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autism © 2004
Measuring developmental SAGE Publications
and The National
Autistic Society
progress of children with Vol 8(1) 89–100; 040641
1362-3613(200403)8:1

autism spectrum disorder on

school entry using parent
report

TONY CHARMAN Institute of Child Health, University College

London, UK

PAT R I C I A H OW L I N St George’s Hospital Medical School,

London, UK

B RYO N Y B E R RY Institute of Child Health, University College

London, UK

E M I LY P R I N C E Institute of Child Health, University College

London, UK

A B S T R AC T Increasing numbers of children with autism spectrum K E Y WO R D S

disorder (ASD) are diagnosed in the preschool years, and their edu- autism;
cational progress must be monitored. Parent questionnaire data can develop-
augment psychometric assessments and individual planning at low mental
cost. One hundred and twenty-five parents of UK children who entered progress;
dedicated autism primary schools and units in two consecutive
monitoring;
calendar years were asked to complete three questionnaires. Fifty-seven
parents repeated the questionnaire measures one year later. Encourag-
parent
ing developmental progress was observed on the Vineland Adaptive report;
Behavior Scales–Screener. Symptom severity as measured by the Social question-
Communication Questionnaire did not change over time. The pattern naires
of change scores on the Autism Treatment Evaluation Checklist was
mixed, and confounding disadvantages this questionnaire. The study
demonstrated that it is possible to collect useful information on the
progress of children with ASD using parents as informants. Such data
would assist in judging claims regarding developmental progress
within particular programmes.
ADDRESS Correspondence should be addressed to: D R T O N Y C H A R M A N ,
Behavioural and Brain Sciences Unit, Institute of Child Health, University College London,
30 Guilford Street, London WC1N 1EH, UK. e-mail: t.charman@ich.ucl.ac.uk

www.sagepublications.com 89
DOI: 10.1177/1362361304040641
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Introduction
Increasing numbers of children with autism spectrum disorder (ASD) are
now diagnosed in the preschool years (Charman and Baird, 2002; Howlin
and Asgharian, 1999). This is due to several factors, including the broader
conceptualization of autism as a spectrum of disorders, the recognition that
ASDs can be present in individuals across the IQ range, and the appreci-
ation that ASD can co-occur in individuals with identifiable organic dis-
orders such as Down syndrome (Howlin et al., 1995) and tuberous
sclerosis (Harrison and Bolton, 1997). Whilst being welcome, this move
towards earlier identification presents considerable challenges to schools
and education systems. These include the provision of specialist placements
where appropriate, and the need for specialist advice, support and training
for professionals and parents (e.g. Kasari et al., 1999; McGregor and
Campbell, 2001).
Whilst a wide range of interventions and education programmes is
promoted as beneficial for children with ASD, well-designed and adequately
controlled studies in this area are few (for reviews see Howlin, 1998;
National Research Council, 2001; New York State Department of Health,
1999; Rumsey et al., 2000). Families and clinicians are confronted by
numerous claims and counter-claims for one therapy after another, but the
lack of data on programme effectiveness means that the evidence base for
evaluating the relative merits of one intervention or programme over
another is limited. Given the number of children with ASD now entering
the education system, it would seem crucial systematically to monitor the
developmental and behavioural progress of these children. Such data would
provide a yardstick for researchers, educators and parents against which to
judge claims regarding the developmental progress of children within
particular programmes.
Systematic data on children’s level of functioning as they enter school
would also be of value to schools and the education system. The progress
of individual children should be monitored through evaluation of target
achievements in their individual education plans (IEPs), as well as their
progress towards government-set education key stage targets and scholas-
tic attainment test scores (SATs). However, at both school and local edu-
cation authority (LEA) level, more systematic monitoring of developmental
and behavioural progress, using standard instruments, is needed. This
information is crucial for service audit and planning. It would also be useful
for identifying the characteristics of children in different types of place-
ment (e.g. mainstream versus specialist autism schools or units). In
addition, such information could be used to test specific research hypoth-
eses, for example, whether the key determining factor of placement in

