EVALUATION TREATMENT

The Autism Treatment Evaluation Checklist (ATEC)

The Autism Research Institute (ARI) has recently provided this research instrument and simple Internet scoring procedure as a valid means of measuring the effectiveness of various treatments for autism.

The Autism Treatment Evaluation Checklist (ATEC) is a one-page form developed by Dr. Bernard Rimland and Dr. Stephen M. Edelson for measuring and evaluating the effectiveness of autism treatments. The test consists of 4 subtests:

  1. Speech/Language/Communication (14 items)
  2. Sociability (20 items)
  3. Sensory/ Cognitive Awareness (18 items)
  4. Health/Physical/Behavior (25 items)

Users of the ATEC may have it scored for free (4 subscores and a total score) by the Autism Research Institute by entering the responses via computer at the Autism Treatment Evaluation Checklist (ATEC) Internet Scoring Program Online Form on their website.

The Importance of the Need for the ATEC

Over the years, researchers have published hundreds of studies attempting to evaluate different biomedical and psycho-educational interventions intended to benefit autistic children, however, much of this research has produced inconclusive or, worse, misleading results, because there are no useful tests or scales designed to measure treatment effectiveness.

Lacking such a scale, researchers have resorted to using scales such as:

  1. The Childhood Autism Rating Scale (CARS)
  2. The Gilliam Autism Rating Scale (GARS)
  3. The Autism Behavior Checklist (ABC)

All of these instruments were designed to diagnose autism – to tell whether or not a child is autistic – and not to measure treatment effectiveness.

Thus, a major obstacle in useful autism research has been the lack of a valid means of measuring the effectiveness of various treatments. By introducing the Autism Treatment Evaluation Checklist, the Autism Research Institute is paving the way for pertinent new research information that has heretofor been unavailable or difficult to evaluate.

As Catherine Lord, in the Handbook of Autism and Pervasive Developmental Disorders, has said, “Often, investigators have to use diagnostic instruments to measure changes in response to treatment. . . this approach has not been very successful. . . because most diagnostic instruments. . . are not sufficiently sensitive to changes within an individual.”

Given that there are 20 or more studies starting soon [2000] to evaluate the use of secretin for autistic children, the release [1999] of this new research instrument now is particularly urgent. 

People Who Can Use the Autism Treatment Evaluation Checklist

The ATEC is designed to be completed by researchers, parents, teachers, or caretakers. Although the Autism Treatment Evaluation Checklist was designed to evaluate the effectiveness of various treatments for autistic individuals, it may also prove useful for other purposes.

One such possible purpose is diagnosis. Since the Autism Treatment Evaluation Checklist is a simple one-page form that can can be scored immediately at no cost on-line, it might be very useful as a diagnostic tool – if it turns out that ATEC scores differentiate autistic children from their normal, non-autistic siblings; other normal, non-autistic children; and non-autistic children diagnosed with ADHD, dyslexia, ADD, mental retardation, etc.

You can help the Autism Research Institute in this effort by filling out ATEC forms for one or more non-autistic children. Better yet, you can ask your friends with non-autistic children to fill out an ATEC on each child at ARI’s Non-Autistic Control Group web site.

Also, practitioners and researchers concerned with various interventions for autism are particularly invited to take advantage of the ATEC. As there are a great many treatment methods used to help autistic children, but very few tests, scales, or other outcome measures that can be used to evaluate the efficacy of these treatments, the Autism Treatment Evaluation Checklist could be a very useful tool for those who specialize in a specific area, such as:

Benefits of the Data Collected by the ATEC

The primary benefits of the data collected by the Autism Treatment Evaluation Checklist will be to scientifically evaluate the effectiveness of many therapies, both traditional and new, being used to treat autism. Not only will the ATEC provide valuable and previously unobtainable direct research information on these treatments, it will also inspire additional research into modalities that – by the results obtained – show a promise of efficacy.

The end result is that parents, teachers and caregivers of autistic children, adolescents and adults will soon have much better, more complete and reliable information on what treatments actually work, and how well they work. This will, we hope, inevitably lead to an improvement in the quality of life for those with autism spectrum disorders.

Because of the large database, researchers and practitioners of specific treatment focuses will also be able to evaluate the effectiveness of their programs, not only in general, but also with specific populations or sub-groups. The immediate on-line feedback of the ATEC scoring system may also help these professionals fine-tune or improve certain treatment programs, and possibly to know – by way of the ATEC’s subtests – what aspects of their patient’s difficulties are being affected by the therapy.

As mentioned earlier, although the Autism Treatment Evaluation Checklist (ATEC) is designed to evaluate the effectiveness of various treatments for autistic individuals, it may also prove useful for other purposes. One such possible purpose is diagnosis.

