Predicting ADOS Scores Based on Behavioral Ratings from Parents and Pre-School Teachers
Information from different informants such as parents and teachers is regarded as valuable as it can contribute to early detection of autism spectrum disorder (ASD; Dereu et al., 2012) and lead to a greater understanding of how the child is functioning in different environments. However, information can differ between informants (Rescorla et al., 2014; Stratis & Lecavalier, 2015). The ASEBA Preschool Forms Child Behavior Checklist (CBCL) and Teacher Report Form (C-TRF) 1.5 - 5 years (Achenbach & Rescorla, 2000) are often used as screening instruments for behavioral symptoms and psychiatric conditions in children. Among other scales, the forms include a total problem scale and a scale that is related to autism symptoms, i.e. Pervasive Developmental Problems (PDP). It is still rather unexplored how well these scales are correlated with clinical assessment of ASD symptoms.
The aim of the study was to investigate how much variance of the ADOS – 2 comparison scores (CS) can be explained by scores on the CBCL and C-TRF (total problem scale and the autism-related PDP scale). We expected that scores from both parents (CBCL) and pre-school teachers (C-TRF) would predict autism symptoms, measured by the ADOS-2 CS at 3 years of age. We also explored if any of the two informants contributed more than the other to the model.
Fifty-seven 3-year-old children from an at-risk-for-ASD sibling study (33 (18 girls) high-risk-for-ASD with no diagnosis; 10 (5 girls) high-risk-for-ASD with ASD diagnosis and 14 (7 girls) controls) participated. Multiple linear regressions with CBCL and C-TRF entered as predictors were conducted separately for the total problems scale and the autism related PDP scale, with ADOS- 2 CS as the dependent variable throughout.
For the total problems scales, the model was significant (R2 = .189, P =.004), and neither CBCL nor C-TRF contributed uniquely to the prediction of ADOS-scores (Betas = .309 - .189, Ps = .186 - .237). For the PDP-scale, the model was significant (R2 = .298, P = < .001) and only the preschool teachers’ ratings contributed uniquely to model fit (Beta = .538, P = .010, explained variance 23 %). This pattern of results was also replicated when excluding all low-risk participants from the analyses.
Combined, behavioral ratings based on the CBCL and C-TRF explained a substantial proportion of the variance in the ADOS scores. Parents´ scores on the CBCL total and PDP subscales did not give a unique contribution to the prediction of ADOS scores over and above the contribution provided by preschool teachers’ ratings. In contrast, the pre-school teachers’ ratings on the PDP scales (but not total scores) made a unique contribution to the prediction of ADOS-2 CS- scores. This suggests that pre-school teachers’ ratings may be particularly useful in the context of early diagnosis of autism.