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special versus mainstream school is the severity of autistic behaviour or the
child’s developmental level.
The present study set out to determine the feasibility of collecting data
on the developmental progress of children with ASD entering school using
standard parental questionnaires. This methodology represents a relatively
low-cost method of collecting information. Parents of two cohorts of
children who entered dedicated autism primary schools or specialist units
in the UK were asked to complete three questionnaires assessing develop-
mental level and symptom severity: the Vineland Adaptive Behavior
Scales–Screener version (VABS–S: Sparrow, 2000), the Social Communi-
cation Questionnaire (SCQ: Berument et al., 1999); and the Autism Treat-
ment Evaluation Checklist (ATEC: Rimland and Edelson, 1999). A
subsidiary aim was to compare the utility of the three scales to measure
developmental change in children’s profiles over time.

Method

Sample
Schools and units in the UK for children with autism spectrum disorders
(ASDs) were identified using The National Autistic Society (NAS) booklet
Schools’ Units and Classes for Children with Autism (1998). In order to maximize the
likelihood that only children with a clinical diagnosis of autism or a related
pervasive developmental disorder were included, only schools and units
providing dedicated provision for primary-school-age children with autism
were included (N = 89). All schools and units agreed to participate in the
research. Letters of invitation were sent out via schools to the parents of all
pupils under the age of 6 years who had started school in the autumn term.
Parents who expressed an interest in taking part were sent a questionnaire
pack and covering letter with prepaid return envelope.
In the autumn of 2000 (cohort 1), 59 schools/units had an intake of
children aged less than 6 years, totalling 198 eligible children. One hundred
and four parents agreed to take part, of whom 76 percent returned com-
pleted questionnaires (N = 79, 40 percent of total eligible sample). In the
autumn of 2001 (cohort 2), 56 schools/units had an intake of children
aged less than 6 years, totalling 146 eligible children. Sixty-seven parents
agreed to take part, of whom 82 percent returned completed questionnaires
(N = 55, 38 percent of total eligible sample). In addition, only children
whose parents reported that they had an autism spectrum diagnosis were
included. Six children were excluded from cohort 1, leaving N = 73. Three
children were excluded from cohort 2, leaving N = 52. The responses from
cohorts 1 and 2 were combined for cross-sectional analysis of the

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questionnaire data. Cohort 1 was also followed longitudinally, with 57
parents completing the questionnaires again in the autumn of 2001 when
their child had been in the school for 1 year (78 percent repeat response
rate).

