Best Practice Review: CCC-2
As a group, higher functioning students with autism spectrum disorders (ASD) tend to demonstrate strength in formal language, but a weakness is pragmatic and social skills. As a result, they often fail to qualify for speech-language services because they present strong verbal skills and large vocabularies, and score well on formal language assessments. Nevertheless, significant and severe deficits in the ability to communicate and interact with others can limit their participation in mainstream academic settings and community activities. Moreover, pragmatic deficits tend to become even more obvious and problematic as social and educational demands increase with age. Assessments to identify pragmatic language deficits are not as well developed as tests of language fundamentals. Although there are few standard measures available to assess these skills in higher functioning children with ASD, the Children’s Communication Checklist (CCC-2) is a promising third party checklist that can be used in screening and identification of pragmatic language problems.
The Children’s Communication Checklist (CCC-2) is a measure designed to assess the communication skills of children 4 to 16.11 years of age. The purposes of the CCC-2 are the identification of pragmatic language impairment, screening of receptive and expressive language skills, and assistance in screening for ASD. The CCC-2 has shown utility in identifying children who may require further assessment for an autism spectrum disorder (ASD). Initially developed in the United Kingdom, the CCC-2 has been adapted for use in the United States (Bishop, 2006). A Caregiver Response Form is completed by an adult who has regular contact with the child, usually a parent, teacher, therapist, or other professional. The CCC-2 consists of 70 items that are divided into 10 scales, each with 7 items. The first 4 scales focus on specific aspects of language and communications skills (content and form). The next 4 scales assess the pragmatic aspects of communication. The last 2 scales measure behaviors that are usually impaired in children with ASDs. The respondent rates the frequency of the communication behavior described in each item from 0 (less than once a week or never) to 3 (several times a day or always). Interpretation is based on a General Communication Composite (GCC) and the Social Interaction Difference Index (SIDI). A significantly depressed communicative competence score, coupled with a score of less than 11 on the SIDI, suggests a profile of ASD and the need for further evaluation. The CCC-2 reports a sensitivity value of .89 and a specificity value of .97 for identifying children with autistic symptomatology and pragmatic social impairment (Bishop, 2006). Previous versions of the CCC-2 have been strongly associated with the ADI-R total score and ICD-10 diagnostic criteria.
The CCC-2 appears to be a well-constructed instrument that has both face validity and reliability to achieve its stated purpose of assisting in identifying children with language and communication problems, especially in the area of pragmatic communication skills. In a recent study (Volden & Phillips, 2010), the CCC–2 was found to be a more sensitive tool than the Test of Pragmatic Language (TOPL) for identifying pragmatic language impairment in high-functioning speakers with ASD who have structural language and nonverbal cognitive scores within typical limits. The CCC-2 also has the advantage of sampling pragmatic skills in the child’s natural environment. In addition to other more comprehensive communication and language assessment tools, the CCC-2 should be a welcome and useful addition as either a screening tool to identify children who are at risk and need additional assessment, or a supplemental tool to other testing.
Bishop, D. V. M. (2006). Children’s Communication Checklist (2nd ed., U.S. ed.). San Antonio, TX: Psychological Corporation.
Volden, J. & Phillips, L. (2010). Measuring pragmatic language in speakers with autism spectrum disorders: Comparing the Children’s Communication Checklist—2 and the Test of Pragmatic Language. American Journal of Speech-Language Pathology, 19, 204–212.
Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His most recent book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools, (2nd Edition).