THE GILLIAM AUTISM RATING SCALE – SECOND EDITON (GARS-2™)

A Training Module for Early Interventionists

VT-ILEHP ASD LEND Program2010

GARS-2 (Gilliam, 2006): What is it? A standardized tool for

screening children at risk & assessing persons with autism and other severe behavioral disorders

Provides norm-referenced information that can assist in the diagnosis of Autism

Based on APA definition of autism

GARS (Gilliam, 1995) vs. GARS-2 (Gilliam, 2006)

Changes made to the GARS to improve reliability & reflect changes in understanding Autism: Structured parent interview form replaces the

Early Development subscale Some items rewritten for clarity Demographic characteristics of the normative

sample were keyed to 2000 U.S. Census data. New norms created Guidelines provided for interpreting subscale

scores Autism Index replaced the Autism Quotient Instructional Objectives for Children Who Have

Autism included to assist in the formulation of instructional goals and objectives based on the GARS-2 results

GARS-2 Examiner’s Manual

Provides detailed instructions on how to administer the GARS-2 along with information about reliability, validity, normative population

Provides insights into using GAR-S results with Applied Behavior Analysis programs

Provides standard scores and %ile ranks

GARS-2 Subscales

Three subscales:Stereotyped BehaviorsCommunicationSocial Interaction

Stereotyped Behaviors

Items 1-14 describe stereotyped behaviors, motility disorders, and other unique and atypical behaviors

Examples: Stares at hands, objects, or items in the

environment for at least 5 seconds. Spins objects not designed for spinning

(e.g. cups, saucers, glasses…) Flaps hands or fingers in front of face or

at sides.

Communication

Items 15-28 describe verbal and non-verbal behaviors displayed by children with Autism and Autism Spectrum Disorders.

Examples: Repeats words or phrases over and over. Looks away or avoids looking at speaker

when name is called Repeats unintelligible sounds (babbles)

over and over.

Social Interaction

Items 29-42 evaluate a child’s ability to relate appropriately to people, events, and objects.

Examples: Does not imitate other people when

imitation is required or desirable, such as in games or learning activities.

Withdraws, remains aloof, or acts standoffish in group situations.

Becomes upset when routines are changed.

Administration

Rater=>completes 14 questions for each subscale Teacher Parent Clinician

Examiner=>scores & interprets the results

Can use structured interview with the rater

Guidelines for Rating

May be necessary for more than one person to complete the rating based on relationship with the child EXAMPLE: Classroom teacher rates the

Stereotyped Behaviors & Social Interactions while SLP rates Communication.

Raters should read the questions carefully & ask questions for clarification

Raters should not take into account a child’s age when rating

Rating Frequency Four different measures of

frequency 0 – Never observed – You have never

seen the individual behave in this manner.

1 – Seldom observed – Individual behaves in this manner 1-2 times per 6-hour period.

2 – Sometimes observed – Individual behaves in this manner 3-4 times per 6-hour period.

3 – Frequently observed – Individual behaves in this manner at least 5-6 times per 6-hour period.

Parent Interview Parents are a good source of information

about their children’s behaviors. Parents/caregivers describe child’s behavior

before age 3 First 10 questions deal with delays 15 questions deal with abnormal functioning Questions are scored ‘yes’ or ‘no’ Examiner can give examples to explain the

behaviors ‘No’ responses indicate abnormality or

developmental delay Necessary to have evidence that an individual

demonstrated delays before age 3 to diagnose Autism.

