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A Review of Assessments For Determining The Content of Early Intensive
A Review of Assessments For Determining The Content of Early Intensive
Review
A R T I C L E I N F O A B S T R A C T
Article history: A large proportion of national education and treatment centers for persons with autism
Received 14 January 2011 spectrum disorders (ASD), including those providing applied behavior analysis (ABA)-
Accepted 15 January 2011 based services, show a relatively high percentage of agreement among practitioners on the
Available online 22 February 2011 instruments they routinely use for a variety of purposes, including curriculum design and
treatment evaluation. In this paper, several assessments are reviewed and evaluated in
Keywords: terms of their utility for designing comprehensive early intensive behavioral intervention
Autism (EIBI) curriculum programs for children with ASD. The assessments found to be most
Assessment
useful for this purpose are reported. A general critique regarding the available pool of
Curriculum
assessment tools is provided and the need for a comprehensive assessment directly linked
Early intensive behavioral intervention
to curricula is discussed.
ß 2011 Elsevier Ltd. All rights reserved.
Contents
1750-9467/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.rasd.2011.01.012
E. Gould et al. / Research in Autism Spectrum Disorders 5 (2011) 990–1002 991
3.4.4. Pragmatics Profile of Everyday Communication Skills in Children Revised Edition . . . . . . . . . . . . . . . . . . . 995
3.4.5. Preschool Language Scale-Fourth Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 996
3.4.6. Reynell Developmental Language Scales [U.S. Edition] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 996
3.4.7. Test of Language Development-Primary: Fourth Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 996
3.4.8. Test of Pragmatic Language-Second Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 996
3.4.9. Verbal Behavior Milestones Assessment and Placement Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 996
3.5. Daily living skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 996
3.5.1. Scales of Independent Behavior-Revised . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 996
3.5.2. Vineland Adaptive Behavior Scales-Second Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 996
3.6. Play skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
3.6.1. Symbolic Play Test-Second Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
3.7. Academics/achievement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
3.7.1. Brigance Diagnostic Comprehensive Inventory of Basic Skills-Revised . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
3.7.2. Peabody Individual Achievement Test-Revised . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
3.7.3. Wide Range Achievement Test Fourth Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
3.7.4. Woodcock–Johnson III Normative Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
3.8. Intelligence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
3.8.1. Wechsler Intelligence Scale for Children-Fourth Edition Integrated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
3.8.2. Wechsler Preschool and Primary Scale of Intelligence-Third Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998
4. Critical analysis of existing assessments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998
4.1.1. VB-MAPP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998
4.1.2. Brigance IED-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998
4.1.3. VABS-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998
4.1.4. CIBS-R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 999
4.2. Concerns with existing assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 999
5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 999
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1000
A substantial amount of research supports early intensive behavioral intervention (EIBI) for the treatment of children
with autism spectrum disorders (ASD). Studies examining the outcomes of EIBI have demonstrated significant
improvements in intellectual, language, and adaptive functioning (Cohen, Amerine-Dickens, & Smith, 2006; Eikeseth,
Smith, Jahr, & Eldevik, 2007; Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Remington et al., 2007), as well as
significant improvement on diagnostic measures of core ASD symptoms (Sallows & Graupner, 2005; Zachor, Ben-Itzchak,
Rabinovich, & Lahat, 2007). The significant body of research on EIBI has resulted in a number of recent reviews and meta-
analyses supporting it (Eldevik et al., 2009; Peters-Scheffer, Didden, Korzilius, & Sturmey, 2011; Reichow & Wolery, 2009;
Rogers & Vismara, 2008).
