Psychiatry Research 247 (2017) 6367

Contents lists available at ScienceDirect

Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Assessing symptoms during comprehensive interventions for young MARK

children with autism spectrum disorder: Development and preliminary
analysis of the Autism Behaviour Coding System (ABCS)
Diana Dima, Olga Lazari, Klaus Schmeck, Ren Spiegel, Anja Brnnimann, Kirstin Goth,

Evelyn Herbrecht
University Department of Child and Adolescent Psychiatry, Basel, Switzerland

A R T I C L E I N F O A BS T RAC T

Keywords: The aims of this paper are to present the Autism Behaviour Coding System (ABCS), a novel, video-based
Early intervention observational instrument for assessing core autism symptoms during intensive early interventions in autism
Video coding system spectrum disorder (ASD), to provide preliminary data on its psychometric characteristics and to discuss its
Observational methods clinical utility. Video recordings of child-therapist interactions during the 'Frhintervention bei autistischen
Child-therapist interaction
Strungen' (FIAS) were coded by treatment-independent raters who were blind with respect to the temporal
Therapy evaluation
order of the sequences. We assessed inter-rater reliability using intra-class correlations (ICCs). Mean ICCs
FIAS
ranged from 0.85 to 0.90. We analysed the sensitivity of the ABCS to change by comparing the change in ABCS
scores with the change in a validated external measure of level of functioning (Developmental Disorder-Child-
Global Assessment of functioning Scale, DD-C-GAS) in a sample of 15 children who received intensive
treatment. Both the ABCS and DD-C-GAS indicated that the intervention improved symptoms. The ABCS has
promise as a research instrument and has good to excellent inter-rater agreement and sensitivity to
intervention-related changes. This pilot study suggests that the ABCS may be useful as an objective method
of assessing the proximal eects of therapy in young children with ASD.

1. Introduction 2013, p. 120). Hawkes et al. also emphasise that OC is an eective

Social reciprocity decits are a core feature of autism spectrum
disorders (ASD) (Williams White et al., 2007). One of the main goals of
intensive ASD interventions is the improvement of interaction skills, to
enable children to integrate better with their peers. Methods of
assessing changes in these crucial behaviours are therefore of great
interest; however the development of tools to be used alongside
standard assessments, i.e. to evaluate psychosocial interventions for
ASD, represents a challenge for researchers (Lord et al., 2005).
Parent- and intervention sta-reports are easy and cheap to collect,
but their subjective and potentially biased character is a major
limitation. Using raters who are independent and blind to subjects
intervention status can reduce but not fully eliminate this bias
(McMahon et al., 2013). Observational coding (OC) by independent,
blind assessors may be even more eective in minimising bias. OC
involves classifying and quantifying verbal and nonverbal (e.g., motor
actions, expressed aect) behavioural events or psychological states,
irrespective of participants reports or impressions (Hawkes et al.,
method of assessing the impact of treatments on symptoms; they claim
that OC may be more sensitive to changes in outcome variables than
other forms of assessment (e.g. self-reports, teacher ratings), especially
with respect to short-term, post-treatment changes. OC can also be
used to capture behaviour in its natural context and thus represents the
most ecologically valid form of behavioural observation (Barkley,
1997). Use of OC in ASD research has provided important insights
into the development of autistic symptoms (Osterling and Dawson,
1994; Cliord et al., 2007; Cliord and Dissanayake, 2008) and it is the
approach most commonly used to assess behavioural interventions
such as Applied Behavioural Analysis (ABA) (Vismara and Rogers,
2010; McMahon et al., 2013).
Direct observation, mostly based on video analysis, has also been
used successfully in the investigation of other therapeutic approaches,
although it is less popular in this context than for the assessment of
behavioural interventions. It has been found to be especially useful for
the evaluation of therapist- or parent-child interactions. Video coding
procedures vary from use of standard scales (Vorgraft et al., 2007;

Correspondence to: University Department of Child and Adolescent Psychiatry, Schahauserrheinweg 55, CH-4058 Basel, Switzerland.
E-mail address: evelyn.herbrecht@upkbs.ch (E. Herbrecht).

