1. The Gilliam Autism Rating Scale – Second editon (GARS-2™) A Training Module for Early Interventionists VT-ILEHP ASD LEND Program 2010

2. GARS-2 (Gilliam, 2006): What is it? A standardized tool for screening children at risk & assessing persons with autism and other severe behavioral disorders Provides norm-referenced information that can assist in the diagnosis of Autism Based on APA definition of autism

3. GARS (Gilliam, 1995) vs. GARS-2 (Gilliam, 2006) Changes made to the GARS to improve reliability & reflect changes in understanding Autism: Structured parent interview form replaces the Early Development subscale Some items rewritten for clarity Demographic characteristics of the normative sample were keyed to 2000 U.S. Census data. New norms created Guidelines provided for interpreting subscale scores Autism Index replaced the Autism Quotient Instructional Objectives for Children Who Have Autism included to assist in the formulation of instructional goals and objectives based on the GARS-2 results

4. GARS-2 Examiner’s Manual Provides detailed instructions on how to administer the GARS-2 along with information about reliability, validity, normative population Provides insights into using GAR-S results with Applied Behavior Analysis programs Provides standard scores and %ile ranks

5. GARS-2 Subscales Three subscales: Stereotyped Behaviors Communication Social Interaction

6. Stereotyped Behaviors Items 1-14 describe stereotyped behaviors, motility disorders, and other unique and atypical behaviors Examples: Stares at hands, objects, or items in the environment for at least 5 seconds. Spins objects not designed for spinning (e.g. cups, saucers, glasses…) Flaps hands or fingers in front of face or at sides.

7. Communication Items 15-28 describe verbal and non-verbal behaviors displayed by children with Autism and Autism Spectrum Disorders. Examples: Repeats words or phrases over and over. Looks away or avoids looking at speaker when name is called Repeats unintelligible sounds (babbles) over and over.

8. Social Interaction Items 29-42 evaluate a child’s ability to relate appropriately to people, events, and objects. Examples: Does not imitate other people when imitation is required or desirable, such as in games or learning activities. Withdraws, remains aloof, or acts standoffish in group situations. Becomes upset when routines are changed.

9. Administration Rater=>completes 14 questions for each subscale Teacher Parent Clinician Examiner=>scores & interprets the results Can use structured interview with the rater

10. Guidelines for Rating May be necessary for more than one person to complete the rating based on relationship with the child EXAMPLE: Classroom teacher rates the Stereotyped Behaviors & Social Interactions while SLP rates Communication. Raters should read the questions carefully & ask questions for clarification Raters should not take into account a child’s age when rating

11. Rating Frequency Four different measures of frequency 0 – Never observed – You have never seen the individual behave in this manner. 1 – Seldom observed – Individual behaves in this manner 1-2 times per 6-hour period. 2 – Sometimes observed – Individual behaves in this manner 3-4 times per 6-hour period. 3 – Frequently observed – Individual behaves in this manner at least 5-6 times per 6-hour period.

12. Parent Interview Parents are a good source of information about their children’s behaviors. Parents/caregivers describe child’s behavior before age 3 First 10 questions deal with delays 15 questions deal with abnormal functioning Questions are scored ‘yes’ or ‘no’ Examiner can give examples to explain the behaviors ‘No’ responses indicate abnormality or developmental delay Necessary to have evidence that an individual demonstrated delays before age 3 to diagnose Autism.

