www.mghcme.org

GAGAN JOSHI, MD Assistant Professor of Psychiatry Director, Autism Spectrum Disorder Program Clinical & Research Program in Pediatric Psychopharmacology Massachusetts General Hospital, Harvard Medical School

www.mghcme.org

To o l s fo r A s s e s s i n g A S D i n C l i n i c & Re s e a rc h S e t t i n g

www.mghcme.org

My spouse/partner and I have the following relevant financial relationship with a commercial interest to disclose: Research Support: PI for Investigator-Initiated Studies: -National Institute of Mental Health (NIMH) grant Award #K23MH100450 -Pfizer pharmaceuticals Site PI for Multi-Site Studies: -Simons Center for the Social Brain -Duke University -Forest Research Laboratories -Sunovion pharmaceuticals Co-Investrigator for Clinical Trials: -U.S. Department of Defense -Merck Schering Plough Corporation -Pamlab LLC. Honoraria: -Governor’s Council for Medical Research and Treatment of Autism in New Jersey -American Academy of Child and Adolescent Psychiatry -Medical Society of Delaware -Simons Foundation

Disclosures

www.mghcme.org

3 1/17/20

17

There continues to be a need for

simplified, relatively brief, and readily accessible

assessment measures to aid

screening and diagnosis of ASD

in clinical and research settings

L a c k i n g A s s e s s m e n t M e a s u r e s f o r A S D

www.mghcme.org

As s e s s m e n t M e a s u res

• SRS is a screening tool for assessing burden of autistic traits in psychiatrically referred and non-referred intellectually capable populations

• CBCL-ASD Profile offers screening for ASD that is integrated with assessment for general psychopathology in referred population of youth with emotional and behavioral difficulties

Screening

Diagnosis

Severity

• DSM-based ASD Symptom Checklist is a rapid and cost-effective diagnostic aid for clinicians

• DSM-based Semi-structured Diagnostic Interview

• Social-Emotional Competence Scale helpful in assessing level of social-emotion functioning

www.mghcme.org

SOCIAL RESPONSIVENESS SCALE©

www.mghcme.org

Social Responsiveness Scale (SRS)

• Observer-rated screening instrument

• Quantitative measure of autistic traits

• 65 item rating scale

• Each item on the scale is rated on a Likert scale from “0” (never true) to “3” (almost always true)

• Requires 15-20 minutes

• The psychometric properties of the SRS are well established (Excellent correspondence between the SRS and the ADI-R)

Social Responsiveness Scale - Subscale Items SOCIAL AWARENESS SOCIAL COGNITION SOCIAL MOTIVATION SOCIAL COMMUNICATION AUTISTIC MANNERISMS

Expressions on his or her face don't match what he or she is saying

Doesn't recognize when others are trying to take advantage of him or her

Seems self-confident when interacting with others

Is awkward in turn-taking interactions with others

When under stress, he or she shows rigid or inflexible patterns of behavior that seem odd

Is aware of what others are thinking or feeling

Recognizes when something is unfair Has good self-confidence Has difficulty relating to peers

Has more difficulty than other children with changes in his or her routine

Focuses his or her attention to where others are looking and listening

Is able to understand the meaning of other people's tone of voice and facial expressions

Would rather be alone than with others Has trouble keeping up with the flow of a normal conversation

Can't get his or her mind off something once he or she starts thinking about it

Doesn't seem to mind being out of step with or "not on the same wavelength" as others

Seems overly sensitive to sounds, textures, or smells

Does not join group activities unless told to do so

Is socially awkward, even when he or she is trying to be polite

Has repetitive, odd behaviors such as hand flapping or rocking

Knows when he or she is talking too loud or making too much noise

Becomes upset in a situation with lots of things going on

Avoids starting social interactions with peers or adults

Gets frustrated trying to get ideas across in conversations

Shows unusual sensory interests or strange ways of playing with toys

Seems to reach to people as if they are objects

Is imaginative, good at pretending (without losing touch with reality)

Seems much more fidgety in social situations than when alone

Plays appropriately with children his or her age

Thinks or talks about the same thing over and over

Walks in between two people who are talking

Doesn't understand how events relate to one another (cause and effect)

Is too tense in social settings Has difficulty making friends, even when trying his or her best

Does extremely well at a few tasks, but does not do as well at most other tasks

Has good personal hygiene Has a sense of humor, understands jokes

Stares or gazes off into space Has difficulty relating to adults Has an unusually narrow range of interests

Is overly suspicious Clings to adults, seems too dependent on them

Offers comfort to others when they are sad

Is not well coordinated

Concentrates too much on parts of things rather than seeing the whole picture.

