Вы находитесь на странице: 1из 38

Asperger Syndrome

Diagnostic Scale (ASDS)


-Brenda Smith Myles, Stacey Jones
Bock, Richard L. Simpson (2001)
-Diana Kelly, PS 616 (9/08)

Brief History of Aspergers


Syndrome
Leo Kanner delineates the diagnostic
criteria for Autism (aka Kanners
Syndrome).
1943: Kanner identifies a group of autistic
children, apparently normal, but who
are nave, lack appropriate speech
pragmatics and prosody, lack empathy,
and have poor non-verbal communication.
(Ozonoff, et al., 2005; Freeman et al., 2002)
9/24/2008

History cont.
In 1944, Hans Asperger describes a
similar group of autistic boys, but
notes no speech delay, the presence of
motor clumsiness, and a late onset of
social deficits.

(Ozonoff et al., 2005; Freeman et. al, 2002)


9/24/2008

History cont.
Wolff & Barlow, in 1979, describe a similar
group of children diagnosed with schizoid
personality disorder characteristics
considered to be stable personality traits.
In 1981, Wing translates Aspergers paper
into English and demonstrates the
connection to Kanners 1943 group.
(Ozonoff et al., 2005: Freeman et al., 2002).

9/24/2008

History cont.
In 1989, Rourke describes yet another
group of children who have been
identified as having NVLD
neuropsychological profiles essentially
autistic-like deficits but with welldeveloped rote verbal repertoires.

(Ozonoff et al., 2005; Freeman et al., 2002)


9/24/2008

AS Included In DSM-IV
By 1994, enough varying views of AS
resulted in the consensus that AS
should be included in the DSM-IV
under the category of PDD.

(Ozonoff et al., 2005; Freeman et al., 2002)


9/24/2008

Current Debate In AS
Assessment
How to assess AS vs. other PDDs?
What characteristics overlap?
Are the characteristics inimical only
to AS to permit differential diagnosis,
and, if so, what are they and how to
measure them?
When are these characteristics
capable of accurate measurement?
9/24/2008

DSM-IV-TR

Criteria for AS

Same qualitative social impairment,


restrictive and stereotypic behavior
patterns and impairment in social,
occupational or important area of
functioning.
Except . . .

9/24/2008

DSM-IV-TR- AS Qualifiers
No clinically significant delay in the onset of:
Language (single words at 2; communicative
phrases -3);
Age-appropriate self-help skills, adaptive behavior
(other than social), and environmental curiosity.
Criteria not met for another PDD or Schizophrenia.
(DSM-IV: American Psychiatric Association, 1994; DSM-IV-TR,
American Psychiatric Association, 2000).

9/24/2008

The ASDS
Developed in 2001.
50 item test, rated as observed (1) or
not observed (0).
Rater needs to be an appropriate
person with regular, sustained contact
with examinee for at least 2 weeks,
(e.g., parent, teacher).
Examiner is person scoring and
interpreting the ASDS results.
9/24/2008

10

ASDS cont.
Appropriate for ages 5-18
Completion time 10-15 minutes
Scale normed on 115 individuals
from 21 states in the U.S.
Provides standard scores and
percentile ranks

9/24/2008

11

Reliability From Manual


Cronbachs (1951) coefficient alpha
used to determine internal consistency
of the instrument and subscales.
Higher consistency on ASDS as a whole
to suggest AS, but less reliable on the
subscales individually, thus
recommends subscales be used only to
determine relative individual strengths
and weaknesses, not to identify AS
9/24/2008

12

Interrater Reliability
14 AS subjects (mean age 12) rated
by teachers & parents.
The resulting correlation coefficient
for the ASQ calculated was .93
considered strong, statistically
significant, and indicative that
ratings will be similar across different
raters with the same subject.
9/24/2008

13

Validity From Manual


Evidence was provided for three
types of validity:
Content
Criterion
Construct
(Interestingly, there is no discussion of
external validity).
9/24/2008

14

Content Validity
Item Analysis:
Items on ASDS derived from the DSM-IV,
the ICD-10; AS literature on ERIC and
PsychInfo databases (1975-1999), and
Aspergers 1944 research. 6 resulting
categories combines into 5.

