Name: use of a video scoring anchor for rapid serial assessment of social communication in toddlers
Uploaded: 2018-03-14T13:00:00.000+00:00
Duration: 9 min 16 s
Description: Watch this Scientific Journal Video about Use of a Video Scoring Anchor for Rapid Serial Assessment of Social Communication in Toddlers at JoVE.com

This project was supported by grants NICHD R01 HD068479 (J.N.C.) and K08 MH112891-01 (N.M.), as well as the Intellectual and Developmental Disabilities Research Center at Washington University (NIH/NICHD P30 HD062171, J.N.C. PI). We thank all the families participating in the Early Reciprocal Social Development study for their generous investment of time and effort. We thank the child serving as the videotaped scoring anchor and her family for her contribution to the vrRSB.&#160;We thank Susan Vugteveen for proofing the written text and appearing in the video protocol.

All methods described here have been approved by the Institutional Review Board of Washington University in St. Louis (Human Resource Protection Office Number: 201208010).
1. Obtaining the vrRSB
<ol>
	<li>To obtain a copy of the vrRSB, send an email request to the senior author, John Constantino (constantino@wustl.edu).</li>
	<li>Specify a preference for the online version of the vrRSB or the hard-copy format.
	<ol>
		<li>Please note that the online version (&#34;Online_vrRSB&#34;) is formatted for implementation in REDCap, a widely used, secure, online data collection tool (www.projectredcap.org) available to individuals at institutions which are members of the REDCap Consortium.</li>
		<li>Please note that the hard-copy version includes PDF&#39;s of the questionnaire, a copy of the password-protected online link to the video clip, and scoring instructions. Interested parties may also request paper copies of these files, as well as a DVD with the video.</li>
	</ol>
	</li>
</ol>
2. Uploading and Enabling the Online vrRSB in REDCap
<ol>
	<li>Save the online file for the vrRSB (Online_vrRSB) in a known computer location.</li>
	<li>Before uploading the Online_vrRSB into REDCap, create a new project to house the questionnaire in REDCap. First, log in to REDCap and click New Project in the ribbon at the top of the page. This step will launch a Create a New REDCap Project page.</li>
	<li>Enter study-specific text into the fields Project title and Purpose of the project. These fields are required to proceed.</li>
	<li>For the prompt Start project from scratch or begin with a template? select the radio button Upload a REDCap project xml file. A window providing access to computer files should then appear; choose the Online_vrRSB file from step 2.1 and click Open.</li>
	<li>Scroll to the bottom of the page and click Create Project. This step will open a Project setup page, which provides a workflow for incorporating surveys into a REDCap project.</li>
	<li>In the box labeled Main Project Settings, click Enable next to the option Use surveys in this project. This step allows the vrRSB to be accessible within the project.</li>
	<li>Proceed to the next box, labelled Design your data collection instruments &#38; enable your surveys. Select Online designer. This will open a screen with a table of instruments within the project.</li>
	<li>In the row which contains the vrRSB, click on Enable a survey. A Set up my survey tab should then appear.</li>
	<li>Scroll to the bottom of the page and click Save changes to complete the enabling of the vrRSB in a REDCap project.</li>
</ol>
3. Customizing the Presentation of the Online vrRSB in REDCap
<ol>
	<li>Click Project Home in the sidebar menu and locate the Quick Tasks box.</li>
	<li>In the Quick Tasks box, select Online designer and upload data dictionary to open a Data collection instruments table listing the vrRSB as part of the REDCap project.</li>
	<li>To modify instructions within the vrRSB text, click the vrRSB listing. Click on the pencil in the upper left of specific text boxes to edit existing text and hit Save after each modification.
	<ol>
		<li>In the box labeled Welcome page, provide study-specific background information as appropriate (for suggestions, see step 4.2).</li>
		<li>Click Add fields to allow entry of additional participant characteristics if needed. The current template includes age of the rated child in months, sex, and the relationship of the rater to the child.</li>
		<li>Edit the instructions preceding the video-referenced items by inserting a study contact person in the event of technical difficulties with the video.</li>
	</ol>
	</li>
	<li>To customize survey format (e.g. background color, font), click Survey settings in the row for the vrRSB within the data collection instruments table.</li>
	<li>To obtain an online link for the survey, return to Project Home and click on Manage survey participants in the Quick Tasks box. A Public survey link page will open, which provides a URL for the survey. Click the button next to the URL to copy the survey link.
	<ol>
		<li>To email a link to study participants, select the Participant list tab. Click Add participants to insert emails and compose survey invitations button to generate an introductory email.</li>
	</ol>
	</li>
</ol>
4. Administering the vrRSB
<ol>
	<li>Select respondents who understand written English and who have spent at least 6 hours observing the target child (18 - 30 months of age) in the past month. Successful completion of the vrRSB does not require or assume specialized training, only that respondents have routinely observed the behavior of a young child in his or her natural interactions with other people.&#160;Respondents may include caregivers, clinicians, other professionals who have worked closely with a child, or researchers who wish to use the video scoring anchor to generate calibrated ratings to compare multiple children. 
	NOTE: A 30-minute observation of a child engaged in a semi-structured interactive play session has been shown to be sufficient for raters to provide scores distinguishing children with and without ASD12. The 6-hour benchmark is intended to account for greater expected variability in real-world social situations.</li>
	<li>When presenting the survey to respondents, provide background information for clarification, e.g., the purpose for administering the vrRSB, the use of video-referenced items, and the expected time for completion (10 - 15 minutes).
	<ol>
		<li>For cases in which respondents participate remotely, include such information in a cover letter accompanying the vrRSB.</li>
		<li>For cases in which participants complete the vrRSB online, provide the web address to access the vrRSB.</li>
	</ol>
	</li>
	<li>Explain whether the video of the scoring anchor is to be accessed online or from a DVD. For online access, include the web address and password.</li>
	<li>Inform respondents whom to contact for help should they have difficulty accessing the full video, seeing the images, or hearing sound. In the online version, this notification is included in the instructions preceding the video-referenced items (step 3.3).</li>
	<li>Remind respondents to attend to the entire 3-minute video clip, which they may watch more than once. 
	NOTE: Respondents next complete questions 1 - 13, the video-referenced items, in which they are to compare the subject child&#39;s current social abilities to that of the child in the video - the scoring anchor. Following completion of the video-referenced items, respondents are to complete the remaining non-video-referenced items, which describe characteristic aspects of social behavior. Both video-and non-video-referenced items use a four-point Likert rating scale, and written instructions precede both sets of items in the body of the questionnaire (Appendix 1).</li>
</ol>
5. Automated Scoring of the Online vrRSB
<ol>
	<li>To view an individual&#39;s scores (which may be useful in clinical settings), click Add/edit records under Data Collection in the sidebar menu.
	<ol>
		<li>In the following screen, under Choose an Existing Participation Identification #, select the participant from the dropdown menu. The Record Home Page for that participant will appear, which contains a table listing instruments collected for that participant.</li>
		<li>To access total and subscale scores for that participant, click Status in the row for vrRSB scores.</li>
	</ol>
	</li>
	<li>To view vrRSB scores for all participants in a given study, return to the project home page and click Create report.
	<ol>
		<li>Enter a name for the report in the text box and proceed to step 2, which allows the selection of data fields to include in the report.</li>
		<li>Next to the option Add all fields from selected instruments, select vrRSB scores from the dropdown menu to obtain total and subscale scores. For item-level data, select vrRSB. To keep only a subset of available fields in the report, click the red x to the right of unwanted fields so they are excluded.</li>
		<li>Scroll to the bottom of the page and click Save report. Accept the option to Return to my reports and exports, which will display a table including a row with the newly created report.</li>
		<li>Click View report to see scores (Table 1) for all participants.&#160;To return to the table of viewing options, click the &#8216;My Reports and Exports&#8217; tab.</li>
		<li>Click Export data and select the format of choice (e.g., csv format). Then click the export data button at the lower right. In the follow-up screen, click on the icon confirming the data format to continue.</li>
		<li>Click the &#34;Stats and charts&#34; button to view descriptive statistics (e.g., means for total scores, standard deviations) and scatterplots of vrRSB scores in REDCap.</li>
	</ol>
	</li>
</ol>
6. Manual Scoring of the vrRSB
<ol>
	<li>Identify items as forward-scored or reverse-scored (Table 1, Classification of Forward- and Reverse-Scored Items). 
	NOTE: Because the scale is designed to quantify deficits in RSB, an indicator of the level of core autistic symptoms, higher point values indicate lower levels of RSB. Forward-scored items are those for which a more affirmative answer indicates less appropriate reciprocal social behavior. Reverse-scored items are those for which a more affirmative answer indicates more appropriate reciprocal social behavior.</li>
	<li>Assign each response a value, as indicated in Table 1 (Point Values for Item Ratings).</li>
	<li>Assign a value of zero for missing item responses. Surveys with more than four missing responses are considered invalid.</li>
	<li>Once items have been assigned the proper point values, add the appropriate items together for the main score(s) or subscale score(s) of choice (Table 1). 
	NOTE: Main scoring options include the RSB Total Score (video-referenced plus non-video-referenced RSB items) and the Video-referenced Score; subscale item totals are also noted for the 2 core symptom domains for ASD (i.e., social communication and restricted, repetitive behavior). Scores &#8805;2 standard deviations below the mean, in the bottom 5% of the scores obtained in a general population sample12, are suggestive of deficiencies in RSB (Table 1).</li>
	<li>Note that some items are not included in scoring for the vrRSB. These supplemental items provide general information on aspects of development other than RSB, which may be of interest to developmental researchers. See the caption of Table 1 for further details.</li>
</ol>

