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Michigan State
University ‘
This is to certify that the
dissertation entitled

A VALIDATION STUDY OF A JORDANIAN VERSION
OF THE AUTISM BEHAVIOR CHECKLIST (ABC)
OF THE AUTISM SCREENING INSTRUMENT
FOR EDUCATIONAL PLANNING (ASIEP)

presented by

Jamil Mahmoud Smadi

has been accepted towards fulfillment
of the requirements for

Ph . D . degree m CounselingL Educational
Psychology, and Special
Education

Major professor

Ronald M. Wolthuis

 

 

 

MS U it an Affirmative Action/Equal Opportunity Institution 0-12771

 

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“I" I

 

 

A VALIDATION STUDY OF A JORDANIAN VERSION
OF THE AUTISM BEHAVIOR CHECKLIST (ABC)
OF THE AUTISM SCREENING INSTRUMENT
FOR EDUCATIONAL PLANNING (ASIEP)

By

Jamil Mahmoud Smadi

A DISSERTATION

presented to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Counseling,
Educational Psychology, and Special Education

1985

Copyright by

JAMIL MAHMOUD SMADI

1985

A VALIDATION STUDY OF A JORDANIAN VERSION
OF THE AUTISM BEHAVIOR CHECKLIST (ABC)
OF THE AUTISM SCREENING INSTRUMENT
FOR EDUCATIONAL PLANNING (ASIEP)

By

Jamil Mahmoud Smadi

ABSTRACT

The purpose of this study was to adapt and validate the Autism Behavior
Checklist (ABC) for use in the country of Jordan. A back-translation procedure
was used to obtain an equivalent Jordanian (Arabic) Version. Validation of the
Jordanian version was then conducted, and a comparison of the Jordanian data
and the original American data was also reported.

A total of 192 Jordanian individuals served as subjects of two data sets used
in the study. The validity data set consisted of 32 individuals diagnosed as
autistic, 38 severely mentally retarded, and 42 non-handicapped. The reliability
data set consisted of 80 individuals diagnosed as moderately to mildly mentally
retarded. Teachers or parents of the subjects completed the checklist about the
subjects.

Major findings of the study were the following:

1. ANOVA results indicated that there were significant differences

in the total score and the subscores across the three diagnostic

groups.

Jamil Mahmoud Smadi

Scheffe results indicated that the three diagnostic groups were
significantly different from each other by total scores as well as
all subscores.

Discriminant analysis results indicated that the total score of
the Jordanian version separates the three diagnostic groups
effectively (10096). Discriminant analysis results of the
subscores indicated that they can predict the three diagnostic
group's membership from 86.61% to 94.54%.

Internal consistency reliability using coefficient alpha was .831;
and .808.

inter-rater reliability results indicated that the mean percentage
of agreement between raters without using item weight was
95.95%. The mean percentage of rater agreement using item
weight was 96.11%.

The generalizability or intra-class correlation coefficient was
.965.

There were significant differences between the mean scores of
the Jordanian autistic group and the autistic group of the
original American standardization study across all symptom
areas.

There were significant differences between the mean scores of
the Jordanian severely mentally retarded group and the severely
mentally retarded group of the original standardization study in
mean total score and two subscores (sensory and relating). No

significant differences were found for other subscores.

Jamil Mahmoud Smadi

9. There were significant differences between the mean scores of
the Jordanian non-handicapped group and the non—handicapped
group of the original American standardization study in the mean
total scores and two subscores (relating and social and self-help).
No significant differences were found in the mean scores of
other subscores.

Based upon the results of this study, a valid and reliable Jordanian version
of the ABC was achieved. Within certain parameters, the author can confidently
recommend the ABC to Jordanian professionals who work with severely
handicapped populations. These parameters include (a) the accuracy of the
Arabic translated version, (b) the small number of subjects, and (c) the accuracy

of the diagnosis of the groups.

DEDICATION

To the memory of my daughter
Rania

(1973 - I980)

ACK NOWLEDGEM ENTS

I would like to express my gratitude and appreciation to the many people
who contributed to the development and completion of this study. I deeply
appreciate and acknowledge Dr. Ronald Wolthuis, my advisor, for his support,
encouragement, patience, and valuable advice throughout my doctoral study and
dissertation research. I am extremely grateful to Dr. William Frey, Director of
the University Center for International Rehabilitation (UCIR), a member of my
committee, for his unlimited help, unstinting support, encouragement, and
valuable guidance throughout the course of this research. I am also greatly
indebted to Drs. William Mehrens and Martha Karson, committee members, for
their encouragement and support. Each has made a significant contribution to
my professional growth. I also appreciate the help and eXpertise of Dr. Robert
Floden. His assistance has been enormous.

Special thanks are due to my best friend ever, Dr. Nasser Al-Ali, Yarmouk
University, Jordan, for his review of the Arabic translated version of the ABC,
his coordination of the back-translated version process, and his sincere support
and willingness to provide help whenever it was needed. I am also deeply
thankful to Drs. Mohammad Fraihat, Lutfi Lutfieh, and Okleh Smadi, Yarmouk
University, Jordan, for their preparation of a back-translated version of the
Arabic ABC. In addition, I wish to acknowledge my friends and colleagues Adel
Tweissi and Jamal Yousef for their review of the first draft of the Arabic
translated version of the ABC. My appreciation goes to Dr. Yaser Salem for his
help and cooperation during the administration of the checklist and to Dr.

Abdulla Kaylani, Dean of the Faculty of Education, the University of Jordan, for
iii

his review of the final version of the ABC and for his support and understanding.
I am indebted to Drs. Rochelle Habeck and Stephen Yelon for their review of the
Arabic back-translated version of the ABC. Many thanks also to the people who
cannot be named individually, the teachers, principals, and parents of the
subjects of the study, all of whom completed the Checklist.

I would like to express my thanks and appreciation to the University of
Jordan for sponsoring my scholarship at Michigan State University. Sincere
thanks are also extended to the University Center for International
Rehabilitation for the graduate assistantship I held there. Special thanks go to
Dr. Denise Tate for her encouragement and support and to all the UCIR staff and
fellow students, especially George Matta, a true friend. I am also grateful to Dr.
James McComb for his computer assistance and to Ms. Barbara Reeves for her
excellent typing.

Finally, my deepest appreciation to my wife Yesra for her many sacrifices
and her understanding and encouragement. The completion of this research as
well as my doctoral study as a whole are a testament to the love, affection, and
support I received from her. My children Randa, Diana, Hazem, and Rania
deserve special recognition for their love and optimism. I owe a final word of
thanks and appreciation to my parents, brothers, and sisters for their

encouragement and support.

iv

TABLE OF CONTENTS

List of Tables

List of Figures

CHAPTER I: THE PROBLEM

Introduction

Statement of Need
Statement of the Problem
Autism Behavior Checklist
Significance of the Study

CHAPTER II: REVIEW OF RELATED LITERATURE

Historical Introduction
Identification and Diagnosis of Autism
Differential Diagnosis of Autism
Mental Retardation and Autism
Childhood Schizophrenia and Autism
Language/Communication Disorder and Autism
Disorders of Hearing and Vision and Autism
Methods of Assessment of Autism
Behavioral Instruments
Review of Prior Behavior Checklists
Review of Current Available Instruments Used for
Differential Diagnosis of Autism
Childhood Autism Rating Scale (CARS)
Rimland's Diagnostic Checklist for Behavior
Disturbed Children (5-2)
Behavior Observation Scale (BOS)
Muskegon Index of Autistic Behavior Checklist (MIAB)
Autism Behavior Checklist (ABC)
Translation of Materials for Cross-Cultural Research
Translation Techniques

CHAPTER III: METHODOLOGY
Subjects

Delimitations
Translation of the Autism Behavior Checklist (ABC)

Vii

ix

—

=OOVIN—

12
12
l5
I9
22
23
24

25
26

28
28

29

30
31

35

36
36
39

Pilot Study
Administration Procedures
Statistical Analysis
Validity
Reliability
Jordanian Scores Versus American Scores
Limitations of the Study

CHAPTER IV: RESULTS

Validity

Reliability

Jordanian Scores Versus American Scores
CHAPTER V: SUMMARY AND DISCUSSION

Summary

Discussion

Implications and Recommendations
APPENDICES

A. The Original American Version of the Autism Behavior
Checklist (ABC)

B. The Jordanian Translated Version of the Autism
Behavior Checklist (ABC)

C. Approval Letter from ASIEP to Use the ABC

BIBLIOGRAPHY

vi

68

69
71

72

10.

11.
12.
13.
14.
15.
16.
17.

LIST OF TABLES

Subjects' Categories and Gender

Means and Standard Deviations of the Total Scores and the
Symptom Areas for the Autistic, Severely Mentally Retarded,
and Non-Handicapped Groups

ANOVA Results Comparing Diagnostic Groups by Total Scores

ANOVA Results Comparing Diagnostic Groups by Mean Subscore:
Sensory

ANOVA Results Comparing Diagnostic Groups by Mean Subscore:
Relating

ANOVA Results Comparing Diagnostic Groups by Mean Subscore:
Body and Object Use

ANOVA Results Comparing Diagnostic Groups by Mean Subscore:
Language

ANOVA Results Comparing Diagnostic Groups by Mean Subscore:

Social and Self-Help

Scheffe Contrasts (Mean Differences) for Total Scores
Across Groups

Scheffe Contrasts (Mean Differences) by All Symptom Areas
(Subscores) Across Groups

Classification Results by Total Score

Classification Results by Subscore: Sensory
Classification Results by Subscore: Relating
Classification Results by Subscore: Body and Object Use
Classification Results by Subscore: Language
Classification Results by Subscore: Social and Self-Help

Estimates of Variance Components

vii

37

#8

49

49

50

50

50

51

51

52
52
53
53
54
54
54
56

18.

19.

20.

Comparisons of Jordanian and American Scores for the
Autistic Group 57

Comparisons of Jordanian and American Scores for the
SMR Group 58

Comparisons of Jordanian and American Scores for the
Non-Handicapped Group 59

viii

1.

LIST OF FIGURES

Profile chart of mean symptom area scores and total scores
for each diagnostic group

ix

#8

 

IN THE NM OF ALLAH
THE MERCIFUL THE OONIPASSIONATE

CHAPTER I
THE PROBLEM

Introduction

Autism is frequently considered to be one of the most severe disabilities
affecting a child, and the disorder crucially impacts on the child's family and
extended environment as well. Diagnosis of autism is dependent upon the
presence of certain behaviors displayed by the child, including social withdrawal,
obsessive desire for maintenance of sameness, repetitive behaviors and
movements, unusual motoric activity, immediate or delayed echolalia,
inappropriate use of objects, and other behaviors (Rutter, 1974, I978; Wing, 1976).
Although there is general agreement among diagnosticians about the most
crucial behaviors necessary for diagnosis, differences might be expected among
them when evaluating some of the other behaviors associated with autism
(Morgan, 1982; DeMeyer, Churchill, Pontius, 6t Gilkey, 1971).

In the case of psychiatric disorders, Schopler (1973) indicated that

There may be three major reasons for diagnostic Classification: (I) if

a clear and specific cause is known for the disorder, which is

distinguishable from other disorders. In the case of autism no such

single cause is known. (2) the existence of a specific treatment not

applicable to other disorders even when the specific cause is

unknown. For autism some success has been reported for many

different treatments. Therefore, this second basis does not apply

either. (3) when certain and observable characteristics can be

identified and described behaviorally. Current effort with diagnostic

classification is mainly at this third level. (p. 2)
Accordingly, most leading scholars and researchers have attempted to describe

and diagnose autism in terms of behavioral characteristics (Morgan, 1981; Wing,

1976).

Although autism is considered to be a distinct disorder, there are some
other disorders which share behaviors commonly associated with autism. These
include mental retardation, aphasia, schizophrenia, hearing and vision
impairments, and others. Accordingly, Ornitz and Ritvo (1976) state, " . . .
autism must always be included in the differential diagnosis when one is
evaluating any child with developmental disability" (p. 609).

Autism is found throughout the world. A growing body of literature
suggests that autistic individuals are found in all countries and cultures (NSAC,
I978). Professionals in many countries differ, however, in terms of their
understanding of the autistic syndrome and their abilities to identify and serve
the autistic population. These differences exist primarily because of such
factors as the development of special education services for areas of
handicapping conditions, the presence of professionals interested in autism, the
availability of advocacy sources, the priority of services for the handicapped,
and legislation.

Quality educational services for autistic students should take into
consideration the nature of the disability (autism) as well as the individual needs
of students. Most authorities feel that it is essential to distinguish autism from
other handicapping conditions in order to establish appropriate services. Those
services remire intensive settings and curriculum designs that utilize repetition,
methods for generalization, and a strong language base. These requirements are
frecpently not available or may not be needed for other handicapping conditions

(Maltz, 1982).

Statement of Need
It would be unusual to find many autistic students in developing countries.

