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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)