http://dx.doi.org/10.1016/j.psychres.2016.11.006
Received 27 April 2016; Received in revised form 26 September 2016; Accepted 6 November 2016
Available online 10 November 2016
0165-1781/ 2016 Elsevier Ireland Ltd. All rights reserved.
D. Dima et al.
Kasari et al., 2012) to development of new coding systems focused on
clinical features of particular interest in a given context (Aldred et al.,
2004; Carter et al., 2011; Casenhiser et al., 2011). To date almost all
coding schemes used in evaluations of ASD therapy have focused on
specic aspects of children's behaviour, with the exact behaviours of
interest varying according to the investigators interests. Here we
present the Autism Behaviour Coding System (ABCS, Dima et al., in
preparation), a mainly research-oriented, observational, video-based
evaluation instrument designed to provide an objective, micro-analy-
tical assessment of children's ASD-related behaviours. The ABCS
enables an external evaluator to assess core autism-related behaviours
and autism-specic interaction characteristics. We originally developed
the ABCS to evaluate the eects of Frhintervention bei Autistischen
Strungen (FIAS), a play-based, intensive therapy for children with
ASD aged up to 4 years, which is intended to encourage children to take
part in social interactions by increasing shared enjoyment of such
interactions. Clinical results from 12 children treated with FIAS
showed that the ABCS was sensitive to intervention-associated changes
in autism symptoms (Herbrecht et al., 2015). The ABCS detected
changes in basic social skill variables, for example eye contact and
imitation, i.e. behaviours that are necessary for more complex social
behaviours and a reduction in the duration of repetitive behaviours.
Computer-based micro-analysis of recordings of children's reactions
revealed behavioural features which would have been missed or
registered less accurately had the assessment been based solely on
overall clinical impressions. The coding schemes previously developed
for use in ASD focus on social behaviour; in contrast the ABCS also
assesses repetitive behaviours, which are a core symptom of autistic
disorder (DSM-5; APA, 2013). The ABCS also captures short-term
eects of treatments for ASD.
As the psychometric properties of a behavioural assessment instru-
ment are a crucial aspect of its utility we assessed two key properties of
the ABCS in this study: its inter-rater reliability (IRR) and its
sensitivity to change. We present data from two small samples of
young patients who received FIAS therapy and compare the results of
ABCS evaluations before, during and after the intervention with
standard clinical assessments made at the same time-points. We also
describe the development of the new coding system and make
recommendations for its use.
1.1. The ABCS: development and coding
Development of the ABCS began in 2011, with the development of a
set of behavioural categories based on existing lists of behaviours
typical of children with ASD; however, only behaviours present in all
children treated in the FIAS centre to date have been retained in the
coding scheme. We assume that these behaviours represent the
majority of the autistic behavioural phenotype. Behaviours that were
only observed in a subset of children (aggression, self-injury, disruptive
behaviour and deance) were progressively eliminated from the initial
list of categories. The coding scheme covers two main behavioural
domains: 1) social interaction, captured in six behavioural categories
and 2) repetitive behaviours. Altogether the coding scheme consists of
seven categories of child behaviour represented by 25 coding variables
(Table 1). Details of the coding scheme are provided in the ABCS
manual (Dima et al., in preparation) and are available from the authors
on request.
1) The social interaction domain comprises behaviours reecting
autism-specic decits in core aspects of social development.
Some qualier variables provide qualitative information about
