Objectives: To explore relationships between non-ASD-specific child characteristics and scores on the Social Responsiveness Scale (SRS; Constantino & Gruber, 2005), a widely used parent-completed ASD screening questionnaire, in a sample of children with non-ASD diagnoses.
Methods: Participants were 161 children with non-ASD diagnoses recruited for a research study. Clinicians blind to previous diagnoses made clinical diagnoses based on information from comprehensive assessments for ASD including questionnaires, the ADI-R, Vineland-II, ADOS and cognitive testing. Diagnoses were grouped into: Intellectual Disability, Anxiety Disorders, ADHD, Language Disorders and Other. Using these clinician diagnoses as the “gold standard,” specificity for the overall sample and individual diagnostic groups was calculated for T-score (60 or 76) and raw score (65 for females/70 for males or 85 for both) cut-offs recommended by the SRS authors for use in different settings. T-Tests were used to compare characteristics of children who did and did not meet cut-offs. Logistic regression was used to determine best predictors of meeting SRS cut-offs; binary predictors grouping children according to common divisions of standard scores (below average/average; borderline to clinical range of concern/normal) were used to compute odds ratios.
Results: Overall specificity ranged from 29-70%. Specificity was lowest when using the ASD cut-off (raw score=65/70) recommended for general population screening and for groups with Intellectual Disability, ADHD, or Other diagnoses. Children meeting cut-offs had more impaired social and expressive communication skills on the Vineland-II, more behavior problems on the Child Behavior Checklist, and lower IQ (p<.001) than children who did not meet cut-offs. For children with Internalizing or Externalizing scores in the borderline/clinical range, the odds of meeting the cut-off was 5.46 and 3.52 times the odds of children in the “normal” range. Post-hoc analyses indicated that scores in the borderline/clinical range on the Anxious-Depressed, Withdrawn-Depressed, Attention Problems, or Syndrome Scale significantly predicted meeting the ASD cut-off on the SRS (odds ratios of 5.53, 4.64 and 3.58, respectively).
Conclusions: Consistent with previous reports in ASD samples, non-ASD-specific characteristics, particularly behavior problems, have considerable effects on SRS scores in non-ASD samples and reduce specificity of this screening instrument. Clinicians and researchers should exercise caution when using the SRS as a screening instrument in populations of children with elevated emotional and behavioral difficulties. Results will be further discussed for different diagnostic groups and from the perspective of using the SRS as a dimensional measure of ASD-related symptoms or social-communication impairments.
See more of: Clinical Phenotype
See more of: Symptoms, Diagnosis & Phenotype