Development and Psychometric Examination of a New Social Competence Outcome Measure for Children with Autism Spectrum Disorder: The Observational Social Competence Assessment
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| Title: | Development and Psychometric Examination of a New Social Competence Outcome Measure for Children with Autism Spectrum Disorder: The Observational Social Competence Assessment |
|---|---|
| Language: | English |
| Authors: | Ming-Hsuan Liu, Fu-Mei Chiang, Cheng-Te Chen, Hsiu-Ching Yang, Kuan-Lin Chen (ORCID |
| Source: | Journal of Autism and Developmental Disorders. 2025 55(11):3838-3850. |
| 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: | 13 |
| Publication Date: | 2025 |
| Document Type: | Journal Articles Reports - Research |
| Descriptors: | Outcome Measures, Test Construction, Psychometrics, Interpersonal Competence, Children, Autism Spectrum Disorders, Test Reliability, Interrater Reliability, Test Validity, Social Adjustment |
| DOI: | 10.1007/s10803-024-06472-6 |
| ISSN: | 0162-3257 1573-3432 |
| Abstract: | Current assessments of social competence for children with autism spectrum disorder (ASD) are mostly designed for screening or diagnosis, not for measuring outcomes. This study aimed to develop a professional-administrated outcome measure, the Observational Social Competence Assessment (OSCA), and examine its psychometric properties. The OSCA was constructed based on a multidimensional view of social competence (i.e., social skill elements, social reciprocity, and social adjustment). For psychometric evaluation, 89 children with ASD between 3 and 12 years (mean = 70.69 months, SD = 15.31) were assessed with the OSCA and with assessments of ASD symptoms, verbal comprehension ability, and adaptive function. The results show that the OSCA has good internal consistency (Cronbach's [alpha] = 0.820-0.954), test-retest reliability (intraclass correlation coefficients [ICC] = 0.917-0.960), and inter-rater reliability (ICC = 0.905-0.974). The OSCA also has good convergent (r = 0.508-0.703, p < 0.01) and divergent validity (r = 0.105, p = 0.496), as well as good responsiveness to changes in the social adjustment dimension (Cohen's d = 1.26 and standardized response mean [SRM] = 1.92). Conclusively, these results show that the OSCA is sufficiently reliable, valid and responsive to be applied as an outcome measure of social competence in children with ASD. |
| Abstractor: | As Provided |
| Entry Date: | 2026 |
| Accession Number: | EJ1493019 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwEnQHzaCXFjAUNqwml2fTpAAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDLE8K4fiKIu5xceYcAIBEICBm9QFI1KxuZVA76atGYAsC8EDRcXwdxvw69Z0gk38_uHip_BpmfUbBBS1vXWJMPhKzIkkJezzWRbNJu5VYmdNA3fGkyiwqqxyWH2_0T1RnKHjfjqsoVvn979zf7zcamXWFG_Wz9B91vneMZ9boD4urCb6xglqPkVsHAfLBBFsKmhHHTehI5nJMDYM1-osHvL6b16eqwQyJKSmi7e9 Text: Availability: 1 Value: <anid>AN0189005188;aut01nov.25;2025Nov03.05:02;v2.2.500</anid> <title id="AN0189005188-1">Development and Psychometric Examination of a New Social Competence Outcome Measure for Children with Autism Spectrum Disorder: The Observational Social Competence Assessment </title> <p>Current assessments of social competence for children with autism spectrum disorder (ASD) are mostly designed for screening or diagnosis, not for measuring outcomes. This study aimed to develop a professional-administrated outcome measure, the Observational Social Competence Assessment (OSCA), and examine its psychometric properties. The OSCA was constructed based on a multidimensional view of social competence (i.e., social skill elements, social reciprocity, and social adjustment). For psychometric evaluation, 89 children with ASD between 3 and 12 years (mean = 70.69 months, SD = 15.31) were assessed with the OSCA and with assessments of ASD symptoms, verbal comprehension ability, and adaptive function. The results show that the OSCA has good internal consistency (Cronbach's α = 0.820–0.954), test–retest reliability (intraclass correlation coefficients [ICC] = 0.917–0.960), and inter-rater reliability (ICC = 0.905–0.974). The OSCA also has good convergent (r = 0.508–0.703, p &lt; 0.01) and divergent validity (r = 0.105, p = 0.496), as well as good responsiveness to changes in the social adjustment dimension (Cohen's d = 1.26 and standardized response mean [SRM] = 1.92). Conclusively, these results show that the OSCA is sufficiently reliable, valid and responsive to be applied as an outcome measure of social competence in children with ASD.</p> <p>Keywords: Autism spectrum disorder; Social competence; Reliability; Validity; Responsiveness; Psychology and Cognitive Sciences Psychology</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <hd id="AN0189005188-2">Introduction</hd> <p>Autism spectrum disorder (ASD) is characterized by early difficulties in social competence, as emphasized in its diagnostic criteria highlighting deficits in interpersonal interaction and communication (American Psychiatric Association, [<reflink idref="bib2" id="ref1">2</reflink>]). The worldwide prevalence of ASD is estimated at 100 per 10,000 individuals, with a male-to-female ratio of 4.2 (Zeidan et al., [<reflink idref="bib56" id="ref2">56</reflink>]). Children with ASD often exhibit challenges in nonverbal communication or verbal expression (Chan et al., [<reflink idref="bib11" id="ref3">11</reflink>]; Cravotta et al., [<reflink idref="bib17" id="ref4">17</reflink>]), along with reduced initiation and response to social interactions compared to typically developing peers (Koegel et al., [<reflink idref="bib34" id="ref5">34</reflink>]). Moreover, they commonly struggle with understanding, developing, and maintaining interpersonal relationships (Bauminger et al., [<reflink idref="bib6" id="ref6">6</reflink>]; Jahromi et al., [<reflink idref="bib31" id="ref7">31</reflink>]; Mendelson et al., [<reflink idref="bib39" id="ref8">39</reflink>]). These social challenges persist across various situations and developmental stages for children with ASD.</p> <p>Social competence develops progressively throughout childhood. During this process, children gradually develop basic to complex social behaviors (Locascio &amp; Slomine, [<reflink idref="bib38" id="ref9">38</reflink>]). In infancy, social development involves infants using eye gazing and smiling to express attention to social stimuli (Carter et al., [<reflink idref="bib9" id="ref10">9</reflink>]), responding to names and initiating vocalizations, and advancing to gestures like pointing (Salo et al., [<reflink idref="bib47" id="ref11">47</reflink>]). Gradually, infants begin to integrate gazes, gestures, and vocalizations to facilitate communication skills (Murillo &amp; Belinchón, [<reflink idref="bib40" id="ref12">40</reflink>]). By the age 2 or 3, children's ongoing development in language and theory of mind, along with social competence, enables them to engage in reciprocal interactions and elevates social responses and initiatives (Chen &amp; Jiang, [<reflink idref="bib12" id="ref13">12</reflink>]; Peterson et al., [<reflink idref="bib42" id="ref14">42</reflink>]; Peterson &amp; Wellman, [<reflink idref="bib41" id="ref15">41</reflink>]).</p> <p>In early childhood, preschool children begin to engage in cooperative play, fostering the development of prosocial behaviors such as turn taking, sharing, cooperation, empathy, and negotiation (Junge et al., [<reflink idref="bib32" id="ref16">32</reflink>]; Scott &amp; Cogburn, [<reflink idref="bib49" id="ref17">49</reflink>]). In middle childhood, as school becomes central to their lives, they focus on peer relationships and acceptance, refining their social cognition and prosocial behaviors in the process (Gest et al., [<reflink idref="bib27" id="ref18">27</reflink>]). Social competence is not only essential for children's social development but also affects their social adaption outcomes. Sufficient social competence can reduce the likelihood of emotional and behavioral problems while improving overall well-being (Hosokawa &amp; Katsura, [<reflink idref="bib30" id="ref19">30</reflink>]; Vahedi et al., [<reflink idref="bib50" id="ref20">50</reflink>]). Children with sufficient social competence generally experience less peer rejection and enjoy greater popularity within their social circles, leading to improved academic performance and school success (Franco et al., [<reflink idref="bib24" id="ref21">24</reflink>]; Green &amp; Rechis, [<reflink idref="bib29" id="ref22">29</reflink>]; Ladd &amp; Sechler, [<reflink idref="bib36" id="ref23">36</reflink>]). Conclusively, children's social competence affects not only their interactions with others but also their social integration, academic achievement, and self-esteem (Ambrose et al., [<reflink idref="bib1" id="ref24">1</reflink>]). Therefore, understanding the social competence of children encountering social challenges during these developmental stages is of paramount importance.</p> <p>Several forms of assessments have been developed to measure social competence in children with ASD, the most common being professional-administrated assessments, caregiver questionnaires, and observational coding systems (Dirks et al., [<reflink idref="bib20" id="ref25">20</reflink>]; Kylliäinen et al., [<reflink idref="bib35" id="ref26">35</reflink>]). However, several issues have been raised regarding the utilization of the existing assessments as outcome measures of social competence in children with ASD. These concerns include the assessment purpose and its corresponding psychometric examination, construct, and clinical applicability (Bolte &amp; Diehl, [<reflink idref="bib8" id="ref27">8</reflink>]; Duncan &amp; Murray, [<reflink idref="bib21" id="ref28">21</reflink>]). First, these assessments were primarily designed for diagnostic purposes, for the classification of autistic symptoms, or specifically for coding certain target behaviors in individual studies (see Appendix1-3). So far, none have been originally designed to measure changes in social competence in children with ASD (Fletcher-Watson &amp; McConachie, [<reflink idref="bib22" id="ref29">22</reflink>]; Provenzani et al., [<reflink idref="bib43" id="ref30">43</reflink>]). For example, the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), a widely used tool for diagnosing children with ASD, may not be sufficiently sensitive to changes when they occur (Anagnostou et al., [<reflink idref="bib3" id="ref31">3</reflink>]). The responsiveness is a crucial psychometric indicator for outcome measures, examining its ability to sensitively represent changes in measured variables over time. The responsiveness of the reviewed social competence assessments remains unexamined, raising questions about their appropriateness as outcome measures (Reszka et al., [<reflink idref="bib44" id="ref32">44</reflink>]).