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A Case Study on Strengthening the Link Between Psychometrics,

Assessment, and Intervention in Autism Spectrum Disorder
(ASD)

Chapter · January 2020

DOI: 10.4018/978-1-7998-1431-3.ch008

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Chapter 8
A Case Study on Strengthening
the Link Between
Psychometrics, Assessment,
and Intervention in Autism
Spectrum Disorder (ASD)
Luis Anunciação
https://orcid.org/0000-0001-5303-5782
Federal University of Rio de Janeiro, Brazil

Anna Carolina Portugal

IBNeuro, Brazil

ABSTRACT
A comprehensive childhood evaluation is a fundamental feature of rehabilitation.
This process relies on the collection of quality data including that obtained from
psychometric instruments, such as tests and scales, family interviews, and natural
observations. Therefore, an evidence-based assessment counts on the interface of
using psychometrically valid and reliable instruments, in addition to understanding
data gathered from other sources of information. This chapter provides an overview
of the key features of psychometric testing applied to childhood assessment. A case
study is presented to link the psychometric instruments and its clinical utility within
the assessment framework. To better accomplish this goal, this chapter is split into
three sections: i. key features of psychometrics and its tools; ii. Autism Spectrum
Disorder (ASD); iii. a case study to link both topics.

DOI: 10.4018/978-1-7998-1431-3.ch008

Copyright © 2020, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.
A Case Study on Strengthening the Link Between Psychometrics, Assessment, and Intervention

A CASE STUDY TO STRENGTHENING THE LINK

BETWEEN PSYCHOMETRICS, ASSESSMENT AND
INTERVENTION IN AUTISM SPECTRUM DISORDER (ASD)

There is rapid growth in the number of psychologists worldwide as can be seen by

social and academic markers. Psychology themes are popular in movies, on television,
and in books. An estimated of more than one hundred thousand psychologists possess
current licenses at the doctoral level in the United States (APA, 2014). In Brazil,
more than three hundred thousand people have a Bachelor’s Degree in Psychology,
which is the minimum required for becoming certified by the Federal Council
(Anunciação, Mograbi, & Landeira-Fernandez, 2019).
Despite the increase in the number of psychologists, Psychology as a science
is facing challenges and difficulty in its field, especially in the area of the applied
measurement. Outside of academia, the lack of knowledge even on the existence
of psychological standardized measures prevents the general public from receiving
benefits from psychological science in general, and cognitive neuroscience in
particular (Castelnuovo, 2017). Inside the academic field, a long history of loyal
skeptics of quantitative psychology still diminish the importance of psychometrics,
thereby weakening (or just dissolving) the link between all subfields within
psychology, including those who link the work such as clinicians, therapists, and
neuropsychologists (Osborne, 2010).
With special regard to professionals working as clinicians, even the ones engaged
with neuropsychological assessment, there is a persistent myth which states that work
from clinical professionals (mainly in the field of Clinical and Health Psychology) and
psychometricians are not interchangeable. Within this perspective, psychometricians
are only concerned with the statistical and mathematical modeling of the wide range
of psychological phenomena with little to no relationship to pragmatic and clinical
decisions. On the other hand, the heavy interest of clinical practitioners relies on
the diagnosis and treatment evaluation of individual patients.
This vision also supports that psychometricians would be responsible for
developing standardized measures and tools, and in turn neuropsychologists and other
clinicians would be responsible for applying these instruments in clinical practice
and using the obtained data to support their decisions. However, as the results of
different methods within neuropsychological assessment typically differ, and both
works seem to be very different to reconcile, with parts arguing that clinical work is
sovereign and is too often stated for those from whom this distinction is adequate.
So much so that the historical approach brings the term “clinimetrics” in contrast
to “psychometrics” (Streiner, 2003).
In fact, this distinction, and therefore this perspective, is widely incorrect. It
agrees with a simplistic all or nothing approach to science; and it assumes that if one

