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Concurrent Validity of the ABAS-II Questionnaire with the Vineland II Interview for Adaptive Behavior in a Pediatric ASD Sample: High Correspondence Despite Systematically Lower Scores

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Title: Concurrent Validity of the ABAS-II Questionnaire with the Vineland II Interview for Adaptive Behavior in a Pediatric ASD Sample: High Correspondence Despite Systematically Lower Scores
Language: English
Authors: Dupuis, Annie, Moon, Michael J., Brian, Jessica, Georgiades, Stelios, Levy, Tomer, Anagnostou, Evdokia, Nicolson, Rob, Schachar, Russell, Crosbie, Jennifer (ORCID 0000-0002-8710-3322)
Source: Journal of Autism and Developmental Disorders. May 2021 51(5):1417-1427.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 11
Publication Date: 2021
Document Type: Journal Articles
Reports - Research
Descriptors: Behavior Rating Scales, Adjustment (to Environment), Student Behavior, Autism, Pervasive Developmental Disorders, Screening Tests, Accuracy, Scores, Test Validity
Assessment and Survey Identifiers: Vineland Adaptive Behavior Scales, Adaptive Behavior Scale
DOI: 10.1007/s10803-020-04597-y
ISSN: 0162-3257
Abstract: We examined the correlation between interviewer-administered Vineland Adaptive Behavior Scale II (VABS-II) and the parent-rated Adaptive Behavior Assessment System II (ABAS-II) questionnaire in 352 participants (ages 1.5-20.8 years) with autism spectrum disorder (ASD) to determine if ABAS could be used as a screen to reduce the number of VABS interviews. Corresponding domain scores between the two measures were highly correlated but scores were significantly lower on the ABAS-II. Screening with ABAS-II significantly reduced the number of VABS-II interviews required with little cost to overall accuracy. The ABAS-II provides a cost- and time-saving alternative to the VABS-II to rule out functional impairment; however, scores are not strictly comparable between the two measures.
Abstractor: As Provided
Entry Date: 2021
Accession Number: EJ1294371
Database: ERIC
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  Value: <anid>AN0150063268;aut01may.21;2021May03.02:16;v2.2.500</anid> <title id="AN0150063268-1">Concurrent Validity of the ABAS-II Questionnaire with the Vineland II Interview for Adaptive Behavior in a Pediatric ASD Sample: High Correspondence Despite Systematically Lower Scores </title> <p>We examined the correlation between interviewer-administered Vineland Adaptive Behavior Scale II (VABS-II) and the parent-rated Adaptive Behavior Assessment System II (ABAS-II) questionnaire in 352 participants (ages 1.5–20.8 years) with autism spectrum disorder (ASD) to determine if ABAS could be used as a screen to reduce the number of VABS interviews. Corresponding domain scores between the two measures were highly correlated but scores were significantly lower on the ABAS-II. Screening with ABAS-II significantly reduced the number of VABS-II interviews required with little cost to overall accuracy. The ABAS-II provides a cost- and time-saving alternative to the VABS-II to rule out functional impairment; however, scores are not strictly comparable between the two measures.</p> <p>Keywords: ABAS; Vineland; Autism spectrum disorder; Children; Adaptive behaviors</p> <p>Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10803-020-04597-y) contains supplementary material, which is available to authorized users.</p> <hd id="AN0150063268-2">Introduction</hd> <p>Adaptive behaviors refer to the skills needed to perform tasks of day to day living related to real life competence. Measurement of adaptive functioning has taken on added importance because of its increasing role in the diagnosis of intellectual and developmental disabilities, in determining eligibility for specialized services and programs, in treatment planning and monitoring, in assessment of functional impairment in research and in diagnosis. In the previous version of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association [<reflink idref="bib2" id="ref1">2</reflink>]), over 70% of conditions required evidence of significant functional impairment (Goldstein and Naglieri [<reflink idref="bib8" id="ref2">8</reflink>]). The DSM-5 (American Psychiatric Association [<reflink idref="bib3" id="ref3">3</reflink>]) extends this approach, with most diagnoses requiring that "the disturbance cause(s) clinically significant distress or impairment in social, occupational, or other important areas of functioning". The increased focus on assessing impairment across mental health disorders has increased usage of existing adaptive behavior measures in diagnosis of disorders ranging from attention-deficit/hyperactivity disorder (ADHD; Yerys et al. [<reflink idref="bib26" id="ref4">26</reflink>]), specific learning disorder (Balboni et al. [<reflink idref="bib5" id="ref5">5</reflink>]), and anorexia nervosa (Bentz et al. [<reflink idref="bib6" id="ref6">6</reflink>]), to medical conditions such as upper limb deficiency (Mano et al. [<reflink idref="bib14" id="ref7">14</reflink>]), cerebral palsy (Tan et al. [<reflink idref="bib23" id="ref8">23</reflink>]), and pediatric cardiac arrest (Silverstein et al. [<reflink idref="bib20" id="ref9">20</reflink>]). Measurement of impairment is particularly important in the assessment and diagnosis of autism spectrum disorder (ASD). DSM-5 combines former categories for autistic disorder (autism), Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorders not otherwise specified into one diagnosis, ASD, but involves specification of severity, functional impairment, and required support. Consequently, there is a clear need to identify a valid and cost-effective measure of functional impairment for use in research and clinical practice.</p> <p>Two of the most commonly used measures of adaptive behaviors are the Vineland Adaptive Behavior Scales II (VABS-II; Sparow et al. [<reflink idref="bib21" id="ref10">21</reflink>]) parent/primary caregiver interview and the Adaptive Behavior Assessment System II (ABAS-II; Harrison and Oakland [<reflink idref="bib9" id="ref11">9</reflink>]) parent/primary caregiver questionnaire. For these reasons, we conducted the first study to examine the concurrent validity of the ABAS-II parent/primary caregiver questionnaire and the VABS-II parent/primary caregiver interview. We evaluated the ABAS-II by comparing it to the VABS-II interview which is often considered the "gold standard" in that it is based on an interview. The VABS-II interview is administered by a Masters in psychology or equivalent whereas the ABAS-II is a questionnaire completed by a knowledgeable informant, in this study, a parent; consequently, the measures differ considerably in training required for administration, cost and time. Both measures incorporate the conceptual framework of adaptive behavior domains described by the American Association on Intellectual and Developmental Disabilities (AAIDD), previously the American Association of Mental Retardation (AAMR). We chose to study the ABAS-II questionnaire because it is the only one that utilizes the ten adaptive skills cited in the AAIDD 1992 framework incorporated in the DSM-IV-TR (American Psychiatric Association [<reflink idref="bib2" id="ref12">2</reflink>]).