The PDD Behavior Inventory
(PDDBI)*
Ira L. Cohen, Ph.D.
Chairman, Psychology Dept.
NYS IBR/DD
*Cohen and Sudhalter (2005)
Psychological Assessment Resources, Inc.
1
PDD Behavior
Inventory
(PDDBI)
Cohen, I.L., Schmidt-Lackner, S., Romanczyk, R., and Sudhalter, V.
(2003). The PDD Behavior Inventory: A rating scale for assessing
response to intervention in children with PDD. Journal of Autism
and Developmental Disorders, 33(1), 31-45.
Cohen, I.L. (2003). Criterion-related validity of the PDD Behavior
Inventory. Journal of Autism and Developmental Disorders, 33(1),
47-53.
Cohen, I.L., and Sudhalter, V. (2005). The PDD Behavior Inventory.
Lutz, Fl: Psychological Assessment Resources, Inc.
2
Goals of Workshop
• Understanding why the PDDBI was developed and it’s
uses
• Learning about autism and the related PDDs
• Learning about administration and scoring of the
PDDBI
• Learning about the reliability and validity of the
PDDBI
• Learning about interpretation of PDDBI score profiles
and score discrepancies and their implications for
diagnosis and intervention
3
Why was the PDDBI Developed?
• I had clinical and research questions that could not easily
be answered with rating scales developed to assess autism
– Children’s Psychiatric Rating Scale
– Childhood Autism Rating Scale
– Autism Behavioral Checklist
– Behavioral Summarized Evaluation scale
– Global Impression-Type Scales (CGI)
– Gilliam Autism Rating Scale
– Autism Diagnostic Interview-Revised
– Autism Diagnostic Observation Schedule-Generic
4
Clinical Questions
When a child with autism shows “challenging behaviors” . . . .
• Is it because he or she has autism? (i.e., other children with
autism show similar problems at the same level of intensity)
• Is something else going on? (i.e., child’s behavior is beyond
what we would expect or is restricted to certain settings)
But there’s a problem
• Assessment tools for autism are not standardized on children
with autism
• Assessment tools for autism are not standardized on different
types of informants
5
Research/Clinical Questions
When a child is treated with medication and repetitive behaviors
decrease. . . . .
• Is there also an improvement in social communication skills?
• Is there a decrease in social communication skills?
But there’s a problem
• Most assessment tools for autism don’t assess the social
communication skills that are important in distinguishing children
with autism from typically developing children
• Instead, they emphasize their problems with communication
• None are standardized on well-diagnosed samples and none are
age-normed
6
Clinical Questions
When a child with autism has difficulty communicating. . . .
• Is it because he or she has autism? (i.e., other children with autism
show similar problems at the same skills level)
• Is something else going on? (i.e., child’s communication is much
worse than we would expect or is restricted to certain settings)
But there’s a problem
• Assessment tools for autism are not age-standardized on children
with autism
• Assessment tools for autism are not standardized on different
types of informants
7
Problems with Existing Assessment
Tools
1. Except for the ADI-R and ADOS-G, all of the assessment
tools focus exclusively on problem behaviors and do not
reflect current research on behaviors that differentiate
children with autism from other groups
2. None of the assessment tools are age-normed
3. Only one provides standard scores (GARS) but the
diagnostic criteria defining the standardization sample are
poorly described
4. Except for the ADI-R and ADOS-G, all focus on behavior
problems seen in the more severely affected cases
5. None of the assessment tools are tailored to inputs from
teachers/therapists (important for assessing generalization)
8
PDD Behavior Inventory (PDDBI)
• The PDDBI can be used to assess response
to intervention, assist in diagnosis and
treatment planning, and help with research
• It:
– Assesses both problem behaviors and appropriate
social communication behaviors (important in assessing
improvement)
– Is age-normed (because there is a need to assess change
due to age from that due to treatment)
– Includes items that are based on the latest research on
behaviors that discriminate autism from other
conditions
– Is standardized on a well-diagnosed autism sample
9
Uses of the PDDBI
• Clinical
– Assisting in Diagnosis and Treatment Recommendations
– Monitoring Changes at Follow-Ups, etc.
• Educational
– Assisting in Placement Decisions
– Assisting in Treatment Planning
– Monitoring Students’ Progress, etc.
• Research
– Measuring Response to Novel Treatments
– Identifying Meaningful Sub-Groups
– Assessing (Endo)phenotypes in Genetic Studies, etc.