</p> <p>Second, the multidimensional construct of social competence has not always been specified or highlighted in the current assessments (Gómez-Ortiz et al., [<reflink idref="bib28" id="ref33">28</reflink>]; Yager &amp; Iarocci, [<reflink idref="bib55" id="ref34">55</reflink>]). Social competence has been surmised to be a multidimensional construct (Junge et al., [<reflink idref="bib32" id="ref35">32</reflink>]; Rose-Krasnor, [<reflink idref="bib46" id="ref36">46</reflink>]), providing a framework for understanding its complexity. The multidimensional model of social competence contains four dimensions: social skill elements, social reciprocity, social adjustment, and social effectiveness (Ashton, [<reflink idref="bib4" id="ref37">4</reflink>]; van Ommeren et al., [<reflink idref="bib51" id="ref38">51</reflink>]). Social skill elements encompass a series of abilities enabling individuals to perform social tasks or behaviors. Social reciprocity refers to the ability to sustain engagement in social exchanges, ensuring participation in social interactions. Social adjustment reflects the quality of the social interaction, how well individuals navigate and adapt to social situations. Social effectiveness focuses on achieving functional outcomes within social context. Each dimension offers unique insights into specific aspects of social competence, collectively contributing to a comprehensive understanding of an individual's social abilities. In contrast, a major problem with the current assessments of social competence is that most of the constructs measured are aligned with clinical symptoms sampling or based on clinical experience.</p> <p>Last, their clinical applicability is an issue because the current assessments are time consuming or overly-reliant on respondents (Anagnostou et al., [<reflink idref="bib3" id="ref39">3</reflink>]; Cunningham, [<reflink idref="bib18" id="ref40">18</reflink>]). Assessments via video recording with behavior coding and interviewing are labor-intensive, requiring that observations be scored according to a coding scheme. As regards caregiver questionnaires, if the respondents are unfamiliar with the child's social performance or misunderstand the questions, the child's social competence may not be objectively and precisely assessed. The lack of a suitable outcome measure for assessing social competence in children with ASD may impede the development of more effective interventions (Cunningham, [<reflink idref="bib18" id="ref41">18</reflink>]).</p> <p>Several issues are important when measuring outcomes of social competence in children with ASD. First, a measure of social competence should be multidimensional. Assessment with a single index would reflect an overly narrow conceptualization of social competence and lead to the loss of important clinical information (Yager &amp; Iarocci, [<reflink idref="bib55" id="ref42">55</reflink>]). Second, the clinical applicability of the assessment, such as ease of administration, scoring, and time cost, should be considered for clinical practitioners (Duncan &amp; Murray, [<reflink idref="bib21" id="ref43">21</reflink>]; Romli et al., [<reflink idref="bib45" id="ref44">45</reflink>]). Last, the psychometric properties are critical for any assessment, and especially for an outcome measure (Cunningham, [<reflink idref="bib18" id="ref45">18</reflink>]). Evidence of the reliability and validity of the assessment confirms the dependability and accuracy of the evaluation results. Sufficient responsiveness confirms that the assessment is able to sensitively detect the outcome change and reflect the effectiveness of interventions (Beaton et al., [<reflink idref="bib7" id="ref46">7</reflink>]). Therefore, the overall aim of this study was to develop a multidimensional outcome measure of social competence in children with ASD to identify their strengths and weaknesses, and to examine the measure's psychometric properties, including its test–retest and inter-rater reliabilities, content validity, construct validity (i.e., convergent and divergent validity), and responsiveness.</p> <hd id="AN0189005188-3">Methods</hd> <p></p> <hd id="AN0189005188-4">Development of the Observational Social Competence Assessment (OSCA)</hd> <p>This study developed a set of assessment tools for professionals in the field to use in the clinical evaluation of social competence in children with ASD aged from 3 to 12 years old. The conceptual framework of the OSCA was constructed on the basis of a comprehensive review of the current literature about theories and assessments of social competence and clinical practicality (Cavell, [<reflink idref="bib10" id="ref47">10</reflink>]; Rose-Krasnor, [<reflink idref="bib46" id="ref48">46</reflink>]; van Ommeren et al., [<reflink idref="bib51" id="ref49">51</reflink>]). The multidimensional structure model of social competence was adopted, as noted in the introduction section. Considering the feasibility of the OSCA being designed as a professional-administered assessment, social skill elements, social reciprocity, and social adjustment were chosen as dimensional subscales for evaluation (Ashton, [<reflink idref="bib4" id="ref50">4</reflink>]; van Ommeren et al., [<reflink idref="bib51" id="ref51">51</reflink>]). The final items were selected based on the definition of each dimension (see Table 1), and rating criteria for each item were established. Subsequently, we designed several task contexts comprising specific toys and instructional prompts to elicit target behaviors, allowing the observation of social competence in children.</p> <p>Table 1 The items of the Observational Social Competence Assessment (OSCA)</p> <p> <ephtml> &lt;table rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;&lt;italic&gt;Dimension&lt;/italic&gt;/ Item&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Operational definition&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="2"&gt;&lt;p&gt;&lt;italic&gt;Social skill elements&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Eye contact&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The location and the duration of one's eye gaze within the social interaction&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Response to joint attention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The completion of response to joint attention&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Initiation of joint attention&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The completion of initiation of joint attention&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Gestures&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The variety and appropriateness of the social information carried by the actions of the hands (or body)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Facial expression&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The variety and appropriateness of the social information carried by the actions of the face&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Content of verbal expression&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The comprehension and completion of expression within communication&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Approach of verbal expression&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The appropriateness and autonomy of expression within communication&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Integrated verbal and nonverbal behavior&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The degree of coordination/ integration of verbal and nonverbal behaviors that facilitate social interaction&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="2"&gt;&lt;p&gt;&lt;italic&gt;Social reciprocity&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Quality of initiation behaviors&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The appropriateness of initiation in the contexts&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Quantity of initiation behaviors&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The variety of contexts wherein the child can initiate interaction with others&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Quality of response behaviors&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The appropriateness of response in the contexts&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Quantity of response behaviors&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The variety of contexts wherein the child responds to others&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Length of reciprocal behaviors&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The degree of continuance of the interaction&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Breadth of reciprocal behaviors&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The variety of topics of interaction&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Depth of reciprocal behaviors-Comment behaviors&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The frequency of using