Models and Methods of Assessing Adaptive Behavior
Abstract and Keywords
This chapter will summarize contemporary models and methods used for the assessment of adaptive behavior functioning in children and adolescents. This chapter will also emphasize how to best use such assessment information for diagnostic and eligibility purposes and in developing interventions and support plans. We will review the use of traditional, norm-referenced adaptive behavior assessment tools as well as what will be referred to as “supplemental methods,” including the direct observation of adaptive skill functioning. The assessment of adaptive behavior with respect to developmental expectations, cultural expectations, systems of care, and legislation will also be discussed. Lastly, case studies will be presented to illustrate the usefulness of these methods in assessing individuals and planning effective interventions and services.
Definition of Adaptive Behavior
One of the most widely accepted definitions of adaptive behavior was first developed by the American Association on Mental Retardation (AAMR; 1992, 2002). As defined by the AAMR (2002), adaptive behavior is “ the collection of conceptual, social, and practical skills that have been learned by people in order to function in their everyday lives” (p. 73). As such, adaptive behavior reflects one’s competence in dealing with social expectations and across environments. Limitations in adaptive behavior affect one’s daily life, one’s ability to respond to life changes and environmental demands, and the degree to which an individual can be independent. The AAMR defines conceptual skills as the ability to understand and communicate via spoken and non-verbal language, the ability to plan out one’s day-to-day activities, and performance of academic skills such as reading or writing. Social skills are defined as one’s ability to relate to others, hold a conversation, and initiate dialogue for the purpose of communicating one’s ideas or needs and wants. Additionally, social skills include the ability to obey rules of an organization, such as family or school, as well as obey the laws of society. Practical skills include independence in performance of daily functions such as planning and preparing meals, putting on clothing, toileting, managing one’s own finances, using the telephone, and ability to take needed medications. Adaptive behavior emphasizes the developmental nature of skills, which become more complex as individuals mature and are faced with new demands from their environment. Ultimately, adaptive behavior assessment must take into account the culture and social standards of the community in which the individual lives and functions.
Adaptive Behavior and Its Relationship with Intelligence
Adaptive behavior assessment evolved out of a concern voiced over 50 years ago, speaking to the need for nonbiased assessment beyond the IQ test for diagnosis, and linking to effective interventions for individuals with intellectual and developmental (p. 652) disabilities (IDD). The first accepted definition of adaptive behavior from the AAMR was developed in 1961) (Heber, 1961), born out of the recognized bias of diagnosing individuals with IDD based upon the results of IQ tests alone, without examining their day-to-day functioning in society. With the advent of the Education for All Handicapped Children Act in 1975 (Public Law 94–142), concern for the over-identification and labeling of some minorities by the sole use of IQ testing lead to several court cases, and subsequently to the inclusion of adaptive behavior in assessing children for IDD (Reschley, Kicklighter & McKee, 1988). Over the years, adaptive behavior has become a required element in determining eligibility for other special education programs besides IDD, as well as in qualifying for federal assistance programs, such as Social Security benefits. Therefore, legislation and litigation came to establish the critical importance of assessment of adaptive behavior in diagnosis, program eligibility, and intervention for individuals with IDD, in that it not only identified limitations, but provided a basis for developing interventions and services towards developing competencies and strengths.
For the past 30 years, several researchers have examined the relationship between adaptive behavior assessment and IQ tests, particularly with respect to individuals with IDD. Across multiple studies, comparing several instruments, the correlations between IQ and adaptive behavior scores were found to be in the low to moderate range (Coulter, 1980; Harrison, 1990; Lambert, Nihira, & Leland, 1993). Some reasons for these findings may be a function of the differences between the construct for intelligence (innate abilities, maximal performance potential, and stability of scores) and the construct for adaptive behavior (daily living skills, typical performance, and developmental/modifiable). Individuals with similar IQ scores will often demonstrate very different skills related to their adaptive behavior functioning, as a result of their opportunities, expectations, or motivation (Harrison & Oakland, 2003). With proper intervention, individuals can be taught and will learn adaptive behavior skills aimed to help them to function more successfully in new environments and situations. (Bruininks, Thurlow, & Gilman, 1987; Kamphaus, 1987).