The reasons for this lack of identification include (a) the recent awareness of the

need for services to all special needs' populations, (b) the difficulty in identifying
and diagnosing all types of handicapped persons, and (c) the relatively low
incidence of autistic children as a specific group in need of diagnosis and service.
Moreover, behaviors associated with autism often overlap or can be confused
with other handicapping conditions, frequently complicating the problem. It
should also be mentioned that even in more advanced countries, the provision of
specific educational services for autistic students began less than two decades
ago (DeMeyer, 1979).

In spite of problems with the identification procedures currently being
used, as well as concerns about the quality of special education services, Jordan
has begun to identify and serve the following groups of handicapped students:
mentally retarded, deaf, blind, and physically disabled. Jordan is also providing
some services for the acute and chronically mentally ill through hospitals and
institutions. Currently, autistic students are not being identified and classified
differently from other groups, and there is no assessment instrument for this
purpose. Because of the frequent overlap between autism and severe mental
retardation, it would be expected that some autistic students are misdiagnosed
and placed in programs for the mentally retarded. The services for low-
functioning autistic students are negligible because some programs for the
mentally retarded do not accept the most severely handicapped individuals.
Accordingly, it can be assumed that some severely impaired and autistic children
remain at home without any specialized educational or mental health services.

Appropriate identification of Jordanian autistic students is essential. The
reasons supporting the need for the accurate identification, diagnosis, and
subsequent development of appropriate services for the autistic population

include the following.

Autism is reported to exist in all parts of the world with an
incidence of four to five per 10,000 births (Ritvo A: Freeman,
1978). Given the population of Jordan (about three million) it
would be expected that 1,200 - 1,500 autistic persons exist in that
country. Although this number is small in comparison to the
total number of handicapped persons, "the impact of one autistic
child who receives no services or less than adequate service is
great!" (Schopler 6c Olley, 1980, p. 462). Autism is one of the
most severe handicapping conditions and should have priority to
be identified for an appropriate intervention.

No formal specialized services exist for autistic students in
Jordan. Even though a population of autistic students exists, it
is very likely that these students are being misdiagnosed or not
identified at all.

The need exists for establishing services for the severely
handicapped. Some schools or other programs do not accept
severely handicapped students.

It has been established that early identification is critical to
long-term prognosis for students. (Ullman dc Kausch, 1979)
Autism is a unique disorder, different from other handicapping
conditions. Language disorders are included in the basic criteria
of autism (Radke, 1981; Churchill, 1978; Rutter, 1974, 1978). Any
program developed for autistic students should include extensive
language intervention approaches in the programming effort
(Callias, 1978). No such interventions are being carried out in
programs for the mentally retarded in Jordan. Moreover,

strategies, curricula, and interventions for autistic students as a

group might be different from the programs being provided for
other handicapping conditions.

6. It is expected that Jordan will continue to have rapid growth in
special education within the coming years. Currently, autism is

one of the most neglected groups of handicapping conditions.

Statement of the Problem

In all quality special education programs for the autistic population, as well
as for any handicapped groups in any society, the first necessary step is to
identify the group(s) to be served. Accurate identification and diagnostic
classification are essential procedures needed to plan effectively for
intervention strategies and to have high quality educational services (Ullman 6c
Dausch, 1979). For autism, (establishing an accurate diagnosis requires a
comprehensive evaluation including medical, neurological, psychological, and
educational assessment (Freeman 6: Ritvo, 19814). From a special education
perspective, the need for a functional, valid educational assessment device is
extremely important. As Krug, Arick, and Almond (1979) suggest, "Requirements
for an educationally useful tool include ease of use, time involvement, and valid
and reliable information which supports educational placement" (p. 1). Currently,
no instrument has been developed or adapted for the purpose of screening and
identifying autistic students in Jordan. Moreover, to the researcher's knowledge,
no such instrument is available in other Arab countries that could be slightly
adapted for use in Jordan. Psychiatrists, psychologists, and special education
teachers in Jordan are in need of an easy, quick, and practical instrument to
identify autistic individuals.

Based on these factors, one of the first priorities for the country of Jordan

is to develop an instrument or standard procedure which could accurately screen

and identify autistic students in order to begin establishing special education
services for them. This instrument should be used with other clinical procedures
needed for the purpose of identification, Classification, and placement decisions.
An instrument of this type would help professionals in all fields of special
education and would properly be used with other information obtained about the
handicapped individuals.

Since it is generally recognized in the fields of special education and
psychology that autism is a behaviorally defined syndrome, any instrument used
in the identification of the autistic population should concentrate on observable
behaviors displayed by autistic individuals with no reference to any causative
agents or assumptions that may not have common professional agreement. For
these reasons, most methods for diagnosing an autistic population have been
developed to include behavior checklists and observational keys.

In the United States, several instruments have been developed for the
purpose of screening and identifying of autistic students, many of which could be
adapted to the Jordanian culture. Examples of these instruments are Rimland's
Diagnostic Checklist for Behavior Disturbed Children, Behavior Rating
Instrument for Autistic and Atypical Children, Behavior Observation Scale for
Autism, Childhood Autism Rating Scale, and Autism Behavior Checklist (Parks,
1983). Each of these instruments is independent, except for the Autism Behavior
Checklist which is a component of a comprehensive instrument known as the
Autism Screening Instrument for Educational Planning.

The present study consisted of a plan to adapt the Autism Behavior
Checklist (ABC) section of the Autism Screening Instrument for Educational
Planning (ASIEP) for the following reasons.

1. The ABC is a major component of the entire instrument which

could initially be adapted independently. Further efforts to

adapt the entire instrument would be useful in the future for a
comprehensive assessment of autism, particularly for the
purpose of educational programming decisions.

The definitions of autism have recently been revised to reflect
the most common behavioral characteristics of this disorder
(Freeman & Ritvo, I984). The categories of the ABC include
assessments of behaviors which relate to the most widely
utilized and accepted definitions of autism.

Behaviors in the various categories of the ABC were selected
from a variety of influential sources. (Krug, Arick, 6t Almond,
1980)

Grouping the behaviors into five symptom areas (sensory,
relating, body and object use, language, and social and self help)
covers many areas reported in the literature as essential in
diagnosing autism.

The behaviors in the checklist are statistically weighted. When
some behaviors (items) are present, they are not only treated as
present versus absent in the individual, but are also considered
differently according to their weights. Behaviors that are more
predictive of autism are given more weight in the result than are
the behaviors that are frequently associated with autism but not
as predictive. This attribute of the ABC is not associated with
any of the other behavior checklists frequently used for
diagnosing autism. (Krug et al., 1980)

The ABC provides a profile for autistic behaviors versus a profile
for other handicapping conditions such as severe mental

retardation, deafness-blindness, and severe emotional

7.

The purpose of this study was to develop an adaptation of the ABC to be
used in Jordan as a primary tool for screening and identifying of Jordanian
autistic persons. For this purpose, the consent of the senior author of the ABC

was obtained (see Appendix C).

disturbances versus profile for normals. Cut points are drawn to
differentiate among autistic students, those with other
handicapping conditions, and non-handicapped students.

The ABC is relatively easy to administer and interpret by

teachers and other diagnostic professionals.

components:

1.

The Autism Behavior Checklist (ABC) is an important part of a complete
instrument called the Autism Screen Instrument for Educational Planning
(ASIEP) developed by Krug, Arick, and Almond in 1978. The first edition of the
ASIEP was copyrighted in 1980 (Krug et al.). The entire ASIEP consists of five
components, the first of which is the Autism Behavior Checklist.
two through five are Sample of Vocal Behavior, Interaction Assessment,

Educational Assessment of Functional Skills, and Prognosis of Learning Rate.

translation of the ABC items from the English language (the
original language of the instrument) into the Arabic language
(the native language of Jordan);

changes in the translated version needed to make this instrument
appropriate for the Jordanian culture;

conducting reliability and validity coefficients for the Jordanian
version of the ABC; and

administration of the Jordanian version of the ABC to samples of
the following groups: autistics, severely mentally retarded, and
non-handicapped, and comparing the results obtained with those
reported for the standardization sample of the original American
verSIon.

Autism Behavior Checklist

The adaptation included the following

Components

The ABC consists of a list of non-adaptive behaviors to be checked if present.
The rest of the components are direct observation procedures in which the
individual is observed while performing certain tasks in a standardized setting.
Although the five components complement each other for a comprehensive
evaluation, each component can stand independently (Krug et al., 1979).

The Autism Behavior Checklist is considered one of the main components
of the ASIEP. It was developed for the purpose of differential diagnosis of
autistic individuals from Other handicapping conditions and non-handicapped
persons. The ABC consists of 57 behavioral descriptions, each of which is
considered a non-adaptive behavior assumed to be displayed by severely
handicapped/autistic individuals (see Appendix A). The items (behaviors) were
chosen from the following resources: Rimland's Form E-2, the nine points of the
British Working Party's Checklist, the Behavior Rating Instrument for Autistic
Children (BRLAC), Rendle-Short and Clancy's Checklist, and Kanner's original
descriptions of the syndrome. The descriptors were then reviewed and grouped
according to symptom characteristics. The symptom areas are sensory, relating,
body and object use, language, and social and self help (Krug et al., 1980; Krug,
Rosenblum, Almond, 6c Arick, 1981).

A chi-square analysis indicated that 55 out of 57 behaviors were Significant
predictors of autism. By using the proportioned reduction in error statistical
analysis, every item in the list was weighted according to its predictive value of
autism. Number values one through four were assigned as weights. An item with
a weighted score of four was considered to be the highest predictor of autism,
and an item with a weight of one the lowest. Scores can be obtained by the sum
of the weighted items checked in each symptom area. The scores of the ABC
can be plotted on a profile chart and can be easily compared with each other and

with other profiles (Krug et a1, 1979, 1980).

10

A standardization sample of the ABC consisted of 1,049 subjects selected
randomly by professionals throughout the United States and Canada familiar with
the disorder. Subject ages ranged from 18 months to 35 years. The ratio of
males to females was 2.5. The sample consisted of the following sub-groups: 172
individuals previously diagnosed as autistics, l423 diagnosed as severely mentally
retarded, 254 diagnosed as emotionally disturbed, 100 deaf-blind, and 100 non-
. handicapped.

Validity and reliability of the ABC were reported by the primary authors
(Krug et al., 1980). Content validity was demonstrated by the result of the
behavior descriptors which were reviewed by experts. A chi-square procedure
was used to demonstrate content validity, and the result indicated that 55 of 57
behavior descriptors were significant (p 0.001) predictors of the diagnosis of
autism when autism was compared with the other groups included in the
standardization sample.

A sample of 62 individuals previously diagnosed as autistic was used to
conduct a criterion-related validity. Results indicated that 8696 of this sample
obtained scores within one standard deviation of the standardization sample.
Discriminant validity was established for the ABC by its ability to discriminate
among symptom area profiles for the autistic, severely mentally retarded,
emotionally disturbed, deaf-blind, and non-handicapped.

When inter-rater reliability data for the ABC were completed using 42
independent raters of Ill Children, the agreement was 9596. Internal consistency
reports using split-half procedures for the whole standardization sample
indicated a Pearson product-moment correlation of .87, and the expected

reliability of the entire test (Spearman-Brown formula) was .94.

ll

Significance of the Study

This study will provide professionals in the field of special education,
psychiatry, and psychology in Jordan with a useful tool to assess individuals with
autism and other severe handicapping conditions. The usefulness of this tool
comes from its practical, quick, and easy use. When used with other evaluation
tools, the ABC will help Jordanian professionals accurately identify autistic
individuals and differentially diagnose them from people with other handicapping
conditions. This study will also offset the shortage of available assessment
instruments in special education and, more specifically, the lack of instruments

which would be helpful for autistic students in Jordan.

CHAPTER II
REVIEW OF RELATED LITERATURE

Historical Introduction

Kanner (1943) was the first to identify the category of autism as a
childhood disorder. Since that time, many different labels have been used to
refer to the same disorder: early infantile autism, early childhood autism,
childhood psychosis, symbiotic psychosis, atypical development, and atypical ego
development (Ornitz 6c Ritvo, 1968; Anthony, 1958; Mahler, 1952; Goldfarb, 1961).
These different labels reflect the historical development of autism and
professionals' differences in areas of interest when dealing with the disorder. In
addition, many different labels have been used because of the ambiguity and
complexity of the differential diagnoses of autism.

Historically, autism as a label was first established in psychiatry when
schizophrenia was defined. At that time, autism was used as an adjective to
describe withdrawn schizophrenics. Later, the same term was used as a noun to
capture an entire disorder (Maltz, 1982).

The lack of social interaction and the isolation exhibited by an autistic
child were believed to be evidence of early severe pathology in the mother-child
relationship and parents' negative attitudes. Labels such as childhood psychosis,
severe emotional disturbance, atypical ego development, childhood
schizophrenia, and symbiotic psychosis were used in this regard (Bettleheim,
1956; Freeman 6: Ritvo, 1980). Accordingly, parents of autistic children were
blamed and stigmatized as being a primary cause of their Children's disorder:

mothers were supposedly cold, rigid, and non-nurturing; fathers were

12

13

characterized as restrictive (Cantwell, Baker, dc Rutter, 1978; Victor, 1983). As a
result of this theory, considerable research was devoted to the study the
characteristics of parents of autistics in order to relate these characteristics to
"producing" autism.