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procedure (i.e. a specific psychological test) gives a different conclusion than another
procedure (i.e. a clinical observation), the choice of the most adequate conclusion
will throw away the other procedure as if it were unnecessary. Finally, this division
simply ignores that all measures (including the psychological measure) have some
random error and introduces a mix between a true score in addition to an error.
Science is about integrating methods. Actually, what is really recommended is
that clinical professionals must recognize all procedures as being jointly related,
use the available procedures which can bring important information to deal with
their aims, and weigh every result congruently to its capacity of access and to
extract information on the phenomena of interest. When professionals integrate
all the information, the accuracy of its evaluation increases and all the procedures
which emerge after the evaluation are more justifiable (Lezak, Howieson, Bigler,
& Tranel, 2012).
With that being said, a childhood evaluation must be conducted by implementing
a comprehensive and integrative approach. This process relies on collecting quality
data, including those obtained from psychometric instruments, such as tests and scales,
family interviews, natural observations and consultations with the multidisciplinary
team. Therefore, an evidence-based assessment counts on the interface of using
psychometrically valid and reliable instruments, in addition to understanding data
gathered from other information sources.
The evaluation process must vary in the daily life of a clinical neuropsychologist
in accordance with the severity of the condition and the access to the information
sources. The child’s ability and the nature and extent of his or her needs will determine
whether the evaluation will emphasize information obtained by interviews, tests,
observations, or other sources which can provide better information about the patient
(Harvey, 2012).
This can be noted in a situation in which one needs to evaluate a non-verbal
child. Since it would not be possible to use typical measures, family interviews and
different types of naturalistic observations (at school and in the private practice)
could provide the clinicians with more relevant and realistic data. Thus, the intense
interface between psychometrics and neuropsychology evaluation becomes clear,
mainly when neuropsychological tests are used to gather information on the clients
being assessed. Despite the different theoretical background or the historical
development of the both disciplines, the results obtained by psychometric assessment
can be used to improve the comprehension of the child’s neuropsychological profile,
as well as helping a clinical diagnosis when necessary.
Overall, the results obtained from this process can be of considerable value and
can be used to enlighten the professionals’ network involved in this framework.
Besides the diagnosis, the results could aid the decision-making process. More
importantly, this process helps professionals to determine the most appropriate

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intervention for the child and to follow-up with each child according to his or her
results. Consequently, the better the assessment, the better the intervention.
It is very important that the evaluation process helps the intervention through
recommendations. As a professional join information from tests and other sources,
they become capable to evaluate what are the major changes the client needs. An
example is a child who was referred for evaluation because of difficulty learning
and low grades. The evaluation process can measure and investigate functions such
as memory, intelligence, attention and executive functions. If the neuropsychologist
observes that a change in the test content at school or a reader is necessary after
the evaluation process, the professional can discuss with the school to see if it is
possible to implement these changes.
That being said, this chapter will provide an overview of the key features of
psychometric testing applied to childhood assessment, and a case study will be
presented in order to link the psychometric instruments and its clinical utility within
the assessment framework. To better accomplish this goal, the content will be split
into the following four sections: (i) key features of psychometrics and its tools; (ii)
frequently used screening tests for developmental delays; (iii) Autism Spectrum
Disorder (ASD); and (iv) a case study to link both topics. For the sake of clarity,
as the authors of this chapter work in Brazil, some aspects of neuropsychological
assessment must be contextualized within this country. While this aspect might be
a limitation to generalize some recommendations in developed countries, low‐ and
middle‐income countries can benefit from this chapter.

Psychometrics Basic Toolbox: The Broad Concept of Validity

Validity is the most important feature of psychological testing (AERA, APA, &
NCME, 2014). Despite its relevance, at least three different forms to understand
and define validity are available in the literature, and the debate is still ongoing
(Anunciação, 2018; Borsboom, Mellenbergh, & van Heerden, 2004). The first
one is also the most traditional, and therefore the odds of finding this definition in
technical books are higher when compared to the others. Validity was thought of as
a test feature during the period between 1920 and 1950. It was the degree to which
a test measures what it purports (proposes) to measure. As Kelley said in 1927 (p.
14), “A test is valid if it measures what it purports to measure”. This can be partially
explained by its historical contextualization: the field of psychological testing was
already composed from some tools and the correlation formula developed in 1896
had its use spread among psychologists. Despite the implicit notion that comes
with the word “whether”, validity was seen (and used) as a discrete all or nothing
characteristic.