While the assessment of adaptive behavior has been primarily used in individuals with IDD, it has also been found useful in assessing the strengths and needs of other clinical groups, including autism spectrum disorders (ASD; Harrison & Boney, 2002; Holman & Bruininks, 1985), Attention-Deficit/Hyperactivity Disorder (ADHD; Harrison & Oakland, 2003), as well as emotional and behavioral disorders (EBD; Armstrong, Dedrick & Greenbaum, 2003). For example, deficits in adaptive behavior functioning are apparent in the early childhood years, and as such have become an integral part of early childhood assessment, diagnosis, and intervention (Harrison & Raineri, 2007). Young children who do not receive intervention to assist in increasing their adaptive skills are at greater risk for later behavior problems (Grossman, 1983). Adolescents with poor adaptive skills are less successful in completing school and assuming adult roles, including independent living, employment, and achieving satisfactory relationships (Armstrong, Dedrick, & Greenbaum, 2003). Furthermore, Armstrong and colleagues found that improvement in adaptive skill functioning was a better predictor of successful adult outcomes than either reduction of behavior problems or IQ scores.
Thus, meeting the demands and expectations for one’s environment is important at all ages, and is critical to consider in providing supports and services that promote adaptation. Everyone, regardless of their age or disability, must learn to take care of themselves and get along with others to the extent that is possible. Interventions specifically designed to address limitations in adaptive skills and build strengths become key to successful and independent functioning, and so become a critical function of special education supports and services (Eldevik et al., 2010; Gresham & Elliott, 1987).
Purpose of Adaptive Behavior Assessment
The overarching purpose of adaptive behavior assessment is to develop supports and services to meet the needs of the individual. To accomplish this, it becomes essential to identify the individual’s functional strengths and needs in relation to their family, culture, and community expectations. Often, adaptive behavior assessment is needed to help establish a diagnosis that may assist in explaining the reasons for the differences. Standard classification systems, including the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; 2000), and the International Classification of Diseases, Ninth Revision (ICD-9; 1998) include the assessment of adaptive behavior for the diagnosis of IDD. Establishing a diagnosis can help link the individual and family to specific support groups, determine eligibility for supports and services, and supply a (p. 653) deeper understanding of the nature of the individual’s differences. The latest revision of the DSM has kept its current definition of mental retardation (now known as IDD) and requires documentation of deficits in adaptive functioning along with deficits in IQ for diagnosis. The DSM-5, which is expected to be released in 2013, is proposing only minor changes in the definition of IDD, and will likely increase its emphasis on adaptive functioning. The DSM-IV-TR stresses that effectiveness in adaptive functioning should be considered within the context of one’s age and cultural expectations, in areas of communication, self-care, home living, social skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety.
A second emphasis of adaptive behavior assessment is to establish the level of an individual’s functioning in order to determine their eligibility for special-education programs and to set goals and objectives. The Individuals with Disabilities Education Act (IDEA, 2004) is a federal law that mandates that all children aged birth to 21 receive free and appropriate services in the least restrictive environment. Part B of IDEA refers to regulations pertaining to children from three to 21 years of age, while Part C addresses regulations for infants and toddlers, from birth to age three. Lastly, there has been an increased focus on educational accountability extending from preschool to high school years, which requires assessment information that documents what children know and can do as part of the No Child Left Behind (NCLB) act of 2004 (NCLB, 2004). Given the developmental nature of adaptive behavior and presumed malleability, the emphasis on early identification and intervention with evidence-based strategies, adaptive behavior assessment becomes crucial. What children can and do perform in their everyday routines must be examined for the purposes of diagnosis and eligibility, as well as to establish interventions and supports needed to address specific functioning, and their response to the intervention (Harman, Smith-Bonahue, & Oakland, 2010).
Both the DSM-IV-TR, as well as the upcoming fifth revision, DSM-5, along with IDEA (2004) strongly emphasize the assessment of adaptive behavior for diagnostic purposes or when assessing an individual for special education services. This emphasis is not accidental. Adaptive behavior assessment initially was developed as a way to prevent misdiagnosing individuals, placing them in more restrictive settings, or giving them inappropriate services. Adaptive behavior assessment provides information both about an individual’s weaknesses and strengths, is useful in planning and evaluating interventions, and helps document progress towards goals.
