SRS- 2: Social Responsiveness Scale

SRS- 2:

Social Responsiveness Scale, 2nd Edition

Validity

Convergent Validity: good overall

agreement

*comparisons with other instruments designed to evaluate symptoms and behaviors on the autism spectrum - high correlations are desirable

• Social Communication Questionnaire (SCQ): .58-65

• Social and Communication Disorders Checklist (SCDC) : .49-.98

How is the SRS-2 used?

Divergent / Discriminant Validity:

overall moderate to low agreement

*comparison to instruments that assess other commonly identified psychological disorders and behavioral problems--moderate to low correlations are desirable as this indicates that SRS-2 explains variance that is unique to the social behavior associated with ASDs

• Identifies and characterizes subtle autism spectrum conditions

• Aids in diagnosis and treatment planning

• Measures subtle variations in symptoms (over time or response to intervention)

• Quantifies the severity --- mild to severe

Standardization

Reliability

• Child Behavior Checklist (CBCL): .48-.64

Internal consistency: .95

School-Age sample: 2,025 reports (teacher and parent) on 1,014 children

• Supported by large standardization samples
• Alpha statistic used to calculate by age, respondent, and gender

• 20 sites
• 13 states

• 493 Males
• 518 Females

History of SRS-2

Test-retest: Shorter intervals .80-.98

Data was collected from numerous sites "widely inclusive and not influenced by conditions at one or a few locations"

Longer intervals (months to years) .88-.95

Interrater agreement : .61

Developed by John N. Canstantino, MD & Christian P. Gruber

Careful monitoring of demographic characteristics such as ethnicity and educational level to represent the 2009 U.S. Census

First edition published in 2005

• two different observers each having a separate experience base with the observed individual
• no overlap therefore although a lower absolute value still strong reliability

effort to precisely define and characterize children with autism and other autism spectrum disorders

Proceed with CAUTION

Looking at the number of students sampled in the School-Age Standardization Sample we noticed the sample numbers decreased as age increased

Sample%

13 6.1

14 5.8

15 5.5

16 5.5

17 4.3

18 3.9

19 0.3

Second edition published in 2012

Looking at the Race/Ethnic background category for the School-Age Standardization Sample we noticed the majority of the students in the sample were White

Sample %

Asian 5.7

Black/African American 15.8

Hispanic/Latino 16.6

Native American 0.3

White 59.5

Other 1.6

similarly focused on assisting in differential diagnosis in the presence of comorbid conditions

Items on the SRS-2

Introduced Preschool and Adult forms

Sample

Questions

(School-Age Form)

How is it

administered?

Some questionable items

Manual claims the items are...

{It's simple! }

How is the

SRS-2 formatted?

2. Expressions on his or her face don't match what he or she is saying

8. Behaves in a way that seem strange or bizarre

Approximately 15-20 minutes to complete

"Judgemental"/subjective?

14. Is not well coordinated

What is the SRS-2?

• Specific and observable elements of social behavior

Selecting a Rater

Materials Needed

25. Doesn't see to mind being out of step with or "not on the same wavelength" as others

22. Plays appropriately with children his/her own age

• 65 items
• Likert-scale
• 2.5 years through adulthood

Can we say this is a "problem"?

• Appropriate rating form depending on age
• Auto Score protocols: rating and scoring on the same form

• Avoids judgments about behavior

• Familiar with social interactions in common venues (home, school, etc)
• Known for at least a month
• 8th grade reading level

An objective measure of symptoms associated with Autism Spectrum Disorder (ASD)

34. Avoids people who want to be emotionally close to him/her

52. Knows when he or she is too close to someone or is invading someone's space"

4 Forms

• Raters are asked to rate on the basis of the frequency of the behavior

Instructions

60. Is emotionally distant, doesn't show is or her feelings

39. Has an unusually narrow range of interests

Preschool Form

-Ages 2.5-4.5

-Completed by parent and/or teacher

Culturally biased? Due to a language discrepancy?

• Complete all items
• Cannot be scored if too many items are missing
• Brief clarification if necessary
• Once completed inspect for unusual response patterns

Adult Self Report (optional)

-Ages 19+

-Completed by individual being assessed

54. Seems to react to people as if they are objects

• The items vary in intensity -- mild to severe abnormal attributes or behaviors

4-Point Likert-Scale

• Each item is assigned to one of the five treatment clusters

1 = Not True

2 = Sometimes True

3 = Often True

4 = Almost Always True

School Age

-Ages 4-18

-Completed by parent and/or teacher

Adult

(Relative or Other)

-Ages 19+

-Completed by relative or friend

*4-point scale eliminates the "middle of the road" scoring

Treatment Subscales

• Social Awareness: Ability to pick up on social cues
• Social Cognition: Ability to interpret social cues
• Social Communication: Includes expressive social communication
• Social Motivation: Extent of motivation to engage in social- interpersonal behavior
• Restricted Interests and Repetitive Behavior: Includes stereotypical behaviors or highly restricted interests

These sub-scales are designed to facilitate the evaluation of behaviorally-oriented treatment goals

Not meant to imply the existence of independent factors related to diagnosis of ASD

Should be used within the context of a comprehensive evaluation

Interpretation requires professional training and experience

What is Autism Spectrum Disorder (ASD)?

