autism © 2009

The usefulness of the Revised SAGE Publications

and The National
Autistic Society
Psychoeducational Profile for Vol 13(2) 179–191; 100687
1362-3613(200903)13:2

the assessment of preschool

children with pervasive
developmental disorders

C L AU D I A P O RTO G H E S E Università degli Studi di Bari, Italy

M AU R A B U T T I G L I O N E Università degli Studi di Bari, Italy

F R A N C E S C A PAV O N E Università degli Studi di Bari, Italy

VITO LOZITO Università degli Studi di Bari, Italy

A N D R E A D E G I AC O M O Università degli Studi di Bari, Italy

D O M E N I C O M A RT I N E L L I Università degli Studi di Bari,

Italy

LUCIA MARGARI Università degli Studi di Bari, Italy

A B S T R AC T Data from the Psychoeducational Profile–Revised (PEP–R) K E Y WO R D S

were analysed in a sample of 46 children, aged from 1.7 to 5.11 years, PEP–R;
of whom 21 had autistic disorder (AD) and 25 had pervasive develop- pervasive
mental disorder not otherwise specified (PDD-NOS). Analysis with a disorders;
t-test for independent samples revealed a significant difference (p < preschool
0.05) between children with AD and those with PDD-NOS on both
developmental and behavioural PEP–R scales, supporting the utility of
the PEP–R in discriminating between two diagnostic groups. This study
emphasizes the effectiveness of the PEP–R as a tool for the early assess-
ment of children with pervasive developmental disorders.
ADDRESS Correspondence should be addressed to: L U C I A M A R G A R I , Full
Professor of Child Neuropsychiatry, Neurological and Psychiatric
Department, University of Bari, Policlinico Piazza Giulio Cesare 11,
Bari 70124, Italy. e-mail: l.margari@neurol.uniba.it