At present, as a result of recent research and clinical experience findings,
early assumptions about autism are being questioned. The psychogenic theory,
which related autism to parental characteristics, is no longer accepted as valid.
The emphasis has shifted from parental pathology to the cognitive and
developmental deficits of the children (Lansing 6c Schopler, 1978). This shift was
a result of pressures from advocacy groups including professionals and parents of
autistic persons and was supported by Public Law 94-142, covering the right of
handicapped students to a free, appropriate education (Wolthuis, 1983).

For the purpose of determining specific cause(s) for autism, autistic
persons have been the subjects of neurological, biological, and environmental
studies. No specific cause has been identified as an absolute causative agent;
however, a central nervous system dysfunction caused by unknown factor(s) is
thought to exist in autistic persons (Wing, I976; Maltz, 1982). Recently,
descriptions of behaviors and symptoms associated with autism are considered of
most importance when identifying and diagnosing autistic persons. Accordingly,
autism as a clinical entity is now viewed as a syndrome (Maltz, 1982; Coleman,
1976).

Many definitions have been developed for the syndrome of autism. The
National Society for Autistic Children's (NSAC) definition (1978) has been widely
accepted by professionals. This definition states that autism is a behaviorally
defined syndrome, the essential features of which are typically manifested prior

to 30 months of age and include disturbances of (a) developmental rates and/or

14

sequences; (b) responses to sensory stimuli; (c) speech, language, and cognitive
capacities; and (d) capacities to relate to people, events, and objects.
Professionals and parents of autistic students are now becoming concerned
about the quality of services which Should be provided to these students and their
families. NSAC has been a powerful advocacy group for educational movements
(Lansing dc Schopler, 1978). More accomplishments have been achieved
throughout the United States in terms of rules and regulations regarding
educational services for autistic students. No longer are they considered
"unteachable" and candidates for placement in institutions. In 1975, when the
United States' definition of developmental disabilities was revised, autism was
included in the category. In 1980, when the federal regulation was again revised,
autism was removed from the category of severely emotionally disturbed. This
change occurred because of the historical confusion of autism and its
relationship to mental illness. Moreover, when the American Psychiatric

Association's Diagnostic and Statistical Manual, Revision III (1980), was issued,

 

autism was defined as a pervasive developmental disorder instead of an
emotional disorder, the category under which it had been categorized in previous
editions of the m.

The state of Michigan is considered to be a leader in rules and educational
provisions for the benefit of autistic students and their families. In July, 1983,
the state's Joint Administrative Rules Committee unanimously approved new
autism rules, including (a) an autism determination rule, (b) an autism
programming rule, and (C) a new endorsement standard for teachers of autistic

students.

15

Identification and Diagnosis of Autism

Any attempt to identify and diagnose the autistic population should
appreciate Kanner's (1943) effect in this regard. In his original paper, Kanner
reported several characteristics of 11 children with an unrecognized syndrome;
his findings based on systematic and careful observation. The purpose of that
study was to identify the behavior characteristics of his subjects and to
differentiate them from characteristics displayed by children with other
psychiatric disorders. These characteristics included an inability, from birth, to
relate to oneself, other people, and situations; a delay in speech acquisition;
noncommunicative use of speech after it had developed; echolalia; obsessive
desire for maintaining sameness in the environment; pronoun reversal; repetitive
and stereotyped play activities; a lack of imagination; a good rote memory; and a
normal physical appearance. Most of these features were reported in many other
clinical studies later as Characteristics of autistic populations. In recent studies,
however, the suggestion that these individuals have normal cognitive
potentialities has been found to be inaccurate. Ritvo and Freeman (1978)
reported that 6096 of the autistic population score below 50 on IQ tests.
Although Kanner provided rich clinical descriptions for the autistic population,
Freeman and Ritvo (1981) pointed out that Kanner " . . . never attempted to
develop an objectively based diagnostic system . . . " (p. 17).

A progress report of the British Working Party (1961) suggested a list of
nine diagnostic points (known as Creak's Nine Points) to be used in diagnosing
"schizophrenic" children. The list included (a) gross and sustained impairment of
emotional relationships with people; (b) apparent unawareness of his/her own
personal identity to a degree inappropriate to his/her age; (c) pathological
preoccupation with particular objects or certain characteristics of them, without

regard to their accepted functions; (d) sustained resistance to change in the

16

environment and a striving to maintain or restore sameness; (e) abnormal
perceptual experience (in the absence of discernible organic. abnormality); (f)
acute, excessive, and seemingly illogical anxiety is a frequent phenomenon; (3)
speech may have been lost or never acquired, or may have failed to develop
beyond a level appropriate to an earlier stage; (h) distortion in mobility patterns;
and (i) a background of serious retardation in which islets of normal, near
normal, or exceptional intellectual function or skill may appear.

These nine points from the British Working Party were accepted by
professionals as a basis for diagnosis of "childhood psychosis" during the 19603
(Freeman 6: Ritvo, 1981). However, Rutter (1966) and Rutter and Lockyer (1967)
criticized using these points in diagnosis, pointing out that there is overlapping
among these points with no specific information to specify how many of the nine
points are necessary to establish the diagnosis. Instead of these points, they used
a Checklist in their studies to compare case histories of 63 psychotic children
with emotional and behavior problems. The checklist they used covered
relationships, speech compulsions, motor phenomena, concentration, self-injury,
response to pain, and behavior problems. Werry (1972), however, suggested that
the items of the checklist were unclear, general, and undefined; therefore, its
reliability was questioned.

Using the term "childhood schizophrenia," Goldfarb (1964) identified two
categories, organic and non-organic, and reported three major behavioral
deviations of diagnostic significance that discriminated between the two
categories and normal children to include (a) abnormal receptor behavior in
which the central finding is auditory and visual inattention (exclusion of distance
receptors), (b) deficient self—awareness, and (c) deficient communication. These

criteria, however, have not been objectively defined.

l7

Ornitz and Ritvo (1968) indicated that autism should be identified by
observable behavior patterns. These behaviors occur as clusters of symptoms
reflecting abnormal development and involve the areas of (a) perceptual
integration, (b) mobility patterns, (c) capacity to relate, (d) language, and (e)
developmental rate. Although they agree that autism should be defined as a
behavioral syndrome, Ornitz and Ritvo add that, at the same time, autism should
be considered a disease. This position was suggested because no one symptom
alone or cluster of symptoms occurring together comprised the syndrome.
Moreover, no one symptom or group of symptoms defined the disease. They also
suggested that developmental failures in autistics were caused by a breakdown of
homeostatic regulation of sensory input. It should be noted that abnormal
development as a way of perceiving autism was new and basic for further
investigations by later professionals. Still, Ornitz and Ritvo did not offer
objective methods to establish a diagnosis of autism.

Ward (1971) suggested the following criteria in establishing a diagnosis for
autistic populations: (a) lack of objective relations, (b) lack of use of speech for
communication, (c) maintenance of sameness in stereotypic behavior, and (d)
lack of neurological dysfunction. Ward also pointed out that many individuals
labeled as autistic have organic causes of their characteristics.

Kolvin (1971), based on a review of literature, suggested that childhood
psychosis can be separated as categories according to age of onset: onset under
three years (infantile psychosis) and over three years (late onset psychosis). The
criteria for infantile psychosis were (a) age of onset before the age of three
years, (b) a self-isolating pattern of social behavior, and (C) at least one of the
following: (1) catastrophic reactions to environmental changes; or (2) gross
stereotypes either of a global class such as headbanging, pirouetting or rocking,

or of the idiosyncratic type such as finger flicking, specific motor patterns, and

l8

self-stimulation. These criteria were based on the early formulation of Kanner
(1943). Kolvin also addressed the problems of establishing objective diagnostic
criteria in establishing a diagnosis of autism.

In 1974, Call presented a detailed table of developmental disability in
infancy. While he was not concerned with objective diagnostic criteria, he
pointed out the importance of considering the course of development when
establishing the diagnosis. From this perspective, his work is considered
important (Freeman 6: Ritvo, 1981).

In 1978, the National Society for Autistic Citizens adopted a definition of
autism proposed by Ritvo and Freeman (1978). This definition is the one most
widely accepted by professionals and includes characteristics and features
exhibited by individuals prior to 30 months of age: (a) disturbances of
developmental rates and/or sequences; (b) disturbances of responses to sensory
stimuli; (c) disturbances of speech, language, and cognitive capabilities; and (d)
disturbances in capacity to relate appropriately to people, events, and objects.

The most recent edition of the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders (DSM-III, 1980) has
established two diagnostic categories of infantile autism: (a) infantile autism,
full syndrome present; and (b) infantile autism, residual state. The diagnostic
criteria for infantile autism, full syndrome present, are (a) onset before 30
months of age; (b) pervasive lack of responsiveness to other people (autism); (c)
gross deficits in language development; (d) if speech is present, peculiar speech
patterns such as immediate and delayed echolalia, metaphorical language, and
pronoun reversal; (e) bizarre responses to various aspects of the environment,
e.g., resistance to change, peculiar interest in or attachment to animate or
inanimate objects; (f) absence of delusions, hallucinations, loosening of

associations, and incoherence as in schizophrenia. The diagnostic criteria for

l9

infantile autism, residual state, are (a) once had an illness that met the criteria
for infantile autism; or (b) the current clinical picture no longer meets the full
criteria for infantile autism, but signs of the illness, such as oddities of
communication and social awkwardness, have persisted to the present.

The criteria offered by DSM-III are considered a guideline for making a
diagnosis by clinicians. These criteria are based on subjective Clinical judgment,
as is the case of most criteria proposed by professionals discussed above. This
situation can be related to the ambiguity of the disorder, the difficulty of
determining specific causes for autism, and the overlapping of autistic symptoms
with the symptoms of other disorders. Furthermore, since autism is a relatively
"new" disorder, much more needs to be learned about its nature.

Despite the fact that autism has been a subject of many studies for more
than two decades,

. . . much confusion exists in the literature not only regarding

the necessary and sufficient conditions to establish the diagnosis, but

also over the term autism. One solution to the problem is to develop

an objective diagnostic schema. Such a tool would not only shed light

on the perplexing clinical problem of diagnosis, but might also aid in

answering other questions. (Freeman dc Ritvo, 1981, pp. 40-41)

Differential Diagnosis of Autism

"Diagnosis continues to be a major problem in the field of autism . . . "
(Maltz, 1982, p. 9). This is because the characteristics of the disorder often
resemble those of other disorders; therefore, accurate data should be obtained in
order to differentially diagnose autistic individuals from others. Most
researchers interested in diagnosis of autism address the issue of other disorders
that share behaviors associated with autism. These disorders are reported to
include mental retardation, childhood schizophrenia, hearing impairment,

language/communication disorder, and others (Regan, 1982; Maltz, 1982; Morgan,

1981; American Psychiatric Association, 1980; Wing, 1976; Ornitz dc Ritvo, 1976).

20

Mental Retardation and Autism

 

When Kanner (1943) proposed a diagnostic criteria for autism, he claimed
that autistics have good cognitive abilities; therefore, mental retardation was
excluded from this population. Later, Ritvo and Freeman (1978) reported that
about 7596 of autistics function in the range of the mentally retarded. Although
the overall functioning of the mentally retarded and mentally retarded autistics
is similar, in mental retardation flat developmental delay across different areas
is reported, while mentally retarded autistics are reported not to have flat
performance. Instead, they score highest on tasks involving short-term memory
or perceptual-motor skills and lowest on verbal tasks (Sindelar, Meisel, Bur, 6c
Klein, 1981).

The confusion between autism and mental retardation came from the fact
that there are some characteristics of mental retardation which are similar to
behaviors seen in autistics. A careful investigation of the syndrome of autism
will lead to points that distinguish autism from mental retardation. The
following differences are reported in the literature.

I. Mentally retarded persons are reported to relate; they are

relatively socially aware. Conversely, the capacity of autistics,
even those with average intelligence, to relate is not evident.
(Maltz, 1982)

2. The ability to perform nonverbal tasks, especially spacial-motor,
Visual-spacial, and manipulative skills, is evident in the mentally
retarded autistic population, while it is not evident in the
mentally retarded population. (Morgan, 1981; Regan, 1982)

3. Language and communication ability are different between the
two groups. The amount and use of language to communicate is

appropriate to the level of intelligence in the mentally retarded;

21

while in mentally retarded autistics, language may either be
absent or, if present, unusual and atypical. (Maltz, 1982; Wing,
1976)

4. Autistic persons have a much lower incidence of physical
abnormality than persons with mental retardation (Morgan, 1981).
This finding supports the early formulation of Kanner (1943) when
he pointed out that autistic children tend to be physically
attractive.

