interventions Typically developing peers are taught how to elicit, prompt, and
reinforce social behaviors. This can be especially helpful with
individuals with Asperger Syndrome.
- Social Skills Groups vs. Clinical Setting Groups Social skills groups are suitable for children with Asperger’s at the
school age. These groups have proven extremely beneficial, especially
for those who are mainstreamed or in an inclusion classroom within a
mainstream school. Since these individuals need help with social
skills, schools provide an abundance of opportunity to work in a small
group setting with their typically developing peers. The typically
developing peers would act as a social role model.
 Examples of social skills group interventions are discussed in more
detail below. The two discussed are LEGO Therapy and the Social Use
of Language Programme (SULP).
 Clinical Settings have also proven somewhat beneficial. They do,
however, have their own drawbacks. The sessions tend to be less
frequent and often last longer. A typically developing peer is often not
present for these sessions. According to Barry et al. (2003), clinic
based groups can be effective at teaching appropriate social initiations
and responses, emotion recognition, and group solving. However,
generalization often remained a problem.
•
Purpose
41
–
–
The purpose of this study was to determine whether LEGO Therapy would be an
effective intervention technique for teaching social skills to individuals with
Asperger Syndrome and High Functioning Autism. The LEGO Therapy was
compared to another socials skills intervention technique called “Social Use of
Language Programme” (SULP).
This study looked at the effectiveness of both the LEGO and the SULP interventions.
Each of these techniques targeted the Asperger Syndrome population, as well as
those individuals classified as having High Functioning Autism. The study
contrasted the methods of teaching and the intervention as a whole.
•
Method
– Sample Population:
• N=47 (LEGO=16, SULP 15, No Intervention=16)
• Recruited through one of the following:
• Autism Research Database
• Cambridge Asperger Outreach Clinic
• Umbrella Autism
• Local primary schools
• Initial recruiting was for the LEGO or SULP groups
– Control Group
• The LEGO and the SULP group were run without a no-intervention control
group. This was due to concerns about high attrition rates (reduction in
performance) in the no intervention group. The no-intervention group was
developed later on using the Autism Research Centre.
• Parents of the children in the control group were actually part of a different
study. They were asked by the researchers if their information could be
used as a comparison to the current study. Parents were told that they
would be part of a control group for a study that would be evaluating the
effectiveness of two social skills interventions for children within the autism
spectrum.
– Inclusion Criteria
• Current diagnosis of Asperger Syndrome or High Functioning Autism
• Age- between 6 and 11 years old
• IQ>70
• Able to speak in phrases
• Could NOT currently receiving other behavioral therapies
– 1 hour per week over 18 weeks
•
Procedure
– Initial Assessment Session
• All groups were measured using the Weschsler Abbreviated Scales of
Intelligence. In order to assess a child’s autism symptom severity and comorbid symptoms, parents completed the following questionnaires:
42
•
•
• The Gilliam Autism Rating Scale
• The Spence Children’s Anxiety Scale
• The Connor’s ADHD Index
• The Child Behavior Checklist
The intervention groups were paired and then randomly assigned to either
the LEGO or the SULP group. They were matched based on the following:
• Availability
• Chronological Age
• IQ
• Autism Symptom Severity
• Verbal IQ
The no-intervention group was matched to a therapy group based on
chronological age, full IQ, verbal IQ, and autism severity.
•
LEGO Therapy (Owens et al, 2008)
– LEGO Therapy uses naturalistic approaches which helps an individual generalize to
real word situations. Naturally reinforcing materials and activities are used to
replicate scenarios close to everyday life.
– LEGO Therapy uses the idea that children will be more motivated to learn and to
produce changes in behaviors is using materials/ items that are more interesting to
the child.
– This type of therapy is extremely structures and predictable. It also utilizes a
“systematic construction toy” (Ownes, 2008). Children with Asperger Syndrome are
attracted to activities and toys that are considered “systematic.” Therefore, these
activities may be more motivating for an individual with Asperger’s.
– With social aspects incorporated into play and interactions, children within a LEGO
therapy group will work towards building a LEGO set.
•
Groups within LEGO Therapy
– These groups are composed of individuals with Asperger’s (or another form of
autism), their peers (typically developing or found to be on the autism spectrum),
and an adult.
– Within these groups individuals have to communicate and follow social rules. This
will help with the completion of a LEGO set. This kind of participation requires an
individual to use verbal and nonverbal communication, as well as collaboration,
turn taking, joint creativity, and problem solving. Persons within these groups will
also show joint attention to a task.
– There are usually a minimum of three individuals within a group. If 3 children are
unable to be a part of the group, an SLP can perform one of the jobs in place of a
child.
– There are three roles within each group:
• Engineer- describes the instructions
• Supplier- finds the materials
43
–
–
• Builder- puts the pieces together
Each of the above roles are played for a certain amount of time (or steps). The roles
would then be switched.
Each child participating within the LEGO groups are asked to adhere to the
following rules. They are also asked to remind the others in the group to follow to
the rules.
–
LEGO Therapy Rules
Build things together!
If you break it, you have to fix it or ask for help.
If someone else is using it, don’t take it, ask first.
Use indoor voices- no yelling.
Keep hands and feet to yourself.
Use polite words.
Clean up and put things back where they came
from.
8. Do not put LEGO bricks in your mouth.
1.
2.
3.
4.
5.
6.
7.

