Modifying and validating the K-CAT mental health scales for children and adolescents on the autism spectrum

Project Abstract Mental health conditions are highly prevalent in the autism population but, due in part to the complexity of assessment, often go undetected and therefore unaddressed. Available tools are insufficient, as many were developed for use with the general population, do not include both youth and caregiver report versions, or are limited to the assessment of a single construct. Given the absence of an effective assessment measure, evaluating mental health conditions in autism is time-intensive and often requires a high level of training and expertise. The proposed study aims to remedy this deficiency by: (1) evaluating the psychometric properties of the K-CAT® with youth on the autism spectrum; and (2) identifying and addressing areas in need of modification to develop a reliable, valid, and acceptable K-CAT® Autism Version. The proposed study consists of two phases. In the first phase, we will examine the differential item functioning, convergent validity, and acceptability of the existing K-CAT® for use with autistic children and adolescents. In the second phase, we will modify the existing K-CAT® to develop and validate the K-CAT® Autism Version. To accomplish this, in Phase I, we will recruit 150 youth/caregiver dyads to complete the existing K-CAT® as well as three additional measures for psychometric evaluation. We will use mixed methods to examine acceptability and identify areas in need of modification with a subsample of youth, caregivers, and autism clinicians. In Phase II, we will modify the K-CAT® with input from youth, caregivers, and clinicians and recruit 350 youth/caregiver dyads from clinical sites across the US (see letters confirming participation) to complete the K-CAT® Autism Version and an accompanying assessment battery for validation. Eligible youth must be 7-17 years old, English speaking, have a documented diagnosis of autism and an IQ over 70. The assessment battery will include the parent and child K-CAT® Autism Version and the parent and child KSADS-COMP as well as several additional measures included in previous psychometric analyses of the existing K-CAT®. Results of the validation assessment battery will be reviewed, and diagnoses confirmed by licensed clinicians with expertise in autism blind to K-CAT® Autism Version scores. These assessments will be used to examine the psychometric properties of the K-CAT® Autism Version in evaluating underlying co-occurring diagnoses assessed (i.e., major depressive disorder, generalized anxiety disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, bipolar disorder, substance use disorder). The newly developed, reliable, valid, feasible and acceptable K-CAT® Autism Version will significantly improve the identification of mental health symptoms in autistic youth, facilitating earlier receipt of evidence-based services and potentially preventing the adverse outcomes associated with untreated mental health needs in this population.