Introduction
The Psychoeducational Profile–Revised (PEP–R: Schopler et al., 1990),
developed in 1990 from an earlier version of the PEP, represents a useful
Copyright © The Author(s), 2009. Reprints and permissions: 179
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AU T I S M 13(2)
tool for the assessment of children with pervasive developmental disorders
(PDDs). The PEP–R offers a developmental approach to the assessment of
children with autism or related developmental disorders, and is designed to
identify idiosyncratic learning patterns. The test provides information on the
developmental level in seven important domains and assesses the nature
and the severity of the disturbed behaviour commonly observed in children
with PDDs, with regard to four areas, yielding an overall qualitative analysis
and thus constituting at the same time a useful assessment and diagnostic
tool (Schopler and Reichler, 1995).
Since it describes the developmental level of several important domains,
it enables careful planning of intervention within individually tailored edu-
cational programmes for children functioning at a level between 6 months
and 7 years (Schopler et al., 1982). The revised version of the PEP also makes
it possible to assess and to plan educational programmes for preschool
children since it provides prescholastic items (Schopler and Reichler, 1995).
In addition, the PEP–R has been used as an outcome measure in pub-
lished studies of treatment effectiveness. Panerai et al. (2002) compared
two educational treatments, the Treatment and Education of Autistic and
Communication Handicapped Children (TEACCH) programme and an
integration programme for individuals with disabilities in two groups of
children with autism associated with severe intellectual disability. The PEP–R
was administered twice with a 1 year interval between assessments. In the
group that had the TEACCH programme, the authors found a statistically
significant improvement on the PEP–R total score, developmental age and
scores in all domains except fine motor skills.
Ozonoff and Cathcart (1998) also evaluated the effectiveness of a
TEACCH-based home programme for young children with autism in a
study comparing a treatment group and a no-treatment control group.
The PEP–R was administered before and after a 4 month interval. Results
demonstrated that children in the treatment group improved significantly
more than those in the control group on the PEP–R subtests of imitation,
fine motor, gross motor and non-verbal conceptual skills as well as in over-
all PEP–R scores. Therefore in these studies the PEP–R was able to differ-
entiate between the treated and control groups, showing the effectiveness
of a TEACCH-based intervention in improving the cognitive and develop-
mental skills of young children with autism.
Several features make the PEP–R suited to the assessment of behaviour
and development in children with PDDs. The test consists of concrete and
interesting material; there is no pressure of time; items do not have to be
done in a fixed order; it needs only limited verbal skills; and language items
are separated from general assessment items. Because of these character-
istics, the PEP–R is well adapted to successfully analyse all children, offering
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 MARGARI ET AL.: PEP–R FOR PRESCHOOL CHILDREN
the possibility of assessing a wide developmental range (Schopler et al.,
1990). Moreover, a total developmental score (DQ) can be calculated from
the PEP–R, which reflects a child’s overall developmental level.
The validity of the original PEP has been reported in the literature. As
reported by Steerneman et al. (1997), Schopler and Reichler (1979) referred
to a study in which the developmental scores of children with autism,
children with intellectual impairment and typically developing children
were compared. The results showed a strong resemblance between the
developmental scores of children with intellectual impairment and those
of typical children; for example the PEP score obtained by a child with an
intellectual impairment and a developmental age of 3 years was the same
as that of a typical child with a chronological age of 3 years. Moreover
children with autism varied in their developmental profile whereas children
with intellectual impairment exhibited equal retardation of all develop-
mental functions.
Furthermore, the behavioural scale of the PEP is derived from the Child-
hood Autism Rating Scale (CARS: Schopler et al., 1988), a diagnostic instru-
ment commonly used for the assessment of children with PDDs, which
draws on the DSM-IV-TR (American Psychiatric Association, 2000). Vali-
dation studies of the original PEP also included comparison with a number
of other standardized assessment instruments and reported that total PEP
scores correlate significantly with scores from the Merrill–Palmer Scale
(Stutsman, 1948), the Vineland Social Maturity Scale (Doll, 1965), the Bayley
Scales of Infant Development (Bayley, 1969), and the Peabody Picture Vocab-
ulary Test (Dunn, 1965). However, the original PEP was not found to corre-
late with scores obtained using the Wechsler Intelligence Scales or the Leiter
International Performance Scale (Schopler and Reichler, 1979).
Since that time, there have been few published assessment studies of
children with PDDs using the PEP–R developmental and behavioural scores.
Steerneman et al. (1997) utilized the PEP–R to compare the developmental
and behavioural scores of children with autism, children with pervasive
developmental disorders not otherwise specified, and typical children. The
results revealed that in typical children each of the developmental areas was
more developed than in children with pervasive developmental disorders.
In the present study, the PEP–R was administered to assess and to discern
differences between preschool children with autism (AD) and children with
pervasive developmental disorders not otherwise specified (PDD-NOS) as
regards their developmental and behavioural levels.

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AU T I S M 13(2)
Methods

Participants
The sample comprised 46 preschool children (38 males, eight females),
aged from 1.7 to 5.11 years (mean age 3.3 years), referred to our depart-
ment because of disturbances related to autistic spectrum disorders, over a
period of 38 months (from November 2003 to January 2007). All children
were tested through a standard battery of assessments consisting of diag-
nostic instruments, namely the Childhood Autism Rating Scale (CARS:
Schopler et al., 1988), Autism Diagnostic Observation Schedule–Generic
(ADOS–G: Lord et al., 2000) and a standardized semi-structured interview
for the child’s caregivers, namely the Autism Diagnostic Interview–Revised
(ADI–R: Lord et al., 1994). ADI–R and ADOS were completed for 43 patients
because three children (two AD, one PDD-NOS) were under 24 months
of age. ADOS module 1 was used for children without phrase speech and
module 2 for children with phrase speech. The clinical assessment of adap-
tive and behavioural function was completed using the Vineland Adaptive
Behavior Scale (Carter et al., 1998).
The diagnostic evaluation comprised physical and neurological examin-
ations, a general laboratory investigation, metabolic screening for the levels
of amino acids, pyruvic and lactic acids, fatty acids and ammonium, thyroid
tests, waking/sleeping EEG and MRI. The diagnoses were made according
to the DSM-IV-TR (American Psychiatric Association, 2000) and corrobor-
ated by clinical observation and by the agreement of the instruments. For
the different instruments the cutoff value for autism was verified and
applied. In accordance with DSM-IV criteria, 21 children were diagnosed
as having an autistic disorder (AD), aged from 1.9 to 5.11 years (mean age
3.2 years) at the time of the observation, and 25 a pervasive developmental
disorder not otherwise specified (PDD-NOS), aged from 1.7 to 5.5 years
(mean age 3.3 years). All diagnoses were made by the same physician with
a specific background in the assessment of PDDs. Administrators of the
ADI–R and ADOS were trained to administer these instruments.
The patients’ characteristics are summarized in Table 1.