</p> <p>To date, there are no direct comparisons of adaptive behavior scores on the VABS-II interview and the ABAS-II questionnaires, but there have been a few comparing the VABS-II questionnaire to the ABAS-II questionnaire. The VABS-II criterion validity studies included a comparison of the parent/self-questionnaire to the ABAS-II parent- and self-rated questionnaires across a typically developing sample of 197 individuals aged 1–74 resulting in moderate to high correlations between the two measures and no evidence of systematic differences in mean scores among the children and youth (Sparow et al. [<reflink idref="bib21" id="ref13">21</reflink>]). Within a sample of children aged 6–11 with high functioning autism (Lopata et al. [<reflink idref="bib13" id="ref14">13</reflink>]), significantly higher VABS-II questionnaire scores compared to the ABAS-II were observed across the composite and all conceptually similar subdomains and domains, with the exception of the VABS-II socialization domain and ABAS-II social domains which had similar mean scores. Given that level of functional impairment is a critical component of the assessment and diagnosis of ASD, it is important to compare the gold standard VABS-II interview with the ABAS-II questionnaire in an ASD sample.</p> <p>In this study, we evaluate the agreement and systematic differences between scores obtained on parent rated ABAS-II questionnaires and those obtained on the VABS-II interview administered by a psychologist in an ASD sample in order to inform clinical decisions and interpretation of research. This study (<reflink idref="bib1" id="ref15">1</reflink>) assessed the criterion validity of the ABAS-II parent questionnaire by comparing it to the gold standard VABS-II interview in a large ASD sample, (<reflink idref="bib2" id="ref16">2</reflink>) examined the association between age (divergent validity), as well as IQ, severity of autistic symptomatology and ADHD trait scores with adaptive functioning to determine whether they are sensitive to variation in these traits as expected (convergent validity), and (<reflink idref="bib3" id="ref17">3</reflink>) evaluated the usefulness of the ABAS-II questionnaire to rule out functional impairment as determined by the gold standard VABS-II interview as the first step in a two-stage screening procedure.</p> <hd id="AN0150063268-3">Methods</hd> <p></p> <hd id="AN0150063268-4">Participants</hd> <p>The study included participants with a primary diagnosis of ASD enrolled in the Ontario Brain Institute Province of Ontario Neurodevelopmental Disorders (OBI-POND) network, a research collaboration including several child mental health institutions between February 2012 and September 2015.</p> <hd id="AN0150063268-5">Measures</hd> <p>The ABAS-II is a questionnaire consisting of eleven skill areas organized into three general domains: conceptual, practical, and social (Harrison and Oakland [<reflink idref="bib9" id="ref18">9</reflink>]). The optional Work skill area available for adolescents and adults was not completed in this study. The composite and domain scores are standard scores with a norm referenced mean of 100 and standard deviation of 15; skill area scores have a mean of 10 and standard deviation of 3. Items are rated on a four-point scale ranging from 0 = <emph>Is not able</emph> to 3 = <emph>Always/almost always</emph>.</p> <p>The VABS-II uses a semi-structured interview consisting of eleven subdomains organized into four domains: communication, daily living skills, socialization, motor skills (birth to age 6), and one optional domain: maladaptive behaviors (Sparow et al. [<reflink idref="bib21" id="ref19">21</reflink>]). The motor skill (gross and fine motor skills) and maladaptive (internalizing and externalizing behaviors) domains were not examined in the present study as there are no corresponding domains in the ABAS; however, the motor skills domain was included in the calculation of the composite score for children birth to age 6. The composite and domain scores are standard scores with a normative mean of 100 and standard deviation of 15. Subdomain v scores have a mean of 15 and standard deviation of 3. Items are scored on a 3-point scale: 0 = <emph>Behavior Never Performed</emph>, 1 = <emph>Behavior Sometimes or Partially Performed</emph>, and 2 = <emph>Behavior Usually or Habitually Performed</emph>. Following observation and supervised administration, trainees with a Masters in psychology or equivalent administered the VABS-II interview independently when their accuracy with a supervisor exceeded 80%.</p> <p>IQ was assessed in various ways depending on the child's age and general level of functioning using the Wechsler Abbreviated Scale of Intelligence (WASI n = 21, WASI2-2 n = 1, WASI2-4 n = 150), the Wechsler Intelligence Scale of Children-IV (n = 14), the Wechsler Preschool and Primary Scale of Intelligence (n = 20), the Stanford Binet Intelligence Scales (n = 75), or the Mullen Scales of Early Learning (n = 44). Nonverbal children were assessed using the Leiter International Performance Scale-Revised (n = 12).</p> <p>The Social Communication Questionnaire (SCQ; Rutter et al. [<reflink idref="bib16" id="ref20">16</reflink>]) was used to measure ASD symptoms. The SCQ is a parent-rated questionnaire developed to parallel the Autism Diagnostic Interview-Revised (ADI-R) (Rutter et al. [<reflink idref="bib17" id="ref21">17</reflink>]). It consists of forty items spanning reciprocal social interaction, communication, and repetitive behavior domains, with each item scored as the presence/absence of abnormal behavior.</p> <p>Eighteen items from the inattentive and hyperactive/impulsive subscales of the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN; Swanson et al. [<reflink idref="bib22" id="ref22">22</reflink>]) were used to measure ADHD trait levels. Items are scored on a 7-point Likert-type scale, ranging from "strength" to "weakness" (−3 = <emph>far below average</emph> to +3 = <emph>far above average</emph>). SWAN scores were reversed so that higher scores represented greater ADHD traits.