SLP’s Role According to Owens et al. (2008), the therapist’s role is not to point out specific
social problems or given solutions to social difficulties. Rather they highlight the
presence of a problem and help children to come up with their own solutions.
 Solutions that children have developed can be practiced until they are able to
perform that task with minimal to no support. The therapist is there to remind
children of the strategies they may be able to use in the future if similar
difficulties come about.

LEGO Levels There are 3 LEGO levels that the children can achieve. Once a skill has been
exhibited at a certain level, the child is given a certificate. This awards their
achievement. The certificates are handed out in front of all the children at the
end of the therapy session. Each award is given on an individual basis rather
than a group basis. This helps to motivate the child to participate socially and to
build models together. Individual children are trying to move up to the next
level.
 The three levels include:
 LEGO Helpers- find bricks and sort them into correct colors
 LEGO Builders- build models in a group and design freestyle models with
adult help
 LEGO Creators- build models in groups and design freestyle models in
pairs without adult help

44
The Social Use of Language Programme (SULP)




•
The SULP is program is a direct teaching approach. It utilizes stories, group activities and
games.
It addresses various social and communication skills that are targeted using a specif
framework. The program starts with comprehension through stories. These stories include
monster characters experiencing a certain social problem/ difficulty. Children would then
move on to adult models in which good and bad skills are exhibited. Children then have to
evaluate these skills and practice the skill through games and conversation.
Skills targeted within this treatment include:
o Eye contact
o Listening
o Turn taking
o Proxemics
o Prosody
Understanding the relevance of the skills being learned is important when using SULP as an
intervention. This will help to generalize the skills being learned to other areas.
Results
– Social Abilities/ Difficulties
• Social abilities/ difficulties found to be autism-specific were measured using
the GARS social interaction subscale. (See assessment section for
information regarding the GARS.)
• Specific social difficulties were reduced following the LEGO therapy. There
was, however, no change in the SULP group or control group.
• It can be noted that the LEGO therapy may be more appropriate for reducing
specific difficulties related to autism than the SULP intervention.
– Maladaptive Behaviors
• Improvements in maladaptive behaviors were seen in both the LEGO and
SULP groups following intervention. The no-intervention group saw no
improvement in maladaptive behaviors.
• This suggests that both interventions can be useful in reducing behaviors
considered to be maladaptive in children within the autism spectrum.
– Socialization and Communication
• Both the intervention groups improved significantly in these areas
compared to the no-intervention group. There were no significant
differences found between the intervention groups.
– Social Interaction Duration
• The LEGO group demonstrated significantly increased duration of social
interaction. The SULP group did not show as a significant increase in
duration.
• This may suggest that the LEGO group provides the opportunity for
generalization.
45
***NOTE***
–
When examining the LEGO and SULP groups separately:
• The LEGO group showed significant improvement in regards to maladaptive
behaviors.
• The SULP group showed significant improvement in the areas of
communication and socialization.
• This suggests that:
• LEGO therapy may be more appropriate for working with autistic
children with maladaptive behaviors.
• SULP therapy may be more appropriate for working with autistic
children with social and communication difficulties.
•
Strengths
– LEGO therapy (and SULP) do not require much time or financial commitment.
– It can easily be implemented.
– It incorporates a naturalistic method of collaborative play.
– The overall outcome showed changes within the intervention groups.
•
Limitations
– There was limited information about the SULP within the article. More information
about the SULP could have proved to be beneficial.
– Small sample size. There were only 47 participants within this study. Each group
had approximately 15 to 16 participants. Future studies should include more
individuals within each group.
– Control group was not randomly assigned with no direct observational data. All
participants should have been randomly assigned as they were with the
intervention groups. Future studies should take this into account.
– Parent bias when completing the GARS and VABS. Parents were aware of the type of
intervention their child would be receiving. Results of the GARS and VABS may have
been completed with bias due to the parent’s expectations. Parents in the control
group were collected as part of a different study. These parents were unaware
when completing the forms that their child would be part of a different study.
– Researcher was instructing both interventions. This helped to keep consistency
across interventions; however, it may have added bias. The therapist was aware of
the hypotheses created for this study.
46
Video Modeling
•
Definition
–
Social Stories™ - “describe a situation, skill, or concept in terms of relevant social
cues, perspectives, and common responses in a specifically defined style and
format” (The Gray Center, 2004)
•
–
•
Video Modeling –use of videos to provide a model of targeted skills (Bellini &
Akullian, 2007)
Rationale for the combination of Social Stories™ and video modeling
–
•
Goal – increase understanding of social situations which enables an
individual to demonstrate appropriate behaviors, reactions, and responses
(Hanley-Hochdorfer, et. al., 2010)
Children with AS experience deficits in reorganizing, understanding and using facial
features, which is a skill that is typically developed within the first 2 years of life. In
addition to a deficit in emotional recognition, students with AS also exhibit a social
