Download The Vineland ABS and The Vineland II

Profiles of Adaptive
Functioning: Autism Spectrum
Disorders, Mental Retardation,
and Beyond.
California Association of School
Psychologists
February 17, 2005
8:30-10:15
Sara S. Sparrow, PhD
Yale Child Study Center
How I Discovered
Adaptive Behavior
Speech Pathology
Psychology
Doman-Delacato
Measurement Dilemmas
4 AREAS FOR TODAY
• NEW FEATURE OF THE VINELAND II
• CHANGES IN THE PURPOSES OF
ADAPTIVE BEHAVIOR
ASSESSMENTS
• RECENT RESEARCH ON EFFECTS
OF INTERVENTION WITH PERSONS
WTH HIGH FUNCTIONING ASD
• CLINICAL APPLICATIONS AND
ADAPTIVE PROFILES
Adaptive Behavior Assessment
Working our way back:
30 years since Pl 94-142 (1975)
16 years earlier AAMD (1959)
24 years earlier Edgar Doll published
The Vineland Social Maturity Scale
(1935)
Purpose
Diagnosis of Mental Retardation
Things Have Changed
More and more assessing adaptive
behavior has had broader applications
One reason is that different research has
demonstrated that there appear to be
different profiles for various diagnostic
groups
USES OF ADAPTIVE
BEHAVIOR ASSESSMENTS
– Confirming or establishing diagnosis
– Special services qualification
– Program planning
– Progress reporting/tracking
– Identifying changes over time
USES, conintued
–
–
–
–
–
–
Mental Retardation
Early Childhood Special Education
Autism Spectrum Disorders
Traumatic Brain Injury
Adult Mental Problems
As a measure to support the diagnosis of other
disabilities
– Death Penalty Cases and
– Many others
A word about Death penalty
cases:
Atkins versus Virginia.
Psychologists will be increasingly asked
to provide testimony in these cases,
mainly regarding adaptive functioning
A Virginia court just ruled that Atkins did
not meet criteria for a diagnosis of
mental retardation
2005
Supreme Court rules that
individuals with (chronological)
age under 18 years cannot be
executed.
What about mental age?
THUS
• Implications for the development of the
Vineland II
Introducing the VinelandII
VINELAND-II Overview
• Because clinicians have different needs
when it comes to assessing adaptive
behavior, we now offer four forms:
--Survey Interview Form
– NEW Parent/Caregiver Rating Form
– Teacher Rating Form
– Expanded Interview Form
MAJOR NEW FEATURES
•
•
•
•
•
•
•
•
•
Ages: Birth to 90 years of age
New Norms
Increase Item density at floor and ceiling
Extensive investigation and elimination of
item bias
Increase items relevant to ASD and young
children
Eliminate outdated items
Increase Items reflecting our society’s
technological advances
Subdomain standard scores
New Maladaptive
Other New Features
• Parent Caregiver Forms
• Teacher report Form –
– Daily Living Skills
• Personal Subdomain
• Academic Subdomain
• School-Community Subdomain
Validity Evidence: 11 Clinical Groups
• Attention Deficit/Hyperactivity Disorder
• Autism – nonverbal
• Autism – verbal
• Learning Disability
• Mental Retardation – Mild (child)
• Mental Retardation – Moderate (child)
• Mental Retardation – Mild (adult)
• Mental Retardation – Moderate (adult)
• Emotional Disturbance
• Visual Impairment
• Hearing Impairment
Validity Evidence: Criterion
• Vineland Adaptive Behavior Scales
• Adaptive Behavior Assessment
System (ABAS)
• WISC III
• WAIS-III
• BASC-2
SUBDOMAIN
V-SCALED SCORES
Mean = 15
SD = 3
VINELAND II
NEW MALADAPTIVE
DOMAIN
STILL BOTH
MINOR AND MAJOR
MALADAPTIVE
FACTOR ANALYTIC STUDIES
REVEALED
THREE FACTORS
Internalizing Items
•
•
•
•
•
•
•
