635465

book-review2016
JPAXXX10.1177/0734282916635465Journal of Psychoeducational AssessmentTest Review

Test Review
Journal of Psychoeducational Assessment
2017, Vol. 35(3) 342­–346
A Test Review © The Author(s) 2016
Reprints and permissions:
sagepub.com/journalsPermissions.nav
journals.sagepub.com/home/jpa

Gilliam, J. E. (2014). Gilliam Autism Rating Scale–Third Edition (GARS-3). Austin, TX: Pro-Ed.

Reviewed by: Benjamin C. Karren, Texas A&M University, College Station, TX, USA
DOI: 10.1177/0734282916635465

General Description
The Gilliam Autism Rating Scale–Third Edition (GARS-3) is a norm-referenced tool
designed to screen for autism spectrum disorders (ASD) in individuals between the ages of
3 and 22 (Gilliam, 2014). The GARS-3 test kit consists of three different components and
includes an Examiner’s Manual, summary/response forms (50), and the Instructional
Objectives for Individuals Who Have Autism booklet. The Examiner’s Manual contains
administration procedures, scoring/interpretation procedures, and technical information
related to the GARS-3. Summary/response forms are completed by the examiner and contain
information related to the examinee’s demographic information, responses to items on the
GARS-3, and information pertinent to the diagnosis of an ASD. Finally, the Instructional
Objectives for Individuals Who Have Autism booklet can be used to help parents and profes-
sionals to develop instructional goals and behavioral interventions based on the findings of
the GARS-3 (Gilliam, 2014).
The GARS-3 is composed of six different subscales and 58 Likert-type items. The six sub-
scales were crafted in accordance with the Autism Society’s (2012) definition of ASD and based
on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American
Psychiatric Association [APA], 2013) definition of an autistic disorder. The subscales are as fol-
lows: Restricted/Repetitive Behaviors (13 items), Social Interaction (14 items), Social
Communication (9 items), Emotional Responses (8 items), Cognitive Style (7 items), and
Maladaptive Speech (7 items; Gilliam, 2014).

Administration
Because the examiner helps to collect diagnostic information from a variety of sources, assimi-
late data, and qualify individuals for services, examiners should be individuals who have training
and experience working with individuals with autism (Gilliam, 2014). Potential examiners may
include school psychologists, speech and language pathologists, educational diagnosticians,
autism specialists, or other trained professionals who know how to interpret and use data to
inform autism diagnoses. In addition, examiners are responsible for selecting appropriate raters
to complete the GARS-3 (Gilliam, 2014).
Most often, raters on the GARS-3 are classroom teachers, parents, or other caregivers who
have sustained contact with the individual being assessed. The manual recommends that a poten-
tial rater have at least 2 weeks of sustained contact with an individual prior to completing the
GARS-3 (Gilliam, 2014). Raters should also understand how the GARS-3 helps to diagnose
autism and should read all questions thoroughly. Examiners should make themselves available to
answer any questions that the rater may have while completing the GARS-3. It is unnecessary for
raters to compare the individual being rated with other people of the same age because normative
Test Review 343

data on the GARS-3 have already taken age of the individual being rated into account. Instead,
each behavior should be evaluated only how accurately the item describes a person’s behavior
(Gilliam, 2014).
The GARS-3 can be completed either as a questionnaire or a structured interview (Gilliam,
2014). Each rater will need a copy of the summary/response form and a writing utensil.
Pertinent information including the name of the person being rated and the data of the rating
should be included on the front page of the GARS-3. Raters are then asked to complete 58
Likert-type items pertaining to observable measurable behaviors related to the person being
rated. The Likert-type items are each rated on a scale of zero to three with zero being not at all
like the individual, one being not much like the individual, two being somewhat like the
individual, and three being very much like the individual. Each item on the GARS-3 must
receive a rating. If the rater is uncertain of how to rate an item, they should observe the indi-
vidual for more time prior to completing the rating or extrapolate data from observations that
have been conducted (Gilliam, 2014).
The Centers for Disease Control and Prevention (2012) reported that roughly 40% of children
with autism are mute. Furthermore, the GARS-3 manual indicates that nearly 25% of the students
who were rated during the norming of the instrument were mute. Therefore, it is reasonable to
conclude that some individuals who are referred for an evaluation will be unable to communi-
cate. In these cases, the authors of the GARS-3 recommend omitting the Maladaptive Speech and
Cognitive Style subscales from the test (Gilliam, 2014).