Because of the ease of use of this free service, and the simple Internet scoring procedure that automatically calculates subscale scores and a summary score from the ATEC, which are weighted according to the response and the corresponding subscale, parents, teachers, caregivers, practitioners and researchers will receive immediate assessment of the impairment of their subjects. The higher the subscale and total scores, the more impaired the subject.

It is also a possibility that other beneficial treatments that have not yet been evaluated or developed – perhaps because of a lack of funding or difficulty in conducting research – may be brought to light and further studied because of the accessibility of this valuable tool.

 

 

Practicalities, Policies and Provisions of this Research Tool

Unlike most scales, the Autism Treatment Evaluation Checklist (ATEC) is not copyrighted and may be used free of charge by any researcher. Paper copies or printable forms in PDF format are available on request from the Autism Research Institute or at the Autism Treatment Evaluation Checklist (ATEC) Website.

Users of the ATEC may have it scored free (4 subscores and a total score) by entering the responses via computer to the ATEC Online Scoring Form, for immediate and free-of-cost scoring.

The ATEC subscale and summary scores will be displayed immediately after you input each checklist. A copy of the data will also be sent to the ARI’s database to help develop norms. Information regarding the identity of each person will be kept confidential. If you wish, you can input an identification number for each person rather than entering his/her name, and/or use a code name rather than entering the intervention.

ARI recently completed a statistical analyses of the ATEC. Reliabilities and score distributions based on the first 1358 initial (baseline) ATEC forms submitted to the Autism Research Institute by mail, fax or via the Internet are available to the public. The purpose of the ATEC is to measure change in an individual due to various interventions – that is – the difference between the initial (baseline) ATEC scores and later ATEC scores. Nevertheless, the Autism Research Institute is often asked for normative data, which permit comparison of one individual with others. Please see Statistical Analyses: May 7, 2000 – Reliabilities and Score Distributions for this data.

Parents can enter their responses into the ATEC database/scoring system on their own home computer and thus receive instant feedback on their child’s progress; or if they do not have a computer, they could give the ATECs to their practitioners for data entry. Using the online form, you can have these results emailed to as many as three people and/or organizations, such as your child’s clinician using a Defeat Autism Now! approach, ABA therapist, speech therapist, etc.

At the end of the year (or whatever period you choose), the Autism Research Institute would be happy to provide your research or practitioner group with the data on all of the cases that were entered using the code name your group selected, whether the ATEC data were entered by the parent at home or by personnel at your office. You and/or your group could analyze the data in terms of the total score, subtest scores, or even at the item level, for any or all of the 77 items comprising the ATEC.

Results of research using the ATEC will appear in future issues of the ARRI (only with the express permission of the researchers who use ATEC, of course). As of December 2005, The Autism Research Institute had examined the internal consistency of the ATEC by conducting a split-half reliability test on over 1,300 completed ATECs. The internal consistency reliability was high (.94 for the Total score). At that time there were three published studies which had shown the ATEC to be sensitive to changes as a result of a treatment:

 

  • Autism Research Institute
    4182 Adams Avenue
    San Diego, CA 92116
    ARI Autism Resource Call Center: 866-366-3361
    Fax: 619-563-6840
 

The Autism Research Institute (ARI) is the hub of a worldwide network of parents and professionals concerned with autism. ARI was founded in 1967 to conduct and foster scientific research designed to improve the methods of diagnosing, treating, and preventing autism. ARI also disseminates research findings to parents and others worldwide seeking help. The ARI data bank, the world’s largest, contains over 40,000 detailed case histories of autistic children from over 60 countries.

ARI publishes the Autism Research Review International, a quarterly newsletter covering biomedical and educational advances in autism research. ARI is a non-profit organization which depends upon charitable contributions from concerned individuals and organizations for its support.

The founder of ARI, Bernard Rimland, Ph.D., was an internationally recognized authority on autism and the father of an autistic son. Dr. Rimland wrote the prize-winning book Infantile Autism: The Syndrome and its Implications for a Neural Theory of Behavior, and was the founder of the Autism Society of America. He served as chief technical advisor on the film Rain Man and earned many awards for his work during his lifetime.

 

Other Autism Rating Scales

Childhood Autism Rating Scale (CARS)

The Childhood Autism Rating Scale (CARS) is the most widely used standardized instrument specifically designed to aid in the diagnosis of autism for use with children as young as 2 years of age. Published in 1980 (Schopler et al., 1980), the CARS was originally correlated to the DSM-III and then to the DSM-III-R. The CARS is intended to be a direct observational tool used by a trained clinician. It takes about 20-30 minutes to administer. The 15 items of the CARS include: Relationships with People, Imitation, Affect, Use of Body, Relation to Non-human Objects, Adaptation to Environmental Change, Visual Responsiveness, Auditory Responsiveness, Near Receptor Responsiveness, Anxiety Reaction, Verbal Communication, Nonverbal Communication, Activity Level, Intellectual Functioning, and the clinician’s general impression.

