Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism
Kids can hit their own ABA goals even when Vineland scores stay flat, so talk with families about what real progress looks like.
01Research in Context
What this study did
Choi and colleagues looked at two ways to measure ABA success. One way was personal goals picked by the family. The other way was the Vineland Adaptive Behavior Scales.
They tracked kids with autism for two years. They wanted to see if the two measures moved together.
What they found
The measures did not match. Kids kept hitting their own goals, but Vineland scores stayed flat or dropped.
In plain words: a child might learn to order at a café, yet the Vineland still said “no progress.”
How this fits with other research
Ostrovsky et al. (2022) saw the opposite. Their kids gained on the Vineland after ABA. The key gap is time. Ostrovsky counted gains at 12 months. Choi waited until 24 months and saw the curve flatten.
Fernell et al. (2011) also found Vineland gains were small and unrelated to how many hours kids got. That study and Choi both warn that more hours do not guarantee higher standard scores.
Kotsopoulos et al. (2021) extend the picture. They tracked kids for three years and saw Vineland go up. Their sample was younger and started with lower scores, so early fast growth may hide later plateaus.
Why it matters
Your treatment notes can look great while the Vineland looks grim. This paper tells you to show families both graphs. Celebrate the personal goals they care about. Explain that flat Vineland scores do not erase real-life wins. When you write reports, pair standard scores with stories of new skills like tying shoes or saying hi to friends.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add one parent-chosen goal to your next data sheet and graph it beside the Vineland summary.
02At a glance
03Original abstract
Applied behavior analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown in clinical trials to improve child functional status. There is substantial focus in ABA on setting and tracking individualized goals that are patient-centered, but limited research on how to measure progress on such patient-centered outcomes. The purpose of this investigation was to assess concordance between patient-centered and standard outcome measures of treatment progress in a real-world clinical sample of children receiving ABA for autism spectrum disorder. This observational study used a clinical sample of children ages 3 to 16 years (N = 154) who received 24 months of ABA from an integrated health system. Concordance between three outcome measures after ABA was assessed using a correlation matrix: (1) patient-centered measures of progress on individualized treatment goals, (2) caregiver-centered measure of progress on treatment participation goals, and (3) the Vineland Adaptive Behavior Scales adaptive behavior composite. There was limited concordance among measures at both 12 and 24 months of ABA. None of the patient-centered measures showed significant positive correlation with adaptive behavior composite difference scores at either 12 or 24 months, nor did the caregiver measure. The percentage of children achieving clinically meaningful gain on patient-centered goal measures increased between 12 and 24 months of ABA, while the percentage of children achieving clinically meaningful gains in adaptive behavior declined during the same time period. In a health system implementation of ABA, there was limited concordance between patient-centered and standard measures of clinically meaningful treatment progress for children with ASD. Clinicians should have ongoing dialogue with patients and parents/caregivers to ensure that interventions for ASD are resulting in progress towards outcomes that are meaningful to patients and families.
BMC Pediatrics, 2022 · doi:10.1186/s12887-022-03383-2