Scoring/Interpretation
After completion of the GARS-3, the examiner will first total raw scores for each of the six sub-
scales or four subscales if the individual being rated is mute (Gilliam, 2014). These raw scores
are then converted into percentile ranks and scaled scores using Appendix A in the back of the
Examiner’s Manual. Each percentile rank indicates the percentage of the normative sample that
is equal to or below the percentile. Scaled scores for subscales were developed by applying a
direct linear transformation to raw scores to obtain a distribution with a mean of 10 and a stan-
dard deviation of 3. Higher scaled scores on a subscale represent increasingly severe autistic
behavior. The GARS-3 manual notes that scaled scores are ideal for comparing an individual’s
performance with the normative sample and that these scores can be manipulated statistically
making them ideal for use in research (Gilliam, 2014).
After scaled scores have been calculated for each subscale, the scaled scores of all sub-
scales should be totaled to calculate an overall composite score known as the Autism Index
(Gilliam, 2014). Examiners should consult Appendix B in the Examiner’s Manual to obtain
corresponding Autism Index scores and percentile ranks from the sum of scaled scores. The
Autism Index composite is a different kind of standardized score with a mean of 100 and a
standard deviation of 15. The greater an Autism Index score is, the higher the probability the
individual being rated has autism and the more severe the autistic behavior. According to
Gilliam, this score is the best score for identifying an individual with autism, as it is com-
posed of the sum of scaled scores. In addition, Gilliam notes that this score is also the most
reliable score among standard scores on the GARS-3. It is further noted that another Autism
Index exists for individuals who are nonverbal by summing the scores of the four subscales
administered. Both the six-subscale and four-subscale versions of the Autism Index have been
found to be reliable, valid, and discriminative. Because all the persons in the normative sam-
ple had autism, the norms of the GARS-3 depict how certain scores relate to scores of other
individuals with autism. On the bottom of the front page of summary/response form is an
Interpretation Guide to help indicate the likelihood of autism, severity level of autism, and
descriptor for recommended support level (Gilliam, 2014).
344 Journal of Psychoeducational Assessment 35(3)

Technical Adequacy
Development and Standardization
When selecting a normative sample for the GARS-3, authors of the measure contacted parents,
teachers, educational diagnosticians, psychologists, speech clinicians, teacher assistants, and
other educational professionals (mainly through electronic solicitation) and asked them to com-
plete the GARS-3 on individuals diagnosed with autism (Gilliam, 2014). To participate in the
research, individuals being rated had to have received a diagnosis of autism, be between 3 and 22
years old, and reside in the United States. The majority of raters in the normative sample were
parents (23.2%), teachers (33.4%), and speech clinicians (13.0%). In addition, the majority of
raters held either a bachelor’s (24.9%) or an advanced degree (58.6%). Most of the raters in the
normative sample claimed to have either studied autism in school or considered themselves very
knowledgeable on the topic (87.3%); furthermore, a large portion of the raters claimed to have
known the person being rated for 4 or more years (80.3%; Gilliam, 2014).
The total normative sample consisted of 1,859 children and young adults with diagnoses of
autism (Gilliam, 2014). The majority of this sample was reported to only have an ASD (61.3%).
This normative sample was drawn from a diverse geographic population that included individu-
als from 48 different states. Age of individuals being rated was fairly evenly spread between 3
and 19 years, with somewhat smaller sample sizes being reported for individuals aged between
20 and 22 years (approximately 60%-75% decline). The normative sample was most males
(77%), Whites (80%) and Black/African Americans (12%). Specifically, only a very small por-
tion of the normative sample was composed of Asian/Pacific Islanders (5%) and American
Indian/Eskimo/Aleuts (<1%), indicating that more research may need to be done to assess accu-
racy of this measure with regard to these races (Gilliam, 2014).