Separates easily from caregivers Responds appropriately to mood changes in others

Touches others in an unusual way

Takes things too literally and doesn’t get the real meaning of a conversation

Avoids people who want to be emotionally close to him or her

Is able to imitate others' actions Behaves in ways that seem strange or bizarre

Gives unusual or illogical reasons for doing things

Is able to communicate his or her feelings to others

Is regarded by other children as odd or weird

Talks to people with an unusual tone of voice

Avoids eye contact or has unusual eye contact

Has overly serious facial expressions

Is too silly or laughs inappropriately

Has difficulty answering questions directly and ends up talking around the subject

Is emotionally distant, doesn't show his or her feelings

Knows when he or she is too close to someone or is invading someone’s space

Gets teased a lot

Wanders aimlessly from one activity to another

Is inflexible, has a hard time changing his or her mind

www.mghcme.org

Total Raw Score T-Score

School-Age* Adult**

Male Female

Severity Levels Normal ≤ 57 ≤ 51 ≤ 67 ≤59 Mild 58 - 72 52 - 65 68 - 84 60 - 65 Moderate 73 - 97 66 - 89 85 - 112 66 - 75 Severe ≥98 ≥90 ≥113 ≥76

Screening Threshold Non-referred ≥70 ≥70 ≥70 Referred ≥85 ≥85 ≥85

S o c i a l R e s p o n s i v e n e s s S c a l e ( S R S )

Scoring Algorithm

*Informant-rated; **Self & Observer-rated

www.mghcme.org

www.mghcme.org

55

60

65

70

75

Anxious/depressed

Somaticcomplaints

Withdrawnbehavior

Socialproblems

Thoughtproblems

Attentionproblems

Delinquentbehavior

Aggressivebehavior

CB

CL

T-sc

ore

Non-ASD Psychiatric Controls (N=62) ASD (N=65)

**

Level of Dysfunction on Child Behavior Checklist in Psychiatrically

Referred Youth

Statistical Significance: *p≤0.05, **p≤0.01, ***p≤0.001

ASD Youth Age range: 6-18 years IQ Mean IQ: 99 ±14 IQ>70: 100%

ASD Subtypes Autistic Disorder = 52% Asperger’s Disorder = 25% PDD-NOS = 23%

***

*** ***

________ ________ ________

** ***

CBCL – ASD Pro f i l e

CBCL-ASD Subscales (Withdrawn behavior, Social, & Thought Problems) aggregate cutoff T-score of ≥195 is suggestive of ASD

www.mghcme.org

CBCL-ASD Profile Items

CBCL – ASD Profile

Withdrawn Behavior Social Problems Thought Problems

- Refuses to talk - Doesn’t get along with other kids - Strange ideas

- Would rather be alone than with others - Prefers being with younger kids - Strange behavior

- Withdrawn, doesn’t get involved with others - Not liked by other kids - Hears sounds or voices that aren’t there

- Too shy or timid - Gets teased a lot - Sees things that aren’t there

- Secretive, keeps things to self - Feels others are out to get him/her - Nervous movements or twitching

- There is little that he/she enjoys - Complains of loneliness - Picks nose, skin, or other parts of body

- Underactive, slow moving, or lacks energy - Poorly coordinated or clumsy - Plays with own sex parts too much

- Unhappy, sad, or depressed - Gets hurt a lot, accident-prone - Plays with own sex parts in public

- Easily jealous - Can’t get his/her mind off certain thoughts;

obsessions

- Clings to adults or too dependent - Repeats certain acts over and over; compulsions

- Speech problem - Stores up too many things he/she doesn’t need

- Deliberately harms self or attempts suicide

- Sleeps less than most kids

- Talks or walks in sleep

- Trouble sleeping

www.mghcme.org

R e p l i c a t i o n S t u d y f r o m S i n g a p o r e

ASD (N=86) vs: -ADHD (N=543)