</p> <hd id="AN0150063268-6">Analyses</hd> <p>Statistical analyses were conducted using SAS v9.3 (SAS Institute Inc., [<reflink idref="bib18" id="ref23">18</reflink>]) and figures, including local regression smoothing curves, were created using R 3.2.2 (The R Foundation for Statistical Computing [<reflink idref="bib24" id="ref24">24</reflink>]). VABS-II v-Scale scores were converted to standard scores (<emph>M </emph>= 10, <emph>SD </emph>= 3) for consistency and ease of comparison with the ABAS-II.</p> <hd id="AN0150063268-7">Criterion Validity</hd> <p>Pearson correlations and their 95% confidence limits were calculated between all pairs of composite, domain, and subdomain/skill area scores on the VABS-II and ABAS-II. Mean differences were tested using paired t-tests for composite and domain scores and Wilcoxon Sign Rank tests for subdomain/skill area scores. Finally, we used local regression smoothing curves (Cleveland et al. [<reflink idref="bib7" id="ref25">7</reflink>]) to predict VABS-II scores for a given ABAS-II score and plotted the resulting curves and their 95% confidence interval (confidence limit for the mean) and 95% prediction interval (confidence limit for an individual value).</p> <hd id="AN0150063268-8">Convergent and Divergent Validity</hd> <p>Linear regression (PROC REG, SAS v9.3) of each composite and domain score was used to estimate the univariable and multivariable model coefficient of determination for age, IQ, SCQ, and SWAN scores. The coefficient of determination represents the proportion of the total variance in the outcome that is explained by the individual variable and by the full, multivariable model. Because of shared variance across the independent variables, the total variance explained by the multivariable model is not equal to the sum of the univariable coefficients of determination. Rather, the individual variables' unique contributions to the total variance explained by the model was estimated using the semipartial ω<sups>2</sups>. We expected moderate correlation between adaptive behavior scores and IQ, SCQ, and SWAN scores (convergent validity), but low correlation with age (divergent validity).</p> <hd id="AN0150063268-9">Two-Stage Screening Procedure</hd> <p>We first classified participants into adaptive functioning levels according to their VABS-II and ABAS-II composite scores and used Fisher's Exact Test to test for deviations in the distribution of adaptive functioning levels between the two measures. We then estimated the sensitivity of a two-stage screening procedure to classify participants into the lowest adaptive functioning level as determined by the VABS-II classification, and the reduction in numbers requiring a gold standard VABS-II interview across a range of ABAS-II cut-off scores.</p> <hd id="AN0150063268-10">Results</hd> <p>Five hundred twenty-eight participants with a primary diagnosis of ASD were enrolled in POND at the time of data analyses. Of these, 352 (276 males, 78%) had parents who completed both the VABS-II interview and the ABAS-II questionnaire and were included in the study. Participants had a mean age of 9.9 years (range 1.5–20.8 years). IQ was assessed in 295 of the 323 participants with an estimated mean IQ of 80.9 (95% CL 78.0; 83.8) and a range of 19-146. IQ and age were similarly distributed among the participants excluded from analysis because of missing VABS-II interview and/or ABAS-II questionnaire (mean age: 10.0 years, 95% CL: 9.3;10.7; mean IQ: 77.8, 95% CL: 72.8; 82.9).</p> <hd id="AN0150063268-11">Criterion Validity</hd> <p>The Pearson correlation of 0.78 for the composite scores (Table 1) on each scale indicated a high overall correspondence between the two measures. The correlations between conceptually similar domains ranged from 0.66 to 0.77, although both the VABS-II daily living and socialization domains showed marginally higher correlations with the ABAS-II conceptual domain than with their corresponding ABAS-II domains. Of note, the correlation between the VABS-II community subdomain and ABAS-II functional academics skill area was 0.73, higher than its correlation with the conceptually similar ABAS-II community use skill area.</p> <p>Table 1 Pearson Correlation coefficients (95% CL) between pairs of VABS-II and ABAS-II domain, subdomain, and composite scores</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="3"><p>Vineland</p></th><th align="left" rowspan="3"><p>Composite</p></th><th align="left" colspan="9"><p>ABAS</p></th></tr><tr><th align="left" colspan="3"><p>Conceptual</p></th><th align="left" colspan="4"><p>Practical</p></th><th align="left" colspan="2"><p>Social</p></th></tr><tr><th align="left"><p>Communication</p></th><th align="left"><p>Functional Academics</p></th><th align="left"><p>Self- Direction</p></th><th align="left"><p>Community Use</p></th><th align="left"><p>Home Living</p></th><th align="left"><p>Health & Safety</p></th><th align="left"><p>Self-Care</p></th><th align="left"><p>Leisure</p></th><th align="left"><p>Social</p></th></tr></thead><tbody><tr><td align="left"><p><bold>Composite</bold></p></td><td char="(" align="char"><p><italic>0.78 (0.74;0.82)</italic></p></td><td char="(" align="char" colspan="3"><p>0.78 (0.74;0.82)</p></td><td char="(" align="char" colspan="4"><p>0.68 (0.62;0.73)</p></td><td char="(" align="char" colspan="2"><p>0.65 (0.58;0.70)</p></td></tr><tr><td align="left"><p><bold>Communication</bold></p></td><td char="(" align="char"><p>0.74 (0.68;0.78)</p></td><td char="(" align="char" colspan="3"><p><italic>0.77 (0.73;0.81)</italic></p></td><td char="(" align="char" colspan="4"><p>0.62 (0.55;0.68)</p></td><td char="(" align="char" colspan="2"><p>0.61 (0.54;0.67)</p></td></tr><tr><td align="left"><p> Expressive</p></td><td align="left" /><td char="(" align="char"><p><italic>0.70 (0.64;0.75)</italic></p></td><td char="(" align="char"><p>0.70 (0.65;0.75)</p></td><td char="(" align="char"><p>0.54 (0.46;0.61)</p></td><td char="(" align="char"><p>0.64 (0.57;0.70)</p></td><td char="(" align="char"><p>0.40 (0.31;0.48)</p></td><td char="(" align="char"><p>0.55 (0.47;0.62)</p></td><td char="(" align="char"><p>0.45 (0.37;0.53)</p></td><td char="(" align="char"><p>0.62 (0.56;0.68)</p></td><td char="(" align="char"><p>0.52 (0.44;0.60)</p></td></tr><tr><td align="left"><p> Receptive</p></td><td align="left" /><td char="(" align="char"><p><italic>0.56 (0.49;0.63)</italic></p></td><td char="(" align="char"><p>0.61 (0.54;0.67)</p></td><td char="(" align="char"><p>0.51 (0.43;0.58)</p></td><td char="(" align="char"><p>0.52 (0.44;0.59)</p></td><td char="(" align="char"><p>0.43 (0.34;0.51)</p></td><td char="(" align="char"><p>0.47 (0.38;0.55)</p></td><td char="(" align="char"><p>0.42 (0.33;0.51)</p></td><td char="(" align="char"><p>0.58 (0.51;0.65)</p></td><td char="(" align="char"><p>0.47 (0.39;0.55)</p></td></tr><tr><td