736201

research-article2017
AUT0010.1177/1362361317736201AutismRescorla et al.

Original Article

Autism

Structure, longitudinal invariance, and 2019, Vol. 23(1) 223­–235

© The Author(s) 2017
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DOI: 10.1177/1362361317736201
https://doi.org/10.1177/1362361317736201

1½–5’s Diagnostic and Statistical Manual journals.sagepub.com/home/aut

of Mental Disorders–Autism Spectrum

Disorder scale: Findings from Generation
R (Rotterdam)

Leslie A Rescorla1, Akhgar Ghassabian2,3, Masha Y Ivanova4,

Vincent WV Jaddoe2, Frank C Verhulst5 and Henning Tiemeier5

Abstract
Although the Child Behavior Checklist 1½–5’s 12-item Diagnostic and Statistical Manual of Mental Disorders-Autism
Spectrum Problems Scale (formerly called Pervasive Developmental Problems scale) has been used in several studies as
an autism spectrum disorder screener, the base rate and stability of its items and its measurement model have not been
previously studied. We therefore examined the structure, longitudinal invariance, and stability of the Child Behavior
Checklist 1½–5’s Diagnostic and Statistical Manual of Mental Disorders-Autism Spectrum Problems Scale in the diverse
Generation R (Rotterdam) sample based on mothers’ ratings at 18 months (n = 4695), 3 years (n = 4571), and 5 years (n
= 5752). Five items that seemed especially characteristic of autism spectrum disorder had low base rates at all three ages.
The rank order of base rates for the 12 items was highly correlated over time (Qs ⩾ 0.86), but the longitudinal stability
of individual items was modest (phi coefficients = 0.15–0.34). Confirmatory factor analyses indicated that the autism
spectrum disorder scale model manifested configural, metric, and scalar longitudinal invariance over the time period
from 18 months to 5 years, with large factor loadings. Correlations over time for observed autism spectrum disorder
scale scores (0.25–0.50) were generally lower than the correlations across time of the latent factors (0.45–0.68). Results
indicated significant associations of the autism spectrum disorder scale with later autism spectrum disorder diagnoses.

Keywords
autism spectrum disorder symptoms, Child Behavior Checklist 1½–5, longitudinal stability, measurement invariance,
preschoolers

The diagnostic criteria for autism spectrum disorder (ASD)
in the Diagnostic and Statistical Manual of Mental
Disorders (5th ed.; DSM-5; APA, 2013) include three
symptoms reflecting social communication and interaction
problems (SCI) and four symptoms reflecting restricted
interests and repetitive behaviors (RRB). As the DSM-5
indicates, each of the seven symptoms can present with a
wide range of severity, suggesting that the symptoms as
well as ASD itself should be considered as dimensional
constructs.
(2003), who used the Social Responsiveness Scale (SRS)
with 788 pairs of twins aged 7–15 years, demonstrated
that ASD-like symptoms were continuously distributed
and common in the general population. When Robinson
1Bryn Mawr College, USA
2Erasmus MC, The Netherlands
3New York University, USA
4University of Vermont, USA
5Erasmus MC-Sophia Children’s Hospital, The Netherlands

Evidence for the dimensionality of ASD comes from

Corresponding author:
research indicating that ASD-like behaviors manifest not Leslie A Rescorla, Department of Psychology, Bryn Mawr College, 101
only in people with an ASD diagnosis but also in the gen- N Merion Avenue, Bryn Mawr, PA 19010, USA.
eral population. For example, Constantino and Todd Email: lrescorl@brynmawr.edu
224 Autism 23(1)
et al. (2011) used the Social and Communication Disorders
Checklist (SCDC) at the ages of 7, 10, and 13 years with
6539 children in the Avon Longitudinal Study of Parents
and Children (ALSPAC), they found that ASD-like traits
were common and stable over time, both in the full sam-
ple and in sub-groups of high-scoring children. Whitehouse
et al. (2011) reported longitudinal findings for ASD-like
traits measured in 760 Australian children at the age of 2
years using the Pervasive Developmental Problems (PDP)
scale of the Child Behavior Checklist 1½–5 (CBCL/1½–
5; Achenbach and Rescorla, 2000) and then followed up
almost 20 years later with the Autism Spectrum Quotient.
Longitudinal correlations were significant but modest for
males for both the total scales of each instrument and vari-
ous subscales.
Constantino and Todd (2003) and Robinson et al.
(2011) have shown that ASD-like traits occur in school-
age children in the general population and show some sta-
bility over time. However, to our knowledge, less research
has explored what percentage of preschool children in the
general population manifest specific ASD-like behaviors
and which symptoms are more common than others
among non-ASD preschoolers. That is, we know rela-
tively little about the base rates for individual ASD-like
symptoms in preschool population samples or the longitu-
dinal stability of these individual ASD-like symptoms
over the preschool period. This is important to know
because the preschool period is when most children with
ASD are diagnosed and hence when clinicians must
decide whether a child’s presenting symptoms warrant a
diagnosis of ASD. Knowing that the ASD-like symptoms
that a child manifests are quite common in the general
population or are rather unstable over time may affect
one’s threshold for diagnosing ASD.
To address this gap in the literature, we used 12 items
from the CBCL/1½–5 rated by an international group of
experts as being very consistent with the DSM-5 diagnostic
category of ASD (Achenbach, 2014). As was done in creat-
ing the earlier Diagnostic and Statistical Manual of Mental
Disorders (4th ed.; DSM-IV; APA, 1994) version of this
scale (Achenbach and Rescorla, 2000), a group of psychia-
trists and psychologists rated each CBCL/1½–5 item as
being not consistent, somewhat consistent, or very consist-
ent with a set of DSM diagnoses commonly used for young
children. Items rated as very consistent with a given diagno-
sis by >60% of the expert judges were assigned to the
respective DSM-oriented scale. The ratings for the 2000
DSM-IV PDP scale, used by Whitehouse et al. (2011),
yielded 13 very consistent items. However, when the experts
rated the items with respect to the DSM-5 diagnostic cate-
gory of ASD, one of the PDP scale items, Afraid to try new
things, did not meet the >60% threshold and was therefore
removed from the scale. Additionally, the scale was renamed
DSM-Autism Problems Scale, abbreviated as DSM-ASD to
be consistent with DSM-nomenclature (Achenbach, 2014).
Seven items on the DSM-ASD scale appear to tap SCI,
namely, item 4. Avoids looking others in the eye; 23.
Doesn’t answer when people talk to him/her; 25. Doesn’t
get along with other children; 67. Seems unresponsive to
affection; 70. Shows little affection toward people; 76.
Speech problem; and 98. Withdrawn, doesn’t get involved
with others. Additionally, five items appear to tap RRB,
namely, item 7. Can’t stand things out of place; 21.
Disturbed by any change in routine; 63. Repeatedly rocks
head or body; 80. Strange behavior; and 92. Upset by new
people or situations. To our knowledge, the composition,
structure, longitudinal invariance, and stability of this
measurement model of the 12-item ASD scale have not
been tested using confirmatory factor analysis (CFA).
Although the CBCL/1½–5 is not a diagnostic instru-
ment, it is widely used in assessment of preschool children
because it provides a profile of the child’s behavioral and
emotional problems using normed scale scores.
Furthermore, several studies have demonstrated significant
associations between the DSM-PDP scale and autism diag-
noses for preschool children, suggesting its potential as an
ASD screening instrument (e.g. Sikora et al., 2008).
Sensitivity (SENS) and specificity (SPEC) of the PDP scale
were 85% and 90%, respectively, when Muratori et al.
(2011) compared Italian preschoolers with ASD with typi-
cally developing (TD) children, but SPEC was only 60%
when children with other psychiatric disorders (OPD) com-
prised the comparison group. Narzisi et al. (2013), using
subsets of the same Italian samples in a case-control design,
reported high SENS and SPEC for the PDP scale both with
the TD comparison group (0.98 and 0.91) and the OPD
comparison group (0.85 and 0.83). Myers et al. (2014)
reported SENS of 79% and SPEC of 48% when the PDP
scale was used to differentiate children with ASD from
those with other developmental disabilities. Rescorla et al.
(2015) reported 80% SENS for the PDP scale, with SPEC
varying by comparison group (87% for non-referred, 55%
for other psychiatric diagnoses, and 60% for developmental
delay). Rescorla et al. (in press) reported SENS of 0.77 and
SPEC of 0.99 in a family-risk ASD study. In contrast,
Havdahl et al. (2016) reported that the CBCL/1½–5 PDP
scale did not provide strong discrimination between 104
preschoolers with ASD and 57 preschoolers with non-ASD
developmental and behavioral/emotional problems.
Goal of the present study
The overarching goal of our study was to conduct a com-
prehensive examination of the structure, invariance, and
longitudinal stability of the CBCL/1½–5’s DSM-ASD
scale (Achenbach, 2014) in a large population sample.
Mothers completed CBCLs at 18 months, 3 years, and 5
years for a diverse sample of children participating in the
longitudinal Generation R Study in Rotterdam (Jaddoe
et al., 2010; Kooijman et al., 2016; Tiemeier et al., 2012).
Rescorla et al. 225

