Dr. Thomas Oakland University of Florida University of Hong Kong Adaptive Behavior as measured by the Adaptive Behavior Assessment System-II (ABAS-II) Dr. Thomas Oakland University of Florida University of Hong Kong

With Appreciation to… The Australian Council for Educational Research Blair Heading Brendan Pye

Purposes of this presentation Today we will learn more about adaptive behavior: What is adaptive behavior How the DSM-5 characterizes Intellectual Developmental Disorder (ID) How the ABAS-II and the DSM-5 overlap Advantages to using the ABAS-II How to use these data beyond making a diagnosis

What is Adaptive Behavior? Adaptive behavior refers to ways an individual meets his or her personal needs as well as deals with natural and social demands and expectations in their environments consistent with their age, social class, and culture. Abilities and skills that enable a person to function effectively and independently daily at home, school, work, and in the community.

Human Growth and Development Most people develop normally Some develop more slowly at first Some then catch up later and others do not Delays may be in One behavior Two or more—and for some, many behaviors May require extra support and assistance Tends to increase to early 20s and then plateaus Tends to decline when in ones 70s

Children who display the following disabilities are likely to display adaptive behavior deficits Attention disorders Autism Behavior disorders Brain disorders and injuries Developmental delays Learning disorders and disabilities Mental retardation/ID Social-emotional disorders Sensory or motor impairment Visual and auditory disorders

Adults who display the following disabilities are likely to display adaptive behavior deficits All of those listed on the prior slide with the exception of early developmental delays Alcohol and drug abuse Alzheimer’s disease Depression Neurobehavioral disorders Neurocognitive disorders Neurodevelopmental disorders Psychosis

Current concepts of adaptive behavior The Conceptual skill domain includes: Communication Functional Academics Self-Direction The Social skill domain includes: Social Skills Leisure The Practical skill domain includes: Self-care Home and School Living Community Use Health and Safety Work

Some general DSM-5 changes Discontinuation of multiple axes (all now are I) Places some disorders on a spectrum, thus changing from nominal to ordinal descriptions Reclassified and recombined some disorders Added disorders Recognition of neurocognitive disorders that may predispose one to display a diagnosis Greater emphasis on (1) clinical (2) utility More reliance on professional (clinical) judgment Let’s review some changes to the DSM-5 before looking at the overlap between the DSM-5 and the ABAS-II

DSM-5 and ID: An introduction Named Intellectual Developmental Disorder Specifies four levels: mild, moderate, severe, profound Does not specify an IQ cut off Greater reliance on adaptive functioning and less reliance on intelligence Is more functionally focused (e.g. base diagnosis and intervention on needed supports)

Intellectual developmental disorder A neurodevelopmental disorder (yet remains a mental disorder) Characterized by deficits in intellectual functioning that lead to deficits in adaptive behavior Deficits in intellectual functioning (no longer an IQ < ~ 70) as seen in An individually administered standardized measure of intelligence A clinical assessment and judgment

Intellectual developmental disorder Deficits in adaptive functioning compared to age, gender, and socially/culturally matched peers in one or more of the following three domains (no score level is specified) Conceptual abilities Social abilities Practical abilities Includes an emphasis on personal independence together with a new quality: social responsibility Its onset occurs during the developmental period (no longer stated as < age 19 yet this is assumed)

Intellectual developmental disorder: more on adaptive behavior ID severity is determined from adaptive behavior A standardized assessment of adaptive behavior Its clinical assessment This information is used to clinically judge the degree a person needs support in reference to the four levels: mild, moderate, severe, profound We do not have standardized measures that assess qualities associated with these four levels. Treatment monitoring may be used to assess severity level The goal is to normalize life as much as possible

Thus, when assessing ID, Place more reliance on adaptive functioning and less reliance on intelligence Place more reliance on professional/clinical judgment and less reliance on specific scores The assessment will be more comprehensive and likely to utilize behavioral ‘need for support’ data to determine the degree of disability 30% to 50% of those with ID display another mental disorder, including a psychiatric disorder

How the ABAS-II and the DSM-5 overlap Emphasizes the importance of assessing adaptive behavior with current standardized tests Can be used as a clinical interview Is the only measure of adaptive behavior that assesses the three DSM-5 domains; conceptual, social, and practical skills Provides an assessment of persons from birth through age 89 and thus includes the DSM-5 ages

How the ABAS-II and the DSM-5 overlap Emphasizes the importance of examining behaviors in light of environmental needs and requirement and thus contributes to an understanding of ‘need for support’. ABAS-2 research confirms that children with more diagnoses generally display more adaptive behavior deficits.

Advantages to using the ABAS-II Standardized on > 7000 persons from birth through age 89 Assesses the 10 skill areas, three domains, the provides a general adaptive composite Clinicians select from five forms Parent/Primary Care Giver for ages 0-5 5-21 Teacher/Day Care Provider for ages 2-5 An adult scale for ages 16-89

Advantages to using the ABAS-II All forms are completed by knowledgeable respondents Administration time ~ 20 minutes The number of guessed item averages < 3 among it ~ 250 items Strong psychometric features: E.G. General Adaptive Composite reliability Internal consistency is .98 to .99 Test-retest reliability is .90. Ratings from two teachers is .91.