•
•
•
•
Is overly dependent
Avoids others and prefers to be alone
Has eating difficulties
Has sleep difficulties
Refuses to go to work or school because of
fear, feelings of rejection, or isolation
Is overly anxious or nervous
Cries or laughs too easily
Has poor eye contact
Is sad for no clear reason
Avoids social interaction
Lacks energy or interest in life
Externalizing Items
• Is impulsive
• Has temper tantrums
• Intentionally disobeys or defies those in
authority
• Taunts, teases, or bullies
• Is inconsiderate or insensitive of others
• Lies, cheats, or steals
• Is physically aggressive
• Is stubborn or sullen
• Says embarrassing things or asks embarrassing
questions in public
• Behaves inappropriately at the urging of others
Group Maladaptive Differences
EBD
Mean
All
21.4
Int
6.4
EX
8.6
Other
6.4
V Imp
Mean
6.1
2.4
1.7
1.9
HI Imp
Mean
5.6
1.4
2.2
1.9
ADHD
Mean
14.6
3.4
5.8
5.4
AutismNonverbal
Mean
21.3
8.9
4.8
7.7
Autism-Verbal
Mean
14.9
5.5
4.3
5.1
Maladaptive Behavior by Age
for Individuals with MR
School-aged children with MR (all levels)
had maladaptive means significantly
higher than age matched clinical
groups but < 1SD difference.
Adults (19-90) with MR (all levels) had
maladaptive means significantly higher
than age matched clinical groups AND
school aged groups with MR
Maladaptive Behaviors by
Age for Individuals with MR
Differences were greatest in the adult
severe-profound group
Only Internalizing behaviors fell into the
“elevated range” (the highest level) for
this group
Adaptive Functioning of
Mental Retardation Groups
For all levels and ages, mean levels of all
domains and the adaptive behavior
composite were at least 2SD below the
mean
100
ABC Std. Score
85
70
55
40
25
Mild
Moderate
MR (6 - 18)
Severe
Mild
Moderate
MR (Adult)
Severe
Verbal
Nonverbal
Autism
ADHD
EBD
High Incidence
LD
Visual
Hearing
Sensory Impairment
Severe
Moderate
Mild
Mean Subdomain Scores
15
14
13
Mild MR
Autism
12
v-scale
11
10
9
8
7
6
Receptive
Expressive
Written
Personal
Domestic
Community
Interpersonal Play Leisure
Coping
Mean Subdomain Scores
15
14
13
Autism
Mod MR
12
v-scale
11
10
9
8
7
6
Receptive
Expressive
Written
Personal
Domestic
Community
Interpersonal
Play Leisure
Coping
Validity Evidence: Mental Retardation
Ages >18
Ages 6-18
MR: Mild
6-18
N-45
MR:
Mod
6-17
N=31
MR: S/P
6-18
N=36
MR: Mild
19-69
N-34
MR: Mod
19-50
N=33
MR: S/P
26-86
N=20
Adaptive
Behavior
Composite
66.3
61.1
41.5
49.9
33.6
20.4
Communication
68.5
60.9
41.4
41.4
27.7
21.2
Daily Living
Skills
66.6
61.9
41.5
56.8
40.1
23.4
68.5
64.3
45.0
56.4
40.7
20.0
Vineland-II
Socialization
Mean scores by age group and level
Mild, Moderate, Severe to Profound
Validity Evidence:
Autism, ADHD, EBD, LD
Vineland-II
Autism
Verbal
3-16
N=46
Adaptive
Behavior
Composite
65.7
50.7 94.1 85.7 95.3
Communication
68.4
47.0 92.4 87.2 91.2
Daily Living
Skills
67.8
52.5 99.5 92.2 98.4
Socializatio
n
64.4
51.0 94.2 82.4 98.3
Motor
(Ages 3-6
only)
81.2
67.4
Autism
Nonverba
l
3-16
N=31
ADHD
6-18
N=55
EBD
8-17
N=34
LD
7-17
N=56
Mean scores by age group and disability
Validity Evidence:
Visual Impairments, Hearing Impairments
Vineland-II
Adaptive
Behavior
Composite
Communication
Daily Living Skills
Socialization
Visual Impairments
6-18
N=36
Hearing
Impairments 6-18
N=58
86.8
90.1
95.6
89.2
82.6
89.7
87.4
95.8
Mean scores by age group and disability
Clinical Group Summary
Vineland-II differentiates clinical groups
from nonclinical groups.