Recommendations

  1. The CARS may be useful as part of the assessment of children with possible autism in a variety of settings: early intervention programs, preschool developmental programs, and developmental diagnostic centers.
  2. Among the autism assessment instruments reviewed, the CARS appears to possess an acceptable combination of practicality and research support, despite the limited research on its use in children under 3 years of age.
  3. Because it gives a symptom severity rating, the CARS may be useful for periodic monitoring of children with autism and for assessing long-term outcomes.
  4. It is very important that professionals using the CARS have experience in assessing children with autism and have adequate training in administering and interpreting the CARS.
  5. An autism assessment instrument that is practical, is supported by research, and includes a severity rating (such as the CARS) may be useful for collecting consistent information to assist with estimating the prevalence of autism and assess functional outcomes (especially if tied to other information about interventions and service delivery).

Gilliam Autism Rating Scale (GARS)

GARS-2, a revision of the popular Gilliam Autism Rating Scale, assists teachers, parents, and clinicians in identifying and diagnosing autism in individuals ages 3 through 22. It also helps estimate the severity of the child’s disorder. Items on the GARS-2 are based on the definitions of autism adopted by the Autism Society of America and the Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition-Text Revision (DSM-IV-TR).

The instrument consists of 42 clearly stated items describing the characteristic behaviors of persons with autism. The items are grouped into three subscales:

  • Stereotyped Behaviors
  • Communication
  • Social Interaction

Using objective, frequency-based ratings, the entire scale can be completed and scored in 5 to 10 minutes. A structured interview form is included for gathering diagnostically important information from the child’s parents.

GARS-2 was normed on a representative sample of 1,107 persons with autism from 48 states within the United States. GARS-2 has strong psychometric characteristics that were confirmed through studies of the test’s reliability and validity. Coefficients of reliability (internal consistency and test-retest) for the subscales and entire test are all large to very large in magnitude. The validity of GARS-2 was demonstrated by confirming that: (a) the items of the subscales are representative of the characteristics of autism; (b) the subscales are strongly related to each other and to performance of other tests that screen for autism; and (c) GARS-2 standard scores discriminate persons with autism from persons with other severe behavioral disorders, such as persons with mental retardation and multi-disabilities.

GARS-2 has been improved in the following ways:

  • A structured parent interview form replaces the Early Development subscale, providing examiners with diagnostically significant information about the child’s development during early childhood.
  • Some items were rewritten for clarity or to remove ambiguity.
  • Demographic characteristics of the normative sample are keyed to 2000 U.S. census data.
  • All new norms were created and the normative sample is more clearly described.
  • The total score on GARS-2 was changed from Autism Quotient to Autism Index.
  • Guidelines for interpreting subscale scores and the Autism Index were changed.
  • A separate chapter is provided in the test manual providing multiple discreet target behaviors for each item on GARS-2. The discreet behaviors are operationally defined and specific examples are given for applied research projects and other research purposes.
  • A separate booklet, Instructional Objectives for Children Who Have Autism, is included in the test kit to assist in the formulation of instructional goals and objectives based on GARS-2 results. In this way, instruction can be directly related to assessment results from GARS-2.

Autism Behavior Checklist (ABC)

The Autism Behavior Checklist (ABC) is a list of questions about a child’s behaviors. The ABC was published in 1980 (Krug et al., 1980) and is part of a broader tool, the Autism Screening Instrument for Educational Planning (ASIEP) (Krug et al., 1978). The ABC is designed to be completed independently by a parent or a teacher familiar with the child who then returns it to a trained professional for scoring and interpretation. Although it is primarily designed to identify children with autism within a population of school-age children with severe disabilities, the ABC has been used with children as young as 3 years of age.

The ABC has 57 questions divided into five categories:

  1. sensory
  2. relating
  3. body and object use
  4. language
  5. social and self-help

Recommendations:

  • The ABC appears to have limited usefulness in identifying children with autism who are under the age of 3.
  • When used in conjunction with other diagnostic instruments and methods, the ABC may have some usefulness as a symptom inventory to be completed by parents or teachers. Clinicians could utilize this inventory in structuring their evaluation.

 

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CLINIC FOR CHILDREN

Yudhasmara Foundation

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646

http://childrenclinic.wordpress.com/

 

 

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

email : judarwanto@gmail.com

 

 

 

 

 

 

 

Copyright © 2009, Clinic For Children Information Education Network. All rights reserved.

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