align="left"><p> Written</p></td><td align="left" /><td char="(" align="char"><p>0.55 (0.47;0.62)</p></td><td char="(" align="char"><p><italic>0.73 (0.68;0.78)</italic></p></td><td char="(" align="char"><p>0.53 (0.44;0.60)</p></td><td char="(" align="char"><p>0.54 (0.45;0.61)</p></td><td char="(" align="char"><p>0.40 (0.30;0.48)</p></td><td char="(" align="char"><p>0.43 (0.33;0.51)</p></td><td char="(" align="char"><p>0.34 (0.24;0.43)</p></td><td char="(" align="char"><p>0.53 (0.44;0.60)</p></td><td char="(" align="char"><p>0.44 (0.35;0.52)</p></td></tr><tr><td align="left"><p><bold>Daily Living Skills</bold></p></td><td char="(" align="char"><p>0.75 (0.70;0.79)</p></td><td char="(" align="char" colspan="3"><p>0.75 (0.70;0.79)</p></td><td char="(" align="char" colspan="4"><p><italic>0.70 (0.65;0.75)</italic></p></td><td char="(" align="char" colspan="2"><p>0.56 (0.48;0.62)</p></td></tr><tr><td align="left"><p> Community</p></td><td align="left" /><td char="(" align="char"><p>0.68 (0.61;0.73)</p></td><td char="(" align="char"><p>0.73 (0.67;0.77)</p></td><td char="(" align="char"><p>0.57 (0.50;0.63)</p></td><td char="(" align="char"><p><italic>0.65 (0.58;0.70)</italic></p></td><td char="(" align="char"><p>0.44 (0.35;0.52)</p></td><td char="(" align="char"><p>0.58 (0.50;0.64)</p></td><td char="(" align="char"><p>0.43 (0.34;0.51)</p></td><td char="(" align="char"><p>0.63 (0.57;0.69)</p></td><td char="(" align="char"><p>0.49 (0.41;0.56)</p></td></tr><tr><td align="left"><p> Domestic</p></td><td align="left" /><td char="(" align="char"><p>0.40 (0.31;0.49)</p></td><td char="(" align="char"><p>0.50 (0.41;0.57)</p></td><td char="(" align="char"><p>0.42 (0.33;0.50)</p></td><td char="(" align="char"><p>0.46 (0.37;0.54)</p></td><td char="(" align="char"><p><italic>0.53 (0.45;0.60)</italic></p></td><td char="(" align="char"><p>0.43 (0.34;0.51)</p></td><td char="(" align="char"><p>0.44 (0.35;0.52)</p></td><td char="(" align="char"><p>0.44 (0.35;0.52)</p></td><td char="(" align="char"><p>0.38 (0.29;0.47)</p></td></tr><tr><td align="left"><p> Personal behavior</p></td><td align="left" /><td char="(" align="char"><p>0.56 (0.49;0.63)</p></td><td char="(" align="char"><p>0.57 (0.50;0.64)</p></td><td char="(" align="char"><p>0.49 (0.41;0.57)</p></td><td char="(" align="char"><p>0.61 (0.53;0.67)</p></td><td char="(" align="char"><p>0.50 (0.41;0.57)</p></td><td char="(" align="char"><p><italic>0.60 (0.53;0.66)</italic></p></td><td char="(" align="char"><p><italic>0.59 (0.51;0.65)</italic></p></td><td char="(" align="char"><p>0.55 (0.47;0.62)</p></td><td char="(" align="char"><p>0.41 (0.32;0.50)</p></td></tr><tr><td align="left"><p><bold>Socialization</bold></p></td><td char="(" align="char"><p>0.71 (0.65;0.75)</p></td><td char="(" align="char" colspan="3"><p>0.68 (0.62;0.73)</p></td><td char="(" align="char" colspan="4"><p>0.59 (0.52;0.65)</p></td><td char="(" align="char" colspan="2"><p><italic>0.66 (0.60;0.72)</italic></p></td></tr><tr><td align="left"><p> Coping</p></td><td align="left" /><td char="(" align="char"><p>0.50 (0.41;0.57)</p></td><td char="(" align="char"><p>0.50 (0.41;0.57)</p></td><td char="(" align="char"><p>0.49 (0.41;0.57)</p></td><td char="(" align="char"><p>0.46 (0.37;0.53)</p></td><td char="(" align="char"><p>0.37 (0.28;0.46)</p></td><td char="(" align="char"><p>0.44 (0.35;0.52)</p></td><td char="(" align="char"><p>0.38 (0.29;0.47)</p></td><td char="(" align="char"><p>0.49 (0.41;0.57)</p></td><td char="(" align="char"><p>0.49 (0.41;0.57)</p></td></tr><tr><td align="left"><p> Play and leisure</p></td><td align="left" /><td char="(" align="char"><p>0.61 (0.54;0.67)</p></td><td char="(" align="char"><p>0.62 (0.55;0.68)</p></td><td char="(" align="char"><p>0.55 (0.47;0.62)</p></td><td char="(" align="char"><p>0.58 (0.51;0.65)</p></td><td char="(" align="char"><p>0.45 (0.36;0.53)</p></td><td char="(" align="char"><p>0.52 (0.43;0.59)</p></td><td char="(" align="char"><p>0.48 (0.39;0.55)</p></td><td char="(" align="char"><p><italic>0.67 (0.60;0.72)</italic></p></td><td char="(" align="char"><p>0.58 (0.50;0.64)</p></td></tr><tr><td align="left"><p> Interpersonal</p></td><td align="left" /><td char="(" align="char"><p>0.58 (0.50;0.64)</p></td><td char="(" align="char"><p>0.57 (0.49;0.63)</p></td><td char="(" align="char"><p>0.49 (0.40;0.56)</p></td><td char="(" align="char"><p>0.48 (0.40;0.56)</p></td><td char="(" align="char"><p>0.40 (0.31;0.48)</p></td><td char="(" align="char"><p>0.46 (0.37;0.54)</p></td><td char="(" align="char"><p>0.41 (0.32;0.50)</p></td><td char="(" align="char"><p>0.65 (0.58;0.70)</p></td><td char="(" align="char"><p><italic>0.63 (0.56;0.69)</italic></p></td></tr></tbody></table> </ephtml> </p> <p>Italicized cells represent conceptually similar domains and subdomains</p> <p>The mean ABAS-II composite score was 9.2 points lower than the mean VABS-II composite (t(df) = 16.40(<reflink idref="bib351" id="ref26">351</reflink>), <emph>p </emph>< 0.0001, Table 2), with lower mean scores on the ABAS-II than on the VABS-II across all domains. These differences ranged from 2.4 between the VABS-II Socialization score and the ABAS-II Social score (t(df) = 3.64(<reflink idref="bib351" id="ref27">351</reflink>), <emph>p </emph>= 0.0003) to 12.1 between the VABS-II Daily Living Skills score and the ABAS-II Practical score (t(df) = 16.71(<reflink idref="bib351" id="ref28">351</reflink>), <emph>p </emph>< 0.0001). Participants obtained the lowest scores on the socialization domain on the VABS-II, in contrast to the ABAS-II where the lowest scores were obtained in the practical domain. VABS-II subdomain scores were significantly higher than their corresponding ABAS-II skill area with the exception of the play and leisure subdomain on the VABS-II compared to the leisure skill area on the ABAS-II (4.7 vs 4.9, t(df) = − 1.59(<reflink idref="bib350" id="ref29">350</reflink>), <emph>p </emph>= 0.07); the personal subdomain on the VABS-II and the health and safety skill area on the ABAS-II (5.0 vs 4.8, t(df) = 1.45(<reflink idref="bib350" id="ref30">350</reflink>), <emph>p </emph>= 0.06); and the expressive communication subdomain on the VABS-II and the communication skill area on the ABAS-II (4.6 vs 4.3, t(df) = 2.44(<reflink idref="bib350" id="ref31">350</reflink>), <emph>p </emph>= 0.02) where no significant differences were found (using a Bonferroni corrected <emph>p</emph> value of 0.05/13 = 0.004 as the cut-off for significance). The largest subdomain/skill area difference, 2.4, was observed between the domestic subdomain on the VABS-II and the home living skill area on the ABAS-II. Local regression smoothing curves of VABS-II domain scores vs ABAS-II domain scores (Supplementary Fig. 1) revealed minimal bias in predicted VABS-II Socialization and Conceptual scores across the full range of corresponding ABAS-II domain scores, but increasing bias in VABS-II Daily Living Skills estimates across ABAS-II Practical scores below 80, with increasing score differences at lower practical scores.