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Table 4 Modifications made to the ABI following round 1 of cognitive interviews

From: Qualitative evaluation of the Autism Behavior Inventory: use of cognitive interviewing to establish validity of a caregiver report scale for autism spectrum disorder

Wording presented in round 1 Final wording presented in round 2 Rationale
Social communication   
 Shows an interest in what other people are doing Pays attention to or notices what other people are doing Re-worded to clarify that this is more about general awareness of people and less dependent on what people are actually doinga
 Responds to attempts to initiate social interaction Responds positively when others try to start social interactions Re-worded to provide claritya
 Combines gestures with vocalizations to enhance communication, e.g., uses actions and words to get point across Combines body language with words or sounds to support communication, e.g., uses actions and words to get point across Re-worded to simplify so it was easier to understanda
 Attends to parts of sentences and misinterprets whole, e.g., focuses on one or two words and misses the point Attends to parts of sentences and misinterprets whole sentences, e.g., focuses on one or two words and misses the point The term “sentences” was added after “whole” to capture the intended meaning of the itema
 Resists affection from familiar people Resists affection from familiar people e.g. pulls away from family members/close friends or rejects verbal displays of affection Examples were added to capture the intended meaning of the itema
 Responds to familiar things, e.g., when a particular song is sung, when a familiar name is mentioned Removed Removed at it was considered unsuitable for older individuals and some caregivers had difficulty interpretingb
Restrictive behavior
 Has mannerisms or odd ways of moving her/his hands or fingers, e.g., flapping or moving fingers in front of eyes Has mannerisms or odd ways of moving her/his hands or fingers, e.g., moving fingers in front of eyes The term “flapping” was removed from the example, this change was based on alleviating potential confusion of this itema
 Makes repetitive movements, e.g., flapping arms, rocking body, rolling head Makes repetitive movements, e.g., flapping arms, rocking body, rolling head, spinning or tapping objects The example “spinning or tapping objects” was added to the example to provide clarity to better understand the item. It was combined with below itema
 Attempts to harm him/herself Behaves in a way that can cause injury to self, e.g., biting self, picking skin, banging head Reworded and examples were added. The rationale to reword was based on providing simpler language to better understand the item clarifying this is not a suicide assessment itema
 Has sensitivities to certain food textures Is overly sensitive to certain food textures, e.g., refuses food that is too crunchy, or too soft Reworded and an example was added based on providing clarification related to food allergies and/or sensitivitiesa
 Has an unusually narrow range of interests Has a very limited range of interests “Unusually narrow” was removed and replaced with “a very limited” to provide clarity to the item as there was difficulty understanding the terms “unusually narrow”a
 Uses objects repetitively Removed Removing this item was based on being potentially confusing. This was combined and covered in the repetitive movements itemb
Mood and anxiety
 Is irritable and whiny, e.g., grouchy, moaning when unhappy Is irritable, e.g., grouchy, cranky, moaning when unhappy The term “whiny” was removed and an example was added due to the lack of understanding of the term “whiny”a
 Worries about things, e.g., generally worries about minor things, making mistakes, going to school Worries about minor things The term “minor” was added and the example was removed for simplificationa
 Clings to adults or is too dependent on them Clings to adults or is overly dependent on them The term “too” was removed and replaced with “overly” based on providing clarification to better understand this item for younger children’s ordinary behavior of dependencea
 Complains about physical problems without a known medical reason, e.g., complains about aches and pains which may not be there Removed Removed due to the potential for this item to capture typical child behavior rather than mood or anxiety concerns. Additionally, this item was removed due to ambiguity if the child is non-verbalb
 Looks worried or concerned, e.g., has a fearful worried expression Removed Removed based on reducing the number of items in this domain and low frequency of occurrence (from this study and previous data)c
 Gets upset when separated from a caregiver Removed Removed based on similarity to clings to adults or is too dependent on themc
Challenging behavior
 Runs away Runs or wanders away, e.g., does not stay in the place they should be The phrase “or wanders” and examples were added to provide clarity to the item so that it is interpreted as “wandering or running away”a
 Is mean to animals, e.g., pulls pet’s tail, shoves, kicks Removed Removed based on the potential to capture behaviors observed during childhood rather than challenging behaviors associated with ASD. It was also removed because of the low incidence of the behavior, thus the potential to change in response to interventionc
 Hits or kicks Removed Removed based on the potential to capture behaviors typical during childhood rather than challenging behaviors associated with ASD. This item was also considered to overlap with physical aggressionc
 Screams, yells, and cries Removed Removed based on the potential for this item to capture behaviors typical of children rather than challenging behaviors associated with ASD and similarity to other itemsc
  1. ABI Autism Behavior Inventory, ASD Autism Spectrum Disorder
  2. aItem reworded
  3. bItem removed due to potential for misunderstanding
  4. cItem understood but removed for other reasons (low frequency/limited applicability/overlap)