10
Assisting in Diagnosis
• Does the child’s profile of domain scores look like
someone his/her age with autism?
– Is the profile consistent with your observations?
– Does the profile suggest an alternate and/or “comorbid” diagnosis that needs to be considered
(diagnostic overshadowing?)?
• Do the domain profiles of parent and “teacher”
agree?
– If not, which scores differ?
– If they differ, does this say something about diagnosis
(e.g., Selective Mutism)?
11
Assisting in Placement Decisions
• Is the child’s problem behavior profile
typical of someone his/her age with autism?
– If not, are some scores so high that a special
treatment setting may be necessary?
12
Treatment Planning
• Is the child’s “social-communication”
behavior profile typical of someone his/her
age with autism?
– If not, do domain scores suggest some other
diagnosis should be considered, e.g.,
Asperger’s?
13
Research
• The PDDBI can be helpful and is being used for measuring
meaningful change as a result of intervention (e.g.,
medication, ABA, dietary, etc.) for people in the autism
spectrum
– For groups (e.g., Are people in my school improving?; Is my
intervention associated with improvement?)
– For individuals (Has this person improved?)
• If so, in what areas?
• If so, is it a meaningful decrease in autism traits?
• It is also being used in large scale genetics studies to identify
genes associated with certain types of autistic behaviors
14
Some Research Programs Using PDDBI
•
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•
Arizona State University
Arkansas Children’s Hospital Research Unit
ASD-Canadian American Research Consortium
Baylor College of Medicine
Binghamton University
Carlos Albizu University
Cleveland Clinic Center for Autism
Columbia University - Psychiatric Institute
Massachusetts General Hospital
M.I.N.D. Institute
Mount Sinai Hospital – Seaver Center (Manhattan)
National Institute of Mental Health (NIMH)
Ohio State University
Royal Prince Alfred Hospital, Sydney, Australia
St. Mary’s Hospital (Wisconsin)
University of California San Diego
University of Illinois
University of North Carolina – Chapel Hill
Washington State University
15
PDDBI
• As will be shown, we have found the PDDBI to
be both reliable and valid
• It can be used for assessing children on the
autism spectrum who are between 18 months
and 12-1/2 years of age
16
Autism and the Related PDDs
17
18
http://www.time.com/time/covers/1101030120
Autism and the Related PDDs
19
Earliest Description of Autism?
“If a woman gives birth and the infant rejects
the mother”
Summa Izbu IV 42
Ancient Mesopotamian medical text
(translated by M. Coleman, M.D.)
20
Leo Kanner’s Observations (1943)
(Kanner, L. Autistic disturbances of affective
contact. Nervous Child, 2, 217-250.)
Sample: 8 boys; 3 girls
• “inability to relate themselves in the ordinary way
to people and situations from the beginning of
life”
• Of 8 speaking children, none used language to
convey meaning
– echolalia and delayed echolalia
– affirmation by repetition
– literalness
– “personal pronouns are repeated as heard”
21
Kanner’s Observations
(continued)
• Excellent rote memories
• “all powerful need for being left undisturbed”
– loud noises and moving objects reacted to with horror
• “anxiously obsessive desires for the maintenance
of sameness”
– routines
– furniture arrangements
22
Kanner’s Observations (continued)
• Monotonous and repetitive motions and
verbal utterances
• Good relation to objects - not to people
• “intelligent physiognomies”
23
Modern Descriptions of Autism
•
•
•
•
•
•
•
•
Kanner
British Working Party
Rimland (E-1 and E-2 Scales)
Rutter
Ritvo and Freeman (NSAC)
DSM III (First use of “PDD” term)
DSM-III-R
DSM-IV
(1943)
(1963)
(1964)
(1972)
(1977)
(1980)
(1987)
(1994)
24
Diagnostic History of PDD
• DSM III (1980)
– Pervasive Developmental Disorder
• Infantile Autism
• Childhood Onset Pervasive Developmental Disorder
• Atypical Pervasive Developmental Disorder
• DSM III-R (1987)
– Pervasive Developmental Disorder
• Autistic Disorder
• Pervasive Developmental Disorder - NOS
25
Current Nosology
• DSM-IV (1994)
– Pervasive Developmental Disorder
•
•
•
•
•
Autistic Disorder
Childhood Disintegrative Disorder
Rett’s Disorder
Asperger’s Disorder
Pervasive Developmental Disorder NOS
