Psychometric properties of the mock interview rating scale for autistic transition-age youth

Background

Employment is a major contributor to quality of life. However, autistic people are often unemployed and underemployed. One potential barrier to employment is the job interview. However, the availability of psychometrically-evaluated assessments of job interviewing skills is limited for autism services providers and researchers.

Objective

We analyzed the psychometric properties of the Mock Interview Rating Scale that was adapted for research with autistic transition-age youth (A-MIRS; a comprehensive assessment of video-recorded job interview role-play scenarios using anchor-based ratings for 14 scripted job scenarios).

Methods

Eighty-five transition-age youth with autism completed one of two randomized controlled trials to test the effectiveness of two interventions focused on job interview skills. All participants completed a single job interview role-play at pre-test that was scored by raters using the A-MIRS. We analyzed the structure of the A-MIRS using classical test theory, which involved conducting both exploratory and confirmatory factor analyzes, Rasch model analysis and calibration techniques. We then assessed internal consistency, inter-rater reliability, and test-retest reliability. Pearson correlations were used to assess the A-MIRS' construct, convergent, divergent, criterion, and predictive validities by comparing it to demographic, clinical, cognitive, work history measures, and employment outcomes.

Results

Results revealed an 11-item unidimensional construct with strong internal consistency, inter-rater reliability, and test-retest reliability. Construct [pragmatic social skills (r = 0.61, p < 0.001), self-reported interview skills (r = 0.34, p = 0.001)], divergent [e.g., age (r = -0.13, p = 0.26), race (r = 0.02, p = 0.87)], and predictive validities [competitive employment (r = 0.31, p = 0.03)] received initial support via study correlations, while convergent [e.g., intrinsic motivation (r = 0.32, p = 0.007), job interview anxiety (r = -0.19, p = 0.08)] and criterion [e.g., prior employment (r = 0.22, p = 0.046), current employment (r = 0.21, p = 0.054)] validities were limited.

Conclusion

The psychometric properties of the 11-item A-MIRS ranged from strong-to-acceptable, indicating it may have utility as a reliable and valid method for assessing the job interview skills of autistic transition-age youth.

Key competencies of students with autism spectrum disorders: Perspectives of Chinese teachers and parents

Well-defined key competencies for students with autism spectrum disorders (ASD) help develop curriculum and pedagogies that emphasize what students with ASD are expected to learn, to know and to do. Most of the current research on the key competencies of ASD is theoretical and based on the social and cultural backgrounds of western countries. The key competencies defined by most of the research lack of the support of empirical evidence. This study sought to identify the key competencies of school-age students with ASD from the perspectives of teachers and parents. Based on the review of existing key competencies frameworks, a key competencies instrument that consisted of 76 learning outcome items in eight domain areas was developed. An online survey to explore the teachers' and parents' views of the key competencies was conducted with 1,618 teachers and 2,430 parents of students with ASD across China. The results showed that teachers believed that the key competencies should consist of eight domain areas including social-communication, learning skills, healthy living, play, motor, emotion, sensory processing, and cognition, while the cognition related competencies were not recognized by parents. The competencies in social-communication, learning skills, healthy living had higher variance contribution. From the perspective of teachers, the variance contribution of social communication was the highest, while from the perspective of parents, the variance contribution of learning skills was the largest. Taken together, the key competencies framework for students with ASD should include eight dimensions and 75 learning outcome items. The similarities and differences between the perspectives of the two group were discussed. The findings could provide empirical data to assist in developing educational guidelines and guide the development of models of support for students with ASD.

The Development of an Escape Room-Based Serious Game to Trigger Social Interaction and Communication Between High-Functioning Children With Autism and Their Peers: Iterative Design Approach

BACKGROUND

Children with autism spectrum disorder (ASD) have social deficits that affect social interactions, communication, and relationships with peers. Many existing interventions focus mainly on improving social skills in clinical settings. In addition to the direct instruction-based programs, activity-based programs could be of added value, especially to bridge the relational gap between children with ASD and their peers.

OBJECTIVE

The aim of this study is to describe an iterative design process for the development of an escape room-based serious game as a boundary object. The purpose of the serious game is to facilitate direct communication between high-functioning children with ASD and their peers, for the development of social skills on the one hand and strengthening relationships with peers through a fun and engaging activity on the other hand.

