A - 60 Validity of Caregiver Reported Behavioral Symptoms in Autism Spectrum Disorder Evaluations

Abstract

Abstract Objective Informant report of a child’s behavior is an important component of Autism Spectrum Disorder (ASD) evaluations. Informant-report measures with symptom validity scales are crucial to identifying invalid reporting of symptoms. This study examined the prevalence of, and characteristics associated with caregiver-report symptom validity (SVT) failure in an ASD evaluation clinic. Method Particpants were 212 youth, 6 to 18 years old (Mage = 11.5, 79.7% white, 91% non-Hispanic) whose caregivers completed a Conners, 3rd Edition, Adaptive Behavior Assessment System (ABAS) 2nd or 3rd Edition, and Child Behavior Checklist (CBCL) as part of a multidisciplinary autism evaluation. Results Rates of symptom validity failure, specifically negative impression (z = −3.338, p < 0.001) and inconsistency (z = −2.051, p = 0.04) were significantly higher in this sample compared to the Conners, 3rd edition general population normative sample. Elevated negative impression index was associated with lower scores on the ABAS Social index (r = 0.152, p = 0.028) and higher scores on the CBCL Withdrawn scale (r = −0.285, p < 0.001). Those with an elevated negative impression index were more likely to not receive an ASD diagnosis [Χ2 = 8.116, p = 0.006]. Conclusion Caregiver report in children seeking diagnostic clarification for ASD is more likely to raise concerns for validity of reported behavioral symptoms than in the general population. Negative impression management is associated with lower likelihood of clinical ASD diagnosis, perhaps suggestive of caregiver motivation to obtain ASD diagnosis for non-autistic children. These findings support consideration of SVT failure when examining caregiver-reported behavioral symptoms.