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Profiles of Adaptive Functioning: Autism Spectrum Disorders, Mental Retardation, and Beyond . California Association of School Psychologists February 17, 2005 8:30-10:15 Sara S. Sparrow, PhD Yale Child Study Center. How I Discovered Adaptive Behavior. Speech Pathology Psychology

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profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Profiles of Adaptive Functioning: Autism Spectrum Disorders, Mental Retardation, and Beyond.

California Association of School PsychologistsFebruary 17, 2005

8:30-10:15

Sara S. Sparrow, PhD

Yale Child Study Center

slide2

How I Discovered Adaptive Behavior

Speech Pathology

Psychology

Doman-Delacato

Measurement Dilemmas

4 areas for today
4 AREAS FOR TODAY
  • NEW FEATURE OF THE VINELAND II
  • CHANGES IN THE PURPOSES OF ADAPTIVE BEHAVIOR ASSESSMENTS
  • RECENT RESEARCH ON EFFECTS OF INTERVENTION WITH PERSONS WTH HIGH FUNCTIONING ASD
  • CLINICAL APPLICATIONS AND ADAPTIVE PROFILES
adaptive behavior assessment
Adaptive Behavior Assessment

Working our way back:

30 years since Pl 94-142 (1975)

16 years earlier AAMD (1959)

24 years earlier Edgar Doll published

The Vineland Social Maturity Scale (1935)

purpose
Purpose

Diagnosis of Mental Retardation

things have changed
Things Have Changed

More and more assessing adaptive behavior has had broader applications

One reason is that different research has demonstrated that there appear to be different profiles for various diagnostic groups

uses of adaptive behavior assessments
USES OF ADAPTIVE BEHAVIOR ASSESSMENTS
  • Confirming or establishing diagnosis
  • Special services qualification
  • Program planning
  • Progress reporting/tracking
  • Identifying changes over time
uses conintued
USES, conintued
  • Mental Retardation
  • Early Childhood Special Education
  • Autism Spectrum Disorders
  • Traumatic Brain Injury
  • Adult Mental Problems
  • As a measure to support the diagnosis ofother disabilities
  • Death Penalty Cases and
  • Many others
a word about death penalty cases
A word about Death penalty cases:

Atkins versus Virginia.

Psychologists will be increasingly asked to provide testimony in these cases, mainly regarding adaptive functioning

A Virginia court just ruled that Atkins did not meet criteria for a diagnosis of mental retardation

slide10
2005

Supreme Court rules that individuals with (chronological) age under 18 years cannot be executed.

What about mental age?

slide11
THUS
  • Implications for the development of the Vineland II
vineland ii overview
VINELAND-II Overview
  • Because clinicians have different needs when it comes to assessing adaptive behavior, we now offer four forms:

--Survey Interview Form

    • NEW Parent/Caregiver Rating Form
    • Teacher Rating Form
    • Expanded Interview Form
major new features
MAJOR NEW FEATURES
  • Ages: Birth to 90 years of age
  • New Norms
  • Increase Item density at floor and ceiling
  • Extensive investigation and elimination of item bias
  • Increase items relevant to ASD and young children
  • Eliminate outdated items
  • Increase Items reflecting our society’s technological advances
  • Subdomain standard scores
  • New Maladaptive
other new features
Other New Features
  • Parent Caregiver Forms
  • Teacher report Form –
    • Daily Living Skills
      • Personal Subdomain
      • Academic Subdomain
      • School-Community Subdomain
slide16

Validity Evidence: 11 Clinical Groups

  • Attention Deficit/Hyperactivity Disorder
  • Autism – nonverbal
  • Autism – verbal
  • Learning Disability
  • Mental Retardation – Mild (child)
  • Mental Retardation – Moderate (child)
  • Mental Retardation – Mild (adult)
  • Mental Retardation – Moderate (adult)
  • Emotional Disturbance
  • Visual Impairment
  • Hearing Impairment
slide17

Validity Evidence: Criterion

  • Vineland Adaptive Behavior Scales
  • Adaptive Behavior Assessment System (ABAS)
  • WISC III
  • WAIS-III
  • BASC-2
slide18
SUBDOMAIN

