Journal of Autism and Developmental Disorders, Vol. 13, No.

3, 1983

The Assessment of Autistic Children:

A Selective Review of Available Instruments 1

Susan L. Parks 2
Maryland Psychiatric Research Center

This review examines five measures specifically designed to assess autistic

symptomatology: Rimland's Diagnostic Checklist f o r Behavior-Disturbed
Children, the Behavior Rating Instrument f o r Autistic and Atypical
Children, the Behavior Observation Scale f o r Autism, the Childhood
Autism Rating Scale, and the Autism Behavior Checklist. Available studies
o f reliability and validity issues are discussed. Reliability indices f o r all
scales, except Rimland's Diagnostic Checklist, are at acceptable levels. Each
scale has been f o u n d to suffer from a lack o f demonstrated discriminant
and/or content validity. Recommendations f o r future research are pro-
vided.

Since Kanner first identified the syndrome of early infantile autism in 1943,
diagnosis of the disorder has provoked unresolved controversy. Clinicians
vary in their theoretical conceptions of the illness and consequently em-
phasize different aspects as essential for the diagnostic label of autism.
Despite the conflicting diagnostic theories and schemes, consensus
does exist about the areas of disturbance involved, the early onset, and the
presence of some undefined processing dysfunction (Cohen, Caparulo,
Gold, Waldo, Shaywitz, Ruttenberg, & Rimland, 1978). While the debates
continue, there remains an overriding need for the careful evaluation of
children currently categorized as autistic. This information is critical for
research on the group as a whole and for important decisions about the in-
dividual child's educational placement. Several new assessment measures

1The author gratefully acknowledges the invaluable support and many helpful suggestions
provided by Robert H. Deluty during the preparation of an earlier manuscript.
2Address all correspondence to Susan L. Parks, Maryland Psychiatric Research Center, Box
3235, Catonsville, Maryland 21228.
255
0162-3257/83/0900-0255503.00/09 1983PlenumPublishingCorporation
256 Parks

have been specifically designed for use with an autistic population

(Freeman, Ritvo, Guthrie, Schroth, & Ball, 1978; Krug, Arick, & Almond,
1980; Makita & Umezu, 1973; Rimland, 1964, 1971; Ruttenberg, Dratman,
Fraknoi, & Wenar, 1966; Schopler, Reichler, DeVellis, & Daly, 1980; Wing
& Gould, 1978). Only those paper-and-pencil assessment tools for which at
least preliminary reliability and validity information is available will be
reviewed here.

ASSESSMENT INSTRUMENTS

Rimland's Diagnostic Checklist for Behavior-Disturbed Children

In 1964 Rimland introduced a multiple-choice diagnostic question-

naire for autism. Form E-1 was to be completed by parents and consisted of
76 questions on topics such as birth history, symptoms, and speech pat-
terns. Parents' responses indicated that after 5 89 the child's behavior pat-
terns tended to become more idiosyncratic and the core symptoms of the
classical syndrome of autism as defined by Kanner became more diffuse
(Rimland, 1968). Therefore, subsequent printings of the Diagnostic
Checklist for Behavior-Disturbed Children (Form E-2) contained questions
applying to the child before age 5.
Form E-2 is scored as if it were a "test." A plus point is given for each
response characteristic of early infantile autism and a minus point for each
answer in the nonautistic direction. Scores of 2,218 completed forms range
from - 4 2 to +45 (Rimland, 1971). Rimland has set +20 as the cutoff
point for diagnosing early infantile autism. Only 9.7% of his sample re-
ceived a score of + 20 or higher, which corresponds with Rimland's and
Kanner's belief that only 10 of every 100 children labeled autistic are really
suffering from early infantile autism (Kanner, 1962, cited in Rimland, 1971,
Rimland, 1964).

Behavior Rating Instrument for Autistic and A typical Children

Another instrument that has been developed for use with an autistic
population is the Behavior Rating Instrument for Autistic and Atypical
Children or BRIAAC (Ruttenberg et al., 1966; Ruttenberg, Kalish, Wenar,
& Wolf, 1977). The instrument was developed from observations of autistic
children in a day care setting with a psychoanalytically oriented therapy
program. However, the scales are behaviorally defined and users need not
adopt the theoretical underpinnings of the developers.