METHODS

This study is structured around the Design Research Framework to develop an escape room through an iterative-incremental process. With a pool of 37 children, including 23 children diagnosed with ASD (5 girls) and 14 children (7 girls) attending special primary education for other additional needs, 4 testing sessions around different prototypes were conducted. The beta prototype was subsequently reviewed by experts (n=12). During the design research process, we examined in small steps whether the developed prototypes are feasible and whether they have the potential to achieve the formulated goals of different stakeholders.

RESULTS

By testing various prototypes, several insights were found and used to improve the design. Insights were gained in finding a fitting and appealing theme for the children, composing the content, and addressing different constraints in applying the goals from the children's and therapeutic perspectives. Eventually, a multiplayer virtual escape room, AScapeD, was developed. Three children can play the serious game in the same room on tablets. The first test shows that the game enacts equal cooperation and communication among the children.

CONCLUSIONS

This paper presents an iterative design process for AScapeD. AScapeD enacts equal cooperation and communication in a playful way between children with ASD and their peers. The conceptual structure of an escape room contributes to the natural emergence of communication and cooperation. The iterative design process has been beneficial for finding a constructive game structure to address all formulated goals, and it contributed to the design of a serious game as a boundary object that mediates the various objectives of different stakeholders. We present 5 lessons learned from the design process. The developed prototype is feasible and has the potential to achieve the goals of the serious game.

Pragmatic and Conversational Features of Arabic-Speaking Adolescents With Autism Spectrum Disorder: Examining Performance and Caregivers' Perceptions

Purpose This study investigates the features of pragmatic and conversational skills in the language of Arabic-speaking adolescents with autism spectrum disorder (ASD) by comparing them with typically developing (TD) Arabic-speaking adolescents in Saudi Arabia. It aims to identify the differences in the pragmatic skills of the two groups and the perception of those skills by caregivers, with respect to four main pragmatic areas: discourse management, communicative function, conversational repair, and presupposition abilities. Method Data for this study were collected from 15 Saudi adolescents with ASD and a control group of 15 TD adolescents, matched for gender and language abilities. All the participants were in the normal IQ range. The caregivers of the adolescents with ASD and TD adolescents also participated in this study. Data were collected on the adolescents' performances using the Yale in vivo Pragmatic Protocol. In addition, the Pragmatics Profile of Everyday Communication Skills (PPECS) was used to collect data on the caregivers' perceptions of the adolescents' abilities. The combination of tools in this study allows for a unique comparison between actual performance and caregivers' perceptions. Results As expected, both the adolescents' performances and the caregivers' perceptions reflected an overall deficit in the pragmatic and conversational skills of adolescents with ASD. However, we also identified an inconsistency between the caregivers' estimation of the participant's pragmatic abilities and the actual abilities demonstrated by the adolescents. In particular, TD adolescents performed significantly better than adolescents with ASD in the pragmatic areas of turn-taking, topic maintenance, and topic initiation, but the caregivers did not detect differences between the two groups in these discourse management abilities. Conclusions This study has important implications for both ASD interventions and assessment. It provides a comprehensive assessment approach for measuring pragmatic skills, including both direct (participants' performances) and indirect (caregivers' perceptions) measures. Future research may benefit from adopting the combined approach used in this study to explore pragmatics in ASD. Differences between caregivers' perceptions and the performances of individuals with ASD should be considered, as well as the influence of various factors on their communication.

Design of a Digital Comic Creator (It's Me) to Facilitate Social Skills Training for Children With Autism Spectrum Disorder: Design Research Approach

BACKGROUND

Children with autism spectrum disorder (ASD) often face difficulties in social situations and are often lagging in terms of social skills. Many interventions designed for children with ASD emphasize improving social skills. Although many interventions demonstrate that targeted social skills can be improved in clinical settings, developed social skills are not necessarily applied in children's daily lives at school, sometimes because classmates continue to show negative bias toward children with ASD. Children with ASD do not blame the difficult social situations they encounter on their lack of social skills; their main goal is to be accepted by peers.

