Identification of Sensitive Outcome Measures of Functional Skills

Background:  Clinicians and researchers have an obligation to evaluate the effectiveness of the interventions they provide. Patient-reported outcome measures are an important component of outcome measurement and effectiveness research and these have gained increase recognition and status with the advent of the Patient-Centered Outcomes Research Institute and initiative (PCORI, 2014); however, they may be subject to response bias. In regard to occupational therapy using sensory integration, a frequently requested and utilized intervention for children with ASD, there is now pilot data showing that this intervention improves the child’s participation in functional activities and that the children show increased independence in activities of daily living and socialization via parent-report measures.  To further explore the evidence for this intervention and others that target these outcomes, valid, reliable, performance-based outcome measures are needed to supplement parent-rated measures. 

Objectives:  

The objective of this presentation is to present the findings from a study funded to identify psychometrically sound, suitable, performance-based outcome instruments to measure functional skills and socialization in children with ASD that could be used in future studies. 

Methods:  

This study used mixed methods to identify performance-based measures of daily living skills and socialization, test their feasibility when applied to children with ASD ages 6-9, and explore their discriminant validity.  Systematic review of the literature was completed to identify currently available performance-based assessments of activities of daily living and socialization for children with ASD.  Inclusion criteria included that the measure 1) evaluates daily living skills and/or socialization; 2) is appropriate for use with children with ASD ages 6-9 years of age; 3) is performance-based; 4) and is norm referenced for use with ASD.  A panel of experts in Autism and/or outcome measurement rated measures using a quality indicator scale that rates psychometric rigor, sensitivity, and appropriateness for ASD.  Top-rated measures were then subject to a modified Delphi Process. In the next stage of this research a feasibility trial of the top-rated measures with 20 ethnically diverse children with ASD will be conducted at an urban clinic.  

Results:  Eight performance-based outcome measures of Activities of Daily Living or Socialization were identified from the literature review.  Quality indicator ratings showed that the top-rated instruments that met most criteria were The Assessment of Motor and Process Skills (AMPS – Fisher & Jones, 2012) and the Evaluation of Social Interaction (ESI - Fisher and Griwold, 2010).  These assessments will be used in the feasibility trial that will be conducted during January and February 2016. 

Conclusions:

The AMPS is a performance-based, standardized assessment of daily living skills that has strong reliability and validity as an outcome measure and has norms for use with ASD.  The ESI is a reliable, valid, performance-based assessment that shows strong promise as an outcome measure of social interaction for children with ASD.  Discriminative validity and feasibility data will also be presented.  This final phase will determine their discriminative validity and utility for use as an outcome measure in a comparative effectiveness trial.