Journal of Autism and Developmental Disorders (2022) 52:1536–1552

https://doi.org/10.1007/s10803-021-05048-y

ORIGINAL PAPER

A Psychometric Evaluation of the Quality of Life for Children

with Autism Spectrum Disorder Scale
Laura C. Chezan1 · Jin Liu2 · Judith M. Cholewicki2 · Erik Drasgow2 · Ruyi Ding3 · Adam Warman4

Accepted: 25 April 2021 / Published online: 7 May 2021

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021

Abstract
Our purpose in this study was to validate the Quality of Life for Children with Autism Spectrum Disorder scale. We first
conducted an exploratory factor analysis to examine the factor structure. Results suggested that a three-factor model (Inter-
personal Relationships, Self-Determination, and Emotional Well-Being) should be retained. Next, we conducted a confirma-
tory factor analysis to compare a higher-order factor model and additional models. Results showed acceptable model fit for
the higher-order factor model. The scale had excellent reliability (α = .90) for the overall scale and for the three subscales
(Interpersonal Relationships, α = .87; Self-Determination, α = .81; and Emotional Well-Being, α = .66). The 16-item scale
showed convergent and divergent validity. Implications for future research and practice are discussed.

Keywords Autism spectrum disorder · Children · Quality of life · Factor analysis · Validation

Quality of life (QOL) refers to an individual’s satisfac-
tion with his or her well-being across multiple domains
of functioning, including physical and emotional health,
interpersonal relationships, social inclusion, self-esteem,
and self-determination and is influenced by environmental
and personal variables (Cummings, 1997; Schalock et al.,
2009; Tavernor et al., 2012). Although there is no univer-
sally accepted definition of QOL, there is growing consen-
sus that QOL is a multidimensional construct consisting of
core domains that may vary across disciplines and popula-
tions (Claes et al., 2010; Dardas & Ahmad, 2014; White-
Koning et al., 2008). For example, the conceptual model of
QOL in the field of intellectual disabilities consists of eight
core domains: Emotional Well-Being, Personal Develop-
ment, Interpersonal Relations, Social Inclusion, Physical
* Laura C. Chezan
lchezan@odu.edu
1
Old Dominion University, 4501 Hampton Blvd., Child Study
Center 122, Norfolk, VA 23529, USA
2
University of South Carolina, 820 Main Street, Columbia,
SC 29208, USA
3
Tsinghua Shenzhen International Graduate School,
University Town of Shenzhen, Nanshan District,
Shenzhen 518055, People’s Republic of China
4
The Faison Center, 1701 Byrd Avenue, Richmond,
VA 23230, USA
Well-Being, Self-Determination, Material Well-Being,
and Rights (Schalock & Alonso, 2002). Furthermore, each
domain consists of specific indicators that allow the evalu-
ation of an individual’s QOL within the context of his or
her personal life experiences and circumstances (Cholewicki
et al., 2019; Claes et al., 2010).
Over the last three decades, the concept of QOL has been
discussed in relation to service delivery and treatment imple-
mentation for individuals with disabilities (Burgess & Guts-
tein, 2007; Dardas & Ahmad, 2014; Schalock & Alonso,
2002). Specifically, researchers have recognized the impor-
tance of QOL as an outcome to evaluate the effectiveness
of treatments and services received by individuals with dis-
abilities in the fields of education, health care, and social
services (Downs et al., 2019; Gomez et al., 2016; Schalock
& Verdugo, 2013). Using QOL as an outcome to evaluate
treatment effectiveness and its impact on an individual’s life
has been proposed as an alternative to address the limitations
of traditional norm-referenced assessments that evaluate uni-
dimensional outcomes, such as intelligence or standardized
academic achievement, and have little to no predictive value
of QOL in individuals with disabilities (Burgess & Guts-
tein, 2007; Granpeesheh et al., 2009; Matson, 2007; Renty
& Roeyers, 2006). Specifically, norm-referenced assess-
ments that capture an individual’s performance at one point
in time and compare it to the average performance of typi-
cal individuals are not good indicators of individuals with

13
Vol:.(1234567890)
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
disabilities’ functioning across life domains and may lead
to inaccurate conclusions about treatment effects. Thus, it
is critical to develop and validate alternative measures that
have the potential to provide accurate data regarding the
effects of a treatment on an individual’s QOL.
One group of individuals with disabilities who would
benefit from examining QOL as an outcome to evaluate
the effectiveness of treatments and services consists of
individuals with autism spectrum disorder (ASD). ASD
is a neurobiological disorder characterized by deficits in
social-communication skills and restrictive, repetitive pat-
terns of behavior (American Psychiatric Association [APA],
2013). These deficits have the potential to lower the QOL
of individuals with ASD across domains such as interper-
sonal relationships, emotional well-being, or social inclusion
(Cholewicki et al., 2019). For example, repetitive social-
communication behaviors, such as persisting on a topic of
interest (e.g., cars) in the presence of social partners have
been associated with negative consequences on the personal
and social life of individuals with ASD, including social iso-
lation and limited friendships and, consequently, low levels
of QOL (Rodriguez & Thompson, 2015; Wolfe et al., 2019).
Despite the increase in the prevalence of ASD (i.e., 1
in 54 children is diagnosed with ASD; Centers for Disease
Control & Prevention, 2020) and the growing evidence base
of effective practices for children with ASD, the research on
QOL as a treatment outcome measure for this population
is virtually nonexistent (Burgess & Gutstein, 2007; Gomez
et al., 2010). Therefore, developing valid and reliable meas-
ures to assess QOL as an outcome measure of treatment
effectiveness in children with ASD is critical for two rea-
sons. First, it has the potential to contribute to and extend the
limited literature on examining QOL as an outcome measure
for children with ASD. Second, it would assist practition-
ers working with children with ASD to make data-based
instructional decisions to guide treatment planning and ser-
vice delivery to enhance their QOL in current and future
environments.
Several condition-specific and generic pediatric QOL
scales have been used to measure the health-related QOL in
children and adolescents with ASD: (a) the Pediatric Qual-
ity of Life Inventory (PedsQL) 4.0 (Varni et al., 2001) is
a 23-item scale developed for healthy and ill children and
adolescents aged 2 to 18 years and consists of four domains
(Physical Functioning, Emotional Functioning, Social Func-
tioning, and School Functioning); (b) the Inventory for the
Assessment of Life Quality in Children and Adolescents
(ILK) (Mattejat & Remschmidt, 2006) is a 9-item scale cre-
ated for children and adolescents aged 6 to 18 years and
consists of six domains (School, Family, Physical Health,
Mental Health, Social Relations with Peers, and Hobbies
and Recreational Activities); (c) the Child Health Illness
Profile-Child Edition (CHIP-CE) (Riley et al., 2001) is a
1537
45-item health-related QOL scale developed for children
and adolescents aged 6 to 11 years and consists of five
domains (Satisfaction, Comfort, Resilience, Risk Avoid-
ance, and Achievement); and (d) the Health Utilities Index 3
(HUI3) (Feeny et al., 1996) is a 45-item health-related scale
designed for children over the age of 5 years and consists of
eight domains (Vision, Hearing, Speech, Ambulation, Dex-
terity, Emotion, Cognition, and Pain).
Researchers have reported acceptable validity and reli-
ability coefficients for most of the scales listed previously
(Kuhlthau et al., 2010; Tilford et al., 2012; Varni et al.,
2003); however, three aspects warrant further discussion.
First, these scales were developed to measure an individual’s
health-related QOL in an effort to improve health outcomes
and examine the effectiveness of healthcare services rather
than evaluating QOL as an outcome for treatments designed
to promote skill acquisition and socially appropriate behav-
iors in individuals with ASD. Second, although these scales
have been used to measure health-related QOL in children
and adolescents with ASD, none of them were developed
specifically for children with ASD who experience unique
social-communication and behavioral characteristics that
influence their functioning across life domains. Third,
researchers have examined the reliability and validity of the
scales listed previously on samples of adolescents with ASD
and no cognitive deficits (Limbers et al., 2009; Sheldrick
et al., 2012, Shipman et al., 2011). However, reliability and
validity of these scales have not been examined with samples
consisting of adolescents with ASD and cognitive deficits
who are characterized by lower levels of intellectual and
adaptive functioning that may influence their QOL. Further-
more, except for the PedsQL 4.0, all existing scales failed
to establish psychometric properties for children with ASD
(Ikeda et al., 2014).
Assuming that these scales are valid across samples
of children with ASD may lead to inaccurate conclusions
regarding the effects of treatments on their QOL. Conse-
quently, it is critical to develop reliable and valid measures
that are good indicators of treatment effectiveness on the
QOL of children with ASD who face unique social-com-
munication and behavioral challenges that impact their
functioning across life domains. Reliable and valid meas-
ures are an important component of evidence-based prac-
tices to promote successful functioning of children with
ASD in current and future environments. To address the
shortcomings related to the lack of measures to assess QOL
as a treatment outcome for children with ASD, two scales
have been recently proposed in the literature. Gomez et al.
(2020) adapted the KidsLife Scale (Gomez et al., 2016) for
use with children and adolescents with ASD and intellectual
disability (ID). The scale was initially designed for children
and adolescents with ID and consists of eight QOL domains
based on the conceptual model proposed by Schalock and
13
1538
Alonso (2002). The adapted version of the scale (i.e., Kid-
sLife-ASD) is a proxy report consisting of 96 items that is
intended for individuals ages 4 years to 21 years old. The
scale has demonstrated good reliability (Cronbach’s alpha
ranged from .78 to .91) and acceptable convergent and dis-
criminant validity (Gomez et al., 2020).
Cholewicki and her colleagues (2019) developed the
Quality of Life for Children with Autism Spectrum Disor-
der (QOLASD-C) scale. The QOLASD-C is intended for
children age 5 years to 10 years old and is comprised of
21 items divided across three QOL domains: Interpersonal
Relationships, Self-Determination, and Emotional Well-
Being. The Interpersonal Relationships domain evaluates
children’s ability to interact with other children and to
engage in social activities. The Self-Determination domain
assesses children’s ability to make choices related to daily
activities and the Emotional Well-Being domain measures
the emotional functioning of children with ASD. The scale
was also developed based on the conceptual model of QOL
proposed by Schalock and Alonso (2002) while incorporat-
ing the variance within the developmental levels of commu-
nication, social interaction, and patterns of behavior charac-
teristic to children with ASD (Plimley, 2007).
According to Cholewicki et al. (2019), the QOLASD-C
includes only three of the eight domains of the conceptual
model of QOL proposed by Schalock and Alonso (2002)
because they (a) represent the most frequently examined
domains in children with similar characteristics, (b) are
the most relevant to the developmental stages of children
with ASD, and (c) can be evaluated based on perceptions
related to social acceptance, well-being, and control over
one’s life (Keith & Schalock, 1994). The QOLASD-C is
a parent-proxy version, and it takes approximately 10 min
to complete. Cholewicki and colleagues collected content
validity evidence through expert feedback and focus groups
with parents of children with ASD. Initial reliability evi-
dence collected within the context of a pilot study at the time
of the scale development indicated strong internal consist-
ency (α = .82).
Although both scales listed previously have been
designed for individuals with ASD based on the same con-
ceptual model of QOL, several aspects warrant discussion.
First, the KidsLife-ASD has been validated on a Spanish
population of children and adolescents with ASD and its
psychometric properties have not been examined for this
population of individuals in other countries, including the
United States. Because perceptions of one’s QOL may
vary across cultures (Hofstede, 1984), the applicability of
KidsLife-ASD to individuals from populations other than
Spanish remains unknown. Second, KidsLife-ASD has been
designed for individuals age 4 years to 21 years old, whereas
the QOLASD-C scale has been designed for children age
5 years to 10 years old. Researchers have demonstrated that
13
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
parents of younger children with ASD reported higher levels
of QOL compared to parents of older children with ASD
(Kuhlthau et al., 2010). Consequently, it is important to
develop and validate QOL scales that account for the char-
acteristics specific to a target age group (e.g., children, ado-
lescents, adults) and have the potential to accurately detect
the QOL in the population for whom it was designed. Third,
although the QOLASD-C demonstrated initial strong reli-
ability for children with ASD in the United States, no rigor-
ous validation, such as factor analysis and construct validity,
was conducted to determine its psychometric properties and
usability for children with ASD. Thus, the purpose of this
study was to extend the existing research on QOL by vali-
dating the QOLASD-C with parents of children with ASD
using exploratory factor analysis (EFA) and confirmatory
factor analysis (CFA). Moreover, we examined the conver-
gent and divergent validity of the QOLASD-C by evaluating
its association with the PedsQL 4.0 (Varni et al., 2001).
Method
Participants
Participants included in this study were parents of children
with ASD. Parents were eligible for participation in the
study if they (a) had a child with ASD between the ages
of 5 years and 10 years and (b) had lived with their child
with ASD during the past 12 months. We recruited partici-
pants through state and national ASD parent organizations,
service providers working with children with ASD, and
social media. A description of the study purpose, eligibility
criteria, voluntary participation, and the URL link to the
scale was posted on social media and emailed to parents
using the organization or service providers’ listserv or email
database. The study was approved by the university Institu-
tional Review Board and all participants signed an electronic
informed consent prior to participating in the study.
A total of 333 participants were recruited for this
study. Twenty-four participants accessed the URL link
but did not submit any responses. Therefore, responses
received from 309 participants who completed the scale
were included in the analysis. Responses received from
169 parents of children with ASD were used to examine
the factor structure of the QOLASD-C and its relation-
ship to the hypothesized model within the context of an
EFA. Responses from the remaining sample of 140 par-
ents of children with ASD were used to conduct a CFA
to confirm the factor solution previously identified. We
decided to use two different samples to explore and con-
firm the factor structure of the scale based on the recom-
mendation published in the literature to first conduct an
EFA to determine the factor structure of a scale based
Journal of Autism and Developmental Disorders (2022) 52:1536–1552 1539