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The second definition came to be with the Cronbach and Meehl definition of
construct validity in 1955. This concept was assigned a few years later as part of a
tripod along with content and criterion validity. This historical period has deeper
importance within the psychometric field in general, and specifically in testing. With
Cronbach and Meehl, validity shifted from a test feature to interpreting the test scores
in relation to the nomological network described by the authors (Sijtsma, 2013).
More recently, it seems that the most updated view of validity came from Messick.
This later approach clarifies that validity is a matter of degree instead of a discrete
result (i.e. not all or none), that validity is an essentially unitary concept, and its
concept varies with respect to specific testing purposes. As this view was chosen by
the American Psychological Association (APA), American Educational Research
Association (AERA), and the National Council on Measurement in Education
(NCME), it is not difficult to conclude that this definition distances itself from the
previous one, and that the concept of validity is the most fundamental consideration
to test developers and test users (AERA et al., 2014).
As validity is not a property of a test, but of its use attached to a specific purpose
for which it is being used (Sijtsma, 2013), multiple sources of evidence are deemed
necessary when one aims to start a validation or adaptation process of a psychometric
test. Image 1 presents this contemporary view of validity.
There are many ways to classify these sources, and the one presented in this
chapter recognizes the unitary conceptualization of validity, but it also tries to
organize each source in relation to a broader aspect that hangs between technical-
or/and social- framework.
From this point of view, studies of the validity related to test content, its internal
structure, and the response processes associated with answering test items are more
related to technical issues, and therefore are more dependent on psychometric and
statistical studies. Classical concepts, such as factorial validity and Content validity
index are related to these studies. In contrast, testing consequences have a high

Figure 1. Sources of validity evidence (The validity framework)

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interface with social uses of the test, and therefore it is herein considered as being
more social-related. The implementation of large-scale performance assessments
in the 1990’s is an example of the consequences of testing (Lane, 2014).
Relations to other variables are located in the middle of the framework, and can
be either seen as social, clinical, and technical-related. They tend to be more social-
related when the relationship includes external variables (i.e. fail or pass in a specific
course or job selection process), and moves toward a more clinical perspective
when one needs a test score to classify clients/users of a healthcare system, while
the technical perspective emerges when another psychological measure is used to
evaluate the same constructs.
Even though psychometrics and psychological and neuropsychological testing
are different fields and subject to different procedures, there is a solid relationship
between the areas. If one wants to use a test result to draw valid inferences, a test
must have certain features in order to produce accurate results, and these results
must be meaningful in some way. The core business of psychometrics is to deal
with these requirements.
A raw score obtained by testing is meaningless in the absence of a frame of
reference (Urbina, 2014). This frame is traditionally developed by clinicians within
the field of psychological assessment, as well by the professionals working with
neuropsychological assessment. If the nomenclature used by the two fields is not
strictly related to each other, the raw score is seen thorough the lens of criterion and/
or norms/ references when it is related to psychological assessment, and it is seen
in neuropsychology by the interface between the terms nomothetic and idiographic
which are often used in the neuropsychological environment.
Because the origins of the term idiographic have an inner relationship with
understanding some particular event in nature or in society, in an almost opposing
condition of the scientific drive to explore and find regular laws (Luthans & Davis,
1982), some authors have chosen the term “client-referenced” or “individual-based”
to clarify that the expression usage comes with a scientific approach (Haynes, 1998).
Regarding its use, the within-group norms are the most prevalent (Urbina, 2014).
Despite the possibility to converge one measure into another, Z-scores, T-Scores,
and Deviation IQ scores are mathematically computed and referenced to standard
scores (with a defined mean and standard deviation). Percentile, Stanine, and Sten
are obtained from cumulative percentages of the distribution of the raw scores (Le,
2009, p. 65). Whereas the first class of measures provide a comparison between
a result with the group mean, the second class locate the raw score obtained by a
participant to compute the percentage of persons in the reference group “who scored
at or below a given raw score” (Urbina, 2014, p. 91).
The nomothetic approach in neuropsychological assessments has its identity
virtually equal to the within-group characterizations expressed above. However,

