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Brief Report: Replication of the Psychometric Characteristics of the Behavioral Inflexibility Scale in an Independent Sample

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Title: Brief Report: Replication of the Psychometric Characteristics of the Behavioral Inflexibility Scale in an Independent Sample
Language: English
Authors: Dallman, Aaron R., Harrop, Clare, Lecavalier, Luc, Bodfish, Jim, Kalburgi, Sahana Nagabhushan, Jones, Desiree R., Hollway, Jill, Boyd, Brian A.
Source: Journal of Autism and Developmental Disorders. Oct 2022 52(10):4592-4596.
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: 5
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Replication (Evaluation), Psychometrics, Student Behavior, Autism Spectrum Disorders, Children, Adolescents, Test Validity
DOI: 10.1007/s10803-022-05515-0
ISSN: 0162-3257
1573-3432
Abstract: The Behavioral Inflexibility Scale (BIS) is a recently developed measure of behavioral inflexibility, defined as rigid patterns of behavior that contrast with the need to be flexible when the situation calls for it. In this study, we sought to replicate previous findings on the psychometric properties of the BIS in a community sample. Data for this study were collected using in-person assessments of 163 autistic and 95 non-autistic children ages 3-17 and included the BIS, measures of social-communication ability and repetitive behaviors, and an assessment of cognitive ability. Our findings replicate the psychometric properties of the BIS, indicating that the measure is a valid measure of behavioral inflexibility in ASD.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1349590
Database: ERIC
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  Value: <anid>AN0159301846;aut01oct.22;2022Sep27.06:42;v2.2.500</anid> <title id="AN0159301846-1">Brief report: replication of the psychometric characteristics of the behavioral inflexibility scale in an independent sample </title> <p>The Behavioral Inflexibility Scale (BIS) is a recently developed measure of behavioral inflexibility, defined as rigid patterns of behavior that contrast with the need to be flexible when the situation calls for it. In this study, we sought to replicate previous findings on the psychometric properties of the BIS in a community sample. Data for this study were collected using in-person assessments of 163 autistic and 95 non-autistic children ages 3–17 and included the BIS, measures of social-communication ability and repetitive behaviors, and an assessment of cognitive ability. Our findings replicate the psychometric properties of the BIS, indicating that the measure is a valid measure of behavioral inflexibility in ASD.</p> <p>Keywords: Autism; Behavioral inflexibility; Replication</p> <hd id="AN0159301846-2">Introduction</hd> <p>Behavioral inflexibility (BI) can be defined as rigid and inflexible patterns of behavior that contrast with the need to be flexible, open to change, and amenable during situations that are unpredictable and require more adaptive responding (Lecavalier et al., [<reflink idref="bib11" id="ref1">11</reflink>]). Inflexibility has been found to be a characteristic of a wide range of domains of functioning in autism spectrum disorder (ASD) including cognition (e.g. cognitive flexibility or set shifting) (Miller et al., [<reflink idref="bib13" id="ref2">13</reflink>]), rumination or repetitive thinking (Gotham et al., [<reflink idref="bib7" id="ref3">7</reflink>]), language (e.g. perseverative language, echolalia) (Muskett et al., [<reflink idref="bib14" id="ref4">14</reflink>]), social function (Christ et al., [<reflink idref="bib3" id="ref5">3</reflink>]), play (Honey et al., [<reflink idref="bib8" id="ref6">8</reflink>]), and eating / mealtime (Johnson et al., [<reflink idref="bib10" id="ref7">10</reflink>]).</p> <p>In a previous study, we reported the development of a novel parent-reported rating measure of the functional impact of BI - The <emph>Behavioral Inflexibility Scale (BIS) -</emph> and examined the psychometric characteristics of the scale using a large and diverse sample of autistic children and youth (Lecavalier et al., [<reflink idref="bib11" id="ref8">11</reflink>]). Validated measures of inflexibility relate only to the occurrence and variety of restricted and repetitive behaviors and as a result may not be optimally sensitive as outcome measures for examining the functional impact of inflexibility (Scahill et al., [<reflink idref="bib16" id="ref9">16</reflink>]). The