Table 1.  Demographic characteristics of the sample at each time point.

18 months (n = 4695) 3 years (n = 4571) 5 years (n = 5752)

Gender, boys; n (%) 2305 (49.6) 2275 (49.8) 2885 (50.2)
Child ethnicity; n (%)
 Dutch 3115 (66.3) 3056 (66.9) 3669 (63.8)
  Other Western 404 (8.0) 417 (9.1) 510 (8.9)
 Non-Western 1124 (23.9) 1064 (23.3) 1571 (27.3)
Gestational age, weeks; mean (SD) 39.8 (1.8) 39.8 (1.8) 39.8 (1.9)
Birth weight, grams; mean (SD) 3436 (569) 3444 (568) 3429 (577)
Apgar score at 1 and 5 min; mean (SD) 9.1 (0.9) 9.1 (0.9) 9.1 (0.9)
Marital status; n (%)
 Married/cohabiting 4107 (87.5) 4024 (88.0) 4890 (85.0)
 Single 373 (7.9) 334 (7.3) 486 (8.4)
 Missing 215 (4.6) 213 (4.7) 376 (6.5)
Paternal age at intake; mean (SD) 31.4 (4.7) 31.6 (4.6) 31.2 (4.8)
Paternal age at intake; mean (SD) 33.8 (5.5) 34.1 (5.4) 33.8 (5.5)
Maternal education; n (%)
  <Secondary 232 (4.9) 227 (5.0) 331 (5.8)
 Secondary 1688 (36.0) 1571 (34.4) 2163 (37.6)
  Higher education 2576 (55.0) 2578 (56.4) 2912 (50.6)
 Missing 195 (4.2) 195 (4.3) 346 (6.0)
Mean (SD) euros/month; income, n (%)
  <1200 226 (4.8) 198 (4.3) 300 (5.2)
 1200–2000 805 (17.1) 751 (16.4) 1003 (17.4)
  >2000 2896 (61.7) 2836 (62.0) 3300 (57.4)
 Missing 768 (16.4) 786 (17.2) 1149 (20)