Measures
Data on development level were collected using the Vineland Adaptive
Behavior Scales–Screener version (VABS–S: Sparrow, 2000). The VABS–S is
a recently developed adaptation of the widely used Vineland Adaptive
Behavior Scales–Survey version (Sparrow et al., 1984). This measures
adaptive behaviour in four domains: communication, daily living skills,
socialization and motor skills (the latter only for children < 6 years).
Although the VABS–S was designed to be administered by interview with
a parent or caregiver, the schedule is only 10 pages long and self-
explanatory in layout. Items are rated: 2 = ‘Yes, usually produces behaviour
X’; 1 = ‘Sometimes or partially produces behaviour X’; 0 = ‘No, never
produces behaviour X’; N = ‘No opportunity to produce behaviour X’; and
D = ‘Don’t know’. Initial piloting demonstrated that parents understood the
questions and were able to complete the schedule as a questionnaire. Raw
scores from the VABS–S are converted to raw score equivalents on the survey
edition. Age-equivalent norms can then be derived from the manual for
each domain of adaptive behaviour. Scores can then be combined to provide
the adaptive behaviour composite (ABC), which is considered a measure of
global developmental level (DQ) (see Sparrow et al., 1984, for details).
However, owing to basal effects, age-equivalent scores are considered the
most appropriate measures of developmental level in young or low-
functioning children and therefore will be the primary data presented in
the analysis (Carter et al., 1998).
The Social Communication Questionnaire (SCQ, previously called the
Autism Screening Questionnaire: Berument et al., 1999) is a short 40-item
questionnaire based on the Autism Diagnostic Interview–Revised (ADI–R:
Lord et al., 1994), a widely used instrument that enquires about character-
istic autistic behaviours. Parents are asked to indicate whether or not their
child shows a particular symptom. Language items not suitable for non-verbal
children can be omitted. Scores are out of a total of 39 or 32 depending on
a child’s language level, with higher scores indicating more severe symptoms.
Cutoffs have been developed for identifying children with probable autism
(22) and all ASD (15) (see Berument et al., 1999, for details).
Data on symptoms and developmental abilities were also collected
using the Autism Treatment Evaluation Checklist (ATEC: Rimland and
Edelson, 1999). Rimland and Edelson describe the ATEC as an instrument
for ‘measuring gradations of improvement’ within treatment trials. It has
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four subscales: speech, language and communication; sociability; sensory
and cognitive awareness; and health, physical and behaviour. For the first
three subscales each item is scored ‘Not very true’, ‘Somewhat true’ and
‘Very true’. These are scored 0/1/2 so that lower developmental ability and
higher severity of autistic and other behavioural problems score 2. For the
health, physical and behaviour subscale each item is scored ‘Not a problem’
(0), ‘Minor problem’ (1), ‘Moderate problem’ (2) and ‘Serious problem’
(3). The subscales have different numbers of items and the ceilings are:
speech, language and communication 28; sociability 40; sensory and cog-
nitive awareness 36; and health, physical and behaviour 75. On all subscales
higher scores indicate more severe symptoms or lower developmental level.
Whilst no data have been published in the peer review literature, Rimland
and Edelson cite some ‘norms’ for children with autism on a website:
www.autism.com/ari. As details of the samples on whom the ATEC has
been used are not available, raw subscale scores were used in the present
analysis.

Results
Given the number of comparisons conducted, to minimize type I errors
alpha was set at p = 0.01.

Cross-sectional data
On entry into school the children (cohorts 1 and 2 combined, N = 125)
had a mean age of 56.7 months (SD = 8.4 months, range = 37 to 75
months). Developmental level (age equivalent in months) as measured by
the VABS–S is shown in Table 1. Paired t-tests indicated that scores on the
daily living skills domain were greater than on the socialization domain
(t = 2.73, d.f. = 124, p < 0.01). Scores on the motor skills domain were
greater than on the communication (t = 7.91, d.f. = 122, p < 0.001), daily
living skills (t = 8.94, d.f. = 122, p < 0.001) and socialization domains (t =
8.76, d.f. = 122, p < 0.001). On the adaptive behaviour composite (ABC)
score of the VABS–S (equivalent to a measure of overall DQ) 38 percent of
the sample had a score below 50, 58 percent between 50 and 69 and only
4 percent 70 or above.
Scores on the SCQ and ATEC are also shown in Table 1. On the SCQ 108
children (86.4 percent) were above the cutoff for ASD (15) and 49 (39.2
percent) of these were above the cutoff for childhood autism (22)
(Berument et al., 1999). Scores on the different ATEC subscales were not
compared with each other as they are not on the same metric and are not
standardized or age-equivalent scores.
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Table 1 Scores on the VABS–S, SCQ and ATEC on entry into nursery/school
for cohorts 1 and 2 combined

N = 125 Mean SD Range

Chronological age 56.7 8.4 37 to 75

VABS–S (age equivalent in months)

Communication domain 22.2 10.3 12 to 52
Daily living skills domain 22.2 8.2 10 to 57
Socialization domain 20.3 7.8 12 to 58
Motor skills domaina 30.1 11.1 10 to 72
Adaptive behaviour composite (standard score) 52.6 9.3 34 to 83

SCQ (raw score) 20.7 5.8 6 to 37

ATEC (raw score)

Social/language/communication (out of 28) 17.4 5.9 5 to 28
Sociability (out of 40)b 17.6 7.8 2 to 39
Sensory/cognitive awareness (out of 36) 19.6 6.2 1 to 34
Health/physical/behaviour (out of 75)b 26.3 13.5 2 to 63
aN = 123 (two children ≥ 72 months of age, motor domain not scored).
bN = 124 (one form incomplete).