5. The autistic population exhibits special skills (splinter skills),
including rote memory, music, and art, which are not typically
reported for the mentally retarded population. (Maltz, 1982;
Morgan, 1981)

6. Common stereotypic motor behaviors of autistic persons involve
arm and hand motions in front of the eyes as well as gross-motor
movements such as rocking. Mentally retarded individuals, on
the other hand, are more prone to confine their stereotypic
motor behaviors to those which involve vestibular and motor
simulation such as rocking, headbanging, etc. (Regan, 1982;
Morgan, 1981)

It is clear from these findings that early childhood autism is not

synonymous with general mental retardation, and that mental

retardation does not explain autism, any more than it explains, for
example, cerebral palsy, which can also be associated with any level

of intelligence. (Wing, 1976, p. 40)

Autism and mental retardation can be distinguished; but, according to Maltz

(1982), the diagnosis will be difficult in cases of very low-functioning autistics

and the mentally retarded when they display similar behaviors.

Autism as a concept was first established in psychiatric practices. At that
time, autism was used to describe one of the major symptoms in schizophrenia,
withdrawal, or loneliness.
were assumed, to the degree that some researchers (Creak, I961; Goldfarb, 1964)
label autistics as schizophrenics. "Only within the last five to ten years has the
issue of autism and its relationship to schizophrenia been clarified" (Maltz, 1982,

p. 11). Following are some research findings regarding the differences between

22

Childhood Schizophrenia and Autism

 

autism and schizophrenia.

I.

Schizophrenics are capable of using symbols and they use them
extensively, while autistics are incapable of using such symbols.
(Maltz, 1982)

Autistics never develop social relationship with others and they
refuse to respond to people and the environment, while
schizophrenics may develop relationships with others, in a cyclic
way, and may often appear anxious and confused about their
environment. (Rimland, 1964)

Hallucinations, delusions, and loosening of associations or
incoherence are present in schizophrenia, while they are absent
in autism. (American Psychiatric Association, 1980)

In autism it is reported that the age of onset is 30 months or
less, while the onset of schizophrenia is usually in early
adolescence. Autism never develops after 30 months of age;
therefore, the early onset of autism is the best factor in
distinguishing autism from schizophrenia. (Schopler 6c Dalldorf,

1980)

Accordingly, similarities between the two disorders

23

5. Epidemiological findings are reported to be different for both
disorders. The male-female ratio of autism is reported to be
approximately four to one, while in schizophrenia it is equal.
Genetics are reported to explain schizophrenia more than
autism. (Maltz, 1982; Schopler & Dalldorf, 1980).

"It is fair to say, on these findings, that it is possible to differentiate between
these types of childhood psychoses on the evidence from history and present
behavior that there is independent evidence for the validity of this

differentiation . . . " (Wing, 1976, p. 39).

Language/Communication Disorder and Autism

Since disturbances of speech, language, and cognitive capacities are
essential features of the syndrome of autism, it is expected that there will be
similarities between autistics and others who display language disorders.
Because of these similarities, autism may be confused with different types of
language disorders.

Receptive developmental language disorders are reported to be similar to
the language disorders displayed by autistics; therefore, confusion in diagnosis
may occur. The results of several studies on this issue Clarify that, although
there might be similarities between autism and receptive developmental
language disorders, it is possible to distinguish between the two disorders
(Morgan, 1981; Wing, 1976; Maltz, 1982; Regan, 1982).

Children with receptive language problems try to communicate with
gestures and facial expressions to compensate for their speech problems
(American Psychiatric Association, 1980), while children with autism do not show

any appropriate emotional expressions or accompanying non-verbal messages.

24

Both groups may display echolalia; however, more frequently echolalia,
especially the delayed form, is reported with autism (Morgan, 1981; Wing, 1976).
Children with autism fail to use the function of language as a tool for
communication with others. On the other hand, children with language problems
learn to understand basic language concepts and non-spoken symbols and try to
communicate with others. Accordingly, the capacity to learn and manipulate

symbols is considered to be a major difference between the two groups.

Disorders of Hearing and Vision and Autism

 

Social withdrawal, becoming upset by changes in routine, and other
behaviors that may be exhibited by children with undiagnosed congenital
deafness are somewhat similar to behaviors exhibited by autistics. These
behaviors are considered secondary for deaf Children and due to their disorder,
while they are primary in autistic children. Most Classically autistic children are
not deaf (Wing, 1976). A child suspected of being autistic should be checked by
an audiologist to rule out deafness when possible.

Blind or partially sighted children may exhibit self-stimulation and
stereotyped movement similar to that exhibited by autistic children. Moreover,
autistic children's abnormality in responding to visual stimuli may indicate

autism at the first impression (Wing, 1976).

Methods of Assessment of Autism
Regan (1982) pointed out three major goals for the assessment of autism:
(a) diagnosing or confirming the disability condition, i.e., autism; (b) determining
the most appropriate educational setting; and (c) selecting and developing
instructional procedures and materials. Regan also suggested four reasons for
testing: (a) educational placement, (b) program planning, (c) individual progress,

and (d) program evaluation.

25

Newsom and Rincover (1981) pointed out that traditional inferential
methods have been used for assessing autistic children. These methods include
interviews and conventional intelligence tests carried out in clinical practice.
Besides these procedures, Newsom and Rincover suggested that assessment of
autistic children include global "whole child" assessment procedures, including (a)
informal observation during which information can be gathered about the child in
different settings such as a screening interview, a pre-placement classroom, or a
home. Information is gathered by informal observation when an observer tries to
answer questions regarding a child's behavior in different settings; (b)
intelligence tests, which can be used for two purposes: (1) as a rough predictor of
scholastic aptitude and (2) reported for long-term follow-up or comparative
treatment outcome; (c) two major behavioral checklists used for assessing
autism: (l) the first type consists of diagnostic checklists which have been
designed to distinguish autistic children from other disorder groups, and (2) the
second type consists of descriptive Checklists which have been designed to
identify the presence and absence of behaviors important in normal functioning;
(d) educational tests designed to provide an assessment of autistic children in
Classroom settings and to provide information about the acquisition of
educational Skills; and (e) structured observational procedures involving direct
observation and the recording of behaviors displayed by autistic children in

controlled situations.

Behavioral Instruments

 

Behavioral instruments have been developed, including behavior rating
scales, checklists, and observations. These instruments were designed to serve

many purposes, dependent on the goal for using each instrument. Smith, Grimes,

26

and Freilinger (I982) classified these instruments according to their primary
purposes and functions:

I. screening tools to identify children suspected of being autistic.
Due to the low incidence of autism, a screening tool is helpful in
school or clinical settings, particularly where professionals are
unfamiliar with or infrequently see an autistic child. The
children identified through the screening may then be referred
for more extensive diagnostics;

2. diagnostic tools to define development criteria for the diagnosis
of autism and to measure the relative severity of the
impairment. Diagnosis of autism is frequently complex and has
been complicated by disagreement and subjective opinions. By
using standardized instruments, the difficult process of diagnosis
can become more objective and consistent between
professionals;

3. prescriptive measures to determine which behavior(s) the child is
exhibiting that are problematic. This information helps to
prioritize and identify behaviors in need of immediate
intervention. Further assessment of these particular behaviors is
usually necessary before specific intervention can be selected;

4. recording progress and change to provide a record of how the
child's behavior has changed over time. Children with autism,
like all children, change as they grow older. Some problems are
more pronounced at certain ages and diminish as the child
matures. Other behaviors need specific intervention for
improvement to occur. A behavior checklist administered at six
months or yearly intervals can record this change, and
programming priorities can be adjusted accordingly; and

5. facilitating communication to help compare the different
behaviors a child is exhibiting in different environments. They
can be a useful, objective way for parents and professionals to
discuss areas of disagreement of differing perceptions of the
problem and/or the severity of a particular behavior.
Review of Prior Behavior Checklists
Behavior checklists are considered to be one of the most common
instruments used by professionals in the field of behavioral science. They have
been designed to provide helpful information in the assessment of children with

maladaptive behaviors. Behavior checklists can be used for all purposes

mentioned earlier and are typically easy to administer and interpret.

27

Polan and Spencer (1959) are considered to have been the first to establish
a checklist in the area of autism (Freeman 6: Ritvo, 1981). They established a
checklist of symptoms displayed by the five autistics they studied. They grouped
these symptoms into five areas: (a) language distortion, (b) social withdrawal, (c)
activities that lack integration, (d) obsessiveness and nervousness, and (e) family
characteristics. In their checklists, Polan and Spencer did not provide objective
definitions and cut scores to determine the disorder.

In 1964, Rimland developed a diagnostic questionnaire which was designed
to be answered by parents. Form E-l consisted of 76 questions and was intended
for children above seven years of age, and Form E-2 consisted of 80 questions
and was developed to cover children younger than age five. This checklist was
designed to differentially diagnose autistics from other autistic-like children. A
recent form (E-3) consists of questions related to the children's behavior and
medical information such as blood types and drugs taken during pregnancy. This
checklist is used mostly in medical research (Rimland, 1971, 1974).

Freeman and Ritvo (1981) reported that Rimland's diagnostic checklist
suffers from the following weaknesses: (a) it relies on parental reporting of
symptoms and does not incorporate observations of the children, (b) it does not
provide objective definitions of behaviors the parents rate, (c) a scoring key that
would allow other investigators to use the checklist scientifically has not been
published, (d) it only differentiates autistic from non-autistic children and does
not really provide a precise description of the non-autistic child, and (c) it begins
with an apri_or_'i definition of the syndrome rather than letting the data divide the
children into different categories.

Wing (1969) used a checklist to be completed by parents in her study. The
purpose of her study was to compare the behaviors of autistic Children with

behaviors displayed by children with sensory, perceptual, and executive

28

disorders. The validity of this checklist has been questioned because it depends
primarily on parents' reports and does not include information gathered on the
children's current behaviors.

Makita and Umezu (1973) developed a checklist called Checklist for
Autistic Children. This checklist was designed to measure the child's progress
during behavior therapy. It consists of 28 items covering 11 areas of behavior
displayed by autistic children daily. A diagram is plotted as a result of parents'
reports about their children. No objective definitions of behaviors are provided.
Methodological problems also exist.

Review of Current Available Instruments
Used for Differential Diagnosis of Autism
Childhood Autism RatiImScale (CARS)

This scale was developed in 1974 by Schopler to be used with the psycho-
educational profile (PEP). It consists of 15 separate subscales, items of the sub-
scales adapted from Kanner's (1943) criteria for autism, and the nine points of
the British Working Party (1961). A continuum of seven points is used for every
scale ranging from "normal" to "severely abnormal" with a definition of every
point. The CARS can be administered by observing a child in a structured
session. Intensity, frequency, and peculiarity of behavior displayed by the child
being assessed influence the ratings. The age of the child must be considered in
interpretation of the CARS (Schopler, Reichler, DeVellis, & Daly, 1980).

A sample of 537 children was used to construct the criteria that should be
used. The scores ranged from 15 to 60 with a cut point of 30. Children who
obtained a score of 30 or less were considered not autistic. Children who scored
above 36 were considered severely autistic. Children who scored between 30 and

36 were considered mildly to moderately autistic (Schopler et al., 1980).

29

Parks (1983) pointed out the strengths of the CARS as follows: (a)
empirically derived scoring criteria, although construction of the sub-scales is
based on diagnostic schemes rather than on direct sampling of behaviors; (b) the
provision of detailed anchor points for the sub-scales; (c) consideration of the
important influence of the child's age; and (d) good inter-rater reliability using a
large number of cases. Further evaluations of criterion validity and a more
complete investigation of discriminant validity using autistic and other
developmentally disabled children are indicated.

Rimland'§_Diagnostic Checklist for
Bawavior Disturbed Children (E-2)

 

The purpose of this checklist is to identify and differentiate early infantile
autism from the broader range of autistic cases. The form (E-Z) consists of
behaviors displayed by the child. Parents are expected to respond to every item,
with the checklist covering the child's development from birth through five
years. This instrument involves two major scales: behavior and speech. Both
scales yield a total score. The higher the score, the more symptoms of classical
autism are exhibited by the child (Rimland, 1971).

The validity of E-2 is determined in terms of percentage of agreement
without using correlation formulas. A high percentage of agreement was
reported between identified infantile autistic children using the E-2 form and
Kanner's criteria. No test of reliability has been reported. This instrument also
lacks discriminant validity. Accordingly, it has been suggested that this
instrument should be used only for screening purposes (DeMeyer, 1971; Parks,
1983).

3O

Behavior Observation Scale (BOS)

 

This scale was designed to objectively diagnose autism through observation.
The BOS consists of 67 objectively defined behaviors in a checklist form. The
child is observed in a playroom situation. Each observation involves recording
the occurrence of the behaviors in nine three-minute intervals. Recording
procedures involve recording whether or not the behavior is present; if a
behavior is present, frequency of occurrence is also recorded. Standardized
stimuli such as a flashing light are introduced during the first 10 seconds of seven
intervals (Parks, 1983; Freeman, Ritvo, Guthrie, Schroth, Ball, 1978).

The BOS has been subjected only to preliminary studies of reliability and
validity. No information is available about criterion validity, and no other
disability group was included in discriminant validity. The B05 is, however, a
useful scale in the sense of using behaviorally defined variables (Parks, 1983).