Specific goals of the study included the following: (a) to
determine the base rate of each ASD-like symptom in the
full sample at each age; (b) to test the longitudinal stabil-
ity of the 12 ASD scale items from 18 months to 5 years;
(c) to test the longitudinal stability of the aggregated
12-item ASD scale as well as the SCI and RRB subscales;
(d) to test the measurement model of the ASD scale and its
SCI and RRB subscales at each age as well as the longitu-
dinal invariance of the model over time; and (e) to test the
associations between the CBCL/1½–5’s ASD, SCI, and
RRB scales and scores on the SRS administered at the age
of 6 years as well as their associations with confirmed
ASD diagnoses. Although not a major goal, we also
looked at the effects of various demographic factors on
ASD scores because our sample was larger and more
diverse than many population samples in which ASD-like
problems have been studied (Constantino and Todd, 2003;
Robinson et al., 2011).
Methods
Participants
The present research was embedded within the Generation
R Study, a multi-ethnic population-based birth cohort in
Rotterdam, the Netherlands (Jaddoe et al., 2010; Tiemeier
et al., 2012). The study was approved by the Medical Ethics
Committee of the Erasmus Medical Center, Rotterdam.
Written informed consent was obtained from parents/car-
egivers, with anonymity guaranteed. To be included in our
study, a child needed to have CBCL/1½–5 data for at least
one of the three time points. Because CBCL protocols with
>8 missing items are considered invalid, all such children
were excluded from the relevant age group sample.
Because there was often a wide time window for Generation
R visits at each data point, we required a visit between 17
and 21 months for the 18-month group, between 34 and 39
months for the age 3 group, and between 59 and 83 months
for the age 5 group (because almost half the children seen
for the age 5 follow-up had already turned 6), yielding
5065, 4976, and 5917 possible cases at the three ages. For
18 months, 3 years, and 5 years, respectively, missing val-
ues across the 12 ASD items ranged from 0.3% of cases
(items 67 and 80) to 2.1% of cases (for item 76); from
0.1% of cases (item 70) to 1.1% of cases (item 14); and
from 0.2% of cases (item 98) to 0.5% of cases (item 14).
We excluded cases with any missing ASD data (370 at 18
months, 225 at 3 years, and 165 at 5 years), resulting in
final sample sizes of 4695 at 18 months, 4571 at 3 years,
and 5752 at 5 years. Table 1 presents the baseline character-
istics of the study participants at the three ages.
Measures
CBCL/1½–5.  We used the CBCL/1½–5 to measure ASD-
like symptoms at all three ages. Even though 42% of the
226 Autism 23(1)
age 5 sample had turned 6, the CBCL/1½–5 was used both
for reasons of continuity and because many children were
not yet in formal schooling. The CBCL/1½–5 contains 99
problem items that parents can score as 0 = not true, 1 =
somewhat or sometimes true, and 2 = very true or often
true of the child based on the preceding 2 months. Good
reliability and validity have been reported for the Dutch
translation of the CBCL/1½–5 (Tick et al., 2007).
SRS.  The Generation R protocol involved administration
of an 18-item short-form of the SRS at age 6 (n = 4778
for our age 5 sample). Autistic traits (i.e. social, language,
and repetitive behaviors) were measured by parental rat-
ings using the scale 0 (never true) to 3 (almost always
true), which we summed to yield a total SRS score. Serd-
arevic et al. (2017) note that the SRS short-form corre-
lated 0.95 with scores from the full SRS in a previous
Dutch study.
ASD diagnosis. As reported by Serdarevic et al. (2017),
Generation R employed a multiple-gating procedure
whereby children who (a) had a high score on the SRS
short-form, (b) had a high score on the Social Communica-
tion Questionnaire (SCQ; Berument et al., 1999), or (c)
had been assessed for ASD according to parental report
were selected for a search of central medical records main-
tained by general practitioners. Only children for whom a
diagnosis of ASD was confirmed by these medical records
were considered ASD cases in this analysis. The specialist
diagnoses of ASD were generally based on clinical con-
sensus by a multidisciplinary team. The standard diagnos-
tic work-up involves an extensive developmental case
history obtained from parents, as well as school informa-
tion and repeated observations of the child. This medical
record information was available for 127 of our age 5 sam-
ple (n = 5752), 60 of whom received an ASD diagnosis
and 67 of whom did not following the multidisciplinary
assessment.
Child and demographic variables. Selected Generation R
measures with known impact on behavioral outcomes
(Tiemeier et al., 2012) were included in some analyses.
Child variables included gender, birth weight, mean of
Apgar scores at 1 and 5 min, and gestational age at birth,
obtained from medical records. Maternal and paternal
age, marital status (married/cohabiting vs single), and
maternal education were obtained from enrollment ques-
tionnaires. Maternal education levels were classified as
<secondary, secondary, and higher education (higher
vocational education or university). Consistent with other
Generation R publications (e.g. Ghassabian et al., 2013),
child’s ethnic background was defined based on the coun-
try of birth of the parents, with three major categories:
Dutch, “Other Western” (Europe plus the United States,
Canada, Australia, etc.) and “Other non-Western” (Cape
Verde, Morocco, the Dutch Antilles, Surinam, Turkey,
Ethiopia, Bolivia, etc.).
Data analyses
We calculated total ASD scale scores, as well as SCI and
RRB subscale scores, by summing the child’s 0-1-2 ratings
for the relevant items. The SCI and RRB subscales were
moderately correlated, with rs of 0.40 at 18 months, 0.44
at 3 years, and 0.53 at 5 years.
In a preliminary analysis, we tested the effects of var-
ious demographic and health factors on ASD scores
using multiple regression. We then determined the base
rate for each ASD item using our full samples at each
time point. We operationalized broad base rate as the
percentage of children with a rating of 1 (somewhat or
sometimes true) or a rating of 2 (very true or often true)
and narrow base rate as the percentage of children with
a rating of 2. We also calculated mean item ratings for
the final sample at each age and examined gender differ-
ences in these ratings.
To examine stability over time, we cross-tabulated
broad base rates for each item from 18 months to 3 years
and from 3 to 5 years. We also computed Q correlations
between the broad base rates over time, as well as between
the mean item ratings over time. Additionally, we exam-
ined the longitudinal stability of the observed ASD scale
and its SCI and RRB subscales over time using correla-
tions. We next used a mixed-model analysis of variance
(ANOVA) to test the effects of age and gender on ASD,
SCI, and RRB scores for the final sample of children with
ASD item data at 18 months, 3 years, and 5 years (n =
3306). In light of the very large sample size and the num-
ber of analyses conducted, we only report findings with p
< 0.001 as significant for all analyses.
To test the measurement model of the DSM-ASD scale
at each age as well as its measurement invariance (MI)
over time, we conducted CFAs. These CFAs used the 12
dichotomized (0 vs 1/2) ASD items as categorical varia-
bles in the weighted least squares with standard errors and
mean- and variance-adjusted (WLSMV) chi-square esti-
mator using Mplus 7.1 (Muthén and Muthén, 2015). MI is
typically conceptualized at three levels of a hierarchy of
stringency. Configural MI means that particular items load
on the same factors across groups. Metric MI means that
items have similar loadings (item–factor associations)
across groups. Finally, scalar MI means that item inter-
cepts (or thresholds for categorical data) are equivalent,
meaning that additive influences on item ratings not asso-
ciated with the underlying factors (e.g. procedural differ-
ences in data collection) are the same across groups. The
root mean square error of approximation (RMSEA) served
as the primary fit index for our CFAs, with an RMSEA
cutoff of 0.05 indicating good fit (Yu and Muthén, 2002).
The Comparative Fit Index (CFI) and the Tucker–Lewis
Rescorla et al. 227
Index (TLI) served as the secondary fit indices, with val-
ues greater than 0.95 considered to indicate good fit (Hu
and Bentler, 1999). We performed CFAs with both the
single-factor ASD model (12 items) and a two-factor SCI
(7 items) and RRB (5 items) models.
In our final analyses, we examined associations between
ASD, SCI, and RRB scores at ages 18 months, 3 years, and
5 years and SRS scores at age 6. We also compared scores
on the ASD, SCI, and RRB scales as well as the SRS for
the 60 children with confirmed ASD diagnoses, the 67
children evaluated but not diagnosed with ASD, and the
rest of the age 5 sample not suspected of having ASD.
Results
Demographic characteristics
As can be seen in Table 1, the sample had roughly equal
gender percentages at all three time points. On average, the
participants were born close to term, had mothers in their
early 30s, had normal birth weights and gestational age, and
had good Apgar scores. Child ethnicity was approximately
66% Dutch, 9% “Other Western,” and 25% “non-Western.”
Relative to the Generation R participants excluded due to
lack of CBCL data, the children we studied had a slightly
greater birth weight and older gestational age at birth, and
their mothers were older and had more education. Similarly,
relative to the children we studied, the children excluded for
missing ASD items were significantly less likely to be
Dutch, had more mothers with less than secondary educa-
tion, and had lower family incomes. However, the excluded
and included groups did not differ significantly in gesta-
tional age, birth weight, mean Apgar score, or maternal age.
Demographic predictors of ASD scale scores
We used simultaneous multiple regression to predict ASD
scale scores (sum of 0-1-2 ratings on the 12 items) at each
age from child gender, gestational age at birth, birth weight,
mean Apgar score, marital status, age of mother and father
at child’s birth, maternal education, ethnicity, and income.
Although all three regressions were significant, these peri-
natal and demographic factors accounted for small and
declining percentages of the variance as the children aged:
R2 values of 8% (18 months), 5% (3 years), and 3% (5–6
years). The standardized betas for significant predictors (p ⩽
0.001) were maternal education (β = −0.07), income (β =
−0.16), and ethnicity (β = 0.10) at 18 months; income (β
= −0.10), ethnicity (β = 0.11), and gender (boys higher, β =
−0.06) at 3 years; and gender (β = −0.12) at 5 years.
Base rates and mean item scores for ASD-like
problems
In Table 2, the first number in each cell (the broad base
rate) indicates the percentage of children for whom the
problem was rated as either 1 or 2, whereas the second
number (the narrow base rate) indicates the percentages
with ratings of 2 only. For the seven SCI items, broad base
rates at 18 months ranged from 2.5% (Shows little affec-
tion toward people) to 30.5% (Doesn’t answer when peo-
ple talk to him/her). As would be expected, narrow base
rates (a rating of 2) were much lower (from 0.2% to 3.2%).
For the five RRB items, broad base rate ranged from 3.4%
(Strange behavior) to 31.6% (Disturbed by any change in
routine), whereas narrow base rates ranged from 0.2% to
2.3%. Similarly, the age 3 and age 5 data showed a wide
range in broad base rates across the items on both subsets
of the ASD scale, as well as much lower percentages if
only a rating of 2 is used to operationalize base rate.
Problems 67, 70, 80, and 98 had low base rates at all three
ages, item 25 became slightly more common with age,
item 63 became much less common with age, and items 23
and 21 had the highest base rates at all three ages. Table 2
also presents the mean ratings for the 12 items at each age.
At 18 months, five items had mean ratings of ⩽0.06 (25,
67, 70, 80, and 98), whereas two had mean ratings of 0.34
(21 and 23), parallel to the base rate findings. The same
pattern emerged at ages 3 and 5 years.
We tested gender effects on our 12 ASD-like items via
t-tests of mean item ratings. Boys had significantly greater
variance for four items at 18 months (23, 63, 70, and 76),
eight items at age 3 (7, 21, 25, 63, 70, 76, 80, and 98), and
all 12 items at age 5. Boys also had significantly higher
mean item ratings than girls on two items at 18 months (63
and 76), two items at age 3 (21 and 76), and seven items at
age 5 (4, 7, 21, 23, 63, 76, and 80).
Longitudinal stability of ASD scale items
The longitudinal stability of the 12 ASD scale items was
first examined using cross-tabulations of broad base rates
across age points, with each item dichotomized as absent
(rating of 0) or present (ratings of 1 or 2). As shown in
Table 3, the phi coefficients were all significant at p <
0.001 but generally small according to Cohen’s (1988)
benchmarks (range = 0.15–0.34). This means that many
but not all children were consistent over time with respect
to whether a given problem was reported as present or
absent for them, with degree of consistency varying widely
across the 12 items. This is shown in Table 3, which dis-
plays the percentage of children with each of four temporal
stability patterns for each item: N/N = problem absent at
both ages, YY = problem present at both ages (Y/Y), Y/N
= “remission” over time, and N/Y = “increase” over time.
More than 89% of children had the N/N pattern for six
items from 18 months to 3 years (25, 63, 67, 70, 80, and
98) and for five of these same items from 3 to 5 years (item
25 = 89%), meaning that the behavior was not rated as
true for the child at either age. The items showing most
change over time were item 23. Doesn’t answer when peo-
ple talk to him/her and item 21. Disturbed by any change
 228

