Wednesday, April 27, 2011

Best Practice Review: The Social Responsiveness Scale (SRS)


The Social Responsiveness Scale (SRS; Constantino & Gruber, 2005) is a brief quantitative measure of autistic behaviors in 4 to 18 year old children and youth. This 65-item rating scale was designed to be completed by an adult (teacher and/or parent) who is familiar with the child’s current behavior and developmental history. The SRS can be completed in approximately 15 minutes and focuses on the child’s reciprocal social interactions, a core impairment in all pervasive developmental disorders. Standardization is based on a sample of 1,636 children drawn from the general population.
 The SRS items measure the ASD symptoms in the domains of social awareness, social information processing, reciprocal social communication, social anxiety/avoidance, and stereotypic behavior/restricted interests. Each item is scored from 1 (not true) to 4 (almost always true).  Scores are obtained for five treatment subscales: Social Awareness (e.g., “Is aware of what others are thinking or feeling”), Social Cognition (e.g., Doesn’t recognize when others are trying to take advantage of him or her”), Social Communication (e.g., Avoids eye contact or has unusual eye contact”), Social Motivation (e.g., “Would rather be alone than with others”), and Autistic Mannerisms (e.g., Has an unusually narrow range of interests”). 
Interpretation is based on a single score reflecting the sum of responses to all 65 SRS questions. Raw scores are converted to T-scores (with mean of 50 and standard deviation of 10) for gender and rater type. A total T-score of 76 or higher is considered severe and strongly associated with a clinical diagnosis of autistic disorder. A T-score of 60 through 75 is interpreted as falling in the mild to moderate range and considered typical for children with mild or “high functioning” ASD, while a T-score of 59 or less suggests an absence of ASD symptoms. A total raw score of > 75 was associated with a sensitivity value of .85 and specificity value of .75 for ASD (Autistic Disorder, Asperger’s Disorder, or PDD-NOS). The AUC was .85 for recommended screening and clinical cutoff scores and indicates good overall discrimination. In school settings, raw scores at or above 85 from two separate informants provides very strong evidence of ASD.  More impressive values have been noted when using lower parent or teacher scores. For example, T-scores of  > 60 from both parent and teacher have been shown to result in a  96.8% likelihood of a clinically identified ASD diagnosis (Constantino et al., 2003, 2007).
The SRS is an efficient tool for capturing the more subtle aspects of social impairment associated with ASD (e.g., PDD-NOS) and reflects the level of severity across the autism spectrum. The scale demonstrates strong reliability across informants, acceptable internal consistency, and correlates highly with the Autism Diagnostic Interview-Revised (ADI-R). Brief, quantitative, and based on naturalistic observations of parents and teachers, the SRS can be used as an effective screener in clinical or educational settings, an aid to clinical diagnosis, or a measure of response to intervention (Wilkinson, 2010, 2011). The SRS compares favorably to more time-intensive measures and can help school and clinical psychologists identify the type of social impairment characteristic of autism spectrum disorders (ASD) in children as young as 4 years of age and guide development of intervention/treatment programs. Of course, the results of questionnaire measures should not replace clinical assessment and must be integrated with information from different sources. The SRS should be used within the context of a comprehensive evaluation, including developmental history and assessment of intellectual, language, and adaptive behavior functioning (Wilkinson, 2010). Further research is needed to assess how the SRS performs when differentiating children with ASD from other childhood disorders (e.g., ADHD) and those with intellectual disability.
References:
Chandler, S., Charman, T., Baird, G., Simonoff, E., Loucas, T., Meldrum, D., & Pickles, A. (2007). Validation of the Social Communication Questionnaire in a population cohort of children with autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1324–1332.
Constantino et al. (2003).  Validation of a brief measure of autistic traits: Comparison of the social responsiveness scale with the autism diagnostic interview-revised. Journal of Autism and Developmental Disorders, 33, 427-433.
Constantino, J. N., & Gruber, C. P. (2005). Social Responsiveness Scale. Los Angeles: Western Psychological Services.
Constantino et al. (2007). Rapid quantitative assessment of autistic social impairment by classroom teachers. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1668-1676.
Mash, E. J., & Hunsley, J. (2005). Evidence-based assessment of child and adolescent disorders: Issues and challenges. Journal of Clinical Child and Adolescent Psychology, 34, 362-379.
Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263–284.
Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.
Wilkinson, L. A. (2011). Identifying students with autism spectrum disorders: A review of selected screening tools. Communiqué, 40, pp. 1, 31-33.

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a new volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools.
© Lee A. Wilkinson, PhD

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