OBJECTIVE

This study aims to design a comic creator-It's me-that would create comics to serve as transformational boundary objects to facilitate and enact a horizontal interaction structure between high-functioning children with ASD and their peers, aiming to increase mutual understanding between children at school.

METHODS

This research project and this study are structured around the Design Research Framework in order to develop the comic through an iterative-incremental process. Three test sessions, which included 13, 6, and 47 children, respectively, were initiated where the focus shifted in time from usability during the first two tests to the initial assessment of acceptance and feasibility in the third session. A stakeholder review, which included six experts, took place after the second test session.

RESULTS

A digital comic creator, It's me, was produced within this study. Children can create their own personal comic by filling in a digital questionnaire. Based on concepts of peer support, psychoeducation, and horizontal interaction, It's me has a rigorous base of underlying concepts that have been translated into design. Based on the first test sessions, the comic has shown its potential to initiate personal conversations between children. Teachers are convinced that It's me can be of added value in their classrooms.

CONCLUSIONS

It's me aims to initiate more in-depth conversations between peers, which should lead to more mutual understanding and better relationships between children with ASD and their peers. The first test sessions showed that It's me has the potential to enact horizontal interaction and greater understanding among peers. It's me was designed as a boundary object, aiming to connect the objectives of different stakeholders, and to trigger reflection and transformation learning mechanisms. The applied design research approach might be of added value in the acceptance and adoption of the intervention because children, professionals, and teachers see added value in the tool, each from their own perspectives.

Brain structure and internalizing and externalizing behavior in typically developing children and adolescents

Mental health problems often emerge in adolescence and are associated with reduced gray matter thickness or volume in the prefrontal cortex (PFC) and limbic system and reduced fractional anisotropy (FA) and increased mean diffusivity (MD) of white matter linking these regions. However, few studies have investigated whether internalizing and externalizing behavior are associated with brain structure in children and adolescents without mental health disorders, which is important for understanding the progression of symptoms. 67 T1-weighted and diffusion tensor imaging datasets were obtained from 48 typically developing participants aged 6-16 years (37M/30F; 19 participants had two visits). Volume was calculated in the prefrontal and limbic structures, and diffusion parameters were assessed in limbic white matter. Linear mixed effects models were used to compute associations between brain structure and internalizing and externalizing behavior, assessed using the Behavioral Assessment System for Children (BASC-2) Parent Rating Scale. Internalizing behavior was positively associated with MD of the bilateral cingulum. Gender interactions were found in the cingulum, with stronger positive relationships between MD and internalizing behavior in females. Externalizing behavior was negatively associated with FA of the left cingulum, and the left uncinate fasciculus showed an age-behavior interaction. No relationships between behavior and brain volumes survived multiple comparison correction. These results show altered limbic white matter FA and MD related to sub-clinical internalizing and externalizing behavior and further our understanding of neurological markers that may underlie risk for future mental health disorders.

The therapeutic alliance in cognitive-behavioral therapy for school-aged children with autism and clinical anxiety

Little is known about the alliance between therapists and children with autism spectrum disorder who are receiving psychological therapies in outpatient treatment settings. This study examined the therapeutic alliance in children with autism spectrum disorder and clinical anxiety, who were receiving cognitive behavioral therapy in a randomized, controlled trial. The Therapeutic Alliance Scale for Children was administered to a sample of children and youth with autism spectrum disorder and anxiety ( N = 64; aged 7–14) as well as to their parents and therapists. A comparison sample of typically developing youth with clinical anxiety ( N = 36; aged 5–12) was included. The child-therapist alliance was more positive among typically developing children than among children with autism spectrum disorder; correspondingly, the parent-therapist alliance was also more positive among parents of typically developing children. Therapist reports of positive child-therapist alliance predicted post-treatment reductions in anxiety among children with autism spectrum disorder, although child reports of this alliance did not. Parent reports of positive parent-therapist alliance also predicted post-treatment reductions in the child’s anxiety in the group with autism spectrum disorder. A strong therapeutic alliance appears to be associated with better treatment outcomes in children with autism spectrum disorder receiving cognitive behavioral therapy, although a thoughtful and diagnostically sensitive approach is advisable to promote a positive alliance with children with autism spectrum disorder.