impairment. The social impairment manifests due to an inability to understand
and/or use nonverbal behaviors as well as a lack of social/emotional exchanges. As
reported by Bernad-Ripoll (2007), “video modeling used the self-as-a-model to
compensate for the difficulty children and youth with AS experience with
generalization. Social Stories™ were introduced to provide static visual stimuli,
which have been determined to be a strength for individuals with AS" (p. 101).
Previous Research
-
-
-
In regards to video modeling, previous research conducted by Bellini & Akullian
(2007) has shown that skills learned via video modeling generalize across different
settings and conditions resulting in maintenance of the positive gains made during
intervention. Another study also found video modeling to be advantageous over
static stimuli because it allows the subject to see themselves engaging in behaviors
in context which includes the environment, antecedents, and consequences.
(Bernad-Ripoll, S., 2007)
Numerous studies have found the use of social stories to be beneficial in helping an
individual understand social situations as well as successful in teaching ways to
correctly respond and behave in those situations.
There is limited evidence in the success of combining both of these methods.
47
4.
Bernad-Ripoll, S. (2007). Using a self-as-model video combined with Social Stories™ to help
a child with Asperger syndrome understand emotions. Focus on Autism and Other
Developmental Disabilities, 22(2), 100-106.
•
Purpose
– This study sought to determine the effectiveness of the use of both video modeling
and Social Stories™ in aiding an individual with AS to recognize and understand
emotions in him as well as others.
•
Method
– This single-subject design research study included a 9 year old male student with a
diagnosis of AS. This student was enrolled in a fourth –grade general education
classroom in the public school system. Although he was a full-scale IQ that fell
within the superior range, the student received assistance from four
paraprofessionals during various times and activities throughout the school day.
This student demonstrated difficulty with controlling his anxiety, frustration and
anger in addition to identifying, talking about and managing these emotions.
– In order to aid this student in this process, the researchers utilized a video camera
to acquire the video model which captured the portrayal of both positive and
negative emotions in real time. A digital camera as also utilized to capture fixed
images of emotions. These images were utilized in combination with the Social
Stories™. All videos, pictures, and Social Stories™ incorporated the emotions of
happiness, anger, anxiety, calmness and frustration. Reinforcements were also
provided following the completion of activities.
– For data collection the researchers utilized a multicolumn form:
• Column 1 – Emotional Situation in Video Segment
• Column 2 – “How did you feel?”
• Column 3 – “Why did you feel like this?”
• Column 4 – “What should you do in that situation?”
•
Procedure
– Researchers videotaped subject’s daily routine at home to compose a set of ten
videotaped segments. These segments were divided into two sets of five videos;
three contained emotion from Social Story™ and two were foils.
– At the baseline, the subject was shown two video segments, which portrayed one
positive and one negative emotion. The subject then responded to three reflection
questions.
– In the intervention stages, the subject was introduced to two Social Stories™ each
session. The Social Stories™ were combined with photographs to help explain to
emotions, again both positive and negative, which were being taught in the story
followed by the video. After being provided a short break, the subject responded to
the three reflection questions.
48
–
During a generalization phase, the subject’s parents were required to review the
Social Stories™ with the subject over a four day period. Following that period, the
parents were required to read a Social Story™ whenever they saw an emotional
state that was focused on during the study. In addition to reading the story, the
parents were encouraged to their son find a solution.
•
Results
– Baseline stage (sessions 1-10):
• Mean accuracy of 55% - application of an emotional label to a clip
• Mean accuracy of 10% - Explanation of the emotion in clip, why he felt that
way, and the action response (i.e., what he should do next time),
– Intervention (sessions 11-20)
• Introduced to social stories that explained and provided a rational for the
emotions, action response, and behavior changes
• Accuracy in labeling emotions rose to 95%
• Accuracy in explaining emotions and determining action responses
increased to 100%
– Generalization (sessions 21 to 27)
• Mean accuracy in identifying alternatives to inappropriate behavior was
maintained at 100%.
• Upon observation of an inappropriate emotion, subject's father would select
the appropriate social story, read it to subject, and provide him with three
alternate behaviors that he could engage in rather than having a tantrum
•
Strengths
– The explanation of emotions via videotaped segments and Social Story™ was
effective in teaching a child with AS to recognize and understand emotions in him
and to generalize them to other situations. (Bernad-Ripoll, S., 2007)
– Previous intervention has not combined the two:
• Social Story™ provides understanding of the meaning of images mean and
how to deal with them
• Video model provides the visual which is imperative to concept
comprehension in individuals with AS.
•
Limitations
– Single case study over a limited period of time
– Current research in this area primarily focuses on autism
– Further investigation needed to validate effectiveness with persons with AS at
different ages, developmental stages, and in different environments.
•
How to implement video modeling and Social Story™:
– Video:
• Record video
49
–
–
• Positive & Negative Behaviors
• Photographs
• Utilize during Social Stories
Social Story™:
• Introduce & explain subject’s emotions
• Also explain two opposing emotions
Steps:
1. Read Social Story related to the clip to be shown during the session
2. View two video clips of emotions
3. One positive emotion/One negative emotion