Standardized and Supplemental Adaptive Behavior Assessment Tools and Techniques
There are many well-standardized instruments that have been developed over the past two decades that are very useful in assessing adaptive behavior in individuals ranging in age from infants to senior citizens. As with other standardized assessment tools, adaptive behavior measures gather information about an individual’s functioning to compare with those from national standardization samples and from certain clinical groups. Additionally, newer assessment techniques have been developed that allow for more in-depth assessment of key adaptive skills, which may be more useful for intervention planning and progress monitoring. Given the rapid changes in technology, and what is needed to interact with the environment and society, the construct of adaptive behavior is constantly changing and being modified (Oakland & Daley, 2010).
Standardized, Norm-based Assessment Methods
Among the most contemporary, well-standardized, and widely used norm-based adaptive behavior assessment instruments are the Adaptive Behavior Assessment System–Second Edition (ABAS-II; Harrison & Oakland, 2003), and the Vineland Adaptive Behavior Scales–Second Edition (VABS-II; Sparrow, Cicchetti & Balla, 2005). In addition, the Battelle Developmental Inventory–Second Edition (BDI-2; Newborg, 2004), and the Behavior Assessment System for Children–Second Edition (BASC-2; Reynolds & Kamphaus, 2004), include measures of adaptive behavior as one of the domains within those assessments. These tools are similar in that they rely on gaining information from caregivers familiar with the individual, such as parents or teachers, obtained through survey and semi-structured interview methods. The strengths and weaknesses of each of these tools will be discussed in the following section, and are outlined in Tables 27.1 and 27.2.
The VABS-II measures adaptive behavior in four domains and eleven subdomains. Scores from the four domains (Communication, Daily Living Skills, Socialization Skills, and Motor Skills) are combined to from the Adaptive Behavior Composite, (p. 654) or overall measure of adaptive behavior. There are three forms: the Survey Form, the Expanded Form, and the Classroom Edition, which are selected by the evaluator based on the age of the individual. The Survey Form gathers information about adaptive functioning from caregivers, is normed for children birth through 18 years of age, and may be used for lower-functioning adults. The Expanded Form offers much more detailed information about adaptive behavior, and is normed for infants through adults up to age 77 years. The Classroom Edition is useful for children ages three to 12, and uses teacher report to assess adaptive functioning within the classroom. Both the Survey and the Expanded Forms include a maladaptive behavior domain for children age five and older, titled the Social-Emotional Early Childhood Scale (SEEC; Sparrow, Balla, Cicchetti, 1998).
Table 27.1 Standardized Assessment Tools for Adaptive Behavior
Age Range, Areas Assessed, and Materials
Adaptive Behavior Assessment System (ABAS-II), 2nd Edition (Harrison &
Age range:Birth–72 Years
Areas Assessed:Domains:General Adaptive Composite: Adaptive Domains—Conceptual (Communication, Functional Academics, Self-Direction,
Social (Leisure, Social,); Practical (Community Use, Home Living, Health & Safety, Self-care, Work,)
Motor domain for children birth–5
Used in Bayley-3
Strong standardization sample
Internal consistency and factor score coefficients were high across all subdomains
Inter-scorer reliability is above .90
Number of clinical samples included
Four-point Likert-type scale (is not able, never or almost never when needed, sometimes when needed, and always or almost always when needed) to assess each skill area rather than simply “yes/no”
Additional data are required to assess utility of using the ABAS-II for progress monitoring
Technical adequacy may be improved by norming the instrument on a larger sample size
Vineland Adaptive Behavior Scales–Second Edition (VABS-II; Sparrow, Cicchetti, & Balla, 2005)
Age range:Birth–90 years of age
Areas Assessed:Four main domains:communication, daily living skills, socialization, and motor skills (only used for individuals birth- 6 years 11 months)
Optional maladaptive behavior domain available
Number of clinical samples included
Both clinical interview and parent/caregiver rating forms available
Comprehensive, life span
Manual scoring is cumbersome and can lead to error
Inter-rater reliability is relatively weak
May be more accurate at measuring adaptive skill deficits versus high levels of performance
The VABS-II used a representative, national sample of 3,000 individuals, selected by sex, race, socioeconomic status, geographic region, and community size. Standard scores are used to express adaptive behavior functioning, with a mean of 100, and standard deviation of 15, percentile ranks, stanines, and age equivalents. Internal consistency, test-retest reliability and inter-rater reliability, and validity data are adequate, and provided in more detail in Table 27.1. The SEEC is available for children birth through age five, and provides standard scores, percentile ranks, stanines, and age equivalents similar to those of the VABS-II.