Procedure
All children were assessed using the PEP–R (Schopler and Reichler, 1995) to
identify skills and behaviours useful for diagnostic and educational planning
aims. Moreover 26 children were tested with the Leiter International Per-
formance Scale–Revised visualization and reasoning battery (Leiter–R: Roid
and Miller, 1997) to obtain an estimate of cognitive functioning. It was not

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 MARGARI ET AL.: PEP–R FOR PRESCHOOL CHILDREN
Table 1 Demographic characteristics and ADI–R and ADOS scores of the two
groups

Variable AD children PDD-NOS children

N 21 25
Boy/girl 15/6 23/2
Age (years):
Mean 3.2 3.3
SD 1.04 0.92
Age distribution (years):
1 2 1
2 6 8
3 7 7
4 5 8
5 1 1
ADI–R and ADOS scores (sample) N = 19 N = 24
ADI RSIa (CFA = 10):
Mean 17.5 13.7
SD 4.5 5.2
ADI Cb (NVC CFA = 7; VC CFA = 8):
Mean 10.4 8.7
SD 2.0 3.4
ADI RSBc (CFA = 3):
Mean 4.6 3.2
SD 1.2 1.7
ADI dev. 36 monthsd (CFA = 1):
Mean 3.9 3.7
SD 0.7 0.7
ADOS Comme (CFA = 4/5; CFASD = 2/3):
Mean 6.9 3.5
SD 1.2 0.9
ADOS Socf (CFA = 7/6; CFASD = 4/4):
Mean 9.3 5.2
SD 1.7 1.4
ADOS Comm + Soc (CFA = 12/12; CFASD = 7/8):
Mean 16.2 8.7
SD 2.6 1.6

CFA = cutoff for autism; CFASD = cutoff for autistic spectrum disorder.
a ADI–R reciprocal social interaction domain.
b ADI–R non-verbal and verbal communication domain.
c ADI–R repetitive and stereotyped behaviour domain.
d ADI–R developmental evident before 36 months.
e ADOS module 1/2 communication domain.
f ADOS module 1/2 social domain.

