Informant Discrepancies in the Assessment of ASD Symptoms of High-Functioning Children with ASD Using the SRS-2

Background: Presentation of ASD characteristics can vary across contexts and in the presence of different raters. Rating scales used to assess such behavior across settings by multiple raters (e.g., parents and teachers) may reflect these influences, potentially complicating assessment, treatment planning and evaluation. The Social Responsiveness Scale (2^nd Edition, SRS-2) is a rating scale designed to assess ASD-related symptoms including social-communication deficits and circumscribed and repetitive behaviors and interests. To date, parent-teacher discrepancies on this scale have not been comprehensively examined.

Objectives: The current study was conducted to comprehensively investigate discrepancies between parent and teacher ratings on the SRS-2 for children with HFASD.

Methods: Participants. Two informant groups (parents and teachers) provided 240 ratings of ASD-related symptoms on the SRS-2; child inclusion criteria – short-form IQ factor score >70; receptive or expressive language score ≥ 80; and score meeting ASD criteria on ADI-R.  Outcome Measure. Parent and staff ratings – Social Responsiveness Scale, 2^nd edition (SRS-2; assesses ASD features).  Procedures. Parent and teacher raters completed the SRS-2 as part of a battery of pretest (baseline) measures. Each child was rated by one parent and one teacher. Rating forms were checked, scored and entered by independent research assistants. Data analyses included (a) sample means vs. estimated population means, (b) parent vs. teacher means, (c) classification accuracy of parent and teacher scores, (d) inter-rater agreement and consistency (ICCs, Pearson correlations, Bland-Altman plot, and regression), (e) examination of potential moderators of parent-teacher discrepancies.

Results: Both parent and teacher SRS-2 Total ratings were significantly higher than population means with large effect sizes (t(119) = 24.77, p < .001, d = 2.47; (t(119) = 21.30, p < .001, d = 2.07), respectively). Parents rated significantly higher than teachers for the SRS Total and four of five treatment subscales (d =.25-.37). Parent-teacher agreement was higher for the moderate and severe clinical severity categories. The parent-teacher reliability was low-to-moderate (ICC =.22 - .47, r =.13 -.33). The Bland-Altman plot of Total scores shows no systematic trend across difference scores and means. No significant moderators (age, IQ, language scores) were found.

Conclusions: Both informant groups provided ratings of elevated ASD symptoms for children, with significantly higher scores reported by parents than teachers. Differences appeared to be systematic, consistent across the range of scores, and not moderated by the child, parent, or teacher variables examined. Systematic informant discrepancies affect screening outcomes, diagnostic determinations and outcome assessments. Screening may be most effective when viewing any elevated parent or teacher score as potentially important. Diagnostic determinations and response to treatment uses may be more greatly affected. Evaluators should seek additional information from raters when substantial discrepancies are observed in order to help determine reasons for disagreement (e.g., understanding of items, perceptions of symptoms, true variability of symptoms across settings). Evaluators might benefit from considering different thresholds for each informant group when considering a diagnosis. Treatment providers should consider targeting different symptoms across settings if actual differences in behaviors and symptoms across settings are indicated.