Conceptual Coverage of Vineland Adaptive Behavior Scales, Second Edition (Vineland™-II): Concept Mapping to a Patient-Centered Conceptual Model of Autism Spectrum Disorder (ASD)

Background:

As new treatments for autism spectrum disorder (ASD) are developed, it is necessary that clinical outcome assessment (COA) measures used to measure treatment efficacy are both valid and reliable. To this end, health authorities recommend that COAs are evaluated for selection based on their content, specifically that instrument content should be aligned with a conceptual model of a disease or disorder.

The Vineland^TM-II, a measure of adaptive behavior from birth to adulthood, was recommended by a recent Autism Speaks expert panel as an appropriate measure of social communication deficits in ASD. The instrument is considered to have strong psychometric properties and high clinical relevance. However, to date, no study has critically evaluated the conceptual coverage of the instrument to an ASD-specific conceptual model.

Objectives:

The objective of this research was to evaluate the conceptual coverage of the Vineland^TM-II by mapping its content to a recently developed conceptual model of high functioning ASD.

Methods:

Items of the Vineland^TM-II Socialization, Communication and Daily Living Skills domains were mapped to a newly developed conceptual model of high functioning autism. The conceptual model (in press) was developed through an iterative process incorporating a review of qualitative literature and DSM-V Diagnostic Criteria, in-depth interviews with high functioning autistic individuals and their caregivers, and expert review. The conceptual model presents a visual summary of relevant symptom concepts, as well as the wider humanistic impacts and burden of ASD.

Results:

Concept mapping demonstrated that the Receptive, Expressive and Written sub-domains of the Vineland^TM-II Communication domain align closely with the core communication deficits of ASD included in the conceptual model. Moreover, Interpersonal Relationships, Play and Leisure Time and Coping Skills sub-domains of the Vineland^TM-II Socialization domain address concepts related to core socialization deficits. As expected, the Vineland^TM-II did not cover repetitive and restrictive behaviors. Concept mapping also showed that the Daily Living Skills sub-domains (Personal, Community and Domestic) of the Vineland^TM-II captures impairments in activities of daily living, identified as one of the most detrimental impacts of ASD. In addition, the Vineland^TM-II addresses some distal symptom concepts, namely cognitive functioning (for example, short-term memory and ability to follow instructions).

Conclusions:

Mapping of items of the Vineland^TM-II to a newly developed patient-centered conceptual model of ASD demonstrates that the Vineland^TM-II provides a comprehensive assessment of social communication deficits associated with ASD. Moreover, the mapping exercise demonstrates that the Vineland^TM-II also assess important concepts related to the broader impacts of ASD. These findings provide additional support that the Vineland^TM-II is a valid measure of social communication deficits for clinical trials in ASD.