The ABAS-II measures adaptive behavior in three domains: Conceptual, Social, and Practical, consistent with the American Association of Intellectual and Developmental Disabilities (AAID; 2007)definition of adaptive behavior. Each of the domains is factored into 11 subdomains, including Communication, Functional Academics, Self-Direction, Leisure, Social, Community Use, Home Living, Health and Safety, Self-care, Motor, (p. 655) and Work (adults only). Scores from the three major domains are combined into a General Adaptive Composite score to represent overall adaptive behavior functioning.
Table 27.2 Behavior and Developmental Assessment Tools Including Adaptive Behavior
Age Range, Areas Assessed, and Materials
Battelle Developmental Inventory–Second Edition (BDI-2; Newborg, 2004)
Behavior Assessment System for Children, Second Edition
(BASC-2; Reynolds & Kamphaus, 2004)
Age Range: Birth–7 years 11 months
Areas Assessed:Adaptive, Social-Emotional, Language, Motor, and Cognitive
Age Range: 2–25 years
Areas Assessed:Adaptive skills and overall behavioral assessment of maladaptive behaviors.
Representative norm sample of 2,500 children in the U.S. 19% of children were identified as of Hispanic origin
Adaptive domain assessed via multiple methods: Structured (child performs the behavior in front of you), Observation (observe the child performing the behavior as part of their daily activities), or Interview (caregiver provides the information)
Internal consistency, test-retest reliability, high validity comparisons with other instruments and inter-rater reliability is medium–high
Representative norm sample including a clinical sample of children and adolescents with a variety of behavioral, emotional, and physical disorders and/or disabilities
Internal consistency, test-retest reliability, high validity comparisons with other instruments and inter-rater reliability is high
Allows for direct observation of a child’s behavior in addition to caregiver/teacher report
Norm sample did not include children at risk for developmental delays
No test-retest reliability data provided for children under the age of 2.
Item gradients for children 23 months old vs. 24 months can change substantially (e.g., earning significantly different scores between 23 and 24 months of age)
Standard scores do not go below 55 thus limiting use with children who are very low-functioning
Interpretation of results from multiple respondents can be difficult for professionals not experienced with the instrument
Smaller sample size reported by authors for ages 2–5. However, authors note this had an insignificant effect on the norm sample overall
There are five available forms, which are selected based upon the individual’s age and the respondent. The Parent/Primary Caregiver Form is administered to parents or caregivers of children to age five. This form is used to assess adaptive behavior by the Bayley Scales of Infant and Toddler Development–Third Edition (Bayley-III; Bayley, 2006). The Parent Form is given to parents of children ages five to 21, so there is some overlap with the younger ages. The Teacher/Daycare Provider is used by teachers of children ages two to 5. The Teacher Form is completed by teachers of children ages five to 21. Lastly, the Adult Form may be used for adults ages 16 to 89 years, and may be completed by the individual when able, or by someone familiar with them.
The ABAS-II was standardized with data gathered from national samples of parents and teachers, which were stratified based upon sex, race, education (p. 656) level, and geographic region. Internal consistency, inter-rater and test-rest reliability, and validity studies are reported in the manual and are acceptable. Table 27.1 summarizes these estimates. In addition, several studies have compared differences between scores of individuals in clinical groups, including ADHD, autism and developmental delay.