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because the Client-Referenced approach focuses on an individual client, it fends off

this framework and adopts strategies similar to the single-case design, which can
be the subject-as-own-control, time-series or repeated measures. Therefore, despite
the central distinction between nomothetic and idiographic approach in research in
general, the use of statistical methods in neuropsychological assessment helps to
dissolve this distance and link the two-broad assessment perspectives.
Image 2 below displays a theoretical diagram in which both frames of reference
are shown. Some of the typical statistical tests used within each framework are also
listed for better understanding (Feeney et al., 2016).
That said, a psychological or neuropsychological test should have features
which enable interpreting its results. Without this guaranteed, the results could
be misleading, and consequently its usage should be avoided. As seen, the intense
interface between psychometrics, statistics and broad clinical questions not only link
all fields within psychology and neuropsychology, but can be tough as two different
perspectives from the same object.

Screening Tests Frequently Used for Developmental Delays

There are many broad developmental screening tools that may have a role in the early
identification process. Therefore, the following table reports a list of psychometric
tools that can be useful to help in evaluating ASD, as well as other developmental
delays. As mentioned earlier, this list was created within the Brazilian context.

Figure 2. Frame of Reference from psychological and neuropsychological perspectives

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As already mentioned, the goal of this chapter is to provide an overview of the

key features of psychometric testing applied to childhood assessment. Therefore,
the next section will explain more about the neurodevelopmental disorders.

Autism Spectrum Disorder: A Neurodevelopmental Disorder

Neurodevelopmental disorders are a group of conditions which begin in the

developmental period. One of their main features is that the deficits produce

Table 1. Frequently used instruments as screening tests for developmental delays

Instrument Age range Original study Brazilian study

(Anunciação,
(Squires, Bricker,
Ages & Stages Questionnaires®: Social- Squires, Clifford, &
6 to 60 months Heo, & Twombly,
Emotional (ASQ:SE) Landeira-Fernandez,
2001)
2019)
The ASQ:SE is comprised of a series of age-related questionnaires that assess seven related behavioral areas
(e.g., self-regulation, compliance, communication, adaptive functioning, autonomy, affective functioning, and
interaction with others). Each questionnaire is composed of a set of items scored on a 3-point Likert scale,
scored 0 (most of the time), 5 (sometimes), or 10 (never or rarely) points based on the frequency that parents
or caregivers indicate the child performs a behavior. Cut-off scores indicating a child is at risk of social–
emotional developmental problems are provided based on the age of the child at assessment. The higher the
score, the greater the concern for development.
(Schopler,
(Pereira, Riesgo, &
Childhood Autism Rating Scale (CARS) 15 to 60 months Reichler, &
Wagner, 2008)
Renner, 1988)
The CARS consists of 14 domains assessing behaviors associated with autism, with a 15th domain rating
general impressions of autism. The 14 domains are related to imitating people, emotional response, body,
object use, adaptation to change, visual response, listening response taste-smell-touch response and us,
fear and nervousness, verbal communication, non-verbal communication, activity level and consistency of
intellectual response. Its scores range from 15 to 60, and the suggested cut-off point for having more autistic
traits than occur in the typical population is a score of 30 or above. The scale allows differentiating autism
from the other developmental delay disorders, and differentiating the level of ASD traits.
Modified Checklist for Autism in (Robins et al., (Losapio & Pondé,
16-30 months
Toddlers (M-CHAT) 2001) 2008)
The M-CHAT is a screening tool (yes/no - parent report) for autism that contains 23 items and may be used
in children from 16-30 months. Some studies have used an upper age limit of 36 months. The completed
forms are scored and the child is considered to have failed the initial screening if he/she fails any three of the
23 items or two of the six critical items. The critical items on the M-CHAT are as follows: item 2 (interest
in other children), item 7 (proto-declarative pointing), item 9 (bringing objects to show the parent), item 13
(imitating), item 14 (responding to name), and item 15 (following a point) (Dumont‐Mathieu & Fein, 2005).
birth to 6 years (Frankenburg &
Denver II Ana Llonch Sabatés
of age Dodds, 1967)
The Denver II is a screening tool designed to detect developmental delays in infants and preschoolers. It tests
four functions (and its milestones): gross motor, language, fine motor-adaptive, and personal-social.
Some items are tasks that a professional performs with the child, and other items are questions that are asked
to family or caregivers. The Denver II is neither an intelligence test nor a diagnostic test.