13. Scoring GARS-2: Subscale Standard Scores and the Autism Index Make sure all items in each subscale have been rated Add raw scores for each item & total these Find %ile rank and standard score for each subscale Standard score (SS) of 7 or higher on a subscale indicates a very likely possibility of Autism (based on a mean of 10; standard deviation (SD) of 3) SS of 4-6 on a subscale indicates a possibility of Autism SS of 0-3 on a subscale indicates Autism is unlikely Add up subscales to determine the Autism Index (based on a mean of 100 & SD of 15 It is possible to use 2 subscales instead of 3 to determine the Autism Index

14. Research behind GARS-2 Normative scores come from a sample of 1,107 children & young adults between the ages of 3 & 22 diagnosed with Autism Internal consistency & test-retest coefficients are large to very large Validity was demonstrated by confirming that: Items on the subscales are representative of the characteristics of autism Subscales are strongly correlated to each other and to the performance of other tests that screen for autism Scores discriminate persons with autism from persons with other severe behavioral disorders as well as persons without disabilities

15. Case Examples

16. Case Study: Beatrice 5-year old, verbal female Background: Kindergarten teacher noticed that she was not socializing with other children & exhibited repetitive motions; school psychologist was asked to complete the GARS-2. Beatrice was receiving speech-language services and her SLP completed the Communication subscale of the GARS-2 while the kindergarten teachers filled out the Stereotyped Behaviors and Social Interaction subscales. Subscale 1 - Stereotyped Behaviors: Teacher reported frequently observing the following behaviors: • 2. Stares at hand objects, or items in the environment for at least 5 seconds. • 8. Spins objects not designed for spinning (e.g., saucers, cups, glasses) • 9. Rocks back and forth while seated or standing. • 12. Flaps hands or fingers in front of face or at sides. Other behaviors were not observed.

17. Case Study: Beatrice QUESTIONS: 1. How often is ‘frequently observed’? 2. What is the subscale SS for Beatrice? 3. Does this mean Beatrice has Autism? ANSWER: 1. Frequently observed means the individual behaves in this manner at least 5-6 times per 6-hour period. 2. The subscale score is ___: 3. No, but her score indicates a high risk for Autism as it is falls in the range of 7 or higher.

18. Case Study: Beatrice Subscale 2 - Communication: The SLP completed the subscale & found that Beatrice sometimes exhibited the following: 17. Repeats words or phrases over and over. 18. Speaks or signs with flat tone, affect, or dysrhythmic patters 28. Inappropriately answers questions about a statement or brief story. The SLP did not observe any other behaviors listed on the subscale.

19. Case Study: Beatrice QUESTIONS: 1. Does this subscale indicate a risk of Autism? ANSWER: Yes, Beatrice scored a __ on this subscale and as such there is some indication of a possibility of Autism. Combined with the Stereotyped Interactions data, there is an indication of a high risk of Autism. 2. Was it appropriate for more than one adult to complete the GARS-2? ANSWER: Yes, each professional has a different perspective & multiple raters who have the best view into a particular domain can complete the subscales of the GARS-2.

20. Case Study: Beatrice Subscale 3 - Social Interaction: The kindergarten teacher completed this subscale and found that Beatrice sometimes: 40. Becomes upset when routines are changed. 42. Lines up objects in precise, orderly fashion and becomes upset when the order is disturbed. The teacher seldom observed Beatrice exhibiting the following: 31. Resists physical contact from others. 33. Withdraws, remains aloof, or acts standoffish in group situations.

21. Case Study: Beatrice QUESTION: Does this subscale indicate a risk of Autism? ANSWER: Yes, Beatrice scored a ___ on this subscale and as such there is some indication of a possibility of Autism. Combined with the Stereotyped Interactions data, and the Communications subscale there is an indication of a high risk of Autism.

22. Case Study:Beatrice Beatrice was referred to a developmental pediatrician for a developmental evaluation. She was eventually diagnosed with PDD-NOS. She was referred to an intensive after school intervention program.

23. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Autism Society of America (2003). What is Autism? Retrieved January 5, 2005, from http://www.autismsociety.org/site/pageserver?pagename=whatisautism Gilliam, James E. (1995). Gilliam Autism Rating Scale. Austin TX: PRO-ED. Gilliam, James E. (2006). GARS-2; Gilliam Autism Rating Scale, Second Edition, Examiner’s Manual. Austin, TX: PRO-ED.