• Documented significant deficits for MR
groups (at least 2 SDs below mean)
• Demonstrated expected mean score changes
for mild, moderate, and severe to profound
levels of mental retardation
• Differentiated between Verbal and Nonverbal
Autism groups
• Demonstrated distinctive profile patterns
Validity Evidence: Criterion
• Vineland Adaptive Behavior Scales
• Adaptive Behavior Assessment
System (ABAS)
• WISC III
• WAIS-III
• BASC-2
Vineland-II and Vineland ABS
High degree of
consistency
between forms
Age Ages Ages
s 0-2 3-6
7-18
N=25
N=29
N=70
Adaptive Behavior
Composite
.87
.94
.89
Communication
.69
.76
.89
.96
.89
.91
Socialization
.89
.95
.71
Motor
.93
.90
Daily Living
Skills
Correlations corrected for restriction of range
IMPORTANT
THERE APPEARS TO BE NO FLYNN
EFFECT
Vineland-II and WISC-III and WAIS-III
Documents the
distinct difference
between IQ and
Adaptive Behavior.
Confirms the need
to assess both
when making
diagnostic
decisions.
WISC-III WAIS-III
FSIQ
FSIQ
6-16
17-68
N=28
N=83
Adaptive Behavior
Composite
.12
.20
Communication
.36
.25
.30
.06
-.39
.27
Daily Living
Skills
Socialization
Correlations corrected for restriction of range
Vineland-II and Behavior
Assessment System for Children,
2nd Edition (BASC-2)
Ages 6-11
Correlations corrected for restriction of range
Conclusions
• Much is the same but much is better!
Manual
Criteria
Case studies
Summer 2006
• Teacher checklist
Winter 2006
• Expanded Form
Adaptive Profiles from
Research Studies
Since 1984 over 1400 studies have been
published investigating adaptive functioning
in the following groups:
Mental retardation
Autism Spectrum
Closed Head Injury
Hearing Impaired
Homeless
HIV
Learning disability
Gifted
Emotionally Disturbed
Spina Bifida
Tourette Syndrome
Conduct Disorder
Cocain Exposed
Low Birthweight
Children exposed to Violence ETC.!
Groups with Mental Retardation
Non Specific MR
All levels of MR
Genetic Forms of MR
Fragile X
Down Syndrome
Praeder Willi
William Syndrome
Special Olympics
Groups on the Autism Spectrum
PDD NOS
Asperger Syndrome
High functioning Autism
Low functioning Autism
Multiplex
Nonverbal Learning Disability (?)
Atypical and Normally Developing
Children
Sparrow, S.S. Rescorla, L.A., Provence, S.,
Condon, S.O., Goudreau, D., Cicchetti, D.V.,
(1986). Follow-up of “atypical” children
Journal of American Academy of Child
Psychiatry. 25, 2:181-185.
Atypical and Normally
Developing
Children
Group
AGE
FIQ
VIQ
PIQ
Atypical
Development 10.1
110
111
108
Normally
Developing
112
111
112
10.4
PDDnos (Atypical) and Non
(Atypical) PDDnos
DOMAIN
Communication
PDDnos
Standard
Score
87
NonPDDnos
Standard
Score
102*
Daily Living
80
89*
Socialization
*significant
74
98*
Social Deficits In Autism
Volkmar, F.R., Sparrow, S.S., Goudreau, D., Cicchetti,
D.V., Paul, R., Cohen, D.J., (1987) Social deficits in
autism: An operational approach using the Vineland
Adaptive Behavior Scales. Journal of the American
Academy of Child and Adolescent Psychiatry. 26,
2:156-161.
AUTISM
• Carter,A. S., Volkmar,F. R., Sparrow,S. S.,
Wang,J. J., Lord,C., Dawson,G.,
Fombonne,E., Loveland,K., Mesibov,G.,
Schopler,E., (1998),The Vineland Adaptive
Behavior Scales - Supplementary Norms
for Individuals with Autism, Journal of
Autism & Developmental Disorders, 28:4,
pp. 287-302.