Five Treatment Subscales

Scoring the SRS-2

DSM-V Diagnostic Criteria

*Scoring and graphing- 5 to 10 minutes to complete

*Auto Score forms provide quick hand scoring; Computer scoring also available

A. Persistent deficits in social communication and social interaction across multiple contexts, manifested by the following:

Step 1:

• Social Awareness (Awr): Ability to pick up on social cues
• Social Cognition (Cog): Ability to interpret social cues
• Social Communication (Com): Includes expressive social communication
• Social Motivation (Mot): Extent of motivation to engage in social- interpersonal behavior
• Restricted Interests and Repetitive Behavior (RBB): Includes stereotypical behaviors or highly restricted interests

Enter the darkened response value for each item in the box in the same row as that item

• Deficits in social-emotion reciprocity
• Deficits in nonverbal communicative behaviors used for social interaction
• Deficits in developing, maintaining and understanding relationships

Step 2:

Total the item response values in each column to find the five Treatment subscale raw scores

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least 2 of the following:

Step 3:

Calculate the raw score for the Social Communication and Interaction (SCI) by totaling the scores of the first four Treatment subscales (Awr, Cog, Com, & Mot)

• Stereotyped or repetitive motor movements, use of objects, or speech
• Insistence on sameness, inflexible adherence to routines, or ritualized patterns
• Highly restricted, fixated interest that are abnormal in intensity
• Hyper or hyperactivity to sensory input or unusual interests in sensory aspects of environment

Step 4:

C. Symptoms present in early developmental period

Calculate the SRS-2 Total raw score by adding the raw scores for all five Treatment subscales

D. Symptoms cause clinically significant impairment in social, occupational or other area of functioning

Step 5:

Transfer all raw scores to Profile Sheet

E. Not explained by Intellectual Disability

*Make sure to use correct profile sheet (gender and rater)

Step 6:

What areas are identified by the SRS-2?

Convert raw scores

to T-scores (M=50, SD=10)

Is the SRS-2 aligned with the DSM-5?

Interpretation Procedures

Yes!

Strengths

Weaknesses

Two sub-scales align with DSM-5 criteria for ASD and Social Communication Disorder (new in DSM-5)

T-Score Classifications

• 59T and Below - Within Normal Limits
• 60T to 65T - Mild Range
• 66T to 75T - Moderate Range
• 76T or Higher - Severe Range

SCI: Social Communication and Interaction (sum of 4 treatment sub-scales)

• Efficient : short and easy to give
• Strong interrater agreement = multiple raters gives "whole" picture
• Aids in diagnosis as well as treatment planning
• Indicates individual's strengths and weaknesses
• Can be used to progress monitor : over time and response to intervention
• Expanded age range- monitor symptoms throughout the lifespan
• Allows for comparison to new DSM 5 ASD diagnostic criteria

Recommendations for assessing students from diverse cultural groups

• The new SRS-2 provides preschool and adult forms but majority of independent research has been limited to school-age form : additional research needed to provide information on preschool and adult forms
• Test questions at 8th grade reading level; This could be too high for some parents and for some ASD-affected individuals (Self-report form) with language deficits
• Some of the items are "judgemental" - somewhat subjective
• Some of the questions are culturally biased and/or could be due to a language discrepancy

Typical scores for children with DSM-5 ASD diagnoses (moderate and clinical severity )

RRB: Restricted Interests and Repetitive Behaviors

SRS- 2 Total Score:

• sum of all 65 questions
• serves as an index as to the severity of social deficits in the autism spectrum

• Learn about the student’s culture → determine appropriate assessment

• Identify the parent’s language and familiarity with English before giving rating scale (interpreter?)

• Take time to establish rapport with parent

• Be self-aware of applying any preconceived notions, prejudices, stereotypes about an individual/parent/ family

• Use a comprehensive assessment design to overcome any culturally limiting factors of any one method

Manual provides interpretation text and language appropriate for case reports

59T and below - Within normal limits

Manual also provides brief case examples

Scores in this range are generally not associated with clinically significant autism spectrum disorders. Children with very mild autistic syndromes may show scores in the upper end of the normal range if they are well adjusted and their adaptive functioning is relatively intact.

66T to 75T - Moderate Range

Scores in this range indicate deficiencies in reciprocal social behavior that are clinically significant and lead to substantial interference with everyday social interactions. Such scores are typical for children with autism spectrum disorders of moderate severity ...