<ol>
	<li>Constantino, J. N., Przybeck, T., Friesen, D., Todd, R. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reciprocal+social+behavior+in+children+with+and+without+pervasive+developmental+disorders.">Reciprocal social behavior in children with and without pervasive developmental disorders.</a> J Dev Behav Pediatr. 21 (1), 2-11 (2000).</li><li>American Psychiatric Association. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Diagnostic and statistical manual of mental disorders, fifth edition. , (2013).</li><li>Constantino, J. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Social Responsiveness Scale. , (2013).</li><li>Constantino, J. N., Hudziak, J. J., Todd, R. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deficits+in+reciprocal+social+behavior+in+male+twins:+evidence+for+a+genetically+independent+domain+of+psychopathology.">Deficits in reciprocal social behavior in male twins: evidence for a genetically independent domain of psychopathology.</a> J Am Acad Child Adolesc Psychiatr. 42 (4), 458-467 (2003).</li><li>Constantino, J. N., Todd, R. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genetic+structure+of+reciprocal+social+behavior.">Genetic structure of reciprocal social behavior.</a> Am J Psychiatry. 157 (12), 2043-2045 (2000).</li><li>Constantino, J. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Developmental+course+of+autistic+social+impairment+in+males.">Developmental course of autistic social impairment in males.</a> Dev Psychopathol. 21 (1), 127-138 (2009).</li><li>Marrus, N., Underwood-Riordan, H., Randall, F., Zhang, Y., Constantino, J. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lack+of+effect+of+risperidone+on+core+autistic+symptoms:+data+from+a+longitudinal+study.">Lack of effect of risperidone on core autistic symptoms: data from a longitudinal study.</a> J Child Adolesc Psychopharmacol. 24 (9), 513-518 (2014).</li><li>Constantino, J. N., Todd, R. 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N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Familial+aggregation+of+quantitative+autistic+traits+in+multiplex+versus+simplex+autism.">Familial aggregation of quantitative autistic traits in multiplex versus simplex autism.</a> Am J Med Genet B Neuropsychiatr Genet. 150B (3), 328-334 (2009).</li><li>Marrus, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rapid+video-referenced+ratings+of+reciprocal+social+behavior+in+toddlers:+a+twin+study.">Rapid video-referenced ratings of reciprocal social behavior in toddlers: a twin study.</a> J Child Psychol Psychiatry. 56 (12), 1338-1346 (2015).</li><li>Bing, M. N., Whanger, J. C., Davison, H. K., VanHook, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incremental+validity+of+the+frame-of-reference+effect+in+personality+scale+scores:+a+replication+and+extension.">Incremental validity of the frame-of-reference effect in personality scale scores: a replication and extension.</a> Journal of Applied Psychology. 89 (1), 150-157 (2004).</li><li>Lievens, F., De Corte, W., Schollaert, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+closer+look+at+the+frame-of-reference+effect+in+personality+scale+scores+and+validity.">A closer look at the frame-of-reference effect in personality scale scores and validity.</a> J Appl Psychol. 93 (2), 268-279 (2008).</li><li>Constantino, J. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+factor+structure+of+autistic+traits.">The factor structure of autistic traits.</a> J Child Psychol Psychiatry. 45 (4), 719-726 (2004).</li><li>Frazier, T. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Confirmatory+factor+analytic+structure+and+measurement+invariance+of+quantitative+autistic+traits+measured+by+the+Social+Responsiveness+Scale-2.">Confirmatory factor analytic structure and measurement invariance of quantitative autistic traits measured by the Social Responsiveness Scale-2.</a> Autism. 18 (1), 31-44 (2014).</li><li>Ozonoff, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Prospective+Study+of+the+Emergence+of+Early+Behavioral+Signs+of+Autism.">A Prospective Study of the Emergence of Early Behavioral Signs of Autism.</a> J Am Acad Child Adolesc Psychiatry. 49 (3), 256.e1-2-266.e1-2 (2010).</li><li>Werner, E., Dawson, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+the+phenomenon+of+autistic+regression+using+home+videotapes.">Validation of the phenomenon of autistic regression using home videotapes.</a> Arch Gen Psychiatry. 62 (8), 889-895 (2005).</li><li>Robins, D. L., Fein, D., Barton, M. L., Green, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Modified+Checklist+for+Autism+in+Toddlers:+an+initial+study+investigating+the+early+detection+of+autism+and+pervasive+developmental+disorders.">The Modified Checklist for Autism in Toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders.</a> J Autism Dev Disord. 31 (2), 131-144 (2001).</li><li>Wetherby, A. M., Allen, L., Cleary, J., Kublin, K., Goldstein, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validity+and+Reliability+of+the+Communication+and+Symbolic+Behavior+Scales+Developmental+Profile+With+Very+Young+Children.">Validity and Reliability of the Communication and Symbolic Behavior Scales Developmental Profile With Very Young Children.</a> J Speech Lang Hear Res. 45 (6), 1202-1218 (2002).</li><li>Lord, C., Rutter, M., DiLavore, P. C., Risi, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Autism Diagnostic Observation Scale. , (2000).</li><li>Wolff, J. J., Boyd, B. A., Elison, J. 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J.N.C. receives royalties from Western Psychological Services for the commercial distribution of the Social Responsiveness Scale (SRS), a quantitative measure of autistic traits for ages 30 months through adulthood. The remaining authors have nothing to disclose.