• All represent the autism “spectrum”
26
Autistic Disorder (DSM-IV)
1) Qualitative impairment in social
interaction (Problems with eye contact,
facial expression, body posture,
gestures, peer relationships, sharing
interests, emotional reciprocity)
2) Qualitative impairments in communication (Delay or lack of
language, problems with conversational desire/skill, stereotyped
language, problems with social and imaginative play)
3) Restricted repetitive and stereotyped patterns of behavior, interests
and activities (Preoccupations, inflexible adherence to routines or
rituals, stereotyped movements, preoccupation with parts of
objects)
4) Onset prior to 3 years; Not Rett’s or Disintegrative
http://news.sie.edu
27
Candle fixation at birthdays
28
“Co-morbid” Features
•
•
•
•
•
•
•
•
•
“Anxiety” Problems and Anxiety Disorders
Hyperactivity Common
Sleeping, Eating, and, sometimes, GI Disturbances
“Incongruous” Mood States and Mood Disorders
Self-Injurious Behaviors Sometimes Seen
Savant Skills in Small Percentage
Tics Sometimes Seen
Epilepsy in 30% to 40% by adulthood
Genetic Syndromes
29
PDD-NOS
• Also known as “Atypical Autism”
– Criteria not met for one of the other PDDs due
to age of onset, or atypical symptoms, or subthreshold symptoms or all of these
– There is severe and pervasive impairment in
development of reciprocal social interaction
skills and impairment in communication skills
OR presence of stereotyped behaviors,
interests, and activities
30
?
Asperger’s Disorder
• Same characteristics as Autistic Disorder,
but:
“Jerry Espenson”
“Boston Legal”
– No general language delay (single words by 2
years; communicative phrases by 3 years)
– No delay in cognitive development or self-help
skills or curiosity about the environment
• Not other PDD or schizophrenia
?
31
Rett’s Disorder
•
•
•
•
•
•
•
•
•
Normal pre- and peri-natal development
Normal psychomotor development up to 5 mos.
Normal HC at birth-HC deceleration 5-48 mos.
Loss of purposeful hand skills (hand wringing)
Loss of social engagement
Poorly coordinated gait and trunk movements
Severe language disorder and retardation
Breathing abnormalities common
Due to MECP2 gene mutation  absence of MECP2 protein 
absence of gene suppression
– “Leaky genes”
http://www.rettsyndrome.org.uk
32
Childhood Disintegrative Disorder
• Normal development first 2 years
• Loss of skills before 10 years in at least 2:
–
–
–
–
–
Expressive or receptive language
Social or adaptive skills
Bowel/bladder control
Play
Motor skills
• Abnormalities in at least 2:
– Qualitative social interaction
– Qualitative impairment in communication
– Repetitive behaviors, restricted interests
• Not other PDD or schizophrenia
33
Differential Diagnosis Issues
•
•
•
•
•
•
Receptive-Expressive Language Disorder
Mental Retardation without PDD
ADHD
Deafness/Hearing Impairment
Selective Mutism
Reactive Attachment Disorder
34
Autism/PDD-NOS Characteristics
• Most are males (about 75%-50%)
• Developmental delay is common (about 70%)
• Parents recognize problems around 18
months, sometimes with loss of skills
• Enlarged head circumference sometimes seen
in younger children (about 37%)
• Genes play a strong role in etiology
35
What Causes Autism?
Genetic
Known/Unknown
Pre/Post-Natal Brain
Development/Function
Pre/Post-Natal
Environment
Autisms
(Disorders/Syndromes)
(viruses, hormones,
neurotransmitters,
etc.)
(Autism is an etiologically
heterogeneous disorder, as is
the case with mental
36
retardation)
Known Genetic Conditions Associated
With Autism
• Fragile X Syndrome
– About 2 to 8 % in males or females with autism
– About 15 % of fragile X males have autism
• Other Genetic Disorders/Conditions
–
–
–
–
Untreated Phenylketonuria (PKU)
Tuberous Sclerosis in about 3% of cases
Angelman’s Syndrome
Chromosome 15q11-13 Duplications (maternal
origin) (Cook, et al., 1997) - Same region as
Prader-Willi (maternal) and Angelman’s
37
(paternal) Deletion Syndromes
Genetics of Autism
• Twin studies (Bailey, et al 1995)
– 60% concordance for autism in 25 MZ twins;
None in DZ
– 92% concordance for cognitive impairment in
MZ twins; 10% in DZ twins
38
The Broader Phenotype
• Autism, per se, may not be inherited
• Rather, there appears to be a Spectrum of social and
language problems inherited in some families.