</p> <p>Table 2 Mean subdomain, domain, and composite scores on the VABS-II and ABAS-II. VABS-II v scores were converted to standard scores (M = 10, SD = 3) for ease of comparison</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>VABS-II</p></th><th align="left"><p>Mean (95% CL)</p></th><th align="left"><p>ABAS-II</p></th><th align="left"><p>Mean (95% CL)</p></th><th align="left"><p>Difference (95% CL)</p></th><th align="left"><p>p value</p></th></tr></thead><tbody><tr><td align="left"><p><bold>Communication</bold></p></td><td char="(" align="char"><p><bold>75.4 (73.5;77.3)</bold></p></td><td align="left"><p><bold>Conceptual</bold></p></td><td char="(" align="char"><p><bold>69.6 (67.9;71.4)</bold></p></td><td char="(" align="char"><p><bold>5.8 (4.6;7.0)</bold></p></td><td char="." align="char"><p><bold>< 0.0001</bold></p></td></tr><tr><td align="left"><p> Receptive</p></td><td char="(" align="char"><p>5.6 (5.2;5.9)</p></td><td align="left" rowspan="2"><p> Communication</p></td><td char="(" align="char" rowspan="2"><p>4.3 (4.0;4.6)</p></td><td char="(" align="char"><p>1.3 (1.0;1.6)</p></td><td char="." align="char"><p>< 0.0001</p></td></tr><tr><td align="left"><p> Expressive</p></td><td char="(" align="char"><p>4.6 (4.3;5.0)</p></td><td char="(" align="char"><p>0.4 (0.1;0.6)</p></td><td char="." align="char"><p>0.02</p></td></tr><tr><td align="left"><p> Written</p></td><td char="(" align="char"><p>6.8 (6.3;7.2)</p></td><td align="left"><p> Functional academics</p></td><td char="(" align="char"><p>5.6 (5.2;6.0)</p></td><td char="(" align="char"><p>1.3 (1.0;1.6)</p></td><td char="." align="char"><p>< 0.0001</p></td></tr><tr><td align="left" /><td align="left" /><td align="left"><p> Self-direction</p></td><td char="(" align="char"><p>3.9 (3.5;4.2)</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p><bold>Daily Living</bold></p></td><td char="(" align="char"><p><bold>75.3 (73.6;77.0)</bold></p></td><td align="left"><p><bold>Practical</bold></p></td><td char="(" align="char"><p><bold>63.2 (61.3;65.1)</bold></p></td><td char="(" align="char"><p><bold>12.1 (10.7;13.5)</bold></p></td><td char="." align="char"><p><bold>< 0.0001</bold></p></td></tr><tr><td align="left" rowspan="2"><p> Personal</p></td><td char="(" align="char" rowspan="2"><p>5.0 (4.7;5.4)</p></td><td align="left"><p> Self-care</p></td><td char="(" align="char"><p>3.8 (3.5;4.1)</p></td><td char="(" align="char"><p>1.3 (1.0;1.5)</p></td><td char="." align="char"><p>< 0.0001</p></td></tr><tr><td align="left"><p> Health and safety</p></td><td char="(" align="char"><p>4.8 (4.4;5.2)</p></td><td char="(" align="char"><p>0.2 (-0.1;0.6)</p></td><td char="." align="char"><p>0.06</p></td></tr><tr><td align="left"><p> Domestic</p></td><td char="(" align="char"><p>6.1 (5.7;6.4)</p></td><td align="left"><p> Home living</p></td><td char="(" align="char"><p>3.7 (3.3;4.0)</p></td><td char="(" align="char"><p>2.4 (2.1;2.7)</p></td><td char="." align="char"><p>< 0.0001</p></td></tr><tr><td align="left"><p> Community</p></td><td char="(" align="char"><p>6.0 (5.6;6.4)</p></td><td align="left"><p> Community use</p></td><td char="(" align="char"><p>4.6 (4.3;5.0)</p></td><td char="(" align="char"><p>1.3 (1.0;1.7)</p></td><td char="." align="char"><p>< 0.0001</p></td></tr><tr><td align="left"><p><bold>Socialization</bold></p></td><td char="(" align="char"><p><bold>71.4 (69.7;73.1)</bold></p></td><td align="left"><p><bold>Social</bold></p></td><td char="(" align="char"><p><bold>69.0 (67.6;70.4)</bold></p></td><td char="(" align="char"><p><bold>2.4 (1.1;3.7)</bold></p></td><td char="." align="char"><p><bold>0.0003</bold></p></td></tr><tr><td align="left"><p> Interpersonal</p></td><td char="(" align="char"><p>4.0 (3.6;4.3)</p></td><td align="left"><p> Social</p></td><td char="(" align="char"><p>3.2 (2.9;3.5)</p></td><td char="(" align="char"><p>0.8 (0.5;1.0)</p></td><td char="." align="char"><p>< 0.0001</p></td></tr><tr><td align="left"><p> Play and leisure</p></td><td char="(" align="char"><p>4.7 (4.3;5.1)</p></td><td align="left"><p> Leisure</p></td><td char="(" align="char"><p>4.9 (4.6;5.2)</p></td><td char="(" align="char"><p>− 0.2 (− 0.5;0.1)</p></td><td char="." align="char"><p>0.07</p></td></tr><tr><td align="left"><p> Coping</p></td><td char="(" align="char"><p>5.6 (5.3;6.0)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p><bold>Composite</bold></p></td><td char="(" align="char"><p><bold>72.4 (70.8;74.0)</bold></p></td><td align="left"><p><bold>Composite</bold></p></td><td char="(" align="char"><p><bold>63.2 (61.5;64.9)</bold></p></td><td char="(" align="char"><p><bold>9.2 (8.1;10.3)</bold></p></td><td char="." align="char"><p><bold>< 0.0001</bold></p></td></tr></tbody></table> </ephtml> </p> <p>Differences were assessed using t-tests for composite and domain scores and Wilcoxon Sign Rank tests between conceptually similar subdomains. A Bonferroni adjusted p value of 0.004 is used for statistical significance</p> <hd id="AN0150063268-12">Convergent and Divergent Validity</hd> <p>Commonality analysis was used to estimate the variance (coefficient of determination) in domain scores explained by age, IQ, SWAN, and SCQ scores (Fig. 1). The coefficient of determination was greater for all VABS-II models than for ABAS-II, with the highest values for the Communication/Conceptual domains. This discrepancy between measures was driven by the much greater proportion of variance explained by IQ in the VABS-II than the ABAS-II (VABS-II Socialization 27.6% vs ABAS-II Social 16.5%; VABS-II Communication 50.8% vs ABAS-II Conceptual 45.2%; VABS-II Daily Living 40.4% vs ABAS-II Practical 26.4%). IQ showed the least association with the Socialization/Social domain across both scales, in contrast with the SCQ and SWAN which showed the highest association with these scores (unique percentage of VABS-II Socialization variance explained by SCQ = 9.0%, SWAN = 6.1%; ABAS-II Social, SCQ = 12.3%, SWAN = 3.2%). Of note, local regression smoothing curves of adaptive functioning scores vs IQ revealed a nonlinear relationship, with greater association between IQ and adaptive functioning at lower IQs but minimal association at higher IQs (Supplementary Fig. 2).</p> <p>Graph: Fig. 1 Percentage of total variance in adaptive behavior domain and composite scores explained by age, IQ, SCQ and SWAN scores in a multiple linear regression model (coefficient of determination, R2). Unique variance: semipartial ω2 Venn diagram represents shared and unique variance (commonality analysis) explained by each variable, with the total given as a separate, rectangular label. Other variables had negligible shared variance with age</p> <p>Graph: Fig. 2 Number of individuals with ASD in a sample of 1000 who would move on to stage 2 testing with a VABS-II interview across a range of ABAS-II cut-off scores. 