Reliability
The internal consistency of each individual subtest on the GARS-3 as well as the two overall
indexes were measured using Cronbach’s alpha (Gilliam, 2014). Overall, the GARS-3 demon-
strated superior internal consistency across various age groups. Average Cronbach’s alphas of .94
and .93 were recorded for the Autism Index 4 and Autism Index 6, respectively, (Gilliam, 2014).
A study in which raters completed the GARS-3 twice within in a 2-week period on 122 indi-
viduals was conducted to determine test–retest reliability (Gilliam, 2014). Reasonable correla-
tions were recorded for the various subscales with average correlation coefficients ranging from
.76 to .87. In addition, superior test–retest correlations of .90 and .90 were recorded for the
Autism Index 4 and Autism Index 6, respectively. To measure interrater reliability, an additional
study was conducted in which 232 raters rated 116 individuals with autism using the GARS-3.
Intraclass correlation coefficients (ICC) were then used to calculate interrater reliability. ICCs are
often used to measure interrater reliability when data are considered to be interval data and are
often preferred over Pearson’s r (Lecavalier, 2005). Average ICCs were within the acceptable
range (.71-.85) for all subscales and were considered to be good for the Autism Index 4 (.84) and
Autism Index 6 (.84; Gilliam, 2014).

Validity
Authors of the GARS-3 present validity information for content-description validity, criterion-
prediction validity, and construct-identification validity in the Examiner’s Manual. To obtain
content-description validity, the authors of the GARS-3 reviewed diagnostic criteria from
Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; APA,
2000), DSM-5 (APA, 2013), International Classification of Diseases, Tenth Edition (ICD-10)
Test Review 345

(World Health Organization, 1992), and the Autism Society (2012) concerning behaviors perti-
nent for the diagnosis of autism (Gilliam, 2014). From this information, a checklist was created
with 120 items that was sent to various parents, university professors, and clinicians for review
(these individuals were asked to rate the importance of each item). This, along with asking vari-
ous parents and professionals to submit electronic ratings using a GARS-3 prototype, was used
to collect data that eventually were analyzed by factor analysis leading to a final product with 58
items. In addition, item discrimination was investigated by examining each item on each subscale
with the total score for that subscale. All point-biserial correlations were within the acceptable
range (.57-.86) indicating that the GARS-3 has good item discrimination (Gilliam, 2014).
To assess the criterion-prediction validity, four independent studies were conducted correlat-
ing scores from the GARS-3 with other assessments used in screening for autism that included
the Autism Behavior Checklist from the Autism Screening Instrument for Educational Planning–
Third Edition (ASIEP-3; Krug, Arick, & Almond, 2008), the Autism Diagnostic Observation
Scale (ADOS; Lord, Rutter, DiLavore, & Risi, 1999), the Carolina Autism Rating Scale–Second
Edition (CARS-2; Schopler, Van Bourgondien, Wellman, & Love, 2010), and the Gilliam
Asperger’s Disorder Scale (GADS; Gilliam, 2001). In each of these studies, both parent and
teacher forms were utilized. On average, scores from the Autism Index 6 correlated with more
than four tests at an acceptable .72 with a range of .68 to .77 across the four different correlations
(Gilliam, 2014). Similarly, the Autism Index 4 averaged a .76 correlation with the other four
instruments and had a range of .72 to .83. To further measure criterion-prediction validity, the
sensitivity and specificity of the GARS-3 were measured using binary classification and receiver
operating characteristic/area under the curve (ROC/AUC) analyses. Results of these analyses
found the Autism Indexes to be excellent in sensitivity (individuals with ASD testing positive)
and fair to excellent for specificity (individuals without ASD testing negative; Gilliam, 2014).
Construct-identification was established by using the GARS-3 on various populations, includ-
ing children with intellectual disability (n = 15), attention-deficit hyperactivity disorder (n = 73),
emotional disturbance/behavioral disorder (n = 58), learning disability (n = 163), speech and
language impairments (n = 54), and nondisabled typically functioning individuals (n = 130;
Gilliam, 2014). Results indicated that the GARS-3 was able to differentiate children with autism
from children with other disabilities or typically developing children. It was noted that children
with intellectual disability scored higher on the GARS-3 than all other diagnostic groups being
rated. This anomaly is most likely due to the small number of participants in the intellectual dis-
ability group or the possibility that some of the children within this group were inaccurately
classified. To further establish construct-identification validity, an exploratory factor analysis
was conducted on GARS-3 items. Results of the analysis revealed six factors that were consistent
with the structure of the GARS-3 and autism domains in the DSM-5 (Gilliam, 2014).