-Clinically referred who did not receive dx (N=200)

-Typically developing community sample (N=436)

Withdrawn/Depressed, Social Problems, & Thought Problems subscales significantly discriminated the ASD from ADHD & TD

• Moderate to high sensitivity (68-78%)

• Moderate to high specificity(73%-92%)

www.mghcme.org

MGH AUTISM SPECTRUM DISORDER DSM-5 DIAGNOSTIC SYMPTOM CHECKLIST©

www.mghcme.org

www.mghcme.org

• Expert clinical diagnostic interview remains “gold standard” for diagnosing ASD

• Semi-structured diagnostic Interviews serve to elicit features required for the diagnosis of psychiatric disorders

• Semi-structured diagnostic interviews in current form lack module for the assessment of ASD

• Autism Diagnostic Interview-Revised [ADI-R] (Semi-structured Diagnostic Interview for Autism)

S e m i - s t r u c t u r e d D i a g n o s t i c M e a s u r e s f o r A S D

www.mghcme.org

Autism Diagnostic Interview-Revised (ADI-R)

• Interview with the caretaker (usually mother)

• Requires trained raters

• (training is expensive, time consuming, and not readily available leading to limited # of trained raters)

• Assessment is expensive, time-consuming (has 93 items and takes up to 3 hrs), with limited accessibility

• ? sensitivity to detect ASD in high-functioning and in adult populations

• ? validity in populations with emotional and behavioral difficulties

www.mghcme.org

DSM-based Semi-structured Diagnostic Interview for ASD©

DSM-based Structured Diagnostic Interview for ASD

Social Interaction Social Communication Restricted & Repetitive Behaviors

These Are Some Questions About How S/He Relates To Others.

These Are Some Questions About How S/He Communicates Or Plays With Others.

These Are Questions About Her/His Activities Or Interests

1. Did s/he ever have difficulties in social interactions?.... lack social skills?.... or was socially awkward or inappropriate?

2. Did s/he ever have difficulty in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body gestures?

3. Did s/he seem unusually unaware of the existence or feelings of others?

4. Did s/he not come for comfort even when hurt, or did s/he seek comfort in an odd way?

5. Does s/he avoid looking at people or avoid greeting people?

6. Does s/he have difficulty playing cooperatively with other children?

7. Is s/he uninterested in making peer friendships? Did s/he ever lack interest in their surroundings?

1. Is s/he unable to communicate?

2. Did s/he seldom, if ever, start a conversation with someone else, even if s/he might talk to her/himself?

3. When s/he speaks does her/his tone seem odd?

4. Did s/he repeat words or phrases s/he has heard, in place of responding to what was said?

5. Is s/he uninterested in imaginative activities or stories?

6. Was s/he unable to imitate others personal behaviors when appropriate?

7. Were s/he ever too literal and didn’t get the implied meaning of conversation (puns, jokes)?

1. Does s/he have an extremely restricted range of interests?

2. Did s/he ever have unusual or peculiar interests that were odd in quality (Example: preoccupation with names of train stations, war battles, etc.) or an extreme preoccupation with usual interest(s)?

3. Did s/he ever have prolonged attachments to certain objects, either holding them or staring at them, or lining them up in a repetitive pattern?

4. Did he/she ever get unusually upset if there were small changes in where things usually were placed in the house?

5. Did he/she get upset when there are changes in daily routine?

6. Did s/he ever have any repetitive patterns of behavior?

www.mghcme.org

• DSM-based interview

• A simplified, relatively brief semi-structured diagnostic measure

• Administered by trained-rater to parent as informant

• Interview format similar to semi-structured diagnostic interviews (K-SADS & SCID)

• Can be incorporated to the structured diagnostic interviews (K-SADS & SCID) as a module for the assessment of ASD.

DSM-based Semi-structured Diagnostic Interview for Assessment of ASD in Referred Populations

www.mghcme.org

The inter-rater reliability of the ASD-SDI was established by having an independent rater with expertise in the diagnosis of ASD listen to audiotapes of 20 randomly selected ASD-SDI with or without a diagnosis of ASD.

