, Marcy Willard1 and Helena Huckabee1
(1)
Emerge: Professionals in Autism, Behavior and Personal Growth, Glendale, CO, USA
Abstract
Cognition is an important area of assessment in ASD and other disorders because cognitive performance provides the foundation to which all other assessment data are compared. Cognitive testing reveals strengths and weaknesses in verbal, nonverbal, working memory, and fluency domains. When diagnosing an ASD, DSM-5 requires comment on the level of cognitive impairment or lack thereof (American Psychiatric Association, Diagnostic and statistical manual of mental disorders (5th edn). Arlington, VA, 2013). Language is crucial to assess as communication is a core feature of an ASD. Parent report of challenges with expressive, receptive, or pragmatic language helps guide the selection of appropriate language measures that may address important areas such as core language, language fluency, language memory, or language content. One of the authors of this text found that in ASD, the percentage of variance of IQ accounted for by language was 27 % (without significant intervention) (Huckabee, Correspondence of DSM-IV criteria for autistic spectrum disorders with standardized language measures of intelligence and language. University of Houston, Unpublished dissertation, Presented April 2003). Language alone or language combined with IQ is generally considered the best predictor of outcomes (Sutera et al., J Autism Dev Disord 37(1), 2007, p. 100; Schreibman et al., International handbook of autism and pervasive developmental disorders. Springer, New York, 2011, p. 295). Indeed researchers claim, “Early language ability and cognitive ability have emerged as the most robust predictors of overall prognosis for autism during childhood, adolescence and adulthood” (Schreibman et al., International handbook of autism and pervasive developmental disorders. Springer, New York, 2011, p. 295). Given these considerations, effective and thorough cognitive and language testing are essential to a comprehensive evaluation for ASD. This chapter provides a best-practice guide for assessing cognition and language, including some of the common intellectual profiles evidenced in children and adults with ASD.
Keywords
Cognitive assessment in ASDLanguage assessment in ASDTest behaviors in ASDProcessing speed in ASDVerbal comprehension in ASDPerceptual reasoning in ASDExpressive language in ASDReceptive language in ASDPragmatic impairment in ASDCentral coherence theoryAssessing for Cognition
With Contributions from Allison Margulies, Ph.D.
Cognitive assessment is generally the first assessment given during a diagnostic evaluation. It provides the foundation for the data analysis process . Provided below are two vignettes highlighting the potential findings that may be uncovered while completing an evaluation for Autism with cognitive concerns as part of the referral question. The remaining sections of Part III shall procedure thusly, a vignette highlighting the area to be assessed will open the section and a description of that assessment area will follow (Table 8.1).
Table 8.1
Assessing for cognition
Core area |
1. Cognitive |
• FSIQ has the most reliability and validity as a composite score: stable and predictive |
• Variation among indexes: Baseline of skill strengths and weaknesses (both relative and absolute strengths and weaknesses profile). Bear in mind that the GAI is much more common in ASD intellectual profiles on WISC-IV (no GAI info on WISC-V as of this writing) |
• Verbal IQ: compare VIQ overall to social and language—look for significant discrepancies |
• Note highest and lowest subtest score: |
– Comprehension subtest score is likely to be low score (particularly lowest within VIQ) in ASD |
Even though Comprehension is not a core test in WISC-V, it is essential this test be administered for ASD evaluations |
– Low scores on Coding subtest is common in ASD |
– Highest score on Matrix Reasoning, followed by Picture Concepts, and Block Design (due to timed test) |
• Consider results from: Bayley-iii/Mullen, DAS-2, KABC-II, Leiter-3, SB5, UNIT-2, WISC-V, WAIS-IV, WJ-IV |
Full measure names: |
Bayley Scales of Infant Development, Third Edition (Bayley-iii) |
Differential Ability Scales, Second Edition, Lower Early Years Record Form (DAS-II) |
Differential Ability Scales, Second Edition, Upper Early Years Record Form (DAS-II) |
Differential Ability Scales, Second Edition, School-Age Record Form |
Kaufman Assessment Battery for Children (KABC-II) |
Leiter International Performance Scale, Third Edition (Leiter-3) |
Mullen Scales of Early Learning (MULLEN), AGS Edition |
Stanford-Binet Intelligence Scales, Fifth Edition (SB5) |
Universal Nonverbal Intelligence Test, Second Edition (UNIT 2) |
Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) |
Wechsler Intelligence Scales for Children, Fifth Edition (WISC-V) |
Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) |
Woodcock Johnson IV Tests of Cognitive Abilities (WJ-IV) |
Vignette #1 Derick: Cognitive Assessment of a Child with a Language Delay
Derick was 3 years old when he came to Emerge for an evaluation for language delay and behavior problems. He was administered the Mullen Scales of Early Learning (MULLEN ) , AGS Edition (select sections); Differential Ability Scales, Second Edition, Lower Early Years Record Form (DAS-II); Autism Diagnostic Observation Schedule, Second Edition, Module 2 (ADOS-2 ) ; Behavior Assessment System for Children, Second Edition (BASC-II ) , Parent and Teacher Reports; and Vineland Adaptive Behavior Scales, Second Edition—Parent/Caregiver Rating Form (VABS-II).