on theory and then cross-validate the results by conduct- Measures

ing a CFA with a different sample to obtain more robust
results (Cabrera-Nguyen, 2010; Worthington & Whit-
taker, 2006). Although there is no consensus on the num-
ber of participants required to estimate the sample size
when conducting factor analyses, numerous researchers
have suggested a rule of thumb of five to ten participants
per item (e.g., Comrey & Lee, 1992; Gorsuch, 1983; Nun-
nally & Bernstein, 1994). According to the rule of thumb
listed previously, the sample sizes included in our analy-
ses should range from 105 to 210 participants.
Children’s demographic data were reported by 233
parents who completed the scale and are displayed in
Table 1 both for the EFA sample and for the CFA sample.
Comparison analysis data revealed that the two samples
did not differ in demographic characteristics related to
age (t(194) = 1.17, p = .24) and type of education (χ2 (1,
N = 202) = 3.81, p = .05). Data also indicated that there
was a gender difference between the two samples (χ 2
(1, N = 208) = 5.91, p = .01). To further investigate this
difference, we calculated the effect size using the phi-
coefficient. A value of .1 is considered a small effect
size, a value of .3 is considered a medium effect size and
a value of .5 is considered a large effect size (Nandy,
2012). Data indicated that the practical significance of the
gender difference between the two samples was minimal
as illustrated by a small effect size (phi = .16).
QOLASD‑C
The QOLASD-C was developed to assess QOL as a treat-
ment outcome for children with ASD across three domains:
Interpersonal Relationships, Self-Determination, and Emo-
tional Well-Being. The scale is designed for children with
ASD age 5 years to 10 years old. It consists of 21 items and
takes approximately 10 min to complete. Parents are asked
to rate their satisfaction level with the child’s QOL in each of
the three domains using a 4-point Likert scale ranging from
1 (i.e., “Strongly Disagree”) to 4 (i.e., “Strongly Agree”).
Nineteen of the 21 items on the scale are positively worded
(e.g., “My child is able to express likes”) and two items are
negatively worded (e.g., “My child regularly feels sad”). The
score for the negatively worded items was inverted prior to
the analysis. Responses are summed for each domain and an
overall score also can be calculated by summing all items
ratings, with higher scores indicating high levels of QOL and
lower scores indicating low levels of QOL. Previous research
has demonstrated that parents’ responses are reliable when
evaluating the QOL of children as illustrated by moderate
correlations between parent-proxy reports and self-reported
QOL scores (Coghill et al., 2009; de Vries & Geurts, 2015).
The QOLASD-C scale has shown good internal consistency
across the domains’ scores (α = .65 to .74) and for the total
scale (α = .82; Cholewicki et al., 2019). No other psycho-
metric information has been reported for the QOLASD-C.

Table 1  Children’s Characteristic EFA sample (N = 93) CFA sample (N = 140) Combined sample
demographic characteristics (N = 233)
n % n % n %

Gender
Male 62 66.7 94 67.1 156 66.9
Female 11 11.8 42 30.0 53 22.7
Not reported 20 21.5 4 2.9 24 10.4
Age
5 years 10 10.8 14 10.0 24 10.3
6 years 5 5.4 24 17.1 29 12.4
7 years 7 7.5 20 14.3 27 11.6
8 years 18 19.4 35 25.0 53 22.7
9 years 6 6.5 20 14.3 26 11.1
10 years 18 19.4 18 12.9 36 15.5
Not reported 29 31.2 9 6.4 38 16.4
Type of education
School 57 61.3 116 82.9 173 74.2
Homeschool 15 16.1 14 10.0 29 12.4
Not reported 21 22.6 10 7.1 31 13.4