EIBI programs share several common features. They are initiated as early as possible (typically before the age of 5) and
involve up to 40 h per week of 1:1 intervention provided by trained tutors or therapists for several years (Love, Carr, Almason,
& Petursdottir, 2009). Treatment is often conducted in the home and then generalized into classroom and community
settings with the ultimate goal of intervention being the successful integration of the child into the classroom (Howard et al.,
2005; Sallows & Graupner, 2005). Individualized treatment programs are designed and supervised by individuals with a
master’s degree or PhD, with advanced training in the provision of EIBI to children with ASD. Treatment consists of breaking
down skills into their simplest components and then teaching them hierarchically, to specified mastery criteria, using
behavior analytic techniques. For example, children are given consistent feedback about their performance, reinforcers are
used to motivate the child and to strengthen new skills, and prompts are provided to maximize success and are faded out as
the child demonstrates progress. Good-quality programs include strategies for ensuring that treatment gains maintain and
generalize to all aspects of the child’s daily life. Data are collected to document progress and inform clinical decisions. The
supervisor and team of therapists meet regularly to review data and discuss cases in order to direct the course of each child’s
treatment (Love et al., 2009).
Despite the common features that most EIBI programs share, there is still great variability between EIBI service-delivery
programs (e.g., differences in curricula, treatment format, and program supervision; Love et al., 2009). Further, research
suggests that not all EIBI programs are equally effective (Bibby, Eikeseth, Martin, Mudford, & Reeves, 2002; Eldevik, Eikeseth,
Jahr, & Smith, 2006; Magiati, Charman, & Howlin, 2007), thus highlighting the need to identify effective treatment
parameters and the mechanisms responsible for change (Kazdin & Nock, 2003). Hayward, Gale, and Eikeseth (2009) have
identified four key variables common to the most effective empirically validated intervention programs that have emerged
through recent outcome research. First, the intensity of EIBI is important and research outcomes suggest that a program of 30
or more hours per week of 1:1 intervention is needed for a minimum of 2 years (Eldevik et al., 2006; Lovaas, 1987). Second,
intervention should be based on behavior principles. Third, supervision should be provided by individuals with extensive
training in applied behavior analysis (ABA) and experience applying the principles of ABA across many different types of
children. Finally, in order to achieve maximum gains for every child, behavioral principles (necessary for optimal learning)
must be paired with a unique, comprehensive curriculum that is tailored to each child’s individual needs across all areas of
functioning (American Academy of Child and Adolescent Psychiatry, 1999; Hancock, Cautilli, Rosenwasser, & Clark, 2000;
992 E. Gould et al. / Research in Autism Spectrum Disorders 5 (2011) 990–1002
Lovaas, 2003). That is, while the fidelity of teaching procedures is clearly important, the content that is taught is also key to
the success and overall outcomes of intervention. It is this factor that this paper is concerned with.
Despite the need for a comprehensive, individualized treatment program and the importance of program content on
treatment outcome, the current literature neglects to specify what constitutes a comprehensive curriculum and does not
describe how clinicians can best design such a program. Within existing EIBI services, hundreds of different skills are taught
to children, and dozens of curricular programs exist (Love et al., 2009). Love et al. (2009) found that 48% of clinicians were
typically using more than one curriculum manual (e.g., Leaf & McEachin, 1999; Lovaas, 1981; Maurice, Green, & Luce, 1996)
and suggested this indicates that no currently available curriculum meets all program needs.
The challenge then becomes identifying what constitutes a comprehensive program. Given that ASD is pervasive and can
potentially affect all areas of a child’s development, building an effective individualized curriculum should start with a
systematic and comprehensive evaluation of the child’s abilities across all areas of functioning (Hancock et al., 2000). We
have identified eight key areas in which children with ASD are likely to be deficient. In addition to impairment in language
and socialization that are foundational to an ASD diagnosis, children with ASD may also present with deficits in any or all of
the following other areas: motor (Dewey, Cantell, & Crawford, 2007; Dyck, Piek, Hay, & Hallmayer, 2007; Miyahara et al.,
1997; Page & Boucher, 1998), daily living (Carpentieri & Morgan, 1996; Liss et al., 2001; Lord & Schopler, 1989), play (Jarrold,
2003), executive functions (Hill, 2004), social cognition or perspective-taking (Baron-Cohen, Leslie, & Frith, 1985), and
academic skills (Mayes & Calhoun, 2006).
A comprehensive curriculum that targets skill deficits in each of these areas is not enough to ensure quality treatment.
The treatment program must be tailored to the individual child’s needs (Hayward et al., 2009). In other words, simply having
a curriculum available does not ensure that appropriate content will be selected and a unique treatment program formulated
that optimally addresses the needs of each individual child. Comprehensive assessment is needed to meet this requirement.