Derick’s parents reported that they struggled to communicate with their son. Specifically, he did not understand them, had limited vocabulary, and threw violent tantrums, which were disruptive at home and in his half-day preschool environment. Derick’s parents were often called to pick him up from preschool due to tantrum behavior and his teacher’s inability to communicate with him. Assessments indicated Derick’s language was significant for articulation challenges, echoing, and he had not yet developed conversation skills. His cognitive ability score was a general conceptual ability score of 70. Derick’s intellectual ability fell into the Borderline Impaired Range. His language core standard score was 65; he spoke in sentences but was not responsive to questions or conversational statements. His pattern of expressive language skills higher than receptive language and difficulty with conversational reciprocity is consistent with a diagnosis of an Autism Spectrum Disorder. Derick was diagnosed with autism and then referred for behavioral therapy at Emerge and speech therapy in the community where he made significant progress, grew in his compliance with adult requests, and was able to interact with others socially. Derick’s tantrums have been reduced significantly and he is now able to spend a full day at preschool. He will be reevaluated in 12 months to assess progress. As cognitive abilities stabilize around age seven, clinicians are hopeful about gains that may be made through therapy and supports.
Vignette #2 Clark: Cognitive Assessment of a Teenager with a Gifted Intellectual Profile
Clark was 13 years old when he came to Emerge for an evaluation for social skills challenges and executive functioning problems. He was administered the Wechsler Intelligence Scale for Children (WISC-IV) ; Autism Diagnostic Observation Schedule, Second Edition, Module 3 (ADOS-2) ; Tower of London-II; Test of Variables of Attention (TOVA ) ; Behavior Assessment System for Children, Second Edition (BASC-II) , Parent and Teacher Reports; Vineland Adaptive Behavior Scales, Second Edition—Parent/Caregiver Rating Form (VABS-II).
Clark’s parents reported that they believed he was very smart but that they struggled to communicate with their son. Specifically, he did not respond at length to questions about his day saying it was “fine” or “I don’t remember.” Clark spent hours in his room on Lego creations or video games and he forgot to turn in his homework. Clark’s parents were often called to meet with the teacher about his motivation. Assessments indicated Clark could sustain attention but he did have challenges with executive functioning and his processing speed was poor relative to his other cognitive abilities. His cognitive ability score was a General Ability Index (GAI) score of 142 with a processing speed index of 105. Clark’s intellectual ability fell into the Very Superior Range, but he had challenges with organization, planning, completing work, and processing speed. His ADOS-2, ADI-R, and observations are consistent with a diagnosis of an Autism Spectrum Disorder. Specifically, Clark could converse on topics he enjoyed but demonstrated limited reciprocity for topics or conversational bids offered by the examiner. He enjoyed talking about World War II and often turned the topic of conversation to his research. Clark made good eye contact but it could be intense at times and he used limited gestures. He was creative in his play only within the realm of his areas of interest. He did not describe his own emotions or relationships well. Clark was diagnosed with Autism Spectrum Disorder and Gifted and Talented. He was referred for a social skills group and an advanced learning plan addresses his need for academic differentiation and extensions, as well as support for his executive functioning challenges. He was advanced to eighth grade classes in math, language arts, and history commensurate with his Very Superior cognitive abilities and his interests.