EFA exploratory factor analysis, CFA confirmatory factor analysis

13
1540
Pediatric Quality of Life Inventory (PedsQL) 4.0
PedsQL 4.0 (Varni et al., 2001) assesses QOL in children
and adolescents aged 2 to 18 years across four domains:
Physical Functioning, Emotional Functioning, Social
Functioning, and School Functioning. The scale consists
of 23 items and takes approximately 5 min to complete.
It includes two versions (i.e., a child or adolescent self-
report and a parent-proxy report) and can be administered
both to healthy individuals and to individuals with acute
and chronic conditions. Items are rated on a 4-point Likert
scale ranging from 0 (i.e., “Never”) to 4 (i.e., “Almost
Always”). Responses are summed for each domain and
an overall score also can be computed by summing all
items ratings, with higher scores being associated with
high levels of QOL and lower scores being associated
with low levels of QOL.
Psychometric information to support the use of Ped-
sQL 4.0 was well-developed. In terms of reliability, total
scores from the child-report version were consistent with
the total scores from the parent-report version (α = .88
for the child report and .90 for the parent report) (Varni
et al., 2001, 2003) and inter-rater reliability was estimated
at .58 (Sheldrick et al., 2012). Convergent validity esti-
mates ranged from .35 to .59 suggesting low to moderate
correlations with measures assessing similar constructs,
such as the Asperger Syndrome Diagnostic Scale (ASDS;
Myles et al., 2001a, 2001b) (Limbers et al., 2009). Dis-
criminant validity estimates revealed low correlations
with scales measuring different constructs, such as the
Wechsler Intelligence Scale for Children Revised (WISC-
R; Wechsler, 1974) (Bastiaansen et al., 2004). Regarding
concurrent validity, researchers have reported positive
and significant correlations between PedQL 4.0 self-
report scores and parent-report scores (Shipman et al.,
2011). We administered PedsQL 4.0 to investigate the
convergent and divergent validity of QOLASD-C. We
selected this measure because it was the only pre-existing
measure used with individuals with ASD that assessed
similar constructs with the QOLASD-C at the time when
data were collected for this project. We only used three
of the four PedsQL 4.0 subscales (i.e., Emotional Func-
tioning, Social Functioning, and School Functioning) that
assessed QOL constructs similar to those evaluated with
QOLASD-C.
Statistical Analyses
Descriptive statistics and EFA data analysis were con-
ducted using the Statistical Package for the Social Sci-
ences (SPSS) (2016) Statistics Version 24.0. CFA data
analysis was conducted in Mplus Version 8.4.
13
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
Reliability
We used Cronbach’s alpha to estimate the internal con-
sistency of the items on the QOLASD-C scale (Cronbach,
1951). Item-total correlation between individual items and
alpha estimates with items deleted were used to examine and
remove items that were not functioning optimally (e.g., items
with negative values). To estimate the internal consistency
of the items on the scale, we used the criterion proposed by
Barker et al. (1994). Alpha coefficients with values of .60
indicate insufficient internal consistency, values between
.60 and .69 indicate marginal internal consistency, values
between .70 and .79 suggest acceptable internal consistency,
values between .80 and .89 show good internal consistency,
and values of .90 or higher indicate excellent internal con-
sistency. Furthermore, to indicate consistency between items
on the scale the item-total correlations should have values
of at least .20 (Crocker & Algina, 1986). If any items were
removed, we reanalyzed the model with the remaining items.
Some researchers have advocated for the use of ordinal alpha
as a measure of reliability for Likert-type scales with less
than five options (Zumbo et al., 2007). However, we decided
to report Cronbach’s alpha rather than ordinal alpha for two
reasons. First, ordinal alpha is not widely used in the field
of social sciences and, thus, its relevance and ease of inter-
pretation may be limited for readers in education. Second,
there is a lack of consensus in the field of psychological
measurement related to the appropriateness of ordinal alpha
for calculating reliability because it represents a measure
of hypothetical reliability rather than a measure of a test’s
reliability and, consequently, it should not be used as a reli-
ability coefficient (Chalmers, 2018).
Factor Structure
EFA To examine the factor structure of the 21-item QOL-
ASD-C and its relationship to the hypothesized model, we
conducted an EFA (Thompson, 2004), as the factor structure
has not been investigated using factor analysis in prior litera-
ture. We employed a principal axis factoring (PAF) extrac-
tion method with an oblique (i.e., promax with Kaiser nor-
malization) rotation using the correlation matrix displayed
in Table 2. PAF was suitable for ordinal data and oblique
rotation was used because we assumed that the factors would
be correlated theoretically (Osborne, 2015). Rotation is com-
monly used to assist with the interpretation of the factor
solution (Benson & Nasser, 1998).
The eigenvalue procedure with a cut-off value of 1.0 (Kai-
ser, 1960) was used in conjunction with the visual scree
procedure (Cattell, 1966) to check the trend of the eigen-
values and to determine the number of factors retained on
the scale. To ensure that each item made a unique contribu-
tion to a specific factor, we excluded items with a loading
 Table 2  Correlation matrix of the 21-item Quality of Life of Children with Autism Spectrum Disorder (QOLASD-C) scale
1 2 3 4 5 6 7 8 10 11 13 15 16 17 18 19 20 21

1 –
2 .097 –
3 .329** .034 –
4 .552** .110 .246** –
5 .350** .136* .100 .400** –
6 .297** .221** .055 .529** .310** –
7 .221** .238** .055 .314** .167* .318** –
8 .074 .352** .000 .070 .155* .222** .437** –
Journal of Autism and Developmental Disorders (2022) 52:1536–1552

10 .100 .373** -.003 .099 .104 .131 .444** .693** –

11 .249** .265** .057 .342** .211** .327** .517** .403** .335** –
13 .086 .346** .075 .149* .130* .199** .447** .586** .685** .393** –
15 -.071 .138* -.011 .079 .010 .085 .233** .291** .206** .269** .264** –
16 .141* .261** -.007 .183* .165* .147* .277** .362** .325** .383** .359** .369** –
17 -.084 .153* -.085 .015 .057 .078 .108 .240** .195** .083 .280** .203** .387** –
18 -.006 .031 -.064 .012 .032 .084 .198** .370** .227** .256** .309** .192** .525** .341** –
19 .122 .208** .097 .208** .293** .201** .167* .348** .290** .271** .324** .320** .509** .466** .424** –
20 .127 .053 .163* .270** .089 .184** .269** .320** .218** .354** .237** .250** .431** .079 .376** .386** –
21 .049 .137* -.036 .069 .111 .155* .108 .221** .147* .303** .112 .192** .322** .196** .369** .278** .220** –

1 = My child regularly feels sad; 2 = My child shows pleasure when learning new skills; 3 = My child likes going to school; 4 = My child is generally happy; 5 = My child sleeps well; 6 = My
child is relaxed when at home; 7 = My child enjoys family activities; 8 = My child shows pleasure when interacting with other children; 10 = My child enjoys playing with groups of children;
11 = My child enjoys spending time with family members; 13 = My child likes to do many activities with others; 15 = My child relies on others to select his or her activities; 16 = My child is able
to express likes; 17 = My child selects his or her clothes for the day; 18 = My child shows preferences for places he or she would like to go; 19 = My child can initiate several tasks independently;
20 = My child shows pleasure about a particular activity; 21 = My child selects what he or she wants to eat. *p < .05. **p < .01

13
1541
1542
below .30 and items that did not load on any factors (Child,
2006). Furthermore, the factors retained should have at least
three to five items as recommended in the literature on factor
analysis (MacCallum et al., 1999). This decision was made
to avoid “overfactoring” as illustrated by unique or specific
factors that had only one or two items and limited theoreti-
cal value which could have led to inaccurate interpretations
(Gorsuch, 1983). Because the final factor solution should
have no or very few cross-loading items (i.e., items that load
on two factors), when we identified a cross-loading item,
we decided to keep the item on one of the factors based on
theory. The factor solution was evaluated upon its interpret-
ability and related theories (Gorsuch, 1983).
Correlations between the three factors of the QOLASD-
C scale were calculated to determine their associations. We
used the correlation coefficients criteria proposed by Dancey
and Reidy (2007) to interpret the relationships between fac-
tors. Correlation coefficients with a value of 1 indicate a
perfect correlation, values between .70 and .90 show strong
correlations, values between .40 and .60 reveal moderate
correlations, values between .10 and .30 indicate weak
correlations.
CFA To confirm the factor structure of the QOLASD-
C scale we examined several models using CFA. First, we
examined the one-factor model loaded onto a single general
factor. Second, we analyzed the factor model with three fac-
tors as identified with EFA. Third, we tested a higher-order
factor model and a bi-factor model. The higher-order fac-
tor model consisted of a second-order factor (i.e., overall
QOL) and three first-order factors (i.e., interpersonal rela-
tionship, self-determination, and emotional well-being). In
this model, the higher-order factor accounts for covariances
among lower-level factors instead of correlating three lower-
level factors (Gignac, 2008). In contrast, the bi-factor model
adds a general factor accounting for the community of all
items in addition to the three factors defined in the three-
factor model. In the bi-factor model, each item is an indica-
tor both of the general factor and of the specific factors. We
used the weighted least squares mean- and variance-adjusted
estimator (WLSMV) within Mplus Version 8.4. (Muthén
& Muthén, 1998–2017). The WLSMV estimation method
was used to accommodate the ordinal data collected with
the QOLASD-C scale. Because ordinal data do not meet
the CFA statistical assumptions (i.e., continuous data and
normal distribution), alternative estimation methods such
as WLSMV are needed to address the concerns related to
the violation of statistical assumptions and to increase the
trustworthiness of model fitting data.
To determine the optimal model, we examined the factor
loadings and model fit. First, items with loadings below .30
on their theoretically expected factors were deleted from the
model (Child, 2006). Model fit was evaluated using several
fit indices: the normed Chi-square test of model fit (NC),
13
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
comparative fit index (CFI), Tucker-Lewis Index (TLI),
standardized root mean square (SRMR), and residual root
mean square error of approximation (RMSEA). Cut-off
values of CFI ≥ .90, TLI ≥ .90, SRMR ≤ .10, RMSEA ≤ .08
demonstrate adequate model fit and values of CFI or
TLI ≥ .95, RMSEA ≥ .05, and SRMR ≤ .08 indicate good
model fit (Burns et al., 2019; Hu & Bentler, 1999). Because
Chi-square is sensitive to sample size and contains a restric-
tive hypothesis test, the ratio of the chi-square goodness of
fit value to the model degree of freedom (NC/df) was exam-
ined and a ratio of less than 3 was considered an acceptable
fit (Schermelleh-Engel et al., 2003). Our data revealed that
the higher-order factor model shared the same model fit as
the three-factor model, as the degree of freedom was the
same for the three-factor correlations and covariates with the
higher-order factors. Therefore, we compared the strength
of correlations between factor correlations and first-order
factor loadings to select an optimal factor solution. Finally,
we correlated certain item residuals to improve the model fit.
Convergent and Divergent Validity
Convergent and divergent validity between the QOLASD-C
and PedsQL 4.0 was investigated in relation to conceptually
relevant constructs across the two scales. One approach that
has been widely used in scale validation to analyze conver-
gent and divergent validity consists of calculating correla-
tions among scales or subscales and utilizing correlation
coefficients cut-off values to compare the magnitude of cor-
relations (e.g., Ding et al., 2021; Gau et al., 2013; Williams
et al., 2018). Weak correlations coefficients provide evidence
of divergent validity, whereas moderate to strong correlation
coefficients provide evidence of convergent validity (John-
son & Morgan, 2016). We used the correlation coefficients
criteria proposed by Dancey and Reidy (2007) to interpret
the relationship between subscales.
Zero-order correlations between the QOLASD-C and
PedsQL 4.0 subscales were examined in SPSS 24.0. One
hypothesis was that factors measuring similar constructs on
the QOLASD-C and the PedsQL 4.0 subscales would show
moderate associations providing evidence of convergent
validity. Specifically, we hypothesized that (a) the QOL-
ASD-C Interpersonal Relationships scores will show the
strongest correlations with the PedsQL 4.0 Social Function-
ing scores, (b) the QOLASD-C Self-Determination scores
will show the strongest correlations with the PedsQL 4.0
School Functioning scores, and (c) the QOLASD-C Emo-
tional Well-Being scores will show the strongest correlations
with the PedsQL 4.0 Emotional Functioning and the PedsQL
Social Functioning scores. Another hypothesis was that fac-
tors measuring different constructs on the QOLASD-C and
the PedsQL 4.0 subscales will have weak and no signifi-
cant associations and, thus, provide evidence of divergent
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
validity. Specifically, we hypothesized that the QOLASD-C
Interpersonal Relationships and Self-Determination scores
will have low correlations with the PedsQL 4.0 Emotional
Functioning scores.
Results
Reliability
Internal consistency estimates for the 21-item QOLASD-
C scale showed good reliability (α = .82) with Cronbach’s
alpha-if-item-deleted values ranging from .79 to .83. Item-
to-total correlations ranged from .15 to .59. However, one
item (“My child would like more friends”) had a negative
item-to-total correlation (α = − .08) and was removed from
the scale. The internal consistency estimate was slightly
higher after the item was removed, suggesting good reli-
ability (α = .83). In summary, data indicated high internal
consistency of the 20-item QOLASD-C and items function-
ing optimally to measure the multidimensional construct of
QOL.
Factor Structure of the QOLASD‑C
EFA We conducted initial EFAs with both the 21-item QOL-
ASD-C and the 20-item QOLASD-C. Table 3 shows the
solution for these two analyses. Although the eigenvalues
suggested the optimal factor number as five, the fourth and
fifth factors had less than three items, indicating overfac-
toring. The eigenvalues also aligned with the trend in the
scree plot. Therefore, the three-factor structure was selected
for initial analysis. One item (“My child would like more
friends”) had a negative item-to-total correlation (α =  − .08)
and was removed from the scale after conducting the EFA
for the 21-item QOLASD-C. After removing this item, we
reran the EFA with the 20-item QOLASD-C. Two items
(“My child has other children that will help him or her when
needed” and “My child is happy to work with his or her
teacher”) did not have a factor loading higher than .30 on
any of the three factors and were dropped from the scale
following the analysis.
After removing the two additional items, we reran
the EFA for the remaining 18 items to increase the item-
respondent ratio. The eigenvalues suggested a five-factor
solution when using the cut-off value of 1.0. However, the
fifth and fourth factors had eigenvalues close to 1.0 and the
scree plot indicated that only three factors were above the
point of inflexion (see Fig. 1). Furthermore, minor changes
in eigenvalues occurred after the third factor. In addition,
we also referred to the original structure of the scale which
contained three factors, namely Interpersonal Relationships,
Self-Determination, and Emotional Well-Being. Therefore,
1543
we decided to select the three-factor model as the optimal
solution.
The three factors measured the following QOL domains:
“Interpersonal Relationships” (Factor 1), Self-Determination
(Factor 2), and Emotional Well-Being (Factor 3). Table 4
displays the EFA solution for the 18-item QOLASD-C. The
final factor solution had a simple structure with most items
meaningfully loaded on one factor. The loadings ranged
from .33 to .93 across the three factors retained. Items on
the Interpersonal Relationships factor were related to the
children’s ability to engage in activities and interact with
peers and family members while learning new skills. “My
child enjoys playing with groups of children” was a marker
variable for this factor. A marker variable is a variable that
loads on one factor and is theoretically unrelated to other
factors as illustrated by low or no correlations with variables
from those factors (Lindell & Whitney, 2001). Items related
to making choices and expressing preferences for items and
activities comprised the Self-Determination factor. Item 16
(“My child is able to express likes”) was a marker variable
for this factor. The third factor, Emotional Well-Being, was
comprised of items related to children’s feelings and emo-
tions. A marker variable for the Emotional Well-Being factor
was “My child is generally happy.”
The three-factor solution aligned with the original factor
structure with several minor changes. One item (“My child
enjoys spending time with family members”) cross-loaded
both on the Interpersonal Relationships factor and on the
Emotional Well-Being factor. The wording of the item was
related to both factors because it emphasized feelings as well
as interactions with family members. To obtain a simple
factor solution, we examined the loadings of this item on
each of the two factors. We decided to keep the item on the
Interpersonal Relationships factor as listed in the original
model because the loading was slightly higher for the Inter-
personal Relationships factor (.33) than for the Emotional
Well-Being factor (.30). Furthermore, two items (“My child
shows pleasure when learning new skills” and “My child
enjoys family activities”) that were initially included in the
Emotional Well-Being factor were moved to the Interper-
sonal Relationships factor based on factor loadings because
the loadings were higher for the Interpersonal Relationships
factor than for the Emotional Well-Being factor.
Correlation data indicated a moderate association
between the Self-Determination factor and the Interpersonal
Relationships factor (r = .53, p < .01). Data also revealed a
weak association between the Emotional Well-Being factor
and the Interpersonal Relationships factor (r = .32, p < .01)
and the Emotional Well-Being factor and the Self-Determi-
nation factor (r = .30, p < .05).
CFA Data revealed that two items that were negatively
worded (i.e., “My child relies on others to select his or her
activities”; “My child regularly feels sad”) had an inadequate
13
1544 Journal of Autism and Developmental Disorders (2022) 52:1536–1552