target behaviours (appropriate; inappropriate) or indicate the level
of social development (verbal or nonverbal expression of desire,
types of joint attention). Play situations are coded using qualier
variables which capture the level of a child's participation and the
extent of his or her social awareness.
64
Psychiatry Research 247 (2017) 6367
Table 1
Behavioural categories and related variables.
Social interaction
(SI)
Gaze (GZ) Eye contact; triadic gaze
Joint attention Initiating JA; responding to JA; shared attention
(JA)
Expression of Nonverbal appropriate; nonverbal inappropriate;
wishes (EW) verbal appropriate; verbal inappropriate; verbal
request accompanied by pointing
Imitation (IM) Motor imitation; vocal or verbal imitation; combination of
motor and vocal or verbal imitation
Social positive Social positive affect; absence of social positive affect
aect (SPA)
Functional play Interactive play; parallel play; solitary play; absence of play
(FP)
Repetitive Ritual play; sensory-motor stereotypes; vocal stereotypes;
behaviour (RB) verbal stereotypes; motor and vocal or verbal stereotypes
combined; sensory-motor or other repetitive behaviours
2) Children with ASD can display a wide spectrum of repetitive
behaviours, depending on their age and developmental level.
Although it is dicult to dierentiate clearly between the dierent
subtypes of repetitive behaviour, a distinction is often made
between 1) lower level repetitive behaviours (repetitive motor
behaviours and persistent preoccupation with parts of objects),
which tend to be displayed by younger and low-functioning children
and 2) higher level behaviours (preoccupation with restricted
interests and non-functional routines and rituals), which tend to
be displayed by high-functioning children (Leekam et al., 2011).
Children may manifest behaviours from both categories at various
points in their lives, but if one accepts this hierarchical taxonomy
the behaviours manifested at a given time-point may provide
information about a child's development.
The ABCS uses a simple classication system which distinguishes
between motor, vocal and verbal repetitive behaviours and ritual play.
Examples of behaviours typical of each of the above categories are
included in the coding manual.
1.1.1. Recommended assessment setting
A child's response to a social initiative is inuenced by multiple
factors such as the play activity, the person with whom the child is
interacting, the type of toys available, the number of persons present in
the room and the adult's interaction style (Guralnick and Groom, 1985;
Baranek, 1999; Cliord et. al., 2007). The ABCS is designed for use in
semi-structured interaction contexts. In the FIAS treatment centre we
carry out assessments in a play context in which a standard toy box
containing a puppet (for symbolic play) and tubes (for functional play)
is available or when the child is eating lunch together with the
therapist. Play contexts in which other toys are available (preferably
several toys which can be used for functional and symbolic play) and
other routine events (mealtimes, bathing, or preparing for bed) are also
suitable contexts for assessing behaviour with the ABCS. The adult
interaction partner, either a therapist or a parent, must be alone with
the child in the room during the interaction and should remain the
same throughout a longitudinal series of assessments.
1.1.2. Coding procedure
The technology underpinning the ABCS is Interact (Mangold
International GmbH, 14th version), a professional software package
that provides multiple functionalities including the ability to watch a
child's behaviour in slow motion, automatic recording of the frequency
and duration of specic behaviours, graphical displays of data and the
option to view behaviour from two perspectives (e.g. recorded from
opposite corners of the room) simultaneously. The ABCS is an event
D. Dima et al. Psychiatry Research 247 (2017) 6367

