The Gilliam Autism Rating Scale – Second editon        (GARS-2™)<br /> A Training Module for Early Interventionists<br />V...
GARS-2 (Gilliam, 2006): What is it?<br />A standardized tool for screening children at risk & assessing persons with autis...
GARS (Gilliam, 1995) vs. GARS-2 (Gilliam, 2006)<br />Changes made to the GARS to improve reliability & reflect changes in ...
GARS-2 Examiner’s Manual<br />Provides detailed instructions on how to administer the GARS-2 along with information about ...
GARS-2 Subscales<br />Three subscales:<br />Stereotyped Behaviors<br />Communication<br />Social Interaction<br />
Stereotyped Behaviors<br />Items 1-14 describe stereotyped behaviors, motility disorders, and other unique and atypical be...
Communication<br />Items 15-28 describe verbal and non-verbal behaviors displayed by children with Autism and Autism Spect...
Social Interaction<br />Items 29-42 evaluate a child’s ability to relate appropriately to people, events, and objects.<br ...
Administration<br />Rater=>completes 14 questions for each subscale<br />Teacher<br />Parent<br />Clinician<br />Examiner=...
Guidelines for Rating<br />May be necessary for more than one person to complete the rating based on relationship with the...
Rating Frequency<br />Four different measures of frequency<br />0 – Never observed – You have never seen the individual be...
Parent Interview<br />Parents are a good source of information about their children’s behaviors.<br />Parents/caregivers d...
Scoring GARS-2: Subscale Standard Scores and the Autism Index<br />Make sure all items in each subscale have been rated<br...
Research behind GARS-2<br />Normative scores come from a sample of 1,107 children & young adults between the ages of 3 & 2...
Case Examples<br />
Case Study: Beatrice<br />5-year old, verbal female<br />Background: Kindergarten teacher noticed that she was not sociali...
Case Study: Beatrice<br />QUESTIONS:<br />	1.	How often is ‘frequently observed’?<br />	2.	What is the subscale SS for Bea...
Case Study: Beatrice <br />Subscale 2 - Communication: The SLP completed the subscale & found that Beatrice sometimes exhi...
Case Study: Beatrice<br />QUESTIONS:<br />1.	Does this subscale indicate a risk of Autism?<br />ANSWER: Yes, Beatrice scor...
Case Study: Beatrice<br />Subscale 3 - Social Interaction: The kindergarten teacher completed this subscale and found that...
Case Study: Beatrice<br />QUESTION:<br />Does this subscale indicate a risk of Autism?<br />ANSWER: Yes, Beatrice scored a...
Case Study:Beatrice<br />Beatrice was referred to a developmental pediatrician for a developmental evaluation.<br />She wa...
References<br />American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., ...
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Gars2

  1. 1. The Gilliam Autism Rating Scale – Second editon (GARS-2™)<br /> A Training Module for Early Interventionists<br />VT-ILEHP ASD LEND Program<br />2010 <br />
  2. 2. GARS-2 (Gilliam, 2006): What is it?<br />A standardized tool for screening children at risk & assessing persons with autism and other severe behavioral disorders<br />Provides norm-referenced information that can assist in the diagnosis of Autism<br />Based on APA definition of autism<br />
  3. 3. GARS (Gilliam, 1995) vs. GARS-2 (Gilliam, 2006)<br />Changes made to the GARS to improve reliability & reflect changes in understanding Autism:<br />Structured parent interview form replaces the Early Development subscale<br />Some items rewritten for clarity<br />Demographic characteristics of the normative sample were keyed to 2000 U.S. Census data.<br />New norms created<br />Guidelines provided for interpreting subscale scores <br />Autism Index replaced the Autism Quotient<br />Instructional Objectives for Children Who Have Autism included to assist in the formulation of instructional goals and objectives based on the GARS-2 results<br />
  4. 4. GARS-2 Examiner’s Manual<br />Provides detailed instructions on how to administer the GARS-2 along with information about reliability, validity, normative population<br />Provides insights into using GAR-S results with Applied Behavior Analysis programs<br />Provides standard scores and %ile ranks<br />
  5. 5. GARS-2 Subscales<br />Three subscales:<br />Stereotyped Behaviors<br />Communication<br />Social Interaction<br />
  6. 6. Stereotyped Behaviors<br />Items 1-14 describe stereotyped behaviors, motility disorders, and other unique and atypical behaviors<br />Examples:<br />Stares at hands, objects, or items in the environment for at least 5 seconds.<br />Spins objects not designed for spinning (e.g. cups, saucers, glasses…)<br />Flaps hands or fingers in front of face or at sides.<br />
  7. 7. Communication<br />Items 15-28 describe verbal and non-verbal behaviors displayed by children with Autism and Autism Spectrum Disorders.<br />Examples:<br />Repeats words or phrases over and over.<br />Looks away or avoids looking at speaker when name is called<br />Repeats unintelligible sounds (babbles) over and over.<br />
  8. 8. Social Interaction<br />Items 29-42 evaluate a child’s ability to relate appropriately to people, events, and objects.<br />Examples:<br />Does not imitate other people when imitation is required or desirable, such as in games or learning activities.<br />Withdraws, remains aloof, or acts standoffish in group situations.<br />Becomes upset when routines are changed.<br />
  9. 9. Administration<br />Rater=>completes 14 questions for each subscale<br />Teacher<br />Parent<br />Clinician<br />Examiner=>scores & interprets the results<br />Can use structured interview with the rater<br />