Muskegon Index of Autistic
Behavior Checklist (MIAB)

 

 

This checklist was developed to be used as a screening tool to assist school
or clinical staffs in identifying children suspected of being autistic. The MIAB is
designed to provide ratings of autistic behavior in six areas: marked aloneness,
severe language problems, perceptual distortions, cognitive dysfunction, bizarre
emotional reactions, and maladaptive behaviors. Each item of the checklist is
scored according to the presence of the behavior and its frequency (Regan, 1982).

No appropriate statistical information is provided for validity. The data
for all groups are combined; therefore, specific information on rater agreement
is obscured. Reliability coefficients are inflated by the great amount of
variability. However, the checklist is easy to use and score and presents the

major characteristics of autism. The overall evaluation of this instrument,

31

however, is that it does not appear to serve the primary purpose for which it was

designed (Regan, 1982).

Autism Behavior Checklist (ABC)

 

The ABC is one component of the Autism Screening Instrument for
Educational Planning (ASIEP) which was designed to be used in the schools for
the identification and placement of autistic children. The other components of
the ASIEP are (a) Sample of Vocal Behavior which includes samples of 50
spontaneous utterances or speech scored in terms of repetitiveness, non-
communication, intelligibility, and babbling; (b) Interaction Assessment,
including social response between child and adult; (c) Educational Assessment,
which includes quantitative interpretation of in-seat behavior, receptive and
expressive language, body concepts, speech limitation, and repertoire of adaptive
behaviors; and (d) Prognosis of Learning Rate, which involves learning acquisition
rate as measured by a sequencing task (Krug et al., 1979; Regan, 1982).

The ABC consists of 57 items of non-adaptive behaviors designed to
discriminate non-handicapped children from autistic children as well as children
with the following handicapping conditions: severely mentally retarded, severely
emotionally disturbed, and deaf-blind. The ABC has been standardized on
autistic subjects of all ages (18 months - 35 years) and the other handicapped
groups and non-handicapped persons. Descriptions were selected from the
following sources: Rimland's Form E-2, the nine points of the British Working
Party, the Behavior Rating Instrument for Autistic and Atypical Children, and
Kanner's criteria (Krug et al., 1980).

The standardization study consisted of 1,049 completed Checklists. A chi-
square analysis was conducted for the standardization sample in order to provide

weight scores assigned to each behavior listed. The items of the ABC have been

32

grouped into five symptom areas: sensory, relating, body and object use,
language, and social and self-help. Sums of the weighted item checked can be
plotted on a profile chart and compared with data profiles for the entire
standardization sample and by chronological age (Krug et al., 1980; Parks, 1983).

Regan (1982) stated that, "The Autism Behavior Checklist was found to
have excellent content, concurrent, was predictive of autism at the .001 level
when compared to severe mental retardation, severe emotional disturbance,
deaf-blind, and normal populations" (p. 203). Regan also reported the desirable
features of the entire instrument to be:

1. the instrument discriminates between autistics and other
severely handicapped populations and, therefore, is a useful
diagnostic tool for making educational placement decisions for
autistic children;

2. standardization is meticulous and complete;

3. each sub-test can be used separately; and

4. the instrument is an excellent screening tool for assessing the
behavioral characteristics of autistic students.

Since the ABC is a major component of the AISEP and is considered to be
one of the "most useful components" (Smith et al., 1982, p. 59), what is applicable
for the entire AISEP as desirable features will apply for ABC except for
educational placement decisions which require the administration of the entire
instrument.

Parks (1983), in her review of several behavior instruments used with
autism, pointed out that the ABC is reported to discriminate autistic children
from other groups of handicapped and non-handicapped children. Split-half and
inter-rater reliability have been reported to be high. However, these procedures
were based on a very small number of children. Parks (1983) also suggested that
investigations of validity need replication using blind raters and a wider range of

diagnostic groups.

33

Smith et a1. (1982) indicated that many children diagnosed autistic by other
means do not receive scores in the autistic range for the ABC. "Only young
autistic children or low functioning children receive scores in the criterion
range" (p. 63). This claim, however, has not been supported by other
investigators.

In a recent study, Teal and Wiebe (1984) investigated the effectiveness of
three instruments to discriminate autistic from trainable mentally retarded. The
Autism Screening Instrument for Educational Planning (AISEP), Childhood
Autism Rating Scale (CARS), and the Diagnostic Checklist for Behavior
Disturbed Children, Form E-2, were used. The result indicated that all three
instruments were found to separate the two samples of children. The CARS and
the AISEP, however, provided for a greater separation of groups.

The ABC and two other components of the AISEP (IA and EA) were found
to be the significant variables for the discriminant analysis used in Teal and
Wiebe's (1984) study. The result of this study indicated that, with the three sub-
tests as predictor variables, autistic group membership was predicted at 10096
and trainable mentally retarded group membership was correctly predicted at
95% with a pooled group accuracy of 97.596.

Because the ABC is a relatively new instrument, it has not been developed
for use in different cultures. However, through the researcher's personal contact
with the senior author of the checklist, it was learned that ABC has been
translated into the Spanish language. It should be noted that the present study is
the first attempt to develop a version of the ABC for use in a different culture

(Jordan).

34

Translation of Materials for
Cross-Cultural Research

In order to complete research in one language and culture on materials
developed for another language, it is necessary to translate these materials. To
achieve a valid translated version, the goal of translation should be toward
developing an equivalent version of the original version. Developing an
equivalent version is not an easy task because the major problem in translation is
to make certain that the translated version is equivalent to the original.
Secherest, Fay, and Zaidi (1972) pointed out the following aspects of equivalence
and the problems related to each aspect:

I. vocabulary equivalence: for many words it is difficult to find an

equivalent word in the second language. Using a dictionary is
not always helpful because frequently more than one definition is
offered for one word;

2. idiomatic equivalence: idioms which are found in one culture
may not be found in another culture. This problem presents
difficulty in developing an equivalent translation. Accordingly,
equivalent meaning may be needed to solve this problem;

3. grammatical-syntactical equivalence: since different languages
frequently use different grammar and syntax, these differences
might have an impact on translation in terms of meaning;

4. experimental equivalence: the use of different terms by various
cultures to refer to certain items or experiences may affect the
equivalence of translation. These situations require a type of
translation called "cultural translation"; and

5. conceptual equivalence: some concepts may be interpreted as
having different meanings in different cultures. To achieve
conceptual equivalence, it is necessary to know what each
concept means in the culture for which the translation is being
made.

To achieve a total equivalent translation, an effort should be made to

determine all aspects of equivalence. Each aspect should be verified to develop

a truly equivalent translation.

35

Translation Techniques
Several techniques and procedures have been used to translate materials to
be used in different cultures. Following are some of the recommended
techniques:

1. direct translation, a technique commonly used by many
researchers, in which bilingual translators translate materials
from one language to another (Secheres et al., 1982);

2. pretest, a technique requiring a field-test procedure to ensure
that materials are understood by individuals in the other culture.
It should be noted that this procedure is necessary even after
careful translation (Brislin, 1970);

3. de-centering, a technique referring to the process of modifying
the translated materials in terms of content when there are
differences in content between the two languages (Secheres et
al., 1972); and

4. back-translation, a technique involving using at least two
bilingual translators. The first person translates the materials
directly to the second language, while the other translates back
from the second language to the original one. The second
translator should do the back-translation blindly (without reading
the original materials). The two versions should be checked to
determine if they are identical (equivalent) (Brislin, I970).

Brislin reported that many researchers have used the back-translation
technique for cross-cultural research. It has been suggested that it is possible to
develop a more accurate equivalent form through the use of a back-translation

technique than by the use of other techniques.

CHAPTER III
M ETHODOLOGY

The primary purpose of this study was to develop a Jordanian adaptation of
the Autism Behavior Checklist (ABC) which could then be used as a screening
and identification instrument for Jordanian autistic persons. The adaptation
process included the following tasks:

1. translation of ABC items from the English language (the original

language of the instrument) to the Arabic language (the native

language of Jordan);

2. systematic review of the Arabic translation version to make
necessary changes for use in the Jordanian culture;

3. administration of the Jordanian version of the ABC to Jordanian
samples of the following groups: autistics, mentally retarded,
and non-handicapped persons;

4. determination of validity and reliability coefficients for the
Jordanian version of the ABC; and

5. comparison of the results of Jordanian samples with the results
reported for the standardization sample of the original American
version.

Subjects
A total of 192 individuals diagnosed as autistic, severely mentally retarded,
moderately and mildly mentally retarded, and non-handicapped persons served as
subjects of the study. This number included 113 males and 79 females; the age
range was 4-18 years with a mean of 9.39 years (see Table l). A total of 142

subjects were enrolled in the mentally retarded schools and care-homes in the

cities of Amman, Zarka, and lrbid in Jordan; 42 subjects were students enrolled

36

37

in regular schools in Amman and Zarka; and eight individuals were clients in

either psychiatric or pediatric clinics in Amman.

Table 1
Subjects' Categories and Gender

 

Data Tm Categories M E I
Validity Autistics 24 8 32
Severely mentally retarded 22 16 38

Non-handicapped 24 18 42

Reliability Mild to severe mental retardation 43 37 80
TOTALS: 113 79 192

 

 

For the purpose of data analysis, two groups of subjects were selected and
treated differently. They were used to obtain either validity or reliability data. '
The sample used to determine validity data consisted of 112 individuals, including
32 autistic persons, 38 severely mentally retarded students, and 42 non-
handicapped students. This data set included 70 males and 42 females; the age
range was 4-18 years with a mean of 8.96 years. In selecting the autistic group,
the researcher visited all mental retardation schools and care-homes in Amman,
Zarka, and lrbid to identify autistic students who were enrolled in these schools.
Twenty-four students who had been diagnosed by psychiatrists and/or
pediatricians were identified in five schools and one care-home and were
included in the autistic group. The diagnosis of autism for these students was
reported in their school records. The rest of the autistic individuals were
located through psychiatric or pediatric out-patient private and military clinics

in Amman.

38

To obtain severely mentally retarded students, one or more of the
following criteria were used: a full scale IQ of 50 or less on the adapted
Stanford-Binet, evidence that the individual met AAMD-ABS criterion measures,
and verification of nominated individuals as being severely mentally retarded by
a professional in the field of special education. All the severely mentally
retarded students were selected from mental retardation schools and care-homes
in Amman, Zarka, and lrbid. Students who met the criteria of being severely
mentally retarded (IQ score, AAMD-ABS, or professional nomination) were
included in the severely mentally retarded group. The students were initially
nominated by the principals of their schools, and their records were then Checked
to determine if they had either IQ scores or met the AAMD-ABS criterion for
severe retardation. In situations where either of these data were not available, a
professional in the field of special education served as a judge to verify or reject
nominated students. Very rarely were IQ or AAMD-ABS data available in
students' files. In most instances, the main criterion used was the nomination of
a school principal verified by a professional knowledgeable of the American
categorization system of determining the level of severity of mental retardation.

Non-handicapped subjects were students selected from various schools: 16
from a public school in Amman, 13 from the University of Jordan Model School,
eight from a private school in Zarka, and five from a nursery school in Amman.
Selection of students from various schools was made to obtain a wide range of
ages and to minimize as much bias from the sample as possible. Within each
school, selection was made by having teachers choose students whom they felt
they knew well enough to complete valid responses to the checklist.

To obtain subjects for the reliability data set, 80 students from several
schools for the mentally retarded in the cities of Amman, Zarka, and lrbid were

included. This group consisted of 43 males and 37 females in the age range of

39

five to 15, with a mean age of 9.98 years. The students selected included persons
across various severity levels of mental retardation as well as autistic students.
This situation would likely approximate conditions where the ABC would be used
as a screening device. Eight pairs of special education teachers from seven
schools for the mentally retarded in Amman, Zarka, and lrbid rated the 80

students. Each pair of teachers independently rated 10 different students.

Delimitations
Based on the characteristics of the subject population of this study,
generalization of the results is affected by the following limitations:

1. Jordanian individuals diagnosed as autistics, severely mentally
retarded, and non-handicapped;

2. Jordanian autistic students in schools for the mentally retarded
and care-homes and autistic clients in an out-patient psychiatric
clinics, severely mentally retarded students in schools for the
mentally retarded and care-homes, and non-handicapped students
in public and private schools; and
3. autistic individuals, severely mentally retarded students, and
non-handicapped students, aged 4-18 years.
Translation of the
Autism Behavior Checklist (ABC)
The ABC was translated from English (the original language) into Arabic
(the native language of Jordan). To obtain an equivalent translation, the
following procedures were employed.
1. The researcher directly translated all items of the ABC into the
Arabic language (the native language of the researcher).
2. The initial Arabic translation was reviewed by two Jordanian
graduate students, one from the University of Michigan and the

other from Ohio State University. These graduate students were

selected because their area of speciality included linguistics and

40

special education. These persons reviewed the translation
individually according to the following criteria:

a. the total number of items in the translated version
should be equal to the number of items on the original
checklist,

b. the content of each item should be the same as the
original, and

c. each item in the checklist should be clear and
understandable by all.

