Personalized autism symptom assessment with the Youth Top Problems Scale: Observational and parent-report formats for clinical trials applications.

Abstract

Few measures of autism-related symptoms have been established as both psychometrically robust and sensitive to the effects of treatment. In the present study, a personalized measure of autism-related symptoms using the Youth Top Problems (YTP) method (Weisz et al., 2011) was evaluated. Participants included 68 children with diagnoses of autism (ages 6-13 years), and their parents, who were randomized to cognitive behavioral therapy (CBT) or enhanced standard community treatment (ESCT) addressing autism-related symptoms. At pretreatment, parents described their child's top autism-related problems (YTPs) in their own words and rated the severity of these problems on a Likert-type scale. Parents also made daily severity ratings on the child's top three YTPs for 5 days prior to treatment and 5 days following treatment while videorecording their child's behavior at home on each of these days. Trained observers coded these videorecordings, focusing on the same YTPs that the parents rated. Parents also completed standardized checklists of autism-related symptoms and general mental health symptoms. There was evidence of convergent and discriminant validity as well as good test-retest reliability for the YTP measures. YTP severity scores converged with the standardized measure of autism-related symptoms. Parent-reported YTP scores predicted observers' YTP scores at the daily level, and both parent-reported and observers' YTP scores decreased from pre-to post treatment. Observers' ratings of the videorecordings exhibited sensitivity to treatment condition. These applications of the YTP method are promising and may complement standardized symptom checklists for clinical trials focusing on autism-related symptoms.

Home‐based video assessment of children's autism‐related behaviours: Psychometric analysis and linkages with parental responsiveness and context

“…Participants were invited to a major research university in the western US to participate in an intake assessment to determine eligibility (Wood et al, 2021(Wood et al, , 2022. During the assessment, parents completed the ADI-R with an independent evaluator while the child participated in the ADOS and cognitive assessments with a separate evaluator.…”

“…Participants included 38 boys and 6 girls ages 6-13 (M = 9.11, SD = 1.79). The children were a subgroup of participants in an intervention study addressing ARBs and mental health needs whose family agreed to videotape daily life at home before and after the intervention (Wood et al, 2021(Wood et al, , 2022. Participants were recruited from a major metropolitan area in the western United States using a network of referrals stemming from local autism research recruitment programs, schools for children with developmental disabilities and community referrals.…”

“…Child and adolescent symptom inventory-4th edition revised (CASI-4R; Gadow & Sprafkin, 2005) The CASI-4R is a parent-report checklist with satisfactory psychometric properties in youth with autism that assesses emotional and behavioural difficulties. In a study of the present sample of children, IRTbased CASI scores were derived in flexMIRT version 3.0 using EAP scoring (Wood et al, 2022), with all included items loading adequately on a single dimension with a marginal reliability of .95. CASI IRT scores were used as a benchmark measure of children's emotional and behavioural difficulties for the evaluation of discriminant validity, with higher scores reflecting more difficulties.…”

“…The YTP is idiographic and its items are different for each participant, as defined by parents, ranging across all domains of behaviour (e.g., communication challenges, fears, disruptive behaviour, self‐care, etc.). Observer ratings of these target behaviours were significantly associated with parent ratings of the same target behaviours over the course of days (Wood et al., 2022), signifying initial evidence of convergent validity for this method. In the present study, the video data from this study were used for the development of two nomothetic—rather than idiographic—measures of children's ARBs and their activities in their naturalistic home environment.…”

“…In a recent study of children on the autism spectrum, naturalistic home video data was recorded for about 10 hr per family over the course of a week before and, again, after intervention participation (Wood et al., 2022). These videos were rated by observers on a personalized measure of parent‐defined youth challenges and goals, the Youth Top Problems (YTP; Weisz et al., 2011) scale.…”