  10. 10. Guidelines for Rating<br />May be necessary for more than one person to complete the rating based on relationship with the child<br />EXAMPLE: Classroom teacher rates the Stereotyped Behaviors & Social Interactions while SLP rates Communication.<br />Raters should read the questions carefully & ask questions for clarification<br />Raters should not take into account a child’s age when rating<br />
  11. 11. Rating Frequency<br />Four different measures of frequency<br />0 – Never observed – You have never seen the individual behave in this manner.<br />1 – Seldom observed – Individual behaves in this manner 1-2 times per 6-hour period.<br />2 – Sometimes observed – Individual behaves in this manner 3-4 times per 6-hour period.<br />3 – Frequently observed – Individual behaves in this manner at least 5-6 times per 6-hour period.<br />
  12. 12. Parent Interview<br />Parents are a good source of information about their children’s behaviors.<br />Parents/caregivers describe child’s behavior before age 3<br />First 10 questions deal with delays<br />15 questions deal with abnormal functioning<br />Questions are scored ‘yes’ or ‘no’<br />Examiner can give examples to explain the behaviors<br />‘No’ responses indicate abnormality or developmental delay<br />Necessary to have evidence that an individual demonstrated delays before age 3 to diagnose Autism.<br />
  13. 13. Scoring GARS-2: Subscale Standard Scores and the Autism Index<br />Make sure all items in each subscale have been rated<br />Add raw scores for each item & total these<br />Find %ile rank and standard score for each subscale <br />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)<br />SS of 4-6 on a subscale indicates a possibility of Autism<br />SS of 0-3 on a subscale indicates Autism is unlikely<br />Add up subscales to determine the Autism Index (based on a mean of 100 & SD of 15<br />It is possible to use 2 subscales instead of 3 to determine the Autism Index<br />
  14. 14. Research behind GARS-2<br />Normative scores come from a sample of 1,107 children & young adults between the ages of 3 & 22 diagnosed with Autism<br />Internal consistency & test-retest coefficients are large to very large<br />Validity was demonstrated by confirming that: <br />Items on the subscales are representative of the characteristics of autism<br />Subscales are strongly correlated to each other and to the performance of other tests that screen for autism<br />Scores discriminate persons with autism from persons with other severe behavioral disorders as well as persons without disabilities<br />
  15. 15. Case Examples<br />
  16. 16. Case Study: Beatrice<br />5-year old, verbal female<br />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.<br />Subscale 1 - Stereotyped Behaviors:<br />Teacher reported frequently observing the following behaviors:<br />• 2. Stares at hand objects, or items in the environment for at least 5 seconds.<br />• 8. Spins objects not designed for spinning (e.g., saucers, cups, glasses)<br />• 9. Rocks back and forth while seated or standing.<br />• 12. Flaps hands or fingers in front of face or at sides.<br />Other behaviors were not observed.<br />
  17. 17. Case Study: Beatrice<br />QUESTIONS:<br /> 1. How often is ‘frequently observed’?<br /> 2. What is the subscale SS for Beatrice? <br /> 3. Does this mean Beatrice has Autism?<br />ANSWER: <br /> 1. Frequently observed means the individual behaves in this manner at least 5-6 times per 6-hour period.<br /> 2. The subscale score is ___:<br /> 3. No, but her score indicates a high risk for Autism as it is falls in the range of 7 or higher.<br />
  18. 18. Case Study: Beatrice <br />Subscale 2 - Communication: The SLP completed the subscale & found that Beatrice sometimes exhibited the following:<br />17. Repeats words or phrases over and over.<br />18. Speaks or signs with flat tone, affect, or dysrhythmic patters<br />28. Inappropriately answers questions about a statement or brief story.<br />The SLP did not observe any other behaviors listed on the subscale.<br />
  19. 19. Case Study: Beatrice<br />QUESTIONS:<br />1. Does this subscale indicate a risk of Autism?<br />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.<br />2. Was it appropriate for more than one adult to complete the GARS-2?<br />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.<br />
  20. 20. Case Study: Beatrice<br />Subscale 3 - Social Interaction: The kindergarten teacher completed this subscale and found that Beatrice sometimes:<br />40. Becomes upset when routines are changed.<br />42. Lines up objects in precise, orderly fashion and becomes upset when the order is disturbed.<br />The teacher seldom observed Beatrice exhibiting the following:<br />31. Resists physical contact from others.<br />33. Withdraws, remains aloof, or acts standoffish in group situations.<br />
  21. 21. Case Study: Beatrice<br />QUESTION:<br />Does this subscale indicate a risk of Autism?<br />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.<br />
  22. 22. Case Study:Beatrice<br />Beatrice was referred to a developmental pediatrician for a developmental evaluation.<br />She was eventually diagnosed with PDD-NOS.<br />She was referred to an intensive after school intervention program.<br />
  23. 23. References<br />American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.<br />Autism Society of America (2003). What is Autism? Retrieved January 5, 2005, from http://www.autismsociety.org/site/pageserver?pagename=whatisautism<br />Gilliam, James E. (1995). Gilliam Autism Rating Scale. Austin TX: PRO-ED.<br />Gilliam, James E. (2006). GARS-2; Gilliam Autism Rating Scale, Second Edition, Examiner’s Manual. Austin, TX: PRO-ED.<br />

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