Kappa coefficient of diagnostic agreement for ASD between Expert Clinician Diagnosis

and Trained-raters assigned diagnosis

= 0.90

ASD-SDI Inter-rater Rel iabi l i ty

www.mghcme.org

ASD by SRS (SRS+ASD; screen-positive=t-score ≥60)

(N=117)

ASD by ASD-Structured Diagnostic Interview (ASD-SDI)

(N=116)

Concurrent Validity

Sensitivity=96%

Diagnostic Correspondence with SRS Screen-positive ASD

96% (112/117)

ASD by Clinical Diagnostic Interview (CDI+ASD)

(N=123)

ASD by ASD-Structured Diagnostic Interview (SDI+ASD)

(N=116)

Sensitivity=94%

Excellent agreement of the DSM- based ASD-SDI instrument with

clinician diagnosis and with SRS+ screeen for ASD

Diagnostic Correspondence with Clinical Diagnosis of ASD

94% (116/123)

www.mghcme.org

100

91

81

60

70

80

90

100

Autistic Disorder Asperger's Disorder PDD-NOS

% w

ith

ASD

-SD

I Dia

gno

sis

of

ASD

ASD Diagnosis Correspondence between

ASD-SDI & ASD-CDI

Clinical Diagnoses of ASD:

Concurrent Validity

www.mghcme.org

71

89

100

60

70

80

90

100

Non-ASD(N=7)

Asperger's Disorderor PDD-NOS

(N=33)

Autistic Disorder(N=83)

Correspondence between ASD-SDI Diagnosis & SRS+ASD (T-Scores ≥60)

Statistical Significance: *p≤0.05, **p≤0.01, ***p≤0.001 A= vs. Non-ASD; B= vs. Asperger’s/PDD-NOS

% w

ith

SR

S T-

sco

re ≥

60

A*** B**

ASD-SDI Diagnoses of ASD:

Concurrent Validity

www.mghcme.org

ADHD by Structured Diagnostic Interview (K-SADS-E)

(N=1563)

ASD by ASD-Structured Diagnostic Interview (SDI+ASD)

(N=172)

Discriminant Validity

Specificity=89%

11% (172/1563) of the ADHD sample met criteria for ASD on the ASD-SDI

11% (172/1563)

www.mghcme.org

Psychometric Properties

Reliability

Inter-rater Reliability Kappa coefficient of diagnostic agreement between

Expert Clinician Diagnosis and Trained-raters assigned diagnosis = 0.90

Validity Concurrent Validity

Diagnostic Sensitivity of the ASD-SDI for: - Clinical diagnosis = 94% - SRS (screen-positive) = 96%

Discriminant Validity Diagnostic Specificity of the ASD-SDI = 89%

Aberrant Behavior Checklist - Subscale Items

IRRITABILITY HYPERACTIVITY SOCIAL WITHDRAWAL

INAPPROPRIATE SPEECH STEREOTYPY

Injures self on purpose Excessively active at home, school, work or elsewhere

Seeks isolation from others Talks excessively Stereotyped behavior; abnormal, repetitive movements

Deliberately hurts himself/herself

Tends to be excessively active Prefers to be alone Repetitive Speech Meaningless, recurring body movements

Does physical violence to self Constantly runs or jumps around the room

Withdrawn; prefers solitary activities

Repeats a word or phrase over and over

Moves or rolls head back and forth repetitively

Aggressive to other children or adults (verbally or physically)

Restless, unable to sit still Isolates from other children or adults

Talks to self loudly Repetitive hand, body, or head movements

Cries and screams inappropriately

Does not stay in seat (during lesson, meals, etc.)

Listless, sluggish, inactive

Waves or shakes the extremities repeatedly

Cries over minor annoyances and hurts

Will not sit still for any length of time

Inactive, never moves spontaneously

Rocks body back and forth repeatedly

Screams inappropriately Boisterous (inappropriately noisy and rough)

Sits or stands in one position for a long time

Odd, bizarre in behavior

Yells at inappropriate times Impulsive (acts without thinking) Does nothing but sit and watch others

Irritable and whiny Disobedient; difficult to control Preoccupied; stares into space

Depressed mood Uncooperative Unresponsive to structured activities (does not react)

Mood changes quickly Disrupts group activities Is difficult to reach, contact, or get through to

