Development and Psychometric Properties of a New Questionnaire to Assess Mental Health and Concerning Behaviors in Children and Young People with Autism Spectrum Disorder (ASD): The Assessment of Concerning Behavior (ACB) Scale.
Joanne Tarver, Silia Vitoratou, Mathilde Mastroianni and 8 others
PMID 33051784WHAT IT FOUND
The new Assessment of Concerning Behavior scale is a 35-item parent-report tool that reliably screens autistic children for both internalizing and externalizing mental health issues.
It correlates strongly with established measures but is tailored to autism, making it a valid alternative for clinical assessment.
Key findings
01The final parent-report ACB consists of 35 items that form two distinct factors: internalizing symptoms (e.g., anxiety, depression) and externalizing symptoms (e.g., aggression, hyperactivity).
02The ACB demonstrates strong concurrent validity, with the externalizing subscale correlating highly (r = 0.80) with the Aberrant Behavior Checklist irritability subscale and the internalizing subscale correlating highly (r = 0.78) with the ASEBA internalizing subscale.
03The scale shows satisfactory test-retest reliability for the parent version, with agreement exceeding 85% for all items over a mean interval of 3.05 months.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The full psychometric validation was conducted only on the parent-report version. The child, young person, and teacher versions had low completion rates and have not yet been fully validated. The child self-report version showed poor test-retest reliability, with 24 of 41 items having less than 85% agreement, suggesting it is not yet ready for clinical use. The study sample was recruited primarily from London clinical services and special needs schools, which may not represent the broader autistic population, particularly those not accessing these services. No norms or cut-off scores were established in this study, so clinicians cannot yet use the ACB to definitively diagnose conditions or determine severity thresholds. Participants completed the ACB in various contexts (home, clinic, online), which could potentially influence responses, although the authors argue reliability analyses suggest this effect was minimal.
Declared interests
The study was part of a National Institute for Health Research (NIHR) programme grant. No commercial funding or conflicts of interest were reported by the authors.
The easy way to misread this
Do not assume the child or teacher versions of the ACB are clinically valid. The study only fully validated the parent-report scale. The child self-report version had poor reliability, and the teacher and young person versions lacked sufficient data for full psychometric analysis.