Evidence of item bias in a national flourishing measure for autistic youth.
The national flourishing scale penalizes autistic youth on social items, so low scores may be a measurement glitch, not a skill gap.
01Research in Context
What this study did
The team ran a psychometric check on the National Survey of Children’s Health flourishing scale. They looked at whether each question works the same way for autistic youth and for neurotypical youth.
They used differential item functioning, or DIF, to spot questions that give biased scores. The sample came from the national data set; exact size was not reported.
What they found
Social-competence items were flagged. Autistic kids were rated lower even when their true skills were the same as non-autistic peers.
In plain words, the scale mistakes autism traits for lower flourishing. A low score may reflect measurement error, not real deficits.
How this fits with other research
Stevanovic et al. (2021) saw the same problem in the Childhood Autism Rating Scale. Their study found items that work differently across countries, while M et al. found items that work differently across diagnoses. Both papers warn: check item bias before you trust scores.
Shahid et al. (2025) also used DIF and caught two biased items on an autism-knowledge test for school staff. Together these studies show that bias can hide in any scale—child or adult, knowledge or flourishing.
Taylor et al. (2017) add the big picture: only seven percent of autism tools have solid psychometric backing. The flourishing scale now joins the long list of measures that need autism-specific vetting.
Why it matters
If you use the NSCH flourishing scale in intake or progress monitoring, treat social-item scores with caution. Low numbers may reflect the measure’s bias, not the child’s growth. Add direct social-skills probes or parent goals before you write treatment targets.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pull any social items from the flourishing scale and re-score the rest before you update the treatment plan.
02At a glance
03Original abstract
Flourishing is a positive health indicator that aligns with strengths-based perspectives and measures within autism research. Flourishing indicators were recently included in the National Survey of Children's Health (NSCH) and have been used to evidence disparities in flourishing experienced by autistic children compared to non-autistic peers. Yet, little has been done to examine the utility of standard flourishing items for this population. This study examined the NSCH caregiver-reported flourishing items for measurement item bias. A cross-sectional, representative sample of autistic and non-autistic US children aged 6-17 years (n = 41,691) was drawn from the 2018-2019 NSCH public dataset. A confirmatory factor analysis using a multiple indicators and multiple causes model (MIMIC-CFA) was conducted to (1) test for differential item functioning (DIF; i.e., measurement bias); and (2) estimate latent mean group differences after controlling for DIF. Findings supported a 3-factor (social competence, school motivation, and behavioral control), 10-item model structure consistent with past literature, yet measurement bias was evident for 6 of the 10 items. Persistent group differences, after accounting for DIF and covariates, indicates that caregivers of autistic children perceive their children are experiencing meaningfully lower flourishing outcomes compared to caregivers of non-autistic children. However, evidence of measurement bias for items related to the social competence dimension calls into question the applicability of this measure for autistic children. Further interpretation of group differences and use of this measure should be approached with caution.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1002/aur.2900