Cognitive Assessment as It Applies to Autism
Cognitive evaluation is essential to any comprehensive assessment as it provides a basis and foundation for understanding the child’s capabilities in a variety of domains . Cognitive assessment provides critical information regarding verbal abilities, nonverbal reasoning skills, spatial skills, processing speed or cognitive efficiency, fluid reasoning, crystallized intelligence, and long-term and short-term memory. Research on optimal outcomes for individuals diagnosed with ASD points to strong cognitive profiles, adaptive skills and language being indicative of positive outcomes (Chlebowski, Fein, & Robins, 2014). With this in mind, assessing cognitive skills provides one metric regarding the child’s potential for optimal outcomes, as well as a list of skill areas to build on when providing recommendations. It is generally considered best practice that every comprehensive battery include some form of cognitive assessment although this may be simply an examination of recent cognitive scores from a previous evaluation. In the context of an evaluation for autism, it is generally recommended that the cognitive evaluation come first in the battery as this provides the clinician with a wide variety of important information about the child’s skills, symptoms, personality traits, behavior, and of general intellectual functioning. Further, observations on facilitators and inhibitors to performance during cognitive testing (discussed in Chap. 6) can provide important data on the individual’s ability to demonstrate his or her understanding, knowledge, and cognitive ability.
Usefulness of FSIQ Scores in ASD
The cognitive profile and full scale IQ score allows for important comparisons with performance in other domains. Social skills and language data obtained in other parts of the evaluation should be consistent with cognitive ability. A child with strong cognitive abilities is expected to be able to perform well on other areas of an assessment; if performance is not congruent, this raises clinical concern. For example, a child with a FSIQ of 135 who is not able to answer the question, “what is a friend?” or “how is a friend different than a classmate?” raises red flags in a clinician’s mind. A very bright child, who does not know what a friend is, likely has significant deficits in social understanding relative to many strengths in other cognitive areas. Further, a child with a 135 IQ should be able to use toys symbolically during play, have an engaging discussion with the examiner, and to report accurately on events in his life. If these abilities are absent or delayed in a bright child, it is possible the child has autism or another neurodevelopmental disability . In this way, cognitive assessment provides a basis for analyzing all other data collected during an evaluation. During feedback meetings with families, a clinician generally provides results from the cognitive assessment first and uses these data as a framework to discuss strengths and weaknesses in a child’s neuropsychological profile and how these relate to the remainder of data collected and diagnostic conclusions.
Cognitive abilities are generally measured using intelligence tests, or tests of “cognitive abilities.” It is important to note that although the use and misuse of intelligence tests has come under scrutiny over the years (Gould, 1996), intelligence or “IQ tests” remain one of the most psychometrically robust and predictive instruments psychologists have during an evaluation. With this in mind, there are a few cautions clinicians should consider during an assessment for ASD. One is that it is generally the case that test developers are unable to capture a large sample of children with Autism in the clinical sample during the norming process. Further complicating the matter, children with ASD fall on such a wide spectrum, it can be quite difficult to evaluate their performance as a group (see the next section regarding norms for the WISC-IV). For example, although the psychometric properties of the WISC-IV are considered excellent (Sattler, 2001), the developers struggled to obtain a clinical sample for ASD.
Even with this potential challenge in terms of developing ASD specific norms, cognitive testing does provide clinicians with information about how this child performs on school-related novel tasks , relative to peers his or her age. This, of course, is highly important information for evaluators to collect and to impart to families. That is, a child with a 75 full scale IQ and an Autism diagnosis is going to struggle relative to typical peers in a general education classroom. Thus, although there may be some limitations of intelligence test scores, this metric alone can provide a context for understanding a child’s challenges relative to typically developing peers which can be a key to helping the family evaluate placement decisions and support needs.