42.9% of the study sample would be classified as having a low level of adaptive functioning based on the VABS-II gold standard testing. The sensitivity of two stage testing across a range of cut-offs is represented by the thick line and shown along the right y-axis. The left y-axis corresponds to the number of individuals identified. Using our study sample prevalence of low adaptive functioning of 42.9% (established using the gold standard VABS-II interview), a hypothetical sample of 1000 individuals with ASD would include 429 with low adaptive functioning. The thin black line indicates the number of people flagged as requiring further testing following initial screening with the ABAS-II across a range of general composite score cut-offs. For example, if using a cut-off of 60,426 individuals would proceed to stage 2 testing; a cut-off of 70 would require further testing in 673. The thick black line indicates the number of people who would go on to meet criteria for low adaptive functioning based on a VABS-II interview, among those who would proceed to stage 2 testing. For example, at a cut-off of 66 on the ABAS-II, 571 individuals would proceed to stage 2 testing of whom 399 would meet criteria for low adaptive functioning, for a positive predictive value of 399/571 = 69.9%. As the total number with low adaptive functioning in this hypothetical sample is 429, the sensitivity of this 2-stage procedure would be 399/429 = 93.0%</p> <p>As expected, the proportion of variance explained by age after controlling for all other covariates was minimal for all domains across both measures. However, where the variance explained by age was less than 1% across all ABAS-II domains, there was some evidence of residual association with age in the VABS-II, with 6.1% of the variance in the communication domain and 4.6% of the variance in the daily living domain explained by age only.</p> <hd id="AN0150063268-13">Two-Stage Screening Procedure</hd> <p>In typical clinical practice, adaptive functioning is classified into one of four categories. However, each scale classifies individuals using different cut-points. In order to determine if the two measures classified individuals in the same way, we divided participants into one of four adaptive level categories using the composite score cut-offs defined in the VABS-II manual (Sparow et al. [<reflink idref="bib21" id="ref32">21</reflink>], p. 64–65) and compared these categories to a similar classification of adaptive level in the ABAS-II. There were significant differences in the classification of adaptive level across the two measures (Fisher's Exact Test, p < 0.0001). Only 59.2% of the sample remained in the same classification category across both measures: 35.5% were classified in a relatively lower category according to the ABAS-II compared to only 5.4% classified in a relatively lower category on the VABS-II (Table 3). Similar results were found when participants were first classified into adaptive behavior categories using composite score cut-offs recommended in the ABAS-II manual. Both the VABS-II and the ABAS-II use the same cut-off to identify individuals with low adaptive functioning (≤ 70). Using VABS-II identified 151 children with low adaptive functioning out of a total of 352 participants (42.9%). Of these participants, 147 were also identified as having low adaptive functioning on the ABAS-II. However, an additional 91 participants with moderate to adequate adaptive functioning according to the VABS-II were also classified as "low" by the ABAS-II. This corresponds to a sensitivity of 97.4% (147/151) but a specificity of only 54.7% (110/201), satisfactory values for use of the ABAS-II as an initial screener within a two-stage diagnostic process.</p> <p>Table 3 Number of participants (%) classified in each adaptive behavior level using cut-offs recommended in the VABS-II manual (Sparow et al. [<reflink idref="bib21" id="ref33">21</reflink>], p. 64–65)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2"><p>ABAS-II composite</p></th><th align="left" colspan="3"><p>VABS-II composite</p></th><th align="left" /></tr><tr><th align="left"><p>Low ≤ 70</p></th><th align="left"><p>Moderately low 71–85</p></th><th align="left"><p>Adequate 86–114</p></th><th align="left"><p>Total</p></th></tr></thead><tbody><tr><td align="left"><p>Low ≤ 70</p></td><td char="(" align="char"><p>147 (61.8)</p></td><td char="(" align="char"><p>81 (34.0)</p></td><td char="(" align="char"><p>10 (4.2)</p></td><td char="." align="char"><p>238</p></td></tr><tr><td align="left"><p>Moderately low 71–85</p></td><td char="(" align="char"><p>4 (5.1)</p></td><td char="(" align="char"><p>40 (51.3)</p></td><td char="(" align="char"><p>34 (43.6)</p></td><td char="." align="char"><p>78</p></td></tr><tr><td align="left"><p>Adequate 86–114</p></td><td char="(" align="char"><p>0 (0)</p></td><td char="(" align="char"><p>15 (42.9)</p></td><td char="(" align="char"><p>20 (57.1)</p></td><td char="." align="char"><p>35</p></td></tr><tr><td align="left"><p>Moderately high 115–129</p></td><td char="(" align="char"><p>0 (0)</p></td><td char="(" align="char"><p>0 (0)</p></td><td char="(" align="char"><p>1 (100.0)</p></td><td char="." align="char"><p>1</p></td></tr></tbody></table> </ephtml> </p> <p>Percentages sum to 100% across rows</p> <p>We then explored the use of alternate cut-off values on the ABAS-II to identify those in need of further testing with the VABS-II interview (Fig. 2). The sensitivity of the ABAS-II increased rapidly through the lower cut-off values, with the curve flattening out at values of 66 at a sensitivity of 93.0%. In a sample of 1000, using a cut-off of 66 would identify 399 of 429 participants with low adaptive functioning (sensitivity of 93%) and require stage 2 testing in 571 participants, 172 of whom would not fall in the lowest adaptive functioning level on the VABS-II interview (specificity of 70%). Although the sensitivity of this strategy would vary across settings, depending on the sample characteristics, these results suggest that the application of the ABAS-II as a screening tool can help rule out functional impairment and reduce costs associated with more in-depth assessments.