4. Provide a short break
5. Present questions regarding the clip
6. Require individual to reflect on emotions felt during video
7. Reinforcement
Parent Training
•
Behavior problems have been shown to decline after parent training programs were
implemented.
•
Although parents receiving access to only written information has been shown to be
effective, having actual contact with the therapist has shown to increase effectiveness of
parent training in improving social skills and problem behaviors.
•
Research in the areas of other disorders has shown that training parents has been effective
during intervention (Sofronoff, et al., 2004).
5. Sofronoff, K., Leslie A., & Brown, W. (2004). Parent management training and Asperger
syndrome: A randomized controlled trial to evaluate parent based intervention. Autism, 8, 301-317.
•
•
•
Purpose
•
The purpose of this article was to evaluate the effectiveness of a parent management
training program in improving social skills of children with Asperger Syndrome.
•
Another goal of the study was to compare the effectiveness of workshop training
programs as opposed to individual sessions.
Background
•
Behavioral problems can occur in situations where a child with Asperger’s has
difficulty with functioning socially or experiences a disruption in a routine.
•
These behavior problems have been shown to decline after parent training
programs were implemented
•
We did not know how effective parent training is in families with a child who has
Asperger Syndrome specifically until this research study was completed.
Method:
50
•
Six Components of intervention:
•
1- Psychoeducation
•
•
2- Comic Strip Conversations
•
•
This component focused on management of the anxiety that is often
experienced by individuals with AS in social situations.
Participants:
•
•
Behaviors associated with AS included strict routines and rituals,
literal interpretation, special interests
6- Management of anxiety
•
•
Targeted problem behaviors included interrupting, temper
tantrums, anger, non-compliance.
5- Management of behaviors associated with Asperger Syndrome
•
•
Social stories are short stories targeting a specific social situation.
4- Management of problems behaviors
•
•
These provide visual supports for understanding components of a
conversation in a comic strip format.
3- Social Stories
•
•
This component focused on the education on the nature and
characteristics of Asperger Syndrome.
The participants involved in the study were 51 parents with a child aged 6-12 years
who has been diagnosed with Asperger Syndrome.
Procedures:
•
Parents returned consent forms.
•
The parents were sent an initial social skills questionnaire after the consent form
was received.
•
Participants were randomly assigned to a workshop group, individual session
group, or waiting list group.
•
Therapists were master’s level clinicians or doctorate students completing an
internship.
•
The therapists followed the format from a manual and were trained in each
technique (e.g., comic strips, social stories) and delivery of materials supplementing
each technique.
51
•
All parents received a manual containing information covered by the six
components of the intervention
•
Workshop group
•
•
•
The worksop group received all six components of intervention in a one day.
•
There were 18 participants in the workshop group.
Individual session group
•
Individuals in the individual session group attended weekly one hour
sessions
•
Parents attended for six sessions (one for each component of intervention).
•
There were also 18 participants in the individual session group.
Waiting list group (Control group)
•
•
•
Parents in the waiting list group completed questionnaires at the same time
as the treatment groups.
There were three measurement times:
•
Pre-treatment
•
1 month post-treatment
•
3 month follow-up
Measures:
•
•
•
The Elyberg Child Behaviour Inventory (ECBI)
•
The ECBI assesses the occurrence of problem behaviors.
•
It includes a 36-item parent rating scale.
•
Parents rate the number of problem behaviors.
•
Parents also rate the intensity of problem behaviors.
The Social Skills Questionnaire
•
This questionnaire assesses social skills.
•
Parents complete a 30- item parent rating scale.
Workshop/Session Questionnaires
•
These were completed to assess the ecological validity/acceptability of the
sessions. Sample questions included:
•
The component was used (yes/no)
52
•
•
•
•
Usefulness of the component (0-5 scale)
•
Comments or suggestions
Parents rated each component of the workshop or individual sessions.
Results:
•
The results indicate that parent management training is an effective method of
intervention for children with Asperger Syndrome.
•
Significant improvement was shown for social skills and problem behaviors after
intervention.
•
No significant improvement was seen in the control group (waiting list group)
before they received intervention. Improvement in the control group after they
received the intervention was not reported.
•
Many individual sessions appeared to be more effective than one-day workshop
sessions.
Limitations/Future Research:
•
Future research should evaluate parent training in smaller groups or two to three
day workshops rather than one.
•
Future research should include longitudinal research over a longer period of time to
determine if parents still utilize the skills that they learn over time or if the
strategies fade out/become forgotten.
Computerized Intervention
•
Computer programs may be used to help simulate real-life situations
•
The Junior Detective Training Program
–
This program is specifically designed for children with Asperger’s Syndrome.
–
Computer programs as teaching tools take advantage of a special interest in
computers, are self-paced, and provide instant feedback.
–
Research shows that computer programs have been successful in teaching children
with AS to recognize simple or complex emotions from photographs or cartoons and
recognize prosody (Beaumont, et al., 2008)
6. Beaumont R., & Sofronoff K. (2008). A multi-component social skills intervention for children
with Asperger syndrome: The junior detective training program. Journal of Child Psychology and
Psychiatry, 49(7), 743-753.
•
Purpose
–