Table 2.  CBCL/1½ –5 DSM-ASD scale item base rates and mean item ratings at 18 months, 3 years, and 5 years.

ASD scale item 18 months 3 years 5 years

(N = 4695) (N = 4571) (N = 5752)

% 1 + 2 (% 2)a Mean ratingb % 1 + 2 (% 2) Mean rating % 1 + 2 (% 2) Mean rating

Social communication/social interaction
4. Avoids looking others in the eye 13.4% (0.6%) 0.14 (0.36) 19.6% (0.7%) 0.20 (0.42) 30.0% (2.4%) 0.32 (0.52)
23. Doesn’t answer when people talk to him/her 30.5% (3.2%) 0.34 (0.54) 35.2% (2.1%) 0.37 (0.53) 40.5% (3.3%) 0.44 (0.56)
25. Doesn’t get along with other children 4.4% (0.5%) 0.06 (0.25) 6.6% (0.4%) 0.07 (0.27) 7.6% (0.6%) 0.08 (0.30)
67. Seems unresponsive to affection 2.7% (0.6%) 0.04 (0.21) 1.5% (0.2%) 0.02 (0.15) 2.1% (0.2% 0.02 (0.16)
70. Shows little affection toward people 2.5% (0.2%) 0.03 (0.18) 2.5% (0.2%) 0.03 (0.18) 3.7% (0.5%) 0.04 (0.23)
76. Speech problem 6.8% (1.6%) 0.10 (0.35) 9.5% (2.1%) 0.12 (0.38) 9.3% (1.0%) 0.11 (0.37)
98. Withdrawn, doesn’t get involved with others 2.8% (0.4%) 0.04 (0.21) 5.6% (0.4%) 0.06 (0.25) 4.6% (0.4) 0.05 (0.23)
Restricted interests/repetitive behaviors
7. Can’t stand things out of place 11.2% (1.4%) 0.13 (0.37) 21.0% (2.3%) 0.23 (0.47) 15.3% (1.8%) 0.17 (0.42)
21. Disturbed by any change in routine 31.6% (2.3%) 0.34 (0.23) 33.0% (2.3%) 0.35 (0.52) 30.4% (3.2%) 0.34 (0.54)
63. Repeatedly rocks head or body 9.9% (1.3%) 0.11 (0.35) 2.5% (0.4%) 0.03 (0.19) 1.5% (0.3%) 0.02 (0.15)
80. Strange behavior 3.4% (0.2) 0.04 (0.19) 3.6% (0.2%) 0.04 (0.20) 5.6% (0.6%) 0.06 (0.27)
92. Upset by new people or situations 17.6% (0.4%) 0.18 (0.40) 13.0% (1.1%) 0.14 (0.38) 10.0% (1.0%) 0.11 (0.34)

CBCL: Child Behavior Checklist; DSM: Diagnostic and Statistical Manual of Mental Disorders; ASD: autism spectrum disorder.
aEach cell contains the percentage of children with ratings of either 1 or 2 on the item, followed by the breakdown of percentage rated 2.
bEach cell contains the mean of the 0-1-2 item ratings and the standard deviation of that mean rating for the full sample.
Autism 23(1)
Rescorla et al. 229

Table 3.  CBCL/1½ –5 DSM-ASD scale items: longitudinal stability from 18 months to 3 years and from 3 to 5 years.

