Informant (Dis)Agreement on Ratings of Challenging Behaviors and Social Communication in Preschool Children With Autism Spectrum Disorder

Abstract

Purpose Cross-informant ratings are considered best practice for assessing children with autism spectrum disorder (ASD). However, informant disagreement often occurs, which can pose significant challenges to various aspects of clinical services. This study explored the degree of parent and speech-language pathologist (SLP) agreement on ratings of challenging behaviors and social communication skills in preschool children with ASD. Method Fifty-eight informant ratings of challenging behaviors and social communication skills were collected from parents and SLPs on the same 29 preschool children with ASD ( M = 49.93 months, SD = 11.67 months) using the Pervasive Developmental Disorder Behavior Inventory. Parent versus SLP group rating comparisons were assessed with paired t tests and Cohen's d effect sizes. Intraclass correlation coefficients were calculated to examine interrater reliability between individual parent and SLP ratings. Bland–Altman plots were generated to evaluate informant agreement across the entire range of Pervasive Developmental Disorder Behavior Inventory composite scores. Results Group comparisons indicated that parents rated arousal regulation problems as more severe than SLPs, with no other group differences observed. Parents and SLPs exhibited poor agreement on ratings of challenging behaviors; however, moderate to good agreement was observed for social communication ratings. Conclusions These results highlight the importance of including parents in the assessment and treatment planning process for preschool children with ASD, as parents may report key behavioral concerns that clinicians may not otherwise observe. Understanding behaviors that may be more prone to informant disagreement has implications for promoting a shared understanding of behavioral concerns and treatment targets between parents and clinicians.

Profiles and correlates of language and social communication differences among young autistic children

“…Profile 3 had similarly low parent-rated language abilities as Profile 1, yet relatively moderate language abilities per clinician-administered direct measures of receptive and expressive language, reflecting an informant discrepancy in language abilities. This finding contrasts with Profiles 1 and 2 as well as extant and emerging literature ( Miller et al, 2017 ; Reetzke et al, 2021b ), showing that parent report of language abilities does not significantly differ from clinician assessment of receptive and expressive language skills. To better understand why this pattern of informant discrepancy was only observed for Profile 3, we examined whether there were specific language differences between Profiles 3 and 1 which might not have been captured by our clinic-based, parent-report measure of child language.…”