Stamps feet or bangs objects or slams doors

Disturbs others Fixed facial expression; lack of emotional responsiveness

Temper tantrums/outbursts Easily distracted Does not try to communicate by words or gestures

Has temper outbursts or tantrums when does not get own way

Does not pay attention to instructions

Resists any form of physical contact

Demands must be met immediately

Pays no attention when spoken to

Responds negatively to affection

Deliberately ignores directions Shows few social reactions to others

CLINICIAN-RATED MEASURE

Ability/Competence

Name:____________________________________________ Above

Average

Av

era

ge

Below Average

Impaired Ability

Date:___________________

Instructions: Please complete the following questions based on the patient’s:

1. Observed behaviors in the past month 2. Developmentally expected abilities/competence E

xce

pti

on

al

Su

pe

rio

r

Bo

rde

rlin

e

M

ild

(D

isti

nc

tly

)

Mil

d-M

od

era

te

(Sig

nif

ica

ntl

y)

Mo

de

rate

ly

(M

ark

ed

ly)

Mo

de

rate

-Se

ve

re

(Min

ima

l A

bil

ity

)

Se

ve

rely

(L

ac

ks

Ab

ilit

y)

1. Share interests/activities with peers (group activities, team sports)? 0 1 2 3 4 5 6 7 8

2. Ability to control odd, repetitive behaviors in social situations 0 1 2 3 4 5 6 7 8

3. Level of frustration tolerance 0 1 2 3 4 5 6 7 8

4. Engage in small talk/chit-chat (goalless conversations)? 0 1 2 3 4 5 6 7 8

5. Appropriate response to facial expressions 0 1 2 3 4 5 6 7 8

6. Offer/seek comfort from others when expected 0 1 2 3 4 5 6 7 8

7. Seek approval from others when appropriate 0 1 2 3 4 5 6 7 8

8. Level of spontaneity 0 1 2 3 4 5 6 7 8

9. Ability to take advice or direction 0 1 2 3 4 5 6 7 8

10. Ability to understand other people’s point of view 0 1 2 3 4 5 6 7 8

11. Ability to “read between the lines” 0 1 2 3 4 5 6 7 8

12. Level of social engagement: time spent talking with/about peers 0 1 2 3 4 5 6 7 8

13. Ability to change his/her routine as needed 0 1 2 3 4 5 6 7 8

14. Try new foods/activities 0 1 2 3 4 5 6 7 8

15. Ability to limit time with preferred activities when required 0 1 2 3 4 5 6 7 8

16. Appropriate response to jokes/puns 0 1 2 3 4 5 6 7 8

17. Show interest in others’ lives 0 1 2 3 4 5 6 7 8

18. Express his/her feelings 0 1 2 3 4 5 6 7 8

19. Ability to address problems through multiple approaches 0 1 2 3 4 5 6 7 8

20. Respect for social and personal boundaries (physical/with socially sensitive issues) 0 1 2 3 4 5 6 7 8

21. Make eye contact during interactions or to seek attention 0 1 2 3 4 5 6 7 8

22. In sync with cultural trends (fashion, fads, etc.) 0 1 2 3 4 5 6 7 8

23. Use tone of voice to express emotions 0 1 2 3 4 5 6 7 8

24. Appropriate response to sarcasm 0 1 2 3 4 5 6 7 8

25. Was s/he able to relate to others’ emotions? 0 1 2 3 4 5 6 7 8

26. Tolerate uncertainty/unstructured time 0 1 2 3 4 5 6 7 8

27. Ability to smile back appropriately 0 1 2 3 4 5 6 7 8

28. Engage in back and forth conversation when talking to others 0 1 2 3 4 5 6 7 8

29. Facial expressions appropriate for given situations 0 1 2 3 4 5 6 7 8

30. Reflect on his/her behavior 0 1 2 3 4 5 6 7 8

31. Ability to compromise 0 1 2 3 4 5 6 7 8

32. Ability to control his/her feelings (excitement, anger, anxiety, etc.) 0 1 2 3 4 5 6 7 8

33. Show appropriate concern for or comment on others’ feelings 0 1 2 3 4 5 6 7 8

34. Ability to appropriately apologize 0 1 2 3 4 5 6 7 8

35. Socially appropriate behaviors 0 1 2 3 4 5 6 7 8

36. Ability to change his/her mind without much difficulty when necessary 0 1 2 3 4 5 6 7 8

37. Ability to tolerate the sensory issues that s/he is typically sensitive to (touch, pain, sound, smell, taste, visual, kinetic, occulogyric)

0 1 2 3 4 5 6 7 8

Rater’s Signature:__________________________________________ _ Total Score:________________

INFORMANT-RATED MEASURE

Subject’s Name:_____________________________________

Date: _________________________________ _

Rater’s Name:______________________________________

Relationship to Child:__________________________________

Instructions:

· Please select the item that best describes your child’s behavior over the past month.