lack of a psychometrically sound outcome measure specific to the impact of repetitive behaviors on daily life likely restricts efforts to develop and examine interventions for this domain. The BIS was specifically developed to measure functional impairment related to repetitive and inflexible patterns of behavior. As opposed to measuring the presence and variety of discrete repetitive behaviors, the items of the BIS reflect a variety of ways that repetitive and inflexible patterns of behavior could limit a person's ability to function and develop within home, school, and community settings. Unlike the simple presence or discrete type of repetitive behaviors, we hypothesize that it is likely that those instances of repetitive behaviors that limit a person's ability to function in everyday settings that is both a reasonable justification for intervention or support and that may change more readily with treatment (Lecavalier et al., [<reflink idref="bib11" id="ref10">11</reflink>]).</p> <p>In our initial study of the BIS (Lecavalier et al., [<reflink idref="bib11" id="ref11">11</reflink>]) we examined data from a large online sample of parents of autistic youth (3–17 years) and found that the BIS was unidimensional, and demonstrated good to excellent levels of internal consistency, short-term test-retest stability, and convergent validity. To date, this is the only study assessing the psychometric properties of the BIS and so replication studies are needed. Our initial BIS study used an online method to develop the final version of the scale and to amass data on a large autistic sample; therefore, a study of the BIS using in-person and additional independent, validated assessments is needed. Further, as the prior online study only included autistic children, we do not yet know if the BIS has the potential to act as a dimensional measure with the ability to capture the continuum of inflexibility found in both clinical and non-clinical populations. Finally, more evidence of acceptable psychometric characteristics of the BIS is needed to support the potential use of the BIS in research and clinical practice. It is widely acknowledged that replication studies are lacking both in ASD research (Serra-Garcia & Gneezy, [<reflink idref="bib17" id="ref12">17</reflink>]) and in clinical science in general (Singh Chawla, [<reflink idref="bib18" id="ref13">18</reflink>]).</p> <p>The purpose of this study was to determine if the psychometric characteristics of the BIS reported in our initial study could be replicated using an in-person data collection method and a rigorously assessed independent sample of autistic children.</p> <hd id="AN0159301846-3">Methods</hd> <p></p> <hd id="AN0159301846-4">Participants</hd> <p>We recruited a sample of 163 autistic children ages 3–17 years (M<subs>age</subs> = 9.9 years, 81.5% male). Children with a diagnosis of ASD were recruited from the research registries at three metropolitan universities as part of a wider multi-site study (Project BIDD). Inclusion criteria were (a) child age between 3 and 17 years, (b) English language proficiency, (c) no reported co-occurring genetic conditions (Fragile X syndrome, Down syndrome, etc.), (c) a clinical diagnosis of ASD, and (d) diagnosis of ASD confirmed by Autism Diagnostic Observation Schedule, second edition (Lord et al., [<reflink idref="bib12" id="ref14">12</reflink>]) testing by study personnel. We also recruited 95 children ages 3–17 without a diagnosis of ASD (M<subs>age</subs> = 9.34 years, 67% male). The neurotypical/non-autistic (NT) control sample was recruited from separate research registries at the three universities. Inclusion criteria for the NT sample were: (a) child age between 3 and 17 years, (b) English language proficiency, (c) no reported genetic conditions (Fragile X Syndrome, Down Syndrome, etc.), (c) no clinical diagnosis of ASD, and (d) score below ASD cutoff on the Social Communication Questionnaire. Participant demographics are reported in Table 1.</p> <hd id="AN0159301846-5">Procedures</hd> <p>Following a brief phone screen, participants were invited to participate in an in-person visit at one of three research sites. Caregivers completed a range of surveys (paper-and-pencil and electronic) and children were evaluated using standardized assessments for study inclusion and characterization.</p> <hd1 id="AN0159301846-6">Measures.</hd1> <p> <emph>Autism Diagnostic Observation Schedule, Second Edition (ADOS-2).