comments to sustain interaction&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Depth of reciprocal behaviors-Questioning behaviors&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The frequency of using questioning to sustain interaction&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Social adjustment&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Helping&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The autonomy of offering help when finding others have difficulty&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sharing&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The autonomy of sharing things that belong to oneself&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Turn-taking&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The autonomy of turn-taking to meet the needs of self and take care of others' needs&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Cooperating&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The autonomy of doing things together to promote the completion of things&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Comforting&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The autonomy of offering comfort when finding others in a bad mood&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Dealing with NO&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;The degree of emotion regulation and appropriateness of dealing with refusal within a dissatisfactory social context&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>The preliminary OSCA then underwent first expert review by 3 experts in autism psychopathology, psychological testing theory and application, and pediatric occupational therapy. The structure, procedures of administration, scoring, and equipment were reviewed. Meanwhile, the developers of this study confirmed the task feasibility of the OSCA through a pilot study involving 3 typically developing children and 3 children with ASD. In the pilot study, both groups of children were aged between 4 and 8 years old, with the majority boys. Incorporating expert suggestions and results from the pilot study, we increased the total number of items from 18 to 22, adding items to assess social competence in more detail. Additional diverse toys were added as materials, and slight modifications were made to the wording of the instruction manual.</p> <p>Finally, in the expert examination for content validity, the OSCA was reviewed by 3 experts in child development and ASD, each with 5 to 24 years of clinical experience in occupational therapy. The experts were provided with an introduction to the OSCA, along with four OSCA video recordings and an instruction manual. The OSCA videos presented an assessor conducting actual evaluations of children with ASD, with the ages of the children being 3, 5, 6, and 10 years old, respectively. The experts determined whether the rating criteria of each item, task feasibility, and fit of an item in its dimension were appropriate by dichotomy. The feasibility of the overall assessment was rated on a 5-point scale. The experts' opinions were collected through a questionnaire. The agreement among the experts was calculated as the content validity index.</p> <p>The OSCA was designed to be a semi-structured performance-based assessment, including two sessions, namely, <emph>Play together</emph> and <emph>Let's have more fun</emph>. These two sessions involve semi-structured play activities. The play activities are tailored to the developmental age of the child, incorporating pretend play, track toys, balls, blocks, dominoes for children ages 3 to 12, and board games additionally used for children in the first to sixth grades. Before the formal administration of the two sessions, a warm-up period of at least 3–5 min is provided for the child to become familiar with the administrator and environment. Throughout this interaction and the subsequent evaluation process, the evaluator observes the child's language ability, interest, and motivation to select or change toys for use in the next two sessions.</p> <p>The <emph>Play together</emph> session, including one play context, is designed to evaluate the child's social skill elements in 10 min. For example, during the pretend play or card playing, the evaluator needs to point to a toy to trigger a response to joint attention or ask questions to induce children to use gestures to explain the details of the conversation. The <emph>Let's have more fun</emph> session is designed as 5 play contexts to assess the child's social reciprocity and social adjustment in 15–20 min. For example, the administrator acts upset upon failing to build blocks to see whether the child will give comfort. Last, after the two sessions, the administrator needs to recheck all items. The whole assessment of the OSCA to measure social competence requires around 30 min. All items are rated from 1 to 4, with higher scores indicating better social competence.</p> <p>The evaluator of the OSCA received thorough training before the commencement of data collection. The evaluator had over one year of experience as an occupational therapist, specifically working with children with ASD. Training was conducted under the supervision of a senior occupational therapist and the developers of the OSCA. To pass the training, the inter-rater consistency between two evaluators had to reach a minimum of 90%.</p> <hd id="AN0189005188-5">Participants</hd> <p>Eighty-nine children with ASD aged between 3 and 12 years and their caregivers were recruited for this study. The inclusion criteria of children with ASD involved a diagnosis of ASD confirmed by licensed psychiatrists using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The exclusion criteria of children with ASD included (<reflink idref="bib1" id="ref52">1</reflink>) symptoms related to organic brain dysfunction (e.g., seizures, cerebral palsy), chromosomal abnormality (e.g., Down syndrome), or rare disorders, and (<reflink idref="bib2" id="ref53">2</reflink>) visual or auditory impairments.</p> <p>All participants and their caregivers had signed a consent form approved by the Institutional Review Boards of the National Cheng Kung University Hospital, National Taiwan University Hospital, and Kaohsiung Municipal Kai-Syuan Psychiatric Hospital.</p> <hd id="AN0189005188-6">Measures</hd> <p></p> <hd id="AN0189005188-7">Observational Social Competence Assessment (OSCA)</hd> <p>The OSCA introduced in the earlier section "Development of the Observational Social Competence Assessment (OSCA)" was used to assess children's social competence for psychometric examination in this study.</p> <hd id="AN0189005188-8">Standard Version of the Childhood Autism Rating Scale, Second Edition (CARS-2)</hd> <p>The CARS-2 (Schopler et al., [<reflink idref="bib48" id="ref54">48</reflink>]) is a 15-item rating scale with two versions for assessing the severity of ASD symptoms. In this study, the standard version was used to measure severity of autistic traits and examine the convergent validity of the OSCA. On this scale, each item is scored from 1 to 4. The CARS-2 has been shown to have good psychometric properties in children with ASD, including internal consistency (Cronbach's α = 0.93–0.96) and inter-rater reliability (<emph>r</emph> = 0.95) (Schopler et al., [<reflink idref="bib48" id="ref55">48</reflink>]). The sensitivity and specificity of the CARS-2 are 0.84 and 1.00, respectively (Dawkins et al., [<reflink idref="bib19" id="ref56">19</reflink>]).</p> <hd id="AN0189005188-9">Social Responsiveness Scale, Second Edition (SRS-2), School-Age Form</hd> <p>The SRS-2 (Constantino &amp; Gruber, [<reflink idref="bib15" id="ref57">15</reflink>]) is a 65-item caregiver-reported behavior scale for children aged from 4 to 18 years to measure symptoms associated with ASD. The SRS-2 was used to confirm the autistic traits and examine the convergent validity of the OSCA in the study. Each item is scored from 0 to 3. The Chinese version of the SRS has been shown to have good psychometric properties in children with ASD, including internal consistency (Cronbach's α = 0.94), test–retest reliability (intraclass correlation coefficients [ICC] = 0.75–0.85), and convergent validity with the Chinese version of the Social Communication Questionnaire (<emph>r</emph> = 0.609–0.865) (Gau et al., [<reflink idref="bib26" id="ref58">26</reflink>]).</p> <hd id="AN0189005188-10">Verbal Comprehension Index (VCI) of the Chinese Version of the Wechsler Preschool and Primary...</hd> <p>The VCI of the Chinese version of the WPPSI-IV or WISC-IV was used for examining the convergent validity of the OSCA in the study. The VCI of the WPPSI-IV (Wechsler, [<reflink idref="bib53" id="ref59">53</reflink>]) or WISC-IV (Wechsler, [<reflink idref="bib52" id="ref60">52</reflink>]) is used to assess verbal comprehension in children aged from 2 years 6 months to 7 years 7 months or from 6 years to 16 years 11 months, respectively. The Chinese version of the WPPSI–IV and the WISC–IV have both been shown to have good psychometric properties. The internal consistency of the Chinese version of the WPPSI–IV ranges from 0.76 to 0.93, and its test–retest reliability ranges from 0.72 to 0.89. The internal consistency of the Chinese version of the WISC–IV ranges from 0.74 to 0.91, and its test–retest reliability ranges from 0.83 to 0.94. The Chinese version of the WISC–IV has good construct validity (Chen et al., [<reflink idref="bib13" id="ref61">13</reflink>]).