Assessment results should guide the development of a structured treatment program or curriculum that is hierarchically
organized and developmentally sequenced (Love et al., 2009). Since it is impossible to target every skill deficit, priority
should be given to key skills, behavioral cusps, or pivotal responses that will remain functional for the child across settings
and over time, as well as ‘‘open doors’’ for the child to new and greater learning opportunities (Rosales-Ruiz & Baer, 1997).
Inadequate assessment could result in a number of problems. For example, the child’s curriculum might be lopsided or
unbalanced (i.e., all or most lessons are addressing one area such as academic skills), nonindividualized or in a ‘‘cook-book’’
format (i.e., the user follows the treatment manual in a particular order even though the manual was not designed to be used
that way), and/or heavily focused on unnecessary skills (i.e., skills irrelevant to the child’s life) or inappropriate skills (i.e.,
prerequisite skills have not been taught and/or skills are age-inappropriate). In this paper, we attempt to identify the ideal
characteristics of an assessment tailored to the needs of an EIBI provider. Each of these characteristics is centered on
facilitating treatment and not on establishing diagnosis. From this perspective we have identified five criteria for evaluating
EIBI assessments, each of which is described below.
First, the assessment should be comprehensive. As discussed above, ASD is pervasive and can potentially affect all areas of
a child’s development; therefore, assessment should address all major areas of human functioning (i.e., social, motor,
language, daily living, play, executive functions, social cognition, and academic skills), allowing clinicians to prioritize
treatment goals and develop a balanced, fully individualized curriculum. Human child development is enormously complex
and an assessment that does not address all relevant details may run the risk of allowing clinicians to overlook important
areas of development.
Second, it should target early childhood development. The goal of an EIBI program is to start early (as soon as a diagnosis is
made or a child is identified to be at risk) so that emerging deficits can be remediated through training. Thus, assessments
must be usable for children with ASD starting very early (i.e., 6 months or less), and extending until such time that a child is
able to be fully included in regular education. Thus, the upper limit of the assessment would likely need to equate to first or
second grade (approximately 7 or 8 years old developmentally). Further, items should be age-appropriate for each child
being assessed and should progress by age of typical development of skills. As such, assessments should ideally be age-
normed, or at a minimum provide developmental markers based upon empirical research.
Third, it should consider behavior function, not just behavior topography. Behavior analysts ensure programs are
individualized by taking a functional analytic approach (i.e., interventions are matched to the function of a child’s behavior,
rather than solely to topography; Hancock et al., 2000). There is a small but significant amount of research that has shown
that the many different ways in which a child might use the same behavior may each need to be taught separately (Sundberg
& Michael, 2001). Technically speaking, the effects of training one operant may not generalize to other functions of the same
topography (e.g., training a child to tact blue things may not lead to him manding them). Therefore, EIBI assessments should
result in curricula matched to what is developmentally and functionally relevant to each individual child’s strengths and
needs (e.g., verbal operants associated with language).
Fourth, there should be a direct link from assessment items to specific curricula targets (i.e., items should ask if the child
exhibits specific behaviors under specific conditions). Behavior analytic interventions are built on operationally defined
target behaviors. If assessment items target behaviors or skill areas that are too general, they will not yield sufficient
information to guide the design of individualized EIBI curricula (i.e., further assessment would be needed in order to
E. Gould et al. / Research in Autism Spectrum Disorders 5 (2011) 990–1002 993
determine exactly what to teach and where to start teaching skills). For example, an assessment item asking, ‘‘Does your
child play independently with age appropriate toys?’’ could help identify whether independent play is an important area to
target, but not which particular types of play (e.g., functional pretend play, symbolic play, etc.), or further still, which
particular components of particular types of play (e.g., one-step imitation of play movements, multiple-step play sequences,
constructing play objects, narrating play, etc.). In addition to identifying specific skills that a child does not possess, the
results of the assessment should also identify specific skill strengths that the child possesses within the same skill area. This
information should provide a starting point for clinicians. For example, if it is determined that a child does independently ask
for preferred items using one-word requests, but does not independently ask for preferred items using modifiers (e.g., ‘‘big,’’
‘‘more,’’ etc.), then a logical starting point for expanding the child’s requesting (manding) language might be to start with
adding simple modifiers to one word requests.