record-based coding system and coding is continuous, consisting of a
record of the presence or absence of a particular behaviour and its total
duration (in seconds) or frequency within a given observation period.
Coding for treatment evaluation purposes should be performed by
raters who are blind to the temporal order of video sequences from a
given treatment period. The ABCS manual describes the variable
categories and codes, and provides general guidance about the
Interact functions which can be used to support ABCS coding.
1.1.3. Analysis options
The behavioural categories gaze, initiation of joint attention,
response to joint attention, expression of wishes and verbal stereo-
type are reported as frequencies. The remaining categories, namely
social positive aect, functional play, repetitive behaviour and
shared attention, are described in terms of total duration of the
behaviour. Other meaningful variables such as the combined codes
gaze with positive aect and joint attention with positive aect are
reported as frequencies.
2. Method
2.1. Inter-rater reliability
2.1.1. Participants
The sample consisted of three boys treated at the FIAS centre. They
were aged between 39 and 49 months at the start of the intervention
and had been diagnosed with ASD using standard instruments, i.e. the
Autism Diagnostic Observation Schedule (ADOS, module 1; German
version by Rhl et al., 2004) and the Autism Diagnostic Interview-
Revised, diagnostic algorithm: 2; 03.11 years old (ADI-R; German
version by Blte et al., 2006). None of the children had additional
neurological or somatic problems. Their parents gave written, informed
consent to the anonymised use of the data.
2.1.2. Rating method
Twenty-seven video sequences were coded (three video sequences
of therapist-child interaction per child at each of three dierent time-
points during the intervention). We chose to record children's beha-
viour in three situations which occur routinely as part of the FIAS
intervention (Herbrecht et al., 2015): functional play, symbolic play (a
standard set of toys was available in both play situations) and
lunchtime. Each video sequence lasted 5 min
The frequency and/or duration of the following variables were
recorded for all three situations: expression of wishes, gaze, imitation,
joint attention, functional play, repetitive behaviour and social positive
aect. Coding was performed by three dierent raters who were blind
to the children's intervention status. None of the raters was involved in
FIAS treatment. Raters 1 and 2 were the rst and second authors of
this article and were heavily involved in the development of the
instrument. Both are clinical psychologists experienced in the treat-
ment of children with autistic disorder. Rater 3 is a medical student
familiar with ASD clinical symptoms and was trained in use of the
ABCS by Rater 1. This training took approximately one working day.
the FIAS intervention. Eligibility for the intervention was based on the
following criteria: a) diagnosis of autism using a standardised assess-
ment instrument; b) aged below 5 years at the start of the intervention;
c) absence of severe neurological disorder. Parents gave written,
informed consent to the anonymised use of the data.
2.2.2. Statistical analysis
Repeated measures (RM) MANOVA was used to analyse the pattern
of changes in core autism-related symptoms, as measured using the
ABCS, over three dierent time-points (days 4, 10 and 17 of the 18-d
intervention). We chose the lunch situation for this analysis as it
constitutes a relatively invariant setting and was thus the situation in
which data from a heterogeneous patient sample would be most
comparable. Other interaction settings such as play situations in which
toys are available or routine events could also be chosen to suit the
specic research question being addressed (more detailed information
about dierent settings is provided in the ABCS manual (Dima et al., in
preparation). We analysed changes in the following categories of
behaviour: gaze, joint attention, imitation, expression of wishes and
repetitive behaviour. Coding of the video sequences was done by the
rst and second author of this article using the same procedure as in
the inter-rater reliability study (see 2.1.2).
Data on level of functioning were also analysed to enable us to
compare the patterns of change suggested by the ABCS and another
tool. The DD-C-GAS (Developmental Disorder-Child-Global
Assessment of functioning Scale; Wagner et al., 2007, German transla-
tion), an adaptation of the Children's Global Assessment Scale
(Schaer et al., 1983) developed for use with children with ASD, was
used as the reference indicator of level of functioning. The DD-C-GAS
ratings were made immediately before and after the intensive inter-
vention (days 0 and 18) by the lead FIAS therapist working with the
child in question. The DD-C-GAS describes ten categories of function-
ing using a 0100 scale; scores below 70 indicate that a child has
important special needs. Level of functioning data were analysed in the
same way as the ABCS data. Changes in everyday functioning,
intellectual performance, communication and social behaviour were
analysed statistically using RM MANOVA. Variance over time is
represented by the partial eta squared (2p) statistic for eect size;
values of 2p > 0.06 indicate a medium eect and values of 2p > 0.14
a large eect. We also calculated the standard signicance parameter
(p).
3. Results
3.1. Inter-rater reliability
IRR (see Table 2) was high for six out of seven variables in the
context of functional play; ICCs ranged from 0.82 to 0.99 (M=0.88), the
only variable with a lower IRR was frequency of joint attention
(ICC=0.56). IRR was also high for six out of seven variables in the
Table 2
Intra-Class Correlation Coefficients (ICCs).