</p> <hd id="AN0189005188-11">Vineland Adaptive Behavior Scales (VABS)</hd> <p>The VABS includes four domains, namely communication, daily living skills, socialization, and motor skills. The socialization domains were assessed to examine the convergent validity of the OSCA. The daily living skills and motor skills domains were used to examine the divergent validity of the OSCA. The VABS is a set of caregiver-reported behavior scales for children aged from 3 to 12 years that assesses adaptive skills in everyday living. The items are scored from 0 to 2 based on the frequency of behaviors. The raw scores can be transformed into standard scores, and the standard scores were used for analysis. The VABS has been shown to have good psychometric properties (Wu et al., [<reflink idref="bib54" id="ref62">54</reflink>]). The split-half reliabilities of domains and subdomains range from 0.66 to 0.98. The test–retest reliability ranges from 0.62 to 0.95. The inter-rater reliability ranges from 0.74 to 0.89. The VABS also shows good discriminative validity to differentiate typically developing children and children with disability.</p> <hd id="AN0189005188-12">Procedures</hd> <p>Figure 1 shows the procedures of this study. In the first visit, 91 children with ASD who met the inclusion criteria were assessed with the CARS-2 and VCI of the WPPSI-IV or the WISC-IV according to their ages, while their caregivers completed the SRS-2 and VABS and were interviewed with the CARS-2. The children who met the inclusion criteria completed the OSCA. Unfortunately, the data of 2 children with ASD were incomplete due to the COVID-19 pandemic. Thus, these data were excluded from subsequent data analysis.</p> <p>Graph: Fig. 1 The flowchart of participant recruitment and retention. Abbreviations IRB, Institutional Review Board; TD, typically developing; ASD, autism spectrum disorder; VCI, Verbal Comprehension Index; CARS-2, Standard version of the Childhood Autism Rating Scale, Second edition; SRS-2, Social Responsiveness Scale, Second edition; VABS, Vineland Adaptive Behavior Scales; OSCA, Observational Social Competence Assessment</p> <hd id="AN0189005188-13">Test–Retest Reliability and Inter-Rater Reliability</hd> <p>For the test–retest reliability, one subgroup of 30 children with ASD were assessed with the OSCA by the same evaluator as in the first visit. For the inter-rater reliability, another subgroup of 10 children with ASD were assessed with the OSCA by a different evaluator from the one in the first visit.</p> <hd id="AN0189005188-14">Responsiveness</hd> <p>The other subgroup of 30 children with ASD and their caregivers received the randomized clinical trial of the social competence group intervention (SCGI) for 4 months and then were assessed with the OSCA. The SCGI was designed based on materials such as "Super skills (Coucouvanis, [<reflink idref="bib16" id="ref63">16</reflink>])", "Social skills training (Baker, [<reflink idref="bib5" id="ref64">5</reflink>])", and the literature on autism social skills. The social skills taught in the SCGI group were mostly related to social adjustment, such as how to cooperate and coordinate with others. These social skills were taught step-by-step through role playing in each session. The 30 children with ASD were randomly assigned to the SCGI experimental group (<emph>n</emph> = 15) or the control group (<emph>n</emph> = 15). The dosage of the SCGI experimental group (5 or 6 group members) was 50 min once a week for 16 weeks. The control group received regular occupational therapy with a dosage of 30 to 50 min once a week for 16 weeks, in groups of 2 to 6. The pre-test and post-test scores of the OSCA of the two groups were used to examine the responsiveness.</p> <hd id="AN0189005188-15">Statistical Analysis</hd> <p>Descriptive analysis was used to describe the demographics and characteristics of the participants. The means and standard deviations of the scores of the OSCA, CARS-2, SRS-2, VCI, and VABS were computed. Cronbach's α was used for the internal consistency of the OSCA. ICCs were used for the test–retest reliability and inter-rater reliability of the OSCA.</p> <p>For content validity, the agreement on the rating criteria of each item, task feasibility, fit of an item in its dimension, and feasibility of the overall assessment of the OSCA were converted into a content validity index. The scores of the three experts were added up and divided by the full mark. The acceptable consent rate was 80%. For construct validity (i.e., convergent and divergent validity), Pearson correlation coefficients (r) were used for examination of the convergent validity and the divergent validity of the OSCA.</p> <p>The responsiveness of the OSCA was examined by paired t-test, Cohen's d (Cohen, [<reflink idref="bib14" id="ref65">14</reflink>]), and standardized response mean (SRM) (Liang et al., [<reflink idref="bib37" id="ref66">37</reflink>]). The total score and three dimension scores were used in responsiveness analysis. The paired t-tests were calculated with the scores of the OSCA of children with ASD at the first visit and at the last follow-up. A <emph>t</emph> value higher than 1.96 (<emph>p</emph> &lt; 0.05) indicated that the OSCA was responsive to the change between the two visits. The Cohen's d was calculated as the ratio of the mean change in the score of the OSCA of children with ASD between the first visit and the last follow-up to the standard deviation of the score of the OSCA of children with ASD at the first visit. The SRM was calculated as the ratio of the mean change in the score of the OSCA of children with ASD between the first visit and the last follow-up to the standard deviation of the change in score of the OSCA between the first visit and the last follow-up of children with ASD. The values of Cohen's d and SRM are interpreted as small (0.2–0.5), moderate (0.5–0.8), and large (greater than 0.8).</p> <hd id="AN0189005188-16">Results</hd> <p>A total of 89 children with ASD were recruited from one municipal hospital and two medical center hospitals in Kaohsiung, Tainan and Taipei, Taiwan. Seventy-eight of the children were boys. The results on the children's verbal comprehension, autism severity, adaptive behaviors and social competence are listed in Table 2. The VCI of the children with ASD varied, ranging from low to excellent verbal comprehension ability. The results of the CARS-2 and the SRS-2 indicated that the average severity of autism of the children ranged from mild to moderate, respectively. The results of the VABS standard scores showed that these children had low to adequate levels of social adaptive function.</p> <p>Table 2 Descriptive statistics of performance of children with ASD (<emph>N</emph> = 89) on the measurements</p> <p> <ephtml> &lt;table rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Measurements&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Mean (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Range&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Age&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;70.69 (15.31)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;36&amp;#8211;125&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;OSCA&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;58.80 (13.40)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25&amp;#8211;77&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Social skill elements&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.09 (4.95)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9&amp;#8211;31&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Social reciprocity&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19.99 (5.16)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8&amp;#8211;27&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Social adjustment&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14.72 (4.31)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&amp;#8211;23&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;VCI&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;97.72 (24.26)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;45&amp;#8211;151&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;CARS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28.48 (3.54)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22&amp;#8211;39&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SRS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;73.60 (8.89)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;51&amp;#8211;93&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;VABS&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Socialization&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;72.91 (13.87)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;50&amp;#8211;104&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Daily living skills&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;76.89 (13.33)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;56&amp;#8211;106&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Motor skills&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;89.23 (11.83)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;65&amp;#8211;111&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Abbreviations</emph> OSCA, Observational Social Competence Assessment; VCI, Verbal Comprehension Index; CARS-2, Childhood Autism Rating Scale, Second Edition; SRS-2, Social Responsiveness Scale, Second Edition; VABS, Vineland Adaptive Behavior Scales</p> <p>The Cronbach's α of the OSCA was 0.954, showing that the OSCA had high internal consistency (Table 3). In addition, the OSCA dimensions also showed high consistency (Cronbach's α = 0.820–0.926). For test–retest reliability, the mean period between two assessments was 12.6 days, ranging from 3 to 34 days. None of the children were in the intervention group (SCGI). The results showed that the total and dimension scores of the OSCA had good test–retest reliability (ICC = 0.917–0.96, see Table 3). For inter-rater reliability, the mean period between two assessments was 9.1 days, ranging from 2 to 22 days. The results showed that the total and dimensional scores had good inter-rater reliability (ICC = 0.905–0.974, see Table 3).