Longitudinal data
Among the 57 children who were assessed on both occasions, the mean
age at time 2 was 67.7 months (SD = 8.8 months, range = 47 to 83
months). The time interval between the two occasions was 11.1 months
(SD = 1.5 months). The scores at time 1 and time 2 and the change scores
on the VABS–S are shown in Table 2. Paired t-tests indicated that age equiv-
alents at time 2 were higher than at time 1 for communication (t = 6.5,
d.f. = 56, p < 0.001), daily living skills (t = 7.1, d.f. = 56, p < 0.001),
socialization (t = 5.7, d.f. = 56, p < 0.001) and motor skills (t = 5.1, d.f.
= 33, p < 0.001). Paired t-tests did not show a significant difference in the
adaptive behaviour composite score from time 1 to time 2.
Scores on the SCQ and ATEC are also shown in Table 2. A paired t-test
indicated that SCQ scores did not differ from time 1 to time 2. On the ATEC,
paired t-tests indicated that scores on the social, language and communi-
cation subscale were lower at time 2 than time 1 (indicating milder
symptoms and/or better developmental skills) (t = 6.9, d.f. = 56, p <
0.001). Scores did not differ significantly on the ATEC sociability, sensory
and cognitive awareness and health, physical and behaviour subscales
between time 1 and time 2.
In order to identify whether the initial characteristics of age, develop-
mental level (VABS–S age-equivalent domain scores) and symptom severity
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Table 2 The scores at time 1, time 2 and the change scores on the VABS–S,
SCQ and ATEC for cohort 1

N = 57 Time 1 Time 2 Change score

Mean (SD) Mean (SD) Mean (SD)

Chronological age 56.6 (8.6) 67.7 (8.8) 11.1 (1.4)

VABS–S (age equivalent in months)

Communication domain 23.5 (11.2) 33.9 (19.5) 10.3 (12.0)
Daily living skills domain 21.8 (6.8) 30.7 (13.2) 8.9 (9.5)
Socialization domain 17.5 (6.6) 28.7 (15.7) 9.2 (12.2)
Motor skills domain 28.2 (9.2)a 33.8 (11.5)b 5.5 (6.3)c
Adaptive behaviour composite (standard score) 53.5 (9.5) 54.2 (12.2) 0.6 (9.1)

SCQ (raw score) 19.8 (6.2) 19.5 (6.0) –0.3 (4.0)

ATEC (raw score)

Social/language/communication 17.0 (6.0) 13.5 (6.2) –3.5 (3.8)
Sociabilityd 15.4 (7.0) 14.2 (6.6) –1.2 (5.0)
Sensory/cognitive awareness 19.0 (6.0) 17.0 (6.0) –2.0 (4.7)
Health/physical/behaviourd 25.4 (11.8) 24.3 (11.7) –1.2 (7.8)
aN = 56 (one child ≥ 72 months of age at time 1).
bN = 41 (16 children ≥ 72 months of age at time 2).
c N = 40 (17 children ≥ 72 months of age at time 1 and time 2).
d N = 56 (one form incomplete at time 1).