The reviewers suggested slight changes in wording of some
items. The researcher reviewed and discussed the recommended
changes with the reviewers and, as a result of this discussion,
some of the changes were incorporated while all agreed that the
others Should be disregarded.

The revised translation version was then reviewed by a faculty
member from the Department of Education at Yarmouk
University in Jordan who suggested minor changes in a few
items. No major content changes in this revision were
suggested.

The researcher reviewed the final translated version item by
item to determine whether each was appropriate for the
Jordanian culture. Since the items of the ABC consist of
behaviors which reflect symptom areas, and since these
symptoms are reported to exist in all countries, no evidence of
cultural concern was noted and no changes in terms of content

were made. In item 15, however, the American names (Joe, Bill,

41

Mary) were changed to common Jordanian names (Mohammad,
Ahmad, Waleed).

5. To obtain an accurate equivalent translation, the reviewed
version was then I back-translated into English by two faculty
members in the Department of Education at Yarmouk
University. The two faculty members are fluent in the English
language.

6. The back-translation version was reviewed by two faculty
members in the College of Education at Michigan State
University who are native English speakers. These two persons
were asked to compare the back-translation version with the
original English version to determine if there were any
differences in the meaning of each item on the list. ‘Ihey
indicated that, overall, there were no significant differences in
item content between the two versions. However, slight
differences in a few items were noted as a result of the use of a
literal translation process in the back-translation. The
differences were judged as having no impact on the content of
the individual items.

7. A final technical and wording review of the translation was made
by the dean of the Faculty of Education at the University of
Jordan. ‘lhe final version was then used for a pilot study (see

Appendix B).

Pilot Study
The pilot Jordanian version was submitted to five special education

teachers from three different schools for the mentally retarded in Amman. They

42

were asked to read the directions and every item on the list and to circle each
item or any part of the directions they found difficult to understand. In addition,
they were asked to write out a suggested alternative wording for any item they
had circled. As a result of the pilot study, since the directions and individual
items were determined to be clear, the Jordanian version was judged ready to be

administered to the subjects of the study.

Administration Procedures

The researcher coordinated the administration procedure of the ABC. All
the subjects were rated by teachers who had known them for at least three
months, except for four autistic subjects who were rated by their mothers since
the children were not enrolled in School programs.

The teachers of the autistic group and the severely mentally retarded
group were asked to rate each student (fill out the checklist). Each student was
rated by his/her own classroom teacher. For non-handicapped students, several
teachers were asked to rate one or more of their students whom they felt they
knew very well.

For the reliability data, eight pairs of special education teachers in seven
schools for the mentally retarded in Amman, Zarka, and lrbid rated 80 students.
The teachers were selected by their principals on the basis that each pair knew
10 different students well. Each pair of teachers rated 10 students independently.
Each student was rated twice by (a) his/her classroom teacher and (b) his/her
second classroom teacher or (c) a teacher s/he had had previously or (d) a
teacher s/he currently knew through shared classroom activities. In those
situations where there were fewer than 10 students in one class, each pair of
teachers was asked to agree with each other on rating students within the school

whom they knew well enough to complete independent ratings.

43

The administration was completed by some teachers in one session or one
day while others were given more time (two or three days). The time needed to

complete a checklist for one subject ranged from 10 to 20 minutes.

Statistical Analysis
Since the purpose of this study was to develop a Jordanian version of the
ABC, an eqiivalent Jordanian (Arabic) translation needed to be developed. It
was also necessary to identify validity and reliability of the Jordanian version.
For further information, a comparison was made between the results of the
Jordanian version and the results of the original instrument. Accordingly, the
statistical analysis for this study was concentrated into validity, reliability, and

comparison procedures.

Validity

To identify the validity of the Jordanian version of the ABC, the following

statistical procedures were employed:

1. one-way analysis of variance (ANOVA) to test the differences
among the means of the three diagnostic groups (autistics,
severely mentally retarded, and non-handicapped) across each of
the symptom areas of the checklist (sensory, relating, body and
object use, language, and social and self-help). This procedure
was chosen for its ability to test the effects of the different
categories of one independent variable on a dependent variable.
The F-ratio was considered statistically significant when found
to be larger than the tabled F-value for alpha ( = .05);

2. a Scheffe test as a type of post-hoc multiple comparison
procedure was used, when the F-value for alpha .05 was found to

be statistically significant in the ANOVA results. This test was

44

chosen because it could be used with unequal Ns which was the
case in this study; I

3. an investigation of the effectiveness of the Jordanian version of
the ABC to discriminate between diagnostic groups across each
symptom area by using discriminant analysis. The ability of the
instrument to separate the three groups across each symptom
area was reported as percentages of predicted group
membership; and

4. the calculation of a table of means and standard deviations for
the three diagnostic groups across symptom areas. A profile

chart was also drawn for a quick comparison.

Reliability

To obtain reliability tests for the Jordanian version of the ABC, the

following procedures were employed.

1. Internal consistency reliability for the instrument using
coefficient alpha was calculated. Coefficient alpha was chosen
for this purpose because it fits the study better than the other
split-half coefficients of equivalence. Coefficient alpha is a
generalized procedure producing good estimates of reliability
when the test is homogeneous in content (Glass 6: Stanley, 1970),
and this is the situation with the ABC. Alpha is the mean of all
possible split-half coefficients (Cronbach, 1967).

Internal consistency reliability was used because the ABC is
not intended to measure static traits or behaviors; the items of
the ABC were developed to reflect a sample of behaviors present

at the time of filling out the checklist. The non-adaptive

45

behaviors of the ABC are symptoms displayed by an individual
that are supposed to be changed (become better) over time due
to psychological and emotional intervention. Accordingly, one of
the purposes in administering the ABC more than once a year is
to measure the improvement (change) of the client for follow-up
goals (plan for the future).

To determine inter-rater reliability, inter-rater agreement for
the eight pairs of teachers was calculated. ‘lhe percentage of
agreement for the eight pairs of teachers who rated a total of 80
students was computed. Two percentages were computed, one
without item weights and the other with items weighted. In this
procedure, each pair of scores had an agreement score
calculated for each item (51 to S57). If the two scores agreed
for an item, their agreement score (5) was one. If they did not
agree, their score was 0. 1he unweighted percentage was
calculated by summing the agreement scores and dividing by the
number of items (57). The weighted score was calculated by
multiplying each agreement score (0, 1) by the weight given to
the item (1, 2, 3, 4), then dividing by the highest possible score--
the sum of the item weights (158).

A generalizability coefficient or intra-class correlation
coefficient was computed using reliability data in which eight
paris of teachers have rated a total of 80 students, with each
pair rating 10 students independently. This procedure was used
to overcome the problem of having more than one source of

variation (i.e., teachers, pairs of teachers).

46

In a real life situation, it is impossible to find two raters (teachers) whom a
large number of subjects (students) might know well enough to have each teacher
rate every student. If this happened, theoretically a correlation coefficient
could be calculated between the ratings of the two raters. But since each pair of
raters, practically, knows well and can rate only a limited number of the same
students, a generalizability or intra-class correlation coefficient can solve the
problem. In this procedure, one looks for a component of variance to obtain
ratio variances which are true variations being compared to error variations. A
generalized analysis of variance (GENOVA), a computer program for
generalizability theory, was used to obtain the generalizability coefficient

(Brennan, 1983).

Jordanian Scores Versus American Scores

 

A t-test was used to test for differences between the mean total score for
each diagnostic group across all symptom areas of the Jordanian sample on the
Jordanian version of the ABC and the mean total score of the diagnostic groups

across all symptom areas of the American original standardization study.

Limitations of the Study
Based upon the design, the procedures, and the instrument used in this
study, the results are subject to the following limitations:

1. the accuracy of obtaining an equivalent Jordanian (Arabic)
translation for the original American ABC,

2. the relatively small number of subjects used in the study,
3. the accuracy of diagnosis of the groups used in the study,
4. the selection procedures used to obtain subjects for the study,

5. the cooperation of teachers and persons rating subjects in the
study, and

6. the ability of the statistical procedures used for analyzing the'
data obtained.

CHAPTER 1V
RESULTS

The purpose of this study was to develop a Jordanian adaptation of the
Autistic Behavior Checklist (ABC). The data collected after administering the
Jordanian version of the ABC to the subjects of the study were analyzed. The
data analysis was directed toward three main issues: validity of the Jordanian
version of the ABC, reliability of the Jordanian version, and the differences
between the scores on the Jordanian version and the original American
standardization study. The total score of the Jordanian version of the ABC as

well as the five symptom areas were considered when reporting the results.

Validity
The scores of the three diagnostic groups in the first sample (autistic,
severely mentally retarded, and non-handicapped persons) were calculated.
Table 2 consists of means and standard deviations of the total scores and the
subscores of the symptom areas of the three groups. The means of the total

scores and subscores were plotted in a profile as shown in Figure 1.

47

48

Table 2
Means and Standard Deviations of the Total Scores and the Symptom Areas for
the Autistic, Severely Mentally Retarded, and Non-Handicapped Groups

 

Symptom Areas

 

 

 

 

 

 

 

 

Total Body and Social and
Groups Scores Sensory RCIBTIIB Object Use Lang1_1age Self-Help
Autistic
3? 123.31 17.34 31.66 32.91 23.41 18.00
Sx 13.21 4.41 3.31 3.52 5.50 4.03
SMR
I“? 37.47 4.79 10.32 7.74 7.26 7.37
5x 12.89 3.57 6.24 4.96 4.30 4.38
Non-Handicapped
‘x 1.81 .31 .29 .43 .26 .52
Sx 2.24 .78 .89 .83 .83 1.06
30-111 and Social and Total
344W: ry Relating object use language self help score
26 38 38 3' 25 E 158
M
(123.81)
It 25 25 16 16 E 102
I
1
I
.2 19 19 12 12 : 77
I A Autlstlcs
1
I
10 16 16 10 10 : 611 . 5"“
I
I I Nonhandlcapped
. (37.47)
M
1
1
l
1
I
Svnpton Synpton Synpton Synptno SylptOl .
area I area 2 area 3 area 4 area 5

Figure 1. Profile chart of mean symptom area scores and total scores for each
diagnostic group.

49

No mean total scores or symptom area scores were overlapping among the
three diagnostic groups. One-way analysis of variance (ANOVA) was used to
differentiate among the mean total scores of the three diagnostic groups.
ANOVA was also used to differentiate among mean scores of each of the
symptom areas of the ABC (sensory, relating, body and object use, language, and
social and self-help). Table 3 contains the results of the ANOVA mean total

scores of the three diagnostic groups on the Jordanian version of the ABC.

 

AfiOeVA Results Comparing Diagnostic Groups by Total Scores

My: .1! Z 2!. E 21.51
Autistic 32 123.81 13.21 1286.9 .0000*
SMR 38 37.47 12.89

Non-handicapped 42 1.81 2.24

*significant at the alpha = .05 level

 

 

‘Ihe results indicated that there were significant differences in the total
scores among the three groups.
Tables 4 through 8 contain the results of ANOVA mean scores of each of

the symptom areas across the three groups.

 

AIVbOeVlA Results Comparing Diagnostic Groups by Mean Subscore: Sensory

m 1:1 Z is E 21.12
Autistic 32 17.84 4.41 288.760 .0000*
SMR 38 4.79 3.57

Non-handicapped 42 .31 .78

*significant at the alpha = .05 level

50

 

X73133}; Results Comparing Diagnostic Groups by Mean Subscore: Relating
m2: 5 ' Z 2‘. 1: 5:1
Autistic 32 31.66 3.31 546.42 .0000*
SMR 38 10.32 6.24
Non-handicapped 42 .29 .89

*significant at the alpha = .05 level

 

 

Table 6
ANOVA Results Comparing Diagnostic Groups by Mean Subscore: Body and
Object Use

 

9221B 1:1. Z .53. E ELF!
Autistic 32 32.91 3.52 835.24 .0000*
SMR 38 7.74 4.96

Non-handicapped 42 .43 .83

*significant at the alpha = .05 level

 

 

 

AfiOeV/A Results Comparing Diagnostic Groups by Mean Subscore: Language
m E Z :93 E 5.131
Autistic 32 23.41 5.50 328.60 .0000*
SMR 38 7.26 4.30

Non-handicapped 42 .26 .83

*significant at the alpha = .05 level

 

 

51

Table 8
ANOVA Results Comparing Diagnostic Groups by Mean Subscore: Social and
Self-Help

 

Ewes .N. Z. S_x 1: BE)
Autistic 32 18.00 4.03 240.61 .0000*
SMR 38 7.37 4.83

Non-handicapped 42 .52 1.06

*significant at the alpha = .05 level

 

 

The results of Tables 4 through 8 indicated that there were significant
mean differences among the three diagnostic groups across all symptom areas
(subscores).

A Scheffe statistic as a post-hoc procedure was used to compare mean
total scores and mean symptom areas among the three diagnostic groups. The
Scheffe comparisons were used for the purpose of identifying where statistical
differences were specifically located. Table 9 contains the results of the

Scheffe contrasts on the total score across the three diagnostic groups.