Depression, Anxiety, and Hyperactivity in Youth with HFASD: A Replication and Extension of Symptom Level Differences in Self-Report Versus Parent Report

The present study compared parent ratings to self-report ratings of depression, anxiety, hyperactivity, attention problems, and atypical behaviors in youth with high-functioning autism spectrum disorder (HFASD) and typically developing (TD) controls. Measures included parent and self-report forms from the Behavioral Assessment System for Children-Second Edition (BASC-2), and self-report forms from the Children's Depression Inventory (CDI) and the Multidimensional Anxiety Scale for Children (MASC). Results across all five BASC-2 scales indicated parent ratings for the HFASD condition were significantly higher than HFASD self-ratings, and were significantly higher than parent and self-ratings from the TD condition. In addition, average self-report scores did not differ significantly between HFASD and TD conditions on any of the BASC-2 scales, the CDI, or the MASC.

Parent and Teacher Concordance of Child Outcomes for Youth with Autism Spectrum Disorder

Cross-informant ratings of are considered gold standard for child behavioral assessment. To date, little work has examined informant ratings of adaptive functioning for youth with autism spectrum disorder (ASD). In a large, diverse sample of youth with ASD, this study evaluated parent-teacher concordance of ratings of adaptive functioning and ASD-specific symptomatology across time. The impact of child clinical characteristics on concordance was also examined. Participants included 246 children, their caregivers and teachers. Parent-teacher concordance was variable but generally consistent across time. Concordance was significantly impacted by autism severity and child cognitive abilities. Findings inform the broader concordance literature and support the need to consider child clinical factors when assessing child functioning in samples of children with ASD.

Understanding the Self in Individuals with Autism Spectrum Disorders (ASD): A Review of Literature

When the system of self is explored in individuals with Autism Spectrum Disorders (ASDs), it is important to measure it via both their own perceptions of the self and their understanding of others' perceptions on themselves at a multidimensional level. This paper reviews existing research in this area using a three-dimension approach. Researchers have found that impairments in the self-system are usually correlated with these individuals' social and cognitive functioning levels: high functioning individuals with ASD who have higher IQ are found to have better awareness of their limitations in social and communication domains than those with lower IQ. Many researchers believe that there are impairments in the psychological (but not physical) self in individuals with ASD, such as theory of mind deficits due to social and communicative impairments. On the other hand, some researchers argue that individuals with ASD have selective rather than global impairments in the self. In other words, the impairment usually lies in a specific aspect of functioning in individuals with ASD. Insights from the review of existing literature on this topic may be able to shed some lights on the development of effective intervention programs to improve social communication deficits in this population.

Quality of life of high-functioning children and youth with autism spectrum disorder and typically developing peers: Self- and proxy-reports

Studies have shown parents to report lower quality of life for their children with autism spectrum disorder than children's self-report scores and the same applies for data on typically developing children. Our objectives were to: (1) explore how high-functioning children with autism spectrum disorder rate their quality of life compared with paired controls without autism spectrum disorder; (2) explore how parents of high-functioning children with autism spectrum disorder rate their children's quality of life compared with parents of paired controls; and (3) compare child self-reports of quality of life with their parent's proxy-reports for both groups of children. Data were collected with the Icelandic self- and proxy-reported versions of the KIDSCREEN-27. Reports of 96 children with autism spectrum disorder, 211 controls and their parents were included in the analyses. Compared with controls, children with autism spectrum disorder had lower means on all quality of life dimensions. Parents of children with autism spectrum disorder evaluated their children's quality of life lower on all dimensions than did parents of controls. On four out of five dimensions, children with autism spectrum disorder reported better quality of life than did their parents. Despite differences in ratings children with autism spectrum disorder and their parents agreed on the most problematic dimensions, namely, social support and peers and physical well-being. Our results highlight the importance of seeking the viewpoints of both children and their parents.