(SCQ score) at time 1 were associated with positive change, a series of

planned hierarchical multiple regression analyses with change scores (time
2 score minus time 1 score) on each measure as the dependent variable
were conducted. To control for autocorrelation effects, for each regression
analysis the initial score on each measure was entered at step 1, and the
remaining time 1 scores were entered at step 2.
For the SCQ change score, step 1 (SCQ time 1 score) was significant
(R2 = 0.15, F(1, 54) = 9.52, p < 0.01). Step 2 (time 1 age, VABS–S motor
skills, communication, daily living skills and socialization domain age-
equivalent scores) was not significant (R2 change = 0.14, F change (5, 49)
= 1.89, p = n.s.). With all time 1 variables entered, only initial SCQ score
predicted SCQ change score (beta = –0.44, t = –2.87, p < 0.01).
For the VABS–S communication domain age-equivalent change score,
step 1 (time 1 communication domain score) was significant (R2 = 0.16,
F(1, 54) = 10.52, p < 0.01). Step 2 (time 1 age, SCQ score, VABS–S motor
skills, daily living skills and socialization domain scores) was not signifi-
cant (R2 change = 0.21, F change (5, 49) = 3.33, p = n.s.). With all time
1 variables entered, no variables predicted communication domain change
score.
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For the VABS–S daily living skills domain change score, step 1 (time 1
daily living skills score) was significant (R2 = 0.15, F(1, 54) = 9.52, p <
0.01). Step 2 (time 1 age, SCQ score, VABS–S motor skills, communication
and socialization domain scores) was not significant (R2 change = 0.20, F
change (5, 49) = 2.81, p = n.s.). With all time 1 variables entered, only
initial communication domain score predicted daily living skills domain
change score (beta = –0.42, t = 2.68, p = 0.01).
For the VABS–S socialization domain change score, step 1 (time 1
socialization score) was not significant (R2 = 0.11, F(1, 54) = 6.82, p =
n.s.). Step 2 (time 1 age, SCQ score, VABS–S motor skills, communication
and daily living skills domain scores) was significant (R2 change = 0.36, F
change (5, 49) = 6.79, p < 0.001). With all time 1 variables entered, both
initial VABS–S communication domain score (beta = 0.59, t = 4.35, p <
0.001) and initial SCQ score (beta = –0.50, t = –3.83, p < 0.001) pre-
dicted socialization domain change score.
Lastly, for the VABS–S motor skills domain change score, step 1 (time
1 motor skills score) was not significant (R2 = 0.00, F(1, 54) = 0.12, p =
n.s.). Step 2 (time 1 age, SCQ score, VABS–S communication, daily living
skills and socialization domain scores) was not significant (R2 change =
0.09, F change (5, 49) = 0.56, p = n.s.). With all time 1 variables entered,
no variables predicted motor skills domain change score.