Commentary and Recommendations

The GARS-3 has undergone significant changes when compared with earlier versions of the
GARS (Gilliam, 2014). The instrument retained only 16 items from the previous version while
adding 42 new items to the rating scale. The GARS-3 was also updated to reflect changes with
regard to autism as it is presented in the DSM-5. In addition to these changes, the GARS-3 under-
went confirmatory and exploratory factor analyses to demonstrate the theoretical and empirical
validity of its subscales. Finally, new normative data were collected in 2010-2011 that were
consistent with demographic characteristics reported in the 2010 U.S. Census (Gilliam, 2014).
The GARS-3 is relatively short and easy to administer and score. It has also demonstrated
reasonable evidence that it can yield valid and reliable scores, making it a psychometrically
sound instrument (Gilliam, 2014). Furthermore, the GARS-3 is currently up to date, and its con-
struction reflects both the DSM-5 and Autism Society’s definition of autism. One other strength
346 Journal of Psychoeducational Assessment 35(3)

of the GARS-3 is that it attempts to link assessment to intervention by including a booklet with
recommended instructional objectives for each item.
Despite its strengths, the GARS-3 also has a few weaknesses that should be noted. First, in
GARS-3, the Examiner’s Manual states that if a rater cannot accurately answer a question, they
should observe the individual for a 6-hr time period or consult someone else to obtain the infor-
mation (Gilliam, 2014). Although observing an individual for a 6-hr time period will improve
accuracy of ratings, it may not always be pragmatic. In addition, the authors provided no empiri-
cal evidence supporting psychometrics for ratings acquired in this manner. The normative sample
collected for the GARS-3 was composed completely of individuals diagnosed with autism,
meaning that individuals rated on this scale can only be compared with individuals diagnosed
with autism. The rationale for this choice is not clear in the Examiner’s Manual. In addition, the
normative sample collected on the GARS-3 is also mainly composed of individuals that are
White or Black/African American between the ages of 3 and 19 (Gilliam, 2014). This may call
into question the utility of this measure when assessing individuals between the ages of 20 to 22
as well as individuals of different races and ethnicities.
Overall, the GARS-3 has made significant strides from earlier editions of the instrument and
currently offers an easy-to-use rating scale that can be used to screen for autism or contribute to
an autism evaluation. The instrument has also been constructed on up-to-date definitions of
autism and includes a booklet of instructional goals to help link assessment to intervention
(Gilliam, 2014). The GARS-3 is also psychometrically sound overall; however, it is recom-
mended that examiners use caution when using the GARS-3 to assess individuals between 20 and
22 as well as individuals from minority groups.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.,
text rev.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Arlington, VA: American Psychiatric Publishing.
Autism Society. (2012). About autism. Available from http://www.autism-society.org
Centers for Disease Control and Prevention. (2012). FACTS: Facts about ASD. Retrieved from http://www.
cdc.gov/ncbddd/actea
Gilliam, J. E. (2001). Gilliam Asperger’s Disorder Scale. Austin, TX: Pro-Ed.
Gilliam, J. E. (2014). Gilliam Autism Rating Scale (3rd ed.). Austin, TX: Pro-Ed.
Krug, D. A., Arick, J. R., & Almond, P. J. (2008). Autism screening instrument for education planning (3rd
ed.). Austin, TX: Pro-Ed.
Lecavalier, L. (2005). An evaluation of the Gilliam Autism Rating Scale. Journal of Autism Developmental
Disorders, 35, 795-806.
Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism Diagnostic Observation Scale. Los Angeles,
CA: Western Psychological Services.
Schopler, E., Van Bourgondien, M. E., Wellman, G. J., & Love, S. R. (2010). Carolina Autism Rating Scale
(2nd ed.). Los Angeles, CA: Western Psychological Services.
World Health Organization. (1992). The ICD-10 classification of mental and behavioral disorders: Clinical
descriptions and guidelines. Geneva, Switzerland: Author.