 

 

:3?sz Contrasts (Mean Differences) for Total Scores Across Groups
$992 SMR Non-Handicapped
Autistic 86.34* 122.00*

SMR -- 35.66*

*significant at the alpha = .05 level

 

 

The results indicated that the three diagnostic groups were significantly
different from each other. Table 10 contains the results of Scheffe contrasts on

the subscores (symptom areas) across the three diagnostic groups.

52

Table 10
Scheffe Contrasts (Mean Differences) by All Symptom Areas (Subscores) Across
Groups

 

Group and Subscore

Body and Social and
Sensory Relating Object Use Language Self-Help

Group SMR N—H SMR N-H SMR N-H SMR N-H SMR N—H
Autistic 13.05 17.53 21.35 31.37 25.61 32.48 16.14 23.14 10.63 17.48
SMR 4.48 10.03 7.31 7.00 6.84

All numbers are significant at the alpha = .05 level.

 

 

These results indicated that all three diagnostic groups were significantly
different from each other across all subscores (symptom areas) of the checklist.

Discriminant analysis was used to investigate the effectiveness of the
Jordanian ABC to discriminate among the three diagnostic groups: autistics,
SMR, and non-handicappers. Table 11 contains the classification results by the

total scores.

 

 

 

Table 11

Classification Results by Total Score

Actual Group No. Cases Predicted Group Membership
.1. Z 2

Autistic l 32 32 0 0

100.0% 0.0% 0.0%

SMR 2 38 0 38 0
0.0% 100.0% 0.0%

Non-Handicapped 3 42 0 0 42

0.0% 0.0% 100.0%

Percent of "grouped" cases correctly classified: 100.0%

 

 

53

The results of the discriminant analysis indicated that the ABC total scores
separate the three diagnostic groups effectively.

Tables 12 through 16 contain results of the classification by each subscore.

 

 

 

Table 12

Classification Results by Subscore: Sensory

Actual Group No. Cases Predicted Group Membership
1 2 2

Autistic l 32 32 0 0

100.0% 0.0% 0.0%

SMR 2 38 3 28 7
7.9% 73.7% 18.4%

Non-Handicapped 3 42 0 5 37
0.0% 11.9% 88.1%

Percent of "grouped" cases correctly classified: 86.61%

 

 

 

 

 

Table 13
Classification Results by Subscore: Relating
Actual Group No. Cases Predicted Group Membership
1 Z 2
Autistic l 32 32 0 0
100.0% 0.0% 0.0%
SMR 2 38 0 30 8

0.096 78.9% I 21.1%

Non-Handicapped 3 42 0 0 42
0.0% 0.0% 100.0%

Percent of "grouped" cases correctly classified: 92.86%

 

 

54

Table 14
Classification Results by Subscore: Body and Object Use

 

 

 

Actual Grog No. Cases Predicted Group Membership
1. 2 2
Autistic 1 32 32 0 0
100.0% 0.0% 0.0%
SMR 2 38 0 31 7
0.0% 81.6% 18.4%
Non-Handicapped 3 42 0 0 42
0.0% 0.0% 100.0%

Percent of "grouped" cases correctly classified: 93.75%

 

 

Table 15
Classification Results by Subscore: Language

 

 

 

Actual Grog No. Cases Predicted Group Membership
1 2 2
Autistic l 32 30 2 0
93.8% 6.3% 0.0%
SMR 2 38 0 34 4
0.0% 89.5% 10.5%
Non-Handicapped 3 42 0 0 42
0.0% 0.0% 100.0%

Percent of "grouped" cases correctly Classified: 94.54%

 

 

Table 16
Classification Results by Subscore: Social and Self-Help

 

 

 

Actual Group No. Cases Predicted GrOg; Membership
2 2 2
Autistic l 32 30 2 0
93.8% 6.3% 0.0%
SMR 2 38 0 34 4
0.0% 89.5% 10.5%
Non-Handicapped 3 42 0 O 42
0.0% 0.0% 100.0%

Percent of "grouped" cases correctly classified: 94.54%

55

‘Ihe classification results of subscores indicated that all subscores were
found to separate the three diagnostic groups. There was a slight difference
between the subscores in classifying the group. Subscores in the sensory,
relating, and body and object use were found to separate the autistic group from
the other two groups perfectly. Language and social and self-help subscores had

somewhat lower predicted classification.

Reliability

To identify internal consistency reliability for the Jordanian version of the
ABC, the data on 80 subjects (reliability data) were used. For accurate results,
coefficient alpha was calculated twice, once for the first rating of the 80
students and the other for the second rating. ‘Ihe results of the first rating were
.834 and for the second .808. These results indicated that the Jordanian version
of the ABC had relatively high internal consistency reliability.

Inter-rater reliability was obtained by calculating the percentage of
agreement between raters. The mean percentage of raters' agreement without
item weight was 95.95%. The mean percentage of raters' agreement with item
weight was 96.11%. These results indicated that the Jordanian version of the
ABC has a high inter-rater reliability.

A generalizability or intra-class correlation coefficient was calculated.

Table 17 contains the estimates of variance components.

56

 

 

 

Table 17
Estimates of Variance Components
Estimated
Variance Standard
Effect D_F Components Error
P 7 46.01 36.85
S:P 72 306.33 51.23
T P 8 .50 .71
ST P 72 10.51 1.73

P = pair of teachers
5 = student
T = teacher

 

 

Assuming that higher interaction terms were negligible, then the
generalizability coefficient (ratio of variances which would be true variation
compared to error variation, analogous to a reliability coefficient) was equal to
.965. This result indicated that the Jordanian version of the ABC had a very high
generalizability or intra-class correlation coefficient. The results suggested that
the variances of the subjects' scores were mostly related to their true variation,

not to variation among teachers within a pair or among pairs of teachers (error).

Jordanian Scores Versus American Scores
A t-test was used to compare the scores on the Jordanian version of the
ABC with the original American results. This test was calculated for the total
score and each subscore (symptom area) across the three diagnostic groups.
Table 18 contains the results of the comparison for the autistic group in total

scores and the subscores.

Table 18

57

Comparisons of Jordanian and American Scores for the Autistic Group

 

Score

Total score

Sensory

Relating

Body and Object Use

Language

Social and Self-Help

*significant mean differences at alpha = .05 level

Com-

Erison

M
SD
N

M
SD
N

M
SD
N

M
SD
N

M
SD
N

M
SD
N

Jordanian

123.8

13.2**
32

17.8
4.4
32

31.7
3.3**
32

32.9
3.5* *
32

23.4
5.5
32

18.0
4.0
32

American

77.5
20.0**
172

12.7
5.2
172

24.0
7.8**
172

15.8
8.3**
172

12.2
6.8
172

12.8
5.7
172

**significant variance differences at alpha = .05 level

T for Mean

Difference

16.6*

5.3*

9.2*

19.3*

8.8*

“09*

NOTE: the appropriate t-test was used, depending upon whether the variances
were equal or unequal

 

 

The results indicated that there were significant differences between the

mean scores of the Jordanian autistic group and the autistic group of the original

standardization study across all symptom areas.

Table 19 contains the results of the comparison for the SMR group in total

score and subscores.

Table 19

Comparisons of Jordanian and American Scores for the SMR Group

58

 

Score

Total score

Sensory

Relating

Body and Object Use

Language

Social and Self -Help

*significant mean differences at alpha 2 .05 level

Com-

Erison

M
SD
N

M
SD
N

M
SD
N

M
SD
N

M
SD
N

M
SD
N

Jordanian

37.5

12.9**

38

4.8
3.5
38

10.3
6.2
38

7.7
4.7
3

7.3
4.3
38

7.4
4.4

38

m

44.0
18.9"

423

7.0
4.2
423

14.3
7.7
423

7.2
5.2
423

7.3
3.5
423

4.4
3.6
423

**significant variance differences at alpha = .05 level

T for Mean

Difference

-2.8*

-3.11*

-3.11*

1.3

NOTE: the appropriate t-test was used, depending upon whether the variances
were equal or unequal

 

 

The results indicated that there were significant differences between the
mean scores of the Jordanian SMR group and the SMR group of the original
American standardization study in the mean total score and two subscores--
sensory and relating. However, no significant differences were found in the

mean scores for the other subscores--body and object use, language, and social

and self-help.

59

Table 20 contains the results of comparison for the non-handicapped group

in total scores and subscores.

 

Table 20
Comparisons of Jordanian and American Scores for the Non-Handicapped Group
Com- T for Mean
Score Erison Jordanian American Difference
Total score M 1.8 3.9 ' -3.4*
SD 2.2** 5.1**
N 42 100
Sensory M .3 .7 -l.6
SD .8** l.8**
N 42 100
Relating M .3 1.0 -2.8*
SD .9** 2.0**
N 42 100
Body and Object Use M .4 .5 - .6
SD .8 .9
N 42 100
Language M .3 .6 -1.4
SD .8** 1.6**
N 42 100
Social and Self-Help M .5 1.2 -2.9*
SD 1.1 1.7
N 42 100

*significant mean differences at alpha = .05 level
**significant variance differences at alpha = .05 level

NOTE: the appropriate t-test was used, depending upon whether the variances
were equal or unequal

 

 

The results indicated that there were significant differences between the
mean scores of the Jordanian non-handicapped group and the non-handicapped
group of the original American standardization study in the mean total scores
and two subscores--relating and social and self-help. However, no significant
differences were found in the mean scores of the other three subscores: sensory,

body and object use, and language.

CHAPTER V
SUMMARY AND DISCUSSION

Summary

The purpose of this study was to adapt and validate the Autism Behavior
Checklist (ABC) for use in the country of Jordan. Since autism is one of the
most neglected groups of handicapping conditions in Jordan, autistic persons are
frequently not properly identified and differentially diagnosed from other
handicapping conditions. The identification of a handicapped person as being
autistic is considered an essential first step for the provision of needed
psychological and educational services. Since no screening or identification
instrument for autistic persons is available in Jordan, the development of such an
instrument is considered essential.

Autism is a behaviorally defined syndrome which should be diagnosed and
described through the specification of behavioral characteristics. Accordingly,
most methods for diagnosing the autistic population which have been developed
include behavior checklists and observational keys. In the United States, several
instruments have been developed for the purpose of screening and identifying
autistic persons, many of which could be adapted to the Jordanian culture. The
study consisted the adaptation of the Autism Behavior Checklist which is a major
component of a large, comprehensive instrument entitled the Autism Screening
Instrument for Educational Planning (ASIEP). The ABC was selected for the
following reasons: (a) the ABC's categories include assessments of behaviors
which relate to the most widely used and accepted definition of autism, (b) the

items of the ABC were selected from a variety of influential

60

61

sources, (c) categories of the ABC cover many areas reported in the literature as
essential in diagnosing autism, and (d) the behaviors in the Checklist are
statistically weighted with more weight given to items that are more predictive
of autism.

The first step of the adaptation process was obtaining an equivalent Arabic
translation version of the ABC. In this process, the items of the ABC were
translated directly from English to the Arabic language, and then the Arabic
version was back-translated to the English language. Both the Arabic translated
version and the original version were reviewed, and no content differences were
noted.

A pilot study was conducted for the Jordanian adapatation of the ABC
before the checklist was administered to the subjects of the study. Five special
education teachers reviewed the pilot version of the ABC and indicated that the
directions and individual items were clear. The pilot version of the ABC was
then determined to be ready for administration to the subjects of the study.

Subjects in the study included 192 individuals diagnosed as autistic, severely
mentally retarded, moderately and mildly mentally retarded, or non-
handicapped. This number included 113 males and 79 females whose age range
was four to 18 years, with a mean age of 9.39 years. A total of 142 subjects were
students enrolled in schools for the mentally retarded or care-homes in the cities
of Amman, Zarka, and lrbid, Jordan; 42 subjects were students enrolled in
regular schools in Amman and Zarka; and eight individuals were clients in
psychiatric clinics in Amman.

For the purpose of data analysis, two groups of subjects were selected and
treated differently to obtain validity or reliability data. The sample used to
collect validity data consisted of 112 individuals, including 32 autistic persons, 38
severely mentally retarded students, and 42 non-handicapped students. This

sample included 70 males and 42 females. The age range was four to 18 years,

62

with a mean age of 8.96 years. The reliability data set consisted of 80 students
from several schools for the mentally retarded. It included) 43 males and 37
females with an age range of five to 15 years and a mean age of 9.98 years.

The equivalent Jordanian (Arabic) translated version of the ABC was
administered to all subjects of the study. ‘lhe administration procedures
included completion of the checklist by teachers or parents of the subjects.

Data analysis for the study included the establishment of validity and
reliability for the Jordanian version of the ABC and the comparison of the
results of those meaures with the results of the original standardization study.
To identify validity, one-way analysis of variance (ANOVA) was used to test for
differences among the means of the three diagnostic groups (autistic, severely
mentally retarded, and non-handicapped) across each of the symptom areas of
the Checklist (sensory, relating, body and object use, language, and social and
self-help). A Scheffe contrast was also used as a type of post-hoc multiple
comparison when the F-value was found to be statistically significant.
Discriminant analysis was used to investigate the ability of the checklist to
separate the three diagnostic groups across each of the symptom areas.

