Nonverbal Social Interaction Rating Scale for Autistic Spectrum Disorders

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Nonverbal Social Interaction Rating Scale for
Autistic Spectrum Disorders

• Robert Schum Robert Russell

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Diagnostic Criteria for Autism

• communication impairment
• social impairment
• restricted/stereotypical behaviors and interests

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Problem of Differential Diagnosis for Autism

• difficult to untangle language functions from
  social functions
• social disorder is key distinguishing criterion
  between autism spectrum disorders and other
  developmental disorders
• autism 1166, SLI 117, MR 150

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Interview and Play Assessments
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Differentiating Social Behaviors

• direct imitation
• joint attention
• affective reciprocity
• representational play

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Participants

• N 60
• 2-7 years old
• nonverbal IQ gt 70
• agreed to 3-year follow-up

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Procedure

• team evaluation neurodevelopmental pediatrician,
  speech-language pathologist, clinical
  psychologist
• psychologist rated CARS, placed aside
• team met 1 month later, determined diagnosis
• psychologist rated behavior descriptions in
  reports 3 years later for nonverbal social
  behaviors

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Nonverbal Social Interaction Rating Scale (NSIRS)
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Imitation (IM)

• Child directly imitates action of examiner (e.g.,
  tapping table with hand or object, touching parts
  of head, drawing lines on paper, wiggling thumb,
  jumping, making mouth noises such as tongue click
  or raspberry).

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Joint attention (JA)

• Showing toy to adult, but not requesting any
  assistance pointing to object and looking at
  adult alternating gaze between looking at adult
  and looking at object/event language could be
  used as part of action, but not necessary (e.g.,
  look, Mommy).

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Affective reciprocity (AR)

• Laughing with adult over a silly event, such as
  when examiner feigns distress as a tower of
  blocks topples over child repeats action to
  elicit repeated silly action from examiner child
  giggles in playing peek-a-boo, chase game, or in
  anticipation during tickle game.

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Representative play (RP)

• Arranging human figures in playhouse on furniture
  and in representative actions pretending to cook
  or eat food offering a bottle to a baby doll
  combining two toys in a scheme (e.g., putting a
  human figure astride a dinosaur).

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Results

• inter-item reliability
• r .15 - .44
• concurrent validity with CARS
• r .61 (p lt .001)
• NSIRS scores per Dx M (SD)
• Autism 5.3 (2.0) (n 9)
• SLI 6.8 (1.4) (n 51)
• F 7.16 (p lt .01)

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3-Year Follow-up

• NSIRS-CARS (parent) r .35 (p lt .02)
• Childrens Communication Checklist-2
• nonverbal section
• NSIRS Teacher r .52 (p lt.001)
• NSIRS Parent r .35 (p lt .02)
• Pragmatic Profile (CELF-IV)-nonverbal
• NSIRS Teacher r .22
• NSIRS Parent r .35 (p lt .02)

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Conclusions

• use as a screening procedure rather than as a
  diagnostic instrument
• continued development
• larger N
• independent rater/diagnostic team
• look at developmental trends to include MR

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rschum_at_mcw.edu
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Assessment References

• Baron-Cohen, S., Cox, A., Baird, G., Swettenham,
  J., Nightingale, N., Morgan, K., et al. (1996).
  Psychological markers in the detection of autism
  in infancy in a large population. British
  Journal of Psychiatry, 168(2), 158-163.
• Lord, C., Rutter, M., Le Couteur, A. (1994).
  Autism Diagnostic Interview-Revised A revised
  version of a diagnostic interview for caregivers
  of individuals with possible pervasive
  developmental disorders. Journal of Autism
  Developmental Disorders, 24(5), 659-685.
• Robertson, J. M., Tanguay, P. E., L'Ecuyer, S.,
  Sims, A., Waltrip, C. (1999). Domains of
  social communication handicap in autism spectrum
  disorder. Journal of the American Academy of
  Child Adolescent Psychiatry, 38(6), 738-745.
• Stone, W. L., Coonrod, E. E., Turner, L. M.,
  Pozdol, S. L. (2004). Psychometric properties of
  the STAT for early autism screening. Journal of
  Autism Developmental Disorders, 34(6), 691-701.
• Wetherby, A., Prizant, B., Hutchinson, T.
  (1998). Communicative, social/affective, and
  symbolic profiles of young children with autism
  and pervasive developmental disorders. American
  Journal of Speech-Language Pathology, 7(2), 79-91.