39
Genetic Factors in Autism
• Family Studies
–
–
–
–
Risk of Autism in siblings of proband 5% to 9%
Risk of Autism itself in the population: about 0.5%
Risk of Asperger’s or PDDNOS in siblings ~ 3%
Risk of other social or communication impairments or
restricted interests ~20% in siblings
• Risk of Mood Disorders is elevated in family
(siblings, parents, extended family)
40
41
42
Other Medical Issues
• There is very little evidence for the role of the
following in causing autism:
– Heavy metals such as mercury
– Vaccines such as MMR and DPT
– Gastro-intestinal problems
• Many of these issues are currently being
investigated at various centers
• The role of immune system problems and CNS
inflammation in autism are also major questions
43
Oxidative Stress Problems in Autism?
Levels of transferrin and ceruloplasmin (antioxidants) are
lower in children with autism who lost skills relative to sibs
44
Administration and Scoring
45
Administration
• Can be completed at home, school, or clinician’s
office (should be free from distractions)
• Ensure confidentiality in reporting
• Clinician should indicate with an X or check mark
whether informant is to complete standard or
extended form
– Standard: if primary concern is with autism diagnosisrelated behaviors (e.g., prevalence studies)
– Extended: if concern is with autism behaviors and more
generic behavior issues
46
General Issues in Administration
• Give an estimate of amount of time needed
to complete the PDDBI (about 20-40
minutes depending on standard or extended
form)
• Review scoring for:
– Question marks (review item with respondent)
– Missing responses or multiple responses
– Missing dates (birth dates and current date)
47
PDDBI Domains
• Domains were conceptually organized as follows:
– Approach/Withdrawal Dimension
– Social Communication Skills
• Domains assess behaviors important for autism (Standard Form)
and for associated behavior problems that are not unique to
autism (Extended Form)
• Different versions were created for parents and teachers (a
generic term that includes teachers, speech therapists, aides,
ABA instructors, etc.)
48
PDD Behavior Inventory (PDDBI)
Approach-Withdrawal Problems (Repetitive, Ritualistic &
Pragmatic Problems)
–
–
–
–
–
–
–
–
Sensory/Perceptual Approach Behaviors
Ritualisms/Resistance to Change
Social Pragmatic Problems
Semantic/Pragmatic Problems
Arousal Regulation Problems
Specific Fears
Aggressiveness
Composite Scores
(Receptive)/Expressive Communication Skills
–
–
–
–
Social Approach Behaviors
Expressive Language
Learning, Memory and Receptive Language
Composite Scores
Autism Composite Score
49
Domains and Item Scoring
A “nested approach” was used for each domain
• Each domain in the PDDBI is made up of a subset of
different “clusters”
– For example, the Sensory/Perceptual Approach Behaviors
domain has 5 clusters in the parent version tapping a
variety of repetitive behaviors
– Each cluster consists of 4 or more exemplars and each is
rated on a Likert scale with the following options:
0 (Does Not Show Behavior); 1 (Rarely Shows Behavior);
2 (Sometimes/Partially Shows Behavior);
3 (Usually/Typically Shows Behavior); and ? (Don’t Understand)
• Each domain is scored (the raw score) by summing
the ratings, taking missing items into account
• Standard scores are computed from the tables and
50
entered on the Summary Sheet
PDD Behavior Inventory (PDDBI)
Scoring System (T-Scores)
• Each domain and composite was age-normed and
according to a T-score system (mean=50; SD=10)
• The higher the T-scores for the “Approach-Withdrawal”
domains and the Autism Composite Score, the more
“severe” or discrepant that child’s scores are from the
average child with autism
• The higher the T-score for the “Receptive/Expressive
Social Communication Abilities” domains, the better that
child’s skills are relative to the average child with autism
51
52
Domain Profile Form
• Standardized T-scores (refer to tables or
software) can be plotted on the Profile Form
53
54
Cluster Score Summary Table
• Cluster scores within domains can be
qualitatively examined along an ordinal