</p> <hd id="AN0150063268-14">Discussion</hd> <p>In this study, we evaluate the agreement and systematic differences between scores obtained on parent rated ABAS-II questionnaires and those obtained on the VABS-II interview administered by a psychologist in an ASD sample in order to inform clinical decisions and interpretation of research. Overall, the scales were moderately correlated across all conceptually similar domain and subdomain scores, with a marginally higher correlation coefficient (<emph>r </emph>= 0.78) between the ABAS-II and the VABS-II composite score than with the previous interview edition of the VABS (ABAS-II with VABS-IE <emph>r </emph>= 0.70; Harrison, 2003). However, systematic differences between the two scales resulted in significantly more participants falling in the low adaptive function range on the ABAS-II than on the VABS-II. The observed difference is not specific to the interview version of the VABS-II, as similar differences between the VABS Parent/Caregiver questionnaire and the ABAS-II were found by Lopata et al. ([<reflink idref="bib13" id="ref34">13</reflink>]) in a sample of children with high functioning autism. Consistent with the findings of Lopata, the play and leisure domain of the VABS-II was the only comparison where scores were lower than on the corresponding ABAS-II domain, although the difference was not statistically significant in this sample.</p> <p>The overall high correspondence between the VABS-II interview and the ABAS-II supports the use of the latter scale within a research context, as the rank ordering of participants is moderately well preserved. However, care should be taken if the ABAS-II is used in a clinical setting for diagnostic purposes. The ABAS-II demonstrated high sensitivity, but relatively lower specificity when used to establish impaired adaptive functioning based on the established cut-offs (≤ 70).</p> <p>We found very high association between IQ and both measures of adaptive behavior with 46.6% of the variance in the VABS-II composite explained by IQ, of which 24.2% was over and above the variance shared with age, ASD symptoms (SCQ), and ADHD trait scores. This result is remarkably similar to values reported by Kanne et al. ([<reflink idref="bib11" id="ref35">11</reflink>]), who reported coefficient of determination values of 44% overall and 28% after controlling for autistic symptoms and age. The variance in the VABS-II composite explained by IQ is much higher than the 36.4% of variance (16.3% unique) in the ABAS-II composite explained by IQ. Given the high level of correlation between IQ and adaptive behavior scores across the two measures, care should be taken when controlling for both IQ and adaptive behavior scores in regression models due to the risk of collinearity. This is less of a concern in high IQ samples as we found a nonlinear relationship between IQ and adaptive functioning with lower association at higher IQ levels.</p> <p>The current study also found strong associations between ASD symptoms and adaptive functioning, with the SCQ accounting for over 30% of the variance in composite and Socialization/Social scores on both the VABS-II and the ABAS-II, and equally high values for the ABAS-II Conceptual Domain. Mixed results have been reported in previous work when looking at the association between ASD symptoms and adaptive behaviors. Klin et al. ([<reflink idref="bib12" id="ref36">12</reflink>]) reported weak correlations, with a maximum of 8% of variance explained (the square of the correlation) by the Autism Diagnostic Observation Schedule (ADOS) social scale on the VABS communication and social scales in their sample. Similarly, Kanne et al. ([<reflink idref="bib11" id="ref37">11</reflink>]) found poor association between VABS-II domain scores and ADOS severity scores; however, measures of association were higher between adaptive functioning domains and ADI-R domain scores, up to a high of 18% of the variance in the VABS-II Socialization domain explained by the ADI-R socialization score, and 21% when the Social Responsiveness Scale was used. These values are nevertheless still lower than our estimates. This may be due to the nature of the measures used to capture ASD symptoms; namely, the SCQ measures total ASD symptomatology (i.e., social-communication and behavioral symptoms) whereas Kanne et al. ([<reflink idref="bib11" id="ref38">11</reflink>]) reported associations only with ADI-R domain scores, which capture communication, social, and behavioral symptoms separately.</p> <p>Our results shed new light on the role of ADHD symptoms among individuals with a primary diagnosis of ASD. In the current sample of ASD participants, the severity of ADHD symptoms as measured with the SWAN predicted adaptive skills. Commonality analysis found that ADHD trait scores explained between 14.0 and 26.1% of the total variance across adaptive behavior domains but that most of the effect of SWAN scores overlapped with that of the SCQ and IQ. Similarly, Yerys et al. ([<reflink idref="bib26" id="ref39">26</reflink>]) and Ashwood et al. ([<reflink idref="bib4" id="ref40">4</reflink>]), found that the unique variance explained by ADHD was highest for the socialization domain on the VABS-II, the domain where IQ showed the least association. However, the three studies differ in the magnitude and significance of the effect. Yerys et al. ([<reflink idref="bib26" id="ref41">26</reflink>]) reported a larger unique ADHD variance component than the present study, which may be explained by their use of the ADOS to measure autistic symptoms which may have captured less of the shared variance between autistic severity and ADHD symptoms than the SCQ. In contrast, the ADHD effect on the VABS-II socialization domain observed by Ashwood et al. ([<reflink idref="bib4" id="ref42">4</reflink>]) was not statistically significant; however, the sample size for that study was small and may have been underpowered. The Ashwood et al. ([<reflink idref="bib4" id="ref43">4</reflink>]) finding contrasts with the findings of Sikora et al. ([<reflink idref="bib19" id="ref44">19</reflink>]) who reported small but consistent and highly significant ADHD effects across all adaptive functioning domains. The variation across studies in the amount of unique and total variance explained by ASD and ADHD symptomatology highlights the importance of choice of measurement scale used for these analyses and the need to take these into consideration when comparing results across studies. Given the high level of shared variance across IQ, autistic symptomatology, and ADHD traits, the use of a less optimal measure to assess any one of these three domains will result in an apparently higher unique contribution of the other two.</p> <p>Given that the association is based on correlation, it is not possible to determine whether ADHD symptoms impair adaptive function, arise as a result of low adaptive function or reflect a shared deficit, such as cognition. Either way, the association of ADHD traits and adaptive function has important clinical implications for individuals with high ADHD symptoms: one needs to use caution in interpreting low adaptive scores given high ADHD symptoms especially when considering a diagnosis of ID in addition to ASD.