Variable Parameter ICC 95% CI

2.1.3. Statistical analysis n=27
Agreement between the three raters was assessed using the intra- ICC (Sit. 1) ICC (Sit. 2) ICC (Sit. 3)
class correlation statistic (ICC), a two-way mixed model with measures m=0.88 m=0.90 m=0.85
of absolute agreement and a 95% condence interval, CI). SPSS v.19
Expression of wishes frequency 0.94 0.96 0.67
was used for the statistical analysis. Each coded video sequence Repetitive behaviour duration 0.99 0.92 0.98
constituted a single case, giving 27 cases in total. Functional play duration 0.99 0.99 -(#1)
Eye contact frequency 0.95 0.92 0.97
2.2. Sensitivity to change Imitation frequency 0.82 0.86 -(#2)
Joint attention frequency 0.56 0.75 0.95
Social positive aect duration 0.94 0.91 0.68
2.2.1. Participants
The participants were 15 young children (11 male; 4 female) aged Sit. 1: functional play situation; Sit. 2: symbolic play situation; Sit. 3=lunch situation
from 32 to 49 months (mean age=43.2 months) who were enrolled in #1 functional play not scored in the lunch situation, #2 behaviour not observed

65
D. Dima et al. Psychiatry Research 247 (2017) 6367

Table 3 with ASD during interactions with an adult. We evaluated the IRR of
MANOVA results for ABCS assessment of core autistic symptoms in 15 patients at three the ABCS and found very good to excellent agreement between raters
time points (days 4, 10, 17 from a total of 18 days of intensive intervention).
for most of the ABCS variables. There were a few variables with less
Variable Parameter Day 4 Day 10 Day 17 p n2p than satisfactory ICCs; for example, in the lunch situation frequency of
m (SD) m (SD) m (SD) expression of wishes had an ICC below the threshold of acceptability
(0.80). It is possible that because the food is already on the table in this
Gaze Frequency 4.7 (6.5) 7.5 (9.0) 8.7 (9.5) 0.109 0.147
situation it oers children little opportunity to express their wishes. For
Joint attention Frequency 1.5 (2.6) 1.0 (1.9) 2.0 (3.2) 0.119 0.141
Limitation Frequency 0.1 (0.4) 0.2 (0.4) 0.3 (0.8) 0.042 0.052 this reason, and because frequency of expression of wishes had good
Expression of Frequency 0.1 (0.4) 0.4 (0.6) 0.5 (1.4) 0.297 0.081 IRR in the contexts of functional play (ICC=0.94) and symbolic play
wishes (ICC=0.96), we decided that coding this variable during the lunch
Repetitive Duration 55.6 38.9 34.8 0.321 0.078 situation should be optional. In general raters found it more dicult to
behaviour (72.6) (42.4) (53.5)
score expression of wishes than other variables, especially in the case
Mean (m), standard deviation (SD), p-value, eect size (2p > 0.140: large eect, > of nonverbal children.
0.060: medium eect) The variable joint attention had lower ICCs than expected in the
contexts of functional play (ICC=0.56) and symbolic play (ICC=0.75).
context of symbolic play; ICCs ranged from 0.86 to 0.99 (M=0.90), This could be because the less structured play settings makes it more
once again only frequency of joint attention had a lower value dicult to observe subtle features of behaviour, such as joint attention.
(ICC=0.75). In the lunch situation (mean ICC=0.85), three out of ve Joint attention had a higher ICC in the lunch situation (see Table 2),
variables had ICCs between 0.95 and 0.98, representing very good IRR. which is more structured: the child and therapist sit next to each other
The behaviours represented by two variables were not observed in any at a small table and interact whilst having lunch. The play situation is
of the sequences and ICC values were lower for frequency of expression mostly object-focused, but as either the therapist or the child tend to be
of wishes (ICC=0.67) and duration of social positive aect (ICC=0.68). moving short periods of joint attention may be dicult to observe.
The ABCS was designed for use in semi-structured settings where
3.2. Sensitivity to change strict control over stimuli is not possible. Behaviour in these situations
tends to be somewhat unpredictable as children are encouraged to
Eect sizes were large for two ABCS variables, gaze and joint initiate social contact rather than just responding to the demands of an
attention, both of which are clinically signicant behaviours, but in adult. This means that a given interaction situation will be similar but
neither case was dierence between pre- and post-intervention scores. not identical at dierent time-points, and this may introduce some bias