V-SCALED SCORES

Mean = 15

SD = 3

slide19

Yale University

VINELAND II

NEW MALADAPTIVE DOMAIN

slide20

STILL BOTH

MINOR AND MAJOR

MALADAPTIVE

slide21

FACTOR ANALYTIC STUDIES

REVEALED

THREE FACTORS

internalizing items
Internalizing Items
  • Is overly dependent 
  • Avoids others and prefers to be alone 
  • Has eating difficulties 
  • Has sleep difficulties 
  • Refuses to go to work or school because of fear, feelings of rejection, or isolation 
  • Is overly anxious or nervous 
  • Cries or laughs too easily 
  • Has poor eye contact 
  • Is sad for no clear reason 
  • Avoids social interaction 
  • Lacks energy or interest in life 
externalizing items
Externalizing Items
  • Is impulsive
  • Has temper tantrums
  • Intentionally disobeys or defies those in authority
  • Taunts, teases, or bullies
  • Is inconsiderate or insensitive of others
  • Lies, cheats, or steals
  • Is physically aggressive
  • Is stubborn or sullen
  • Says embarrassing things or asks embarrassing questions in public
  • Behaves inappropriately at the urging of others
maladaptive behavior by age for individuals with mr
Maladaptive Behavior by Age for Individuals with MR

School-aged children with MR (all levels) had maladaptive means significantly higher than age matched clinical groups but < 1SD difference.

Adults (19-90) with MR (all levels) had maladaptive means significantly higher than age matched clinical groups AND school aged groups with MR

maladaptive behaviors by age for individuals with mr
Maladaptive Behaviors by Age for Individuals with MR

Differences were greatest in the adult severe-profound group

Only Internalizing behaviors fell into the “elevated range” (the highest level) for this group

adaptive functioning of mental retardation groups
Adaptive Functioning of Mental Retardation Groups

For all levels and ages, mean levels of all domains and the adaptive behavior composite were at least 2SD below the mean

slide29

Severe

Moderate

Mild

slide33

Validity Evidence: Mental Retardation

Ages >18

Ages 6-18

Mean scores by age group and level

Mild, Moderate, Severe to Profound

slide34

Validity Evidence: Autism, ADHD, EBD, LD

Mean scores by age group and disability

slide35

Validity Evidence:

Visual Impairments, Hearing Impairments

Mean scores by age group and disability

slide36

Clinical Group Summary

Vineland-II differentiates clinical groups from nonclinical groups.

  • Documented significant deficits for MR groups (at least 2 SDs below mean)
  • Demonstrated expected mean score changes for mild, moderate, and severe to profound levels of mental retardation
  • Differentiated between Verbal and Nonverbal Autism groups
  • Demonstrated distinctive profile patterns
slide37

Validity Evidence: Criterion

  • Vineland Adaptive Behavior Scales
  • Adaptive Behavior Assessment System (ABAS)
  • WISC III
  • WAIS-III
  • BASC-2
slide38

Vineland-II and Vineland ABS

High degree of consistency between forms

Correlations corrected for restriction of range

important
IMPORTANT

THERE APPEARS TO BE NO FLYNN

EFFECT

slide40

Vineland-II and WISC-III and WAIS-III

Documents the distinct difference between IQ and Adaptive Behavior.

Confirms the need to assess both when making diagnostic decisions.

Correlations corrected for restriction of range

slide41

Ages 6-11

Vineland-II and Behavior Assessment System for Children, 2nd Edition (BASC-2)

Correlations corrected for restriction of range

conclusions
Conclusions
  • Much is the same but much is better!

Manual

Criteria

Case studies

Summer 2006

  • Teacher checklist

Winter 2006

  • Expanded Form
adaptive profiles from research studies
Adaptive Profiles from Research Studies

Since 1984 over 1400 studies have been published investigating adaptive functioning in the following groups:

Mental retardation Autism Spectrum

Closed Head Injury Hearing Impaired

Homeless HIV

Learning disability Gifted

Emotionally Disturbed Spina Bifida

Tourette Syndrome Conduct Disorder

Cocain Exposed Low Birthweight

Children exposed to Violence ETC.!

groups with mental retardation
Groups with Mental Retardation

Non Specific MR

All levels of MR

Genetic Forms of MR

Fragile X

Down Syndrome

Praeder Willi

William Syndrome

Special Olympics

groups on the autism spectrum
Groups on the Autism Spectrum

PDD NOS

Asperger Syndrome

High functioning Autism

Low functioning Autism

Multiplex

Nonverbal Learning Disability (?)

atypical and normally developing children
Atypical and Normally DevelopingChildren

Sparrow, S.S. Rescorla, L.A., Provence, S., Condon, S.O., Goudreau, D., Cicchetti, D.V., (1986). Follow-up of “atypical” children Journal of American Academy of Child Psychiatry. 25, 2:181-185.

social deficits in autism
Social Deficits In Autism

Volkmar, F.R., Sparrow, S.S., Goudreau, D., Cicchetti, D.V., Paul, R., Cohen, D.J., (1987) Social deficits in autism: An operational approach using the Vineland Adaptive Behavior Scales. Journal of the American Academy of Child and Adolescent Psychiatry. 26,