Table 3  Standardized factor loadings for the 21-item and 20-item Quality of Life for Children with Autism Spectrum Disorder (QOLASD-C)
scale
21-Item QOLASD-C Factor loading 20-Item QOLASD-C Factor loading
1 2 3 1 2 3

Factor 1: Interpersonal Relationships Factor 1: Interpersonal Relationships

10. My child enjoys playing with groups of .94 − .1 − .1 10. My child enjoys playing with groups of .94 − .1 − .1
children children
13. My child likes to do many activities with .77 .02 − .02 13. My child likes to do many activities with .77 .03 − .02
others others
8. My child shows pleasure when interacting .74 .14 − .1 8. My child shows pleasure when interacting .74 .14 − .1
with other children with other children
11. My child enjoys spending time with family .32 .19 .3 11. My child enjoys spending time with family .32 .19 .3
members members
9. My child has other children that will help .15 .21 .04 9. My child has other children that will help .15 .21 .04
him or her when needed him or her when needed
12. My child is happy to work with his or her .19 0 .29 12. My child is happy to work with his or her .19 0 .29
teacher teacher
14. My child would like more friends − .04 0 − .07
Factor 2: Self-Determination Factor 2: Self-Determination
16. My child is able to express likes .02 .74 .04 16. My child is able to express likes .02 .74 .04
18. My child shows preferences for places he or − .04 .76 − .15 18. My child shows preferences for places he − .04 .76 − .15
she would like to go or she would like to go
19. My child can initiate several tasks indepen- − .05 .7 .09 19. My child can initiate several tasks indepen- − .05 .7 .09
dently dently
17. My child selects his or her clothes for the day .01 .53 − .18 17. My child selects his or her clothes for the .01 .53 − .18
day
21. My child selects what he or she wants to eat − .07 .5 .01 21. My child selects what he or she wants to − .07 .5 .01
eat
20. My child shows pleasure about a particular 0 .46 .2 20. My child shows pleasure about a particular 0 .46 .2
activity activity
15. My child relies on others to select his or her .14 .37 − .06 15. My child relies on others to select his or .14 .37 − .06
activities her activities
Factor 3: Emotional Well-Being Factor 3: Emotional Well-Being
4. My child is generally happy − .08 0 .86 4. My child is generally happy − .08 0 .86
1. My child regularly feels sad − .02 − .11 .7 1. My child regularly feels sad − .02 − .11 .7
6. My child is relaxed when at home .09 .04 .49 6. My child is relaxed when at home .09 .04 .49
5. My child sleeps well − .02 .07 .44 5. My child sleeps well − .02 .07 .44
3. My child likes going to school 0 − .11 .41 3. My child likes going to school 0 − .11 .41
2. My child shows pleasure when learning new .45 − .04 .09 2. My child shows pleasure when learning new .45 − .04 .09
skills skills
7. My child enjoys family activities .51 − .03 .24 7. My child enjoys family activities .51 − .03 .24

N = 169. The extraction method was principal axis factoring with an oblique (promax with Kaiser normalization) rotation. Factor loadings above.
30 are in bold

factor loading (below .30) and, thus, were removed from
the final model in all factor solutions. The removal of both
items from the tested models improved all model fit indices.
Table 5 presents the model fit values for all tested mod-
els after the removal of the two negatively worded items.
Fit indices for the one-factor solution including NC, CFI,
TLI, SRMR, and RMSEA were above the acceptable cut-
off values. In contrast, the overall model fit of the correlated
three-factor model, the higher-order factor model, and the
bi-factor model were acceptable in terms of most fit indices
(i.e., NC < 3, CFIs and TLIs ≥ .90, SRMRs ≤ .10). How-
ever, RSMEAs were above the acceptable cut-off values.
Although the bi-factor model exhibited better model fit com-
pared to the three-factor CFA model (i.e., the higher-order
factor model) as shown in Table 4, it could not be justified
theoretically. For example, after the inclusion of the general
factor, low or negative loadings were identified for multiple
items with three other factors. Therefore, this factor solution
was excluded from following examination.

