# Evidence-based assessment/Instruments/Autism Treatment Evaluation Checklist

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The Autism Treatment Evaluation Scale (ATEC) is a 77-item diagnostic assessment tool that was developed by Bernard Rimland and Stephen Edelson at the Autism Research Institute. The ATEC was originally designed to evaluate the effectiveness of autism treatments, but it may also be beneficial as a screening tool for children. The questionnaire, which is designed to be completed by parents, teachers, or others who see the individual's behavior on a regular basis, takes about 10–15 minutes to finish and is designed for use with children ages 5–12.

## Psychometrics
### Reliability

Evaluation for norms and reliability for the Autism Treatment Evaluation Checklist :
| Criterion | Rating (adequate, good, excellent, too good) | Explanation with references |
| Norms | Adequate | One study reports the norms for the longitudinal changes of ATEC scores |
| Internal consistency | Excellent | Cronbach's alphas of 0.91; r = -0.94 |
| Inter-rater reliability | Not applicable | Designed to be completed by caregivers instead of trained technicians. |
| Test-retest reliability | Excellent | r > 0.9 for all subscales and the total score |

### Validity

Evaluation of validity and utility for the Autism Treatment Evaluation Checklist :
| Criterion | Rating (adequate, good, excellent, too good) | Explanation with references |
| Content validity | Good | Covers areas of communication, sociability, sensory and cognitive awareness, and health and physical behavior |
| Construct validity | Good | Shows convergent validity with Childhood Autism Rating Scale (Pearson correlation coefficient = 0.71, p < .0001) |
| Treatment sensitivity | Good | Multiple studies used ATEC to measure treatment effects and progress over time in ASD |
| Clinical utility | Adequate | Quick and easy implementation and interpretation; limited evidence of norms, reliability, and validity; can't be used for ASD diagnosis |

## Scoring and interpretation
### Item breakdown

Questions are divided into four sub-scales based on content.
* Section 1: speech/language and communication
* Section 2: sociability
* Section 3: sensory and cognitive awareness
* Section 4: physical/health behavior

### Scoring

For Sections 1-3, parents are asked to read the statement in each item and indicate whether it is "not true/descriptive," "somewhat true/descriptive," or "very true/descriptive" of their child. Section 4 asks parents to indicate whether the statements describe something that is "not a problem," a "minor problem," a "moderate problem," or a "serious problem" for their child.
Total scores on the ATEC range from 0-180 and are calculated by summing the scores of each subscale. In general, a higher score indicates a greater degree of impairment from symptoms. Responses to each question are assigned a numeric value, and then added together.
* In sections 1-3, an answer of "not true/descriptive" receives 0 points, an answer of "somewhat true/descriptive" receives 1 point, and an answer of "very true/descriptive" receives 2 points.
* In section 4, an answer of "not a problem" receives 0 points, an answer of a "minor problem" receives 1 point, an answer of a "moderate problem" receives 2 points, and an answer of a "serious problem" receives 3 points.

### Cutoffs and interpretation

Both subscale scores and total scores can be used to calculate a percentile of severity that the participant falls under, relative to score distributions provided by the Autism Research Institute. The following criteria for interpreting scores of the ATEC are as follows:
* Total scores of less than 30- Indicate that the child possesses somewhat normal behavior patterns and communication skills and has a high chance of leading a normal and independent life.
* Total scores of less than 50- Indicate that the child will most likely be able to lead a semi-independent life without needing to be placed in a formal care facility.
* Total scores of 104 or higher- Indicate that the child would fall into the 90th percentile and would be considered severely autistic. He or she will likely need continuous care, perhaps at an institution, and may be unable to achieve any degree of independence from others.
Additional research on the ATEC identifies the various cutoffs and percentiles for subscale and total scores.

## External Links

* Society of Clinical Child and Adolescent Psychology
* EffectiveChildTherapy.Org information on autism spectrum disorder