Reliability was determined using a reliability data set. Coefficient alpha
was used to identify the internal consistency reliability of the instrument, and
inter-rater agreement was used to identify inter-rater reliability of the
instrument. A generalizability or intra-class correlation coefficient was also
used.

The results of this study were compared with the results of the original
standardization study. A t-test was used to test for differences between the

mean total score of each diagnostic group across all symptom areas.

63

The major findings of the study were the following.

1.

ANOVA results indicated that there were significant differences
in the total score and the subscores across the three diagnostic
groups.

Scheffe results indicated that the three diagnostic groups were
significantly different from each other by total scores as well as
all subscores.

Discriminant analysis results indicated that the total score of
the Jordanian version separates the three diagnostic groups
effectively (100%). Discriminant analysis results of the
subscores indicated that they can predict the three diagnostic
group's membership from 86.61% to 94.54%.

Internal consistency reliability using coefficient alpha was .834
and .808.

Inter-rater reliability results indicated that the mean percentage
of agreement between raters without using item weight was
95.95%. The mean percentage of rater agreement using item
weight was 96.11%.

The generalizability or intra-class correlation coefficient was
.965.

There were significant differences between the mean scores of
the Jordanian autistic group and the autistic group of the
original American standardization study across all symptom
areas.

There were significant differences between the mean scores of
the Jordanian severely mentally retarded group and the severely

mentally retarded group of the original standardization study in

64

mean total score and two subscores (sensory and relating). No
significant differences were found for other subscores.

9. There were significant differences between the mean scores of
the Jordanian non-handicapped group and the non-handicapped
group of the original American standardization study in the mean
total scores and two subscores (relating and social and self-help).
No significant differences were found in the mean scores of

other subscores.

Discussion

Establishing a valid and reliable Jordanian version of the ABC was the main
purpose of the present study. In order to adapt this instrument for the Jordanian
culture, the first step was to translate the ABC items from the English to the
Arabic language. The next step was to determine the validity and reliability of
the translated version. The last step was to compare results of this study to the
results of the original American standardization study.

Developing an equivalent, translated version of material for the purpose of
cross-cultural research is unusually complicated because of language and cultural
factors. Materials differed from each other, however, in terms of the degree of
difficulty in translation. Since the ABC items consist of behaviors which can be
observed and operationally defined, it was possible to obtain an equivalent
Arabic translated version. While it was difficult to match some English words
with their exact equivalents in Arabic, content equivalence was achieved.

The results of this study, through the use of a variety of statistic
procedures, demonstrated that the Jordanian version of the ABC was both valid
and reliable. Inspection of Table 2 and Figure 1 (page 48) indicate that the mean

total and subscores of the three diagnostic groups were significantly different

65

from each other. 1he significant differences among the three diagnostic groups
were determined through the use of one-way analysis of variances (ANOVA).
The results of Scheffe contrasts for the mean total score and subscores indicated
that all three diagnostic groups were different from each other.

Classification results, using discriminant analysis, indicated clearly that
the Jordanian version of the ABC mean total score separates the three
diagnostic groups effectively (100%). It should be noted, however, that even
though the separation among subscores was relatively high, they were not
perfect (86.61 -94.54%). This result justifies using the whole instrument instead
of using parts of it. Language and social and self-help subscores had the same
percentage of classification (94.54%). It could be concluded that using one of
these would be sufficient to predict group membership. In general, discriminant
analysis results support and go along with the results of the ANOVA and Scheffe
post-hoc comparisons.

Reliability results were obtained through using different measures. All the
results obtained indicated that the Jordanian version of the ABC is reliable.
Internal consistency reliability, using coefficient alpha, was .834 or .808. This is
relatively high, but it could be higher since the reliability sample used was a
relatively homogeneous group which maintained a small range of scores.

The percentage of agreement among raters both without Using item weight
and with item weight were high (95.95 - 96.11%) and close to each other.
Although inter-rater agreement using item weight was justified, since the weight
of items contributes to the total score, it could be misleading. For instance, two
raters may obtain 100% agreement between total scores while they might be
totally different.

The use of a generalizability or intra-class correlation coefficient was

another procedure conducted to determine the reliability of the Jordanian

66

version of the ABC. The high generalizability coefficient (.965) supported
previous indications regarding inter-rater reliability.

The findings of comparing the Jordanian results with the original American
standardization study for the three diagnostic groups indicated significant
differences in mean total scores. The Jordanian autistic group obtained a very
high mean total score (123.2) compared to the mean total score for the autistic
group in the original study (77.5). This high mean cannot be explained only by
the ability of the instrument to discriminate among the diagnostic groups; the
fact that the Jordanian autistic subjects were low-functioning autistics who
displayed active symptoms must also be taken into consideration. If the
Jordanian sample had included higher functioning autistic individuals, the mean
total score would likely have been lower. In addition to mean total score
differences, all subscores of the Jordanian autistic subjects were significantly
different from the scores reported for the original study.

The Jordanian severely mentally retarded mean total score and two mean
subscores were also significantly different from mean scores reported for the
severely mentally retarded group used in the original study. Similar differences
were noted for the Jordanian non-handicapped group. These differences may be
due to the small number of subjects in the Jordanian severely mentally retarded

and non-handicapped groups.

Implications and Recommendations
Taking into consideration the limitations of the study (accuracy of the
Arabic translated version, small number of subjects, and accuracy of the
diagnosis of the groups), the results of this study would suggest the following

implications and recommendations for future research.

67

An equivalent Jordanian (Arabic) translated version of the ABC
was achieved.

The Jordanian version of the ABC appears to be valid and
reliable; therefore, it can be used with confidence as a screening
tool to identify Jordanian autistic persons.

It is recommended that a future standardization study be
conducted which would use more and other diagnostic groups.

It is recommended that future research efforts be devoted to the
adaptation of the entire ASIEP to develop a complete assessment

instrument for autistic persons.

APPENDIX A

THE ORIGINAL AMERICAN VERSION OF THE
AUTISTIC BEHAVIOR CHECKLIST (ABC)

AUTISM IEHAVIOH CHECKLIST

 

 

 

 

 

3 e
:3 o
Student's Name 3 z;
e =
Date 3 "O,
Examiner ° . 2
e e E r -
8 7; a a E
lNSTRUCTthlS; Clrcle the number to lndlcate the Items that most accurately descrlbe the child. 5 :e: E S 5
I 2 - . 3 4 3
Whirlsselllorlonoperlodsottlme .................................... ............. I. 1..... 4
Learns a whale task but"10'9013"00t€kly ................................ . .............. . .............. . . . . .. . . . . . . . . . . 2
Chlld frequently does not attend to IOCIIIIOMIIOHMOI'HOI sttrnutl ..................................... . . . . . . . 4
Does n01 lollow slmple commands whtcn are glven once (sit down. come here. stand up) .................. ... . . l. . . . . . . . 1
Does n01 use toys appropriately (spins tires. etc 1 ........................................ . .......... . .. .. . ..
Poor use 01 vtsual dlscmnlnatron when learning (ti-ates on one characteristlc
such as size color or oosltlonl 9 .................................. . ..... . .......... . ...... . . . ........ 2
Has no soc-a1 smile .............. I ....................................................... . ............. . . . . . 2
HasbronOUnreversaltyOutortetc.)....- ............................................................... .....r... 3
lnslsts on keeping certaln oblects wlth hlmrher ......................................................... . . . . ...... 3
Seems not to hear. so that a hearing loss 1s suspected ........................ . ............. . . . . . . ...... 3
Speecmsatonalandarhythrmc ............................................ . ............ . ......... 4
Rocksselltorlongperlodsolturne ......................................... . .......
Does not tor dld not as a babyt reach out when reached tor ............... . .................... . .......... .. . . . 2
Strong reactuonstocmnges lnroutmelenvlronrnent ................................... 3
Does not respond to own name when called out among two others (Joe. lttt, Mary) ..................... . . . . . . . . . . . . .. 2
Does a lot at lunqmg and dertlng about, Interrupting with spinntng. toe walking, Mapping, etc. ............. . . . . . ..... 4
Not responslve to other people's lacsal espresslonsrteellngs ....... ...... . . . . . 3. .
Seldornuses"yes"or"l" ............................................................................ . .. 2
Has "specul apllltles” ln one area oldevelopment,erh1ch seems to rule out mental retardation ............. . . . . ..... . 4
Does n01 toltow simple commands Involving propositions (“put the ball on the box" or
"puttheballtnthebor'j ............................................................... ........ ...... . . I
Sometlmes shovvs no "startle response" to a laud nause (may have thought ch11d was dealt ................ 3
Flaps hands .......................................................................................... . . . .. ..... 4
SevereternpertantrumsandlorlreOuentmmortantrums ........................ . ...... . .. 3
Actlvelyavoidseyecontact....... ........................................ ........ e
Reslsts belng tOuched or held ........................................................ . .. ............. . . . .. 4
Sometlmes Dltnful Silmul' such as brurses. Cuts and Injectlons evoke no reaction .............. . ...... . .. 3
1s tor was as a pabyt SI!" and hard to hold .............................................................. ..... 3
Is tlaccld tdoesn 1 cling) when held to arms . .. ......................................................... .. .. 2
Gets deslred 0010613 by gesturing ................................................................... .. . . ...... .... 2
Walnsonloes .............................. .. .............................................. ...... 2
Hurts others by biting,h1ttrng,tt1cxlng.etc ............................................................. . . . .. ..... ,. .... 2
Repeats phrases over and Over ........................................................................ .... ..... .. 3
Does not Inmate other chlldren at play .. ............................................... 3
Olten wlll not bunt: when a brlqnt hght 1s dlrected toward eyes .......................................... 1
Hurts sell by pangung head bltmg hand etc ....................................................... ..... ..... 2
Does not vvalt tor needs to be rnet twants thlngs mmeduately) ........................................... .... ...... ... .... 2
Cannot oomt to more than lnve named Objects ......................................................... ..... ..... .1. 1
Has not developed any trtendshlps .................................................................... 1.... 4
Covers ears at many moods. ........................................................................ 4
Twlrls. spins and bangs op ects a lot ................................................................... .... ...... 4
Dllllcwt-es mth tonet trarmng . ........................................................ . ...... .... 1
Uses 0- 5 spontaneous words per day to communicate wants and needs .................................. . . ...... 2
Otten lrngntened or very annous. .................................................................. ..... 3
Soulnts. trowns or cavers eyes when m the presence pl natural light ..................................... 3
Does not dress sell wrthOut trequehl help .............................................................. . ...... .... t
Repeats scenes or uprds over and over ............................................................. . .. .... ...... 3
“Locks thr0ugh” people ........................................................................... . , . 4
Echoes questions or statements made by others . . ................................................. . . . 4
Frequently unaware of sunbundlnqs. and may be obllvrous to dangerous sltuatlons ....................... . . . . ...... 2
Preters to mahlpulate and be occupled Wtih thanlrnate Ihtng! ............................................ .... ...... .... . 4
Will leel. smell andlor taste oblects 1n the enmonment .................................................. . . . ....... 3
Frequently has no v-sual reaction to a "new ' person .................................................. T. 3
Gets Invowed In cornpllcatec ”YIIUI'S” Suctt as lIn-ng thongs up. etc. ..................................... ..... ..... 4
Is very destructvve (toys and heusehold Items are soon brouem .......................................... . . . ....... 2
A develoomental delay was Identltled at or belore 30 months at age ....................................... . . . ...... 1
Uses at least 15 but less than 30 spontanwus phrases daily to commumcate .............................. ... ......
Stares Into space lor long perioos ol ttme ................ . . . .. ..................................... 4

 

Q 1978 Krug, A'lci 8 Almond

68

 

 

 

 

1

‘2

 

APPENDIX B

THE JORDANIAN TRANSLATED VERSION OF THE
AUTISTIC BEHAVIOR CHECKLIST (ABC)

 

 

 

 

 

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, . . . .................... 1:11.333” lfi.:t'- 9.915 L‘uFJIV),$La,LL.>,J _
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5,...11
o e t e T e T 41

APPENDIX C

APPROVAL LETTER FROM ASIEP TO USE THE ABC

     
   
  

AMEND-r“
SYSTEMS: ’1
lnstrudion

Evaluation *1
Nblishijt‘gpjd

 
 

 

  

 

ASIEP Education Company, 3216 NE. 27th, Portland, Oregon 97212 telephone: (503) 2131-4115

March 5, 1985

Jamil Smadi, Doctoral Candidate

1540-D Spartan Village

East Lansing, MI 48823

Dear Mr. Smadi,

You may use the Autism Behavior Checklist, as published by ASIEP
Education Company, Inc., for purposes of your doctoral research
study.

All publication, distribution and marketing rights of the Autism
Behavior Checklist (in English and Arabic) remain the sole
property of ASIEP Education Company.

Sincerely,

David A.4 rug, resident
ASIEP Education CO., Inc.

(II fl/Qé’lom/a/%/K‘ 73 41944 wrfrwt
W.

71

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