The next word of caution is that, although the Full Scale IQ has value, and the soundest psychometric data to support its use, this score is only one piece of data. It is an overall measure to characterize an individual’s ability but does not necessarily speak to an entire skill set. It may underestimate a child’s potential in the case of a profile with significantly discrepant index scores. Intelligence testing can provide data that is useful considering both a full scale score and index scores independently. Overall, using a composite IQ score has psychometric support but an individual subtest score may be telling also. For example, one child at the Emerge clinic with a 120 Full Scale IQ score obtained a scaled score of “2” on the comprehension test of the WISC-IV. Although not diagnostic, relatively low scores on the comprehension subtest are a red flag for autism.
Intelligence tests are often utilized to inform about a collection of strengths and weaknesses, as well as for the rich body of data that can be obtained through observations. The clinical observations obtained during a cognitive evaluation are of great value when assessing for autism. A thorough explanation of the key factors for clinicians to consider during an ASD evaluation was provided in Chap. 6: Testing Begins.
Cattell–Horn–Carroll Theory of Intelligence
With cautions clearly stated, IQ testing as a practice is reliable, valid, and has a high degree of clinical utility, largely due to the extensive work of Raymond B. Cattell, John Horn, and John Carroll (Sattler, 2001). The Cattell–Horn–Carroll (CHC ) model of intelligence is the most widely used and respected model for understanding cognitive ability (Flanagan & Kaufman, 2004). The model includes two primary forms of intelligence: Fluid Intelligence (Gf) and Crystalized Intelligence (Gc). Fluid intelligence generally involves mental efficiency for novel tasks, or abilities that are not encountered in school or daily life. In CHC theory, Fluid Intelligence includes symbolic classification, concept formation, inductive reasoning, and similar nonverbal tasks. Crystallized Intelligence involves knowledge and acquired understanding that tend to have been learned in school, are influenced heavily by cultural factors, and may have a verbal component. Skills such as general information, verbal comprehension, and semantic relationships fall within this cognitive ability. Also included in the comprehensive CHC theory is a three-stratum factor structure, whereby Stratum I consists of narrow abilities; Stratum II includes broad abilities; and Stratum III includes general ability. Narrow abilities are skills in specific areas such as Reading Comprehension. Broad abilities include fluid and crystallized intelligence as well as retrieval, memory, processing speed, and learning. Finally, the third stratum is represented by (g) and represents overall ability or General Intelligence (Sattler, 2001).
Intelligence testing in ASD can occur by using a variety of valid and reliable measures. For very young infants and toddlers, the Bayley-iii is often used. For children who are toddlers or preschoolers, examiners may prefer the Mullen Scales or Early Learning. Assessment of children who are beyond the age limits for the Mullen but too young for the WISC-V may be assessed using the Differential Ability Scales, Second Edition (DAS-II). The Stanford-Binet, Fifth edition is often a preferred instrument in cognitive testing for ASD. Often, individuals with autism struggle to demonstrate their intelligence on a test that primarily taps language skills; which is often a weakness area. It also may be that the child is from another cultural background or is an English language learner. In these cases, it may be helpful to utilize a nonverbal assessment such as the Leiter-3 or the UNIT-2. As was noted in the beginning of this chapter, examiners may consider results from the following instruments:
Consider results from Bayley-iii/Mullen, DAS-2, KABC-II, Leiter-3, SB5, UNIT-2, WISC-V, WAIS-IV, and WJ-IV
A full list of these instruments, spelling out the full names and separating assessments by area, is provided in the “Sample Checklist” chart in Chap. 5. This explanation of the cognitive profile in ASD is not intended to be comprehensive of all of the potential tests that could be used. Instead, these authors prescribe an approach for some of the major assessments commonly used in an evaluation for ASD . Research shows that individuals with ASD have unique cognitive profiles, requiring specific supports and interventions (Coolican, Bryson, & Zwaigenbaum, 2008; Mayes & Calhoun, 2003; Matthews et al., 2015; Saulnier & Ventola, 2012; Siegel, Minshew, & Goldstein, 1996). Therefore, when choosing an assessment tool, it is imperative to consider the individuals’ overall level of functioning, language ability, and any motor challenges, not just chronological age, especially for those suspected of having ASD.