18 months–3 years (N = 3727) 3–5 years (N = 3920)

  N/N N/Y Y/N Y/Y phi N/N N/Y Y/N Y/Y phi
Social communication/social interaction
4. Avoids looking others in the eye 73% 14% 8% 5% 0.22*** 61% 20% 9% 10% 0.26***
23. Doesn’t answer when people talk to him/her 50% 20% 16% 15% 0.20*** 45% 20% 14% 21% 0.30***
25. Doesn’t get along with other children 91% 5% 3% 1% 0.18*** 89% 5% 5% 2% 0.18***
67. Seems unresponsive to affection 97% 0.8% 2% 0.3% 0.16*** 98% 1% 0.9% 0.3% 0.25***
70. Shows little affection toward people 96% 1% 2% 0.5% 0.22*** 95% 3% 2% 0.7% 0.22***
76. Speech problem 86% 7% 5% 2% 0.21*** 86% 5% 6% 3% 0.34***
98. Withdrawn, doesn’t get involved with others 92% 5% 2% 0.8% 0.19*** 92% 3% 5% 1% 0.20***
Restricted interests/repetitive behaviors
7. Can’t stand things out of place 74% 16% 6% 4% 0.18*** 72% 8% 14% 7% 0.27***
21. Disturbed by any change in routine 53% 17% 16% 15% 0.24*** 53% 14% 17% 16% 0.28***
63. Repeatedly rocks head or body 89% 1% 8% 1% 0.23*** 98% 0.6% 2% 0.5% 0.32***
80. Strange behavior 94% 3% 3% 0.6% 0.15*** 93% 4% 2% 1% 0.23***
92. Upset by new people or situations 75% 8% 13% 5% 0.21*** 81% 6% 9% 3% 0.23***

CBCL: Child Behavior Checklist; DSM: Diagnostic and Statistical Manual of Mental Disorders; ASD: autism spectrum disorder.

in routine, with about one-third of the sample inconsistent
(N/Y or Y/N) across time, compared to <3% for item 67.
We also examined longitudinal stability of ASD items
by calculating Q correlations (Qs) between the broad base
rates for the 12 items across ages. These correlations were
very large (18 months × 3 years = 0.93, 18 months × 5
years = 0.86, and 3 years × 5 years = 0.95; all p < 0.001),
indicating highly consistent rank-ordering of problem base
rates over time. The same strong longitudinal consistency
was found when mean item ratings were used. These
results further demonstrate that the problems rarely
reported at one age were also rarely reported at the other
two ages (especially items 67, 70, 80, and 98).
Longitudinal stability of ASD, SCI, and RRB
scales
The correlations among total ASD scale scores over time
indicated moderate stability: 18 months to 3 years =
0.44, 18 months to 5 years = 0.32, and 3 to 5 years =
0.50, all p < 0.001 and medium-to-large sized correla-
tions based on Cohen’s (1988) benchmarks. As with the
full ASD scale, the rs across age periods for the SCI and
RRB subscales were largest from 3 to 5 years (0.40,
0.43), smallest from 18 months to 5 years (0.26, 0.25),
and intermediate from 18 months to 3 years (0.35, 0.36).
These findings indicate that the SCI and RRB items did
not differ appreciably in their longitudinal stability.
Additionally, whether we used the full ASD scale or the
two subscales, rank-ordering of children over time in
ASD scale scores was moderate, with high-scoring chil-
dren quite likely to maintain this status over time.
The mixed-model ANOVA for the 12-item ASD
scale yielded significant but very small effects of age,
F(2, 3304) = 25.3, p < 0.001, η2 < 0.01; gender, F(1,
3304) = 47.1, p < 0.001, η2 = 0.01; and the age × gender
interaction, F(2, 3304) = 21.4, p < 0.001, η2 < 0.01, with
a significant linear but not quadratic contrast. Figure 1
shows the raw scores by gender for the ASD, SCI, and
RRB scales for the “three-wave” sample with data at all
three ages (n = 3306). As shown in Figure 1, ASD scores
increased with age for boys but not for girls. The SCI sub-
scale yielded a slightly larger effect for age, F(2, 3304) =
102.3, p < 0.001, η2 = 0.03; a small effect for gender,
F(1, 3304) = 41.7, p < 0.001, η2 = 0.01; and a small age
× gender interaction F(2, 3304) = 13.4, p < 0.001, η2 <
0.01, again with a significant linear contrast. Both boys
and girls showed an increase in scores across the three age
points, but the boys had a steeper slope. For RRB, all
three effects were small: age, F(2, 3304) = 16.2, p <
0.001, η2 < 0.01; gender, F(1, 3304) = 30.7, p < 0.001,
η2 < 0.01; and the age × gender interaction, F(2, 3304) =
13.5, p < 0.001, η2 < 0.01, with a significant linear con-
trast. Boys’ scores were flat across age, whereas girls
showed no change in score from 18 months to 3 years and
then a decline between age 3 and 5.
Measurement model of the CBCL ASD scale
Because not all participants were assessed at all three
ages, we performed CFAs of the ASD scale’s measure-
ment model in a sequential fashion. In our first prelimi-
nary analyses, we tested the one-factor and two-factor
models cross-sectionally at each age. Both the one-factor
models and two-factor models had good fit at all three
ages (RMSEAs = 0.029–0.044, CFIs = 0.924 –0.951,
and TLIs = 0.908 –0.939). Mean factor loadings, which
indicate the strength of the items’ relations to the hypoth-
230 Autism 23(1)
Figure 1.  ASD, SCI, and RRB raw scores by gender and age in three-wave sample (N = 3306).
esized construct (factor), were 0.59 to 0.71 in these cross-
sectional models (see Table 4).
In our second set of preliminary analyses, we tested
both the one-factor and the two-factor models over time
for our three age pairings (18 months–3 years, N = 3727;
18 months–5 years, N = 3834; and 3–5 years, N = 3920).
RMSEAs (0.023–0.028) were very good, and CFIs (0.926–
0.954) and TLIs (0.915–0.946) were adequate, with the
one-factor and two-factor models showing similar fit.
Mean item loadings were similar to those obtained in the
cross-sectional models (0.58–0.71), indicating that on
average items related to their hypothesized constructs,
albeit with some items showing consistently higher load-
ings than others.
To systematically examine variations in factor loadings
across the 12 items, we calculated the mean loading by
item across the 15 CFA data point obtained (e.g. 18-month
loadings for 18-month sample, 18–3 and 18–5 age-pair
samples, and 18–3–5 three-wave samples = 5). Five items
had a mean loading ⩾0.68 (25, 67, 70, 80, and 98), two
others had mean loadings ⩾0.60 (21 and 92), four had
mean loadings from 0.52 to 0.57 (4, 7, 23, and 63), and
item 76 had a mean loading of 0.40 (range = 0.35–0.49).
It is noteworthy that the five items with the most consist-
ently high loadings are the same five items with the lowest
base rates (25, 67, 70, 80, and 98).
As shown in Table 4, the 12-item ASD scale latent fac-
tors were highly correlated across time: 0.64 (18
months–3 years), 0.50 (18 months–5 years), and 0.67
(3–5 years). For the SCI and RRB latent factors, cross-
time loadings were 0.59 and 0.64 (18 months–3 years),
0.48 and 0.49 (18 months–5 years), and 0.66 and 0.65
(3–5 years). Interestingly, the cross-factor (SCI × RRB)
within-time latent factor correlations (ranging from 0.78
to 0.85) were much higher than the within-factor, cross-
time correlations.
Our main CFA was to test the model’s structure and sta-
bility for the full age range, using the 3306 children with
CBCL data at 18 months, 3 years, and 5 years. We did this
first for the one-factor model (treating the ASD scale as a
unified set of 12 items) and then for the two-factor model
(treating the ASD scale as comprised of SCI and RRB sub-
scales). For the one-factor model, RMSEA = 0.020, CFI
= 0.938, and TLI = 0.930, all in the same range as the
age-pair models. Mean factor loadings were also compara-
ble to those in earlier models, with a range of 0.59–0.65 for
the 12-item scale. As seen in Table 4, fit indices were com-
parable for the two-factor model across three ages (RMSEA
= 0.018, CFI = 0.924, and TLI = 0.917, mean factor
loadings from 0.58 to 0.70).
All the preceding analyses tested for configural MI
only, namely, that the same items loaded on the same fac-
tors for all groups (e.g. ages and age pairs). For our final
three-wave analysis, following procedures for testing MI
of categorical variables suggested by Muthén and Muthén
(2015), we also tested metric and scalar longitudinal invar-
iance by constraining equality across time for factor load-
ings and thresholds (i.e. possible systematic influences on
observed scores that are not the hypothesized construct).
These additional equality constraints for loadings and
thresholds had virtually no effect on our CFA results (one-
factor model: RMSEA = 0.022, CFI = 0.924, and TLI =
0.942; two-factor model: RMSEA = 0.020, CFI = 0.938,
and TLI = 0.931). These results, taken in aggregate, indi-
cated that the ASD scale model comprised of the SCI and
RRB subscales manifested configural, metric, and scalar
Rescorla et al. 231