dimension for their clinical importance
55
56
Test Materials
• Parent Form (PDDBI-P; PDDBI-PX*)
– PDDBI-P (124 Items)
– PDDBI-PX (188 items)
• Teacher Form (PDDBI-T; PDDBI-TX*)
– PDDBI-T (124 Items)
– PDDBI-TX (180 items) Score Summary Sheets
• Profile Forms
• (PDDBI-SP – software)
X=Extended (if concern is with autism behaviors
and with more generic behavior issues)
57
Appropriate Populations
• Any child with a Pervasive Developmental
Disorder
• Ages 18 months through 12 years, 5 months
• English speaking informants
– Flesch-Kincaid Reading Level – Grade 4.7
– Gunning Fog Index – 7.8 (“Reader’s Digest” level)
58
Selecting Raters
• Parent
– Parent or legal guardian with the most recent
and frequent contact over the previous 6
months (ideally both parents)
• Teacher
– Teacher or other professional (speech therapist;
teacher’s aide, etc.) must have had at least daily
contact for at least one month or more than 4
weeks of several days per week contact
59
Approach-Withdrawal Problems Clusters
(Repetitive, Ritualistic & Pragmatic
Problems)
• Sensory/Perceptual Approach Behaviors
(Head to Body Arrangement) - SENSORY
–
–
–
–
–
–
–
Visual Behaviors
Non-Food Taste Behaviors
Touch Behaviors (PDDBI-P)
Noise Making Behaviors (PDDBI-T)
Proprioceptive/Kinesthetic Behaviors
Repetitive Manipulative Behaviors
Gait-Based Kinesthetic Behaviors (PDDBI-T)
60
Approach-Withdrawal Problems Clusters
(Repetitive, Ritualistic & Pragmatic
Problems)
• Ritualisms/Resistance to Change (RITUAL)
– Resistance to Change in the Environment
– Resistance to Change in Schedules/Routines
– Rituals
• Social Pragmatic Problems (SOCPP)
– Problems with Social Approach
– Social Awareness Problems
– Inappropriate Reactions to the Approaches of Others
61
Approach-Withdrawal Problems Clusters
(Repetitive, Ritualistic & Pragmatic
Problems)
• Semantic/Pragmatic Problems (SEMPP)
– Aberrant Vocal Quality When Speaking
– Problems with Understanding Words (e.g.,
echolalia)
– Verbal Pragmatic Deficits (e.g., problems with
conversations or perseverative language)
62
Approach-Withdrawal Problems Clusters
• Arousal Regulation Problems (AROUSE)
– Kinesthetic Behaviors
– Reduced Responsiveness
– Sleep Regulation Problems (PDDBI-P)
• Specific Fears (FEARS)
–
–
–
–
–
Sadness When Away From Caregiver…(PDDBI-P)
Anxiousness When Away From Caregiver…(PDDBI-P)
Auditory Withdrawal Behaviors
Fears and Anxieties
Social Withdrawal Behaviors
63
Approach-Withdrawal Problems Clusters
• Aggressiveness (AGG)
– Self-Directed Aggressive Behaviors
– Incongruous Negative Affect
– Problems when Caregiver…Returns from an
Outing or Vacation
– Aggressiveness Toward Others
– Overall Temperament Problems
64
(Receptive)/Expressive
Communication Skills Clusters
• Social Approach Behaviors (SOCAPP)
–
–
–
–
–
–
–
–
–
Visual Social Approach Behaviors
Positive Affect Behaviors
Gestural Approach Behaviors
Responsiveness to Social Inhibition Cues
Social Play Behaviors
Imaginative Play Behaviors
Empathy Behaviors
Social Imitative Behaviors
Social Interaction Behaviors (PDDBI-P)
65
(Receptive)/Expressive
Communication Skills Clusters
• Expressive Language (EXPRESS)
–
–
–
–
–
–
Vowel Production
Consonant Production
Diphthong Production
Expressive Language Competence
Verbal Affective Tone
Pragmatic Conversational Skills
66
Receptive/Expressive
Communication Skills Clusters
• Learning, Memory, and Receptive Language
(LMRL)
– General Memory Skills
– Receptive Language Competence
– Associative Learning (PDDBI-T)
67
Composite Scores
• Approach-Withdrawal Problems (AWP)
• Repetitive, Ritualistic & Pragmatic Problems (REPRIT)
• Receptive/Expressive Social Communication Skills
(REXSCA)
• Expressive Social Communication Skills (EXSCA)
• Autism
(SENSORY+RITUAL+SOCPP+SEMPP) –
(SOCAPP + EXPRESS)
68
Discrepancy Scores
• Social Pragmatic Problems – Social Approach
Behaviors
• Semantic/Pragmatic Problems – Expressive
Language
• Parent - Teacher
69
Development and Standardization
70
“You can observe a lot by just watching”
Yogi Berra
71
Development
• Items were selected based on observation and by review of
