Social Responsiveness Scale, Second Edition (SRS-2)
The SRS-2 identifies social impairment associated with autism spectrum disorders (ASD) and quantifies its severity. It is sensitive enough to detect even subtle symptoms, yet specific enough to differentiate clinical groups, both within the autism spectrum and between ASD and other disorders. It clearly distinguishes the social impairment feature of ASD from that seen in ADHD, anxiety, and other diagnoses.
SRS-2 is supported by a multitude of independent, peer-reviewed studies involving diverse populations and diagnostic groups. When SRS-2 reveals social deficits associated with autism, it identifies where those symptoms lie on the spectrum. And when the test indicates that autism is not present, it points to other conditions in which social impairment plays a role.
The 5 subscales include;
- Social conscience:Ability to pick up on social cues.
- social cognition:Ability to interpret social cues once they are picked up
- Social comunication:Includes expressive social communication.
- social motivation: the extent to which a respondent is generally motivated to engage in social-interpersonal behavior; Included here are elements of social anxiety, inhibition, and empathic guidance.
- Restricted interests and repetitive behaviors:Includes stereotyped behaviors or highly restricted interest traits of autism
Trial Review of the Social Response Scale, Second Edition (SRS-2)
Yetter, G. (2014).
Em J. F. Carlson, K. F. Geisinger y J. L. Jonson (Eds.),The Nineteenth Yearbook of Mental Measurements.. Retrieved from http://marketplace.unl.edu/buros/
DESCRIPTION
The Social Response Scale, Second Edition (SRS-2) is a 65-item rating scale that assesses symptoms associated with autism in individuals 30 months to 89 years of age. It is intended to be completed by adults familiar with an individual's social functioning in natural settings.
The SRS-2 consists of four forms: preschool (30-54 months of age), school-age (4-18 years), adult (19-89 years), and adult self-report. All forms produce two group scores: Communication and Social Interaction (SCI; 53 items) and Restricted Interests and Repetitive Behavior (RRB; 12 items), as well as a total score. The SCI items are divided into four treatment subscales: Social Awareness (8 items), Social Cognition (12 items), Social Communication (22 items), and Social Motivation (11 items). These four subscales were formed based on clinical judgment rather than statistical analysis and were included to aid in intervention development and evaluation in treatment settings.
All items are evaluated on a 4-point Likert-type scale anchored to false and almost always true, where high scores indicate greater dysfunction. Scoring is done by hand and is simple. Raw scores are converted to T scores for interpretation. A summary profile sheet is provided to record and plot SCI, RRB, and Total T scores and classify them as within normal limits (T = 59 or less), mild (T = 60–65), moderate (T = 60– 65 = 66–75) or severe (T = 76 or higher). Evaluators can complete the questionnaire in 15 to 20 minutes. Scoring and charts can be completed in 5-10 minutes.
DEVELOPMENT
The SRS-2 is an extension of the SRS (Constantino & Gruber, 2005), a well-established trigger for autism symptoms between 4 and 18 years of age. The SRS-2 form for school-age children is the same as the original SRS. New forms for preschoolers and adults have been developed adapting the wording of the form items for school-age children, generally keeping the wording of the items as similar as possible on all forms.
Diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013) specified two distinct areas of impairment for autism spectrum disorder (ASD): impaired communication and interaction social, and restricted and repetitive behavior patterns. The adequacy of the two-dimensional framework for the school-age SRS-2 form (parent report) was examined with approximately 5,000 school-age children diagnosed with ASD and 3,000 siblings without ASD. The results suggested a moderate separation of the SCI and RRB domains. Confirmatory factor analyzes with preschool, school-age, and adult samples indicated an adequate fit to the two-dimensional model, supporting the interpretation of separate SCI and RRB indices for the various SRS-2 forms.
TECHNICIAN
Representative standardization samples from the 2009 US Census were pooled by gender, race, US geographic region, and parental education level to provide evidence of technical strength preschool (n = 247), school age ( n = 1014) and adults (n = 702). ) forms. For each form, average ratings by gender, ethnicity, age, and respondent (eg, parent, teacher, myself) were compared. Normal samples included too few Asians and Native Americans to support analysis of ethnic differences with these populations. Using a 3-point T-score difference in mean scores as criteria for developing separate norm tables, the test authors concluded that, while separate norm tables by respondent and gender were warranted for school age, a single table of standards was more appropriate. appropriate for each of the other forms.
The internal consistency of all SRS-2 forms is excellent by gender, age, and respondent for clinical and non-clinical samples; alpha coefficient values were consistently in the range of 0.92–0.95. Correlation coefficients reflecting interrater agreement for school-age children with ASD were 0.91 for mothers with fathers and 0.72 to 0.82 for fathers with teachers. Interrater reliability of the preschool form ranged from 0.70 to 0.79 for parents with teachers in 6-month-old increments. Interrater reliability for the Adult form was fair to good, with correlation coefficients ranging from 0.66 (comparing self-rating to all other informants) to 0.88 (comparing mother's rating to all other informants). . Small sample sizes for some age groups in the adult sample precluded analysis of interrater reliability per respondent and age simultaneously.