</emph> The ADOS-2 (Lord et al., [<reflink idref="bib12" id="ref15">12</reflink>]) was administered by trained, reliable assessors to all autistic participants. The ADOS-2 is a semi-structured assessment that uses play activities to diagnose ASD in children and adolescents. This measure correlates strongly with clinical diagnoses of ASD (Gotham et al., [<reflink idref="bib5" id="ref16">5</reflink>]; Hus & Lord, [<reflink idref="bib9" id="ref17">9</reflink>]). ADOS-2 calibrated severity scores (CSS; Gotham et al., [<reflink idref="bib6" id="ref18">6</reflink>]; Hus & Lord, [<reflink idref="bib9" id="ref19">9</reflink>]) were used to characterized our sample. CSS values range from 0 to 10 and scores greater than 3 indicate a diagnosis of ASD.</p> <p> <emph>Stanford-Binet Intelligence Test, Fifth Edition (SB-5).</emph> The SB-5 (Roid, [<reflink idref="bib15" id="ref20">15</reflink>]) was administered to determine verbal, nonverbal, and general IQ for all participants. Participants completed both the Vocabulary subtest and the Object Series/Matrices subtest, which assesses verbal knowledge and nonverbal fluid reasoning respectively. Raw scores for verbal knowledge and nonverbal fluid reasoning were summed and standardized to generate general IQ scores.</p> <p> <emph>Behavioral Inflexibility Scale.</emph> The BIS (Lecavalier et al., [<reflink idref="bib11" id="ref21">11</reflink>]) is a 38-item caregiver-completed scale. Items are rated on a 6-point scale ranging from "not at all a problem" [0] to "Very severe or Extreme problem" [<reflink idref="bib5" id="ref22">5</reflink>] and behaviors are rated based on the past month. The scale demonstrates high reliability (alpha = 0.97) and test-retest reliability (ICC = 0.92). Sample items include "my child takes a long time to get comfortable in new situations" and "my child insists we eat certain foods at mealtimes."</p> <p> <emph>Social Communication Questionnaire (SCQ).</emph> The SCQ (Chandler et al., [<reflink idref="bib2" id="ref23">2</reflink>]) consists of 40 items that are organized into three subscales: social interaction, communication, and stereotyped behaviors. There are two versions of the SCQ. The lifetime version considers the child's entire developmental history. The current version focuses on the child's behaviors over the last 3 months. In the present study, we used the current version.</p> <p> <emph>Repetitive Behavior Scale-revised (RBS-R).</emph> The RBS-R (Bodfish et al., [<reflink idref="bib1" id="ref24">1</reflink>]) is a 43-item caregiver-reported measure of repetitive behaviors. Items are rated on a 4-point Likert scale and are organized into six subscales: stereotyped behavior, self-injurious behavior, compulsive behavior, ritualistic behavior, sameness behavior, and restricted behavior. Sample items include body rocking, bites self, and eating (i.e., strongly prefers/insists on eating certain items) and are rated based on the behaviors' frequency, difficulty to interrupt, and how much it interferes with ongoing events.</p> <p> <emph>Social Responsiveness Scale (SRS-2).</emph> The SRS-2 (Constantino & Gruber, [<reflink idref="bib4" id="ref25">4</reflink>]) is a 65-item rating scale that measures autism symptoms. Each item is rated on a scale from never true [0] to almost always true [<reflink idref="bib3" id="ref26">3</reflink>]. Items are organized into five content areas of social deficits including: social motivation, social awareness, social cognition, social communication, and restricted interests and repetitive behavior.</p> <hd id="AN0159301846-7">Analytic Plan</hd> <p>Internal consistency of the BIS was assessed with Cronbach's alpha. Convergent validity was examined through correlations with the RBS-R (total score and subscale scores) and the SRS-2 (total score and subscale scores) with Pearson's correlations. The discriminant validity of the BIS as a function of diagnostic status (ASD, TD) using linear multiple regression. We added one to each BIS sum score and then log-transformed this outcome because the distribution of BIS scores in the NT group was positively skewed and had a modal score of zero.</p> <hd id="AN0159301846-8">Results</hd> <p> <emph>Internal Consistency</emph>. The Cronbach's alpha for the BIS scale in this sample was 0.98.</p> <p> <emph>Convergent validity.</emph> Table 1 shows the relationship between BIS scores and demographic and clinical variables. The total BIS score had negligible correlations with demographic characteristics, indicating that BI is largely independent of demographic variables. The BIS was strongly related to RBS-R Total score and to each of the RBS-R subscales. Among autistic participants, the BIS showed a moderate relationship with the SRS-2 total score and each of the subscales (see Table 1). Among the subscales of the SRS-2, the strongest relationship was observed in the Restricted Interest and Repetitive Behavior (RIRB) Subscale.