In addition to broad-adaptive behavior measures that can be used with individuals from birth onward through geriatric populations, several behavioral and developmental assessment tools also include adaptive behavior as a component within the evaluation. Two of these tools, the BDI-2, and the BASC-2, may be used to provide supplemental information about children’s adaptive behavior.
The BDI-2 measures adaptive behavior as a component of a comprehensive assessment of five domains of development (adaptive, personal-social, communication, motor, and cognitive skills). The adaptive component of the BDI-II assesses adaptive behavior in two sub-domains: Adaptive and Personal Responsibility. Scores derived from each subdomain creates a composite score that is expressed as a developmental quotient with a mean of 100 and standard deviation of 15. The BDI-II may be used with children ages birth through age 7 years 11 months. A single form is utilized with the BDI-II. However, with respect to adaptive behavior, the BDI-II assesses only adaptive behavior related to activities of daily living in children under two (e.g., feeding and helping with dressing) while children over two are assessed with the sub-domain Personal Responsibility (e.g., understanding common dangers). The BDI-2 uses caregiver interview, direct observation, or a structured format face-to-face with the child to determine whether or not children have attained a developmental skill. The BDI-II was standardized with a representative sample of the U.S. population of 2,500 children. Internal consistency, test-retest reliability and inter-rater reliability, and validity data are adequate and provided in more detail in Table 27.2.
The BASC-2 measures adaptive behavior as a component of an overall behavioral assessment in five domains: activities of daily living, adaptability, functional communication, leadership, social skills, and study skills. Scores derived from these subdomains create a composite of Adaptive Behavior. There are five available forms that the user selects based on the age of the respondent. The Teacher Rating Scale (TRS) is separated into three forms: Preschool (ages 2–5), Child (ages 6–11), and Adolescent (ages 12–21). All items are rated on a four-point scale of behavioral frequency from “Never” to “Almost Always.” The Parent Rating Scale (PRS) follows the same format as the TRS as well as using the same four-point scale. The Self-Report of Personality (SRP) consists of three separate forms: Child (ages 8–11), Adolescent (ages 12–21) and College (ages 18–25). An interview format (SRP-I) is used for the Child form in which a child is asked to answer simply “yes” or “no” to each item. A Parent Relationship Questionnaire (PRQ) is also available and is designed to gather information about the relationship between a child or adolescent and his or her parents.
The BASC-2 was standardized with two populations: (1) A representative general population of children, adolescents, and young adults in the U.S. from a variety of public/private schools, mental health clinics, and preschools; and (2) A additional clinical norm sample was also used in the standardization process consisting of children and adolescents diagnosed with a variety of behavioral, emotional, and physical disorders or disabilities. T-scores are used to express adaptive behavior functioning. Internal consistency, test-retest reliability and inter-rater reliability, and validity data are adequate and provided in more detail in Table 27.2.
Supplemental Methods Assessing Adaptive Behavior
In addition to traditional norm-referenced methods that typically rely on caregiver reports to obtain information about an individual’s functioning, it is possible to obtain meaningful and practical estimates of an individual’s acquisition of adaptive skills through more objective methods. Specifically, two methods deserve consideration: (a) criterion-referenced assessments, as illustrated by The Assessment of Basic Language and Learning Skills–Revised (ABLLS-R; Partington, 2006); and (b) direct-observation data collected during probes teaching specific adaptive skills. Although these nontraditional methods have their own strengths and weaknesses, they offer clinicians a valid supplement to more traditional assessment methodologies of adaptive behavior assessment.
The ABLLS-R is a combined assessment, curriculum, and progress-monitoring system that was designed for children with language delays. Twenty-five different skill areas are grouped into four different assessments that are used to benchmark a child’s acquisition of developmental skills. These include (1) the Basic Learner Skills Assessment; (2) the Academic Skills Assessment; (p. 657) (3) the Self-Help Skills Assessment; and (4) the Motor Skills Assessment. The Basic Learner Skills Assessment comprises the following skill areas: cooperation and reinforcer effectiveness, visual performance, receptive language, motor imitation, vocal imitation, labeling, intraverbals, spontaneous vocalizations, syntax and grammar, play and leisure, social interaction, group interaction, following classroom routines, and generalized responding. The Academic Skills Assessment includes sections dedicated to reading, math, writing, and spelling, while the Self-Help Skills Assessment measures dressing, eating, grooming, and toileting skills. Finally, both gross motor and fine motor skills are assessed via the Motor Skills Assessment.