· Please rate your child’s behavior relative to behavior expected of his/her peers.

· Please rate item based on your child’s behavior rather than interpreting his/her thoughts

When Appropriate

A

ll t

he

tim

e

A

lmo

st

Alw

ay

s

O

fte

n

S

om

eti

me

s

O

cc

as

ion

all

y

R

are

ly

N

ev

er

1. Did s/he share interests/activities with peers (group activities, team sports)? 0 1 2 3 4 5 6

2. Was s/he able to control odd, repetitive behaviors in social situations? 0 1 2 3 4 5 6

3. Was s/he able to tolerate frustration? 0 1 2 3 4 5 6

4. Did s/he engage in small talk/chit-chat (goalless conversations) when appropriate? 0 1 2 3 4 5 6

5. How often did s/he respond appropriately to facial expressions? 0 1 2 3 4 5 6

6. Did s/he offer/seek comfort from others when expected? 0 1 2 3 4 5 6

7. Did s/he seek approval from others when appropriate? 0 1 2 3 4 5 6

8. How often was s/he spontaneous? 0 1 2 3 4 5 6

9. Was s/he able to take advice or direction when necessary? 0 1 2 3 4 5 6

10. Did s/he understand other people’s point of view? 0 1 2 3 4 5 6

11. How often was s/he able to “read between the lines”? 0 1 2 3 4 5 6

12. When given the chance, did s/he spend time talking with or about peers? 0 1 2 3 4 5 6

13. Was s/he able to change his/her routine as needed? 0 1 2 3 4 5 6

14. Did s/he try new foods or pursue new activities when given the chance? 0 1 2 3 4 5 6

15. Did s/he limit his/her time with preferred activities when required? 0 1 2 3 4 5 6

16. How often did s/he respond appropriately to jokes/puns? 0 1 2 3 4 5 6

17. Was s/he generally interested in others’ lives? 0 1 2 3 4 5 6

18. Did s/he express his/her feelings when appropriate? 0 1 2 3 4 5 6

19. Was s/he able to address problems through multiple approaches? 0 1 2 3 4 5 6

20. How often did s/he respect social and personal boundaries (physically/with socially sensitive issues)? 0 1 2 3 4 5 6

21. Did s/he appropriately make eye contact during interactions or to get someone’s attention? 0 1 2 3 4 5 6

22. Was s/he in sync with cultural trends (fashion, fads, etc.)? 0 1 2 3 4 5 6

23. Did his/her tone of voice match the emotion s/he was expressing? 0 1 2 3 4 5 6

24. How often did s/he respond appropriately to sarcasm? 0 1 2 3 4 5 6

25. Was s/he able to relate to others’ emotions? 0 1 2 3 4 5 6

26. Did s/he tolerate uncertainty/unstructured time? 0 1 2 3 4 5 6

27. How often did s/he smile back appropriately? 0 1 2 3 4 5 6

28. Did s/he engage in back and forth conversation when talking to others? 0 1 2 3 4 5 6

29. Were his/her facial expressions appropriate for a given situation? 0 1 2 3 4 5 6

30. Did s/he reflect on his/her behavior when appropriate? 0 1 2 3 4 5 6

31. Was s/he open to compromise when needed? 0 1 2 3 4 5 6

32. Was s/he able to control his/her feelings (excitement, anger, anxiety, etc.) when appropriate? 0 1 2 3 4 5 6

33. Did s/he show concern for or comment on others’ feelings when appropriate? 0 1 2 3 4 5 6

34. Was s/he able to appropriately apologize? 0 1 2 3 4 5 6

35. How often was his/her behavior socially appropriate? 0 1 2 3 4 5 6

36. Was s/he able to tolerate the sensory issues that s/he is typically sensitive to? (touch, pain, sound, smell, taste, visual) 0 1 2 3 4 5 6