The purpose of the article was to determine the effectiveness of a multi-component
intervention for social skills involving a computer program, small group sessions,
parent training sessions, and teacher handouts.
53
•
•
•
Background
–
A review of past research shows lack of generalization from other treatment
methods.
–
Generalization to real life situations after computerized instruction has been limited
in the past.
Participants
–
49 children with AS participated in the study.
–
Inclusion/Exclusion
•
They must have an AS diagnosis confirmed by a doctor.
•
Individuals were required to have a normal IQ to participate in the study.
•
They target age range for participants was 7.5-11 years old.
•
Children were excluded from the study if they did not meet the above
criteria.
Method:
–
“The Junior Detective Training Program” (JDTP)
•
•
Group social skills training
•
The purpose of the group social skills training was to facilitate
generalization from computer program.
•
The group was also utilized to teach additional social and problem
solving skills
•
The group gave opportunities to practice skills learned in the
computer program.
•
‘Secret Agent Journal Entries’ were utilized as homework
assignments.
•
A token economy was utilized as reinforcement.
Parent training
•
•
Teacher handouts
•
•
The purpose of the parent training component was hopeful
generalization to the home setting.
Teachers received 1-2 page handouts describing skills taught during
intervention.
Computer game
54
–
A junior detective character decodes how others are feeling.
–
Level 1:
–
•
The junior detective decodes the feelings of characters from facial
expressions, posture, and prosody.
•
The child formulates scales to evaluate/detect own emotions.
Level 2:
•
–
The junior detective decodes feelings of characters from non-verbal and
environmental clues.
Level 3:
•
“Virtual reality missions” were utilized to simulate real-life situations.
•
Ex: dealing with bullies, playing with others, and trying new things
–
Signed consent forms were returned by the parents of participants.
–
Treatment was provided over seven weekly sessions (once per week).
–
The study involved a treatment group and waiting list (control) group.
*Source: Fitzgerald-Hood, 2005
55
*Source: Fitzgerald-Hood, 2005
*Source: Fitzgerald-Hood, 2005
•
Measurements:
–
Pre-treatment measurements
56
•
A developmental history questionnaire was sent to the parents of
participants.
•
Childhood Asperger Syndrome Test (CAST)
–
•
Wechsler Intelligence Scale for Children-III (WISC-III) Short-form
–
–
•
Spence Social Skills Questionnaire-parent and teacher versions
•
Emotion Regulation and Social Skills Questionnaire (ERSSQ)
•
Assessment of Perception of Emotion from Facial Expression
•
Assessment of Perception of Emotion from Posture Cues
•
James and the Maths Test
•
The student writes out a solution to a verbally presented problem.
Dylan is Being Teased task
–
•
The WISC-III was used to match groups on intelligence.
Pre and Post measurements
–
•
The CAST ensured that participants met the criteria for Asperger’s.
The student writes out a solution to a verbally presented problem.
Results:
–
Significant improvement was reported for the treatment group, but not for the
control group.
–
Follow-up measurements from parents showed that children maintained these
skills; however, teachers reported that children did not maintain skills. This showed
effectiveness from a parent’s point of view; however, skills may not have been
generalized to the school setting. There was also a lack of teacher questionnaires
that were returned at the post-treatment phase, which may have caused inaccurate
results from teachers.
Limitations/Future Research:
–
Many teachers in the study neglected to return questionnaires; future research can
evaluate the effectiveness of this treatment in school settings.
–
More complex emotion-recognition measures should have been used.
•
–
Suggestions included Golan and Baron-Cohen’s Cambridge Mindreading
Face-Voice Battery for Children (CAM-C)
Social competence in the playground should be observed to determine progress in
realistic situations through direct observation.
57
–
The multi-component nature of the program made it difficult to determine the
effectiveness of separate components.
•
Components should be separated into individual studies in order to
determine the effectiveness of each separate component.
58
New Research
 Retherford, K.S., Sterling-Orth, A.J. (2009). Facilitating functional social-communication
skills in adolescents with Asperger's syndrome. Perspectives on Language Learning
and Education, 16, 55-61.
 Purpose
o The purpose of this article presented a pilot service delivery model for youth
and young adults with AS. Individuals with AS have significant difficulty
regarding the demands of initiating and maintain social relationships, and
securing a job.
o This model was designed to bridge the gap in various areas, specifically
addressing skills in social communication, daily and functional living
activities & settings
 Method
o Direct services were provided during 2-3 hour sessions a week. A toolbox of
skills was developed for intervention purposes.
o Successive skills were identified from year to year and taught to expand
communication skills of participants.
- Year 1: 8 participants, ranging in age 18;0-26;0
- Year 2: 12 participants
- Year 3: 18 participants
 Procedure
o Year 1: A Toolbox Skill Set including 6 core domains with multiple skill sets
implemented through activities and reflections including:
- Taught explicitly
- Role play
- Real-life situations
o Resource “Portfolios”
- An important element of this project was the development of a
portfolio, containing written information related to community
supports and services in the areas of healthcare, recreation, financial
issues for each participant, which would help to bridge the gap(s) in
these specific areas after completing the project.
 Measures
o The Functional Communication Profile-Behavior Rating Scale was developed
as a part of this grant and encompassed seven domains and skills that
further paralleled the characteristics developed within the toolbox skills set
developed for this project.
- Each participant was evaluated pre and post intervention
 2009 Funding year: New initiatives
59