statistically signicant. Eects sizes were medium for improvement in into comparisons of results from dierent time-points e.g. pre- and
expression of wishes and repetitive behaviour during the course of post-intervention. The denitions of variables in the ABCS manual are
the intervention. There was least improvement in imitation, for which designed to minimise this kind of bias. For example, children's requests
the eect size was small (see Table 3). In summary, scores on all ABCS tend to increase in frequency if an initial request is refused; if simple
variables indicated that the intensive intervention had produced some frequency data were used this might be misinterpreted as an improve-
improvement in autistic symptoms. Analysis of DD-C-GAS data ment in ability to express wishes, so the ABCS scores only requests
indicated that there were very large, highly signicant improvements expressed before a refusal.
in several symptom domains over time (see Table 4). In our sample scores on the ABCS variables indicated that there was
The variance in ABCS results was high, indicating that there were an improvement in symptoms, especially towards the end of the
considerable dierences between patients. This reects the heteroge- intervention. This nding corresponds well with our clinical impression
neity of symptom expression in this patient group. It is also notable that children's development during the FIAS intervention is discontin-
that improvements in behaviour were not apparent until the end of the uous. Improvements in social interaction and communication skills
intervention (third time-point, day 17); at the second time-point (day and a reduction in repetitive behaviours seem to occur as part of a
10) there was no substantial improvement in behaviour and in some discontinuous maturation process. The ABCS seems to be capable of
cases behaviour had actually deteriorated. capturing even subtle changes in behaviour during the intervention.
The ABCS was developed to provide a more nely grained assess-
4. Discussion ment of the eects of intensive therapeutic interventions for children
with ASD than other ASD assessment tools. However, although eect
Designing reliable, video-based instruments for coding the beha- sizes were large for changes in some ABCS variables the improvements
viour of children with ASD is a challenge, because of the heterogeneity did not reach statistical signicance, whereas the improvements in DD-
in expression of the disorder. The frequency of changes in the quantity C-GAS scores, which are based on assessments made by the therapists
and quality of the behaviour of young children with ASD presents a working with the children rather than by an external rater, were greater
further challenge. in absolute terms and were statistically signicant. Thus, contrary to
We attempted to address these challenges by developing an the claim made by Hawkes et al. (2013), the ABCS - which captures
instrument, the ABCS, for capturing behaviours produced by children behaviour at the micro-analytical level - proved to be less sensitive to
changes in behaviour than the DD-C-GAS, which captures behaviour in
Table 4
broader terms. It remains to be determined whether and to what extent
MANOVA results of level of functioning (DD-C-GAS) in 15 children before and after the the apparently superior sensitivity of the DD-C-GAS is genuine rather
intensive intervention. than a product of therapist bias.
It takes approximately ve to six hours to code 90 min (30 minx3
Variable Day 0 Day 18 p n2p
time-points) of recordings of a child. Because of this the ABCS is
m (SD) m (SD)
primarily intended for use in research, and is not considered suitable
Self-care (score 1100) 34.9 (16.1) 44.3 (17.0) 0.006*** 0.429 for routine use in clinical settings. In research contexts the ABCS can
Communication (score 1100) 34.8 (15.3) 43.6 (17.7) 0.002*** 0.492 be used as OC tool to provide objective, precise assessments of
Social behaviour (score 1100) 27.0 (11.0) 37.7 (13.1) 0.001*** 0.553
clinically relevant changes in core autistic symptoms during and after
Intellectual skills (score 1100) 43.8 (17.5) 51.6 (17.9) 0.002*** 0.499
intensive therapeutic interventions (Herbrecht et al., 2015). The ABCS
Mean (m), standard deviation (SD), p-value (*p < 0.05; ***p < 0.01), eect size (2p > diers from other video-based approaches such as the BOSCC
0.140: large eect, > 0.060 medium eect) (Kitzerow et al., 2015; Grzadzinski et al., 2016) in that it does not