</p> <p>Table 3 The reliability results of the OSCA (<emph>N</emph> = 89)</p> <p> <ephtml> &lt;table rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Score&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Cronbach's alpha&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Test&amp;#8211;retest reliability (ICC)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Inter-rater reliability (ICC)&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Social skill elements&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.907&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.960&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.949&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Social reciprocity&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.926&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.948&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.934&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Social adjustment&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.820&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.917&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.905&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.954&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.960&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.974&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Abbreviations</emph> ICC, intraclass correlation coefficient</p> <p>The OSCA was found to have good content validity. The final version of the OSCA was reviewed by three experts with clinical experience in child development and ASD. The content validity indexes of the rating criteria of each item were mostly 100%, except for the content of the verbal expression item, which was 80%. The content validity indexes of the task feasibility also reached 100%, with only the comfort item requiring a reminder that the evaluator must act properly when administrating this item. The content validity indexes of degree of fit between items and dimensions were also good, as all three experts agreed. Finally, the feasibility of the overall assessment of the OSCA concerning issues such as the ability to capture the authenticity and integrity of social competence, the ability to distinguish children with ASD from those without ASD, and clinical applicability were confirmed by the content validity indexes, which were 100%, 93% and 87% respectively. Overall, the OSCA was confirmed to measure social competence in children with ASD.</p> <p>The results on the convergent validity and divergent validity of the OSCA are shown in Table 4. The correlations between the three dimensions and the total score were good. The correlations between the OSCA and the VCI (<emph>r</emph> = 0.585–0.703, <emph>p</emph> &lt; 0.001), CARS-2 (<emph>r</emph> = -0.521 to -0.405, <emph>p</emph> &lt; 0.001), and socialization domain of the VABS standard scores (<emph>r</emph> = 0.458–0.508, <emph>p</emph> &lt; 0.001) were moderate, suggesting good convergent validity between these measures. A small correlation was found between the OSCA and SRS-2 (<emph>r</emph> = -0.291 to -0.228), <emph>p</emph> = 0.019–0.038). No significant correlation was found between the OSCA and motor skills domain of the VABS standard scores (<emph>r</emph> = 0.007–0.195, <emph>p</emph> = 0.205–0.964), indicating that social competence assessed by the OSCA and motor ability are relatively different. In terms of the correlations with daily living skills, the scores of the daily living skills domain of the VABS standard scores (<emph>r</emph> = 0.340–0.490, <emph>p</emph> = 0.001–0.024) showed small to moderate correlations with the OSCA scores.</p> <p>Table 4 Correlations between the OSCA and other measures for convergent validity and divergent validity of the OSCA (<emph>N</emph> = 89)</p> <p> <ephtml> &lt;table rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left" colspan="4"&gt;&lt;p&gt;OSCA&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Variables&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;SSE&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;SR&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;SA&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SSE&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.851&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.729&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.931&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SR&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.796&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.955&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SA&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.897&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;VCI&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.678&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.688&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.585&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.703&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;CARS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.521&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.468&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.405&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.503&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SRS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.220&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.237&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.233&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-0.248&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="2"&gt;&lt;p&gt;VABS&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Socialization&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.505&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.485&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.458&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.508&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Daily living skills&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.490&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.340&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.395&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.429&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Motor skills&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.195&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.007&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.102&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.105&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Note</emph>: *<emph>p</emph> &lt; 0.05, **<emph>p</emph> &lt; 0.01 <emph>Abbreviations</emph>: SSE, social skill elements; SR, social reciprocity; SA, social adjustment; VCI, Verbal Comprehension Index; CARS-2, Childhood Autism Rating Scale, Second Edition; SRS-2, Social Responsiveness Scale, Second Edition; VABS, Vineland Adaptive Behavior Scales</p> <p>The results on the responsiveness of the OSCA are shown in Table 5. No statistically significant difference was found between the pre-test scores of the OSCA of the two groups. The results of the paired <emph>t</emph> tests showed that the three dimension and total scores of both groups were significant. The OSCA displayed moderate responsiveness in both groups.</p> <p>Table 5 The responsiveness results of the OSCA in the SCGI group and control group (<emph>n</emph> = 30)</p> <p> <ephtml> &lt;table rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" rowspan="2" /&gt;&lt;th align="left" colspan="2"&gt;&lt;p&gt;Mean (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;t&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;&lt;italic&gt;p&lt;/italic&gt;&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;Difference mean&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;SD of&lt;/p&gt;&lt;p&gt;score changes&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;ES&lt;/p&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;SRM&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Pre&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Post&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="3"&gt;&lt;p&gt;SCGI group (&lt;italic&gt;n&lt;/italic&gt; = 15)&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SSE&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25.67 (3.85)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27.07 (2.55)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-2.365&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.033&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.400&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.283&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.36&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.61&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22.13 (3.68)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.13 (3.29)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-4.369&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.001&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.000&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.773&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.54&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.13&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SA&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15.12 (3.13)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19.20 (3.23)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-7.425&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.000&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.933&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.052&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.26&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.92&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;63.07 (9.38)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;70.40 (7.93)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-6.226&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.000&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7.333&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.562&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.78&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.61&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="4"&gt;&lt;p&gt;Control