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AU T I S M 13(2)
possible to obtain information about the cognitive abilities of another 22
children using standard intelligence tests due to their poor compliance.
The PEP–R consists of a series of toys, games, objects and pictures which
are offered to the child during structured play sessions. The child’s reactions
are observed and classified during the observation. The version adopted
included a developmental scale (131 items) and a behavioural scale (43
items).
The developmental scale consists of seven developmental areas: (a)
imitation (16 items); (b) perception (13 items); (c), (d) fine and gross
motor activity (16 and 18 items respectively); (e) eye–hand coordination
(15 items); (f ) cognitive performance (26 items); (g) cognitive verbal
operations (27 items). The scoring was classified as ‘pass’ when the item
task was achieved, ‘emerging’ when partially achieved, and ‘fail’ when the
child failed completely to achieve the task.
A developmental score for each of the developmental areas can be
calculated by summing the number of the successfully completed items. In
this way a developmental profile can be derived. This will show in graph
form the child’s relative strengths and weaknesses in different areas, indi-
cating the specific developmental level for each of the developmental areas.
The developmental level in each area can be compared, providing infor-
mation on learning patterns, ability and difficulty of the child in each area.
Additionally, a number of emerging scores for each of the developmental
areas can be assigned. In this way the developmental scale of the PEP–R has
an assessment aim.
An overall developmental score is calculated by summing all items
successfully completed, which can be used to estimate age-equivalent scores.
Dividing the child’s overall age-equivalent score by his/her chronological
age, an overall developmental quotient (DQ) can be calculated. This value
indicates an overall developmental level as compared to the normal develop-
ment of a typical child.
In addition to the developmental items, the PEP–R also contains a number
of behavioural items that measure the severity of autistic disorder in children
with regard to: (a) affect and development of relationships (12 items);
materials (8 items); (b) sensory modalities (12 items); language (11 items).
For each item, the degree of disturbed behaviour is scored as ‘appro-
priate’ for behaviour typical of the child’s chronological age, ‘mild’ for
atypical behaviour, and ‘severe’ for atypical and dysfunctional behaviours
of greater intensity and type than in the previous levels. ‘Not applicable’ is
only for language items that cannot be scored because of the young age of
the child or the absence of spoken language.
A behavioural profile can be derived by summing the number of items
in each area classified in this way. This profile reveals behavioural problems
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 MARGARI ET AL.: PEP–R FOR PRESCHOOL CHILDREN
not shown by the developmental profile, providing information on the
severity of a child’s behavioural difficulties. The items on the behavioural
scale are not norm-referenced like those on the developmental scale since
these particular behaviours are abnormal for children at any age. Therefore
this scale has a diagnostic aim, permitting behaviours compatible with a
diagnosis of autistic disorders to be identified.
After analysis of the developmental and behavioural data means, develop-
mental and behavioural profiles were drawn for each group. Analysis of the
mean scores on the PEP–R developmental and behavioural scales was made
with the t-test for independent samples to evaluate the difference between
two diagnostic groups.
Data were tabulated and analysed using SPSS 11.0.4 for Mac OSX 10.4.8.

Results
The mean developmental profile for both groups resulted in typical dis-
harmonies, showing a variable combination of more developed areas near
to the child’s chronological age and more delayed areas under the child’s
chronological age. Comparison of the developmental profile in the two
groups revealed that in AD children each of the developmental areas was
more impaired than in PDD-NOS children.
Imitation, cognitive performance and cognitive verbal domains were
the most delayed domains in both groups. The gross motor area was also
frequently delayed in both groups although this domain showed a higher
developmental level than the imitation, cognitive performance and cogni-
tive verbal domains. The more developed domains in both groups were
found to be perception, fine motor and eye–hand coordination (Figure 1).
Analysis with the t-test for independent samples of the mean scores on
the PEP–R developmental areas revealed a significant difference (p < 0.05)
between AD and PDD-NOS children as regards all PEP–R developmental
domains with the exception of the cognitive verbal. All these functions
exhibited a greater developmental delay in the AD group as compared with
the PDD-NOS group (Table 2).
Each of the developmental areas showed some results that were scored
as emerging in both groups. Cognitive performance was the domain with
the greatest number of reactions judged as emerging in both groups despite
being one of the more impaired areas in the developmental profile. On
the other hand, cognitive verbal was the most strongly impaired domain
in this as it was in the developmental profile. Analysis with the t-test for
independent samples of the mean scores of the results judged as emerging
revealed a significant difference (p < 0.05) between the AD and PDD-NOS
groups as regards cognitive performance and cognitive verbal, which showed
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AU T I S M 13(2)
Age (months)
84