Skill areas on the ABLLS-R are composed of a series of discrete tasks. Each skill is defined operationally, has an interview question, an illustrative example, and a set of scoring criteria. Clinicians, educators, and parents are able to use three different sources of information to address scoring criteria, including interview, direct observation, and presentation of the task itself (i.e., an intervention probe). Data are then transferred into a skill-tracking grid for subsequent analysis.
The ABLLS-R has several distinct advantages. First, the ABLLS-R is versatile, serving several important functions, including as an assessment, instructional curriculum, and progress monitoring system. In this regard, the design of the ABLLS-R allows one to link assessment to intervention with relative ease (e.g., individualized educational plans, behavior intervention plans). Second, the ABLLS-R enhances its validity and utility through multi-method assessment, using a combination of interview, direct observation, and intervention probes. Third, its scoring criteria are highly observable and measurable, a feature that can be traced back to the behavior-analytic origins of the ABLLS-R’s design. Fourth, the ABLLS-R allows for comprehensive analysis of a child’s skill acquisition/progress. Data can be analyzed within the task itself, as well as both within and across skill areas across a maximum of four separate administrations using the same protocol. Not only does the ABLLS-R allow for fine-grained analysis of skill acquisition within a specific skill area, but its criterion-referenced design is also sensitive to changes in growth over time.
However, the ABLLS-R cannot be used to compare a child’s performance to a normative sample, and consequently, it cannot be used to document a delay or an intellectual disability, as is the case with norm-referenced assessments of adaptive behavior. In addition, the ABLLS-R only purports to offer approximations of the actual developmental sequence of a child’s skill acquisition with a specific skill area (i.e., it is not necessarily an exhaustive list of tasks associated with the developmental progression of skill acquisition relative to a specific skill area). Another limitation pertains to the scope of the Self-Help Skills Assessment. The ABLLS-R addresses dressing, eating, grooming, and toileting skill areas, but does not include assessments of domestic and community-based skills. Finally, the ABLLS-R does not discriminate between performance and skill deficits. For example, if a child demonstrated challenging behavior when presented with demands to perform a specific task, it is not possible to use the ABLLS-R to determine whether or not a child’s behavior may be predicted by the difficulty of the task, gaps in prerequisite skill acquisition, or other features of the child’s environment. In such situations, a functional behavior assessment would be indicated either as an alternative or in conjunction with an ABLLS-R assessment.
Behavioral observations in the individual’s natural environment offer another strategy to assess adaptive behavior functioning. In addition, one can administer specific probes across several periods of time, to assess skill mastery and response to intervention. Several steps are required in order to conduct adaptive skill probes, and are described by Table 27.3.
Using intervention probes of specific adaptive skills as a nontraditional method of assessing adaptive behavior presents both advantages and disadvantages. Given that the intervention itself is intended to take place within the person’s natural environment, the most significant advantage involves generalization. Specifically, skills taught using this method are more likely to successfully generalize because they are trained within the natural environment during naturally occurring routines (e.g., mealtime, personal hygiene, (p. 658) shopping, completing chores); they can incorporate multiple caregivers and/or examples; and they can be trained via variations in stimuli, responses, and reinforcers. In addition, this method allows for efficient error analysis. Through direct observation during intervention probes, it is possible to pinpoint which specific steps or prerequisite skills that have yet to be mastered may be inhibiting a child from acquiring a more complex skill. These skills can then be taught directly within the context of naturally occurring routines (with increased levels of prompting) or in isolation through discrete trials.
Table 27.3 Steps to Generate Adaptive Skill Probes
Step 1. Identify and observe the specific skill to be targeted for acquisition.
Step 2. Create operational definition.
Step 3. Set criterion for mastery.
Step 4. Select or generate training materials.
Step 5. Teach the skill (modeling, role play, performance feedback).
Step 6. Collect observation data.
Step 7. Evaluate relative to mastery criterion.
