A Diagnostic Tool for Reciprocal Behavior in Children, Adolescents and Adults with ASD

Background: Individuals with Autism Spectrum Disorder (ASD) are characterized by a poor understanding of the social norms for reciprocal behavior. The DSM-5 now includes deficits in reciprocity as a necessary criterion for an ASD diagnosis, whereas the DSM-IV included it as a possible criterion (APA 2000, 2013). Qualitative differences in social reciprocal skills of individual with Autism Spectrum Disorder (ASD) across gender, IQ levels and ages have not been studied to date. A new test for reciprocity, the Interactive Drawing Test (IDT; Backer van Ommeren, et al,. 2012; 2015; 2017^a, 2017^b), was shown to be a valid measure of the quality of reciprocal behavior, and highly sensitive to differences between individuals with and without ASD.

Objectives: To measure the sensitivity of the IDT for differences in reciprocal behavior in participants with or without ASD, across age and intelligence levels.

Methods: Reciprocal behaviors of individuals with autism were analyzed using the Interactive Drawing Test (IDT), a valid instrument to assess reciprocal behavior. In 5 studies, we analyzed over 500 individuals with or without ASD, including children, adolescents, and adults, intellectually disabled or normally intelligent, male and female. In addition to the paper version, we also tested a digital touch table version of the test.

Results: The IDT showed a high sensitivity to ASD. Large effect sizes indicated strong differences between ASD and TD participants in the quality of reciprocal behavior. These differences were independent of gender, IQ and age. ASD girls performed better than ASD boys, but both groups showed more limitations compared to TD children. Specific response patterns will be discussed, including comparisons to ADOS. The digital version of the IDT showed equal sensitivity to ASD.

Conclusions: The IDT seems highly suitable to assess impairments in reciprocal behavior and to differentiate between performances of ASD and TD children and adolescents with and without MID. The administration is short and cheap, participants appreciate the procedure (making a mutual drawing), and the IDT will be a welcome addition to standardized test batteries for ASD.