Table 4.  Cross-sectional and longitudinal CFA results for ASD and SCI/RRB models.

RMSEA CFI TLI Mean loading (range) Latent factor rs

12-item ASD model
  18 months 0.032 0.940 0.927 0.60 (0.45–0.80)  
  3 years 0.041 0.924 0.908 0.63 (0.38–0.78)  
  5 years 0.044 0.934 0.919 0.66 (0.39–0.81)  
  18 months–3 years 0.025 0.926 0.915 ASD-18: 0.59 (0.42–0.78); ASD-3: 0.62 (0.40–0.77) 0.64
  18 months–5 years 0.025 0.933 0.923 ASD-18: 0.59 (0.43–0.79); ASD-5: 0.65 (0.36–0.78) 0.50
  3–5 years 0.028 0.939 0.930 ASD-3: 0.63 (0.41–0.79); ASD-5: 0.66 (0.37–0.79) 0.67
  Three waves 0.020 0.938 0.930 ASD-18: 0.59 (0.41–0.76); ASD-3: 0.62 (0.39–0.80); 0.68, 0.50, 0.66
ASD-5: 0.65 (0.35–0.76)
  Three waves, full MI 0.022 0.924 0.942 ASD-18: 0.59 (0.41–0.75); ASD-3: 0.63 (0.36–0.75); 0.66, 0.49, 0.66
ASD-5: 0.66 (0.38–0.78)
SCI/RRB model
  18 months 0.029 0.951 0.939 SCI: 0.64 (0.47–0.82), RRB: 0.59 (0.49–0.73)  
  3 years 0.037 0.941 0.927 SCI: 0.67 (0.40 –0.80), RRB: 0.64 (0.59–0.69)  
  5 years 0.040 0.947 0.934 SCI: 0.68 (0.40–0.83), RRB: 0.71 (0.59–0.82)  
  18 months–3 years 0.024 0.937 0.925 SCI-18: 0.63 (0.44–0.81); SCI-3: 0.66 (0.42–0.80) 0.58
RRB-18: 0.58 (0.51–0.68); RRB-3: 0.64 (0.60–0.69) 0.64
SCI × RRB: 0.85, 0.80
  18 months–5 years 0.023 0.944 0.935 SCI-18: 0.64 (0.46–0.81); SCI-5: 0.67 (0.37–0.81) 0.48
RRB-18: 0.59 (0.50–0.69); RRB-5: 0.71 (0.60–0.79) 0.49
SCI × RRB: 0.83, 0.81
  3–5 years 0.024 0.954 0.946 SCI-3: 0.67 (0.43–0.82); SCI-5: 0.67 (0.38–0.82) 0.66
RRB-3: 0.65 (0.59–0.72); RRB-5: 0.70 (0.55–0.80) 0.65
SCI × RRB: 0.78, 0.84
  Three waves 0.018 0.924 0.917 SCI-18: 0.64 (0.44–0.81); SCI-3: 0.66 (0.41–0.84); 0.59, 0.45, 0.63
SCI-5: 0.66 (0.37–0.80) 0.64, 0.51, 0.68
RRB-18: 0.58 (0.51–0.68); RRB-3: 0.65 (0.59–0.70); SCI × RRB = 0.85,
RRB-5: 0.70 (0.55–0.78) 0.79, 0.81
  Three waves, full MI 0.020 0.938 0.931 SCI-18: 0.64 (0.40–0.78); SCI-3: 0.67 (0.38–0.79); 0.50, 0.45, 0.63
SCI-5: 0.67 (0.39–0.83) 0.64, 0.51, 0.68
RRB-18: 0.59 (0.51–0.72); RRB-3: 0.66 (0.55–0.70); SCI × RRB = 0.85,
RRB-5: 0.73 (0.68–0.78) 0.79, 0.81

CFA: confirmatory factor analysis; ASD: autism spectrum disorder; RRB: restricted interests and repetitive behaviors; RMSEA: root mean square
error of approximation; CFI: Comparative Fit Index; TLI: Tucker–Lewis Index; MI: measurement invariance.
The same sequence of CFAs was performed for the 12-item scale model and for the 2-subscale model. The first three CFAs tested the configural
model at each age; the second three CFAs tested longitudinal structural invariance using the pair-wage age groupings; the seventh analysis tested
longitudinal structural invariance using the children with data at all three time points, whereas the eighth included constraints to test configural,
metric, and scalar longitudinal invariance simultaneously (i.e. the most rigorous test of the model).

