Diagnosing Intellectual Disability Using

the Diagnostic Adaptive Behavior Scale

Robert L. Schalock
Schalock & Associates

Marc J. Tass
The Ohio State University

Giulia Balboni
Universit di Pisa
 Bob Schalock

AAIDD Conference - June 3, 2015

 Item Characteristics
o Theta
o Item Characteristic Curve
o Item Difficulty
o Item Calibration

Standard Score

Confidence Interval

Sensitivity and Specificity

 Item Response Theory (IRT) postulates that item
characteristics are specific to the item and are
considered invariant across groups.
Theta=ability level on a latent trait (i.e. adaptive
behavior)
o Theta is essentially a z (or standard) score
o Theta metric: Mean=0; Standard Deviation=1
An item characteristics curve: X axis=theta (ability); Y
axis=probability of a correct response
Item difficulty: point along the theta at which the
probability of responding correctly=50%
Item calibration: comparable to norming in Classical
Test Theory
 The Samejima Graded Response IRT model is used
to compute the individuals Theta (i.e. ability level)
based on their responses to the DABS items.

The Theta is then converted into a standard score

metric (mean=100; SD=15).
 Confidence interval (CI) is the score-based interval
within which the individuals true score falls.

DABS: The Confidence Interval is based on +/-2

SEM around the obtained standard score (i.e. 95% CI)
o Standard Error of Measurement (SEM) is the variation around
a hypothetical true score for the person.

o A tests SEM can be estimated from the standard deviation of

the test and a measure of the tests reliability.
 Sensitivity: The percent of DABS standard scores
correctly including individuals who had a diagnosis
of ID
o DABS: 81-93%; Mean=88%

Specificity: The percent of DABS standard scores

correctly excluding individuals who do not have a
diagnosis of ID
o DABS: 89-90%; Mean=90%
 Overview of the
Diagnostic Adaptive Behavior Scale

Marc J. Tass
The Ohio State University
Nisonger Center
 Acknowledgements
CO-AUTHORS on DABS

Robert L. Schalock, PhD, Hastings College

Giulia Balboni, PhD, Universit di Pisa Italy
Henry (Hank) Bersani, PhD
Sharon A. Borthwick-Duffy, PhD, University of California Riverside
Scott Spreat, EdD, Woodland Center for Challenging Behaviors
David M. Thissen, PhD, University of North Carolina at Chapel Hill
Keith F. Widaman, PhD, University of California Riverside
Dalun Zhang, PhD, Texas A&M University

FUNDING

American Association on Intellectual and Developmental Disabilities

Administration on Intellectual and Developmental Disabilities
Construct of Adaptive Behavior

Significant deficits in one of the

three Adaptive Behavior
AAIDD Domains:
DSM-5
CONCEPTUAL
ICD-11 SOCIAL
PRACTICAL
 Construct of Adaptive Behavior
CONCEPTUAL
language, functional academics, self-direction, money management,
time concepts.
SOCIAL
interpersonal skills, responsibility, self-esteem, wariness / navet, follow
rules, etiquette, social problem solving.
PRACTICAL
activities of daily living, occupational skills, safety, healthcare, travel.
 Measuring Adaptive Behavior
For the diagnosis of intellectual disability, significant
limitations in adaptive behavior should be established
through the use of standardized measures normed on the
general population, including people with disabilities and
people without disabilities.
+ Clinical Judgment
- AAIDD 11e (Schalock et al. 2010 p. 43)

DSM-5 (American Psychiatric Association, 2013)

American Psychiatric Association (2013). Diagnostic and Statistical Manual for Mental Disorders, 5th edition. Arlington, VA: American Psychiatric
Publishing.
Schalock, R. L. et al. (2010). Intellectual disability: Definition, classification, and system of supports (11e). Washington, DC: American Association on
Intellectual and Developmental Disabilities.
 AB Scales
200 + adaptive behavior instruments (Schalock, 1999).