Finally, an assessment should be useful for tracking child progress over time. Ongoing measurement and analysis of the
effects of the intervention is a central feature to all EIBI programs, and a comprehensive assessment that is repeatable over
time should contribute to painting a comprehensive picture of changes in child learning. Ideally, such an assessment would
not only yield a reliable and valid picture of each child’s individual skills at any given time, but should also be relatively easy,
cost-effective, and time-efficient for clinicians to administer repeatedly. An assessment that is difficult or cumbersome to
administer, complicated to interpret, or expensive/time-consuming is less likely to be administered on a regular basis and
therefore may be less useful for the purposes of tracking ongoing child progress.
Direct observation is generally considered the gold standard for measuring a person’s abilities within ABA programs
(Cooper, Heron, & Heward, 2007). Direct observation has the advantages of providing direct information on the skills that a
child actually displayed, not merely third-person reports of what a child may have done, or worse still, information on a
variable that is assumed to be a proxy for the state of a hypothetical construct. However, direct observation is not without
its limitations. Perhaps the largest limitation of direct observation is that it may simply not be practical within many
treatment settings. Direct observation requires ‘‘trained observers, objectively defined target behaviors, and . . . must be
systematic, repeated at regular intervals, and of sufficient duration to ensure the assessment yields an adequate and
representative (i.e., valid) sample of behavior’’ (Sigafoos, Schlosser, Green, O’Reilly, & Lancioni, 2008, p. 181). Thus, direct
observation of all areas of human functioning between the ages of 0 and 8 years would be time and resource intensive and
therefore unrealistic in most treatment settings. Furthermore, because of the reliance on human observers, only a small
number of the most salient behaviors can be selected for assessment at any one time in order to achieve reliable results
(Matson, 2007). Given all of these reasons, it would be difficult to obtain a comprehensive inventory of deficits and excesses
through observation alone.
Assessment in the form of rating scales (measures of frequency and/or severity of skill deficits and behavioral excesses)
and checklists (recording whether skills are present or absent from the child’s repertoire) generally require less time and
fewer resources to conduct than direct observation methods (Sigafoos et al., 2008). Both ask informants to make judgments
based on their familiarity with the person’s behavior over some time frame (e.g., the last 3–6 months). The resulting
information provides an estimate of a child’s behavioral repertoire, across the time that the informant was present to witness
it, which may mean that data are less influenced by transient environmental variables than data collected through direct
observation. Furthermore, variability is a natural property of behavior, so several direct observations may be required before
an accurate estimate of the overall level of a behavior may be obtained. Therefore, when practical constraints do not allow for
the dozens or even hundreds of hours that may be required to gain a comprehensive estimate of every area of child
functioning through direct observation, results from indirect assessments may be the only reasonably accurate option, even
though data may potentially be biased by the informant’s idiosyncratic interpretation of the meaning of items and ratings
(Sigafoos et al., 2008). Thus, a comprehensive indirect assessment that allows for the integration of direct observation data
(when informants are unsure of the answer to a given item) may be a viable option.
In the absence of an assessment scale developed specifically for the creation of EIBI treatment programs that addresses all
major areas of human functioning, clinicians have attempted to adapt a vast number of existing assessments for this purpose.
Essentially, any instrument which yields information regarding social, motor, language, adaptive, play, executive functions,
cognition, or academic skills may be used to guide treatment planning. However, as already discussed, simply because an
instrument provides information regarding a construct does not ensure that the information is useful in teaching particular
skills within that domain of functioning.
A large portion of national education and treatment centers for persons with ASD, including those providing ABA-based
services, show a relatively high percentage of agreement among practitioners on the instruments they routinely use for a
variety of purposes, including curriculum design (Luiselli et al., 2001). For the current review, we began by limiting the
assessments reviewed to those reported as having some daily use within ASD treatment centers by Luiselli et al. (2001), and
which were publicly available for use at the time this review was conducted. Further, to be included in this review, an
994 E. Gould et al. / Research in Autism Spectrum Disorders 5 (2011) 990–1002
instrument was minimally required to have published data regarding its reliability and validity. The final list of assessments
reviewed was expanded slightly to include those assessments that are currently in common use in EIBI programs.
