Differences in profiles of emotional behavioral problems across instruments in verbal versus minimally verbal children with autism spectrum disorder.
The CBCL under-counts anxiety and the ABC over-counts irritability in minimally-verbal autistic kids.
01Research in Context
What this study did
The team compared two parent-report checklists in 83 autistic kids. Half spoke in sentences. Half used few or no words.
Parents filled out the CBCL and the ABC on the same day. Researchers asked: do the forms give the same picture of behavior when the child talks little?
What they found
Minimally-verbal children scored higher on ABC irritability, lethargy, and hyperactivity. Yet they scored lower on CBCL internalizing scales like anxiety and depression.
Same kids, same parents, opposite patterns. The tool you pick decides what problems you see.
How this fits with other research
So et al. (2013) warned that ABC scores can mislead in children under five. Megan’s study shows the risk continues into school age when kids talk little.
De Kegel et al. (2016) found CBCL misses many autistic traits. Megan adds a twist: CBCL also misses internalizing problems, but only in minimally-verbal youth.
So et al. (2013) and Megan together tell one story. ABC over-calls behavior issues in low-language samples across age bands.
Why it matters
If you rely on one checklist you may chase “irritability” that is partly measurement noise, or overlook real anxiety that the CBCL hides. Run both forms, compare scores, and let language level guide interpretation. A spike on the ABC with a flat CBCL in a minimally-verbal child deserves direct observation before treatment planning.
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02At a glance
03Original abstract
There has been increasing attention to the assessment of minimally verbal (MV) children with autism spectrum disorder (ASD). Previous research has begun to examine the relationship between verbal abilities and emotional and behavioral problems (EBP). The current study compared parent-reported EBP in children of differing language levels on two instruments commonly used in ASD research and clinical practice, the Child Behavior Checklist (CBCL) and Aberrant Behavior Checklist (ABC). The study consisted of 1,937 6-18 years old children with ASD from the Simons Simplex Collection. Children were divided into three language groups, by ADOS module (Module 1 = MV, 2 = phrase speech (PS), and 3 = verbally fluent (VF)) and then compared on CBCL and ABC subscales. The ABC and CBCL showed different patterns of elevations across the language groups. MV children were reported to have more impairment than VF children on the ABC irritability, lethargy, and hyperactivity scales. Children with less language (MV and PS) exhibited less impairment on the CBCL internalizing domain than VF children, but did not differ on the externalizing domain. Post hoc comparisons showed that internalizing differences were driven by fewer children with less language exhibiting clinically elevated anxious/depressed scores compared to VF children. The present study underscores the significance of considering language when assessing EBP. Results have implications for the psychiatric screening of children with ASD, particularly those with language impairments. Researchers should exercise caution when applying EBP instruments designed for use with different populations and purposes to broad samples of children. Autism Res 2019, 12: 1367-1375. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Some emotional and behavioral problem (EBP) scales include items that may be inappropriate for children with ASD and limited language. The present study found that there was a tendency for children with language impairment to have lower internalizing scores on the Child Behavior Checklist, but higher scores lethargy and irritability scores on the Aberrant Behavior Checklist, relative to verbally fluent children. This suggests that each of these instruments may underestimate EBPs in certain subsets of children.
Autism research : official journal of the International Society for Autism Research, 2019 · doi:10.1002/aur.2126