The Gilliam Autism Rating Scale

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The Gilliam Autism Rating Scale Second editon
(GARS-2)

• A Training Module for Early Interventionists
• VT-ILEHP ASD LEND Program
• 2010

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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

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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

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GARS-2 Examiners 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

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GARS-2 Subscales

• Three subscales
• Stereotyped Behaviors
• Communication
• Social Interaction

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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.

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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.

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Social Interaction

• Items 29-42 evaluate a childs 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.

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Administration

• Ratergtcompletes 14 questions for each subscale
• Teacher
• Parent
• Clinician
• Examinergtscores interprets the results
• Can use structured interview with the rater

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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 childs age
  when rating

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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.

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Parent Interview

• Parents are a good source of information about
  their childrens behaviors.
• Parents/caregivers describe childs 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.

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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

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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

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Case Examples
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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.

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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.

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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.

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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.

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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.

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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.

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Case StudyBeatrice

• 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.

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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?pagen
  amewhatisautism
• Gilliam, James E. (1995). Gilliam Autism Rating
  Scale. Austin TX PRO-ED.
• Gilliam, James E. (2006). GARS-2 Gilliam Autism
  Rating Scale, Second Edition, Examiners Manual.
  Austin, TX PRO-ED.