o Partnered and collaborated in the development of service delivery models
with campus personnel, i.e., the office of services for students, etc. and
community resources for recreation
o Greater use of technology, e.g., record video social stories on iPod, etc.
o Camp Campus
- “A university immersion experience for college-bound individuals
with AS” (Retherford & Sterling-Orth, 2009).
Results
o Just beginning to be examined, e.g., regarding sustained employment & other
aspects of the project
2012 Outlook
Source: UW-Eau Claire, 2012

More Information
- http://www.uwec.edu/newsreleases/10/june/0615CampCampus.h
tm
- http://www.uwec.edu/csd/insights/
60
 Longhurst, J., Richards, D., Copenhaver, J., & Morrow, D. (2010). “Outside in” group
treatment of youth with Asperger’s. Reclaiming Children and Youth, 19(3), 40-44.
 Background
o Starr Commonwealth is a well-recognized leader in therapeutic programs
for individuals with a variety of special needs. This organization founded the
Montcalm School for Boys in 2000 which is a private therapeutic boarding
school for boys ages 12-21. Students attending the boarding school are
provided with therapy services, which include both individual & group
sessions. The uses of group sessions eventually lead to the formation of the
program “Outside In.”
o “Outside In” was developed for individuals within the autistic spectrum who
experience difficulties with social skills, forming peer relationships and who
may not “fit in.” This program is has found strength in the belief in the
“power of the peers.” Most importantly, during these sessions the focus is
less about labels (i.e., Asperger’s, Bipolar and ADHD) and more about the
common desire to obtain control and avoid anxiety.