The above example analyses demonstrate the vrRSB&#39;s strong psychometric properties as a quantitative toddler measure of RSB. Scores on the vrRSB showed several analogous features to the SRS, a well-validated measure of RSB for older children3, including continuous score distributions in the general population, evidence of heritability, and the ability to distinguish children with and without ASD (in pilot testing for the vrRSB). vrRSB scores at 18 and 24 months of age correlated with 36-month SRS scores, confirming that trait-like stability of RSB is measurable in early childhood. Thus, the vrRSB represents an effective downward extension of the SRS and the first instrument, to our knowledge, to provide a dimensional measure of RSB quantifying individual differences in typically and atypically developing toddlers. This ability is in contrast to screeners like the M-CHAT and CSBS, which adopt a categorical approach to risk of ASD or other delays19,20 and do not specifically index RSB. Implementation of the vrRSB may enhance the efficient delivery of early interventions, by facilitating rapid assessment of change in core ASD symptoms, which may show a distinct response compared to other areas of impairment in ASD, such as adaptive function. This tool also has the advantages of being brief, accessible, and amenable to multiple administration options, including the fully developed online option in REDCap, which are appropriate for both clinical and research settings. In addition to the Missouri study population reported here, our team has successfully administered this survey in a primarily Hispanic population of twins, with results showing comparable psychometric properties (unpublished data, Harris, B., 2017). This tool is thus applicable to diverse populations and would be easily amenable to translation into other languages, particularly as interpreting the scoring anchor&#39;s social behavior does not rely on spoken language.
We applied two approaches to overcome the inherent challenges of caregiver reporting for RSB in toddlers: a) adapting a subset of SRS items which could be made developmentally appropriate for toddlers and b) implementing a videotaped scoring anchor to provide a frame of reference for caregiver ratings. These strategies permitted a Video-referenced Score describing social communication, a central component of RSB, and a broader RSB Total Score covering social communication and restricted repetitive behavior, the two core symptom domains of ASD. Both scores demonstrated useful measurement properties. The Video-referenced Score, by using a video of a single reference child at all ages of assessment, was designed to be sensitive to change in RSB during toddlerhood, and of all scores, it showed the largest effect size for improvement in RSB from 18 to 24 months. This score was also more strongly correlated with expressive language than RSB Total Score, consistent with this scale&#39;s focus on social communication. In the case of the RSB Total Score, the incorporation of SRS items representing traits related to RSB and ASD was associated with stronger test-retest reliability and higher correlations with 36-month total SRS scores; these observations are in keeping with the enhanced sensitivity of Video-referenced Scores to incremental change in social communication. Both the Video-referenced and RSB Total Scores showed high monozygotic twin-twin concordances, implying low measurement error and strong reliability, while corroborating findings of good test-retest reliability, which may have been susceptible to underestimation given rapid developmental change between 18 and 24 months of age. Additionally, in pilot testing, Video-referenced and RSB Total Scores distinguished children with and without ASD. The effect size of this difference, while large for both scores, was slightly greater for RSB Total Score, which maximizes the opportunity to capture variation in autistic traits through a greater number of items and coverage of both ASD symptom domains (i.e., restricted repetitive behavior in addition to social communication). Nevertheless, a strong effect size was also observed for the Video-referenced Score, suggesting its potential viability as a very brief, quantitative ASD screening measure in toddlers.
A critical step for the success of this protocol involves the appropriate selection of informants, who must have sufficient experience with the child to be capable of rating the child&#39;s level of RSB. To date, we have been successful with parents as informants, although this survey is also appropriate for other caregivers, such as daycare providers or other family members who have frequent contact with the child (i.e., no less than 6 hours either interacting with the child or watching the child interact with others over the past month). Survey respondents should be reminded to watch the full video, so that the scoring anchor provides a uniform standard of comparison across raters, and it is helpful to inform respondents in advance to allow 15 - 20 minutes to view the video and complete the questionnaire. If the survey is administered online, recording the amount of time spent on the survey is helpful for quality control, since surveys completed too quickly raise concerns for validity. Finally, because the multiple steps for scoring the survey provide an opportunity for error, we recommend using an automated scoring algorithm and cross-checking sums of subscales with the total score.
One limitation of the vrRSB is the potential for floor effects with the video-referenced items at older ages, given that toddlers approaching 30 months are likely to display more advanced social communication than the 19-month old scoring anchor. Thus, at older ages, the RSB Total Score is expected to capture more representative variation in RSB. Additionally, because the scoring anchor displays strong social communication ability, some caregivers might be inclined to rate their child as similar to the scoring anchor across all items, rather than to consider differences between the child and the anchor. Our results, including the broad score distributions and sensitivity of video-referenced scores to developmental change, suggest this was not a major issue in this sample; nevertheless, subsequent iterations of the vrRSB may explore the use of multiple scoring anchors with varying levels of RSB, as well as reverse-scored video-referenced items to check for conceptual consistency of responses.
Future directions include testing of the vrRSB in larger samples of children with and without ASD, to confirm the measure&#39;s psychometric properties and to determine the extent to which vrRSB scores predict risk of ASD. A larger sample will also facilitate data reduction approaches to allow refinement of the instrument by removing any items with low contributions to variance in RSB. From the methodological standpoint, the promising psychometrics of the Video-referenced Score support the general utility of a video scoring anchor in promoting reliability and validity of a behavioral ratings. An infant scoring anchor could feasibly allow further downward extension of an RSB measure to younger toddlers and infants, which could enhance timeliness of referral to early interventions and broaden characterization of typical and atypical social developmental trajectories. In summary, the vrRSB provides important opportunities to improve clinical assessment of ASD risk and response to intervention. The vrRSB&#39;s ability to detect dimensional variation in RSB, change in RSB, and genetic influences on RSB at the stage when ASD emerges is also important for clarifying the early impact of genes and environment on RSB, which can guide future treatments for ASD and related disorders.

A prerequisite for the development of social competency is reciprocal social behavior (RSB), the normative capacity to engage in emotionally appropriate, socially contingent behavior with others1. Disruption of RSB, which is associated with marked deficits in social communication, interpersonal awareness, and social interest and engagement, is a defining feature of autism spectrum disorder (ASD). This heritable neurodevelopmental condition, which presents with a broad range of impairment in social and adaptive function, generally arises by the toddler period and can respond to early intervention. Quantification of RSB in early life is thus relevant both for clinical assessment of ASD risk, as well as characterization of the typical development of social competency.
The Social Responsiveness Scale (SRS) is a rapid quantitative rating scale of RSB applicable for children over age 30 months. This caregiver-report measure capitalizes on respondents&#39; cumulative observations of a child in naturalistic situations to obtain nuanced ratings of RSB. Items query raters&#39; impressions about the extent of a child&#39;s social communication deficits and restricted repetitive behaviors, the two core symptom domains of ASD2, thereby indexing quantitative deficits in RSB. Extensive research with the SRS has confirmed its strong psychometric properties3, including a continuous, unimodal score distribution which encompasses variation in the general population while also differentiating individuals with ASD4,5. Quantitative variation in RSB exhibits longitudinal stability6, consistent with a behavioral trait; is distinguishable from adaptive function7, another salient aspect of impairment in ASD; and is heritable5,8,9,10,11, supporting the relevance of RSB to the genetics and neurobiology underlying ASD.
Because the SRS only extends downward to 30 months of age, an alternative rapid, quantitative measure of RSB for toddlers is needed to a) quantify early signs of ASD risk and b) track responses to early interventions for ASD. However, measurement of RSB in toddlers is complicated by substantive inter-individual variation in social communicative abilities, which can be difficult for raters to differentiate reliably based on written descriptions. Furthermore, caregivers&#39; impressions may be susceptible to reduced consistency, due to the inherent subjectivity of interpreting limited verbal output in toddlers, the sensitivity of toddler behavior to situational and environmental contexts, and the accelerated progression of social abilities during a prolific period of development.
To address these methodological challenges, we developed the video-referenced Rating of Reciprocal Social Behavior (vrRSB), a quantitative index of RSB designed for children 18 - 30 months of age12. We used two strategies to represent the trait-based continuity of RSB while conferring sensitivity to early developmental change in RSB. First, to promote homology between the vrRSB and the SRS, we adapted a subset of items from the SRS so that they were developmentally appropriate for toddlers. Second, we incorporated a series of novel, unique video-referenced items in which caregivers rated their child&#39;s social communicative behavior in comparison to that of a videotaped child serving as a scoring anchor. This approach capitalized on the frame of reference effect, in which providing additional contextual information to raters improves both reliability and validity of behavioral trait measures13,14. Here, a visual frame of reference was provided by a 3-minute video montage of a typically developing 19-month old displaying strong social communication skills while engaging in a play-based interaction with an adult. Since aspects of RSB are highly correlated within individuals15,16, the video featured a multifaceted view of a single child, rather than brief clips of several children, to enhance ecological validity. Previous studies additionally support the ecological validity of the video-referenced approach, as subtle signs of ASD can be detected on videotaped observations prior to clinical diagnosis17,18. Selected video segments visually highlighted hallmarks of social communication, including turn-taking, motivation to engage, and responsiveness to social and emotional cues1, thereby ensuring content validity for essential aspects of RSB, and spoken language use was limited to avoid rater misattribution of language ability to RSB.
To our knowledge, there is currently no alternative brief measure of RSB for toddlers which indexes dimensional variation in RSB in both the general population and cases of ASD or other social delays. Established caregiver-report screeners for ASD and related delays in toddlers, such as the Modified Checklist for Autism in Toddlers (M-CHAT)19 or the Communication and Symbolic Behavior Scales (CSBS)20 generally consist of items indicating whether or not a behavioral milestone has been achieved, and are not explicitly designed to quantify subtle variation in social competency. Additionally, unlike the vrRSB, these instruments are not specific to RSB and do not index levels of core autistic symptoms (i.e., impairment in social communication and restricted, repetitive behavior). Observational assessments, such as the Autism Diagnostic Observation Schedule21, have been developed to assist with diagnosis; however, these are generally time-intensive, with a duration of 40 - 60 minutes, and require trained raters, limiting their feasibility in some clinical settings. No training is required to complete the vrRSB, making it appropriate for use with caregivers, service providers, and other informants who have sufficient recent experience observing a child&#39;s naturalistic social interactions and who understand written English. The measure, including the 3-minute video, is brief, requiring 15 - 20 minutes, and is amenable to administration in-person or remotely, as it can be mailed to participants or completed online22. Thus, the vrRSB&#39;s brevity, accessibility, and flexibility facilitate its implementation in research, clinical, and educational settings to obtain serial, quantitative measurement of RSB at an earlier age than previously possible.