72

60

48
Items passed AD
Items passed PDD-NOS
36

24

12

0
n

ce
n
n

or
or

al
io
tio
tio

rb
ot

an
ot

t
na
ep
ita

ve
m
m

rm
di
rc
Im

ss
ne

e
o
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Pe

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ro
Fi

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pe

ni
G

og
nd

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tiv

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Graph 1

= mean age of AD group

= mean age of PDD-NOS group

Figure 1 Mean developmental profiles of AD and PDD-NOS groups

more reactions judged as emerging in the PDD-NOS group as compared

with the AD group (see Table 2).
The mean behavioural profile of children with AD showed more severely
disturbed behaviour in all areas than children with PDD-NOS.
Language gave the lowest scores in both groups, followed by affect and
relationships, materials and sensory modalities.
The ‘not applicable’ items were scored as ‘severe’ for non-verbal children
with a chronological age > 2 years. Therefore three children under 2 years
of age, two with AD and one with PDD-NOS, were excluded from this
analysis (Figure 2).
Analysis with the t-test for independent samples of the mean scores on
the PEP–R behavioural scale revealed a significant difference (p < 0.05)
between the AD and PDD-NOS groups as regards all areas which were more
severely disturbed in the AD group than the PDD-NOS group (see Table 2).
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 MARGARI ET AL.: PEP–R FOR PRESCHOOL CHILDREN
Table 2 Mean PEP–R scores of the two groups and results of the statistical
analyses

AD children PDD-NOS t p
(n = 21) children (n = 27)

Mean SD Mean SD

PEP–R development: passed a

Imitation 2.29 2.667 5.88 4.236 –3.497 <0.05
Perception 6.90 2.931 9.00 2.723 –2.510 <0.05
Fine motor 6.24 2.143 9.28 2.558 –4.321 <0.05
Gross motor 8.95 3.074 11.72 2.590 –3.315 <0.05
Eye–hand coordination 3.48 2.112 5.76 2.833 –3.049 <0.05
Cognitive performance 2.52 2.926 5.80 4.848 –2.822 <0.05
Cognitive verbal 1.00 2.074 2.36 2.998 –1.810 n.s.

PEP–R development: emerging b

Imitation 2.76 1.480 3.00 2.141 –4.44 n.s.
Perception 2.71 2.572 1.80 1.607 1.470 n.s.
Fine motor 2.24 1.179 2.12 1.740 0.264 n.s.
Gross motor 2.62 2.617 3.00 1.658 –0.599 n.s.
Eye–hand coordination 1.52 1.250 1.68 1.108 –0.449 n.s.
Cognitive performance 3.86 2.435 5.40 2.483 –2.118 <0.05
Cognitive verbal 0.76 0.768 1.92 2.060 –2.604 <0.05

PEP–R pathology c
Affect/relationship 5.52 2.676 3.16 2.511 3.086 <0.05
Material 3.71 1.875 1.48 1.229 4.851 <0.05
Sensory 2.71 1.793 1.12 1.236 3.556 <0.05
Language 9.26 1.593 5.96 3.544 4.077 <0.05
a Developmental scores refer to the number of items that were ‘passed’.
b Developmental scores refer to the number of items that were rated as ‘emerging’.
c Pathology scores pertain to the number of items that were judged severe + not applicable.

Only 26 children, seven with AD (33%) and 19 with PDD-NOS (76%),

were tested using a standardized non-verbal intelligence test (Leiter–R).
The mean non-verbal IQ score for the sample was 76.88 (range = 34–103;
SD = 15.9). The mean non-verbal IQ score for the children with autism
was 74.29 (range 34–94; SD = 21.282); The mean non-verbal IQ score
for the children with PDD-NOS was 77.84 (range 53–103; SD = 13.19).

Discussion
In our study the mean developmental profiles of the two groups were found
to be disharmonious. Thus the PEP–R was able to reveal the typical uneven
profile in different developmental areas which consisted of particular
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AU T I S M 13(2)
100%

80%

60%
Severe + not applicable
Mild
Absent
40%

20%

0%
)

S)

S)

S)

S)
)

)
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D
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ffe
A