Evidence for temporal stability is strong, indicating reliability over time in school-age clinical samples, where correlation coefficients ranged from 0.88 to 0.95 for periods of three months to five years. Test-retest reliability coefficients for samples of the general school-age population are also acceptable. The test manual does not document the temporary stability of the Adult form or the Preschool form.
Support for the validity of the SRS-2 for school-age children was provided through its convergence with other measures of autism-related symptoms. Correlations with the Social Communication Questionnaire (Rutter, Bailey, & Lord, 2001) produced coefficients between 0.58 and 0.68. Correlation coefficients for the SRS-2 and the Child Communication Checklist (Bishop, 1998) ranged from -0.49 to -0.75. Agreement with the Childhood Autism Rating Scale (Schopler, Reichler, DeVellis, & Daly, 1980) was r = 0.61. Relationships with the Autism Diagnostic Interview Revised (ADI-R; Rutter, Le Couteur, & Lord, 2003) were mixed, but overall supported the validity of the SRS-2 form for school-age children. Correlation coefficients for SRS-2 and ADI-R domain scores ranged from 0.26 to 0.77. The coefficients for the domain scores of the SRS-2 and the Autism Diagnostic Observation Program (ADOS; Lord, Rutter, DiLavore, & Risi, 2001) were also variable, with a range of 0.15 to 0.58. The relationship of the SRS-2 form for school-age children with the Vineland adaptive behavior scales (Sparrow, Balla, & Cicchetti, 1984) was of moderate magnitude (r = -0.36 for the Vineland composite and -0.34 to -0.43 for the subscales), but in the predicted direction.
The validity of the SRS-2 form for school-age children was further evidenced by substantial differences between the mean SRS-2 total scores for children with ASD and those without ASD; M = 106.6 (SD = 30.0) for a group of approximately 5000 children with ASD versus M = 24.6 (SD = 24.7) for their unaffected siblings. Studies of preschool and adult forms have also reported substantially higher mean scores for people with ASD or at risk for developmental problems. One area of concern relates to the evidence of higher mean scores for adults aged 60 and over on the adult score card. The average raw total score for older adults (n = 127) in the standardization sample was 61, more than 20 points higher than for the general sample of adults.
A receiver operating characteristic (ROC) analysis of the school-age form revealed a test sensitivity of 0.93 and specificity of 0.91 when using a cutoff score of 60 and a sensitivity of 0. 84 and a specificity of 0.94 with a cut-off of 75. ROC analyzes for the preschool and adult forms have not yet been reported.
COMMENT
The original SRS is widely used in clinical and research settings to measure the severity of ASD symptoms. By extending its age range, SRS-2 has the potential to expand its applicability. Several concerns are noted with SRS-2. First, the item development procedures for the new preschool and adult forms were not ideal. The assumption that items that adequately distinguish ASD symptoms among school-age children will also be appropriate for people of other ages (with minimal reformulation) is questionable, as the diagnostic utility of items depends on developmental appropriateness. of the behaviors they display. . The adequacy of the items at both ends of the age range (younger children and older adults) is not sufficiently demonstrated. The representation of older people in the standardization sample is small, and their mean scores were inexplicably high.
Second, the test manual offers relatively little evidence to support the validity of the preschool and adult forms. Studies with larger clinical samples and ROC analyzes are needed to establish the sensitivity and specificity of the test at these ages.
SUMMARY
The SRS-2 is a short, easy-to-administer Likert scoring instrument that can be helpful in detecting ASD symptoms in people. The second edition expanded the original SRS age range downward to include preschool-age children and upward to include people up to 89 years of age. Extensive evidence supports its validity and sensitivity in predicting ASD-related symptomatology in school-age children. However, more studies are needed before the new forms can be used with confidence in adults and preschool children.
REVIEWER REFERENCES
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publications.
- Bishop, DVM (1998). Development of the Child Communication Checklist (CCC): A method to assess qualitative aspects of communication impairment in children. Journal of Child Psychology and Psychiatry, 39, 879-891.
- Constantino, J. N., & Gruber, C. P. (2005). A Scale of Social Responsivity. Los Angeles, CA: Western Psychological Services.
- Lord, C., Rutter, M., DiLavore, PC. and Risi, S. (2001). Autism Diagnostic Observation Program (ADOS). Los Angeles, CA: Western Psychological Services.
- Rutter, M., Bailey, A. & Lord, C. (2001). Social Communication Questionnaire (SCQ). Los Angeles, CA: Western Psychological Services.
- Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism Diagnostic Interview Revised (ADI-R). Los Angeles, CA: Western Psychological Services.
- Schopler, E., Reichler, R., DeVellis, R. & Daly, K. (1980). Toward an objective classification of childhood autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental Disorders, 10, 91–103.
- Sparrow, S.S., Balla, D.A., & Cicchetti, D.V., (1984). Vineland Adaptive Behavior Scales. Circle Pines, MN: American Guidance Service.