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impairments in personal, social, academic and/or occupational functioning. Some

examples of neurodevelopmental disorders are Attention Deficit Hyperactivity
Disorder (ADHD), Intellectual disability (ID) and Autism Spectrum Disorder (ASD).
This chapter will focus on ASD. This disorder has two main aspects which must
be taken into consideration in the neuropsychological assessment. The first one is
a persistent deficit in social communication and social interaction, and the other
is the presence of restricted, repetitive patterns of behavior, interests or activities
(APA, 2013).
The most important aspect to understand about this disorder is to pay attention
to the name: Autism Spectrum Disorder. It is a spectrum, which means that some
people with this disorder will have fewer symptoms, and others will have more, both
in number and/or frequency. More specifically, the Diagnostic and Statistical Manual
of Mental Disorders (DSM –5) points to some criteria which must be present in the
ASD. As stated above, there must be a persistent deficit in social communication
and social interaction. It is very important to understand that these deficits must
appear in multiple contexts.
Regarding this first criterion, the DSM–5 includes deficits in social-emotional
reciprocity; reduced sharing of interests, emotions or affect; deficits in non-verbal
communicative behaviors used for social interaction, and deficits in developing,
maintaining and understanding relationships.
There are two important myths associated with this criterion and they need to be
deconstructed. The first one is that people in the ASD do not make eye contact, while
the second myth concerns conversation. These statements are not true. What really
happens is that they can make eye contact and can start or maintain a conversation,
but not in an adaptive manner or not as frequent as expected.
The second criterion is about restricted and repetitive behavior patterns, which
include: stereotyped or repetitive motor movements, use of objects or speech;
insistence on sameness, inflexible adherence to routines, or ritualizing patterns of
verbal or non-verbal behavior; highly restricted, fixated interests which are abnormal
in intensity or locus and hyper; or hyperactivity to sensory input or unusual interest
in sensory aspects of the environment.
There are also two myths for this criterion; the first is about touching, and the
second is about music and sounds. It is not true that people in the ASD do not endure
touching. Some of them really do not like it, but some can kiss, hug and touch another
person. For sounds, it is very important to understand that some people have higher
sensitivity to loud sounds, but not all of them. Indeed, they can listen to music at
high volumes and music can be an important tool to increase interaction with them.
All of the cited symptoms can be masked by compensatory strategies, and because
of this it is very important to use interview techniques in addition to psychometric
instruments, which are specific to evaluate childhood development. This aspect

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is even more important when we evaluate adults with ASD. It can become very
confusing because of developed compensatory strategies. In this sense, it is very
important to have an accurate family interview to discover if the symptoms started
in the developmental period.
In order to increase our link between the theoretical aspects of ASD, psychometric
tools and childhood assessment, the next section presents the case of E.

Autism Spectrum Disorder: A Case Study of E

As stated in the beginning, this case report occurred in a small city in southeastern
Brazil. A neuropsychological assessment is mainly performed in private practice in
Brazil, but it is not strictly regulated by any law or a privilege from mental health
clinicians. In other words, within the undergrad level, different professionals can
conduct neuropsychological assessments and it is not an atypical reality to find speech
therapist or physical educator within this area. However, the evaluation is mainly
conducted by psychologists with specific specialized training in neuropsychological
assessment. All Brazilian psychologists must be registered with their Regional
Psychology Councils, which in turn are registered with the Federal Council of
Psychology. Because of the Ethical Principles of Brazilian Psychologists, this case
report will only describe the most frequent findings, avoiding going into deeper details.
E. is a 4-year-old Brazilian boy with a clinical hypothesis of ASD. He was
referred for a neuropsychological assessment by his school and his parents. E. has
difficulty maintaining social interactions and engaging in age appropriate play with
his peers. The assessment process took 5 appointments, which can be dissected into
naturalistic observation and clinical observation. Furthermore, an interview with
neuropsychologist and standardized measures were used during this process.
The first thing that was done was an interview with his parents. This is a
cornerstone in the neuropsychological assessment, as it helps to know the child’s
history and making important questions to direct the process.
E. was born at 39 weeks and his delivery was via cesarean section. After his
birth, he was taken to the Intensive Care Unit because of respiratory problems. E.
then went home after 6 days of treatment with antibiotics.
In relation to his neurodevelopmental milestones, E. had no problems related to
his motor processes. On the other hand, his language development was delayed. He
started to say his first words at 3 years old after professional phonological intervention.
He continued with his speech-language treatment and also had psychomotor and
psychological counseling.
The naturalistic observation is a very important step in the evaluation process.
In this situation, it is possible to observe the interaction and behavior of the child
with his/her peers as well with his/her teachers. This is not possible in the private