AUTISM AND ASPERGER
Dissanayake,Cheryl, Macintosh,Kathleen,
(2003), Mind reading and social functioning
in children with autistic disorder and
Asperger's disorder. Pp 213-239
Individual differences in theory of mind:
Implications for typical and atypical
development. Repacholi,Betty,
Slaughter,Virginia (Editors), Macquarie
Monographs in Cognitive Science,
Psychology Press, New York, NY.
Subject Characteristics
Age and IQ matched children with mental
retardation without and with autism
Mean age 11.8
Mean IQ 54
Vineland scores were so low we had to
use age equivalents/mental age ratios
Thus, if Adaptive Behavior was
consistent with MA, Score should be
near 100.
SOCIAL DEFICITS IN AUTISM
DOMAIN
AUTISTIC
NONAUTISTIC
ABDomain/MA ABDomain/MA
Communication
66
81*
Daily Living
97
95
Socialization
*significant
39
70*
SOCIAL DEFICITS IN AUTISM
Communication
SUBDOMAIN
Receptive
AUTISTIC
Age
Equivalent
3.2
NONAUTISTIC
Age
Equivalent
3.5*
Expressive
2.9
4.4*
Written
*significant
4.4
5.1
SOCIAL DEFICITS IN AUTISM
Socialization
SUBDOMAIN
Interpersonal
AUTISTIC
Age
Equivalent
1.6
NONAUTISTIC
Age
Equivalent
3.5*
Play and Leisure
2.5
3.6*
Coping
*significant
2.7
4.4*
Other Populations
Precocious readers (not hyperlexic)
IQs: 121 to 122
Ages: 3-2 to 4-9
Asperger and high functioning autism
Special Thanks
• Ami Klin
• Fred R. Volkmar
• Celine Saulnier
• Kathy Lord
• Domenic V. Cicchetti
•All the participating families from the Yale
Child Study Center and the Autism and
Communication Disorders Center at the
University of Michigan
• NICHD grant 5-PO1-HD03008
Recent Research in ASD
• Autism symptoms have a severe
impact on a person’s ability to meet
the demands of everyday life
• Extreme variability in
symptomatology and cognitive ability
affects daily functioning
• “Higher-functioning” individuals,
despite potential, fail to translate
their skills to real-life adaptation
Outcome in ASD
• Increasing focus on early diagnosis &
intensive intervention = progress
• Still enormous variability in outcome
– 12% achieving “very good outcome”
– 60% with “poor” or “very poor outcome” (Howlin,
Goode, Hutton, & Rutter, 2004)
• Cognitive & language measures
• Does higher cognitive ability = greater
outcome in adulthood???
• Translating potential into real-life skills
becomes critical – Adaptive Behavior
Adaptive Functioning in Autism
• “Real-life” Skills
• Vineland Adaptive Behavior Scales
(Sparrow, Balla, & Cicchetti, 1984)
– Communication
Daily Living Skills
– Socialization Motor
• Communication & Socialization skills =
central & defining features
• Deficits in adaptive skills fall below
cognitive ability across the spectrum
– Significant deficits in socialization
– Intermediate deficits in communication
(Bolte & Pustka, 2002; Carter et al., 1998)
Adaptive Communication
Adaptive Social Skills
Relationship between
IQ and Adaptive Functioning
• Consistent findings:
– Adaptive impairments exist beyond MR
– No entitlement for services without MR
• Inconsistent findings:
(Freeman, Del’Homme, Guthrie, & Zhang, 1999; Liss et
al., 2001; Schatz & Hamden-Allen, 1995; Szatmari,
Bryson, Boyle, Streiner, & Duku, 2003)
– Positive relationship
• e.g., Vineland Communication & VIQ
• Early language and nonverbal IQ predicting
outcome for both comm. & socialization skills
– Negative relationship
Relationship between
Age and Adaptive Functioning
•Equally unclear relationship:
– Stable relationship
(e.g., Schatz & Hamden-Allen, 1995)
– Increase in AF w/ age