66
D. Dima et al.
produce global scores representing children's behaviour over a given
period of time; instead it provides a detailed, continuous protocol of a
child's behaviour in a given situation. Such protocols may enable the
identication of turning points in intensive therapeutic interventions
such as the FIAS; however the ABCS is essentially an instrument for
measuring quantitative rather than qualitative changes in behaviour.
This is an important limitation, given that over longer periods of time
qualitative changes in behaviour (e.g. the social modulation of eye
contact) may be better indicators of the course of autistic symptoms
than quantitative indices (e.g. frequency of eye contact). It means that
the ABCS may be most suited to short-term evaluations.
The most important limitations of this pilot investigation are (1) the
small sample size in the IRR study and (2) the sensitivity-to-change
analysis must be regarded as preliminary, as we only calculated IRR for
the main variables and other properties of the instrument, such as its
validity have not been investigated.
5. Conclusion
Although they are relatively time-consuming, observational assess-
ments of children undergoing treatment for ASD by independent
observers have important advantages over retrospective assessments
by therapists or parents. They can provide detailed information about
changes during the course of treatment that is not captured by other
assessment methods. The ABCS was designed for monitoring changes
in core ASD symptom domains during and after therapy, at a micro-
analytical level. Documented changes over time indicate that the ABCS
is sensitive to FIAS intervention-associated changes in symptoms;
however the changes detected using the ABCS were not signicant.
This preliminary analysis suggests that the ABCS is a reliable tool and
could be used to evaluate early interventions for ASD. Evaluation of
videotapes using the ABCS can add value to standard assessments of
psychosocial functioning and intellectual performance, as the ABCS
focuses on basic, autism-sensitive aspects of interaction and commu-
nication. The ABCS is particularly recommended for assessing thera-
pist- or parent-child interactions when proximal treatment eects are
the main object of interest. The clinical utility of this new instrument
will be evaluated in future research.
Conict of interest
Diana Dima was founded by the Botnar foundation. No other
potential conict of interest was reported.
Acknowledgments
We thank Nadine Fink for her important initial input into the
design of the ABCS and Julia Frh for her contribution to rating the
child participants in this study.
References
Aldred, C., Green, J., Adams, C., 2004. A new social communication intervention for
children with autism: pilot randomized controlled treatment study suggesting
eectiveness. J. Child Psychol. Psychiatry. http://dx.doi.org/10.1111/j.1469-
7610.2004.00338.x.
American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental
67
Psychiatry Research 247 (2017) 6367
Disorders. American Psychiatric Association, Washington, DC.
Baranek, G.T., 1999. Autism during infancy: a retrospective video analysis of sensory-
motor and social behaviours at 9-12 months of age. J. Autism Dev. Disord. 29 (3),
213224.
Barkley, R.A., 1997. Attention-decit/ hyperactivity disorder. In: Marsh, E.J., Terdal,
L.G. (Eds.), Assessment of Childhood Disordersthird ed.. Guilford Press, New York,
71129.
Blte, S., Rhl, D., Schmtzer, G., Poustka, F., 2006. Diagnostisches Interview fr
Autismus-Revidiert (ADI-R). Huber, Bern.
Carter, A.S., Messinger, D.S., Stone, W.L., Celimli, S., Nahmias, A.S., Yoder, P., 2011. A
randomized controlled trial of Hanen's More Than Words' in toddlers with early
autism symptoms. J. Child Psychol. Psychiatry. http://dx.doi.org/10.1111/j.1469-
7610.2011.02395.x.
Casenhiser, D.M., Shanker, S.G., Stieben, J., 2011. Learning through interaction in
children with autism: preliminary data from asocial-communication-based
intervention. Autism. http://dx.doi.org/10.1177/1362361311422052.