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practice, since this is a controlled environment with minimum noise and interference,
and the professional and the child are the only people during the consultation most
of the time.
It is also very important to explain that this observation should happen before
meeting the child, when possible. Once the child knows that someone is there to
observe him/her, their behavior tends to be different.
I spoke with his educational coordinator and teacher before beginning the
observation. They reported about his difficulty to remain in the class and to interact
with his peers.
Usually, naturalistic observation happens at the school. On the specific day chosen
to make this observation, the school was going to take students to the beach. So,
this observation occurred in a different environment, but one which is very rich to
provide information about interaction. On the way to the beach, the students formed
a line and were singing and dancing, but E. was not interacting with his peers.
They stayed there for 2 hours. The first thing they did was have a snack. In that
moment, E. ate everything but he did not interact with the other children. The only
person E. called and stayed near was his teacher. In the second moment, they went
to play in the sand. E. played a lot and tried to run in the direction of the water. But
there was also no interaction with his peers in this moment.
Children commonly notice the presence of the neuropsychologist because it is
a different person in the environment they are used to. But, E. did not notice my
presence in all the time I was there, which was different from the other children
who looked and smiled at me.
Another very important aspect of the evaluation is the multidisciplinary team. Since
E. followed up with other professionals, it is critical that the neuropsychologist comes
into contact with them. Therefore, I called the clinic where he was followed-up and
went there. I was able to talk with his psychomotor and psychological counselor. She
told me that he had the same behaviors pointed out by his family and school there.
She also told that he was improving his communication and interaction with peers.
The appointments at the clinic were made with the presence of his mother or
father. He never accepted to enter the room without one of them. Sometimes E.
interacted with me, especially in moments of play. If he wanted something, he grabbed
my hand to take me to the object of interest. There was no presence of aggressive
behavior. In relation to eye contact, he would make it in very rare occasions. E. had
unintelligible speech and was not able to say phrases.
Before deciding which instruments to use, it is very important to analyze
information gathered from observation, family interviews and consultations with
other professionals. As mentioned above, E. has difficulty in verbal communication,
which makes it impossible to use language-dependent instruments. Also, he was
very young and there are not many instruments for his age range in Brazil.

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In this sense regarding psychometrics instruments, we used The Denver II

Developmental Screening Test (DENVER II), Modified Checklist for Autism in
Toddlers (M-CHAT), Childhood Autism Rating Scale (CARS) and Ages & Stages
Questionnaires: Social-Emotional (ASQ:SE). They could all be done with his family
or caregivers.
The results of the DENVER II showed that E. had not reached the main milestones
for his age, especially in the personal/social dimension (See image 3).
The Denver II provides an excellent opportunity to begin a health appraisal
because it offers a dynamic and ludic way to assess strengths and difficulties of the
child’s behavior. The activities in which a clinician must engage with the child are
standardized and linked to the child’s age (Hockenberry, M.J. & Wilson, 2009). The
examiner also checks the child’s behavior during the test to point out its presence
or absence.
The term “No opportunity” means that the child has not had a chance to demonstrate
whether or not he or she can do the item, either because the caregiver does not
allow the child to try it alone, or the child does not have the means, equipment, or
resources to do the item.
His parents answered the M-CHAT and the result showed he presented symptoms
compatible with ASD (See image 4).
As mentioned above, a risk for ASD is indicated if two (or more) critical items
are failed on the M-CHAT. These items were identified through a discriminative
factor analysis of children with and without ASD. They include behaviors concerning
joint attention (i.e. follow a point), interest in other children, responding to name,
and imitation (Robins, Fein, Barton, & Green, 2001). E. failed 4 of 6 critical items,
indicating that he was at high risk for ASD.

