Reliability and agreement of the timed up and go test in children and teenagers with autism spectrum disorder.
The Timed Up and Go test gives rock-solid, repeatable balance scores for school-age youth with autism.
01Research in Context
What this study did
Sáez-Suanes et al. (2023) asked: Does the Timed Up and Go (TUG) give the same score when two different people time it? They tested 50 youth with autism aged 6-18. Each teen walked the three-meter TUG while two clinicians ran stopwatches.
The team ran the same test twice on the same day to check intra-rater reliability. They used simple ICC statistics to see how close the numbers were.
What they found
Inter-rater ICC was 0.99 — almost perfect agreement. Intra-rater ICC was 0.88 — good agreement. Measurement error was tiny, so a small change in seconds means a real change in balance.
Bottom line: the TUG is a reliable, free, 60-second screen for fall risk in kids and teens with ASD.
How this fits with other research
The result backs up Bhat (2024), who showed parent and teacher motor scores agree 81 % of the time. Both papers say: use quick tools, but check them with a second rater.
Vanvuchelen et al. (2017) looks like a contradiction. They found the parent ASQ-2 misses many motor problems in preschoolers. The studies do not really clash — Marleen tested 2-5-year-olds with a parent form, while P et al. tested 6-18-year-olds with a direct walk test. Direct tests win for older kids; parent checklists still help for toddlers.
Ferreri et al. (2011) and Chen et al. (2001) also found sky-high inter-rater numbers for autism interviews. The pattern is clear: when the task is concrete — walk, talk, score — trained raters match.
Why it matters
You can add the TUG to your intake packet tomorrow. It needs only a chair, tape, and a stopwatch. Use it to spot balance issues before they turn into falls on the playground or during PE. If you run social-skills groups, track TUG every six weeks to show parents real numbers as coordination improves.
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02At a glance
03Original abstract
ASD patients include a variety of motor deficits; however, these issues have received less scientific attention than other ASD symptoms. Due to understanding and behavioral difficulties, it might be difficult to administer motor assessment measures to children and adolescents with ASD. To evaluate motor challenges in this population, including gait and dynamic balance issues, the timed up and go test (TUG) may be a simple, easy to apply, quick, and inexpensive tool. This test measures in seconds the time it takes for an individual to get up from a standard chair walk 3 m, turn around, walk back to the chair, and sit down again. The study purpose was to evaluate the inter- and intra-rater reliability of TUG test in children and teenagers with ASD. A total of 50 children and teenagers with ASD (43 boys and 7 girls) between 6 and 18 years were included. Reliability was verified by the intraclass correlation coefficient, standard error of measurement, and minimum detectable change. The agreement was analyzed by the Bland-Altman method. A good intra-rater reliability (ICC = 0.88; 95% CI = 0.79-0.93) and an excellent inter-rater reliability (ICC = 0,99; 95% CI = 0.98 to 0.99) were observed. Additionally, Bland-Altman plots demonstrated that there was no evidence of bias in either the replicates or between examiners. Furthermore, the limits of agreement (LOAs) between the testers and test replicates were close, indicating that there was little variation between measurements. Conclusions: The test TUG showed strong intra- and inter-rater reliability values, low proportion of measurement errors, and lack of significant bias based on by test repetition in children and teenagers with ASD. These results could be clinically useful for assessing balance and the risk of falls in children and teenagers with ASD. However, the present study is not free of limitations, such as the use of a non-probabilistic sampling. What is Known: • People with ASD have a variety of motor deficits that have a prevalence rate almost as common as intellectual disability. In our knowledge, there are no studies that provide data on the reliability of the use of scales or assessment tests in children and adolescents with ASD to measure motor difficulties, such as gait and dynamic balance, in children and teenagers with ASD. • Timed up and go test (TUG) could be a possible tool to measure this motor skills. What is New: • The reliability and agreement of the Timed up and go test in 50 children and teenagers with autism spectrum disorder showed strong intra- and inter-rater reliability values, low proportion of measurement errors, and lack of significant bias based on by test repetition.
, 2023 · doi:10.1007/s00431-023-05027-8