<table><tbody><tr><td>Video-Referenced Rating of Reciprocal Social Behavior (vrRSB): hard copy version</td><td>n/a</td><td>n/a</td><td>pen-and-paper questionnaire consisting of 3-minute video clip and written questions</td></tr><tr><td>Online_vrRSB</td><td>n/a</td><td>n/a</td><td>REDcap xml file consisting of all items on the vrRSB and information for web link to video clip; this online version of the vrRSB must be administered in Redcap</td></tr><tr><td>REDCap software</td><td>Vanderbilt University</td><td>n/a</td><td>secure web application for creating and managing online surveys and databases; available at no cost to users from institutions which are members of the REDCap Consortium</td></tr></tbody></table>

use of a video scoring anchor for rapid serial assessment of social communication in toddlers

Reciprocal social behavior (RSB), an early-emerging capacity to engage in social contingency&#8212;which is foundational for both social learning and social competency&#8212;is hypothesized to be disrupted in autism spectrum disorder (ASD). The ability to quantify the full range of RSB during the toddler period, when core symptoms of ASD often arise, is pivotal for evaluating early risk for ASD, characterizing social development, and tracking response to early interventions. However, important parameters of variation in RSB&#8212;especially prior to the development of verbal language&#8212;can be nuanced and difficult to characterize using questionnaire-based methods. To address this challenge, we developed a system for measuring quantitative variation in RSB in toddlers (ages 18 - 30 months) that incorporated not only standard questionnaire data from caregivers but also a novel set of video-referenced items, through which a respondent compares the behavior of a subject to that observed in a short video of a young child manifesting a highly competent level of social communication. Testing of this measure in a general population sample of twins confirmed that both the video-referenced items and the RSB Total Score (video-referenced items plus non-video-referenced items) displayed unimodal, continuous distributions, strong internal consistency, marked preservation of individual differences, and extremely high heritability. In addition, video-referenced items were particularly sensitive to quantifying incremental changes in social communication, a major element of RSB, over the course of early childhood development. Scores on the vrRSB clearly differentiated children with and without ASD and these data comprise an initial validation of this promising method for quantifying early RSB&#8212;cross-sectionally, over time, and as a function of early intervention.