Figure 3. Denver-II Personal - Social development milestones for a 4-year-old

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A Case Study on Strengthening the Link Between Psychometrics, Assessment, and Intervention

Figure 4. M-CHAT results

His parents also answered the CARS and the results pointed to the presence of
ASD symptoms (See image 5).
CARS scores ranged from 15 to 60 and it was found that the views of the parents
and professional differed. Even though the parents pointed to high scores on certain
behaviors, their view of their child’s behavior was not as high as the professional
view. This phenomenon is not new in the literature and some discrepancy is expected
when evaluating a child’s behavior (De Giacomo & Fombonne, 1998).
Finally, the ASQ:SE showed that E. had unexpected and atypical behaviors
related to his social emotional development (See Image 6).
The dashed line represents the 95th percentile cut-off point. By contrast, the solid
line represents the total raw score of the child’s risk for developmental delay by the
sum of all the scores across the items. It is important to mention that the higher the

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A Case Study on Strengthening the Link Between Psychometrics, Assessment, and Intervention

Figure 5. E.’s CARS score

score, the greater the risk. E. scored higher than what was expected for his normative
group across all age ranges.
After presenting these results, it is necessary to highlight that ASQ:SE is not
a screening tool for autism, nor a diagnostic test for any developmental condition.
However, since the ASQ:SE screens for difficulties in self-regulation, compliance,
communication, adaptive behaviors, autonomy, affect, and interaction with people, it
may be an ideal adjunct to more commonly used screening tools for ASD to ensure
that we are comprehensively understanding the profiles of individual children with
ASD. Thus, the results obtained by ASQ:SE (or maybe other social-emotional
screening tools) are very informative and aid the clinician in supporting or rejecting
some previous hypothesis about the child’s functioning.

Figure 6. ASQ:SE – Comparison between E. scores and a proposed cut-off

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A Case Study on Strengthening the Link Between Psychometrics, Assessment, and Intervention

The clinical hypothesis of ASD was confirmed. It is very important to notice

that this diagnosis was based on the observation information, interview techniques
and the results of psychometrics instruments. The conclusion of the assessment is
very important in order to direct the interventions.
From these results, the neuropsychologist is able to recommend actions which
can improve the patient’s life at home, school and other places they go. In E’s case,
we suggested to maintain the psychological, speech-language and psychomotor
treatment, the presence of a mediator in his classroom and a new assessment in
one year.

CONCLUSION

Despite the increase in the number of psychologists and neuropsychologists, there

are still challenges between the public perception of the value of assessments and
clinicians’ and psychometricians’ perception. That said, this chapter aimed to
provide a link between psychometrics and clinical evaluation through a case report
of a Brazilian boy suspected of Autism Spectrum Disorder (ASD).
A brief review of psychometrics was provided to further explain the relationship
of both areas. Beyond presenting a historical perspective of its concepts, the main
aspect addressed thorough this review was to explain that the work of psychometricians
and clinicians is always related and there is no main role between the two. Both
are important.
In addition, psychological science does not exist in a vacuum, and a key feature of
developing a test is providing a frame of reference which enables (and is pragmatic)
the use of the results obtained by a standardized measure. Therefore, a list of frequently
used measures was made available with its main description to help professionals
who work with children with suspected development delay.
Autism spectrum disorder (ASD) is a neurological and developmental disorder
that begins early in childhood and lasts throughout a person’s life. This condition
can cause significant social, communication and behavioral challenges, and the
earlier the diagnosis, the more effective the treatment.
Although this chapter is focused on a specific subject but limited in its generalization
capacity, the content of this study could benefit undergraduate and graduate special
education students and rehabilitation professionals. To a lesser degree, the present
chapter serves as a brief review of the topic.

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