Reliabilities and Validities of the Chinese Mandarin Version of the Social Communication Questionnaire (SCQ) From a Population-Based Study in Taiwan

Background: Many people live with ASD without being diagnosed.  Such under-diagnosis is especially prominent for underserved populations.  While providing clinical assessments to each individual in a population is not practical, multi-stage case identification that involves screening followed by clinical evaluation is a feasible way to identify ASD, especially for populations without complete autism or autism-related services registries.  Screeners that aim to identify individuals at high risk for ASD are vital for multi-stage case identification.  The SCQ rates autism-related behaviors and was used as a screener to identify children at high risk for ASD.  The SCQ was developed and widely used for studies in Western countries.  In order to adapt the tool for use in international settings outside of Western countries required provision of its strong reliabilities and validities. 

Objectives: To establish reliabilities and validities of the Chinese Mandarin Version of the SCQ, and to present distributions of the SCQ total score and three sub-domain scores by child sex and SES factors. 

Methods: A population-based epidemiologic study of autism in children aged 6-8 involving a multi-stage case identification design was conducted in PingTung, Taiwan from 2008-2010.  The SCQ was translated and back-translated into traditional Chinese Mandarin and pilot tested before its use in this population.  Data from a total of 2279 primary caregivers (60.0% mothers, 17.5% fathers, 22.5% grandparents and others) who completed the screener on their child (1083 boys and 1156 girls) are included in this analysis.  The three sub-domains of SCQ are: Reciprocal Social Interaction, Communication, and Restricted/ Repetitive/ Stereotyped Behaviors.  Reliability was assessed using Cronbach’s alpha (internal consistency).  Factor analyses in full sample, and sample with total score >=15 (a high risk for ASD) were performed separately to assess the difference in SCQ-measured behaviors in full sample and in ASD high-risk sample. 

Results: The reliability alphas are 0.67, 0.80, 0.81, and 0.83 for Communication, Reciprocal Social Interaction, Restricted/ Repetitive/ Stereotyped Behaviors, and full scale, respectively.  Factors of SCQ measured behaviors are different for the full sample and the ASD high-risk sample (i.e. SCQ>=15).

Conclusions: Overall, the internal consistency (measured by alpha) of the SCQ full scale and three domains are good, but the Communication domain is fair.  Results from the factor analyses reveal different factors in the sub-sample with high ASD risk (SCQ>=15) and in the full sample. The mean scores of the caregiver reported autism-related behaviors in boys are higher than in girls when the SCQ scores are examined as continuous; however, the difference is not substantial.  Caregiver reported autism-related behaviors are associated with respondents’ characteristics in this large scale population-based study in Taiwan.  Fathers reported more behavioral issues in their child than did mothers and other caregivers; and lower education levels were associated with reports of clinically concerning autism-related behaviors.