(e.g. Freeman et al., 1999)
– Decrease in AF w/ age
(e.g. Szatmari et al., 2003)
Autism Symptomatology
• Varying measures to assess severity of
autism symptoms
–Autism Behavior Checklist
–Childhood Autism Rating Scale
–Autism Diagnostic Observation Schedule
• Other factors (e.g., adaptive behavior and
language) appear to be stronger predictors
of outcome than severity of symptoms
• Very little research on relationship between
symptomatology and adaptive behavior
Many Unanswered Questions
• Cognitive potential may or may not play a
role in positive outcomes
• Severity of autism symptoms may or may
not play a role in positive outcomes
• Early detection and intensive intervention
are beneficial to some, but not all,
individuals on the spectrum
• “Real-life” skills are important for outcome
– adaptive communication & social skills
Present Study
• Examines relationship between
adaptive behavior (ability) and
severity of symptoms (disability)
– Vineland Adaptive Behavior Scales
– Autism Diagnostic Observation Schedule
• Investigates nature of ability &
disability in relation to:
– Age
– IQ
– Diagnostic Classification
Participants
Total Sample
• 187 males with a diagnosis of an ASD
• Diagnosis based on ADI, ADOS, & clinical
judgment of 2 licensed clinicians
• Verbal IQ > 70
• Age range from 7 to 18 years
Yale Site
• N = 84
– Autism=32; Asperger’s=35; PDD-NOS=17
Michigan Site
• N = 103
– Autism=31; Asperger’s=1; PDD-NOS=66
Measures
• Autism Diagnostic Observation
Schedule
(Lord, Rutter, DiLavore, & Risi, 1999)
• Vineland Adaptive Behavior Scales
(Sparrow, Balla, & Cicchetti, 1984)
• Intelligence Scales
– Yale: Wechsler scales: WISC-III, WAIS-R
(The Psychological Corporation)
– Michigan: Mix of Wechsler scales,
Differential Ability Scales, & Stanford-Binet
Characterization by Site
Yale(n=84)
Mean
(SD)
Age
Michigan(n=103)Mean
(SD)
12.4
(2.9)
10.0
(2.4)
99.8
104.7
94.5
(20.6)
(21.3)
(19.7)
99.0 (17.1)
101.2 (18.3)
98.5 (18.9)
72.2
52.0
(17.1)
(11.5)
83.5
67.0
(20.0)
(15.4)
4.0
9.5
(1.5)
(2.6)
3.2
6.5
(1.7)
(3.0)
IQ
Full Scale
Verbal
Performance
Vineland*
Communication
Socialization
ADOS**
Communication
Social
Note. ADOS Commun. scores range 0-8 & Social scores 0-14
*For Vineland scores, higher numbers indicate greater ability
**For ADOS scores, higher numbers indicate greater disability
Real-life (adaptive functioning) in higher
functioning individuals with autism and
PDDs
• N=187
• Autism, AS, and PDD-NOS
• Socialization (Vineland): Mean 52 Yale
(SD 12.6)
• Interpersonal Age Equivalent: Yale
Mean 3.6 years (SD 1.7 years)
From Klin, Saulnier, Sparrow, Cicchetti, Lord & Volkmar (submitted)
Real-life (adaptive functioning) in higher
functioning individuals with autism and
PDDs
• Social ability and disability: two relatively
dissociated domains (correlation)!!!!!!!
• Social disability is not correlated with age (stable)
• Social ability is negatively correlated with age
(decline relative to peers, relative to increasing
demands of the environment)
• Most programs emphasize reduction of symptoms
• Conclusion: all programs should prioritize
adaptive functioning (REAL-LIFE SKILLS)
From Klin, Saulnier, Sparrow, Cicchetti, & Volkmar (submitted)
High Functioning ASD
Prototypical Comparative
Profiles
Based on our work and those of many
others
These are group data and some affected
individuals may not demonstrate the
prototypical profiles
ASPERGER AND AUTISM
• Szatmari,Peter; Archer,Lynda;
Fisman,Sandra; Streiner,David L.