group (&lt;italic&gt;n&lt;/italic&gt; = 15)&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SSE&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.87 (3.87)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;26.60 (3.07)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-2.551&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.023&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.733&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.631&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.45&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.66&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SR&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19.87 (3.74)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22.80 (3.19)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-5.358&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.000&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.933&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.120&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.78&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.38&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;SA&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13.87 (3.62)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15.87 (3.46)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-4.971&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.000&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.000&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.558&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.55&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.28&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Total&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;58.60 (9.75)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;65.27 (8.61)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;-7.214&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.000&amp;#42;&amp;#42;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6.667&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.579&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.68&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.86&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Abbreviations</emph> ES, effect size; SRM, standardized response mean; SCGI, social competence group intervention; SSE, social skill elements; SR, social reciprocity; SA, social adjustment</p> <p>According to the Cohen's d and SRM results, the OSCA displayed large responsiveness in the social adjustment dimensions (Cohen's d = 1.26; SRM = 1.92) in the SCGI group. In addition, in this dimension, responsiveness was higher in the SCGI group than in the control group. Overall, the OSCA reflected the main outcome of the SCGI, which focused on improving the children's social adjustment.</p> <hd id="AN0189005188-17">Discussion</hd> <p>In this study, the OSCA was developed and its psychometric properties were examined in children with ASD between 3 and 12 years old. The OSCA has shown good reliability, validity, and responsiveness, and it can be applied as an outcome measure. The multidimensional design of the OSCA provides elaborate information on social competence with its dimensions of social skill elements, social reciprocity, and social adjustment. With the OSCA, professionals who work with children with ASD can understand their strengths and weaknesses in social competence so as to formulate corresponding interventions. Furthermore, the OSCA can also reflect children's progress or development in social competence to check the effectiveness of interventions.</p> <p>The OSCA was developed with three characteristics: multidimensional design, good clinical applicability, and good psychometric properties. These characteristics allow the OSCA to serve as an appropriate outcome measure to overcome the issues of the current assessments. First, the OSCA was designed based on the multidimensional theory of social competence to assess the diversity of social competence in children with ASD. The items in each dimension were selected and designed based on the definitions of the concepts embedded in the items and their corresponding dimensions while considering behaviors that can be easily observed in children with ASD. Therefore, the OSCA can evaluate and analyze the strengths and weaknesses of social competence in children with ASD.</p> <p>Second, the OSCA has good clinical applicability, as supported by the pilot study. The OSCA has several advantages in terms of its clinical applicability, such as administration (i.e., time, convenience, and acceptability) and rating design. The assessment context of the OSCA allows clinical practitioners to interact with children in a structured manner for about 30 min. Through interesting and age-appropriate activities or contexts, clinical practitioners can observe children's reactions to social cues in the assessment. In addition, the concrete and detailed scoring criteria also enable clinical practitioners to understand the child's social competence.</p> <p>Third, the OSCA has been shown to have good psychometric properties, including internal consistency, test–retest reliability, inter-rater reliability, content validity, and construct validity. First of all, the high internal consistency shows that the items in the OSCA are homogenous on social competence. Not only the total score of the OSCA but also its three dimensions show high internal consistency, ensuring that the three dimensions of the OSCA can measure homogeneous concepts of social competence under the multidimensional architecture. Also, the OSCA has acceptable test–retest reliability in three dimensions and in the whole assessment, indicating that the OSCA measures social competence with good consistency.</p> <p>The results on the content validity indicated that the items and their definitions represent social competence, and the instructions are clear and appropriate. The OSCA has good convergent validity, as evidenced by the moderate correlations with the assessments of the VCI, CARS-2, and socialization domain of the VABS standard scores. However, another assessment for assessing autism severity, the SRS-2, which is rated by caregivers, did not have results similar to those of the CARS-2. The lower correlation between the OSCA and the SRS-2 may have been caused by the different evaluation methods of the assessments. Previous studies have shown low correlation between caregiver questionnaires and behavioral observations measured by professionals (Kitzerow et al., [<reflink idref="bib33" id="ref67">33</reflink>]; Reszka et al., [<reflink idref="bib44" id="ref68">44</reflink>]).</p> <p>The OSCA has good divergent validity with the motor skills domain of the VABS standard scores. The insignificant correlations indicate that social competence and motor ability are two distinct constructs. However, contrary to our hypothesis, the correlation between the daily living skills domain of the VABS standard scores and the OSCA was significant. This result may have been due to the sample characteristics, such as verbal IQ and autism severity. Previous studies have also found that higher symptom severity is correlated to lower adaptive functioning, such as daily living skills; meanwhile, cognitive ability accounts for significant variance in daily living skills (Franchini et al., [<reflink idref="bib23" id="ref69">23</reflink>]; Frost et al., [<reflink idref="bib25" id="ref70">25</reflink>]). Children with low IQ and severe autism severity, who have more social deficits, are likely to have lower daily living skills. Therefore, although daily living skills and social competence are different constructs, daily living skills may not be a suitable variable for examining the divergent validity of the OSCA in children with ASD.</p> <p>In addition to reliability and validity, the OSCA also has good responsiveness as an outcome measure to complement the lack of sufficient psychometric properties of the current assessments of social competence. The OSCA was responsive to changes occurring over 4 months in both the experimental and control groups, but the degrees of responsiveness in the separate dimensions were different. Regardless of the types of responsiveness indices, the social adjustment dimension had significant responsiveness in the SCGI group. It is worth noting that all three types of responsiveness of the social adjustment dimension of the SCGI group were greater than those of the control group, indicating that the OSCA reflected that the children in the SCGI group improved more in the social adjustment dimension. On the other hand, the social reciprocity dimension was more responsive to the control group than to the SCGI group. Indeed, the SCGI group focused on how to get along and coordinate with others during social interaction, and these social skills were intentionally taught through cognitive learning. The control group focused on promoting reciprocity in interaction, and the skills were implicitly learned through games. The different focuses of social competence of the two interventions were revealed by the change scores in the different domains of the OSCA.