Normed on gen. pop. & recommended for Dx of ID

Adaptive Behavior Assessment System II
Adaptive Behavior Scales: School Edition II
Scales of Independent Behavior Revised
Vineland Adaptive Behavior Scales II
- Tass et al. (2012)
Schalock, R. L. (1999). The merging of adaptive behavior and intelligence: Implications for the field of mental retardation. In R. L.
Schalock (Ed.), Adaptive behavior and its measurement: Implications for the field of mental retardation (pp. 43-59). Washington, DC: American
Association on Mental Retardation.

Tass, M. J., Schalock, R. L., Balboni, G., Bersani, H., Borthwick-Duffy, S. A., Spreat, S., Thissen, D. T., Widaman, K. F., & Zhang, D.
(2012). The Construct of Adaptive Behavior: Its Conceptualization, Measurement, and Use in the Field of Intellectual Disability.
American Journal on Intellectual and Developmental Disabilities, 117, 291-303.
 Significant Deficits in AB
On these standardized measures, significant
limitations in adaptive behavior are operationally
defined as performance that is approximately 2
standard deviations below the mean of either: (a)
one of the following three types of adaptive
behavior: conceptual, practical, OR social, or (b) an
overall score on a standardized measure of
conceptual, practical, and social skills.

- AAIDD 11e (Schalock et al. 2010 p. 43)

Normal Curve
DABS
DIAGNOSTIC ADAPTIVE BEHAVIOR SCALE
 Features of the DABS
(Tass et al., in press)
Exclusively diagnostic focus on cut-off; 4 - 21 years old
Semi-structured interview (approx. 30 min)
Tailored to the AAIDD tri-partite definition of adaptive behavior
Short-precise assessment instrument (Total = 75 items)
No maladaptive (or problem behavior) subscale;
Expanded items related to higher order social adaptive skills
Gullibility/Navet
Avoid Victimization
Use of Item Response Theory
Scale development/item selection & Scoring

Tass, M. J., Schalock, R. L., Thissen, D., Balboni, G., Bersani, H. A., Borthwick-Duffy, S. A., Spreat, S., Widaman, K. F., Zhang, D., &
Navas, P. (under review). Development and Standardization of the Diagnostic Adaptive Behavior Scale: Application of Item Response Theory to the
Assessment of Adaptive Behavior.
 DABS Administration
o 4 21 years (person assessed)
o Semi-structured face-to-face interview
between INTERVIEW RESPONDENT
o No self-report
o Approximately 30 minutes (age forms)
o Assess actual performance of adaptive behavior ratings should be
based on respondents direct observation and knowledge of the
individual being assessed
o Ratings: 0 = no, does not do
1 = does it with reminders
2 = does it sometimes independently
3 = yes, does it
NS = No Score
 INTERVIEWER
Interviewer should be a professional
(e.g., psychologist, social worker, teacher, etc.)
who has completed at least a Bachelors degree
and has previous individual assessment
experience.
ASSESSED
PERSON
 RESPONDENT
Respondent should know the individual being
assessed very well and have had the opportunity to
observe the person on a daily or weekly basis -
respondents may be family members, friends,
teachers, co-workers, direct-support staff,
employers or other adults who meet the above
criteria.
ASSESSED
PERSON
 Rating Scale
0 No rarely or never does it.
No Ability
1 Yes does it with reminders or assistance but rarely or never
independently.
Partial Ability
2 Yes does it sometimes independently but sometimes needs
reminders or assistance.
Partial Ability +
3 Yes does it always or almost always independently never or
rarely needs reminders or assistance.
Full Ability
NS No Score. (used only exceptionally)
o Lack of opportunity due to cultural, gender, and/or geographic/regional factors
o Lack of opportunity due to environmental constraints
o Respondent has no direct knowledge of individuals typical performance

NS => SKIP => MISSING INFORMATION

 DABS: Sample Items
CONCEPTUAL SKILLS:

Arranges words alphabetically.