The vrRSB was tested in 156 twin pairs epidemiologically ascertained from the Missouri Family Register as part of the Early Reciprocal Social Behavior Study, a prospective, longitudinal study of the development of RSB12. We selected a twin study design to examine whether the vrRSB could detect individual differences in RSB within toddlers from the general population and whether this variation was heritable. Both these features have been demonstrated with the SRS in older children5,8 and are key for evaluating the vrRSB&#39;s ability to capture genetically informative variance in RSB which is relevant for both typical and atypical development.
Caregivers completed behavioral measures on the twins at 18, 24, 36, and 48 months of age; the vrRSB (primarily the hard-copy version, as the online version was developed later in the study) was collected at the 18- and 24-month time points. The sample was primarily Caucasian (80.1%) and non-Hispanic (91.6%), similar to the Missouri population23, whereas median annual household income of the sample ($60,001 - $90,000) was higher than that of Missouri ($47,200). Informal feedback from participants regarding the survey was generally positive, with over 95% of returned surveys being correctly completed. To account for non-independence of twin data, analyses of reliability, behavioral correlations, and longitudinal differences included data from one twin selected at random. One child, who underwent a developmental regression and ultimately received a community diagnosis of ASD, was excluded from these twin analyses.
Both the Video-referenced Scores and the RSB Total Score demonstrated a continuous, unimodal distribution at 18 and 24 months across the general population sample (Figure 1). For the Video-referenced Score, a greater preponderance of lower scores at 24 months of age suggested a slight floor effect due to more advanced development (higher scores indicate less RSB). Distributions of the RSB Total Score, like those for the SRS3, were right-skewed, reflecting the small proportion of individuals with significant deficits in RSB. Similar score distributions have been observed in an independent sample of primarily Hispanic, bilingual twins from California (unpublished data, Harris, B., 2017).
Good internal reliability for both video-referenced items and the RSB Total score was observed at 18 months (Cronbach&#39;s alpha Video-referenced Score = .841, p &#60;.001; Cronbach&#39;s alpha RSB Total Score = .879, p &#60;.001) and 24 months (Cronbach&#39;s alpha Video-referenced Score = .881, p &#60;.001; Cronbach&#39;s alpha RSB Total Score = .868, p &#60;.001). The strong internal consistency suggests that these item indices represent cohesive constructs throughout toddlerhood.
Test-retest reliability was calculated according to intraclass correlation coefficients (ICCs; two-way mixed single measures) based on scores obtained at the 18- and 24-month time points. Good 6-month test-retest reliability was observed for the Video-referenced Score (ICC(3,1) = .505, p &#60;.001, Figure 2a), and strong test-retest reliability was observed for RSB Total Score (ICC(3,1) = .735, p &#60;.001; Figure 2b).
In addition to demonstrating test-retest reliability and, by extension, the capacity to detect trait-related consistency in RSB across time, an important goal for the vrRSB was to track progress in RSB over development. Both the Video-referenced and RSB Total Score were able to detect significant improvement in RSB over time, manifested by decreased scores (lower scores signify better RSB) between 18 and 24 months (Table 2). Video-referenced Scores showed a larger effect size for these decreases vs. the RSB Total Score (Cohen&#39;s d = 0.66 vs. 0.48). Separate calculations for the non-video-referenced items (Table 2), which were not designed to track change, revealed a much smaller effect size for these items (Cohen&#39;s d = 0.22).
Since variation in RSB has been shown to be heritable in older populations, twin-twin concordances were calculated for Video-referenced Scores and RSB Total Scores at 18 months (Table 3). Higher intraclass correlations in monozygotic (identical) twins, who share all their genetic material, vs. dizygotic (fraternal) twins, who share on average half of their genetic material, are consistent with heritability of RSB. Concordances for monozygotic twins were quite high and in many cases roughly double those of dizygotic twins, supporting a strong role for genetic influences. Of note, monozygotic twin concordances also indicate of the upper limit of possible measurement error. For both vrRSB scores, the possible measurement error is less than 9% at the level of the entire twin sample (error = 1 - monozygotic twin concordance).
As a test of concurrent validity, we examined correlations of scores on the M-CHAT, a screener for ASD, with the vrRSB. Positive correlations were consistent with the vrRSB&#39;s capacity to capture variation related to ASD risk (Video-referenced Score: r = .444, p &#60;.001; RSB Total Score: r = .654, p &#60;.001). We also obtained correlations between vrRSB scores and expressive vocabulary (percentile scores) as measured by the MacArthur-Bates Communicative Development Inventory Short Form24, given an anticipated relationship between language and social communication. Significant correlations were found for both the Video-referenced Score (r = -.419, p &#60;.001) and the RSB Total Score (r = -.309, p &#60;.001).
Lastly, in pilot testing (Table 4), we compared scores for twins without a diagnosis of ASD and a small sample of children with either a community diagnosis of ASD or a rating of autism or autism spectrum on the Autism Diagnostic Observation Schedule21 (mean age(SD): 24.75(5.56) months; age range: 17 - 33 months). Both Video-referenced Scores and RSB Total Scores differentiated between children with and without ASD, with an effect size (Cohen&#39;s d) of -1.39 for the video-referenced score and -1.66 for the RSB Total Score. Group differences were also observed on item scores for ASD core symptom domains (Social Communication: Cohen&#39;s d = -1.58; Restricted, Repetitive Behavior: Cohen&#39;s d = -1.52). At the level of quantitative RSB scores, both the 18-month Video-referenced Score and RSB Total Score were correlated with total scores on the 36-month SRS (Video-referenced Score: r = .298, p = .001; RSB Total Score: r = .624, p &#60;.001).
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/57041/57041fig1.jpg" /> 
Figure 1: Continuous Unimodal Score Distributions for Video-referenced Score and RSB Total Score at 18 and 24 months 
Panels illustrate scores for the vrRSB, including both Video-referenced Score and RSB Total Score, which is comprised of video-referenced items plus traditionally presented survey items adapted from the Social Responsiveness Scale. These distributions are based on a sample of twins ascertained from the general population (n = 156 pairs). Panels 1a and 1b show scores for video-referenced items at 18 and 24 months while panels 1c &#38; 1d show RSB Total Scores at 18 and 24 months. In all cases, scores are continuously distributed and unimodal, consistent with RSB operating as a dimensional construct in toddlers. Means and standard deviations (SD) are indicated for each time point in upper right of panel. <a href="https://cloudflare.jove.com/files/ftp_upload/57041/57041fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/57041/57041fig2.jpg" /> 
Figure 2: 6-month Test-Retest Reliability for Video-referenced Score and RSB Total Score 
Scatterplots illustrate a cross-time comparison at 18 and 24 months for subjects&#39; Video-referenced Score (2a) and RSB Total Score (2b). Intraclass correlation coefficients (ICC(3,1)) show good test-retest reliability for the Video-referenced Score and strong test-retest reliability for RSB Total Score. <a href="https://cloudflare.jove.com/files/ftp_upload/57041/57041fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td colspan="12">Classification of Forward- and Reverse-Scored Items</td>
		</tr>
		<tr>
			<td colspan="5">Forward-Scored Items</td>
			<td colspan="7">15 - 16, 18 - 26, 28 - 34, 36, 40 - 41, 47, appendix item 1</td>
		</tr>
		<tr>
			<td colspan="5">Reverse-Scored Items</td>
			<td colspan="7">1 - 13; 14, 17, 27, 35, 37 - 39, 42</td>
		</tr>
		<tr>
			<td colspan="12">Point Values for Item Ratings</td>
		</tr>
		<tr>
			<td></td>
			<td colspan="5">Video-referenced Items</td>
			<td colspan="6">Non-video Referenced Items</td>
		</tr>
		<tr>
			<td>Rating option</td>
			<td>Not at all</td>
			<td colspan="2">Somewhat but less than child in video</td>
			<td>About the same as child in video</td>
			<td>More than child in video</td>
			<td>Not true</td>
			<td colspan="2">Sometimes true</td>
			<td colspan="2">Often true</td>
			<td>Almost always true</td>
		</tr>
		<tr>
			<td>Forward- scored</td>
			<td colspan="5">None</td>
			<td>0</td>
			<td colspan="2">1</td>
			<td colspan="2">2</td>
			<td>3</td>
		</tr>
		<tr>
			<td>Reverse-scored</td>
			<td>3</td>
			<td colspan="2">2</td>
			<td>1</td>
			<td>0</td>
			<td>3</td>
			<td colspan="2">2</td>
			<td colspan="2">1</td>
			<td>0</td>
		</tr>
		<tr>
			<td colspan="12">Item Lists for Main Scores and Subscale Scores</td>
		</tr>
		<tr>
			<td colspan="3" rowspan="2">Scale/Subscale</td>
			<td colspan="5" rowspan="2">Item numbers</td>
			<td colspan="4">Score &#8805;2 SD of Mean</td>
		</tr>
		<tr>
			<td colspan="2">18 months</td>
			<td colspan="2">24 months</td>
		</tr>
		<tr>
			<td colspan="3">RSB Total</td>
			<td colspan="5">1 - 13;14 - 42; 47; appendix item 1</td>
			<td colspan="2">41</td>
			<td colspan="2">35</td>
		</tr>
		<tr>
			<td colspan="3">Video-referenced</td>
			<td colspan="5">1 - 13</td>
			<td colspan="2">21</td>
			<td colspan="2">19</td>
		</tr>
		<tr>
			<td colspan="3">Social Communication</td>
			<td colspan="5">1 - 15; 17; 19; 21; 25 - 28; 30; 32 - 33, 35 - 40, 42, appendix item 1</td>
			<td colspan="2">36</td>
			<td colspan="2">32</td>
		</tr>
		<tr>
			<td colspan="3">Restricted Repetitive Behavior</td>
			<td colspan="5">16, 18, 20, 22 - 24, 29, 31, 34, 41, 47</td>
			<td colspan="2">7</td>
			<td colspan="2">5</td>
		</tr>
	</tbody>
</table>
Table 1: Guidelines for Video-referenced Rating of Reciprocal Social Behavior (vrRSB) Scoring 
This table provides a breakdown of item types, point values, and item lists used for scoring. The vrRSB contains 2 main scores, the RSB Total Score and the Video-Referenced Score, and 2 subscale scores, Social Communication and Restricted Repetitive Behavior, which include items related to the 2 core symptom domains of ASD. These scores quantify the level of deficits in RSB and thus also indicate the burden of core autistic symptoms. Note that select items address aspects of general development, and these items are not included in scoring. Items 49 and 50 provide an indication of the achievement of two key language milestones for toddlers: the use of spoken language and combining words into phrases or sentences. Item 43 regards unusual sleep patterns, with greater endorsement suggesting a less typical developmental profile. For items regarding spatial abilities (44, 48) and intellectual curiosity (45, 46), greater endorsement corresponds to more advanced development.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Paired Samples</td>
			<td colspan="5">Paired Differences</td>
			<td>T</td>
			<td>df</td>
			<td>Sig.</td>
		</tr>
		<tr>
			<td></td>
			<td>Mean</td>
			<td>Standard Deviation</td>
			<td>Standard Error Mean</td>
			<td>95% Confidence</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td>&#160;&#160;&#160;&#160;&#160;&#160; Interval</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td>Lower</td>
			<td>Upper</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>18m Video-referenced Score &#8211;</td>
			<td>2.91</td>
			<td>4.38</td>
			<td>0.37</td>
			<td>2.17</td>
			<td>3.64</td>
			<td>7.79</td>
			<td>137</td>
			<td>&#60;.001</td>
		</tr>
		<tr>
			<td>24m Video-referenced Score</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>18m RSB Total Score &#8211;</td>
			<td>4.30</td>
			<td>6.48</td>
			<td>0.55</td>
			<td>3.21</td>
			<td>5.40</td>
			<td>7.80</td>
			<td>137</td>
			<td>&#60;.001</td>
		</tr>
		<tr>
			<td>24m RSB Total Score</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>18m non-video items &#8211;</td>
			<td>1.40</td>
			<td>4.47</td>
			<td>0.38</td>
			<td>0.65</td>
			<td>2.15</td>
			<td>3.68</td>
			<td>137</td>
			<td>&#60;.001</td>
		</tr>
		<tr>
			<td>24m non-video-items</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>
Table 2: Differences in Video-referenced Rating of Reciprocal Social Behavior (vrRSB) scores from 18 to 24 months 
Paired t-tests are used to calculate differences between scores at 18 and 24 months (n = 138). Score differences are for Video-referenced Scores, RSB Total Scores, and scores for the non-video referenced items (RSB Total Score - Video-referenced Score). vrRSB indicates Video-referenced Rating of Reciprocal Social Behavior. Df indicates degrees of freedom. Sig. indicates significance.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Twin Type (pairs)</td>
			<td>Video-referenced</td>
			<td>RSB Total</td>
		</tr>
		<tr>
			<td>MZ (n = 54)</td>
			<td>.928 (p &#60;.001)</td>
			<td>.912 (p &#60;.001)</td>
		</tr>
		<tr>
			<td>DZ (n = 95)</td>
			<td>.388 (p &#60;.001)</td>
			<td>.218 (p &#60;.001)</td>
		</tr>
		<tr>
			<td>&#160; Male MZ (n = 28)</td>
			<td>.894 (p &#60;.001)</td>
			<td>.914 (p &#60;.001)</td>
		</tr>
		<tr>
			<td>&#160; Male DZ (n = 30)</td>
			<td>.348 (p = .028)</td>
			<td>.286 (p &#60;.059)</td>
		</tr>
		<tr>
			<td>&#160; Female MZ (n = 26)</td>
			<td>.956 (p &#60;.001)</td>
			<td>.878 (p &#60;.001)</td>
		</tr>
		<tr>
			<td>&#160; Female DZ (n = 29)</td>
			<td>.660 (p &#60;.001)</td>
			<td>.369 (p &#60;.023)</td>
		</tr>
		<tr>
			<td>&#160; Opposite Sex (n = 36)</td>
			<td>.301 (p = .035)</td>
			<td>.062 (p = .358)</td>
		</tr>
	</tbody>
</table>
Table 3: Twin-Twin Concordances for Toddler Reciprocal Social Behavior at 18 months 
Twin-twin concordances [ICC(3,1)] for Video-referenced Scores and RSB Total Scores at 18 months are shown for monozygotic (MZ) and dizygotic (DZ) twins. Values are reported for all MZ and DZ twin pairs grouped together as well as twin pairs analyzed separately by gender. Seven unclassified pairs were not able to be included in these analyses.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td></td>
			<td>no-ASD (n=310)</td>
			<td>ASD (n=14)</td>
			<td>Mean Difference</td>
			<td>T</td>
			<td>Df</td>
			<td>Sig.</td>
		</tr>
		<tr>
			<td></td>
			<td>Mean (SD)</td>
			<td>Mean (SD)</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Video-referenced</td>
			<td>12.77 (4.44)</td>
			<td>21.86 (8.09)</td>
			<td>-9.08</td>
			<td>-4.17</td>
			<td>13.36</td>
			<td>0.001</td>
		</tr>
		<tr>
			<td>RSB Total</td>
			<td>21.84 (9.79)</td>
			<td>56.79 (28.17)</td>
			<td>-34.95</td>
			<td>-4.63</td>
			<td>13.14</td>
			<td>&#60;.001</td>
		</tr>
		<tr>
			<td>Social Communication</td>
			<td>20.15 (8.14)</td>
			<td>44.57 (20.16)</td>
			<td>-24.42</td>
			<td>-4.52</td>
			<td>13.19</td>
			<td>0.001</td>
		</tr>
		<tr>
			<td>Restricted, Repetitive Behavior</td>
			<td>1.68 (2.76)</td>
			<td>12.21 (9.37)</td>
			<td>-10.53</td>
			<td>-4.20</td>
			<td>13.10</td>
			<td>0.001</td>
		</tr>
	</tbody>
</table>
Table 4: Comparison of Video-referenced Rating of Reciprocal Social Behavior (vrRSB) Scores for Toddlers with and without autism spectrum disorder (ASD) 
Means, mean differences and results of t-tests for vrRSB scores are shown for comparison of scores between twins without an ASD diagnosis and a small group of children with ASD. SD indicates standard deviation. Df indicates degrees of freedom. Sig. indicates p-values for 2-tailed significant differences.
Appendix 1: Copy of the Video-Referenced Rating Scale of Reciprocal Social Behavior <a href="http://cloudflare.jove.com/files/ftp_upload/57041/_JoVE_appendix1_vr_RSB.pdf">Please click here to download this file.</a>