Method
o “Outside In” group sessions occur five days a week for 45 minutes to 1 hour.
These sessions always start on time which is very important because many
of the individuals who attend these sessions require strict routines. These
sessions, however, do not always end at exactly the same time. Conclusion of
the session is dependent on topics covered in the session and the time
needed to achieve closure.
o Meetings always occur mid-morning. Professionals at the boarding schools
found that if the session occurred in the morning or late evening, the
students were focusing their entire day on what went wrong in the morning
session or what they will talk about in the evening session.
o Reminders are a crucial component to this program because students must
remember that they need to listen and accept the point of view of others in
order to be able to help one another.
o A unique component to these sessions is the flexible seating and fidget tools.
Flexibility in the seating allows the students to be most comfortable and
fidget tools reduce anxiety which keep their focus on the session.

Benefits
o Students learn they are not alone
o They also have the opportunity to talk about experiences and find
commonalities
o Sessions encourage socialization
o Feeling that they belong to a group
o Provides repeated opportunities to identify feelings/emotions of others
61
o Recognition of signals of anxiety, stress, happiness, etc. of other members of
the group

Strengths
o Group setting
- Provides repeated opportunities to identify feelings/emotions of
others
o Use of Reminders
- “Students must listen and accept others’ viewpoints in order to help
one another”
o Increased opportunities for socialization

Limitations
o Sessions conducted by psychologists and occupational therapist
o Boarding School – strong possibility of constant supervision
o Few research articles to support group sessions
 Winner, M., & Crooke, P. (2009). Social thinking: A training paradigm for professionals and
treatment approach for individuals with social learning/social pragmatic challenges.
Perspectives on Language Learning and Education, 62(2), 62-69.
 Background
o ILAUGH Model of Social Thinking (Winner, 2000)
- Theoretical model for parents and professionals to help individuals:
a. Systematically organize and “make sense” of the strengths
and challenges
b. understand the relationship between social interaction,
problem solving and the ability to interpret and respond to
aspects of the academic curricula to create more efficient
treatment programs