</p> <p>Considering the aforementioned advantages, the OSCA shows promise as an outcome measure for evaluating social competence as compared with existing diagnostic tools or proxy questionnaires. Diagnostic and screening tools, such as the ADOS-2 and SRS-2, are designed for identifying children with ASD or confirming ASD traits, so they include items on not only social interaction but also ASD symptoms such as restricted and repetitive behaviors. In contrast, the OSCA focuses specifically on social competence, incorporating three theoretically based dimensions of social competence. This approach allows clinical practitioners to dissect social competence into finer components, enhancing their understanding of social competence in children with ASD. Furthermore, the OSCA aims to measure intervention effectiveness, and as such, we examined not only its reliability and validity but also its responsiveness in this study. With this robust psychometric evidence, clinical practitioners trained in OSCA administration can gather trustworthy and efficient information on children's social competence in busy clinical environments. Administering observational assessments by these trained professionals can provide standardized profiles of social competence, reducing the risk of overestimating or underestimating social competence compared to proxy questionnaires alone. In summary, the OSCA demonstrates its uniqueness and potential as a tool for assessing social competence, making it well-suited for application in clinical practice.</p> <hd id="AN0189005188-18">Limitations and Future Suggestions</hd> <p>The current study had several limitations. First, the sample for psychometric examination may not have been representative of the population. The OSCA is designed for children with ASD aged 3–12 years. However, 72% of the recruited children with ASD were 5–6 years old. Second, the sample size for examining responsiveness was small (<emph>n</emph> = 30). The responsiveness of the OSCA could be further examined with a larger sample size. Last, the multidimensional structure of the OSCA has not been examined. Although the OSCA was developed based on the theoretical basis of social competence, its three-dimensional structure was not tested in this study. Meanwhile, real-world social contexts are inherently complicated. The extent to which the tasks or social contexts designed in the OSCA can effectively reflect children's genuine social competence remains to be tested. The structural validity and ecological validity of the OSCA can be examined in future studies. Evidence such as factor analysis will better support the construct of the OSCA. Future studies addressing the limitations of this study could lead to improvements of the OSCA as a measure of social competence in children with ASD.</p> <hd id="AN0189005188-19">Conclusion</hd> <p>In conclusion, the OSCA has been developed to measure children's social competence based on the multidimensional theory. The OSCA not only overcomes the issues of the current assessments but also can serve as a psychometrically sound outcome measure of social competence in children with ASD. The administration design of the OSCA involved full consideration of its feasibility for application in the clinical setting to promote the use of this standardized assessment. Without adding burden to clinical practitioners or researchers, a more complete picture of social competence can be measured by using the OSCA. The OSCA offers clinicians or researchers an option when choosing an outcome measure of social competence for developing social interventions.</p> <hd id="AN0189005188-20">Acknowledgements</hd> <p>We especially thank the children and caregivers who participated in our study. Besides, we would like to offer our sincerest thanks to the staff at the participating hospitals for their invaluable assistance.</p> <hd id="AN0189005188-21">Author Contributions</hd> <p>[Ming-Hsuan Liu], [Fu-Mei Chiang], [Cheng-Te Chen], [Hsiu-Ching Yang], [Kuan-Lin Chen]; Methodology: [Ming-Hsuan Liu], [Fu-Mei Chiang], [Cheng-Te Chen], [Hsiu-Ching Yang], [Kuan-Lin Chen]; Formal analysis and investigation: [Ming-Hsuan Liu], [Fu-Mei Chiang], [Cheng-Te Chen] [Kuan-Lin Chen]; Writing - original draft preparation: [Ming-Hsuan Liu]; Writing - review and editing: [Ming-Hsuan Liu], [Fu-Mei Chiang], [Cheng-Te Chen], [Hsiu-Ching Yang], [Kuan-Lin Chen]; Funding acquisition: [Kuan-Lin Chen]; Resources: [Fu-Mei Chiang], [Kuan-Lin Chen]; Supervision: [Fu-Mei Chiang], [Hsiu-Ching Yang], [Kuan-Lin Chen].</p> <hd id="AN0189005188-22">Funding</hd> <p>This study was supported by grants from the Ministry of Science and Technology (MOST 109-2628-B-006-023, MOST 110-2628-B-006-019, MOST 110-2628-B-006-031, MOST 111-2628-B-006-019 and MOST 111-2628-B-006-021).</p> <hd id="AN0189005188-23">Data Availability</hd> <p>Data not available due to ethical considerations. Based on the signed informed consent, participants of this study did not agree that their data could be shared with the public.</p> <hd id="AN0189005188-24">Declarations</hd> <p></p> <hd id="AN0189005188-25">Ethical Approval</hd> <p>The study protocol was approved by the Institutional Review Boards of three hospitals in Taiwan.</p> <hd id="AN0189005188-26">Consent for Publication</hd> <p>The manuscript has been read and agreed on by all authors, and consent forms of all participants have been collected.</p> <hd id="AN0189005188-27">Competing Interests</hd> <p>Not applicable</p> <hd id="AN0189005188-28">Appendix</hd> <p>Appendix 1 Overview of observational coding systems of social competence in children with autism spectrum disorder</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Authors (Year)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Age range&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Aim&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Observation and coding targets&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Corbett et al. (2019)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8&amp;#8211;16&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;To investigate the treatment of social behavior&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Social exchange of cooperative behaviors, the percentage of time engaging in:&lt;/p&gt;&lt;p&gt;1. Verbal bout&lt;/p&gt;&lt;p&gt;2. Cooperative play&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Usher, Burrows, Schwartz, and Henderson (2015)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9&amp;#8211;18&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;To measure social competence&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Social initiative, reciprocity, self monitoring&lt;/p&gt;&lt;p&gt;1. Total time talking&lt;/p&gt;&lt;p&gt;2. The number of Share, Seek, Response without elaboration, Showing actions, Verbal directive, suggestions made&lt;/p&gt;&lt;p&gt;3. Frequency of waiting&lt;/p&gt;&lt;p&gt;4. Rating of Eye contact, Conversational efficacy, Rapport, Teaching efficacy&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>Appendix 2 Overview of caregiver-reported questionnaires of social competence in children with autism spectrum disorder</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Assessment&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Authors (Year)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Age range&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Aim&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Domains (Items)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Content related to social competence&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Scoring&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Social Responsiveness Scale, Second Edition (SRS-2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Constantino (2012)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.5 years to adult&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;To identify the presence and severity of social impairment of ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5 treatment subscales (65)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4 treatment subscales: Social awareness, Social cognition, Social communication, and Social motivation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Four-point scale&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Vineland Adaptive Behavior Scales, Third Edition (VABS-3)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Sparrow, Cicchetti, and Saulnier (2016)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Birth to 90 years old&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;To assess adaptive behaviors of individuals with intellectual, developmental, and other disabilities&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5 domains (502)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 domains: Communication and Socialization&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Three-point scale&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Multidimensional Social Competence Scale (MSCS)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Yager and Iarocci (2013)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11&amp;#8211;18&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;To assess multidimensional social competence&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7 domains (77)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Social motivation, Social inferencing, Demonstrating empathic concern, Social knowledge, Verbal conversation skills, Nonverbal sending skills, and Emotion regulation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Five-point scale&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Abbreviations</emph> ASD, autism spectrum disorder</p> <p>Appendix 3 Overview of professional-administered assessments of social competence in children with autism spectrum disorder</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Assessment&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Authors (Year)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Age range&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Aim&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Domains/items&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Content related to social competence&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Administration&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Autism Diagnostic Observation Schedule, Second Edition (ADOS-2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Lord et al. (2012)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12 months to Adult&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;To assess and diagnose ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5 categories&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 categories: Communication, Social interaction&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Task administration and behavior observation&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Autism Diagnostic Interview Revised (ADI-R)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Rutter, LeCouteur, and Lord (2003)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 years and older&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;To assess and diagnose ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 domains&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 domains: Language/Communication, Reciprocal Social Interactions&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Interview&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Childhood Autism Rating Scale, Second Edition (CARS-2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Schopler, Van Bourgondien, Wellman, and Love (2010)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 years and older&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;To help identify and diagnose ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15 items&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5 items: Relating to people, Emotional response, Verbal communication, Nonverbal communication, General impression&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Interview with clinical observation&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>Abbreviations</emph> ASD, autism spectrum disorder</p> <hd id="AN0189005188-29">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0189005188-30"> <title> References </title> <blist> <bibl id="bib1" idref="ref24" type="bt">1</bibl> <bibtext> Ambrose K, Simpson K, Adams D. 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Autism Research. 2022; 15; 5: 778-790. 10.1002/aur.2696. 35238171. 9310578</bibtext> </blist> </ref> <aug> <p>By Ming-Hsuan Liu; Fu-Mei Chiang; Cheng-Te Chen; Hsiu-Ching Yang and Kuan-Lin Chen</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib56" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib17" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib34" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib31" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib39" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib38" firstref="ref9"></nolink> <nolink nlid="nl8" bibid="bib47" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib40" firstref="ref12"></nolink> <nolink nlid="nl10" bibid="bib12" firstref="ref13"></nolink> <nolink nlid="nl11" bibid="bib42" firstref="ref14"></nolink> <nolink nlid="nl12" bibid="bib41" firstref="ref15"></nolink> <nolink nlid="nl13" bibid="bib32" firstref="ref16"></nolink> <nolink nlid="nl14" bibid="bib49" firstref="ref17"></nolink> <nolink nlid="nl15" bibid="bib27" firstref="ref18"></nolink> <nolink nlid="nl16" bibid="bib30" firstref="ref19"></nolink> <nolink nlid="nl17" bibid="bib50" firstref="ref20"></nolink> <nolink nlid="nl18" bibid="bib24" firstref="ref21"></nolink> <nolink nlid="nl19" bibid="bib29" firstref="ref22"></nolink> <nolink nlid="nl20" bibid="bib36" firstref="ref23"></nolink> <nolink nlid="nl21" bibid="bib20" firstref="ref25"></nolink> <nolink nlid="nl22" bibid="bib35" firstref="ref26"></nolink> <nolink nlid="nl23" bibid="bib21" firstref="ref28"></nolink> <nolink nlid="nl24" bibid="bib22" firstref="ref29"></nolink> <nolink nlid="nl25" bibid="bib43" firstref="ref30"></nolink> <nolink nlid="nl26" bibid="bib44" firstref="ref32"></nolink> <nolink nlid="nl27" bibid="bib28" firstref="ref33"></nolink> <nolink nlid="nl28" bibid="bib55" firstref="ref34"></nolink> <nolink nlid="nl29" bibid="bib46" firstref="ref36"></nolink> <nolink nlid="nl30" bibid="bib51" firstref="ref38"></nolink> <nolink nlid="nl31" bibid="bib18" firstref="ref40"></nolink> <nolink nlid="nl32" bibid="bib45" firstref="ref44"></nolink> <nolink nlid="nl33" bibid="bib10" firstref="ref47"></nolink> <nolink nlid="nl34" bibid="bib48" firstref="ref54"></nolink> <nolink nlid="nl35" bibid="bib19" firstref="ref56"></nolink> <nolink nlid="nl36" bibid="bib15" firstref="ref57"></nolink> <nolink nlid="nl37" bibid="bib26" firstref="ref58"></nolink> <nolink nlid="nl38" bibid="bib53" firstref="ref59"></nolink> <nolink nlid="nl39" bibid="bib52" firstref="ref60"></nolink> <nolink nlid="nl40" bibid="bib13" firstref="ref61"></nolink> <nolink nlid="nl41" bibid="bib54" firstref="ref62"></nolink> <nolink nlid="nl42" bibid="bib16" firstref="ref63"></nolink> <nolink nlid="nl43" bibid="bib14" firstref="ref65"></nolink> <nolink nlid="nl44" bibid="bib37" firstref="ref66"></nolink> <nolink nlid="nl45" bibid="bib33" firstref="ref67"></nolink> <nolink nlid="nl46" bibid="bib23" firstref="ref69"></nolink> <nolink nlid="nl47" bibid="bib25" firstref="ref70"></nolink> |
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| Items | – Name: Title Label: Title Group: Ti Data: Development and Psychometric Examination of a New Social Competence Outcome Measure for Children with Autism Spectrum Disorder: The Observational Social Competence Assessment – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Ming-Hsuan+Liu%22">Ming-Hsuan Liu</searchLink><br /><searchLink fieldCode="AR" term="%22Fu-Mei+Chiang%22">Fu-Mei Chiang</searchLink><br /><searchLink fieldCode="AR" term="%22Cheng-Te+Chen%22">Cheng-Te Chen</searchLink><br /><searchLink fieldCode="AR" term="%22Hsiu-Ching+Yang%22">Hsiu-Ching Yang</searchLink><br /><searchLink fieldCode="AR" term="%22Kuan-Lin+Chen%22">Kuan-Lin Chen</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-9996-814X">0000-0001-9996-814X</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2025 55(11):3838-3850. – Name: Avail Label: Availability Group: Avail 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/ – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 13 – Name: DatePubCY Label: Publication Date Group: Date Data: 2025 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Outcome+Measures%22">Outcome Measures</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Construction%22">Test Construction</searchLink><br /><searchLink fieldCode="DE" term="%22Psychometrics%22">Psychometrics</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Competence%22">Interpersonal Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Reliability%22">Test Reliability</searchLink><br /><searchLink fieldCode="DE" term="%22Interrater+Reliability%22">Interrater Reliability</searchLink><br /><searchLink fieldCode="DE" term="%22Test+Validity%22">Test Validity</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Adjustment%22">Social Adjustment</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1007/s10803-024-06472-6 – Name: ISSN Label: ISSN Group: ISSN Data: 0162-3257<br />1573-3432 – Name: Abstract Label: Abstract Group: Ab Data: Current assessments of social competence for children with autism spectrum disorder (ASD) are mostly designed for screening or diagnosis, not for measuring outcomes. This study aimed to develop a professional-administrated outcome measure, the Observational Social Competence Assessment (OSCA), and examine its psychometric properties. The OSCA was constructed based on a multidimensional view of social competence (i.e., social skill elements, social reciprocity, and social adjustment). For psychometric evaluation, 89 children with ASD between 3 and 12 years (mean = 70.69 months, SD = 15.31) were assessed with the OSCA and with assessments of ASD symptoms, verbal comprehension ability, and adaptive function. The results show that the OSCA has good internal consistency (Cronbach's [alpha] = 0.820-0.954), test-retest reliability (intraclass correlation coefficients [ICC] = 0.917-0.960), and inter-rater reliability (ICC = 0.905-0.974). The OSCA also has good convergent (r = 0.508-0.703, p < 0.01) and divergent validity (r = 0.105, p = 0.496), as well as good responsiveness to changes in the social adjustment dimension (Cohen's d = 1.26 and standardized response mean [SRM] = 1.92). Conclusively, these results show that the OSCA is sufficiently reliable, valid and responsive to be applied as an outcome measure of social competence in children with ASD. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2026 – Name: AN Label: Accession Number Group: ID Data: EJ1493019 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s10803-024-06472-6 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 13 StartPage: 3838 Subjects: – SubjectFull: Outcome Measures Type: general – SubjectFull: Test Construction Type: general – SubjectFull: Psychometrics Type: general – SubjectFull: Interpersonal Competence Type: general – SubjectFull: Children Type: general – SubjectFull: Autism Spectrum Disorders Type: general – SubjectFull: Test Reliability Type: general – SubjectFull: Interrater Reliability Type: general – SubjectFull: Test Validity Type: general – SubjectFull: Social Adjustment Type: general Titles: – TitleFull: Development and Psychometric Examination of a New Social Competence Outcome Measure for Children with Autism Spectrum Disorder: The Observational Social Competence Assessment Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Ming-Hsuan Liu – PersonEntity: Name: NameFull: Fu-Mei Chiang – PersonEntity: Name: NameFull: Cheng-Te Chen – PersonEntity: Name: NameFull: Hsiu-Ching Yang – PersonEntity: Name: NameFull: Kuan-Lin Chen IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 0162-3257 – Type: issn-electronic Value: 1573-3432 Numbering: – Type: volume Value: 55 – Type: issue Value: 11 Titles: – TitleFull: Journal of Autism and Developmental Disorders Type: main |
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