longitudinal invariance over the time period from 18
months to 5 years in this large population sample.
SRS and ASD diagnoses results
For the 3442 children who had CBCL/1½ –5 ASD data at
18 months and SRS data at age 6 (mean age = 72.5 months,
SD = 3.8), the Pearson rs between SRS scores and CBCL
scores were 0.26 for ASD, 0.24 for SCI, and 0.20 for RRB,
all p < 0.001. The rs for age 3 CBCL scores and SRS
scores (n = 3601) were 0.38 (ASD), 0.37 (SCI), and 0.27
(RRB), all p < 0.001. For the 4778 children in the age 5
sample with age 6 SRS data, rs were 0.61 (ASD), 0.54
(SCI), and 0.52 (RRB), all p < 0.001. As would be
expected, rs were larger with shorter time intervals and
roughly comparable for the SCI and RRB scales.
In our final analysis, we used one-way ANOVAs to
compare differences in age 5 ASD, SCI, and RRB scores
as well as age 6 SRS scores for the 60 children diagnosed
with ASD, the 67 assessed for ASD but not diagnosed, and
the 4651 children not flagged for ASD assessment. All
four ANOVAs yielded large group differences (all p <
0.001), with η2 values of 0.19 for the SRS (means = 16.8,
13.4, and 3.7, respectively), 0.12 for the 12-item ASD
scale (means = 6.9, 5.3, and 1.6), 0.09 for the SCI (means
= 3.7, 3.1, and 1.0), and 0.09 for RRB (means = 3.2, 2.2,
and 0.6).
Discussion
Although Robinson et al. (2011) examined the prevalence
and stability of ASD-like traits in a large population
232 Autism 23(1)
sample, their study did not involve the preschool period,
which is when many children first receive an ASD diagno-
sis. Additionally, they did not examine the base rate of spe-
cific ASD-like problems. Our study therefore provides
important information on the base rate and longitudinal
stability of ASD-like behaviors in the general preschool
population, as well as results of tests of the measurement
model of the CBCL/1½–5 ASD scale and its SCI and RRB
subscales.
Item-level analyses
The 12 items of the CBCL/1½–5 ASD scale that we used
to operationalize the DSM-5 ASD criteria varied greatly in
base rate at all three ages, with broad base rates (ratings of
1 or 2) naturally much higher than narrow base rates (rat-
ings of 2). Rank-ordering of the 12 items, whether opera-
tionalized using base rates or mean item ratings, was very
consistent over time (Qs ⩾ 0.86), indicating that some
behaviors on the ASD scale were very common at all three
age points, whereas others were quite uncommon. That the
DSM-ASD scale contains both kinds of items may be the
reason it discriminates better between children with ASD
and TD children (i.e. is a good Level 1 screener) than
between children with ASD and those with other diagno-
ses (i.e. is less good as a Level 2 screener) (Havdahl et al.,
2016; Muratori et al., 2011; Rescorla et al., 2015).
Five of the 12 ASD problem items (25. Doesn’t
get along with other children, 67. Seems unresponsive to
affection, 70. Shows little affection toward people, 80.
Strange behavior, and 98. Withdrawn) were rarely
endorsed at any age. The relative rarity of these problems
coupled with their centrality to the construct of ASD may
make them especially important for identifying ASD in
young children. Item 63. Repeatedly rocks head or body
was somewhat common at 18 months (9.9% rated 1 or 2)
but rare at 3 and 5 years (2.5% and 1.5%), suggesting that
its link to ASD may increase with age, as more TD chil-
dren discontinue this behavior. In contrast, problems
such as 21. Disturbed by any change in routine and 23.
Doesn’t answer when people talk to him/her, while cer-
tainly manifested by many children with ASD, seem to be
common problems in young children more generally and
hence less specific to ASD.
Measurement model and scale findings
Our CFA analyses revealed that the CBCL/1½–5 ASD
scale and its SCI and RRB subscales manifested configu-
ral, metric, and scalar longitudinal invariance from 18
months to 5 years as indicated in low RMSEAs and mod-
erately high CFIs and TLIs. Second, mean factor loadings
were large in all models, indicating that at all three ages,
the 12 ASD items in aggregate were good indicators of the
latent construct of ASD, as well as of the SCI and RRB
subscales. Additionally, the items with the highest factor
loadings on the ASD factor across 15 data points were the
same items with the consistently lowest base rates, namely,
items 25, 67, 70, 80, and 98.
Our rs between the SCI and RRB subscales of 0.40 at
18 months, 0.44 at 3 years, and 0.53 at 5 years are consist-
ent with previous reports that the social communication
problems and repetitive interests, behaviors, and activities
aspects of ASD are only moderately correlated (Happé
et al., 2006; Mandy and Skuse, 2008). However, the cor-
relations between the SCI and RRB latent factors were
much higher than the correlations between the observed
raw scores for these subscales (i.e. 0.78–0.85 vs 0.40–
0.53). Because latent factors in CFA are considered to be
free of measurement error, they may be more robust indi-
cators of ASD problems than observed factor scores at
each assessment period.
ASD scale scores were moderately stable over time,
with rs ranging from 0.31 (18 months–5 years) to 0.49
(3–5 years). However, the cross-time correlations for the
latent factors were considerably higher, notably 0.64 (18
months–3 years), 0.50 (18 months–5 years), and 0.67 (3–5
years) for the ASD scale latent factor loadings and 0.58
and 0.64 (18 months–3 years), 0.48 and 0.49 (18 months–5
years), and 0.66 and 0.65 (3–5 years) for the SCI and RRB
latent factors. Again, this may be due to the fact that CFA
latent factors are presumed to be free of measurement error
and thus are more robust indicators than observed scores,
leading to higher correlations across time. These results
suggest that using latent factors derived from the
CBCL/1½–5 ASD scale provides a more robust measure
of ASD-like behaviors across the early childhood period
than using observed scores.
Associations with other ASD measures
As would be predicted, rs between the three CBCL/1½–5
ASD scales and age 6 SRS scores were largest (i.e. 0.52–
0.61) when the measures were roughly concurrent (age
5–6) and smallest for the longest time interval (0.20–0.26
for 18 months to age 6). Given that the SRS has more
items, different content, and more rating options than the
CBCL/1½–5 ASD scale, the concurrent correlations are
quite impressive. Because the SRS has some research sup-
port as an ASD screener (Norris and Lecavalier, 2010), its
solid association with the CBCL/1½–5 ASD scale in our
study adds to the research evidence supporting the
CBCL/1½–5 ASD scale as a screener for ASD. It should
also be noted that correlations with the SRS were roughly
comparable for the SCI and RRB scales.
Because we had ASD diagnosis information for only a
small fraction of our age 5 sample (about 1%), very incom-
plete diagnostic information about the 67 children assessed
as non-ASD, and no diagnostic information about the rest
of the sample, our ANOVA results must be interpreted
Rescorla et al. 233
cautiously. However, the three groups showed impressive
differences on the SRS, ASD, SCI, and RRB scales, with
the ASD group having scores 4–5 times higher than the
non-assessed group. Consistent with the notion of the
broader autism phenotype (BAP), the 67 children assessed
for ASD but not so diagnosed also had elevated scores on
the SRS, ASD, SCI, and RRB scales but not as high as
those with an ASD diagnosis.
Limitations and strengths
An important limitation of the study is that we only used
mothers’ ratings on the 12 ASD items. Thus, we cannot
determine the degree to which consistency over time in our
results (e.g. large Q correlations for mean item ratings) is a
rater effect or a child effect. We did not analyze fathers’
ratings, nor did we analyze ratings by teachers/examiners
or any observational measures. Use of such alternative
measures might have yielded different results. We also
note that missing data resulted in slight reductions in our
sample sizes, although even our smallest sample (children
