Development of the Behavioral Inflexibility Scale for Children with Autism Spectrum Disorder and Other Developmental Disabilities

Abstract

Behavior inflexibility (BI) refers to rigid patterns of behavior that contrast with the need to be adaptable to changing environmental demands. We developed a parent‐reported outcome measure of BI for children with autism spectrum disorder (ASD) and other developmental disabilities with a multi‐step iterative process. A pool of 62 candidate items was generated through expert panel feedback, review of existing scales and focus groups. A consensus process was used to generate the final 38 items. Parents of 943 children (age range, 3–18 years; average, 11.4 years; 79% boys) with ASD completed an online survey. One hundred thirty‐three parents rated their child twice within 3 weeks (average = 16.5 days). A series of factor analyses suggested that the 38 items measured a single construct. Scores had a weak correlation with level of functioning (−0.12) and did not differ based on sex. Scores had a negligible correlation with age (−0.07), although measurement invariance was not supported. The mean total score for the Behavioral Inflexibility Scale (BIS) was normally distributed. Internal consistency was α = 0.97 and temporal stability was r = 0.92. Correlations with parent ratings on the subscales of the Repetitive Behavior Scale—Revised varied from 0.48 to 0.89. The correlation with parent ratings on the Social Communication Questionnaire total score was 0.52. Our data show that BI in children with ASD ranges significantly from mild to severe and that the 38‐item BIS is valid and reliable. Autism Res 2020, 13: 489–499. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. Lay Summary We developed a parent‐completed rating scale of behavior inflexibility (BI) for children with developmental disabilities using a multistep process. The Behavioral Inflexibility Scale (BIS) contains 38 questions rated on a 6‐point scale. Parents of 943 children with autism spectrum disorder (ASD) completed an online survey. We examined associations between the BIS and other scales and demographic variables. The BIS is valid and reliable. BI in children with ASD ranges from mild to severe.

Conversational adaptation in children and teens with autism: Differences in talkativeness across contexts

“…In this view, reduced conversational adaptation may have resulted from participants with ASC getting “stuck” on the social demands of the Interested condition. This explanation aligns well with descriptions of cognitive and behavioral inflexibility in ASC, which can range in severity and present in diverse ways across individuals (Bertollo et al, 2020; Bodfish et al, 2021; Lecavalier et al, 2020). Prior research that has investigated the impact of cognitive flexibility on language use through an object description task found that when autistic children were required to be cognitively flexible (e.g., use a different referential label) during an experimental task, their descriptions were less appropriately informative compared to those of NT peers (Malkin & Abbot‐Smith, 2021).…”

“…Interestingly, reduced conversational adaptation in ASC can manifest quite differently from person‐to‐person; whereas some verbally fluent autistic people engage in monologuing (i.e., talking too much), others are overly reticent (i.e., talking too little) across conversations (Adams et al, 2002). Reduced conversational adaptation in ASC may also be driven by difficulties with behavioral inflexibility, which is widely acknowledged to be a core feature of the restricted and repetitive behaviors/interests domain of autism (Bertollo et al, 2020; Kanner, 1943; Lecavalier et al, 2020). Thus, for some autistic individuals, behavioral inflexibility may present as indiscriminate levels of talkativeness about a particular interest or preferred topic across a number of social settings, even when it is not appropriate.…”

Response (minimum clinically relevant change) in ASD symptoms after an intervention according to CARS-2: consensus from an expert elicitation procedure

“…If experts emphasize the need to develop psychometrically sound outcome measures [5,6], it is also well reported that the proliferation of a scattered variety of instruments to assess changes in specific symptoms or abilities prevent effective comparisons across intervention studies and the development of best practice recommendations [2,3,5]. That is why the core symptoms of ASD represent obvious outcome measurement targets [6] and should, if possible, be assessed with one or few tools. It is also important to be able to monitor progress in a way that is not only reliable and systematic but also practical and time-efficient for families, schools**** and other service providers.…”

The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond

“…While a third potential subdimension within RRBs, “circumscribed interests”, has emerged in some studies (Lam et al 2008 ) encompassing restricted interests and unusual preoccupations, the items within this factor have more commonly been incorporated into the previously described two factors (Bishop et al 2006 ). Additionally, a relatively new area of research proposes that behavior inflexibility (i.e., patterns of rigid behavior that contrast with the need to adapt to changing environments) may encompass and measure several of the RRBs observed in ASD, and thus may represent a subdimension within core ASD symptoms (Boyd et al 2012 ; Lecavalier et al 2020 ).…”