</p> <p>Table 1 Participant Demographic Characteristics</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>ASD (n = 163)</p></th><th align="left" colspan="2"><p>TD (n = 95)</p></th><th align="left"><p>Difference?</p></th></tr></thead><tbody><tr><td align="left" /><td align="left"><p>N/average (SD)</p></td><td align="left"><p>%</p></td><td align="left"><p>N/average (SD)</p></td><td align="left"><p>%</p></td><td align="left" /></tr><tr><td align="left"><p>Age</p></td><td align="left"><p>9.94 (3.88)</p></td><td align="left" /><td align="left"><p>9.34 (3.34)</p></td><td align="left" /><td align="left"><p>t[221.23]=-0.81</p></td></tr><tr><td align="left"><p>Gender</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Males</p></td><td align="left"><p>119</p></td><td align="left"><p>73.00</p></td><td align="left"><p>62</p></td><td align="left"><p>65.30</p></td><td align="left" /></tr><tr><td align="left"><p>Child Race</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>White</p></td><td align="left"><p>102</p></td><td align="left"><p>62.60</p></td><td align="left"><p>73</p></td><td align="left"><p>73.70</p></td><td align="left" /></tr><tr><td align="left"><p>Black</p></td><td align="left"><p>22</p></td><td align="left"><p>13.50</p></td><td align="left"><p>8</p></td><td align="left"><p>9.47</p></td><td align="left" /></tr><tr><td align="left"><p>Asian</p></td><td align="left"><p>6</p></td><td align="left"><p>3.68</p></td><td align="left"><p>3</p></td><td align="left"><p>3.16</p></td><td align="left" /></tr><tr><td align="left"><p>Bi/Multi-racial</p></td><td align="left"><p>14</p></td><td align="left"><p>8.59</p></td><td align="left"><p>8</p></td><td align="left"><p>8.42</p></td><td align="left" /></tr><tr><td align="left"><p>ABIQ</p></td><td align="left"><p>85.98 (23.04)</p></td><td align="left" /><td align="left"><p>107.35(12.94)</p></td><td align="left" /><td align="left"><p>t[219.69] = 8.85*</p></td></tr><tr><td align="left"><p>ADOS CS</p></td><td align="left"><p>7.03 (2.00)</p></td><td align="left" /><td align="left"><p>N/A</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Household Income</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p><$20,000</p></td><td align="left"><p>57</p></td><td align="left"><p>35.00</p></td><td align="left"><p>52</p></td><td align="left"><p>54.70</p></td><td align="left" /></tr><tr><td align="left"><p>$20,001 - $40, 000</p></td><td align="left"><p>32</p></td><td align="left"><p>19.60</p></td><td align="left"><p>16</p></td><td align="left"><p>16.80</p></td><td align="left" /></tr><tr><td align="left"><p>$40,0001- $60,0000</p></td><td align="left"><p>21</p></td><td align="left"><p>12.90</p></td><td align="left"><p>18</p></td><td align="left"><p>18.90</p></td><td align="left" /></tr><tr><td align="left"><p>$60,0001- $90,0000</p></td><td align="left"><p>18</p></td><td align="left"><p>11.00</p></td><td align="left"><p>4</p></td><td align="left"><p>4.32</p></td><td align="left" /></tr><tr><td align="left"><p>$90,0001+</p></td><td align="left"><p>16</p></td><td align="left"><p>9.82</p></td><td align="left"><p>2</p></td><td align="left"><p>2.11</p></td><td align="left" /></tr><tr><td align="left"><p>BIS mean</p></td><td align="left"><p>2.17 (1.07)</p></td><td align="left" /><td align="left"><p>0.24 (0.35)</p></td><td align="left" /><td align="left"><p>T[298.99] = 8.96*</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Discriminant validity.</emph> To determine if the degree of BI varies based on the presence of an ASD diagnosis, we compared BIS scores of our NT sample to that of our ASD sample. BIS score was positively skewed in the NT sample (see Fig. 1). To compare means of the log-transformed BIS sum, we used a linear multiple regression, controlling for age (Beta=-0.03, SE = 0.02), IQ (Beta=-0.00, SE = 0.00), and sex (Beta=-0.11, SE = 0.14). Autistic children scored significantly higher on BIS total score (Beta = 2.63, SE = 0.14, t[<reflink idref="bib3" id="ref27">3</reflink>, 205] = 19.24, p <.001) than their NT peers.