Using Parental and Teacher's Ratings for Differential Screening of Taiwanese Children with Higher Functioning Autism Spectrum Disorder from Children with Attention-Deficit/Hyperactivity Disorder

Background: Past research and clinical reports have revealed similarities in the symptomatic and behavioral characteristics between children with higher functioning autism spectrum disorder (HFASD) and those with attention-deficit/hyperactivity disorder (ADHD). Children with either diagnosis not only experience difficulties in social information processing, interpersonal relationships, attention, home and school adjustment, but also display oppositional behaviors and emotional problems. These behavioral similarities and overlapping symptoms make it difficult to differentiate HFASD and ADHD in clinical practice or even result in misdiagnosis, causing inappropriate or delayed treatments. Chao et al. (2013) have examined the validity of seven commonly used behavior rating scales in differentiating HFASD and ADHD children. They have found that either measure for general psychopathology, for specific symptomatology, or for social reasoning/functioning could significantly differentiate clinical groups (HFASD and ADHD) from typically developing (TD) comparison group. However, only two ASD symptom measures could differentiate HFASD from ADHD, i.e., the Gilliam Asperger’s Disorder Scale and the Australian Scale for Asperger's Syndrome.

Objectives: To examine the utility of parental and teacher’s ratings on behavior rating scales for differential screening of Taiwanese HFASD and ADHD children.

Methods: From August 2011 to November 2013, three groups of Taiwanese school-age (1^st -6^th grade) children were recruited to participate in this study, including: (1) children with HFASD (n=31), (2) children with ADHD (n=33), and (3) TD children (n=20). A comprehensive assessment protocol and indices were developed and cross-validated for differential screening of HFASD and ADHD. Five measures were used: (a) Child Behavior Checklist (CBCL)/Teacher Report Form (TRF), (b) Checklist for Autism Spectrum Disorder (CASD), (c) Gilliam Asperger’s Disorder Scale (GADS), (d) the 4^th Edition of Swanson, Nolan and Pelham Questionnaire (SNAP-IV), and (e) Socialization subscale of Vineland Adaptive Behavior Scale (VABS). All measures were employed to evaluate all the participating children by their parents and teachers. All the parental ratings and teacher’s ratings were compared across three groups.

Results: Five parent-rated measures were found to differentiate the clinical groups from the TD group (i.e., CBCL, CASD, GADS, SNAP-IV, VABS) and two of which (i.e., CASD, GADS) could differentiate between HFASD and ADHD group. Likewise, five teacher-rated measures could differentiate the clinical groups from the TD group (i.e., TRF, CASD, GADS, SNAP-IV, VABS) and two of which (i.e., CASD, GADS) could differentiate HFASD from ADHD group.

Conclusions: Parental and teacher’s ratings are useful in differentiating HFASD and ADHD from TD group. However, measures of general psychopathology or ADHD symptoms fail to differentiate HFASD from ADHD effectively. Only the behavior rating scales that assess ASD symptoms specifically is the most effective measures in differentiating HFASD and ADHD. Therefore, it is suggested that information regarding ASD symptoms should be routinely collected from parents and teachers when making differential diagnosis of HFASD and ADHD. It might also be helpful for special education teachers or school counselors to use ASD symptoms rating scales as a screening tool in initial assessment for high-risk children.