9/24/2008

15

Item Discrimination
An item analysis was not done at separate
age levels since research indicate that
there is not relationship between age and
ASDS scores.
Item discrimination was tested by the
Pearson item-total-score correlation index,
yielding statistical significance, and
coefficients indicating items wellexceeded minimum criteria for magnitude.
9/24/2008

16

Criterion Validity
ASDS ability to differentiate amongst
different diagnostic groups.
2 groups: 115 diagnosed with AS;
normative group of 177 with autism,
behavior disorders, ADHD, LD.
Discriminant analysis showed a
statistically significant difference
between the mean ASQ for the AS and
non-AS samples; accuracy of 85%
correct classification.
9/24/2008

17

Construct ValidityHypotheses
AS characteristics not correlated with age,
so ASQ should not be related to age.
ASDS item characterize AS and should
correlate with total test score
As ASDS measure AS characteristics, it
should not correlate strongly with scale for
autism
ASDS measures AS characteristics and
should differentiate between AS and non-AS
groups.
9/24/2008

18

ASDS Evaluation of ASQ


Age
Little published research by 19992001.
Correlated ASDS raw scores between
sample groups, ages 5-18.
Coefficient of .14 confirms no
practical relation.

9/24/2008

19

Discriminant Validity
Correlated ASDS scores with GARS
scores.
GARS targets autism and ASDS targets
AS.
Correlational coefficient was not
significant, magnitude reported as
moderate.
Thus, conclusions that ASDS and GARS
measure different conditions.
9/24/2008

20

Group Differentiation
Expectation that each groups results
should make sense: that individuals
not having AS would have ASQ and
subscale scores significantly different
than those having AS
Mean subscale and quotient standard
scores were significantly higher for
those with AS.
9/24/2008

21

The Test Itself


The 50 items are divided into 5
subscales:
Language: Receptive & Expressive (9)
Social: reciprocity, eye contact, gestures,
perspective (13)
Maladaptive: Obsessions, rituals, routine
change, behavioral control, anxiety (11)
Cognitive: rote & visual memory,
intelligence, related cognitive issues (10)
Sensorimotor: auditory, tactile, olfactory,
gustatory sensitivities; fine & gross motor
9/24/2008

22

ASDS Instructions
Examiners manual includes:
Specific administration & scoring
procedures: computing &
converting raw scores, standard
scores, percentile ranks, and the
resultant Asperger Syndrome
Quotient (ASQ).

9/24/2008

23

Scoring
Total raw scores converted by table into
%ile and ASQ. (ASQ has a mean of 100
and standard deviation of 15, compares
this individual with others with AS.)
Raw score for each subscale converted
in %ile rank and standards scores.
(Mean of 10, standard deviation of 3).

9/24/2008

24

Profile
Profile of Scores: scatter plot
graphic plotting of subscale standard
scores and ASQ.
Provides visual assessment of
likelihood of AS and the areas of
strength and weakness.
Higher scores = greater probability of
AS.
9/24/2008

25

Examiners Manual Cautions


The ASDS results may be indicative of
AS, but does not diagnose AS as all
testing has error and confounds to be
considered
Advises comprehensive evaluation for
diagnosis
Suggests that ASDS has utility in
aiding diagnosis & in treatment
planning or modification
9/24/2008

26

ASDS Written Report


Form includes a brief written report:
Description of specific symptoms
observed,
Functional impact on subject,
Implications and recommendations re:
work, leisure, instruction
Recommendations for strategies and
interventions regarding instruction,
behavior, parenting, and related services
9/24/2008

27

Early Development
Interview
In addition, the ASDS includes 10 key
questions (also in the questionnaire)
to flesh out additional information on
the onset of symptoms, relative
severity, relativity across settings.

9/24/2008

28

Reasons To Use ASDS

The ASDS is easy to administer


Takes little time, 10-15 minutes
Easy to score and scale and read
Allows for additional information on
an individual subjects idiosyncrasies
that is useful in treatment planning.

9/24/2008

29

Relevant Research on ASDS


Only one review could be located
giving strong support for the ASDS as
a tool to differentiate AS from
autism.

(Mirenda, P., 2003).