37. Was s/he able to change his/her mind without much difficulty when necessary? 0 1 2 3 4 5 6

Total Score:_______________________

M G H S O C I A L - E M O T I O N A L C O M P E T E N C E S C A L E ©

www.mghcme.org

Social processing (awareness, motivation, response)

Cognitive Rigidity (rigid routine, poor social adaptability, rigid thinking, transitional difficulties)

Non-verbal Communication

Abstract Thinking (concrete/literal, black & white, tolerate ambiguity, tolerate unstructured time)

Level of Executive Control (control over feelings/ interests/ motivations)

Respect for social & personal

boundaries

(physical/with socially sensitive

issues)

Engage in small talk/chit-chat

(goalless conversations)

Appropriate response to sarcasm Ability to address problems through

multiple approaches

Ability to limit time with preferred

activities when required

Share interests/activities with peers

(group activities, team sports)

Ability to change his/her mind without

much difficulty when necessary

Ability to smile back appropriately

Ability to “read between the lines” Ability to control his/her feelings

(excitement, anger, anxiety, etc.)

Engage in back and forth

conversation (dialogue versus

monologue)

Ability to take advice or direction? Make eye contact during interactions

or to seek attention

Tolerating uncertainty/unstructured

time

Level of frustration tolerance

In-sync with cultural trends

(fashion, fads, etc.)

Ability to change their routine as

needed

Facial expressions appropriate for

given situations

Appropriate response to jokes/puns

Seek approval from others when

appropriate

Ability to compromise? Appropriate response to facial

expressions

Level of social engagement Try new foods/activities?

Time spend talking with/about peers Level of spontaneity?

Socially appropriate behaviors

Show interest in others’ lives

Emotional processing (awareness, motivation, response)

Ability to Empathize (Theory of Mind)

Introspective Ability (cognitive processing, self awareness, self reflection)

Mannerisms Sensory Dysregulation

Show appropriate concern for or

comment on others’ feelings

Ability to understand other people’s

point of view

Reflect on his/her behavior? Ability to control odd repetitive

behaviors in social situations

Ability to tolerate the sensory issues

that s/he is typically sensitive to

Offer/seek comfort from others when

expected

Relate to others’ emotions Ability to appropriately apologize

Express his/her feelings

Domains of Social-Emotion Competence

Rating Scale

www.mghcme.org

• SRS is a screening tool for assessing burden of autistic traits in psychiatrically referred and non-referred intellectually capable populations

• CBCL ASD Profile offers screening for ASD that is integrated with assessment for general psychopathology in referred population of youth with emotional and behavioral difficulties

• DSM-based ASD Structured Diagnostic Interview could serve as a rapid and cost-effective diagnostic aid for reliably identifying ASD in clinical and research settings

• DSM-based ASD Symptom Checklist is a rapid and cost-effective diagnostic aid for clinicians

• Social-Emotional Competence Scale helpful in assessing severity levels of social-emotion functioning

In Summary

www.mghcme.org

T h e A l a n a n d L o r r a i n e B r e s s l e r

C l i n i c a l a n d R e s e a r c h P r o g r a m

for Aut ism Spect rum Disorder

Massachusetts General Hospi ta l

Boston MA

Joseph Biederman, MD

Janet Wozniak, MD

Atilla Ceranoglu, MD

Lynn Grush, MD

Amy Yule, MD

Carrie Vaudreuil, MD

Robert Doyle, MD

A c k n o w l e d g m e n t s

Yvonne Woodworth, BA

Daniel Kaufman, BS

Ryan Kilcullen, BA

Abigail Belser, BA

Philia Henderson, BA

Stefani Callinan, BS

Melissa De Leon

Sheeba A. Anteraper, PhD

Kaustubh R. Patil, PhD

Stephen Faraone, PhD

Ronna Fried, EdD

Maribel Galdo, LCSW

Maura Fitzgerald, MA

Phone: (617) 726-7899 Email: MGHASDprogram@Partners.org Facebook:

Facebook.com/BresslerMGH

Web Link: http://www.massgeneral.org/psychiatry/services/autism_conditions.aspx