Mullen Scales of Early Learning (MULLEN)
The MULLEN test provides an effective opportunity to assess young children using engaging materials and quickly administered items. This test does not directly measure cognitive ability; however, it is an excellent assessment of development in a variety of domains that align closely with areas of intelligence , such as visual reception, and expressive and receptive language. In the examiner’s experience, it can be very helpful to utilize multiple examiners in the administration of the MULLEN. One examiner might administer the items, while the other organizes materials and ensures that all of the necessary items are administered. In the author’s experience, individuals with ASD tend to be more engaged in the Visual Reception tasks and may perform much better, relative to the language and/or motor scales. Due to the language problems in ASD, it is often the case that Receptive or Expressive Language scales are the lowest scores of the assessment. Bearing in mind that individuals with ASD tend to favor expressive language over receptive, it stands to reason that the receptive language score may be relatively low as compared to other areas when autism is present. It is important when testing children this young to remind families that cognitive abilities do not stabilize until about the age of seven (Schneider, Niklas, & Schmiedeler, 2014) so this is simply an estimate at this point, and certainly should not be seen as set in stone.
As in other assessments, examiners should note the child’s test behaviors. If the examinee refuses items, tantrums, runs away, hides on mom’s lap, or gives up easily, these observations should be seen as red flags. If the child shows great confidence and effort on Visual Reception but suddenly disengages on language items, examiners should take note. Overall, any delay in any area may be a sign of ASD or another neurodevelopmental disability and should be carefully analyzed .
DAS-II
The Differential Ability Scales, Second Edition (DAS-II ; Elliott, 2007) is an assessment modeled after the CHC theory of intelligence and allows for the identification and interpretation of cognitive profiles of strengths and weaknesses, rather than an overall intelligence quotient (i.e., “g”). This is an essential consideration for the assessment of individuals with ASD, given their tendency to display variable cognitive profiles. In fact, with respect to the DAS-II normative sample, significantly more children with ASD demonstrated a discrepancy indicating better developed nonverbal than verbal abilities. Such findings are consistent with existing research using the Wechsler scales and the SB5. The DAS-II includes teaching items on each subtest, which, for individuals with ASD, is beneficial given their difficulty completing novel tasks without concrete directions, explanations, models, and demonstrations. The DAS-II also includes norms to accommodate those whose cognitive abilities fall in the extremes of the bell curve. The Early Years battery has extended norms through age 8, and the School-Age battery has extended norms down to age 5. Lastly, clinicians can discontinue a subtest based on two options, by either reaching a ceiling or by completing a set block of items. This option allows clinicians to alleviate the frustration that children may experience with designated ceiling rules.
The DAS-II measures cognitive abilities in children ranging in age from 2 years, 6 months to 17 years, 11 months. It comprises two batteries, the Early Years battery (2 years, 6 months to 8 years, 11 months) and the School-Age battery (5–17 years, 11 months). The Early Years battery is composed of the Lower Level (2 years, 6 months to 3 years, 5 months) and the Upper Level (3 years, 6 months to 8 years, 11 months). Regarding the Early Years Lower Level, four subtests yield an overall ability score, as well as two domain scores. The Verbal domain is composed of the Verbal Comprehension and Naming Vocabulary subtests, and the Nonverbal domain is composed of the Picture Similarities and Pattern Construction subtests. The Early Years Upper Level battery is made up of six subtests that also yield an overall ability score, as well as three domain scores. The Verbal domain includes the Verbal Comprehension and Naming Vocabulary subtests, the Nonverbal domain includes the Picture Similarities and Matrices subtests, and the Spatial domain includes the Pattern Construction and Copying subtests. The School-Age battery also composes six subtests and three domains, including Verbal Reasoning (Similarities and Word Definitions), Nonverbal Reasoning (Matrices and Sequential and Quantitative Reasoning), and Spatial (Recall of Designs and Pattern Construction). For the Early Years Upper Level and School-Age batteries, the Nonverbal and Spatial domain scores are combined to formulate a Special Nonverbal Composite. The Verbal domain score is then compared to the Special Nonverbal Composite to identify the presence of a discrepancy.
