Evaluating the Social Abilities of Children with Autism Spectrum Disorders and Complex Communication Needs

Background: It has been well recognized that non-verbal children with Autism Spectrum Disorders (ASD) are underrepresented in the research literature, especially when considering social interaction abilities. Recently, an expert panel convened by NIH highlighted the need for research in this population and recommended the development of creative solutions for assessment of non-verbal school-aged children with ASD that could be used for descriptive information and to measure outcomes for research participants. Domains recommended for consideration included joint attention skills and social impairment severity.

 Objectives: To measure these outcomes systematically, an assessment battery was created which includes the Social Responsiveness Scale (SRS) and a novel behavior assessment, the Standardized Joint Attention Assessment (SJAA), which measures initiation of joint attention (IJA) abilities. The SJAA was designed to measure IJA bids that are made by participants purely for social engagement. Participants who are viewed as being more socially capable by their teachers and caregivers should evidence higher rates and more complex IJA bids during the SJAA.

 Methods: Eleven non-verbal (defined as fewer than 10 functional words) children with ASD between the ages of 8 and 15 were enrolled in this study. Parents and teachers of the participants completed the SRS. The participants received the SJAA, which includes a series of 15 second clips from highly preferred videos activated at regular intervals from different sources. This provides opportunities for the child to initiate the sharing of his or her attention with a confederate social partner. The confederate social partner does not reference the stimulus unless the participant makes an IJA bid and modifies their response to the participant such that there is opportunity for 2 potential IJA bids per clip.

 Each participant’s SJAA was videotaped; the complexity of IJA bids was coded on a 4 point scale.  Each participant received a first bid and a second bid score which is created by summing the complexity coding of any first bids and any second bids offered. This number is divided by 16, the total number of possible clips, creating IJA proficiency rates.

 Results: Factors of interest for data analysis included SRS scores and IJA proficiency rates. The teacher-report total SRS score negatively correlated for first bid scores (r=-.64, p<.05) and second bid scores (r=-.65, p<.05). Additionally there were negative correlations between second bid scores and the social awareness (r=-.68, p<.05) and social motivation (r=-.61, p<.05) subscales of the SRS. The parent-report SRS scores did not correlate with SJAA scores.

 Conclusions: The SJAA offers a systematic means of measuring IJA proficiency in non-verbal school-aged children with ASD. This assessment is novel in that any offered IJA bids by participants are for engagement with a social partner and not dependent on expressive language abilities. The scoring algorithm quantifies social proficiency in a clinical population that is difficult to characterize and is in dire need of assessment strategies with clinical relevance.  SJAA bid scores negatively correlating with teacher-report SRS scores but not with parent-report SRS scores points to the difficulty of assessing social capabilities in this population.