</p> <hd id="AN0159301846-9">Discussion</hd> <p>We found that the psychometric characteristics of the BIS derived from an independent sample of autistic children replicated those reported in the Lecavalier et al., ([<reflink idref="bib11" id="ref28">11</reflink>]) study. Autistic children demonstrated higher levels of BI when compared to non-autistic children and in fact many non-autistic children demonstrated almost no BI, suggesting that BI is highly characteristic of ASD. It is also possible that typically developing children may demonstrate more age-related changes in BI with these behaviors occurring more in younger than older children as they mature and are able to better adapt to their environments.</p> <p>In both the present sample and the initial sample, we found that BI was strongly associated with both overall RRB severity (RBS-R total score, SRS-2 RIRB Subscale) and with the severity of discrete subtypes of RRB (RBS-R subscales). Like the RBS-R, we found different associations between SRS-2 subscales and the BIS. While the RRB subscale of the SRS was more strongly correlated with the BIS, subscales related to cognition, communication, and social motivation were less so. This extends the findings of Lecavalier et al., ([<reflink idref="bib11" id="ref29">11</reflink>]) and highlights conceptual overlap between BI and restricted repetitive behaviors. Within the broader domain of RRB, we found that that BI as measured by the BIS in participants with ASD, was correlated significantly with each of the discrete subtypes of RRB. In the present sample of children with ASD, correlations of the BIS total score with subscale scores from the RBS-R ranged from 0.59 to 0.83 for sameness, rituals / routines, compulsions, and restricted interests, and from 0.40 to 0.46 for stereotyped movements and repetitive self-injurious behaviors. A similar pattern of correlations of BI with all the discrete subtypes of RRB was reported in Lecavalier et al., ([<reflink idref="bib11" id="ref30">11</reflink>]).</p> <p>While our results suggest some overlap between the BIS and similar measures such as the RBS-R or the RIBI subscale of the SRS-2, the BIS was specifically designed to examine the functional impact of inflexibility. The RBS-R, for example, was developed to measure the presence and variety of RRBs and not the functional impact of these behaviors. The replication of previous psychometric performance in this study provides further evidence for the use of the BIS to examine the impact of BI on the lives of autistic children and their families. Moreover, we believe these promising results support the use of the BIS in future clinical trials.</p> <hd id="AN0159301846-10">Limitations</hd> <p>A weakness in our approach is that the measures used in the analyses for this study were all parent-report measures taken at the same time point, although a clinician-rated measure (ASD diagnosis as determined by the ADOS-2) was used to help examine discriminant validity. This limitation was present in both the present study and in Lecavalier et al., ([<reflink idref="bib11" id="ref31">11</reflink>]), and thus potential effects of shared method variance driven by parent-report measurement still need to be examined in future studies. For example, further studies are needed to determine if parent reported BI as measured by the BIS is in line with BI as measured by other methods such as clinician interview or performance-based tasks.</p> <hd id="AN0159301846-11">Conclusions</hd> <p>In this cross-sectional study, we sought to replicate previous findings on the psychometric properties of the Behavioral Inflexibility Scale (BIS), a recently developed measure of behavioral inflexibility. Our findings replicate the psychometric properties of the BIS, indicating that the measure is a valid measure of behavioral inflexibility in ASD. This suggests that the BIS may be a reliable measure of BI for use in clinical trials and in clinical settings, though future studies are needed to validate this claim. Our findings also suggest that BI has conceptual overlap with restricted and repetitive behaviors.