Although much research regarding the cognitive profiles of individuals with ASD is based on the Wechsler scales and the SB5, more research is beginning to surface using other assessment tools, such as the DAS-II. It is noteworthy that cognitive profiles also were explored with the predecessor of the DAS-II. Joseph, Tager-Flusberg, and Lord (2002) examined the cognitive profiles of 120 children administered the Differential Ability Scales. Seventy-three of the participants were given the DAS Preschool Battery (now called the DAS-II Early Years battery) and 47 were given the School-Age battery. Of the 73 participants who completed the DAS Preschool Battery, discrepancies were noted with more participants demonstrating verbal domain scores that were significantly lower than nonverbal domain scores. For those who completed the DAS School-Age battery, more participants also demonstrated a variable profile that favored nonverbal reasoning abilities . Further, results indicated that the larger the discrepancy, the more significant the level of social impairment (Joseph et al., 2002).
Research using the DAS-II is limited but is beginning to surface due to large scale studies such as the Simons Simplex Collection (SSC ) through the Simons Foundation Autism Research Initiative (SFARI ) . Ankenman, Elgin, Sullivan, Vincent, and Bernier (2014) examined cognitive profile discrepancies using the DAS-II in a sample of children with ASD. The sample included 1954 children with ASD (1710 boys and 244 girls) between the ages of 4 and 17 years from the SSC. Results indicated that approximately 60 % of participants did not display a significant discrepancy, whereas 28 % showed a cognitive split favoring the nonverbal domain and 14 % showed a cognitive split favoring the verbal domain. Additionally, when compared to the DAS-II normative sample, a greater frequency of significant discrepancies favoring nonverbal reasoning was observed in the sample of individuals with ASD. Results also highlighted more severe symptomatology in those with a profile favoring nonverbal reasoning, which is consistent with findings from Joseph et al. (2002). Nowell, Schanding, Kanne, and Goin-Kochel (2015) also used the DAS-II to examine cognitive profiles of children with ASD and to explore discrepancies between verbal and nonverbal reasoning . Results indicated that a larger proportion of individuals in the ASD sample had significant discrepancies between the VIQ and NVIQ, compared to the normative sample.
Stanford-Binet 5
Stanford-Binet Intelligence Scales, Fifth Edition (SB5)
The Stanford-Binet Intelligence Scales, Fifth Edition (SB5; Roid, 2003) is an individually administered assessment of intelligence and cognitive abilities used for a variety of clinical (e.g., diagnostic and psychological assessments, neuropsychological assessments, and special education assessments) and research purposes . Distinctive patterns of strengths and weaknesses have been identified on assessments of intelligence for individuals with ASD (Coolican et al., 2008; Matthews et al., 2015; Mayes & Calhoun, 2003; Siegel, Minshew, & Goldstein, 1996). The SB5 offers clinicians an opportunity to assess these patterns in ASD, taking into consideration mental age and verbal abilities. The SB5 differs from its predecessors in that the number of subtests has changed; there are now five instead of four cognitive ability dimensions ; there are two routing subtests to determine start points, and half of the test items require only a nonverbal response. There also are a variety of engaging materials (e.g., toys, manipulatives, and pictures), and an increased range of test items and norms to accommodate a wide range of ages (2–85 years) and ability levels. Assessment time ranges from 15 to 75 min, depending on the number of subtests administered.
The SB5 yields a Full Scale IQ (FSIQ ), a Nonverbal IQ (NVIQ) , a Verbal IQ (VIQ) , and an Abbreviated Battery IQ (ABIQ ). The SB5 also includes measures of five important dimensions of cognitive ability (Fluid Reasoning, Knowledge, Quantitative Reasoning, Visual–Spatial Processing, and Working Memory), and tools to examine narrower abilities at the subtest level that parallel the CHC theory of intelligence. The CHC model, referenced previously, proposes that intelligence has a hierarchical structure with three levels (narrow abilities, broad cognitive abilities, and a general measure of ability [g]). The ability to use the SB5 to analyze skills at all three levels of the CHC model enhances decision making related to instructional style, accommodations and modifications, and choice of curricula. For example, if results highlight a deficit in categorical reasoning (feature, function, class), then a recommendation is made to support the development of such skills using appropriate strategies across a variety of contexts and activities.