13
Journal of Autism and Developmental Disorders (2022) 52:1536–1552 1545

Fig. 1  Scree plot for the 18-item

Quality of Life for Children
with Autism Spectrum Disorder
(QOLASD-C) scale

Table 4  Standardized Factor QOLASD-C Item Factor loading

Loadings for 18-Item Quality
of Life for Children with 1 2 3
Autism Spectrum Disorder
(QOLASD-C) Scale Factor 1: Interpersonal Relationships
10. My child enjoys playing with groups of children .93 − .11 − .11
13. My child likes to do many activities with others .77 .03 − .04
8. My child shows pleasure when interacting with other children .75 .12 − .09
7. My child enjoys family activities .54 − .04 .25
2. My child shows pleasure when learning new skills .44 − .02 .06
11. My child enjoys spending time with family members .33 .19 .30
Factor 2: Self-Determination
16. My child is able to express likes .02 .75 .03
18. My child shows preferences for places he or she would like to go − .04 .74 − .15
19. My child can initiate several tasks independently − .04 .70 .09
17. My child selects his or her clothes for the day .02 .53 − .17
21. My child selects what he or she wants to eat .06 .48 .02
20. My child shows pleasure about a particular activity .01 .46 .18
15. My child relies on others to select his or her activities .14 .37 − .07
Factor 3: Emotional Well-Being
4. My child is generally happy − .07 − .01 .87
1. My child regularly feels sad − .01 − .11 .70
6. My child is relaxed when at home .11 .03 .51
5. My child sleeps well − .00 .07 .46
3. My child likes going to school − .03 − .08 .34

N = 169. The extraction method was principal axis factoring with an oblique (promax with Kaiser normali-
zation) rotation. Factor loadings above .30 are in bold

Because the correlated three-factor model and the higher-
factor model exhibited the same fit, we further examined
loadings and factor correlations. Although the factor load-
ings were similar across both solutions, relations between
the first-order factors and the higher-order factor were higher
than the correlations among factors indicating stronger
associations. Therefore, the higher-order factor model was
selected as the final model. A further look at the modifica-
tion indices indicated that the model fit could be significantly
improved by allowing error covariances for certain items
(refer to Fig. 2). Examination of the item content showed
that adding correlations between these pairs of items were
meaningful. These modifications significantly improved all
fit indices.
The 16-item QOLASD-C scale factor solution and the
standardized parameter estimates are displayed in Fig. 2.
Data showed that all factor loadings were higher than .40.
The associations between the first-order factor and the

13
1546 Journal of Autism and Developmental Disorders (2022) 52:1536–1552

second-order factors ranged from .83 to .91, indicating
strong correlations between the two layers of factors. Com-
pared to the original model, the Cronbach’s alphas in the
final CFA model were higher for the Interpersonal Rela-
tionships and Self-Determination factors, and lower for the
Emotional Well-Being factor with an overall Cronbach’s
alpha of .90 for the total scale (Table 6). Cronbach’s alpha
coefficients suggested good internal consistency for the
Interpersonal Relationships (α = .87) and the Self-Deter-
mination (α = .81) subscales and marginal internal consist-
ency (α = .66) for the Emotional Well-Being subscale. The
reliability for the 16-item QOLASD-C scale was excellent
with a Cronbach’s alpha value of .90.
Convergent and Divergent Validity
Table 7 displays the correlations between the 16-item QOL-
ASD-C scale and PedsQL 4.0. Convergent validity data indi-
cated weak to moderate significant correlations between (a)
the Emotional Well-Being subscale and the PedsQL 4.0
subscales, (b) the Interpersonal Relationships subscale
and the PedsQL Social Functioning and School Function-
ing subscales, and (c) the Self-Determination subscale and

Table 5  Fit indices for CFA models

Models χ2/df CFI TLI SRMR RMSEA (90% CI)

Model A: one factor 383.68/104 .89 .87 .11 .14 (.12, .15)
Model B: CFA with three factors/higher-order factor model 281.43/101 .93 .91 .09 .11 (.10, .13)
Model C: bi-factor model 210.69/88 .95 .93 .07 .10 (.08, .12)
Model D: higher-order factor model with error covariances (final 223.77/99 .95 .94 .08 .10 (.08, .11)
solution)

CFA confirmatory factor analysis, CFI Comparative Fit Index, SRMR standardized root-mean square residual, RMSEA root-mean-square error of
approximation, CI confidence interval

Fig. 2  The higher-order factor

model for the 16-item Qual-
Q2 Interpersonal
ity of Life for Children with Q7 Relaonships
Autism Spectrum Disorder Q8

(QOLASD-C) scale Q10

0.30 Q11

Q13

Q16

Q17
0.79 Self- 0.84 Overall Life of
Q18
Determinaon Quality
Q19

Q20

Q21

0.34 Q3

Q4

Q5 Emoonal Well-
Q6
being

Table 6  Cronbach’s Alpha and items distribution in original model, the model after EFA, and the final model
Subscale Original model Model after EFA Model after CFA
Items α Items α Items α

Interpersonal relationships 8, 9, 10, 11, 12, 13, 14 .54 2, 7, 8, 10, 11, 13 .82 2, 7, 8, 10, 11, 13 .87
Self-determination 15, 16, 17, 18, 19, 20, 21 .74 15, 16, 17, 18, 19, 20, 21 .74 16, 17, 18, 19, 20, 21 .81
Emotional well-being 1, 2, 3, 4, 5, 6, 7 .71 1, 3, 4, 5, 6 .67 3, 4, 5, 6 .66
Total scale 21 items .82 18 items .83 16 items .90

