1. Children’s Communication Checklist-2™ (CCC-2) (D. V. M
Children’s Communication Checklist-2™ (CCC-2) (D.V.M. Bishop, 2006, NCS Pearson, Inc.) United States Edition
A Training Module for Early Interventionists
VT-ILEHP ASD LEND Program
2011

2. Overview of CCC-2™ Purpose
Identifies children with pragmatic language impairment
Identifies children with possible speech and language impairment
Assists in identification of those requiring further assessment of an autistic spectrum disorder (ASD)

3. Overview of CCC-2™ Materials Manual Caregiver Response Form Scoring CD
Scoring Worksheet

4. Overview of CCC-2™ Used with children 4:0 to 16:11 who:
Speak in sentences
Primary language is English
Do not have a permanent hearing loss
Uses a Caregiver Response Form
An adult who has regular contact with the child
Completion time: minutes
Scored by a trained clinician: minutes

5. Overview of CCC-2™ 70 items divided into 10 scales
Each scale has 7 items (5 address difficulties, 2 focus on strengths)
Scales A, B, C, & D assess articulation and phonology, language structure, vocabulary and discourse
Scales E, F, G & H address pragmatic aspects of communication
Scales I & J assess behaviors commonly impaired in children with ASD

6. Overview of CCC-2™ Scale A speech Scale B syntax Scale C semantics
Scale D coherence
Scale E initiation
Scale F scripted language
Scale G context
Scale H nonverbal communication
Scale I social relations
Scale J interests

7. Overview of CCC-2™ Manual Provides detailed instruction administering
scoring
interpreting
background
evidence of reliability & validity

8. Administering and Scoring
Caregiver Response Form
Identifies areas of concern
Guides assessment process
Respondent should:
Be in regular contact with the
child (3-4 days/wk for at least 3 months)
Have appropriate language & literacy skills
Understand the critical nature of his/her responses

9. Administering and Scoring
Caregiver Response Form
Items 1-50 = statements that refer to difficulties that effect child’s ability to communicate
Items = statements that refer to communication strengths demonstrated by the child

10. Administering and Scoring
Rating Key for Caregiver Response Form
0 = less than once a week (or never)
1 = at least once a week, but not everyday (or occasionally)
2 = once or twice a day (or frequently)
3 = several times (more than twice) a day (or always)
3 = poorest rating for items 1-50
0 = poorest rating for items 51-70

11. Administering and Scoring
Caregiver Response Form – After Completion:
Review for missing responses
Discuss any blank items to encourage completion
Clarify unanswered questions
May use as a guided interview
If only one or two unanswered items remain assign the poorest rating for that section

12. Administering and Scoring
Scoring - Two options
Scoring CD
Scoring Worksheet

13. Administering and Scoring
Using the Scoring CD
Uses Excel
Has three tabs
Instructions
Raw Data
Summary

14. Administering and Scoring
Using the Scoring CD
To derive child’s scores:
Complete identifying information
Record item ratings
Converts raw scores to scaled scores, composite scores and percentile ranks
Print and save the summary chart

15. Administering and Scoring
Using the Scoring Worksheet
Step 1 Complete Identifying Information
Step 2 Record Raw Scores (transfer from Caregiver Response Form to Scoring Worksheet)
Step 3 Sum Ratings for Section 1 (items 1-50)
Step 4 Sum Ratings for Section 2 (items 51-70)
Step 5 Check for Consistency

16. Administering and Scoring
Using the Scoring Worksheet
Step 6 Sum Total Raw Scores
Step 7 Derive Scaled Scores
Step 8 Derive Percentile Ranks for Corresponding Scaled Scores
Step 9 Derive the General Communication Composite (GCC) Standard Score, Confidence Interval, and Percentile Rank
Step 10 Derive the Social Interaction Difference Index (SIDI) Score

17. Interpreting CCC-2 Interpretation
Useful in both clinical and research contexts
Combined with other data to aid in clinical decision making
Adds to assessment and intervention processes by describing current behaviors and identifying areas of communication that need additional assessment

18. Interpreting CCC-2
Description of Scores upon which to base your interpretation
Scaled scores
A composite score
An index score
Percentile ranks

19. Interpreting CCC-2 Scaled Scores
Norm-referenced (sample: 4:0 to 16:11)
Derived from raw scores (M = 10, SD = 3)
Domains measured: speech, syntax, semantics, coherence, initiation, scripted language, context, nonverbal communication, social relations and interests.

20. Interpreting CCC-2 General Communication Composite (GCC)
Norm-referenced standard score
Enables comparison of child’s performance to other children the same age
Sum of subtest scaled scores derived from subtests A – H
Represents equal weighting of each subtest
May identify significant communication problems

21. Interpreting CCC-2 Social Interaction Difference Index (SIDI)
Helpful to identify children w/communicative profile characteristic of language impairment or ASD
Typical scores range -10 to 10 (90% of normative sample)
Scores >11 = similar to children w/SLI Dx
Scores <-11= similar to children w/ASD Dx
Use with caution & in combination w/other measures

22. Interpreting CCC-2 Percentile Ranks
Indicate child’s standing relative to others of the same age
Based on standardized sample
Range from < 0.1 to > 99.9 (M = 50)
Provides age-based %ile ranks for scaled scores A through J and the GCC

23. Interpretation Guidelines for Clinical Profiles
Children w/Dx of Specific Language Impairment
Expected difficulty with Scales A,B,C, & D
Relatively better with Scales E, H, I and J though generally lower than typically developing communication skills
More likely to have GCC below mean of 100
More likely to have SIDI that is 11 or greater