Cliord, M.S., Dissanayake, C., 2008. The early development of joint attention in infants
with autistic disorder using home video observations and parental interview. J.
Autism Dev. Disord.. http://dx.doi.org/10.1007/s10803-007-0444-7.
Cliord, S., Young, R., Williamson, P., 2007. Assessing early characteristics of autistic
disorder using video analysis. J. Autism Dev. Disord.. http://dx.doi.org/10.1007/
s10803-006-0160-8.
Dima, D., Lazari, O., Schmeck, K., Herbrecht, E. The Autism Behaviour Coding System
Manual. Department of Child and Adolescent Psychiatry, Psychiatric University
Clinics (UPK) Basel, 2016 (in preparation).
Grzadzinski, R., Carr, T., Colombi, C., McGuire, K., Dufek, S., Pickles, A., Lord, C., 2016.
Measuring changes in social communication behaviors: preliminary development of
the Brief Observation of Social Communication Change (BOSCC). J. Autism Dev.
Disord. 46, 24642479.
Guralnick, M.J., Groom, J.M., 1985. Correlates of peer-related social competences of
developmentally delayed preschool children. Am. J. Ment. Dec. 90 (2), 140150.
Hawkes, D.J., Dadds, M.R., Pasalich, D.S., 2013. Observational coding strategies. In:
Colmer, J.S., Kendall, P.C. (Eds.), The Oxford Handbook of Research Strategies for
Clinical Psychology. Oxford University Press, Oxford, 120141.
Herbrecht, E., Kievit, E., Spiegel, R., Dima, D., Goth, K., Schmeck, K., 2015. Become
related: FIAS, an intensive early intervention for young children with autism
spectrum disorders. Psychopathology. http://dx.doi.org/10.1159/000375504.
Kasari, C., Gulsrud, A., Freeman, S., Paparella, T., Hellemann, G., 2012. Longitudinal
follow-Up of children with autism receiving targeted interventions on joint attention
and play. J. Am. Acad. Child Adolesc. Psychiatry 51 (5), 487495.
Kitzerow, J., Teufel, K., Wilker, Ch, Freitag, Ch.M., 2015. Using the Brief Observation of
Social Communication Change (BOSCC) to measure autism-specic development.
Autism Res. 9 (9), 940950.
Leekam, S.R., Prior, M.R., Uljarevic, M., 2011. Restricted and repetitive behaviours in
autism spectrum disorders: a review of research in the last decade. Psychol. Bull. 137
(4), 562593.
Lord, C., Wagner, A., Rogers, S., Szatmari, P., Aman, M., Charman, T., Dawson, G.,
Durand, V.M., Grossman, L., Guthrie, D., Harris, S., Kasari, C., Marcus, L., Murphy,
S., Odom, S., Pickles, A., Scahill, L., Shaw, E., Siegel, B., Sigman, M., Stone, W.,
Smith, T., Yoder, P., 2005. Challenges in evaluating psychosocial interventions for
autistic spectrum disorders. J. Autism Dev. Disord. 35 (6), 695708.
McMahon, C.M., Vismara, L.A., Solomon, M., 2013. Measuring changes in social
behavior during a social skills intervention for higher-functioning children and
adolescents with autism spectrum disorder. J. Autism Dev. Disord. 43 (8),
18431856.
Osterling, J., Dawson, G., 1994. Early recognition of children with autism: a study of rst
birthday home videotapes. J. Autism Dev. Disord. 23 (3), 247257.
Rhl, D., Blte, S., Feineis-Matthews, S., Poustka, F., 2004. ADOS, Diagnostische
Beobachtungsskala fr Autistische Strungen. Huber, Bern.
Schaer, D., Gould, M.S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., Aluwahlia, S.,
1983. A children's global assessment scale (CGAS). Arch. Gen. Psychiatry 40,
12281231.
Vismara, L.A., Rogers, S.J., 2010. Behavioural treatments in autism spectrum disorders:
what do we know? Annu. Rev. Clin. Psychol. 6, 447468.
Vorgraft, Y., Farbstein, I., Spiegel, R., Apter, A., 2007. Retrospective evaluation of an
intensive method of treatment for children with pervasive developmental disorder.
Autism 11, 413. http://dx.doi.org/10.1177/1362361307079605.
Wagner, A., Lecavalier, L., Arnold, L.E., Aman, M.G., Scahill, L., Stigler, K.A., Johnson,
C.R., McDougle, C.J., Vitiello, B., 2007. Developmental disabilities modication of
the children's global assessment scale. Biol. Psychiatry 61, 504511.
Williams White, S., Keonig, K., Scahill, L., 2007. Social skills development in children
with autism spectrum disorders: a review of the intervention research. J. Autism
Dev. Disord.. http://dx.doi.org/10.1007/s10803-006-0320-x.