Scoring GARS-2: Subscale Standard Scores and the Autism

Index Make sure all items in each subscale have been

rated Add raw scores for each item & total these Find %ile rank and standard score for each

subscale Standard score (SS) of 7 or higher on a

subscale indicates a very likely possibility of Autism (based on a mean of 10; standard deviation (SD) of 3)

SS of 4-6 on a subscale indicates a possibility of Autism

SS of 0-3 on a subscale indicates Autism is unlikely

Add up subscales to determine the Autism Index (based on a mean of 100 & SD of 15

It is possible to use 2 subscales instead of 3 to determine the Autism Index

Research behind GARS-2

Normative scores come from a sample of 1,107 children & young adults between the ages of 3 & 22 diagnosed with Autism

Internal consistency & test-retest coefficients are large to very large

Validity was demonstrated by confirming that: Items on the subscales are representative of the

characteristics of autism Subscales are strongly correlated to each other and

to the performance of other tests that screen for autism

Scores discriminate persons with autism from persons with other severe behavioral disorders as well as persons without disabilities

Case Examples

Case Study: Beatrice5-year old, verbal femaleBackground: Kindergarten teacher noticed that she was not

socializing with other children & exhibited repetitive motions; school psychologist was asked to complete the GARS-2. Beatrice was receiving speech-language services and her SLP completed the Communication subscale of the GARS-2 while the kindergarten teachers filled out the Stereotyped Behaviors and Social Interaction subscales.

Subscale 1 - Stereotyped Behaviors:Teacher reported frequently observing the

following behaviors:• 2. Stares at hand objects, or items in the environment for at least 5

seconds.• 8. Spins objects not designed for spinning (e.g., saucers, cups, glasses)• 9. Rocks back and forth while seated or standing.• 12. Flaps hands or fingers in front of face or at sides.

Other behaviors were not observed.

Case Study: Beatrice

QUESTIONS:1. How often is ‘frequently observed’?2. What is the subscale SS for Beatrice? 3. Does this mean Beatrice has Autism?

ANSWER: 1. Frequently observed means the individual behaves in this manner at least 5-6 times per 6-hour period.2. The subscale score is ___:3. No, but her score indicates a high risk for Autism as it is falls in the range of 7 or higher.

Case Study: Beatrice

Subscale 2 - Communication: The SLP completed the subscale & found that Beatrice sometimes exhibited the following:

17. Repeats words or phrases over and over. 18. Speaks or signs with flat tone, affect, or

dysrhythmic patters 28. Inappropriately answers questions about a

statement or brief story.

The SLP did not observe any other behaviors listed on the subscale.

Case Study: Beatrice

QUESTIONS:1. Does this subscale indicate a risk of Autism?ANSWER: Yes, Beatrice scored a __ on this subscale and as

such there is some indication of a possibility of Autism. Combined with the Stereotyped Interactions data, there is an indication of a high risk of Autism.

2. Was it appropriate for more than one adult to complete the GARS-2?

ANSWER: Yes, each professional has a different perspective & multiple raters who have the best view into a particular domain can complete the subscales of the GARS-2.

Case Study: Beatrice

Subscale 3 - Social Interaction: The kindergarten teacher completed this subscale and found that Beatrice sometimes:

40. Becomes upset when routines are changed. 42. Lines up objects in precise, orderly fashion

and becomes upset when the order is disturbed.

The teacher seldom observed Beatrice exhibiting the following:

31. Resists physical contact from others. 33. Withdraws, remains aloof, or acts standoffish

in group situations.

Case Study: Beatrice

QUESTION:1. Does this subscale indicate a risk of

Autism?

ANSWER: Yes, Beatrice scored a ___ on this subscale and as such there is some indication of a possibility of Autism. Combined with the Stereotyped Interactions data, and the Communications subscale there is an indication of a high risk of Autism.

Case Study:Beatrice

Beatrice was referred to a developmental pediatrician for a developmental evaluation.

She was eventually diagnosed with PDD-NOS.

She was referred to an intensive after school intervention program.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Autism Society of America (2003). What is Autism? Retrieved January 5, 2005, from http://www.autismsociety.org/site/pageserver?pagename=whatisautism

Gilliam, James E. (1995). Gilliam Autism Rating Scale. Austin TX: PRO-ED.

Gilliam, James E. (2006). GARS-2; Gilliam Autism Rating Scale, Second Edition, Examiner’s Manual. Austin, TX: PRO-ED.