Some Implications from the Definitions Limitations in present functioning must be considered within the context of community environments, including schools and homes, typical of the individual’s age peers and culture. Let’s discuss this important point: see next slide

Some Implications from the Definitions Limitations exist when the needs and requirements found in a person’s environment exceed the person’s adaptive skills Thus, we need to know what the person’s environment requires of the person to clinically judge if there is a limitation Low scores in themselves do not indicate a limitation A change in environments may result in a change in needed requirements.

Some Implications from the Definitions A person’s personal life functioning generally will improve With appropriate personalized education and support When interventions are sustained over time used daily valued by the person, and important to his/her caretakers and important in his/her environment.

Some Implications from the Definitions The success of these interventions is higher when the person participates in selecting the interventions values the behaviors wants to acquire them thus is motivated to both develop the behaviors and sustain their display

Some Implications from the Definitions The success of these interventions is higher when important caregivers also participate in the selection of the interventions value the behaviors want them acquired thus are motivated to both help develop the behavior and help sustain an environment in which these behaviors can be displayed and rewarded regularly

Some Implications from the Definitions The success of these interventions is higher when the caregiver has the resources to implement and sustain the behavior program the interventions are within the zone of proximal development training occurs in the environment in which the desired behaviors eventually will be displayed.

ABAS–II Information to Plan and Implement Interventions Basic considerations: Analyze the client’s adaptive skills at the item level Analyze environmental needs: current environment target environment Match between skills and environmental demands Identify support needs Assumption: adaptive skills interventions are more effective than those on adaptive behavior.

Using the ABAS scores to plan and monitor intervention programs What resources are needed to help develop or display needed behaviors? Intermittent help Limited help Extensive help Pervasive help For how long will this help be needed?

Using the ABAS scores to plan and monitor intervention programs Does the person’s environments have the resources to provide needed support? display a desire to provide support? What changes in these environments are need to provide needed assistance?

Using the ABAS scores to plan and monitor intervention programs The possibility of change—the issue of prognosis. With mild levels of delay: good. Many children with mild levels of ID can assume a somewhat normal adult life— with support With moderate levels of delay: less good. Prognosis is better if they are educated, live, and work in normal environments With severe to profound levels of delay: generally not good. They are likely to need life-long assistance to meet their basic needs of food, clothing, shelter, and toileting.

Using the ABAS scores to plan and monitor intervention programs Where is change most likely to occur? On specific behaviors (that is, at the item level) Less likely: skill area Least likely: domains and GAC levels

Validity Studies with Clinical Samples

Mean Performance across Adaptive Skill Area Developmentally Delayed Mean Performance across Adaptive Skill Area Teacher Parent (n=48) (n=78) Age Range 2–5 0–5 Mean Conceptual 84 (99) 81 (102) Social 86 (97) 84 (100) Practical 86 (101) GAC 84 (97) 82 (101) % ≤ 70 26 (4) 28 (1) 17 (2) 20 (8) 20 (9) 19 (5) 22 (4) 25 (4) % of 2 or More Skill ≤ 4 35 (8) 70 (9) Note. Numbers in parenthesis represent non-clinical sample cases. Adaptive Skill Area

Mean Performance across Adaptive Skill Area Motor Impairment Mean Performance across Adaptive Skill Area Teacher Parent (n=32) (n=50) Age Range 2–5 0–5 Mean Conceptual 84 (98) 86 (98) Social 87 (99) Practical 71 (96) 79 (97) GAC 76 (97) 79 (98) % ≤ 70 30 (13) 18 (4) 29 (6) 16 (0) 58 (13) 24 (2) 40 (10) 33 (0) % of 2 or More Skill ≤ 4 53 (9) 36 (4) Note. Numbers in parenthesis represent non-clinical sample cases. Adaptive Skill Area

Mean Performance across Adaptive Skill Area Mild Mental Retardation Mean Performance across Adaptive Skill Area Teacher Parent (n=31) (n=27) Age Range 2–5 Mean Conceptual 67 (101) 68 (100) Social 71 (104) 71 (101) Practical 71 (99) GAC 66 (100) % ≤ 70 65 (0) 70 (0) 58 (0) 52 (4) 52 (3) 43 (0) % of 2 or More Skill ≤ 4 68 (0) Note. Numbers in parenthesis represent non-clinical sample cases. Adaptive Skill Area

Mean Performance across Adaptive Skill Area Autism/Asperger’s Mean Performance across Adaptive Skill Area Teacher Parent (n=30) (n=49) Age Range 3–5 Mean Conceptual 73 (102) 72 (98) Social 67 (101) 65 (99) Practical 66 (101) 65 (98) GAC 67 (102) 64 (98) % ≤ 70 62 (0) 56 (0) 74 (0) 65 (6) 71 (0) 71 (6) % of 2 or More Skill ≤ 4 77 (0) 71 (9) Adaptive Skill Area Note. Numbers in parenthesis represent non-clinical sample cases.

Summary of Clinical Findings The ABAS-II can assist in validly assessing individuals with various disabilities and disorders. Further research is needed with larger samples. Assessment of adaptive skills can provide important information to a comprehensive assessment. Information on strengths and weaknesses in adaptive skills may provide useful information for program planning and monitoring.

Summary of Clinical Findings The ABAS-II has good clinical sensitivity in distinguishing (1) some clinical from non-clinical groups and (2) individuals with mild and moderate levels of mental retardation. The mean GACs are significantly lower for clinical groups than matched control groups. Most clinical cases obtained GACs < 71. Most clinical cases obtained adaptive skill scaled cores <5.

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