2:156-161.

autism
AUTISM
  • Carter,A. S., Volkmar,F. R., Sparrow,S. S., Wang,J. J., Lord,C., Dawson,G., Fombonne,E., Loveland,K., Mesibov,G., Schopler,E., (1998),The Vineland Adaptive Behavior Scales - Supplementary Norms for Individuals with Autism, Journal of Autism & Developmental Disorders, 28:4, pp. 287-302.
subject characteristics
Subject Characteristics

Age and IQ matched children with mental retardation without and with autism

Mean age 11.8

Mean IQ 54

Vineland scores were so low we had to use age equivalents/mental age ratios

Thus, if Adaptive Behavior was consistent with MA, Score should be

near 100.

other populations
Other Populations

Precocious readers (not hyperlexic)

IQs: 121 to 122

Ages: 3-2 to 4-9

Asperger and high functioning autism

slide57

Special Thanks

  • Ami Klin
  • Fred R. Volkmar
  • Celine Saulnier
  • Kathy Lord
  • Domenic V. Cicchetti
  • All the participating families from the Yale Child Study Center and the Autism and Communication Disorders Center at the University of Michigan
  • NICHD grant 5-PO1-HD03008
slide58

Recent Research in ASD

  • Autism symptoms have a severe impact on a person’s ability to meet the demands of everyday life
  • Extreme variability in symptomatology and cognitive ability affects daily functioning
  • “Higher-functioning” individuals, despite potential, fail to translate their skills to real-life adaptation
slide59

Outcome in ASD

  • Increasing focus on early diagnosis & intensive intervention = progress
  • Still enormous variability in outcome
    • 12% achieving “very good outcome”
    • 60% with “poor” or “very poor outcome” (Howlin, Goode, Hutton, & Rutter, 2004)
  • Cognitive & language measures
  • Does higher cognitive ability = greater outcome in adulthood???
  • Translating potential into real-life skills becomes critical – Adaptive Behavior
slide60

Adaptive Functioning in Autism

  • “Real-life” Skills
  • Vineland Adaptive Behavior Scales(Sparrow, Balla, & Cicchetti, 1984)
    • Communication Daily Living Skills
    • Socialization Motor
  • Communication & Socialization skills = central & defining features
  • Deficits in adaptive skills fall below cognitive ability across the spectrum
    • Significant deficits in socialization
    • Intermediate deficits in communication

(Bolte & Pustka, 2002; Carter et al., 1998)

slide63

Relationship between

IQ and Adaptive Functioning

  • Consistent findings:
    • Adaptive impairments exist beyond MR
    • No entitlement for services without MR
  • Inconsistent findings:

(Freeman, Del’Homme, Guthrie, & Zhang, 1999; Liss et al., 2001; Schatz & Hamden-Allen, 1995; Szatmari, Bryson, Boyle, Streiner, & Duku, 2003)

    • Positive relationship
      • e.g., Vineland Communication & VIQ
      • Early language and nonverbal IQ predicting outcome for both comm. & socialization skills
    • Negative relationship
slide64

Relationship between

Age and Adaptive Functioning

  • Equally unclear relationship:
    • Stable relationship

(e.g., Schatz & Hamden-Allen, 1995)

    • Increase in AF w/ age

(e.g. Freeman et al., 1999)

    • Decrease in AF w/ age

(e.g. Szatmari et al., 2003)

slide65

Autism Symptomatology

  • Varying measures to assess severity of autism symptoms
    • Autism Behavior Checklist
    • Childhood Autism Rating Scale
    • Autism Diagnostic Observation Schedule
  • Other factors (e.g., adaptive behavior and language) appear to be stronger predictors of outcome than severity of symptoms
  • Very little research on relationship between symptomatology and adaptive behavior
slide66

Many Unanswered Questions

  • Cognitive potential may or may not play a role in positive outcomes
  • Severity of autism symptoms may or may not play a role in positive outcomes
  • Early detection and intensive intervention are beneficial to some, but not all, individuals on the spectrum
  • “Real-life” skills are important for outcome
    • adaptive communication & social skills
slide67

Present Study

  • Examines relationship between adaptive behavior (ability) and severity of symptoms (disability)
    • Vineland Adaptive Behavior Scales
    • Autism Diagnostic Observation Schedule
  • Investigates nature of ability & disability in relation to:
    • Age
    • IQ
    • Diagnostic Classification
slide68

Participants

Total Sample

  • 187 males with a diagnosis of an ASD
  • Diagnosis based on ADI, ADOS, & clinical judgment of 2 licensed clinicians
  • Verbal IQ > 70
  • Age range from 7 to 18 years

