parent interviews questionnaires - oregon health & … · as a reminder,this slide ... in this...

Parent Interviews and Questionnaires

Lark Huang‐Storms, PhD 2

We will ….. (read text as above)



As a reminder, this slide presents the OCASD recommendations for the components of the diagnostic evaluation or identification. The diagnostic interview is specifically mentioned but parent‐completed questionnaires are not. In this presentation, we will discuss the use of the parent or diagnostic interview and make recommendations for use of parent‐completed questionnaires that can complement other sources of information on the child. Disclosure: not a lot of validated tools are available for children under 4 years of age



Read bullet 1…. Examples of direct measures are the ADOS and developmental testing as well as informal observations in clinic. Examples of indirect measures are the parentinterview and parent or teacher completed questionnaires.Read bullet 2

6Lark Huang‐Storms, PhD


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As per the slide and then….. Behavior during a clinic visit may not be representative of the child’s typical behavior (anxious, overwhelmed, fear shots)Some behaviors only happen in specific contexts (e.g., routines around driving or grocery shopping; sensory interests/aversions)



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Why use both the family interview and an ASD questionnaire? ….. As per the slide



And …… as per slide



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Instruments used in the identification of young children with ASD should be standardized. They should have moderate ……. (As per slide)

‐ * AAP HandoutWe are more interested here in Level 2 screeners that serve a more diagnostic function (vs. level 1 screeners which simply indicate need to refer for assessment).



Tools should be valid. Sensitivity and specificity are measures of predictive validity. The tools should also be reliable, The results from one observer to another or one week to the next should be consistent. The test norms should be based ……. (rest as per slide)



As per the slide…. I will discuss the ADI‐R , the SRS‐2 and the SCQ.



I also will briefly discuss the Childhood Autism Rating Scale 2nd Edition or CARS2, however, it is not recommended for use by the autism identification teams since educational members of the team will be using the ADOS 2 as an observational measure and the pediatrician on the team will use the STAT (Screening Test for Toddlers and Young Children). Some AIT sites do score the CARS 2 in addition to the ADOS. The other ASD questionnaires listed are used widely, but are not as appropriate for this younger age group



The CARS 2 is an older instrument that was revised in recent years. It is unique in that it incorporates both caregiver input by a parent questionnaire and direct observations of the child in clinic during standardized testing and interview. The parent questionnaire is unscored but serves the purpose of gathering information to assist with scoring each domain of the CARS2. The CARS‐ST is equivalent to the original CARS. In past, valid in identifying low functioning autism, but children who have autism and normal intelligence were missed. The 2nd edition addresses this with the new High Functioning Version.It id designed for use with children 2 years of age and older. It identifies children with ASD …… (rest as per slide)



This slide lists the 15 domains of the CARS 2. 14 ASD symptom domains with a 15th domain rating overall impressions of autism.



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Now I will discuss the ADI‐R and the OHSU ASD Parent interview



Autism Diagnostic Interview‐Revised or ADI‐R is a standardized semi‐structured interview that assesses 3 core areas; social skills, communication and restricted behaviors and interests. It is intended for use with individuals with a mental age of 18 months or older. It includes other items relevant for treatment planning, such as self‐injury and over‐activity. It used extensively in the US and international research communities. It is considered the gold standard in research (especially when paired with the ADOS)



The ADI‐R contains 93 items which cover family….. (rest as per slide)



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As per slide……. A short version of ADI‐R has been rumored to be in the works for years, but yet to be released.



The ASD Parent Interview used in the Autism clinic at OHSU and by the autism identification teams is based on DSM‐5 criteria for ASD. Completion and scoring of the interview will assist with completion of a DSM checklist at the completion of the identification evaluation. This interview is not normed, validated or published. Questions have been drawn from a number of sources…… (rest as per slide)



The next 2 slides present the instructions for the interviewer…… (rest as per slide)



As per slide…….. Individual items are rated rarely, sometimes and often. Check boxes are provided to score each DSM domain



This slide presents examples of questions for deficits in nonverbal communicative behaviors….. (rest as per slide)



This slide presents examples of questions for social‐emotional reciprocity….. (rest as per slide)



Similarly, here are examples of questions for developing and maintaining relationships…… (rest as per slide)



The next 4 slides give examples of interview questions for the 4 criteria for restricted and repetitive behaviors……. (the rest as per s;ode)



Here are questions related to routines and rituals….. (rest as per slide)



Questions related to fixated interests…… (rest as per slide)



Questions related to sensory issues….. (rest as per slide)



The interview also includes supplemental questions related to possible regression, pica, motor concerns and other mental health and behavioral issues….. (rest as per slide)



Now I will discuss the use of ASD Parent Questionnaires. Each team can choose whether or not to use these questionnaires in addition to the interview. I will discuss the Social Responsiveness Scale 2nd Edition and the Social Communication Questionnaire.



Social Responsiveness Scale, Second Edition or SRS‐2 identifies impairment related to ASD and quantifies its severity….. 9rest as per slide)



The SRS‐2 was developed not on a clinical sample, but on a general population sample to distinguish children with ASD from children with typical development (as well as those who may have other psychiatric disorders). It is brief… (rest as per slide)



As per slide….It is an ideal way to compare Parent and Teacher ratings across environments



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The total score …….It has 5 treatment subscales that support …..And 2 DSM‐5 compatible sub‐scales…..The subscale scores are helpful in designing and evaluating treatment programs.



As per slideIn summary, nice instrument for this group because it is normed down to 2.5 years, has a teacher and parent form, has good psychometric properties, aligns with DSM‐5, and is pretty quick to complete and to score.



The Social Communication Questionnaire or SCQ was previously known as the Autism Screening Questionnaire. The authors are also authors of the ADI‐R;. It functions as a level 2 screener which helps evaluate communication skills and social functioning.



It is …… (as per sldie)



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This slide reviews data from the Wiggins et al study. The Table shows the increase in sensitivity without loss of specificity when using cutoff score of 11 for children under 4. Using a cut‐off range of 11‐15 may be most appropriate.In summary, the SCQ is more of a level 2 screener; was not designed for 2‐3 year olds but constructs align with ADI‐R and research suggests it can be reliably used with the lower threshold for younger children.



ASD Questionnaires support the diagnostic interview. They serve an adjunctive role……. (rest as per slide)



This slide presents some guidelines for the use of the SRS‐2 or the SCQ based on age or other factors.



Now I will discuss adaptive behavior measures.



As per the first bullet ……I will describe the Adaptive Behavior Assessment Scale or ABAS III and the Vineland Adaptive Behavior Scales or VABS‐II



The ABAS III ….. As per slide



The ABAS III has ….. As per slide



The Vineland Adaptive Behavior Scale 2 edition evaluates ….. As per slide



The last type of questionnaire I will discuss is a multi‐dimensional social emotional assessment



The 2 instruments I will discuss are the Child Behavior Checklist and the Behavioral Assessment System for Children‐3rd Edition. Use of these measures can be very helpful for considering differential ….. (rest as per slide)



The CBCL has a preschool version which covers ages 1 ½ to 5 years. It includes a language development survey and there are parent and teacher forms. It has empirically‐based ….. (rest as per slide)



The BASC‐3 has Teacher and Parent rating forms for children ages 2‐5 years and takes 10‐20 minutes for parents to complete. In a study that compared children with typical development, those with delays and those with ASD, ….. (rest as per slide)



In summary ….. (rest as per slide)



parent interviews questionnaires - oregon health & … · as a reminder,this slide ... in this...

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