α = Cronbach’s Alpha

13
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
Table 7  Correlations between the 16-Item Quality of Life for Chil-
dren with Autism Spectrum Disorder (QOLASD-C) and the Pediatric
Quality of Life (PedsQL) Inventory 4.0 scale domains
QOLASD-C scale PedsQL 4.0 scale PedQL total
EF SocF SchF
Interpersonal relationships .08 .42** .26* .33**
Self-determination .14 .22* .36** .19
Emotional well-being .65** .42** .37** .67**
QOLASD-C total .17 .50** .45** .49**
EF emotional functioning, SocF social functioning, SchF school
functioning
*p < .05. **p < .01
the PedsQL 4.0 Social Functioning and School Function-
ing subscales. Divergent validity data revealed weak and no
significant associations between the PedsQL 4.0 Emotional
Functioning subscale and the 16-item QOLASD-C Self
Determination and Interpersonal Relationships subscales.
Discussion
Our purpose in this study was to validate the QOLASD-C
scale (Cholewicki et al., 2019) that intends to assess QOL as
a treatment outcome for young children with ASD. Overall
internal consistency estimates were high, suggesting excel-
lent reliability of the items comprising the scale. The EFA
suggested a three-factor model (i.e., Interpersonal Relation-
ships, Self-Determination, and Emotional Well-Being) con-
sistent with the structure of the original scale. Our analysis
indicated that three items should be deleted from the origi-
nal scale and two items should be moved to a different fac-
tor based on factor loadings and theoretical meaning. The
CFA revealed that two negatively worded items had inad-
equate factor loadings and were removed from the model.
The CFA analysis indicated that a higher-order factor model
consisting of a second-order factor (i.e., overall QOL) and
three first-order factors (i.e., Interpersonal Relationship,
Self-Determination, and Emotional Well-Being) had good
model fit and should be selected as the final model. The final
16-item QOLASD-C indicated marginal to good internal
consistency across factors and excellent internal consist-
ency for the total scale. Convergent validity was supported
by weak to moderate significant correlations across the
16-item QOLASD-C and PedsQL 4.0 subscales measuring
similar constructs. Divergent validity was demonstrated by
weak and no significant associations between the PedsQL
4.0 Emotional Functioning subscale and the QOLASD-C
Interpersonal and Self-Determination subscales. Results of
this study indicate excellent reliability and construct validity
evidence to support the use of the 16-item QOLASD-C as an
1547
outcome measure to evaluate the effectiveness of evidence-
based practices in improving children’s functioning across
life domains.
Several interesting findings of this study have conceptual
significance and merit further discussion. The first finding
is the removal of five items included in the original 21-item
QOLASD-C scale. Three items (i.e., Items 9, 12, and 14)
were excluded from the EFA and two items (i.e., Items 1
and 15) were excluded from the CFA. Item 9 (“My child
has other children that will help him or her when needed”)
and Item 12 (“My child is happy to work with his or her
teacher”) did not load on any of the three QOLASD-C fac-
tors. Item 14 (“My child would like more friends”) did not
perform optimally as illustrated by negative item-to-total
correlations suggesting that the item did not have a strong
unique contribution to the construct measured. Although the
conceptualization of the Interpersonal Relationships factor
supported the inclusion of these items to evaluate the social
functioning of children with ASD within the context of inter-
actions with peers and adults, data revealed that the items
had no contribution to any of the three factors comprising
the QOLASD-C scale.
One potential explanation for the lack of contribution of
the three items listed previously to the QOLASD-C scale
may be provided by the unique characteristics of children
with ASD and social functioning. Specifically, some chil-
dren with ASD may possess the skills to initiate, maintain,
and terminate interactions with social partners. However,
they prefer to engage in solitary activities and, consequently,
have no desire to make friends, seek the company of other
children, or interact with social partners in the natural envi-
ronment (Chezan et al., 2020; Ikeda et al., 2014). There-
fore, these items may have not been the best indicators of
interpersonal relationships for children with ASD consider-
ing that some children have limited interest in establishing
friends and engaging in interactions with social partners.
The impact of these characteristics on the social functioning
of children with ASD has been documented in the literature
on health-related QOL as illustrated by consistently lower
scores on the social domain of the PedsQL 4.0 and the World
Health Organization Quality of Life Instrument, Abbreviated
Version (WHOQOL-BREF; Kuhlthau et al., 2010; Limbers
et al., 2009).
Another potential explanation for the lack of contribu-
tion of the three items listed previously to the QOLASD-
C scale may be provided by differences in QOL between
children with ASD and typically developing children. Some
researchers have advanced the idea that not all factors that
contribute to the QOL in typically developing children are
relevant for children with ASD (McConachie et al., 2018).
Specifically, the QOL may be different for children with
ASD due to the contribution of unique factors specific to
this population. For example, Smerbeck (2019) argues that
13
1548
restricted interests displayed by some individuals with ASD
have positive consequences on their life, including happi-
ness, source of identity, and achievement in employment.
Therefore, children with ASD may be more motivated to
engage in solitary activities related to their interests rather
than engaging in social interactions with other children or
adults who may not share the same interests.
Item 1 (“My child regularly feels sad”) and Item 15 (“My
child relies on others to select his or her activities”) had
inadequate loadings and did not contribute to any of the
three factors. One potential explanation for the lack of con-
tribution of these two items may be provided by the negative
wording of the items. Researchers have demonstrated that
items worded negatively can influence both the response on
a Likert scale and the value of the item-total correlation
(Burke, 1999; Roszkowski & Soven, 2010). Specifically,
when negatively worded items are used on a Likert scale,
respondents tend to agree rather than disagree with the state-
ment regardless of its content and may provide an inaccurate
response due to non-attendance to the item or to difficulties
interpreting the item (Bors et al., 2006; Woods, 2006). It is
possible that participants in our study did not carefully read
the two items worded negatively which led to inaccurate
responses. Furthermore, researchers have demonstrated that
negatively worded items on a Likert scale have lower than
average item-total correlations, the value of the item-total
correlation is below the generally acceptable level required
for retaining the item on a scale, and their removal improves
the reliability of the scale (Roszkowski & Soven, 2010). In
our study, the removal of the two negatively worded items
increased the reliability of the QOLASD-C scale from .83
to .90 and, thus, supported previous findings in the literature
on scales development.
The second finding relates to two items that were moved
to a different factor than the factor on the original scale. Item
2 (“My child shows pleasure when learning new skills”) and
Item 7 (“My child enjoys family activities”) were assumed
to measure children’s emotional state or satisfaction with
different activities within a specific location (e.g., school or
home) and were included initially on the Emotional Well-
Being factor. Our analysis indicated that the items identi-
fied better with the Interpersonal Relationships factor. One
potential explanation may be that participation in activities
or learning experiences and the emotional state associated
with these experiences have mutually interdependent influ-
ences. For example, Item 2 (“My child shows pleasure when
learning new skills”) may illustrate not only the emotional
state of pleasure or enjoyment associated with the learn-
ing process, but it also may imply that the learning process
occurs within the context of interactions with social part-
ners (i.e., interpersonal relationships). Therefore, these items
were moved to the Interpersonal Relationships factor based
on loadings.
13
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
The third interesting finding relates to the slightly lower
internal consistency estimates for the Emotional Well-Being
factor (α = .66) compared to the other two factors included
in the 16-item QOLASD-C scale. One potential explana-
tion for the lower internal consistency estimates of Emo-
tional Well-Being factor may be related to the number of
items comprising this factor. Specifically, the Emotional
Well-Being factor on the original scale consisted of seven
items; however, two items were moved to the Interpersonal
Relationships factor and one item was removed because of
inadequate factor loadings. Therefore, this factor had four
items while the other two factors had six items, which could
explain the discrepancy among reliability estimates. Future
studies may examine whether the addition of several new
items to this factor would improve its reliability.
Another potential explanation for this finding may be
the influence of subjective variables. For example, it is pos-
sible that parents of children with ASD may perceive and
evaluate their children’s emotional well-being differently
than the children themselves. Disagreements between child
self-reports and parent proxy-reports have been previously
reported in the literature, suggesting that parents of youth
with ASD rate QOL, including emotional functioning, dif-
ferently than youth with ASD and no cognitive deficits. Spe-
cifically, emotional well-being is one of the domains scored
lower by parents than by youth with ASD (Kamp-Becker
et al., 2010; Sheldrick et al., 2012; Shipman et al., 2011) A
question that remains unanswered in this study is whether
such disagreements would also occur for young children
with ASD with and without cognitive disabilities.
A significant finding of this study is the established
convergent validity of 16-item QOLASD-C with PedsQL
4.0. Overall, the convergent validity evidence was support-
ive suggesting that (a) Emotional Well-Being was associ-
ated with Emotional, School, and Social Functioning, (b)
Interpersonal Relationships was associated with Social and
School Functioning, and (c) Self-Determination was associ-
ated with Social and School Functioning. It was not surpris-
ing that the strongest association was between the 16-item
QOLASD-C Emotional Well-Being subscale and the Ped-
sQL 4.0 Emotional Functioning subscale. This association
is rooted in the conceptualization of these domains of QOL
that refer to a child’s emotional state as illustrated by basic
feelings, such as anger, happiness, or worry, and their impact
on his or her daily functioning.
It is noteworthy that the PedsQL 4.0 Emotional Func-
tioning subscale had no significant relations with the QOL-
ASD-D Interpersonal Relationships and Self-Determination
subscales and, thus, provide evidence of the divergent valid-
ity of the scale. This finding was expected considering the
conceptualization of emotional functioning, interpersonal
relationships, and self-determination which reflect unique
and distinct constructs. For example, emotional functioning
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
as a QOL domain is defined as a child’s ability to express
basic emotions, such as happiness, worry, sadness, or sleep
patterns, whereas interpersonal relationships represent
one’s ability to interact with others in the natural environ-
ment (Schalock & Alonso, 2002). The conceptualization of
emotional functioning and interpersonal relationships as
two distinct domains of QOL is also supported by previ-
ous research findings suggesting that children with ASD
can acquire the skills needed to develop interpersonal rela-