research studies
• The items were chosen to best represent the cluster to which they
were assigned
72
73
Percent with ADI or ADOS confirmed Autism:
92% (PDDBI-P); 89% (PDDBI-T)
74
Reliability
• Internal Consistency (Alpha)
• Stability (Test-Retest)
• Interrater
75
Internal Consistency
76
Internal Consistency
G. Leonard Burns, Ph.D., Washington State University, Pullman, WA
Mother
Approach-Withdrawal Problems
Receptive/Expressive ………
Father
(.81-.90) (.85-.92)
(.83-.90)*
(.92-.98) (.94-.98)
(.91-.95)*
Teacher
Aide
(.82-.92) (.81-.92)
(.81-.89)*
(.95-.99) (.93-.95)
(.95-.97)*
*PDDBI Manual Data
77
Stability
78
Interrater (Teacher-Teacher)
79
Interrater (Parent-Teacher)
80
Interrater
G. Leonard Burns, Ph.D., Washington State University, Pullman, WA
Mother-Father
Teacher-Aide
Mother-Teacher
Approach-Withdrawal …
(.44-.59)
(.46-.63)
(.40-.83)
(.20-.55)
(.23-.55)
Receptive/Expressive …
(.70-.85)
(.59-.89)
(.65-.82)
(.85-.92)
(.51-.82)
81
Validity
•
•
•
•
•
Internal Structure (intercorrelation matrices)
Construct (principal components analyses)
Developmental
Criterion-Related
Clinical
82
Internal Structure
83
Internal Structure
84
Construct Validity
85
Factor 1: Confirms Social Communication Dimension
Factor 2: Confirms Approach-Withdrawal Dimension
86
Developmental Validity
y=k*Age^n/(C+Age^n)
87
Criterion-Related Validity
• Childhood Autism Rating Scale (CARS)
• Nisonger Child Behavior Rating Form
(CBRF)
• Vineland Adaptive Behavior Scales
• Griffiths Mental Development Scales
88
89
90
91
92
Clinical Validity
• ADI-R (AGRE* Definitions)
– Autism
– Not Quite Autism
– Broad Spectrum
• ADOS-G
– Autism
– Spectrum
– Not Spectrum
• Vineland Adaptive Functioning Level
– Adequate/Moderately Low
– Mild/Moderate
– Severe/Profound
• Seizure Disorders
*http://www.agre.org/agrecatalog/algorithm.cfm
93
94
95
96
97
Clinical Interpretation
98
PDDBI Profiles
• For clinical and research purposes, it is important
to examine the overall profile of scores, as well as
the magnitude of the composite scores, for both
parent and teacher observations
• Such profiles can provide important information
about the child, and identify behaviorally-defined
sub-groups
• Remember that the PDDBI is standardized on an
autism sample.
99
Case 1 - Michael
• Visit 1 (23 months of age):
– Vineland
• Communication – 6 months
• Socialization – 11 months
• Motor Skills – 23 months
– ADOS-G: Autism
• Visit 2 (28 months of age; After 25 hrs/wk of
ABA and O.T.):
– Vineland
• Communication – 21 months
• Socialization – 20 months
• Motor Skills – 28 months
– ADOS-G: Autism Spectrum Disorder
100
Kinesthetic Behaviors Reduced Responsiveness Sleep Regulation Problems
Moderate
Very High
Moderate
101
6
7
10
9
7
6
5
5
6
7
6
90% CI
102
103
Case 4 - Albert
• IQ (SB-5): 103
• Vineland:
– Communication: 89
– Daily Living Skills: 60
– Socialization: 59
• Extreme anxiety noted on first observation
• History of aggressiveness as presenting problem with PDD
• Positive family history for anxiety and depression
• Medication:
– Visit 1. 5 years, 11 months of age - Dextroamphetamine
– Visit 2. 7 years of age - Olanzapine (Zyprexa) – became
manic on an SSRI with d-amphetamine
• Final Diagnoses: BP II; Social Anxiety Disorder;
Asperger’s Disorder
104
105
106
Case 5 - Ted
• Boy, 10 years of age with Fragile X
Syndrome
• Vineland:
– Communication: 63
– Daily Living Skills: 46
– Socialization: 65
• Medication: Methylphenidate (Ritalin)
• History of delayed milestones
107
108
Ted’s Cluster Scores
SOCPP
SEMPP
S
O
C
A
P
P
Inappropriate Reactions.. Others
Verbal Pragmatic Deficits
Visual Social Approach
Positive Affect
Gestural Approach
Imaginative Play
Empathy
Social Imitative
Social Interaction
Social Play
Very High
Very High
Very High
Very High
Very High
Very High
High
High
Moderate
Low
109
Case 6 - Huda
• Girl, age 3 years, 2 months
• Rett’s Disorder
• Vineland:
–
–
–
–
Communication: 43
Daily Living Skills: 42
Socialization: 50
Motor Skills: 39
• ADOS-G: Autism
110
Rett’s Disorder
•
•
•
•
•
•
•
•
•
Normal pre- and peri-natal development
Normal psychomotor development up to 5 mos.
