Investigating the Construct Validity of the Social Communication Schedule for Young Children with Severe Visual Impairment 'at Risk' of ASD: Relations with the Child Behaviour Checklist

Background:

Children with congenital profound or severe visual impairment (VI) are at high risk of ASD and social communication difficulties. Studies report a much higher prevalence of ASD in children with VI (~30%) compared to rates in the sighted population (Jure et al., 2016). Socio-communicative difficulties in children with VI become evident from around 2 years of age (Dale & Sonksen, 2002). Existing tools used to measure early socio-communicative development are highly vision-dependent and not valid for children with VI. We developed the Social Communication Schedule (SCS) to examine social-communicative difficulties in 2-year-olds with VI. SCS is based on the Visual Impairment and Social Communication Schedule (VISS - Absoud et al., 2010), which had preliminary validation with children with VI and was highly reliable in predicting a later diagnosis of ASD. The SCS was developed further to include standard behavioural items and social ‘presses’ to elicit social and communicative behaviours that allow for reliable behavioural coding. We also developed the Negative Behavioural Screener (NBS) to examine ASD related difficulties including repetitive behaviours. To begin to establish construct validity parents completed the Children’s Behavior Checklist (CBCL 1.5 – 5 years), a standardized parental questionnaire which measures behavioural difficulties and problems in preschool children. It includes the subscale PDP (Pervasive Developmental Problems) which has consistently provided predictive relations with existing ASD screening tools (Muratori et al., 2011; Sikora, et al, 2008).

Objectives:

To examine the construct validity of the SCS and NBS at 2 and 3 years of age by cross-sectional and longitudinal comparisons to the CBCL PDP subscale.

Methods:

Preliminary data from 50 children at 2 years (M=26.10, SD=2.30) and 39 at 3 years (M=38.28, SD=2.91), with ‘simple’ congenital disorders of the peripheral visual system from the longitudinal OPTIMUM project (Dale et al.) were rated using the SCS (high scores indicated better social communicative abilities) and a negative behaviour screener (NBS – higher scores indicated more negative behaviours), whilst engaging in social and independent play tasks. Parents rated the CBCL when children were 2 and 3 years of age and the PDP subscale was extracted for analyses.

Results:

Strong negative relations between SCS scores and NBS scores (ρ =-.73, p<.001), suggested that children who scored higher on socio-communicative abilities on SCS had lower negative behaviour scores on NBS. At 2 years of age, a negative correlation was found between PDP and SCS (ρ =-.45, p<.01) and a positive correlation between PDP and NBS (ρ =.37, p<.01). Similar patterns were found at 3 years on the same scales (ρ =-.41, p<.01, ρ =.48, p<.01). Children with lower SCS scores and higher NBS scores were rated higher on PDP by parents at both time points.

Conclusions:

The SCS, which is newly developed for young children with VI, and NBS showed moderate relations with the CBCL PDP subscale at 2 and 3 years. Findings suggest that this ‘early stage’ tool may provide a useful means of differentiating behaviours, which may be early signs of autism.