The first step involves identifying the specific skill to be targeted for acquisition. Skills can be selected in several ways, including from norm-referenced assessments of adaptive behavior, direct observations of prerequisite and targeted skills, or interviews (e.g., with parents, teachers, or therapists). Selection of skills targeted for acquisition should consider patterns of prerequisite skill acquisition, the child’s needs and preferences, linkage into more complex skills, and the overall utility of the skill for the child and family (i.e., whether or not the skill will contribute toward incremental improvements in the individual child or family’s quality of life). The skill should be observed with baseline data collected (e.g., percent accuracy) in order to both document the need for skill acquisition and establish a baseline. Once the target skill is identified and baseline data are obtained, the next step is to create an operational definition and set a criterion for mastery. The operational definition should be observable and measurable in order to lend itself to direct observation and measurement. The criterion for mastery should be defined prior to instruction and reflect a minimum degree of accuracy that would indicate the child is able to independently demonstrate the skill.
The next step entails selecting or generating materials for use in training. Depending on the skill targeted for acquisition, materials may either be readily available (e.g., Mannix, 1992; Mannix, 1995; Stages Learning Materials, 2004) or require custom development. With regard to the latter, some materials may only require modification to meet the needs of the child (e.g., enlarged size, using digital pictures instead of drawings, adding text to a stimulus). In other situations, materials may need to be developed, such as creating a pictorial/text task analysis of steps to demonstrate a complex skill (e.g., steps to brush teeth, steps to tie shoes, steps to load/unload the dishwasher), or arranging and modifying materials for instructional purposes (e.g., using color-coded laundry baskets to teach sorting dirty laundry). The goal of materials selection/generation is to use materials that are both cost-effective and typically used by the child/family during naturally occurring routines. Once materials are available, teaching should proceed, using a combination of modeling the skill and subsequently delivering prompts and performance feedback. Given that the new skill has not been mastered, most-to-least prompts should be used and systematically faded over time in order to promote both mastery and independence. Data collection resumes (using the same metric as collected during baseline), and data are compared to the baseline in order to document the evaluee’s response to intervention/skill acquisition.
Finally, treatment plans generated based on nontraditional assessments possess a greater degree of contextual fit than those developed using more traditional methods. Referring to the degree to which a treatment plan is congruent or compatible with variables related to an individual or environment (Albin et al., 1996), contextual fit takes three sets of variables into account: (1) characteristics related to the child and his or her patterns of behavior; (2) variables related to the people involved in the development and implementation of the intervention plan; and (3) features of the environments where the plan will be implemented and the systems in place within those environments. Treatment plans taking such variables into account may be more consistently implemented over time since they address potential barriers to treatment integrity on an a priori basis (e.g., considering the intervention strengths and weaknesses of natural intervention agents, considering how well the intervention could fit within the child’s routines).
With regard to disadvantages of nontraditional assessments of adaptive behavior, the greatest barrier to their use is their greatest strength—they require that clinicians have access to a home- and community-based service delivery model. Clinicians who work in clinics, schools, and analogous settings would therefore have greater difficulties using a nontraditional method. Conversely, some community-based settings present with unique features that may limit or reduce the degree to which they are accessible or amenable to intervention (e.g., airports, hospitals). Aside from these disadvantages, concerns can be raised with potential risks of prompt dependence, dependence on (p. 659) resources (both time and material), and the need to have a fluent knowledge of prerequisite skills (in order to effectively identify and account for gaps in individual skills encapsulated within complex skills.
In an effort to illustrate the differences between both traditional and nontraditional methods of assessing adaptive behavior, two cases studies are presented below. For the sake of illustration, both cases describe assessment of community-based adaptive skills. (p. 660) (p. 661) (p. 662) (p. 663) (p. 664)
In response to changes in social, legal, and educational conditions over the past 50 years, the significance of the assessment of adaptive behavior has intensified. No longer is adaptive behavior assessment limited to diagnosis and program eligibility, but it is increasingly recognized as critical to understanding development and needs of the individual. Furthermore, adaptive behavior assessment has gained notice outside the world of IDD, and is now recognized for its key role in identifying strengths and needs of all persons, with or without disabilities. As a result of this attention, adaptive behavior assessment approaches have become more sophisticated, comprehensive, and useful, and they may combine standardized and alternative assessment approaches. Whereas, in the past, psychometric concerns relative to the instruments were of primary concern for researchers, current and future interests are likely to focus on the utility of using adaptive behavior assessment information in understanding the needs of the individual, and in planning, monitoring, and evaluating interventions.
