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The Gilliam Autism Rating Scale – Second editon (GARS-2 ™)

The Gilliam Autism Rating Scale – Second editon (GARS-2 ™). A Training Module for Early Interventionists VT-ILEHP ASD LEND Program 2010 . GARS-2 (Gilliam, 2006) : What is it?.

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The Gilliam Autism Rating Scale – Second editon (GARS-2 ™)

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  1. The Gilliam Autism Rating Scale – Second editon (GARS-2™) A Training Module for Early Interventionists VT-ILEHP ASD LEND Program 2010

  2. GARS-2 (Gilliam, 2006): What is it? • A standardized tool for screening children at risk & assessing persons with autism and other severe behavioral disorders • Provides norm-referenced information that can assist in the diagnosis of Autism • Based on APA definition of autism

  3. GARS (Gilliam, 1995) vs. GARS-2 (Gilliam, 2006) • Changes made to the GARS to improve reliability & reflect changes in understanding Autism: • Structured parent interview form replaces the Early Development subscale • Some items rewritten for clarity • Demographic characteristics of the normative sample were keyed to 2000 U.S. Census data. • New norms created • Guidelines provided for interpreting subscale scores • Autism Index replaced the Autism Quotient • Instructional Objectives for Children Who Have Autism included to assist in the formulation of instructional goals and objectives based on the GARS-2 results

  4. GARS-2 Examiner’s Manual • Provides detailed instructions on how to administer the GARS-2 along with information about reliability, validity, normative population • Provides insights into using GAR-S results with Applied Behavior Analysis programs • Provides standard scores and %ile ranks

  5. GARS-2 Subscales • Three subscales: • Stereotyped Behaviors • Communication • Social Interaction

  6. Stereotyped Behaviors • Items 1-14 describe stereotyped behaviors, motility disorders, and other unique and atypical behaviors • Examples: • Stares at hands, objects, or items in the environment for at least 5 seconds. • Spins objects not designed for spinning (e.g. cups, saucers, glasses…) • Flaps hands or fingers in front of face or at sides.

  7. Communication • Items 15-28 describe verbal and non-verbal behaviors displayed by children with Autism and Autism Spectrum Disorders. • Examples: • Repeats words or phrases over and over. • Looks away or avoids looking at speaker when name is called • Repeats unintelligible sounds (babbles) over and over.

  8. Social Interaction • Items 29-42 evaluate a child’s ability to relate appropriately to people, events, and objects. • Examples: • Does not imitate other people when imitation is required or desirable, such as in games or learning activities. • Withdraws, remains aloof, or acts standoffish in group situations. • Becomes upset when routines are changed.

  9. Administration • Rater=>completes 14 questions for each subscale • Teacher • Parent • Clinician • Examiner=>scores & interprets the results • Can use structured interview with the rater

  10. Guidelines for Rating • May be necessary for more than one person to complete the rating based on relationship with the child • EXAMPLE: Classroom teacher rates the Stereotyped Behaviors & Social Interactions while SLP rates Communication. • Raters should read the questions carefully & ask questions for clarification • Raters should not take into account a child’s age when rating

  11. Rating Frequency • Four different measures of frequency • 0 – Never observed – You have never seen the individual behave in this manner. • 1 – Seldom observed – Individual behaves in this manner 1-2 times per 6-hour period. • 2 – Sometimes observed – Individual behaves in this manner 3-4 times per 6-hour period. • 3 – Frequently observed – Individual behaves in this manner at least 5-6 times per 6-hour period.

  12. Parent Interview • Parents are a good source of information about their children’s behaviors. • Parents/caregivers describe child’s behavior before age 3 • First 10 questions deal with delays • 15 questions deal with abnormal functioning • Questions are scored ‘yes’ or ‘no’ • Examiner can give examples to explain the behaviors • ‘No’ responses indicate abnormality or developmental delay • Necessary to have evidence that an individual demonstrated delays before age 3 to diagnose Autism.

