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The Development of Chinese Norms for the Autism Spectrum Rating Scale
Research on ASD has only started recently in China. Up to now, very few screening and diagnostic instruments were available for the Chinese population; In particular, instruments that require population norms are still very scarce. Three years ago, an important initiative funded by the Ministry of Health was launched to boost autism awareness and clinical and research expertise. As part of this recent program, a national epidemiological survey of ASD among the school-aged population of China was designed. In order to conduct the screening phase of this survey involving 8 provinces, we needed an instrument, properly validated for the Chinese population. After reviewing several instruments, we decide to employ the Autism Spectrum Rating Scale (ASRS) for the epidemiological survey. We first established the reliability and validity of the ASRS in a Chinese pilot sample, and re-examined the factor structure that was proposed in the initial US study. We report here on the part of our study that aimed at establishing population norms for the ASRS.
Objectives: To develop Chinese norms for the Autism Spectrum Rating Scale (ASRS) for both the Parent and the Teacher versions, for children aged 6-12 years. Our specific aims were: a) to recruit a large sample of community participants to establish the norms for the subscales of the ASRS, and; b) to compare Chinesenorms to US norms in order to detect possible cultural differences.
Methods:
A representative community-based study sample was recruited from 4 cities in China. Parents and teachers of selected subjects were invited to complete the Chinese versions of ASRS questionnaire. Higher scores indicate less proficient general social communication skills associated with more ASD traits. Social communication(SC), Unusual behavior (UB) and Self regulation (SR) sub scale scores were standardized to according to a normal distribution with mean of 50 and standard deviation of 10, raw total scores (T score) was computed based on which and then standardized to standardized T-score. The effect of age, gender and site were analyzed. To compare US and Chinese norms, community participants were scored using the 2 sets of norms and correlations between these 2 scores were subsequently calculated. A p-value of 0.05 was retained as level of statistical significance.
Results:
In total 1684 out of 2053 eligible children participated in this study (mean age 8.85+1.78 year; 830 boys (51%). Boys in community-based sample had significant higher scoring in Social Communication (SC), Unusual Behavior (UB), Self-Regulation (SR) and standardized total score (T-score) by 2-3 points than that in girls, Ps<0.001. Minor effects of age were found for both parent and teacher ratings on the ASRS T-scores (r=-0.0856 to 0.1106, Ps<0.001 or non-significant. T-score of the current reference sample showed statistically significant positive correlation with the scores computed based on the norms of the United States (r=0.98, p<0.001).
Conclusions:
This is the first application of ASRS in screening ASD in China. The norms of Chinese version of ASRS for children aged 6-12 years old have been proposed.