Although much cognitive profile research related to ASD has been completed using the Wechsler scales, research utilizing the SB5 is available and consistent with the cognitive profile research discussed throughout this section. Coolican et al. (2008) completed a study with 63 participants (12 girls and 51 boys) with diagnoses of Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS ). Results highlighted an overall profile characterized by a FSIQ and NVIQ in the Below Average range, whereas the VIQ fell in the Borderline range. Regarding diagnostic subgroups, those with Asperger’s Disorder obtained higher FSIQ, NVIQ, and VIQ scores (Average, High Average, and Average, respectively), as did those with PDD NOS (Below Average and Borderline), than those with Autistic Disorder (Borderline). Matthews et al. (2015) conducted a study with 73 children and adolescents with ASD, and reported similar findings.
It is this author’s experience that, when assessing individuals with ASD using the SB5, more often than not cognitive profiles are in line with those just described. The SB5 provides a more comprehensive profile of abilities across nonverbal and verbal domains . Therefore, given variability in profiles in ASD across domains, the FSIQ, although meaningful and robust, is important to consider in the context of the individual profiles of domain and subtest scores. Clinicians should clearly state information in psychological reports highlighting that the entire profile of strengths and weaknesses should be considered, as opposed to global ability in isolation.
The SB5 FSIQ comprises ten subtests, and different pairings or groupings of these subtests yield additional verbal and nonverbal domain scores, as well as factor index scores. The NVIQ and the VIQ, each, are composed of five corresponding subtests that represent the five factors measured by the SB5. The ABIQ is composed of two routing subtests (Object Series/Matrices and Vocabulary). The Fluid Reasoning factor index assesses verbal and nonverbal inductive and deductive reasoning. Knowledge provides an assessment of learned information acquired at home, school, and in the community. Often times, these subtests appear to be areas of relative strength for individuals with ASD due their strong memory for details and facts. The Quantitative Reasoning factor index measures understanding and application of numerals and number concepts. These subtests also appear to represent areas of relative strength due to the concrete nature of the math problems. It is noteworthy, though, that some individuals with ASD may experience difficulty with the word problems due to language delays (including pragmatics). This difficulty can be evidenced during story problems in mathematics (see Chap. 18: School-Based Assessment for ASD). Visual–Spatial Processing assesses the ability to see patterns, relationships, spatial orientations, and the gestalt among visual displays. Lastly, the Working Memory factor index assesses the ability to store and manipulate verbal and visual information in short-term memory. Individuals with ASD may appear more successful on rote memorization tasks compared to those that require the active manipulation of information while holding it in short-term memory on this instrument.
The routing subtests, nonverbal Fluid Reasoning (Object Series/Matrices) and verbal Knowledge (Vocabulary), are administered at the beginning of the SB5 and identify the developmental starting point for all other subtests. The clinician, then, administers appropriate levels of nonverbal and/or verbal items, based on the predetermined starting points. If an individual has language or communication difficulties, including those associated with ASD, the examiner may choose to administer only the nonverbal subtests because language demands may yield a distorted profile, as evidenced by the aforementioned research. Additionally, examinees may experience undue frustration, which, in turn, may impact their performance on other subtests, again yielding an inaccurate representation of their profiles. However, if the verbal subtests are administered, clinicians are encouraged to be sensitive to the individual’s behavior and provide breaks, as needed. The clinician also may consider “testing the limits” once standardized administration is completed to determine effective accommodations and modifications. For example, if an examinee is unable to complete a task successfully within a specified time limit, the clinician may readminister the item without time constraints to determine if it can be completed successfully. If so, the clinician can determine if the time failure is related to a lack of ability or due to processing speed weaknesses.
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