Reads at least 10 words.
States correct day, month and year of birth.
States value (in cents) of penny, nickel, dime & quarter.
Adapts activities to coincide with the current season or
weather conditions.
Manages own money.
Makes a list (e.g., things to do, things to buy).
Sets a clock or watch to the correct time.
 DABS: Sample Items
SOCIAL SKILLS:
Asks for help when needed.
Says hello or hi and good-bye or bye when
coming and going.
Stands a comfortable distance from others during
conversations, as appropriate for culture.
Discusses differences of opinion.
Follows rules and regulations when playing games
(e.g., board games, sports, etc.).
Shows emotions/feelings appropriately.
Recognizes when her/his rights are being violated.
Uses a variety of strategies that are effective in
resolving social problems.
Recognizes signs that someone is trying to exploit
her/him.
 DABS: Sample Items
PRACTICAL SKILLS:

Adjusts the water temperature at the faucet.

Uses the restroom.
Tests hot liquids/foods before drinking/eating.
Wears clean clothes.
Follows a daily schedule.
Discriminates between potentially dangerous items
from safe ones.
Maintains steady work pace and quality under
pressure.
Makes local travel arrangements.
Makes purchases relative to his/her budget/means.
 Scoring
Computer scoring of DABS

* 95% confidence interval = 2 SEM

 DABS: Summary
Standardized adaptive behavior scale
Normed on the general population
Focused on diagnostic information
Age: 4 21 years
Total Items: 75
Conceptual Skills = 25 items
Social Skills = 25
Practical Skills = 25
Administration semi-structured interview
Computer scoring based on IRT model
Standard Scores:
Conceptual Skills (Mean = 100; SD = 15)
Social Skills (Mean = 100; SD = 15)
Practical Skills (Mean = 100; SD = 15)
DABS Total Score (Mean = 100; SD = 15)
 139th AAIDD Annual Meeting
Louisville, KY, June 1-4, 2015

Concurrent Session:
Diagnosing Intellectual Disability Using the
Diagnostic Adaptive Behavior Scale

DABS Scores and Reports:

What to Do With Them and
How Dependable They Are
Giulia Balboni
University of Pisa, Italy
 Background

DABS was developed to

facilitate the diagnosis of ID of 4-21 y.o.

individuals

allow to determine if the individual presents

the significant limitations in AB necessary
for the ID diagnosis
 Background

Significant limitations in AB are operationally defined

as performance that is approximately 2 SDs below
the mean of either
Conceptual
Social
(a) one of the following three types of AB: Practical

(b) or an overall score on a standardized measure Conceptual

Social
Practical

Standard Error of Measurement of the AB scale

must be considered in the determination of the cut-
off point
 Background
Mild
Moderate
Severe
Classification of the severity of ID into Profound

must be based on the severity of impairment of

AB and no longer of intellectual functioning (i.e.,
IQ scores)
 Background

Few of all the existing scales of AB have

been considered valid and reliable to identify
the significant limitations in AB

DABS has several unique features that should

increase its reliability and validity (e.g., DABS
has been developed based on the IRT theory)
 Goals

To present:
(1) how the SS on the DABS and shown in the
Scoring Report can be used in the ID diagnostic
process

(2) how dependable the SS on the DABS is for ID

diagnosis
to briefly summarize its validity
 DABS

4-8 9-15 16-21 y.o.