  13. Scoring GARS-2: Subscale Standard Scores and the Autism Index • Make sure all items in each subscale have been rated • Add raw scores for each item & total these • Find %ile rank and standard score for each subscale • Standard score (SS) of 7 or higher on a subscale indicates a very likely possibility of Autism (based on a mean of 10; standard deviation (SD) of 3) • SS of 4-6 on a subscale indicates a possibility of Autism • SS of 0-3 on a subscale indicates Autism is unlikely • Add up subscales to determine the Autism Index (based on a mean of 100 & SD of 15 • It is possible to use 2 subscales instead of 3 to determine the Autism Index

  14. Research behind GARS-2 • Normative scores come from a sample of 1,107 children & young adults between the ages of 3 & 22 diagnosed with Autism • Internal consistency & test-retest coefficients are large to very large • Validity was demonstrated by confirming that: • Items on the subscales are representative of the characteristics of autism • Subscales are strongly correlated to each other and to the performance of other tests that screen for autism • Scores discriminate persons with autism from persons with other severe behavioral disorders as well as persons without disabilities

  15. Case Examples

  16. Case Study: Beatrice 5-year old, verbal female Background: Kindergarten teacher noticed that she was not socializing with other children & exhibited repetitive motions; school psychologist was asked to complete the GARS-2. Beatrice was receiving speech-language services and her SLP completed the Communication subscale of the GARS-2 while the kindergarten teachers filled out the Stereotyped Behaviors and Social Interaction subscales. Subscale 1 - Stereotyped Behaviors: Teacher reported frequently observing the following behaviors: • 2. Stares at hand objects, or items in the environment for at least 5 seconds. • 8. Spins objects not designed for spinning (e.g., saucers, cups, glasses) • 9. Rocks back and forth while seated or standing. • 12. Flaps hands or fingers in front of face or at sides. Other behaviors were not observed.

  17. Case Study: Beatrice QUESTIONS: 1. How often is ‘frequently observed’? 2. What is the subscale SS for Beatrice? 3. Does this mean Beatrice has Autism? ANSWER: 1. Frequently observed means the individual behaves in this manner at least 5-6 times per 6-hour period. 2. The subscale score is ___: 3. No, but her score indicates a high risk for Autism as it is falls in the range of 7 or higher.

  18. Case Study: Beatrice Subscale 2 - Communication: The SLP completed the subscale & found that Beatrice sometimes exhibited the following: • 17. Repeats words or phrases over and over. • 18. Speaks or signs with flat tone, affect, or dysrhythmic patters • 28. Inappropriately answers questions about a statement or brief story. The SLP did not observe any other behaviors listed on the subscale.

  19. Case Study: Beatrice QUESTIONS: 1. Does this subscale indicate a risk of Autism? ANSWER: Yes, Beatrice scored a __ on this subscale and as such there is some indication of a possibility of Autism. Combined with the Stereotyped Interactions data, there is an indication of a high risk of Autism. 2. Was it appropriate for more than one adult to complete the GARS-2? ANSWER: Yes, each professional has a different perspective & multiple raters who have the best view into a particular domain can complete the subscales of the GARS-2.

  20. Case Study: Beatrice Subscale 3 - Social Interaction: The kindergarten teacher completed this subscale and found that Beatrice sometimes: • 40. Becomes upset when routines are changed. • 42. Lines up objects in precise, orderly fashion and becomes upset when the order is disturbed. The teacher seldom observed Beatrice exhibiting the following: • 31. Resists physical contact from others. • 33. Withdraws, remains aloof, or acts standoffish in group situations.

  21. Case Study: Beatrice QUESTION: • Does this subscale indicate a risk of Autism? ANSWER: Yes, Beatrice scored a ___ on this subscale and as such there is some indication of a possibility of Autism. Combined with the Stereotyped Interactions data, and the Communications subscale there is an indication of a high risk of Autism.

  22. Case Study:Beatrice • Beatrice was referred to a developmental pediatrician for a developmental evaluation. • She was eventually diagnosed with PDD-NOS. • She was referred to an intensive after school intervention program.

  23. References • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. • Autism Society of America (2003). What is Autism? Retrieved January 5, 2005, from http://www.autismsociety.org/site/pageserver?pagename=whatisautism • Gilliam, James E. (1995). Gilliam Autism Rating Scale. Austin TX: PRO-ED. • Gilliam, James E. (2006). GARS-2; Gilliam Autism Rating Scale, Second Edition, Examiner’s Manual. Austin, TX: PRO-ED.

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