Normal HC at birth-HC deceleration 5-48 mos.
Loss of purposeful hand skills (hand wringing)
Loss of social engagement
Poorly coordinated gait and trunk movements
Severe language disorder and retardation
Breathing abnormalities common
Due to MECP2 gene mutation  absence of MECP2
protein  absence of gene suppression
– “Leaky genes”
111
112
Case 7: JM
• 4 year, 10 month old boy with Costello
Syndrome
– Grand mal at 3 months of age – stopped breathing
– Currently petit mal seizures
• Tested positive for autism on the ADOS-G
• Parent report data provided by Dr. G. Hintz
(Wisconsin)
113
Costello Syndrome
• Rare multi-organ disorder of
unknown etiology
• Physical characteristics
– Growth delay
– Short stature
– Excessive skin on neck, palms,
fingers, soles
– Characteristic facial appearance
• Macrocephaly
• Low set ears
• Thick ear lobes and lips, wide
nostrils
• Cognitive delay
• Behavior – “Warm, sociable, and
humorous”
114
Case 7: JM
90
80
Domain T-Scores
70
60
50
40
30
20
10
SENSORY
SOCPP
AROUSAL
AGGRESS
EXPRESS
AUTISM
RITUAL
SEMPP
FEARS
SOCAPP
LMRL
115
Do PDDBI Domains Reflect Improvement?
116
PDDBI SOCIAL APPROACH AND VINELAND SOCIALIZATION
RELATIVE TO CHANGE IN ADOS CLASSIFICATION
PDDBI: F(1, 62)=4.0, p<.05
80
80
75
75
70
PDDBI
70
65
65
60
60
55
55
VINELAND
50
50
45
45
40
40
SOCAPP1
SOCAPP2
SSS 1
SSS 2
VINELAND SCORES (SD=15)
PDDBI T-SCORES (SD=10)
VINELAND F(1,62)=2.1, p=.16
NO CHANGE
N=45
IMPROVE
N=15
TIME
117
Discriminating PDD from Non-PDD Cases
ROC Curve
1.00
.75
Sensitivity
.50
.25
0.00
0.00
.25
.50
.75
1.00
1 - Specificity
PDD (n=475) vs. Not PDD (n=50; language impaired, emotional
problems, typically developing, etc.) - PDDBI-P Autism Composite
Area under curve=0.90 (+/- .023); 95% CI: .86-.95
118
Summary
• The PDDBI is a new reliable and valid tool
for measuring treatment effects; assisting in
diagnosis, placement, and treatment
planning; and analyzing behavioral subgroups
• It is sensitive to shifts in diagnostic status
• It correlates well with other measures of
autism and adaptive skills
119
PPV and NPV
Sensitivity and Specificity=90%
Test
Positive
for PDD
Test
Negative
for PDD
Base rate
N
Actual
PDD
Actual Not PPV and
PDD
NPV %
90
10
90
10
90
90
100
100
120
PPV and NPV
Sensitivity and Specificity=90%
Test
Positive
for PDD
Test
Negative
for PDD
Base rate
N
Actual
PDD
Actual Not PPV and
PDD
NPV %
90
1
99
10
9
47
100
10
121
PPV and NPV
Sensitivity and Specificity=90%
Test
Positive
for PDD
Test
Negative
for PDD
Base rate
N
Actual
PDD
Actual Not PPV and
PDD
NPV %
9
100
8
1
900
99
10
1000
122