Conceptual
Social Total AB skills score
Practical Skills
 ID Diagnosis Cut-off Point

3 DABS Domains, Total AB skills

Standard Score
- obtained with IRT model
- Mean = 100 SD = 15

2 SDs below the mean cut-off = 70 SS

 ID Diagnosis Cut-off Point

To take into account the variability of the

individuals score caused by several potential
sources of measurement errors

2 SEM must be added to this ID diagnosis

cut-off SS
ID Diagnosis
3 DABS FORMS SEM Cut-off SS
Domain
Conceptual SS 3 76
Social SS 3 76
Practical SS 3 76

Total AB skills SS 2 74
 ID Diagnostic Process

SEM must be taken into account also for the

computation of the SS obtained by the
individual in the DABS

For each SS on the DABS domains and Total

AB skills:

SS 2 SEM = 95% Confidence Interval

 Goal:

1. To present how the SS on the DABS and

shown in the Scoring Report can be used in
the ID diagnostic process
It can be said that John meets
the ID diagnosis criterion of
significant limitations in AB

ID diagnosis
cut-off SS

76

74
 ID Diagnostic Process

If John meets also the ID diagnosis criterion

of significant limitations in intellectual
functioning
it could be said that John has an ID disorder

Based on the severity of impairment in AB,

the ID could be classified as mild
 Goal:

2. To present how dependable the SS on

the DABS is for ID diagnosis

summarize its validity

How valid the DABS is

in measuring AB around the cut-off point for
determining significant limitations in AB
 Sensitivity & Specificity

Ability of the DABS in correctly identifying individuals

with and without ID based on their results on the
Scale

(1) Sensitivity
Percentage of all the individuals WITH an ID
diagnosis who have a DABS SS BELOW the ID cut-
off point

(2) Specificity
Percentage of all the individuals WITHOUT an ID-
diagnosis who have a DABS SS ABOVE the cut-off
 Sensitivity & Specificity

Participants: DABS normative sample

TOTAL
(n = 1,058)
Age
Mean (SD) 11.1 (4.9)
Range 4 - 21

Gender (%)
Male - Female 50 - 50

Diagnosis (%)
ID Non ID 12 - 88
 Sensitivity & Specificity

DABS Form SENSITIVITY (%) SPECIFICITY (%)

4 8 y.o. 81 91

9 15 y.o. 86 89

16 21 y.o. 98 90
Mean 88 90
 Sensitivity & Specificity

DABS Form SENSITIVITY (%) SPECIFICITY (%)

4 8 y.o. 81 91

9 15 y.o. 86 89

16 21 y.o. 98 90
Mean 88 90
 Sensitivity & Specificity

DABS Form SENSITIVITY (%) SPECIFICITY (%)

4 8 y.o. 81 91

9 15 y.o. 86 89

16 21 y.o. 98 90
Mean 88 90
 Sensitivity & Specificity

DABS Form SENSITIVITY (%) SPECIFICITY (%)

4 8 y.o. 81 91

9 15 y.o. 86 89

16 21 y.o. 98 90
Mean 88 90
 Sensitivity & Specificity

DABS Form SENSITIVITY (%) SPECIFICITY (%)

4 8 y.o. 81 91

9 15 y.o. 86 89

16 21 y.o. 98 90
Mean 88 90
 Sensitivity & Specificity

DABS Form SENSITIVITY (%) SPECIFICITY (%)

4 8 y.o. 81 91

9 15 y.o. 86 89

16 21 y.o. 98 90
Mean 88 90
 Sensitivity & Specificity

DABS Form SENSITIVITY (%) SPECIFICITY (%)

4 8 y.o. 81 91

9 15 y.o. 86 89

16 21 y.o. 98 90
Mean 88 90
 Sensitivity & Specificity

DABS Form SENSITIVITY (%) SPECIFICITY (%)

4 8 y.o. 81 91

9 15 y.o. 86 89

16 21 y.o. 98 90
Mean 88 90

(1) Sensitivity: 88% of the normative sample with a

formal diagnosis of ID obtained a DABS SS BELOW
the ID cut-off point in at least one domain

(2) Specificity: 90% of the individuals WITHOUT an ID

diagnosis obtained a DABS SS ABOVE the cut-off
 Sensitivity & Specificity

DABS Form SENSITIVITY (%) SPECIFICITY (%)