tionships with social partners and function effectively in
the presence of other children despite deficits in expressing
emotions (Bauminger, 2002; Travis & Sigman, 1998). Previ-
ous findings support our results that indicate no significant
associations between emotional functioning and interper-
sonal relations and, thus, document divergent validity.
Emotional functioning and self-determination are also
considered distinct domains of QOL. For example, a child’s
ability to make choices and exert control over his or her
life (i.e., self-determination) does not depend on the emo-
tions expressed by the child across various daily situations.
Self-determination requires a different set of skills, includ-
ing choice-making, decision-making, goal setting, and self-
management. Researchers have demonstrated that children
with ASD can acquire these skills when provided effective
instruction and supports regardless of expressing emotions,
although their unique characteristics should be considered
when developing educational programs to promote self-
determination (Wehmeyer et al., 2010). Consequently, these
findings support the conceptualization of emotional func-
tioning and self-determination as distinct domains of QOL
and are aligned with our results revealing no significant
associations between these two subscales. It is also impor-
tant to note that PedsQL 4.0 was not developed specifically
for children with ASD, although psychometric properties
of the scale have been reported for children and youth with
ASD and no cognitive disabilities. Future studies could
examine the psychometric properties of PedQL 4.0 as related
to children with ASD with cognitive disabilities who com-
prise a population of children with unique characteristics.
Results of this study provide psychometric evidence that
supports the use of the 16-item QOLASD-C as an outcome
measure that can be used by practitioners delivering ser-
vices to young children with ASD. Several advantages of the
16-item QOLASD-C include (a) a simple structure consist-
ing of three domains based on the QOL conceptualization
for individuals with disabilities, (b) the short length of the
scale (i.e., 16 items), and (c) decent psychometric properties.
The advantages listed previously, the limited availability of
QOL measures for children with ASD, and the importance
of assessing the effects of treatments on children’s overall
functioning across life domains are only a few reasons that
have the potential to facilitate the adoption and use of the
16-item QOLASD-C by practitioners in applied settings.
1549
The findings of this study should be interpreted with
caution because of several limitations. First, the conclu-
sions may be limited due to the relatively small sample
size included in our analysis. Although the rule of thumb
of five to ten participants per item was met suggesting
an appropriate sample size, some researchers argue that
a sample of at least 300 participants is needed when con-
ducting CFA (Tabachnick & Fidell, 2013). Nonetheless,
it is important to note that the study targeted a very spe-
cific population (i.e., parents of young children with ASD)
which posed challenges to the recruitment of a large sam-
ple size. Second, one of the three factors (i.e., Emotional
Well-Being) had marginal reliability than the other two
factors. Third, demographic data related to children’s age,
gender, and school attendance were available only for a
subsample of children and, thus, the representativeness of
the population targeted needs to be further investigated.
Although the 16-item QOLASD-C scale showed good
psychometric properties, future studies should continue
to examine the factor structure of this scale with a larger
sample of participants and evaluate the measurement qual-
ity of the scale by conducting invariance measurement. It
would be interesting to examine whether the items that did
not load on any of the three QOLASD-C factors and were
removed from the scale would have different loadings if
data were collected from a larger sample of participants.
As other relevant QOL measures are developed for young
children with ASD, future research is needed to investigate
the 16-item QOLASD-C scale’s concurrent validity. Addi-
tionally, the 16-item QOLASD-C scale currently contains
only a parent-proxy version. Researchers should investi-
gate the possibility of developing self-report versions of
this scale that could be used with children with ASD with
and without cognitive disabilities while considering their
language and communication challenges when developing
such scales. Future research is needed to examine whether
usability and appropriateness of 16-item QOLASD-C in
assessing treatment effectiveness and information the
instructional decision-making process in applied settings.
In summary, this study indicates that the 16-item QOL-
ASD has excellent total scale reliability and acceptable
convergent and divergent validity. Prior to this study, there
was no validation of QOLASD-C using factor analysis.
Considering that previous scales used to evaluate QOL in
children with ASD were not designed for this population
of individuals, this study makes a significant contribution
to the literature by providing psychometric evidence that
the 16-item QOLASD-C is a reliable and valid measure
developed to address the unique characteristics of children
with ASD. Therefore, we suggest that this scale can be used
as a treatment outcome measure for children with ASD to
guide the decision-making process regarding the selection,
implementation, and evaluation of treatments and services to
13
1550
improve their functioning in current and future environments
and, consequently, their QOL.
Author contributions Conceptualization: [Laura C. Chezan,
Erik Drasgow, Judith M. Cholewicki]; Methodology: [Jin
Liu, Ruyi Ding]; Writing—original draft preparation: [Laura
C. Chezan]; Writing—review and editing: [Laura C. Chezan,
Erik Drasgow, Jin Liu]; Recruitment: [Laura C. Chezan,
Adam Warman]. All authors commented on previous ver-
sions of the manuscript and approved the final manuscript.
Funding No funding was received for conducting this study.
Declarations
Conflict of interest The authors have no conflicts of interest to declare.
Ethical Approval All procedures performed in studies involving human
participants were in accordance with the ethical standards of the insti-
tutional and/or national research committee and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards.
Informed Consent All participants signed an electronic informed con-
sent prior to participating in the study.
References
American Psychiatric Association. (2013). Diagnostic and statisti-
cal manual of mental disorders. (5th ed.). American Psychiatric
Publishing.
Barker, C., Pistrang, N., & Elliott, R. (1994). Research methods in
clinical and counseling psychology. Wiley.
Bastiaansen, D., Koot, H. M., Bongers, I. L., Varni, J. W., & Verhulst,
F. C. (2004). Measuring quality of life in children referred for
psychiatric problems: Psychometric properties of the PedsQL 4.0
generic core scales. Quality of Life Research, 13, 489–495. https://​
doi.​org/​10.​1023/B:​QURE.​00000​18483.​01526.​ab
Bauminger, N. (2002). The facilitation of social-emotional under-
standing and social interaction in high-functioning children with
autism: Intervention outcomes. Journal of Autism and Develop-
mental Disorders, 32(4), 283–298. https://​doi.​org/​10.​1023/A:​
10163​78718​278
Benson, J., & Nasser, F. (1998). On the use of factor analysis as a
research tool. Journal of Vocational Education Research, 23(1),
13–33
Bors, D. A., Vigneau, F., & Lalande, F. (2006). Measuring the need
for cognition: Item polarity, dimensionality, and the relation with
ability. Personality and Individual Differences, 40(4), 819–828.
https://​doi.​org/​10.​1016/j.​paid.​2005.​09.​007
Burgess, A. F., & Gutstein, S. E. (2007). Quality of life for people with
autism: Raising the standard for evaluating successful outcomes.
Child and Adolescent Mental Health, 12(2), 80–86. https://​doi.​
org/​10.​1111/j.​1475-​3588.​2006.​00432.x
13
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
Burke, B. G. (1999). Item reversals and response validity in the Job
Diagnostic Survey. Psychological Reports, 85(1), 213–219.
https://​doi.​org/​10.​2466/​pr0.​1999.​85.1.​213
Burns, G. L., Geiser, C., Servera, M., Becker, S. P., & Beauchaine, T.
P. (2019). Application of the bifactor S-1 model to multisource
ratings of ADHD/ODD symptoms: An appropriate bifactor model
for symptom ratings. Journal of Abnormal Child Psychology,
48(7), 881–894. https://​doi.​org/​10.​1007/​s10802-​019-​00608-4
Cabrera-Nguyen, P. (2010). Author guidelines for reporting scale
development and validation results in the Journal of the Society
for Social Work and Research. Journal of the Society for Social
Work and Research, 1(2), 99–103. https://​doi.​org/​10.​5243/​jsswr.​
2010.8
Cattell, R. B. (1966). The scree test for the number of factors. Multi-
variate Behavioral Research, 1(2), 245–276. https://​doi.​org/​10.​
1207/​s1532​7906m​br0102_​10
Centers for Disease Control and Prevention (2020). Identifying autism
among children: An easy-read summary. Retrieved October 4,
2020 from https://w ​ ww.c​ dc.g​ ov/n​ cbddd/a​ utism/a​ ddm-c​ ommun​ ity-​
report/​an-​easy-​read-​summa​ry.​html
Chalmers, R. P. (2018). On misconceptions and the limited usefulness
of ordinal alpha. Educational and Psychological Measurement,
78(6), 1056–1071. https://​doi.​org/​10.​1177/​00131​64417​727036
Chezan, L. C., Drasgow, E., & Grybos, E. M. (2020). Conversation
skills and self-initiated interactions in young adults with autism
and intellectual disability. Research in Autism Spectrum Disorder,
75, 1–12. https://​doi.​org/​10.​1016/j.​rasd.​2020.​101554
Child, D. (2006). The essentials of factor analysis. (3rd ed.).
Continuum.
Cholewicki, J., Drasgow, E., & Chezan, L. C. (2019). Parental percep-
tion of quality of life for children with autism spectrum disorder.
Journal of Developmental and Physical Disabilities, 31, 575–592.
https://​doi.​org/​10.​1007/​s10882-​019-​09660-w
Claes, C., Van Hove, G., van Loon, J., Vandevelde, S., & Schalock, R.
L. (2010). Quality of life measurement in the field of intellectual
disabilities: Eight principles for assessing quality of life-related
personal outcomes. Social Indicators Research, 98, 61–72. https://​
doi.​org/​10.​1007/​s11205-​009-​9517-7
Coghill, D., Danckaerts, M., Sonuga-Barke, E., & Sergeant, J. (2009).
Practitioner review: Quality of life in child mental health-concep-
tual challenges and practical choices. Journal of Child Psychology
and Psychiatry, 50(5), 544–561. https://​doi.​org/​10.​1111/j.​1469-​
7610.​2009.​02008.x
Comrey, A. L., & Lee, H. B. (1992). A first course in factor analysis.
(2nd ed.). Academic Press.
Crocker, L., & Algina, J. (1986). Introduction to classical and modern
test theory. Holt, Rinehart, and Winston.
Cronbach, L. J. (1951). Coefficient alpha and their internal structure
of tests. Psychometrika, 16, 297–334. https://​doi.​org/​10.​1007/​
BF023​10555
Cummings, R. A. (1997). Assessing quality of life. In R. I. Brown
(Ed.), Assessing quality of life for people with disabilities: Mod-
els, research, and practice. (pp. 116–150). Stanley Thornes.
Dancey, C. P., & Reidy, J. (2007). Statistics without maths for psychol-
ogy. Pearson Education.
Dardas, L. A., & Ahmad, M. M. (2014). Validation of the world
health organization’s quality of life questionnaire with parents
of children with autistic disorder. Journal of Autism and Devel-
opmental Disorders, 44, 2257–2263. https://​doi.​org/​10.​1007/​
s10803-​014-​2110-1
de Vries, M., & Geurts, H. (2015). Influence of autism traits and execu-
tive functioning on quality of life in children with an autism spec-
trum disorder. Journal of Autism and Developmental Disorders,
45, 2734–2743. https://​doi.​org/​10.​1007/​s10803-​015-​2438-1
Ding, R., He, W., Liu, J., Liu, T., Zhang, D., & Ni, S. (2021). Interper-
sonal regulation questionnaire (IRQ): Psychometric properties and
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
gender differences in Chinese young adolescents. Psychological
Assessment. https://​doi.​org/​10.​1037/​pas00​00997
Downs, J., Jacoby, P., Leonard, H., Epstein, A., Murphy, N., Davis,