(1995), Asperger's syndrome and
autism: Differences in behavior,
cognition, and adaptive
functioningJournal of the American
Academy of Child & Adolescent
Psychiatry, Dec. 34:12, pp.1662-1671.
ASPERGER AND AUTISM
Klin, A., Volkmar, F.R., Sparrow, S.S.,
Cicchetti, D.V., and Rourke, B.P.
(1995). Validity and Neuropsychological
Characterization of Asperger
Syndrome. Journal of Child Psychology
and Psychiatry. 36:1127-1140.
High Functioning Autism and
Asperger
DIAGNOSIS:
DOMAIN:
HIGH
FUNCTIONING
AUTISM
ASPERGER
FIQ
VCI
Same
Lower
Same
Higher
PRI
Communication
Higher
Lower
Lower
Higher
Daily Living
Similar
Similar
Socialization
Motor
Similar
Higher
Similar
Lower
ADHD
Roizen,N. J., Blondis,T. A., Irwin,M.,
Stein,M.(1994) Adaptive functioning in
children with attention-deficit
hyperactivity disorder, Archives of
Pediatrics & Adolescent Medicine
Nov,148:11, pp 1137-1142.
ADHD, ADD
• Stein,Mark A., Szumowski,Emily,
Blondis,Thomas A. (1995) Adaptive
skills dysfunction in ADD and ADHD
children, The Journal of Child
Psychology and Psychiatry and Allied
Disciplines, May, pp.36, 663-670.
Cognitive and Adaptive Profiles
of Normally developing
children and ADHD
DOMAIN
I.Q.
DIAGNOSIS
NORMAL
Same
ADHD
Same
Communication Higher
Lower
Daily Living
Higher
Lower
Socialization
Higher
Lower
Motor
Similar
Similar
DOWN-SYNDROME
Dykens,E. M.,Hodapp,R. M., Evans,D. W.(1994)
Profiles and Development of Adaptive Behavior
in Children with Down-Syndrome,
American Journal of Mental Retardation,
March, 98:5, pp. 580- 587
Cognitive and Adaptive Profiles
of
Nonspecific MR and Down
syndrome
DOMAIN
I.Q.
Communication
Daily Living
Socialization
Motor
DIAGNOSIS
NON DOWN
SPECIFIC SYNDROME
MR
Same
Same
Higher
Lower
Similar
Similar
Lower
Higher
Higher
Lower
DOWN-SYNDROME
Burack,J. A.; Shulman,C.; Katzir,E.; Schaap,T.;
Brennan,J. M.; Iarocci,G.; Wilansky,P.;
Amir,N.(1999) Cognitive and behavioural
development of Israeli males with fragile X and
Down Syndrome International Journal of
Behavioral Development, JUNE, 23:2, pp. 519-531
• Cicchetti,Domenic V., Sparrow,Sara
S.(1990)Assessment of adaptive
behavior in young children, pp173-196,
Johnson,James H., Goldman,
Jacquelin, Developmental assessment
in clinical child psychology: A
handbook. Pergamon general
psychology series, 163 Pergamon
Press, Inc, Elmsford, NY.
Cognitive and Adaptive Profiles of Normal
Development and Hearing Impaired
DOMAIN
DIAGNOSIS
NORMAL
HEARING
IMPAIRED
I.Q.
Same
Same
Communication
Higher
Lower
Daily Living
Similar
Similar
Socialization
Higher
Lower
Motor
Similar
Similar
Cognitive and Adaptive Profiles of Prototypical
Autism and Mental Retardation
DOMAIN:
DIAGNOSIS:
AUTISM
MENTAL
RETARDATION
I.Q.
Same
Same
Communication
Lower
Higher
Daily Living
Similar
Similar
Socialization
Lower
Higher
Motor
Higher
Lower
Conclusions
Assessment of Adaptive functioning is
important for individuals within any
diagnostic category
Determining how everyday life (adaptive
functioning) is affected by nature or nurture
(or both) should be our goal
Research and clinical work has shown us how
different profiles are found in different
groups
Aside:(Program planning and assessment of
change after intervention are other goals of
adaptive behavior assessment)