Method
o I = Initiation of Language
- Ability to use language skills to seek assistance or information
- Students with social cognitive deficits often have difficulty asking for
help, seeking clarification, and initiating appropriate social entrance
and exit with other people
o L= Listening With Eyes and Brain
- Individuals with social cognitive deficits demonstrate difficulty with
auditory comprehension
- Integration of both auditory and visual information
- Attention to verbal and nonverbal cues as well as other contextual
cues
o A = Abstract and Inferential Language/Communication
62
Interpretation of literal and figurative language
Success depends on 4 aspects of communication:
a. Listener’s background knowledge about the speaker and
their motive for communicating
b. Context of message being shared
c. Use of literal words
d. Nonverbal meaning and physical gestures
o U = Understanding Perspective
- Ability to understand emotions, thoughts, beliefs, experiences,
motives, intentions, and personality of yourself and others
- Perspective is important for:
- Involvement in social and/or academic groups
- Integral to academic subjects – reading comprehension, history,
social studies, etc.
- Important for formulating clear written expression
- Weakness in perspective taking is a significant part of the diagnosis
of social cognitive deficits
o G=Gestalt Processing/Getting the Big Picture
- Conveying concepts, not just facts to the whole picture is gestalt
processing
- During conversation they intuitively understand the underlying
concept being discussed.
- Knowledge helps them stay on track, make relevant comments,
know when they’re veering off topic
- Reading – importance is to follow the overall meaning (concept)
rather than just collect a series of facts
- Relationship between conceptual processing and organizational
strategies (in addition to executive functioning)
- Weakness in one area is typically accompanied by weakness in the
other
o H= Humor and Human Relatedness
- Anxiety brought on by knowledge that subtle cues which are
beneficial to social interaction are missed
- Important to focus on humor to minimize anxiety
- At the same time, humor may be utilized inappropriately which
requires direct lessons on this topic
-


Strengths
o New method to teach communication skills to individuals who demonstrate
difficulty with this task
- Potential to reach individuals who found prior methods to be
ineffective
Limitation – lacks empirical research
63
Resources
 Faces for Kids
o
Resource for early intervention
 Matrix
o
Parent Resource Network
 Provides parents/caregivers/teachers with a wealth of resources, i.e.,
websites, books, e.g., books for children with AS and siblings.
 Asperger Fact Sheet
o
Resource defining autism, Asperger syndrome and differentiating between the
two, parent concerns & how to help
 My Friend Quest
o
Interactive animated computer game created to teach children to recognize
emotions and respond to them appropriately
 Autism Speaks
o
Nation's largest autism science and advocacy organization
 Social Thinking
o
Woks with the concept of what we do during interactions as well as
understanding of emotions during conversation.
o
Information available for when working with individuals with HFA, AS, ADHD,
nonverbal learning disorders and similar diagnoses finding these concepts to be
challenging
o
Research supported specific strategies
 Teacher Resource
o
Winter, M. (2003). Asperger syndrome: What teachers need to know. London:
Jessica Kingsley Publishing Inc.
 Outlines AS specifically for a teacher
 Definition/Characteristics
 Classroom Strategies
 Homework
 Study Help
 Changing Classes/Schools
 Further Resources
64
Appendix A
Definitions for Psychometric Properties
•
Validity- the extent to which a test measures what it claims to measure.
o Content validity/ Internal Consistency: A systematic evaluation of the test
questions to determine if it covers a representative sample of the behavior/
topics to be measured.
o Criterion-related Validity: The extent to which an examiner can predict
from an individual’s score on a test to how they will perform on another test
that is measuring the same objective.

Concurrent Validity- Criterion measures are acquired at the same
time as the test scores. This will accurately determine the degree that
the test scores estimate an individual’s current condition. If an
individual is taking a test to measure pragmatic skills, are the current
levels of pragmatic skills being measured by the test?

Sensitivity- the degree that a diagnostic test will predict a particular
condition when it actually exists.

Specificity- the degree to which a diagnostic test will indicate
negative results when a condition is truly absent.
o Construct Validity: This type of validity demonstrates a correlation between
the test scores and the predicted condition being measured. It examines the
relationship of the test performance to the assumed concepts that can
explain test performance.
•
Reliability- The consistency between two measures of the same thing.
o Test-Retest Reliability- This type of reliability examines the extent to which
an individual’s test performance is consistent over time.
o Inter-Rater Reliability- This is the degree to which at least two individuals
agree on the same responses to test questions/ observations. When using
the measure of a topic, similar results are warranted between the two raters.
Usually a rating system is implemented.
o Intra-Rater Reliability- The same assessment/ evaluation is being scored
by the same person on two or more occasions. The ratings are then
compared to see if similar results have been obtained.
65
o Coefficient Alpha’s- This helps to determine the extent to which items on
the test correlate with one another.
66
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