A central purpose of this chapter was to describe models and methods for assessing adaptive behavior. As compared to other domains of assessment, such as cognitive or personality, adaptive behavior assessments offer a natural link to intervention by targeting skills that are underdeveloped, and preventing further problems by addressing those needs within intervention plans. The links between assessment, intervention, and supports should be addressed within an ongoing, problem-solving process that improves outcomes.
Traditionally, clinicians have relied on information gathered from traditional, norm-referenced methods for diagnostic, intervention planning, and progress monitoring purposes. A second purpose of this chapter was to describe and illustrate nontraditional methods and tools that can also used to pinpoint specific skills or skill deficits within the context of naturally occurring routines and environments. Both traditional and nontraditional techniques have their tradeoffs as well; namely, limitations due to restrictions in scope of practice (traditional), and both available time and resources (nontraditional). However, a third option may be most efficacious—using a combination of both approaches. Using a combined approach enhances the traditional method’s scope of assessment and access to feedback from multiple respondents, while also incorporating essential nontraditional elements that allow one to directly assess skills within the child’s natural environment and facilitate generalization/transfer of training. Armed with these tools and techniques, clinicians will be able to customize assessment methods in order to obtain a more comprehensive understanding of the individual’s strengths and needs, and ensure that interventions that are being provided are effective at improving outcomes.
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(p. 666) Chapter 27:Appendix
Community Helpers Worksheet
Location: Doctor’s Office
Which community helper works at this location?
B. Postal Workers
Which other type of community helper works at this location?
A. Dental Hygienists
B. Postal Workers
D. Construction workers
What are the Doctor Office’s hours Monday through Friday?_____________________________________________________________________
What are the Doctor Office’s hours Saturday and Sunday?_____________________________________________________________________
What is the first thing you should do when you walk into the office?
a. Watch TV
b. Sign in at the counter and tell the receptionist your name
c. Read a book
d. Sit down quietly
Look around the waiting room, what can you do while you are waiting for your turn to see the doctor? ________________________________________________________________________
Does this doctor’s office accept insurance? ____ If so, what kinds of insurance do they take? _____________________________________________________________________ _____________________________________________________________________
Look at your insurance card. Do they accept your insurance?___________________________
Give your insurance card to the receptionist.
How do you know when it’s your turn to see the doctor?
a. You wait for your mom to tell you it’s your turn.
b. Someone comes on the TV and tells you it’s your turn.
c. The nurse comes out to the waiting room and tells you it’s your turn.
d. You just walk back whenever you feel like it.
What is your doctor’s name?_______________________________________________
(p. 667) Are there other doctors who work in this office? ________________________________
If so, what are their names? __________________________________________________________________________________________________________________________________________
What is your nurse’s name? ___________________________________________________
What can you do if you need to take a break during your visit? _____________________________________________________________________
If you are not sick and are at the doctor’s office for a simple check-up, which of the following can you expect the doctor to do?(HINT: There can be more than one correct answer)
a. Check your weight
b. Check your blood pressure
c. Give you medicine
d. Clean your teeth
Are you able to get your teeth cleaned at the Doctor’s Office?
Are you able to get vaccines at the Doctor’s Office?
Are you able to get X-rays at the Doctor’s Office?
If you feel sick and have a fever but you do not have another doctor’s appointment for 2 months, what should you do?
a. Hope it gets better on its own.
b. Call your dentist and schedule an appointment.
c. Call your pediatrician (doctor) and schedule an appointment.
d. Don’t do anything.
How often should you go to the doctor’s office for a check-up?
a. Every 6 months
b. Once a year
c. Only when you need vaccinations
d. I don’t need to go to the doctor’s office
Great work! You are all done! (p. 668)