Each of the assessments reviewed were evaluated in terms of how well they fit the criteria outlined above. What follows is
first a brief description of each of the assessments reviewed. The brief descriptions outline the domain of functioning
intended to be assessed, how the assessment data are obtained (e.g., administered tests versus questionnaire, etc.), the
intended age range, the approximate length of the assessment (including time needed to administer), and the level of
training required to administer the assessment. Following these brief descriptions, we discuss four assessments that most
closely meet the criteria outlined above.
3.1. Developmental/educational
3.1.4. Denver II
The Denver II (Frankenburg et al., 1990) is a screening instrument designed to identify developmental deficits in children
ages 0–6 years. The instrument evaluates personal–social, fine motor-adaptive, language, and gross motor abilities. Roughly
20 min are required to administer the Denver II. The Denver II was developed to be used by trained examiners (Hughes &
Mirenda, 1995).
should be familiar with the administration procedures. Furthermore, the profile was designed to be used by professionals in
fields pertaining to language and communication development (e.g., speech and language therapists, educational and
clinical psychologists, health visitors, child development teams, teachers, and researchers). Both versions of the profile can
be completed in roughly 30 min (Dewart & Summers, 1995).
developed including two survey forms (the Survey Interview Form and the Parent/Caregiver Rating Form), the Expanded
Interview Form, and the Teacher Rating Form. The Survey forms assess areas including communication, daily living skills,
socialization, motor skills, and maladaptive behavior. It takes approximately 20–60 min to complete a survey form and an
additional 15–30 min to score it. The authors recommend that examiners, administering the Survey Interview Form, have a
detailed understanding of the items and previous experience performing semi-structured interviews (Sparrow et al., 2005).
3.7. Academics/achievement
3.8. Intelligence
After reviewing the assessments described above, four meet our original five criteria most closely: the VB-MAPP, Brigance
IED-II, VABS-II, and CIBS-R. We now turn to a description of how these four can be used for designing EIBI programs, as well as
a critical analysis of the strengths and limitations of each for this purpose.
4.1.1. VB-MAPP
The VB-MAPP was designed for and is used by providers for designing EIBI programs. It addresses five of the
identified skill areas (social, motor, language, play, and academic skills) for children between the ages of 0 and 4 years.
The items within the assessment progress by age of typical development of skills. The items are not only operationally
defined but they also consider function (and not just topography) of behavior. Specifically, there are questions to assess
whether the child uses his or her language skills under all relevant conditions (i.e., assesses verbal operants associated
with language such as echoics, mands, tacts, and intraverbals). The greatest limitation to the VB-MAPP is the lack of
psychometric evaluation. Sufficient reliability and validity of assessments is not a default assumption, but rather, a
consideration that requires empirical investigation. Another potential limitation of the VB-MAPP is that administration
can be lengthy because it requires the assessor to test the child on each item, although the manual states that caregivers
can be interviewed in lieu of direct administration if the report of the caregivers is deemed likely to be accurate. Once
the items are administered though, results of the assessment are easily obtained and interpreted. The assessor is
presented with a list of skills that need to be taught and some direction in terms of the order in which to teach the skills;
however, there is no clear presentation of what the prerequisites are for each item. While the items are not directly
linked to curricula, the items are meant to guide curriculum design. If the supervisor of the child’s EIBI program has
expertise in translating specific skill deficits into lessons to teach the skills, then the results of the VB-MAPP should
significantly aid in curriculum design. The assessment also comes with tracking charts that allow the user to see skill
strengths and to measure progress over time.