Yale Site

  • N = 84
    • Autism=32; Asperger’s=35; PDD-NOS=17

Michigan Site

  • N = 103
    • Autism=31; Asperger’s=1; PDD-NOS=66
slide69

Measures

  • Autism Diagnostic Observation Schedule

(Lord, Rutter, DiLavore, & Risi, 1999)

  • Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984)
  • Intelligence Scales
    • Yale:Wechsler scales: WISC-III, WAIS-R (The Psychological Corporation)
    • Michigan:Mix of Wechsler scales, Differential Ability Scales, & Stanford-Binet
slide70

Characterization by Site

Note. ADOS Commun. scores range 0-8 & Social scores 0-14

*For Vineland scores, higher numbers indicate greater ability

**For ADOS scores, higher numbers indicate greater disability

real life adaptive functioning in higher functioning individuals with autism and pdds
Real-life (adaptive functioning) in higher functioning individuals with autism and PDDs
  • N=187
  • Autism, AS, and PDD-NOS
  • Socialization (Vineland): Mean 52 Yale (SD 12.6)
  • Interpersonal Age Equivalent: Yale Mean 3.6 years (SD 1.7 years)

From Klin, Saulnier, Sparrow, Cicchetti, Lord & Volkmar (submitted)

real life adaptive functioning in higher functioning individuals with autism and pdds1
Real-life (adaptive functioning) in higher functioning individuals with autism and PDDs
  • Social ability and disability: two relatively dissociated domains (correlation)!!!!!!!
  • Social disability is not correlated with age (stable)
  • Social ability is negatively correlated with age (decline relative to peers, relative to increasing demands of the environment)
  • Most programs emphasize reduction of symptoms
  • Conclusion: all programs should prioritize adaptive functioning (REAL-LIFE SKILLS)

From Klin, Saulnier, Sparrow, Cicchetti, & Volkmar (submitted)

prototypical comparative profiles
Prototypical Comparative Profiles

Based on our work and those of many others

These are group data and some affected individuals may not demonstrate the prototypical profiles

asperger and autism
ASPERGER AND AUTISM
  • Szatmari,Peter; Archer,Lynda; Fisman,Sandra; Streiner,David L. (1995), Asperger\'s syndrome and autism: Differences in behavior, cognition, and adaptive functioningJournal of the American Academy of Child & Adolescent Psychiatry, Dec. 34:12, pp.1662-1671.
asperger and autism1
ASPERGER AND AUTISM

Klin, A., Volkmar, F.R., Sparrow, S.S., Cicchetti, D.V., and Rourke, B.P.

(1995). Validity and Neuropsychological Characterization of Asperger

Syndrome. Journal of Child Psychology and Psychiatry. 36:1127-1140.

slide78
ADHD

Roizen,N. J., Blondis,T. A., Irwin,M., Stein,M.(1994) Adaptive functioning in children with attention-deficit hyperactivity disorder, Archives of Pediatrics & Adolescent Medicine Nov,148:11, pp 1137-1142.

adhd add
ADHD, ADD
  • Stein,Mark A., Szumowski,Emily, Blondis,Thomas A. (1995) Adaptive skills dysfunction in ADD and ADHD children, The Journal of Child Psychology and Psychiatry and Allied Disciplines, May, pp.36, 663-670.
slide82

Cognitive and Adaptive Profiles

of

Nonspecific MR and Down syndrome

down syndrome1
DOWN-SYNDROME

Burack,J. A.; Shulman,C.; Katzir,E.; Schaap,T.; Brennan,J. M.; Iarocci,G.; Wilansky,P.; Amir,N.(1999) Cognitive and behavioural development of Israeli males with fragile X and Down Syndrome International Journal of Behavioral Development, JUNE, 23:2, pp. 519-531

slide84
Cicchetti,Domenic V., Sparrow,Sara S.(1990)Assessment of adaptive behavior in young children, pp173-196, Johnson,James H., Goldman, Jacquelin, Developmental assessment in clinical child psychology: A handbook. Pergamon general psychology series, 163 Pergamon Press, Inc, Elmsford, NY.
slide85

Cognitive and Adaptive Profiles of Normal

Development and Hearing Impaired

conclusions1
Conclusions

Assessment of Adaptive functioning is important for individuals within any diagnostic category

Determining how everyday life (adaptive functioning) is affected by nature or nurture (or both) should be our goal

Research and clinical work has shown us how different profiles are found in different groups

Aside:(Program planning and assessment of change after intervention are other goals of adaptive behavior assessment)

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