with complete data at 18 months, 3 years, and 5 years) still
exceeded 3000. Children excluded for missing data were
more likely to be from non-Dutch families with lower lev-
els of maternal education and family income. Nevertheless,
our final samples were still highly diverse. Our follow-up
information about ASD status was also somewhat incom-
plete, although the multiple-gating procedure used by
Generation R probably resulted in identifying most of the
children with ASD in the sample.
Despite these limitations, our study had important
strengths, including use of a large population-based diverse
sample, modest attrition from 18 months to 5 years, and
repeated measurements of ASD-like problems with the
same instrument. An additional strength is that we used
multiple approaches to examine prevalence and stability of
ASD-like symptoms, conducting analyses at the item, sub-
scale (SCI/RRB), and scale (12-item ASD) levels. Our
design allowed us to obtain a detailed picture of the base
rate of DSM-ASD scale items at three ages, as well as
important information about the structural and longitudi-
nal invariance of the measurement model.
Clinical implications
The CBCL/1½–5 is an extensively researched instrument
that is widely used in clinical settings serving young chil-
dren because it does not require a professional to adminis-
ter, can be completed and scored quickly (including
online), has a parallel form that can be completed by teach-
ers or caregivers, spans the entire preschool age range, and
provides information about a wide range of behavioral/
emotional problems (e.g. attention problems, aggressive/
oppositional behavior, anxiety, and sleep problems).
Although the CBCL/1½–5 was not designed as an ASD
screener, several studies have shown moderate-to-strong
associations between the CBCL’s PDP/ASD scale and
ASD diagnoses (Muratori et al., 2011; Myers et al., 2013;
Narzisi et al., 2013; Rescorla et al., 2015, in press; Sikora
et al., 2008). All of these factors support use of the
CBCL/1½–5 as a screening tool for ASD in general popu-
lation settings, such as pediatric practices.
Consistent with the greater prevalence of ASD in boys,
we found that male gender was one of few significant demo-
graphic predictors of ASD score in our study. Interestingly,
we found significantly larger variance in mean item ratings
in boys than in girls, a trend that increased with age (i.e. in
4, 7, and 12 items across ages). Gender differences in mean
item ratings also increased with age, with boys having
higher ratings than girls on 7 of the 12 items by age 5.
Although gender effects were consistently small in our
repeated-measures ANOVAs, all three analyses showed that
boys had significantly higher ASD, SCI, and RRB scale
scores than girls. For practitioners using the CBCL/1½–5 in
clinical settings, the means and SDs in Table 5 for the ASD
scale and its SCI and RRB subscales, based on the complete
sample at each age point, can serve as useful supplements to
the electronic scoring program that generates T scores, per-
centiles, and clinical-borderline-normal range cutpoints for
all scales, including the DSM-ASD scale.
Our base rate analyses showed that items 25. Doesn’t
get along with other children, 67. Seems unresponsive to
affection, 70. Shows little affection toward people, 80.
Strange Behavior, and 98. Withdrawn were endorsed as
very true or often true for very few children at each age.
These same items also had the highest loadings on the
ASD latent factor and seem to capture essential features of
ASD. High scores on these items may therefore be particu-
larly important for identifying ASD. Item 63. Repeatedly
rocks head or body was somewhat common at 18 months
and rare at 3 and 5 years, suggesting that its link to ASD
may increase with age, as more TD children discontinue
this behavior. The items with consistently high base rates
(e.g. 21. Disturbed by any change in routine and 23.
Doesn’t answer when people talk to him/her) may be less
specific to ASD than these rarer items and more character-
istic of maladjusted young children in general.
Our CFAs showed that the 12-item scale, as well as its
two subscales, has strong measurement properties, namely,
configural, metric, and scalar longitudinal MI. These find-
ings support use of the ASD scale and its SCI and RRB
subscales for operationalizing the extent to which children
assessed with the CBCL/1½–5 have elevated scores on
two sets of problems reflecting the two major symptom
groupings for ASD. Additionally, our base rate results sug-
gest that a child whose elevated score on the DSM-ASD
scale derives mainly from the items with relatively higher
base rates in population samples may be less likely to meet
ASD diagnostic criteria than a child who also has high rat-
ings on most of the items with lower base rates.
234 Autism 23(1)
Table 5.  CBCL/1½–5 DSM-ASD mean (SD) scale scores by gender at 18 months, 3 years, and 5 years.
18 months 3 years
  Boys (n = 2305) Girls (n = 2390) Boys (n = 2275)
ASD scale scores 1.62 (1.93) 1.44 (1.78) 1.79 (2.10)
SCI scores 0.79 (1.20) 0.67 (1.07) 0.94 (1.31)
RRB scores 0.83 (1.11) 0.77 (1.05) 0.85 (1.16)
CBCL: Child Behavior Checklist; DSM: Diagnostic and Statistical Manual of Mental Disorders; ASD: autism spectrum disorder; SCI: social
communication and interaction; RRB: restricted interests and repetitive behaviors.
The CBCL/1½–5 is normed up to age 6, and therefore,
clinicians can use its ASD scale as a screener for children
up to their sixth birthday. The CBCL/6–18 does not have a
DSM-oriented ASD scale. A few articles (Ooi et al., 2011;
So et al., 2013) have created ad hoc scales to capture ASD
that include a few of the same items (e.g. Withdrawn and
Strange behavior) as the CBCL/1½–5 ASD scale, but
these ad hoc scales are not currently included in the
CBCL/6–18 scoring software and so are less practical for
clinical use.
Future directions
Because information about the base rates and longitudinal
stability of the ASD scale’s 12 items has been hitherto
lacking, as has evidence about the scale’s measurement
model, our data, obtained from a very large and diverse
population sample, begin to address these issues. However,
our findings on CBCL/1½–5 ASD item base rates and the
measurement model associated with these items need rep-
lication in other samples. For example, it would be good to
see if the findings replicate in other large population sam-
ples, such as the 24 international samples for which
Rescorla et al. (2011) reported CBCL/1½–5 results. It will
also be important to test replicability of the findings in
large samples with well-defined groups of young children
diagnosed with ASD, other developmental or psychiatric
disorders, or typical development, in order to determine
whether the five items highlighted in our results in fact are
the best discriminators of diagnosed ASD.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article:
The general design of the Generation R Study is supported by the
Erasmus Medical Center Rotterdam, the Erasmus University
Rotterdam, the Netherlands Organization for Health Research
and Development (ZonMw “Geestkracht” programme
10.000.1003), the Netherlands Organization for Scientific
Research, and the Ministry of Health, Welfare and Sport. The
Generation R Study is conducted by the Erasmus Medical Center
in close collaboration with the School of Law and the Faculty of
Social Sciences of the Erasmus University Rotterdam, the
Municipal Health Service Rotterdam area, the Rotterdam
Homecare Foundation, and the Stichting Trombosedienst and
5 years
Girls (n = 2296) Boys (n = 2885) Girls (n = 2867)
1.53 (1.82) 2.04 (2.47) 1.49 (1.87)
0.79 (1.12) 1.22 (1.49) 0.92 (1.20)
0.74 (1.04) 0.82 (1.29) 0.58 (0.99)
Artsenlaboratorium Rijnmond. The second author was supported
by the Intramural Research Program of the Eunice Kennedy
Shriver National Institute of Child Health and Human
Development (NICHD).
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