Watch this Scientific Journal Video about Use of a Video Scoring Anchor for Rapid Serial Assessment of Social Communication in Toddlers at JoVE.com

Use of a Video Scoring Anchor for Rapid Serial Assessment of Social Communication in Toddlers

Here we present a protocol for administration of the video-referenced rating of reciprocal social behavior (vrRSB) using a paper or online version. This survey quantifies RSB, a prerequisite for social competence, in toddlers through &#34;video-referenced&#34; items whereby a subject is compared to a reference child shown in a three-minute video.

Reciprocal social behavior (RSB), an early-emerging capacity to engage in social contingency&#8212;which is foundational for both social learning and ...

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Research

JoVE Journal

Behavior

10.2K Views.  Washington University School of Medicine. Hier presenteren we een protocol voor het beheer van de video-georefereerde rating van wederzijdse sociale gedrag (vrRSB) met behulp van een papieren of een online versie. Deze enquête kwantificeert RSB, een voorwaarde voor sociale competentie, in peuters door "video-referentie" items waarbij een onderwerp wordt vergeleken met een referentie-kind getoond in een drie minuten durende video.

Video: Use of a Video Scoring Anchor for Rapid Serial Assessment of Social Communication in Toddlers

Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are now recognized as a core symptom in autism spectrum disorder (ASD). Our ability to perceive and interact with the external world is rooted in sensory processing. For example, listening to a conversation entails processing the auditory cues coming from the speaker (speech content, prosody, syntax) as well as the associated visual information (facial expressions, gestures). Collectively, the &#8220;integration&#8221; of these multisensory (i.e., combined audiovisual) pieces of information results in better comprehension. Such multisensory integration has been shown to be strongly dependent upon the temporal relationship of the paired stimuli. Thus, stimuli that occur in close temporal proximity are highly likely to result in behavioral and perceptual benefits &#8211; gains believed to be reflective of the perceptual system&#39;s judgment of the likelihood that these two stimuli came from the same source. Changes in this temporal integration are expected to strongly alter perceptual processes, and are likely to diminish the ability to accurately perceive and interact with our world. Here, a battery of tasks designed to characterize various aspects of sensory and multisensory temporal processing in children with ASD is described. In addition to its utility in autism, this battery has great potential for characterizing changes in sensory function in other clinical populations, as well as being used to examine changes in these processes across the lifespan.