24. Interpretation Guidelines for Clinical Profiles
Children w/Dx of Pragmatic Lang. Impairment
Often exhibit level pattern of moderate impairment across CCC-2 scales
Typically better on Scales A-D than children w/SLI Dx
On pragmatics scales perform similar to children w/SLI Dx
Identification of pragmatic deficits may be influenced by child’s structural (e.g., syntax) language skills

25. Interpretation Guidelines for Clinical Profiles
Children w/Dx of ASD
Profile contrasts w/children with Dx/SLI
Performance on Scales A-D (language skills) below typical levels
Performance on Scales E-J (pragmatic skills) even more depressed
Profiles show low scaled scores on I (social relationships) and J (interests)
Coupled w/SIDI score <-11 suggests possible ASD – refer for further evaluation

26. Interpretation Guidelines for Clinical Profiles
Interpretation when not all items are rated
Not possible to derive GCC or SIDI score if three or more items are not rated
If no response is obtained, use ratings only as clinical information
Do not attempt to summarize the scores

27. Research & Development of CCC-2
Preceded by CLIC (Checklist for Language Impaired Children) & CLIC-2
CCC Originally developed for classification of children with known SLI
Interest in wider application as screening tool for SLI led to revision resulting in CCC-2
Rating scale revised, items added to address semantics and syntax, item order changed & development of additional composite scores

28. Research & Development of CCC-2
Originally developed in United Kingdom
U.S. Edition has norm-referenced scores using standardized sample representative of children in the U.S. (2005)
n= 950 children in the United States, ages 4:0 – 16:11
Adaptations for spelling and
common wording/phrasing

29. Evidence of Reliability & Validity
Evidence of Test-Retest Reliability
n=98 drawn from standardization study
3 age groups of children in each group: 4:0-6:11, 7:0-9:11 and 10:0-16:11
52 males and 46 females, representative range of racial/ethnic groups
Caregiver responders representative range of educational levels
Second completion within 1 to 28 days

30. Evidence of Reliability & Validity
Evidence of Test-Retest Reliability
r 1,2 range of .86 to .96 reliability coefficients
Reflects strong stability from first to second rating
Reliabilities range from for all scales by ages, from for all scales averaged across all ages.
Reliabilities for GCC range from .94 to .96 indicating very strong reliability

31. Evidence of Reliability & Validity
CCC-2 developed to reflect developmental communication abilities ages 4:0 to 16:11 yrs
Relevant content and coverage
Special emphasis on aspects of social communication
Skills addressed well-documented in literature and based on extensive research of children with pragmatic language impairments (Bishop, 2003).

32. Evidence of Reliability & Validity
Validity – Source of data
Three clinical samples:
Children with SLI
Children with PLI
Children with ASD
Matched control sample of typically developing children
Matched by age, gender, race/ethnicity and parent education level
Data provides strong support for clinical use

33. Case Studies

34. Case Study a. She has a pragmatic language impairment
Amelia is 8 years old and is in second grade. She received a GCC of 69 and a SIDI of -19 following completion of the CCC-2 by her father. Language performance is below expected levels & pragmatic skills were even more depressed with poor performance on social relationships & interests. Based on this information, it is likely that:
a. She has a pragmatic language impairment
b. She is performing as expected
c. She is at risk for ASD and she should be referred
d. She has a specific language impairment

35. What do we suspect for Amelia?
The CCC-2 scores indicate that Amelia has a profile typical of children suspected of ASD for the following reasons:
Children with ASD usually have low performance on language scales and pragmatic scales with the later even poorer
Children with an SIDI of less than -11 suggest the possibility of ASD
Children with ASD usually have low scores on the social relationships & interests scales

36. Case Study
Jacob is a 4 year old in preschool. He received a GCC of 80 and a SIDI of 13 following completion of the CCC-2 by his mother. His scores on the language scales were poorer than the pragmatic scales. Based on this information, it is likely that:
a. He has a pragmatic language impairment
b. He is performing as expected
c. He is at risk for ASD and she should be referred
d. He has a specific language impairment

37. What do we suspect for Jacob?
The CCC-2 scores indicate that Jacob has a profile typical of children SLI for the following reasons:
Children with SLI usually have lower performance on the language scales than the pragmatic scales
Children with SLI usually have a GCC of less than 100
Children with SLI usually have a SIDI of greater than 11

38. Case Study
Ethan is 13 years old and is in junior high. He received a GCC of 85 and a SIDI of 2 following completion of the CCC-2 by his mother. Based on this information, it is likely that:
a. He has a pragmatic language impairment
b. He is performing as expected
c. He is at risk for ASD and she should be referred
d. He has a specific language impairment

39. What do we suspect for Ethan?
The CCC-2 scores indicate that Ethan has a profile typical of children PLI for the following reasons:
Children with PLI usually have slightly better performance on the language scales than children with SLI and similar scores on the pragmatic scales as children with SLI
Children with PLI usually have a lower SIDI than children with SLI as it is a reflection of the relationship between language impairment and pragmatic language impairment

40. Reference
Bishop, D. V. M. (2006), CCC-2; Children’s Communication Checklist-2, United States Edition, Manual. San Antonio, TX: Pearson
Bishop, D. V. M. (2000). Pragmatic language impairment: A correlate of SLI, a distinct subgroup, or part of the autistic continuum? In D. V. M. Bishop & L. B. Leonard (Eds.), Speech and language impairments in children: Causes, characteristics, intervention & outcome (pp ). Hove, UK: Psychology Press