Services for Children With Autism Spectrum Disorders

Recommendations for improving school and community-based services for children with autism spectrum disorders (ASD) in the state of Virginia were investigated. Participants consisted of 783 parents of children birth to age 22 with a medical diagnosis of ASD. Data obtained through an open-ended survey question were analyzed both quantitatively and qualitatively. Parents recommended improving the quality, quantity, accessibility, and availability of services; educating and training individuals to work effectively with children with ASD; increasing funding for services; and creating appropriate school placements and educational programs. The findings from this study suggest the need for increased individualization of and accessibility to services. Future state-level research must examine the variables that affect parent recommendations and evaluate the quality of existing services for children with ASD.

Brief Report of Preliminary Outcomes of an Emotion Regulation Intervention for Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) often present with comorbid psychopathology including problems with emotion regulation. The goal of the present research was to investigate the feasibility of a multicomponent manualized cognitive behavior therapy treatment program for improving emotion regulation in youth with ASD 8-12 years of age. Thirteen males and their parents participated in the intervention, reporting high satisfaction with the activities and program overall, and attending all sessions. Preliminary outcomes regarding emotion regulation and psychopathology, and feasibility of the intervention, are summarized and discussed.

Informant agreement for youth with autism spectrum disorder or intellectual disability: a meta-analysis

This study investigated informant agreement on emotional and behavior problems and social skills in youth with autism spectrum disorder or intellectual disability using meta-analytic methods. Forty-nine studies were included, consisting of 107 effect sizes. The mean weighted effect size across all raters and all behaviors was .36, reflecting moderate agreement. Consistent with meta-analyses in typically developing youth, pairs of similar informants (e.g., parent-parent) demonstrated higher agreement compared to pairs of different raters (e.g., parent-teacher). With all rater pairs combined, agreement was significantly higher for externalizing problems (r = .42) than either internalizing problems (r = .35) or social skills (r = .30). Several factors appear to moderate the level of agreement among informants, including the youth's diagnosis, age, and IQ.

Cognitive, adaptive, and psychosocial differences between high ability youth with and without autism spectrum disorder

Research on Autism Spectrum Disorder (ASD) is thriving; however, scant empirical research has investigated how ASD manifests in high ability youth. Further research is necessary to accurately differentiate high ability students with ASD from those without the disorder, and thus decrease the risk of misdiagnosis. The purpose of the present study is to provide an empirical account of the intellectual, adaptive, and psychosocial functioning of high ability youth with and without ASD utilizing a group study design. Forty youth with high cognitive ability and ASD and a control group of 41 youth with high cognitive ability and no psychological diagnosis were included in the study. In comparison to the control group, the ASD group showed poorer functioning on measures of processing speed, adaptive skills, and broad psychological functioning, as perceived by parents and teachers. These findings have significant implications for diagnosing ASD among those with high ability, and the development of related psychological and educational interventions to address talent domains and areas of concern.

Parent, teacher, and self perceptions of psychosocial functioning in intellectually gifted children and adolescents with autism spectrum disorder

Parent, teacher, and self-perceptions of 54 high ability students with autism spectrum disorder (ASD) were assessed through administration of the Behavioral Assessment Scales for Children, Second Edition. Parent reports resulted in clinically elevated scores on the Atypicality, Attention Problems, Depression, Hyperactivity, Withdrawal, Activities of Daily Living, Adaptability, and Social Skills subscales, and teacher reports resulted in clinically elevated scores on the Atypicality, Depression, Withdrawal, and Adaptability subscales. Self-report scores were in the average range. Parents and teachers of adolescents reported greater adaptability and fewer symptoms of atypicality than parents and teachers of children. Psychosocial functioning appears impacted in high ability students with ASD and developmental differences in severity may exist.

Behavioral forms of stress management for individuals with Asperger syndrome

Although many children and youth with AS exhibit anxiety that may lead to challenging behaviors, stress and subsequent behaviors should be viewed as an integral part of the disorder [36]. As such, it is important to understand the cycle of behaviors to prevent seemingly minor events from escalating. Although understanding the cycle of tantrums, rage, and meltdowns is important, behavior changes will not occur unless the function of the behavior is understood and the student is provided instruction and support in using (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming. Because little research exists on the cycle of behaviors exhibited by students with AS and interventions appropriate at each stage, a systematic program of research is required to identify which techniques are most appropriate for children and youth, the context in which they can be used, and methods to ensure that individuals with AS generalize these skills to home, school, and community.