We describe how to implement a battery of behavioral tasks to examine the processing and integration of sensory stimuli in children with ASD. The goal is to characterize individual differences in temporal processing of simple auditory and visual stimuli and relate these to higher order perceptual skills like speech perception.

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are ...

Eye Tracking Young Children with Autism

The rise of accessible commercial eye-tracking systems has fueled a rapid increase in their use in psychological and psychiatric research. By providing a direct, detailed and objective measure of gaze behavior, eye-tracking has become a valuable tool for examining abnormal perceptual strategies in clinical populations and has been used to identify disorder-specific characteristics1, promote early identification2, and inform treatment3. In particular, investigators of autism spectrum disorders (ASD) have benefited from integrating eye-tracking into their research paradigms4-7. Eye-tracking has largely been used in these studies to reveal mechanisms underlying impaired task performance8 and abnormal brain functioning9, particularly during the processing of social information1,10-11. While older children and adults with ASD comprise the preponderance of research in this area, eye-tracking may be especially useful for studying young children with the disorder as it offers a non-invasive tool for assessing and quantifying early-emerging developmental abnormalities2,12-13. Implementing eye-tracking with young children with ASD, however, is associated with a number of unique challenges, including issues with compliant behavior resulting from specific task demands and disorder-related psychosocial considerations. In this protocol, we detail methodological considerations for optimizing research design, data acquisition and psychometric analysis while eye-tracking young children with ASD. The provided recommendations are also designed to be more broadly applicable for eye-tracking children with other developmental disabilities. By offering guidelines for best practices in these areas based upon lessons derived from our own work, we hope to help other investigators make sound research design and analysis choices while avoiding common pitfalls that can compromise data acquisition while eye-tracking young children with ASD or other developmental difficulties.

Eye tracking has long been used to study gaze patterns in typically-developing individuals, but recent technological advancements have made its use with clinical populations, including autism, more feasible. While eye-tracking young children with autism can offer insight into early symptom manifestations, it involves methodological challenges. Suggestions for best practices are provided.

The rise of accessible commercial eye-tracking systems has fueled a rapid increase in their use in psychological and psychiatric research. By providing a ...

Medicine

Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses

Collecting reliable behavioral data from toddlers and preschoolers is challenging. As a result, there are significant gaps in our understanding of human auditory development for these age groups. This paper describes an observer-based procedure for measuring hearing sensitivity with a two-interval, two-alternative forced-choice paradigm. Young children are trained to perform a play-based, motor response (e.g., putting a block in a bucket) whenever they hear a target signal. An experimenter observes the child&#39;s behavior and makes a judgment about whether the signal was presented during the first or second observation interval; the experimenter is blinded to the true signal interval, so this judgment is based solely on the child&#39;s behavior. These procedures were used to test 2 to 4 year-olds (n = 33) with no known hearing problems. The signal was a 1,000 Hz warble tone presented in quiet, and the signal level was adjusted to estimate a threshold corresponding to 71%-correct detection. A valid threshold was obtained for 82% of children. These results indicate that the two-interval procedure is both feasible and reliable for use with toddlers and preschoolers. The two-interval, observer-based procedure described in this paper is a powerful tool for evaluating hearing in young children because it guards against response bias on the part of the experimenter.

This paper describes a procedure for measuring hearing sensitivity in 2 to 4 year-old children. Children are trained to perform play-based responses when they hear a target signal. Thresholds are then estimated in a two-interval, two-alternative forced-choice paradigm, based on observations of the child&#39;s behaviors.

Collecting reliable behavioral data from toddlers and preschoolers is challenging. As a result, there are significant gaps in our understanding of human ...

Portable Intermodal Preferential Looking (IPL): Investigating Language Comprehension in Typically Developing Toddlers and Young Children with Autism

One of the defining characteristics of autism spectrum disorder (ASD) is difficulty with language and communication.1 Children with ASD's onset of speaking is usually delayed, and many children with ASD consistently produce language less frequently and of lower lexical and grammatical complexity than their typically developing (TD) peers.6,8,12,23 However, children with ASD also exhibit a significant social deficit, and researchers and clinicians continue to debate the extent to which the deficits in social interaction account for or contribute to the deficits in language production.5,14,19,25
Standardized assessments of language in children with ASD usually do include a comprehension component; however, many such comprehension tasks assess just one aspect of language (e.g., vocabulary),5 or include a significant motor component (e.g., pointing, act-out), and/or require children to deliberately choose between a number of alternatives. These last two behaviors are known to also be challenging to children with ASD.7,12,13,16
We present a method which can assess the language comprehension of young typically developing children (9-36 months) and children with autism.2,4,9,11,22 This method, Portable Intermodal Preferential Looking (P-IPL), projects side-by-side video images from a laptop onto a portable screen. The video images are paired first with a 'baseline' (nondirecting) audio, and then presented again paired with a 'test' linguistic audio that matches only one of the video images. Children's eye movements while watching the video are filmed and later coded. Children who understand the linguistic audio will look more quickly to, and longer at, the video that matches the linguistic audio.2,4,11,18,22,26
This paradigm includes a number of components that have recently been miniaturized (projector, camcorder, digitizer) to enable portability and easy setup in children's homes. This is a crucial point for assessing young children with ASD, who are frequently uncomfortable in new (e.g., laboratory) settings. Videos can be created to assess a wide range of specific components of linguistic knowledge, such as Subject-Verb-Object word order, wh-questions, and tense/aspect suffixes on verbs; videos can also assess principles of word learning such as a noun bias, a shape bias, and syntactic bootstrapping.10,14,17,21,24 Videos include characters and speech that are visually and acoustically salient and well tolerated by children with ASD.

Portable Intermodal Preferential Looking IPL: Investigating Language Comprehension in Typically Developing Toddlers and Young Children with Autism

A reliable home-based way to assess the language comprehension of very young typically developing children, as well as those with autism, is described. The method analyzes children's eye gaze while viewing side-by-side images but hearing an audio that matches only one image. Stimuli are designed with young participants in mind.

One  of the defining characteristics of autism spectrum disorder (ASD) is difficulty  with language and communication.1  Children with ASD's onset of ...

Using Rapid Serial Visual Presentation to Measure Set-Specific Capture, a Consequence of Distraction While Multitasking

This method uses a rapid serial visual presentation (RSVP) paradigm to measure the cost of distraction when participants maintain multiple search goals. The protocol identifies two types of distraction within a single task - contingent attentional capture and set-specific capture - that represent different types of limitations of cognitive processing. Participants search for letters in two or more &#34;target&#34; ink colors (e.g., green and orange) within a continuous RSVP stream of heterogeneously colored letters, while ignoring two peripheral RSVPs of letters. Upon detecting a target, participants are to identify the letter. On some trials, target-colored distractors appear in the periphery just prior to the presentation of a target, causing a drop in target identification performance. Contingent attentional capture is observed by examining performance on trials in which the peripheral distractor is the same color as the target on that trial (e.g., both orange). Set-specific capture is represented by performance on trials in which the peripheral distractor is target-colored (e.g., orange), but not the same color as the target on that trial (e.g., green.) By varying the amount of time (i.e., the number of stimuli appearing) between the presentation of the distractor and the target, researchers can observe how participants recover from these distraction costs over time. As compared to static displays that are often used to measure contingent attentional capture, the dynamic display produces much larger effects, allowing the researcher to identify subtle effects of smaller manipulations. An unusual aspect of our design is that it employs a continuous display; &#34;filler&#34; stimuli connect one trial to the next seamlessly, and participants respond during this interval whenever they detect a target. The continuous display reduces chance performance to near-zero levels (rather than 50%) and provides researchers with a more sensitive measure of performance differences across trial types.

