Caregiver and Teacher Correspondence on Ratings of Problem Behaviors for Children with Autism Spectrum Disorder Receiving Community Mental Health Care

Background:  Children with autism spectrum disorder (ASD) are served in multiple service settings (Brookman-Frazee et al., 2009), and have significant psychiatric comorbidity, particularly with disruptive behavior disorders (Simonoff et al., 2009). Multi-informant assessment of behavior problems is important to inform appropriately tailored treatment for children with ASD. Informant agreement is weak to moderate for behavior problems in children with ASD (Stratis et al., 2015). Factors shown to impact caregiver-teacher agreement broadly include educational setting and child clinical and sociodemographic characteristics (Berg-Nielsen et al., 2012; Pearson et al., 2012).

 Objectives: This study: 1) examined the correspondence between the severity of caregiver and teacher ratings of problem behaviors in a sample of school-aged children with ASD receiving community mental health (MH) services, and 2) identified child characteristics associated with informant correspondence.

 Methods: Data were drawn from baseline assessments of an ongoing randomized community effectiveness trial of AIM HI (“An Individualized Mental Health Intervention for ASD”), a clinical intervention targeting challenging behaviors in children with ASD conducted in community and school-based MH settings. This sample included 138 children (M = 9.05 years; 79% male) with existing ASD diagnoses, their primary caregivers, and teachers. Caregiver report of behavior problems was obtained using the Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999), which includes 36 items rated on a 7-point Intensity Scale that is converted into a t-score. Teacher report of behavior problems was obtained using the Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R; Eyberg & Pincus, 1999). Overall agreement between caregiver and teacher ECBI/SESBI-R Intensity scores was calculated first through the intraclass correlation coefficient (ICC). Intensity t-scores were then dichotomized into clinically significant versus non-clinically significant. Agreement was calculated using the kappa statistic followed by the McNemar test to compare the proportion of children whose problem behaviors were rated as clinically significant. Follow-up logistic regression analyses were conducted with child age, gender, ethnicity, ASD severity (as measured by the comparison score from the ADOS-2, Lord & Rutter, 2002), educational placement, and diagnostic comorbidity (as measured by an adapted MINI-KID, Sheehan et al., 1998) as predictors of agreement.

 Results: Informant agreement on the severity of problem behaviors was poor, overall, as shown by the ICC of 0.16 on the ECBI/SESBI Intensity Scale. Poor agreement remained when examining clinically significant levels of problem behaviors, κ =.19, which falls below standards for fair agreement (κ = 0.4; Cohen, 1960). The proportion of caregiver ratings (62%) was significantly higher than the proportion of clinically significant teacher ratings (40%) (p < .001). Regression analyses indicated that older child age was associated with less agreement (OR = 0.79, p < .05) while greater number of non-ASD psychiatric disorders (OR = 1.31, p < .05) was associated with greater agreement.

 Conclusions: Caregiver-teacher agreement of problem behaviors was poor in this sample of children with ASD receiving community MH services. Child age and degree of psychiatric comorbidity were associated with informant agreement of clinically significant problem behaviors. Findings have implications for optimally using multi-informant assessment to tailor MH care for children with ASD.