</p> <p>Our results show that, given its relatively low cost, the ABAS-II could be used as a screening tool prior to administering a more specific measure such as the VABS-II. Using a two-stage process, one could rule out low adaptive functioning in those individuals with ABAS-II scores above a particular cut-off. One would proceed with further testing on the VABS-II in those with ABAS-II scores below the cutoff. The major cost of this approach would arise from the imperfect sensitivity of the ABAS-II resulting in some individuals classified as having low adaptive functioning on the VABS-II being screened negative by the ABAS-II. The benefit would be that far fewer individuals would have to be assessed using the VABS-II. If one wanted to miss fewer cases, one could increase the cutoff on the ABAS-II. The cost would be that an increasing number of individuals would have to be assessed on the VABS-II.</p> <p>New versions of the VABS and ABAS for establishing level of adaptive functioning are now available. Further study will be required to determine if these changes impact the conclusions of this study. While both scales retain the same domain and subdomain structures as their previous versions, items on the ABAS-III have been reorganized which may alter ABAS-III domain correlations with VABS-III. However, we do not anticipate that revisions to either scale will substantially alter the central findings of this study.</p> <p>Although the VABS-II includes a motor skills domain in its form for children from birth to age 6, the ABAS-II assesses motor skills by way of a less comprehensive skills area from birth to age 5. Comparisons between the VABS-II motor skills domain and ABAS-II motor skills area were not conducted as part of this study. Research examining motor skills deficits in ASD has tended to rely on scales other than the VABS-II, including the Movement Assessment Battery for Children 2 (Ament et al. [<reflink idref="bib1" id="ref45">1</reflink>]; McPhillips et al. [<reflink idref="bib15" id="ref46">15</reflink>]) and gait analyses (Hasan et al. [<reflink idref="bib10" id="ref47">10</reflink>]; Weiss et al. [<reflink idref="bib25" id="ref48">25</reflink>]).</p> <hd id="AN0150063268-15">Conclusion</hd> <p>The ABAS-II offers an economical and time-efficient alternative to the VABS-II, with high concordance of scores across domains. Nevertheless, scores are not directly equivalent, and lower scores on the ABAS-II contribute to variations in adaptive function classification from those obtained using the VABS-II. ABAS-II screening provides a cost-effective strategy for ruling out impaired adaptive functioning.</p> <hd id="AN0150063268-16">Acknowledgments</hd> <p>This research was supported by the grant IDS-I l-02 (Anagnostou, Lerch) from the Ontario Brain Institute. We thank all staff involved in data collection and families for volunteering their time and effort.</p> <hd id="AN0150063268-17">Author Contributions</hd> <p>AD, MM, RS and JC to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by AD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.</p> <hd id="AN0150063268-18">Funding</hd> <p>This research was supported by the grant IDS-I l-02 (Anagnostou, Lerch) from the Ontario Brain Institute.</p> <hd id="AN0150063268-19">Compliance with Ethical Standards</hd> <p></p> <hd id="AN0150063268-20">Conflict of interest</hd> <p>RS is the TD Bank Group Chair in Child and Adolescent Psychiatry, owns equity in Ehave, and has consulted for Highland Therapeutics, Purdue Pharma, E Lilly Corp and Ehave. EA has received consultation fees from ROCHe and Quadrant, royalties from APPI and Springer, research funding from ROCHe, in kind supports from AMO Pharma, and editorial honoraria from Wiley. EA holds a provisional patent for the device, "Anxiety Meter". RN has received grant funding from Hoffman-La Roche Limited. All other authors no conflicts to declare.</p> <hd id="AN0150063268-21">Ethical Approval</hd> <p>All procedures performed in this study involving human participants were in accordance with the ethical standards of Holland Bloorview Kids Rehabilitation Hospital, The Hospital for Sick Children, McMaster's Children's Hospital, and the Lawson Health Research Institute, as well as the National Council on Ethics in Human Research and with the 1964 Declaration of Helsinki and its later amendments. This study was approved by the Research Ethics Board of each institution: Holland Bloorview Kids Rehabilitation Hospital, The Hospital for Sick Children, McMaster's Children's Hospital, and the Lawson Health Research Institute.</p> <hd id="AN0150063268-22">Informed Consent</hd> <p>Informed consent, and verbal assent when applicable, approved by each institution's Research Ethics Board were obtained from all participants.</p> <hd id="AN0150063268-23">Electronic supplementary material</hd> <p>Below is the link to the electronic supplementary material.</p> <p>Graph: Supplementary material 1 (DOCX 248 kb)</p> <hd id="AN0150063268-24">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0150063268-25"> <title> References </title> <blist> <bibl id="bib1" idref="ref15" type="bt">1</bibl> <bibtext> Ament K, Mejia A, Buhlman R, Erklin S, Caffo B, Mostofsky S, Wodka E. 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  Data: Concurrent Validity of the ABAS-II Questionnaire with the Vineland II Interview for Adaptive Behavior in a Pediatric ASD Sample: High Correspondence Despite Systematically Lower Scores
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
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  Data: 10.1007/s10803-020-04597-y
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  Data: We examined the correlation between interviewer-administered Vineland Adaptive Behavior Scale II (VABS-II) and the parent-rated Adaptive Behavior Assessment System II (ABAS-II) questionnaire in 352 participants (ages 1.5-20.8 years) with autism spectrum disorder (ASD) to determine if ABAS could be used as a screen to reduce the number of VABS interviews. Corresponding domain scores between the two measures were highly correlated but scores were significantly lower on the ABAS-II. Screening with ABAS-II significantly reduced the number of VABS-II interviews required with little cost to overall accuracy. The ABAS-II provides a cost- and time-saving alternative to the VABS-II to rule out functional impairment; however, scores are not strictly comparable between the two measures.
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