This method uses a dynamic visual display to index costs of distraction during visual search, including both &#34;contingent attentional capture&#34; and &#34;set-specific capture,&#34; which is a cost of distraction that occurs when the participants maintain multiple search goals simultaneously. This method has revealed basic mechanisms and limitations of visual attention.

This method uses a rapid serial visual presentation (RSVP) paradigm to measure the cost of distraction when participants maintain multiple search goals. ...

An Electrophysiology Protocol to Measure Reward Anticipation and Processing in Children

We present a protocol designed to measure the neural correlates of reward in children. The protocol allows researchers to measure both reward anticipation and processing. Its purpose is to create a reward task that is appropriate for young children with and without autism while controlling reward properties between two conditions: social and nonsocial. The current protocol allows for comparisons of brain activity between social and nonsocial reward conditions while keeping the reward itself identical between conditions. Using this protocol, we found evidence that neurotypical children demonstrate enhanced anticipatory brain activity during the social condition. Furthermore, we found that neurotypical children anticipate social reward more robustly than children with autism diagnoses. As the task uses snacks as a reward, it is most appropriate for young children. However, the protocol may be adapted for use with adolescent or adult populations if snacks are replaced by monetary incentives. The protocol is designed to measure electrophysiological events (event-related potentials), but it may be customized for use with eye-tracking or fMRI.

This protocol is designed to measure reward anticipation and processing in young children with and without autism. Specifically, the protocol is designed to study the neural correlates of reward during social and nonsocial conditions while controlling for reward between conditions.

We present a protocol designed to measure the neural correlates of reward in children. The protocol allows researchers to measure both reward anticipation ...

Comparing Eye-tracking Data of Children with High-functioning ASD, Comorbid ADHD, and of a Control Watching Social Videos

Children with autism spectrum disorders (ASD) are known to have sensory-perceptual processing deficits that weaken their abilities to attend and perceive social stimuli in daily living contexts. Since daily social episodes consist of subtle dynamic changes in social information, any failure to attend to or process subtle human nonverbal cues, such as facial expression, postures, and gestures, might lead to inappropriate social interaction. Traditional behavioral rating scales or assessment tools based on static social scenes have limitations in capturing the moment-to-moment changes in social scenarios. An eye-tracking assessment, which can be administered in a video-based mode, is therefore preferred, to augment clinical observation. In this study, using the single-case comparison design, the eye-tracking data of three participants, a child with autism spectrum disorder (ASD), another with comorbid attention deficit-hyperactive disorder (ADHD), and a neurotypical control, are captured while they view a video of social scenarios. The eye-tracking experiment has helped answer the research question: How does social attention differ between the three participants? By predefining areas of interest (AOIs), their visual attention on relevant or irrelevant social stimuli, how fast each participant attends to the first social stimuli appearing in the videos, for how long each participant continues to attend to those stimuli within the AOIs, and the gaze shifts between multiple social stimuli appearing concurrently in the same social scene are captured, compared, and analyzed in a video-based eye-tracking experiment.

This is a qualitative comparative case study analysis of eye-tracking data on the first moments of social video scenes as viewed by three participants: one with autism spectrum disorder, one with comorbid attention deficit-hyperactive disorder, and one neurotypical control.

Children with autism spectrum disorders (ASD) are known to have sensory-perceptual processing deficits that weaken their abilities to attend and perceive ...

Modeling Verbal Behavior Deficits with the Stimulus Control Ratio Equation, SCoRE

Verbal operant analyses are the extension of functional analysis technology to the field of verbal behavior, of particular relevance to autism spectrum disorders and associated developmental disabilities. Similarly, a verbal operant analysis carefully controls specific environmental factors that influence language, and measures strength of responding across four verbal operant classes: tact, mand, echoic, and sequelic. The frequency of each independent verbal operant is then measured against one another using the stimulus control ratio equation (SCoRE) to summarize the relative strength of the speaker&#8217;s repertoire. The verbal behavior SCoRE yields a statistic that can be compared against itself (e.g., for the purposes of pre/post testing) or against others (e.g., for the purposes of randomized controlled trials). The results of this evaluation provide an individualized hierarchy for diverging stimulus control across the verbal operants, from which a treatment plan for errorless language learning may be prescribed.

This article describes the procedures for conducting a verbal operant analysis (VOA), calculating the stimulus control ratio equation (SCoRE), and developing individualized verbal behavior treatment plans, specifically significant to address the deficits characteristic of autism.

Verbal operant analyses are the extension of functional analysis technology to the field of verbal behavior, of particular relevance to autism spectrum ...

An Automated Assessment of Visual Acuity in Infants and Toddlers

An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System

Visual acuity measurement is an important visual function test to perform in infancy and childhood. However, accurate visual acuity measurement in infants is difficult because of deficiencies in their communication ability. This paper presents a novel automated method to assess visual acuity in children (5-36 months old). This method, the automated acuity card procedure (AACP), uses a webcam for eye tracking and recognizes children's watching behaviors automatically. A two-choice preferential-looking test is performed when the tested child watches the visual stimuli shown on a high-resolution digital display screen. When the tested child watches the stimuli, their facial pictures are recorded by the webcam. These pictures are used by the set computer program to analyze their watching behavior. With this procedure, the child's eye movement responses to different stimuli are measured, and their visual acuity is assessed without communication. By comparing the results with grating acuity obtained by Teller Acuity Cards (TACs), AACP performance is deemed comparable to that of TACs.

Author Spotlight: An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System  

In this paper, we present a novel automated method for assessing visual acuity in infants and toddlers by using an eye-tracking system.

Visual acuity measurement is an important visual function test to perform in infancy and childhood. However, accurate visual acuity measurement in infants ...

Measuring Cardiac Autonomic Nervous System (ANS) Activity in Toddlers - Resting and Developmental Challenges

The autonomic nervous system (ANS) consists of two branches, the parasympathetic and sympathetic nervous systems, and controls the function of internal organs (e.g., heart rate, respiration, digestion) and responds to everyday and adverse experiences 1. ANS measures in children have been found to be related to behavior problems, emotion regulation, and health 2-7. Therefore, understanding the factors that affect ANS development during early childhood is important. Both branches of the ANS affect young children&#8217;s cardiovascular responses to stimuli and have been measured noninvasively, via external monitoring equipment, using valid and reliable measures of physiological change 8-11. However, there are few studies of very young children with simultaneous measures of the parasympathetic and sympathetic nervous systems, which limits understanding of the integrated functioning of the two systems. In addition, the majority of existing studies of young children report on infants&#8217; resting ANS measures or their reactivity to commonly used mother-child interaction paradigms, and less is known about ANS reactivity to other challenging conditions. We present a study design and standardized protocol for a non-invasive and rapid assessment of cardiac autonomic control in 18 month old children. We describe methods for continuous monitoring of the parasympathetic and sympathetic branches of the ANS under resting and challenge conditions during a home or laboratory visit and provide descriptive findings from our sample of 140 ethnically diverse toddlers using validated equipment and scoring software. Results revealed that this protocol can produce a range of&#160;physiological responses to both resting and developmentally challenging conditions, as indicated by changes in heart rate and indices of parasympathetic and sympathetic activity. Individuals demonstrated&#160;variability in resting levels, responses to challenges, and challenge reactivity, which provides additional evidence that this protocol is useful for the examination of ANS individual differences for toddlers.

Measuring Cardiac Autonomic Nervous System ANS Activity in Toddlers - Resting and Developmental Challenges

We describe the methods for continuous monitoring of the autonomic nervous system under resting and challenge conditions with 18 month old children. Results revealed that this protocol can produce meaningful physiological responses in both branches of the autonomic nervous system and elicit significant individual variability in patterns of responses.

The autonomic nervous system (ANS) consists of two branches, the parasympathetic and sympathetic nervous systems, and controls the function of internal ...

Use of a Video Scoring Anchor for Rapid Serial Assessment of Social Communication in Toddlers

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