The Brigance IED-II also suffers from the limitation that its psychometric properties have not been evaluated in published
research. However, in addition to covering the five areas addressed by the VB-MAPP, this assessment also covers adaptive
skills. Furthermore, it extends the population of children who can be assessed up through the age of 7 years. And, because the
VB-MAPP is primarily a language assessment, the pool of test items within the Brigance IED-II is more comprehensive in the
areas of motor and academic skills. The assessment questions progress by age of typical development of skills and are well-
defined. A benefit of the Brigance IED-II is that there is reportedly no specialized training needed by persons who administer
it. The method used for assessment is flexible. Assessors can either obtain information by interviewing caregivers, testing the
child, or gathering data from school records. If direct observation is a chosen method, there are few materials needed for this
assessment. The results are easily interpreted in that the assessor is provided with a list of skills that the child needs to be
taught; however, interpreting what to do with this list is not as clear. The assessment does not link to curricula/lesson plans,
nor provide any indication of prerequisites for deficient skills. On the other hand, the way in which the testing booklet is
scored provides a visual depiction of the child’s strengths within various skill domains and also allows the assessor to see the
child making progress over time.
4.1.3. VABS-II
The VABS-II not only has impressive psychometrics (Beail, 2003) but is also by far the most popular assessment and is
among the most widely used scales (Balboni, Pedrabissi, Molteni, & Villa, 2001; Dixon, 2007). This assessment addresses five
of the eight skill areas (social, motor, language, daily living, and play skills) and includes skills relevant from birth through 90
years. The items within the assessment progress by age of typical development of skills and are well-defined. This
assessment does not require direct observation and can be filled out in an interview format leading to a great deal of
information being obtained in a relatively short period of time with no materials needed other than a scoring booklet and
pencil. Information is easily obtained and scored, and the assessor is provided with a graphical depiction of the child’s
strengths by domain (e.g., within the daily living skills section, the assessor obtains information as to how the child is doing
with personal, domestic, and community skills). However, interpretation of the results in order to use the information for
E. Gould et al. / Research in Autism Spectrum Disorders 5 (2011) 990–1002 999
curriculum design is difficult because each of the items scored as deficient would need to be compiled into a list and
compared with one another to determine which should be targeted within a child’s curriculum. There is no indication of how
skills relate to one another in terms of knowing if any are prerequisites for others or the order in which to teach skills. In
addition, although the VABS-II covers a broad range of skill areas, it lacks detailed information on specific skills within those
areas. Therefore, much more detailed information would be needed in order to develop targeted lesson plans that teach
particular component skills that are needed.
4.1.4. CIBS-R
The CIBS-R is an assessment designed for the purpose of assessing academic skills from kindergarten through 9th grade.
The items within this assessment progress by academic grade of typical development of skills and are well-defined. Like the
Brigance IED-II the testing methods are flexible and the assessment does not require an assessor with specialized training.
Also like the Brigance IED-II, few materials are needed should direct observation be the chosen method of assessment. The
results are easily obtained in that the assessor is provided with a list of skills that the child needs to be taught; however,
interpreting what to do with this list is not as clear. The assessment does not link to curricula/lesson plans, nor provide any
indication of prerequisites for deficient skills. However, given that the test items pertain specifically to academics, there are
likely other academic curricula from which teachers can pull. The way in which the testing booklet is scored provides a
visual depiction of the child’s strengths within various skill domains and also allows the assessor to see the child making
progress over time.
Of all the assessments reviewed in this paper, four were identified as best meeting the criteria we suggested are important
for their use in designing EIBI programs. Despite the strengths of these assessments, some concerns warrant discussion. For
one, there is no single assessment that is comprehensive enough to be used for developing a fully comprehensive EIBI
curriculum for a child who has deficits across all developmental domains. Assessments used for the purpose of intervention
planning must ‘‘identify specific skills that are either present or absent from the person’s repertoire, appropriate or
inappropriate, and effective or ineffective’’ across all skill domains (Sigafoos et al., 2008, pp. 169–170). However, within the
history of assessment development for this population, assessments have been designed by individuals from differing
perspectives with an emphasis on specific features of ASD; thus a comprehensive assessment designed to measure all areas
of human functioning has not been established (Richdale & Schreck, 2008).