9/24/2008

30

Limitations cont.
The most significant limitation of the
ASDS is the lack of agreed upon
operational differential diagnostic
components to distinguish AS from or
as a variant of autism, HFA, and PDDNOS.
(Toth & King, 2008; Boggs et al., 2006; Campbell,
J.M., 2005; McConachcie et al., 2005; Ozonoff et al.,
2005; Freeman et al., 2002; Blair, K. A. (2003).
9/24/2008

31

GARS measures autism.


GADS and the KADI, the only other AS
specific tests also have same
weaknesses as ASDS with respect to
diagnoses verification.
KADI has strong psychometrics, ASDS
the weakest. KADI also has age groups.
(Campbell, J.M., 2005; McConachie et al., 2005;
Ozonoff et al., 2005; Blair, K., 2003).
9/24/2008

32

Some studies note that most if not all


symptoms seen in autism are seen in AS;
other recent studies suggest that AS and
autism appear different at young age,
that by adolescence the differences are
less apparent, and individuals appear
less distinct. Perhaps the course
should be included in screening.
(Boggs et al., 2006); McConachie et al., 2005; Ozonoff
et al., 2005; Freeman et al., 2002).
9/24/2008

33

The debate also suggests that to


determine the presence of AS:
evaluate the type and use of language &
skills that appear, not simply their age of
onset;
presence of hyperactivity, depression,
motor clumsiness
the course of repetitive behaviors
(Boggs wt al., 2006; (Ozonoff et al., 2005;
McConachie, et al., 2005).
9/24/2008

34

ASDS Compared To Other


Tools
There are no published comparison studies
that would use the ASDS alone or rank it as
superior to other AS-specific screening tools.
One study found that KADI to be the most
thorough; one preferred the ASSQ (but could
not recommend any scale); one found a
combination of the ASDS, GARS and SSRS to
be most reliable.
(Boggs et al., 2006; Ozonoff et al., 2005; Campbell, J.M.,
2005).
9/24/2008

35

References

Blair, K. A. (2003) Test review of the Asperger Syndrome


Diagnostic Scale. From Plake, B. S., Impara J.. C., & Spies,
R.A. (Eds), The fifteenth mental measurements yearbook,
[Electronic version]. Retrieved 9/15/2008, from the Buros
Institutes Test reviews Online website:
http://www.unl.edu/buros.

Boggs, K. M., Gross, A. M., & Gohm, C. L. (2006). Validity of


the Asperger
Syndrome Diagnostic Scale. Journal of
Developmental and Physical
Disabilities, 18:2, 163-182.
Campbell, J. M. (2005). Diagnostic assessment of
Aspergers disorder: A
review of five third-party rating
scales. Journal of Autism and
developmental Disorders,
35:1, 25- 35.

9/24/2008

36

References cont.

Freeman, B. J., Cronin, P.,& Candela, P. (2002). Asperger


syndrome or
autistic disorder? The diagnostic
dilemma. Focus On Autism and
Other
Developmental Disabilities, 17:3, 145-151.
Goldstein, S. (2002). Review of the Asperger Syndrome
Diagnostic Scale. Journal of Autism and Developmental
Disorders, 32:6, 611-614.
McConachie, H., Couteur, A. L.,& Honey, E. (2005). Can a
diagnosis of
Asperger syndrome be made in very
young children with suspected autism spectrum disorder?
Journal of Autism and Developmental Disorders, 35:2,
167-176.

9/24/2008

37

References cont.
Mirenda, P. (2003) Test review of the Asperger Syndrome
Diagnostic Scale. From Plake, B. S., Impara J.. C., & Spies, R.A.
(Eds), The fifteenth
mental measurements yearbook,
[Electronic version]. Retrieved 9/15/2008, from the Buros
Institutes Test reviews Online website:
http://www.unl.edu/buros.
Myles, B.S., Bock, S. J., & Simpson, R. L. (2001). Asperger
Syndrome Diagnostic Scale (ASDS), PRO-ED, Austin, TX.
Ozonoff, S., Goodlin-Jones, B. L., & Solomon, M. (2005).
Evidence-based assessment of autism spectrum disorders in
children and
adolescents. Journal of Clinical Child and
Adolescent Psychology, 34:3, 523-540.
Toth, K., & King, B.H., (2008). Aspergers syndrome: diagnosis
and treatment. The American Journal of Psychiatry, 165:8, 958963.
9/24/2008

38