Collateral Reports of ASD Symptoms in Adults: A Preliminary Comparison of Caregiver and Clinician Ratings

Background:  ASD symptoms and psychiatric comorbidities in adults with ASD are notoriously difficult to assess. Recently, versions of the Social Responsiveness Scale, Second Edition (SRS 2) have been normed on adults. The general consensus in assessment is to obtain collateral information from other informants when possible in order to increase the validity of the assessment. However, little is known about the agreement between other-reports of ASD symptoms in adults with ASD on available assessment tools.

Objectives:  To explore agreement between self-, caregiver-, and clinician-report of ASD symptoms in adults with ASD.

Methods:  Fourteen adults with ASD completed a baseline assessment for a larger project examining the effectiveness of an assessment monitoring system for participants enrolled in the Adult Community Autism Program (ACAP) a state-funded program for adults with ASD. 79% were Caucasian and 93% were male. The mean number of years of education was 12.86 (SD = 1.88) and 43% reported being employed. For all individuals who reported living at home, a parent residing in the household completed the SRS 2; for all individuals who reported living alone, a support staff employed by ACAP who had been working with the participant for at least six months completed the SRS 2.

Results:  Participants who lived with at least one parent and had a parent as collateral raters did not differ from participants who lived alone and had ACAP staff as collateral raters on years of education (F = 1.33, ns), employment status (50% were employed for wages and the remaining 50% were either unemployed or a student in each group), or race (each group was 86% Caucasian). Only one female was in the entire sample and she reported living alone and therefore had an ACAP staff as a reporter. In regards to ASD symptoms, the self-report of the two groups did not differ on any subscale. Parents rated social cognition symptoms (F = 1.10, ns) and restricted and repetitive behaviors (F = 2.09, ns) higher than clinicians, while clinicians rated social communication symptoms (F = 1.31, ns) as higher. At this time, these were only at trend level significance due to a lack of power. However, by February, 2017 a total of 60 individuals will have enrolled in this pilot project. The preliminary data presented within this submission will be re-run on the full dataset by May, 2017 and it is fully expected that there will be significant differences between parents and clinicians on ratings of ASD symptoms at that time.

Conclusions: The SRS 2 demonstrated a trend toward significant differences between collateral ratings of symptoms of ASD in adults enrolled in a state-funded program for adults with ASD. Caregivers of young adults with ASD rated their children higher on the SRS 2 in terms of social cognitions and restricted and repetitive behaviors than clinicians, while clinicians rated their clients higher on the SRS 2 on social communication in comparison to parents. This suggests that importance of exploring potential differences between patterns of ratings of adults’ symptoms of ASD depending on the rater.