Figure 2 Mean behavioural profiles of AD and PDD-NOS groups

strengths and weaknesses, confirming the delay and asynchronism of

different skills commonly observed in children with PDDs (Schopler and
Reichler, 1979). Moreover, the usefulness of the tool in providing an
overall assessment of each developmental area and identifying idiosyn-
cratic learning patterns typical of PDDs has been confirmed (Schopler and
Reichler, 1995).
In our sample, significant differences were found for all developmental
domains, which were more severely impaired in the AD group, with the
exception of the cognitive verbal, which was equally delayed in both groups.
This finding revealed an overall and pervasive developmental delay, support-
ing the impairment of specific functions reported in children with autism
(Charman et al., 1997; Fombonne, 1999; Johnson et al., 1992; Ornitz et
al., 1997; Rogers and Pennington, 1991; Smith and Bryson, 1998; Stone
et al., 1997). On the other hand, although the cognitive verbal domain was
shown to be one of the more impaired areas in the developmental profile in
both groups, no significant difference between AD and PDD-NOS children
was found in this domain. The language skills that had not yet emerged, due
to the young mean age of the PDD-NOS group, could explain this result.
In our sample no significant differences between AD and PDD-NOS
children were found in the mean scores judged as ‘emerging’ with the
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 MARGARI ET AL.: PEP–R FOR PRESCHOOL CHILDREN
exception of the cognitive performance and cognitive verbal domains,
which showed more ‘emerging’ in the PDD-NOS group. These findings
support the greater impairment of these two skills in children with autism
(American Psychiatric Association, 2000; Fombonne, 1999; Rapin and
Dunn, 2003; Rapin and Katzman, 1998).
Cognitive performance was the domain with the most reactions judged
as ‘emerging’ in both groups, suggesting that cognitive functioning may be
the domain with the greatest developmental potential in younger children
with PDDs. Follow-up after educational intervention may allow us to con-
firm this result.
In our study a significant difference was found between children with
AD and children with PDD-NOS in all behavioural areas, showing more
severely autistic behaviour in the AD group as compared with the PDD-NOS
group. Therefore, the validity of the behavioural scale is confirmed as an
assessment tool for the severity of the disorder and consequently may serve
as a diagnostic tool (Schopler and Reichler, 1995), these results being in
agreement with the DSM-IV criteria for AD and PDD-NOS. In fact the DSM-
IV criteria for these two categories are focused on pathological behavioural
characteristics.
Finally, all these findings provide evidence of the effectiveness of the
PEP–R for the assessment of preschool children with PDDs, identifying the
differences in developmental and behavioural patterns between individuals
with autism and those with pervasive developmental disorder not other-
wise specified.
To our knowledge only one previous study has been reported in the liter-
ature in which the PEP–R was used to compare children with autism, children
with pervasive developmental disorders and typical children (Steerneman
et al., 1997). The results revealed that in typical children each of the devel-
opmental areas was more developed than in children with PDDs, taken
altogether. Moreover, the AD group exhibited a more severe retardation in
each of the developmental areas than the PDD-NOS group. Nevertheless,
no significant differences between AD and PDD-NOS children were found
on any of the PEP–R developmental scales. On the other hand, the PEP–R
pathology scores showed the expected pattern: AD children exhibited more
severely disturbed behaviour than PDD-NOS children, whereas typical
children displayed no pathological behaviour. The sample analysed by the
authors consisted of children with an average IQ score of about 80 and
with a mean age of 4.7 years. Therefore the different findings emerging
in our study with regard to the developmental areas could be attributed to
our sample which consisted of younger and low-functioning children.
Moreover in our sample only 26 children were tested using Leiter–R.
The young chronological age of our sample could explain this result. On
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AU T I S M 13(2)
the other hand, all children were assessed using the PEP–R. In fact, the tool
offers a potential advantage for testing this population since it covers a wide
developmental range, offers structured and attractive material, and separ-
ates language items from general assessment items. Therefore the PEP–R is
also able to assess low-functioning children, and children with significant
language and social deficits and with behavioural disturbances, obtaining
data on the developmental level of otherwise untestable children. Moreover
the PEP–R provides further advantages in delineating the abilities in each
area, recovering data which would be lost when using aggregate scores
such as IQ score. All these data form the basis for designing the subsequent
intervention which must start from the developmental level of the child in
each domain.
The current study provides further evidence of the effectiveness of the
PEP–R for the assessment of preschool children with PDDs, identifying the
differences between diagnostic groups, and providing data on the develop-
mental level of these children.

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