Discussion
As expected for a sample of children with autism spectrum disorders, the
mean age-equivalent scores on the VABS–S domains were all considerably
below the sample’s chronological age, and only a small minority had
adaptive scores in the normal range. The VABS–S age-equivalent scores for
the total sample at school entry showed a similar pattern to that found in
previous studies of young school-age children (Harris et al., 1995; Stone
et al., 1999). Thus, age-equivalent scores were lowest in the socialization
domain, greatest in the motor skills domain and intermediate in the com-
munication and daily living skills domains. On total adaptive behaviour
composite score only 4 percent of children had a DQ in the typical range
(> 70). However, it is important to note that in children of this age, basal
effects mean that the ABC standard score needs to be viewed with caution,
and age-equivalent scores are considered the most appropriate measures of
developmental level (Carter et al., 1998). On the SCQ the majority of the
sample scored above the cutoff for probable ASD (Berument et al., 1999),
broadly confirming that the children in the sample had an ASD, as indicated
by their specialist placement and parent report.
The critical test of whether the measures might be useful for
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monitoring progress of children with ASD in school is provided by the
longitudinal data collected on a subsample of the cohort. The VABS–S age-
equivalent domain scores show clear evidence of developmental progress
from time 1 to time 2. In 11 calendar months the sample gained 10 age-
equivalent months in communication skills and 9 age-equivalent months
in both daily living and socialization skills. The apparently lower gain in
motor skills is an artefact since the screener version of the VABS does not
include any motor items for subjects over 6 years of age (because they are
not used in the calculation of the ABC in children over 6). In terms of the
relative rate of progress analysis performed on similar data from the survey
version of the VABS by Harris et al. (1995), the group as a whole made
more rapid development progress in the 11 months in school than they had
preschool. Whether this encouraging rate of progress subsequently con-
tinues or slows down as found by Harris et al. (1995) will require longer-
term follow-up of the sample. The fact that despite this promising
developmental progress there was no change over time in the ABC com-
posite standard score reflects basal (or floor) effects of the scale, reinforc-
ing the view that age-equivalent scores are the most appropriate measures
of developmental level in young children (Carter et al., 1998). In contrast,
there was no change over time in symptom severity as measured by the
SCQ. This suggests that there was relative stability of autistic symptoms
between the fourth and fifth year of life, and that these were not signifi-
cantly affected by the educational programmes the children attended.
However, it might be that the gains in social and communication develop-
ment indicated by the change in VABS–S scores will have a secondary,
beneficial effect on symptomatology over a longer time course. This will
be an important aim of a further follow-up study.
The pattern of change on the ATEC was mixed. On the social, language
and communication subscale the scores did significantly reduce over time,
but on the sociability and health, sensory and cognitive awareness, physical
and behaviour subscales there was no change. This in part reflects the
content of the ATEC subscales which include both developmental and
symptom severity items, making it a less useful measure in monitoring
progress than the VABS–S.
In terms of the characteristics that were associated with change scores
across time, initial symptom severity was negatively associated with SCQ
change score, although this is probably due to instrument effects and
regression to the mean. In terms of improvement in developmental
abilities, as measured by VABS–S age-equivalent change scores, initial com-
munication level and lower symptom severity predicted positive change in
socialization abilities and initial communication level also predicted
positive change in daily living abilities. Thus, the best developmental
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progress was made by children with better communication skills at the
outset. There are very limited data on the initial characteristics of children
with ASD that are associated with positive outcomes in different inter-
vention and education programmes. Note, though, that several studies
suggest initial IQ is an important predictor of outcome (Fenske et al., 1985;
Harris and Handleman, 2000). Should further evidence of specific associ-
ations emerge over time, then the mechanisms of such associations will
require testing in more focused, comparative intervention studies.
There are a number of limitations to the present study. Whilst the
screener version of the VABS has been shown to correlate well with the
survey edition when used as an interview measure (Sparrow, 2000), its use
as a questionnaire has not been validated. The fact that similar profiles of
scores were found to those in previous studies of 3- and 4-year-old children
with ASD in both school-recruited (Harris et al., 1995) and clinic-recruited
(Stone et al., 1999) samples gives us some confidence in the present data.
However, validation of its use as a parent report questionnaire requires con-
firmation. The response rate of approximately 40 percent is also a limi-
tation, and it is not known how the sample on whom data were obtained
compared with the total eligible sample. The low response rate might also
place a limit on questionnaire methodology as a procedure for acquiring
service-wide or school-wide monitoring information. However, the
present data were gathered by an independent research team and response
rates would be expected to be better when the data gathering was con-
ducted within the school system itself.
This pilot study has demonstrated that it is possible to collect system-
atic monitoring data on a large cohort of young school-age children via the
use of parent questionnaires. Such a method would allow individual
schools or groups of schools to collect data on the developmental progress
of children with autism spectrum conditions. The results could be used to
set and monitor individual education plan targets for individual children
or to compare the relative progress of children within different types of
specialist and mainstream facilities. In order to develop and maintain such
monitoring systems, schools (or independent monitoring agencies) would
need access to minimal funds (postage and photocopying costs, data entry)
and very basic training or advice in the use of data management packages
and statistics. Such low-cost information could also provide background
data for many types of specific hypothesis-driven research questions related
to the education for young school-age children with ASD. Currently, the
research basis of early education of children with ASD is inadequate in
many ways (Howlin, 1998; Jordan et al., 1998; National Research Council,
2001). Systematic data on the developmental progress of a large cohort of
children with ASD will provide a useful comparison against which to judge
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claims regarding the effectiveness of particular programmes. With increas-
ing numbers of children with diagnoses of ASDs entering the school system
(Croen et al., 2002; Department for Education and Skills, 2002) a diversity
of methodologies will need to be employed in order to build an evidence
base, and the collection of data via parent report questionnaires can form
one important part of this enterprise.

Acknowledgements
The authors are grateful to the parents who participated in this research and
to the many staff at schools and units who facilitated the process. The
authors would like to thank Sara S. Sparrow for permission to use the
VABS–S. The research was funded by the Inge Wakehurst Trust. Research at
the Institute of Child Health and Great Ormond Street Hospital for Children
NHS Trust benefits from R&D funding received from the NHS Executive.

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