Between these four assessments, the following five of the eight skill areas are addressed: social, motor, language,
adaptive, play, and academic skills. With respect to evaluating executive functioning skills, only one of the reviewed
assessments measures this repertoire (WISC-IV); however, the results are not useful in aiding clinicians to design targets to
teach children with ASD executive functions. With respect to evaluating social cognition, none of the assessments reviewed
have a section designed to test this repertoire; however, there are a few items on the VABS-II that address it (albeit not
thoroughly).
Guidelines regarding the assessment of children with ASD still generally focus almost exclusively on differential
diagnosis (American Academy of Child and Adolescent Psychiatry, 1999). Scales designed for treatment planning require
greater emphasis on an in-depth measurement of skill domains than those designed for diagnostic purposes (i.e., focus on
areas of intervention, not symptoms indicative of ASD). Thus, assessments that identify specific deficits and/or excesses are
likely to be the most relevant for selecting treatment targets. Although commonly used screening and diagnostic tools
provide data on some aspects of each domain, they contain too few items on specific skills to be used to identify and prioritize
treatment targets. Further, while domain-specific instruments may provide a more detailed picture regarding skills, they
often cover too generalized a behavior repertoire to be considered useful for curriculum development. Operationally defined
target behaviors are the ‘‘hallmark of behaviorally-based treatment programs’’ (Matson, 2007, p. 212). EIBI programs rely on
operational definitions of specific component and composite skills. However, assessments are generally not designed to
measure changes in specific behaviors and instead measure change in overall functioning, or changes in variables assumed to
be proxies for hypothetical constructs. All too often, poor performance within a specific domain is indicative that the child
needs further evaluation in that domain in order to then identify specific targets for intervention/specific skill deficits (e.g.,
Bayley-III).
Perhaps the most concerning feature of all the assessments reviewed here is that none of them are linked directly to
established curricula/lesson plans with outlined prerequisites. Assessment items linked to established EIBI curricula would
remove some of the guessing that likely currently determines what lesson plans are targeted.
5. Conclusion
There is a general dissatisfaction, particularly among ABA treatment providers, with existing assessments that are used
within EIBI programs. Without appropriate assessment tools, clinicians are left to assess as they see fit and to choose
programs as best they can. They are left to employ a battery of tests and assessment techniques for identifying a child’s skills
and deficits in order to determine where to begin intervention. ‘‘In most cases, the assessment will involve a combination of
1000 E. Gould et al. / Research in Autism Spectrum Disorders 5 (2011) 990–1002
approaches and procedures, including interview, behavioral observation, and administration of standardized rating scales or
checklists’’ (Sigafoos et al., 2008, p. 177). Not only is it time-consuming and expensive to become trained to administer a
variety of assessments, but test selection is also arbitrary and dependent on the clinician’s personal preferences, training
(different assessments require different training/expertise), and experience, as well as on the availability of tests, time, and
settings. Therefore, program content may be based more on clinician expertise, experience, and tradition, rather than on a
detailed and accurate assessment of child functioning. Such a state of affairs likely contributes to the wide variation in
quality, which is common today across EIBI programs.
The assessments reviewed and critiqued in this paper revealed that the VB-MAPP benefits from including information on
very specific skills and is based on a functional approach to language. However, it suffers from a lack of data on
psychometrics, extends only to age 4, and is not as comprehensive as may be desired, with respect to including skills from all
developmental domains. Others may be more comprehensive (e.g., Brigance IED-II) or have excellent psychometrics (e.g.,
VABS-II), but do not provide sufficient information to identify specific behavioral targets for treatment. Most concerning,
none of the assessments reviewed here are linked directly to a comprehensive curriculum.
The diverse expression and complexities across and within individuals with ASD over the course of development present
significant challenges for clinicians involved in assessment and treatment (American Academy of Child and Adolescent
Psychiatry, 1999). Curriculum content is crucial to intervention success and thus a comprehensive assessment capable of
determining curriculum content is important. Currently available assessments, such as those reviewed in this paper,
represent a good start. However, much future work is needed to develop an assessment that is comprehensive enough to
address all developmental domains while also being precise enough to determine specific targets for intervention. Such an
assessment will likely aid clinicians in reliably developing treatment programs that are more comprehensive and
individualized than the programs commonly found in applied settings today.
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