E., Reddihough, D., Whitehouse, A., & Williams, K. (2019).
Psychometric properties of the quality of life inventory-disability
(QI-Disability) measure. Quality of Life Research, 28, 783–794.
https://​doi.​org/​10.​1007/​s11136-​018-​2057-3
Feeny, D., Torrance, G. W., & Furlong, W. (1996). Health Utilities
Index. In B. Spilker (Ed.), Quality of life and pharmacoeconom-
ics. (2nd ed.). Lippincott- Raven Press.
Gau, S. S. F., Liu, L. T., Wu, Y. Y., Chiu, Y. N., & Tsai, W. C. (2013).
Psychometric properties of the Chinese version of the social
responsiveness scale. Research in Autism Spectrum Disorders,
7(2), 349–360. https://​doi.​org/​10.​1016/j.​rasd.​2012.​10.​004
Gignac, G. E. (2008). Higher-order models versus direct hierarchical
models: Gas superordinate or breadth factor? Psychology Science,
50(1), 21
Gomez, J. L. C., de la Fuente Anuncibay, R., & Conde, R. M. S. (2010).
Evaluation of the quality of life in people with autistic spectrum
disorder. Vertex, 21(90), 117–125
Gomez, L. E., Alcedo, M. A., Arias, B., Fontanil, Y., Arias, V. B.,
Monsalve, A., & Verdugo, M. A. (2016). A new scale for the
measurement of quality of life in children with intellectual disa-
bilities. Research in Developmental Disabilities, 53–54, 399–410.
https://​doi.​org/​10.​1016/j.​ridd.​2016.​03.​005
Gomez, L. E., Moran, M. L., Alcedo, M. A., Arias, V. B., & Verdugo,
M. A. (2020). Addressing quality of life of children with autism
spectrum disorder and intellectual disability. Intellectual and
Developmental Disabilities, 59(5), 393–408. https://​doi.​org/​10.​
1352/​1934-​9556-​58.5.​393
Gorsuch, R. L. (1983). Factor analysis. (2nd ed.). Erlbaum.
Granpeesheh, D., Tarbox, J., Dixon, D. R., Carr, E., & Herbert, M.
(2009). Retrospective analysis of clinical records in 38 cases
of recovery from autism. Annals of Clinical Psychiatry, 21(4),
195–204
Hofstede, G. (1984). The cultural relativity of the quality of life con-
cept. Academy of Management Review, 9(3), 389–398. https://d​ oi.​
org/​10.​5465/​amr.​1984.​42796​53
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covari-
ance structure analysis: Conventional criteria versus new alterna-
tives. Structural Equation Modeling, 6(1), 1–55. https://​doi.​org/​
10.​1080/​10705​51990​95401​18
Ikeda, E., Hinckson, E., & Krägeloh, C. (2014). Assessment of quality
of life in children and youth with autism spectrum disorder: A
critical review. Quality of Life Research, 23, 1069–1085. https://​
doi.​org/​10.​1007/​s11136-​013-​0591-6
Johnson, R., & Morgan, G. (2016). Survey scales: A guide to develop-
ment, analysis, and reporting. Guilford Publications.
Kaiser, H. F. (1960). The application of electronic computers to fac-
tor analysis. Educational and Psychological Measurements, 20,
141–151
Kamp-Becker, I., Schröder, J., Remschmidt, H., & Bachmann, C. J.
(2010). Health-related quality of life in adolescents and young
adults with high functioning autism-spectrum disorder. Psycho-
Social Medicine, 7, 1–10. https://​doi.​org/​10.​3205/​psm00​0065
Keith, K. D., & Schalock, R. L. (1994). The measurement of quality of
life in adolescence: The quality of student life questionnaire. The
American Journal of Family Therapy, 22, 83–87. https://​doi.​org/​
10.​1080/​01926​18940​82513​00
Kuhlthau, K., Orlich, F., Hall, T., Sikora, D., Kovacs, E., Delahaye, J.,
& Clemons, T. E. (2010). Health-related quality of life in children
with autism spectrum disorders: Results from the Autism Treat-
ment Network. Journal of Autism and Developmental Disorders,
40(6), 721–729. https://​doi.​org/​10.​1007/​s10803-​009-​0921-2
Limbers, C., Heffer, R., & Varni, J. W. (2009). Health-related quality
of life and cognitive functioning from the perspective of parents
1551
of school-aged children with Asperger’s Syndrome utilizing the
PedsQL. Journal of Autism and Developmental Disorders, 39(11),
1529–1541. https://​doi.​org/​10.​1007/​s10803-​009-​0777-5
Lindell, M. K., & Whitney, D. J. (2001). Accounting for common
method variance in cross-sectional research designs. Journal of
Applied Psychology, 86(1), 114–121. https://​doi.​org/​10.​1037/​
0021-​9010.​86.1.​114
MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999).
Sample size in factor analysis. Psychological Methods, 4(1),
84–89
Matson, J. L. (2007). Determining treatment outcome in early interven-
tion programs for autism spectrum disorders: A critical analysis
of measurement issues in learning based interventions. Research
in Developmental Disabilities, 28(2), 207–218. https://d​ oi.o​ rg/1​ 0.​
1016/j.​ridd.​2005.​07.​006
Mattejat, F., & Remschmidt, H. (2006). ILK Inventar zur Erfassung
der Lebensqualita¨t bei Kindern und Jugendlichen. [assessment
instrument]. Bern.
McConachie, H., Mason, D., Parr, J. R., Garland, D., Wilson, C.,
& Rodgers, J. (2018). Enhancing the validity of a quality of
life measure for autistic people. Journal of Autism and Devel-
opmental Disorders, 48, 1596–1611. https://​doi.​org/​10.​1007/​
s10803-​017-​3402-z
Muthén, L. K., & Muthén, B. O. (1998–2017). Mplus user’s guide
(8th ed.). Author.
Myles, B. S., Bock, S. J., & Simpson, R. L. (2001a). Asperger Syn-
drome Diagnostic Scale (ASDS). [Assessment instrument].
PRO-ED.
Myles, B. S., Bock, S. J., & Simpson, R. (2001b). Asperger syndrome
diagnostic scale examiner’s manual. Berlin: Pro Ed.
Nandy, K. (2012). Understanding and quantifying effect sizes.
Retrieved April 2021, from http://​nursi​ng.​ucla.​edu/​workf​i les/​
resea​rch/​Effect%​20Size%​204–9–2012.​pdf
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory.
McGraw-Hill.
Osborne, J. W. (2015). What is rotating in exploratory factor analy-
sis? Practical Assessment, Research, and Evaluation, 20(1),
1–7. https://​doi.​org/​10.​7275/​hb2g-​m060
Plimley, I. A. (2007). A series of quality of life issues and people
with autism spectrum disorders. British Journal of Learning
Disabilities, 35, 205–213. https://​doi.​org/​10.​1111/j.​1468-​3156.​
2007.​00448.x
Renty, J. O., & Roeyers, H. (2006). Quality of life in high-func-
tioning adults with autism spectrum disorder: The predictive
value of disability and support characteristics. Autism, 10(5),
511–524. https://​doi.​org/​10.​1177/​13623​61306​066604
Riley, A. W., Robertson, J., Forrest, C. B., Green, B., Rebok, G.,
& Starfield, B. (2001). Manual for the child health and illness
profile-child edition (CHIP-CE). The Johns Hopkins University.
Rodriguez, N. M., & Thompson, R. H. (2015). Behavioral variabil-
ity and autism spectrum disorder. Journal of Applied Behavior
Analysis, 48(1), 167–187. https://​doi.​org/​10.​1002/​jaba.​164
Roszkowski, M. J., & Soven, M. (2010). Shifting gears: Conse-
quences of including two negatively worded items in the middle
of a positively worded questionnaire. Assessment & Evaluation
in Higher Education, 35(1), 113–130. https://​doi.​org/​10.​1080/​
02602​93080​26183​44
Schalock, R. L., & Alonso, M. A. V. (2002). Handbook on quality
of life for human service practitioners. American Association
on Mental Retardation.
Schalock, R. L., & Verdugo, M. A. (2013). The transformation of
disability organization. Journal of Intellectual and Develop-
mental Disabilities, 51(4), 273–286. https://​doi.​org/​10.​1352/​
1934-​9556-​51.4.​273
Schalock, R. L., Keith, K. D., Verdugo, M. A., & Gomez, L. E.
(2009). Quality of life model development and use in the field of
13
1552
intellectual disability. In R. Kober (Ed.), Enhancing the quality
of life of people with intellectual disabilities: From theory to
practice.Springer.
Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003).
Evaluating the fit of structural equation models: Tests of sig-
nificance and descriptive goodness-of-fit measures. Methods of
Psychological Research Online, 8(2), 23–74
Sheldrick, R. C., Neger, E. N., Shipman, D., & Perrin, E. C. (2012).
Quality of life of adolescents with autism spectrum disorders:
Concordance among adolescents’ self-reports, parents’ reports,
and parents’ proxy reports. Quality of Life Research, 21(1),
53–57. https://​doi.​org/​10.​1007/​s11136-​011-​9916-5
Shipman, D. L., Sheldrick, R. C., & Perrin, E. C. (2011). Quality
of life in adolescents with autism spectrum disorders: Reliabil-
ity and validity of self-reports. Journal of Developmental and
Behavioral Pediatrics, 32(2), 85–89. https://​doi.​org/​10.​1097/​
DBP.​0b013​e3182​03e558
Smerbeck, A. (2019). The survey of favorite interests and activities:
Assessing and understanding restricted interests in children with
autism spectrum disorder. Autism, 23(1), 247–259. https://​doi.​
org/​10.​1177/​13623​61317​742140
Statistical Package for the Social Sciences. (2016). Statistics (Version
24.0) [Computer Software]. IBM Corp. Retrieved March 2021,
from https://​www.​ibm.​com/​produ​cts/​spss-​stati​stics
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics.
(6th ed.). Pearson.
Tavernor, L., Barron, E., Rodgers, J., & McConachie, H. (2012). Find-
ing out what matters: Validity of quality of life measurement
in young people with ASD. Child Care, Health, and Develop-
ment, 39(4), 592–601. https://​doi.​org/​10.​1111/j.​1365-​2214.​2012.​
01377.x
Thompson, B. (2004). Exploratory and confirmatory factor analysis.
American Psychological Association.
Tilford, J. M., Payakachat, N., Kovacs, E., Pyne, J. M., Brouwer, W.,
Nick, T. G., Bellando, J., & Kuhlthau, K. (2012). Preference-based
health-related quality-of-life outcomes in children with autism
spectrum disorders. PharmacoEconomics, 30(8), 661–679.
https://​doi.​org/​10.​2165/​11597​200-​00000​0000-​00000
Travis, L. T., & Sigman, M. (1998). Social deficits and interpersonal
relationships in autism. Mental Retardation and Developmental
Disabilities Research Reviews, 4, 65–72
Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQLTM 4.0: Reli-
ability and validity of the pediatric quality of life inventoryTM
Version 4.0 Generic Core Scales in Healthy and Patient Popula-
tions. Medical Care, 39(8), 800–812
13
Journal of Autism and Developmental Disorders (2022) 52:1536–1552
Varni, J. W., Burwinkle, T. M., Seid, M., & Skarr, D. (2003). The Ped-
sQL™* 4.0 as a pediatric population health measure: Feasibility,
reliability, and validity. Ambulatory Pediatrics, 3(6), 329–341.
https://​doi.​org/​10.​1367/​1539-​4409(2003)​003<​0329:​TPAAP​P>2.​
0.​CO;2
Wechsler, D. (1974). Manual for the Wechsler Intelligence Scale for
Children-Revised. Psychological Corporation.
Wehmeyer, M. L., Shogren, K. A., Zager, D., Smith, T. E. C., & Simp-
son, R. (2010). Research-based principles and practices for edu-
cating students with autism: Self-determination and social inter-
actions. Education and Training in Autism and Developmental
Disabilities, 45(4), 475–486
White-Koning, M., Grandjean, H., Colver, A., & Arnaud, C. (2008).
Parent and professional reports of the quality of life of children
with cerebral palsy and associated intellectual impairment. Devel-
opmental Medicine and Child Neurology, 50(8), 618–624. https://​
doi.​org/​10.​1111/j.​1469-​8749.​2008.​03026.x
Williams, W. C., Morelli, S. A., Ong, D. C., & Zaki, J. (2018). Inter-
personal emotion regulation: Implications for affiliation, perceived
support, relationships, and well-being. Journal of Personality and
Social Psychology, 115(2), 224–254. https://d​ oi.o​ rg/1​ 0.1​ 037/p​ spi0​
000132
Wolfe, K., Pound, S., McCammon, M. N., Chezan, L. C., & Drasgow,
E. (2019). A systematic review of interventions to promote varied
social-communication behavior in individuals with autism spec-
trum disorder. Behavior Modification, 43(6), 790–818. https://d​ oi.​
org/​10.​1177/​01454​45519​859803
Woods, C. M. (2006). Careless responding to reverse-worded items:
Implications for confirmatory factor analysis. Journal of Psycho-
pathology and Behavioral Assessment, 28(3), 186–191. https://​
doi.​org/​10.​1007/​s10862-​005-​9004-7
Worthington, R., & Whittaker, T. (2006). Scale development research:
A content analysis and recommendations for best practices. Coun-
seling Psychologist, 34, 806–838. https://​doi.​org/​10.​1177/​00110​
00006​288127
Zumbo, B. D., Gadermann, A. M., & Zeisser, C. (2007). Ordinal ver-
sions of coefficients alpha and theta for Likert Rating Scales.
Journal of Modern Applied Statistical Methods, 6(1), 21–29.
https://​doi.​org/​10.​22237/​jmasm/​11779​92180
Publisher’s Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.