</p> <p>Graph: Fig. 1 BIS Score Distributions in the TD and ASD Groups</p> <p>Table 2 Relationship Between BIS and Other Relevant Measures</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>ASD</p></th><th align="left"><p>TD</p></th></tr></thead><tbody><tr><td align="left" /><td align="left"><p>Correlation in the present study</p></td><td align="left"><p>Correlation from Lecavalier et al., (<xref ref-type="bibr" rid="bibr11">2020</xref>)</p></td><td align="left" /></tr><tr><td align="left"><p>Demographic Variables</p></td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Child age</p></td><td align="left"><p>-0.12</p></td><td align="left"><p>-0.07</p></td><td char="." align="char"><p>-0.12</p></td></tr><tr><td align="left"><p>Child IQ</p></td><td align="left"><p>0.10</p></td><td align="left" /><td char="." align="char"><p>-0.32</p></td></tr><tr><td align="left"><p>Child Sex</p></td><td align="left"><p>0.01</p></td><td align="left" /><td char="." align="char"><p>-0.14</p></td></tr><tr><td align="left"><p>RBS-R</p></td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Total</p></td><td align="left"><p>0.80**</p></td><td align="left"><p>0.84</p></td><td align="left" /></tr><tr><td align="left"><p>Stereotyped Behavior</p></td><td align="left"><p>0.46**</p></td><td align="left"><p>0.52</p></td><td align="left" /></tr><tr><td align="left"><p>Self-Injurious Behavior</p></td><td align="left"><p>0.40**</p></td><td align="left"><p>0.48</p></td><td align="left" /></tr><tr><td align="left"><p>Compulsive Behavior</p></td><td align="left"><p>0.65**</p></td><td align="left"><p>0.68</p></td><td align="left" /></tr><tr><td align="left"><p>Ritualistic Behavior</p></td><td align="left"><p>0.74**</p></td><td align="left"><p>0.73</p></td><td align="left" /></tr><tr><td align="left"><p>Sameness Behavior</p></td><td align="left"><p>0.83**</p></td><td align="left"><p>0.89</p></td><td align="left" /></tr><tr><td align="left"><p>Restricted Behavior</p></td><td align="left"><p>0.59**</p></td><td align="left"><p>0.61</p></td><td align="left" /></tr><tr><td align="left"><p>SCQ</p></td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Total</p></td><td align="left"><p>0.56**</p></td><td align="left"><p>0.52</p></td><td align="left" /></tr><tr><td align="left"><p>Social Interaction</p></td><td align="left"><p>0.39*</p></td><td align="left"><p>0.36</p></td><td align="left" /></tr><tr><td align="left"><p>Communication</p></td><td align="left"><p>0.34*</p></td><td align="left"><p>0.33</p></td><td align="left" /></tr><tr><td align="left"><p>Stereotyped behaviors</p></td><td align="left"><p>0.41*</p></td><td align="left"><p>0.51</p></td><td align="left" /></tr><tr><td align="left"><p>SRS-2</p></td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Total</p></td><td align="left"><p>0.65**</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Social Awareness</p></td><td align="left"><p>0.54**</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Social Cognition</p></td><td align="left"><p>0.56**</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Social Communication</p></td><td align="left"><p>0.55**</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Social Motivation</p></td><td align="left"><p>0.55**</p></td><td align="left" /><td align="left" /></tr><tr><td align="left"><p>RIRB</p></td><td align="left"><p>0.65**</p></td><td align="left" /><td align="left" /></tr></tbody></table> </ephtml> </p> <p>Note: SRS, ABAS, Clinical Global Impression, and ADOS were not reported in Lecavalier et al., ([<reflink idref="bib11" id="ref32">11</reflink>]). RIRB = Restricted Interest and Repetitive behavior Subscale. ** indicate significant at the 0.05 level</p> <hd id="AN0159301846-12">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0159301846-13"> <title> References </title> <blist> <bibl id="bib1" idref="ref24" type="bt">1</bibl> <bibtext> Bodfish JW, Symons FJ, Parker DE, Lewis MH. Varieties of repetitive behavior in autism: Comparisons to mental retardation. Journal of Autism and Developmental Disorders. 2000; 30; 3: 237-243. 10.1023/a:1005596502855. 11055459</bibtext> </blist> <blist> <bibl id="bib2" idref="ref23" type="bt">2</bibl> <bibtext> Chandler S, Charman T, Baird G, Simonoff E, Loucas T, Meldrum D, Pickles A. Validation of the Social Communication Questionnaire in a population cohort of children with autism spectrum disorders. 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  Data: The Behavioral Inflexibility Scale (BIS) is a recently developed measure of behavioral inflexibility, defined as rigid patterns of behavior that contrast with the need to be flexible when the situation calls for it. In this study, we sought to replicate previous findings on the psychometric properties of the BIS in a community sample. Data for this study were collected using in-person assessments of 163 autistic and 95 non-autistic children ages 3-17 and included the BIS, measures of social-communication ability and repetitive behaviors, and an assessment of cognitive ability. Our findings replicate the psychometric properties of the BIS, indicating that the measure is a valid measure of behavioral inflexibility in ASD.
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