4 8 y.o. 81 91

9 15 y.o. 86 89

16 21 y.o. 98 90
Mean 88 90

These results are particularly relevant given that

the purpose of the DABS is to determine whether
the individual presents the significant limitations in
AB necessary for an ID diagnosis
 Convergent & Divergent
Validity

Convergent and divergent validity of the DABS in

comparison with the Vineland-II Scale
Vineland-II
Communication Socialization Daily Living Composite
Skills
Conceptual
D
A Social

B Practical

S Total
 Convergent & Divergent
Validity

Convergent and divergent validity of the DABS in

comparison with the Vineland-II Scale
Vineland-II
Communication Socialization Daily Living Composite
Skills

D
Conceptual +
A Social

B Practical

S Total
 Convergent & Divergent
Validity

Convergent and divergent validity of the DABS in

comparison with the Vineland-II Scale
Vineland-II
Communication Socialization Daily Living Composite
Skills

D
Conceptual + - - -
A Social

B Practical

S Total
 Convergent & Divergent
Validity

Participants
TOTAL
(n = 28)
Age
Mean (SD) 11.5 (5.1)
Range 4 - 21

Gender (%)
Male - Female 68 - 32 With the same
interviewer interviewing
Diagnosis (%) the same respondent
ID Other NDD 61 - 39
 Convergent & Divergent
Validity

Vineland-II
Communication Socialization Daily Living Composite
Skills
Conceptual .78 .25 .69 .69
D
A Social .37 .74 .51 .70

B Practical .56 .48 .70 .73

S Total .65 .59 .75 .84

 Convergent & Divergent
Validity

Vineland-II
Communication Socialization Daily Living Composite
Skills
Conceptual .78 .25 .69 .69
D
A Social .37 .74 .51 .70

B Practical .56 .48 .70 .73

S Total .65 .59 .75 .84

Convergent correlations obtained between the domains

of the two instruments that measure the same AB
skills are very high
 Convergent & Divergent
Validity

Vineland-II
Communication Socialization Daily Living Composite
Skills
Conceptual .78 .25 .69 .69
D
A Social .37 .74 .51 .70

B Practical .56 .48 .70 .73

S Total .65 .59 .75 .84

They are generally higher than the corresponding

divergent correlations between each of the DABS
domains and the other Vineland-II scales which
measure different areas (reported in the rows)
 Convergent & Divergent
Validity

Vineland-II
Communication Socialization Daily Living Composite
Skills
Conceptual .78 .25 .69 .69
D
A Social .37 .74 .51 .70

B Practical .56 .48 .70 .73

S Total .65 .59 .75 .84

 Convergent & Divergent
Validity

Vineland-II
Communication Socialization Daily Living Composite
Skills
Conceptual .78 .25 .69 .69
D
A Social .37 .74 .51 .70

B Practical .56 .48 .70 .73

S Total .65 .59 .75 .84

 Convergent & Divergent
Validity

Vineland-II
Communication Socialization Daily Living Composite
Skills
Conceptual .78 .25 .69 .69
D
A Social .37 .74 .51 .70

B Practical .56 .48 .70 .73

S Total .65 .59 .75 .84

 Convergent & Divergent
Validity

Vineland-II
Communication Socialization Daily Living Composite
Skills
Conceptual .78 .25 .69 .69
D
A Social .37 .74 .51 .70

B Practical .56 .48 .70 .73

S Total .65 .59 .75 .84

These results are particularly relevant given that

the Vineland-II Scale is one of the most valid
scales of AB available
 In Conclusion

DABS forms are valid

and therefore
the SS obtained may be used to verify if
the individual presents the significant
limitations in AB necessary for the ID
diagnosis
Diagnosing Intellectual Disability Using
the Diagnostic Adaptive Behavior Scale

Robert L. Schalock
Schalock & Associates

Marc J. Tass
The Ohio State University

Giulia Balboni
Universit di Pisa