Development of the Critical Communication Skills Assessment

Background:

The first step in the Picture Exchange Communication System (PECS) training program (Bondy & Frost, 1994; Frost & Bondy, 2002) is to assess ability to follow nine critical communication skills according to checklist criteria. The nine critical communication skills are: 1) requesting reinforcers, 2) requesting help, 3) requesting a break, 4) accepting items, 5) rejecting items, 6) responding to wait, 7) responding to directions, 8) following a visual schedule and 9) transitioning between activities. Skills 1-5 relate to expressive communication and skills 6-9 relate to receptive communication.

Objectives:

The aim of this study was to pilot and validate an assessment protocol of the nine critical communication skills for use in intellectual disability (ID) and autism spectrum disorder (ASD) populations.

Methods:

The Critical Communication Skills (CCS) assessment was developed based on a model employed in a school for children with ASD. The refined CCS assessment protocol is composed of 38 items that allow for both spontaneous and prompted demonstration of the nine critical communication skills. Ten of the items are also administered by the parent/caregiver to determine whether communicative ability varies according to social demands. Each item is scored on a 0-2 scale, with 0 indicating a communication error or incorrect response and 2 indicating a correct response. The assessment is administered in a naturalistic environment utilising the child’s own toys and activities as reinforcers and preferred items. Excluding time needed to brief the parent/caregiver on administration strategy, the CCS assessment takes approximately 30-40 minutes to administer.

To determine inter-rater reliability and concurrent validity, scores were compared between two raters, and expressive and receptive communication scores obtained on the CCS assessment were compared to expressive and receptive language raw scores on the Vineland Adaptive Behavior Scales (VABS-2; Sparrow, Cicchetti, & Bala, 2005).

Results:

The CCS assessment was piloted with 20 children aged 2-15 years (M age = 7.65; SD = 4.32), with a confirmed diagnosis of a genetic syndrome. Most children in the study (n = 15) were diagnosed with Kleefstra syndrome, a disorder characterised by language delay and ASD symptomatology.

Inter-rater reliability ranged from good to excellent across items (weighted Cohen’s κ = 0.63-1.00; M = .85), and a strong correlation was found between the CCS and VABS-2 for expressive communication (r_{s =} .666, p = .001), but not for receptive communication (r_{s =} .358, p = .060).

Conclusions:

The CCS assessment is a valuable tool to measure critical communication abilities in ID and ASD populations, particularly expressive communication skills. This measure is now being used to examine the relationship between communication abilities, difficult behaviours, ASD symptomatology, age and level of ability in a cohort of young children with tuberous sclerosis complex. However, the CCS assessment also shows promise as a measure of critical expressive communication skills pre- and post- intervention in randomised controlled trials, and its use within both academic and clinical contexts will be discussed.