Autism Treatment Evaluation Checklist
Measuring Treatment Response
For the results of any scientific study to be credible, researchers must use assessment tools that allow data to be gathered and recorded in a clear and consistent manner and presented in a format that can be easily understood. Most autism testing tools are designed for use by medical professionals in diagnosing the condition rather than evaluating and monitoring the efficacy of a given treatment. To ensure our data was properly recorded and presented, we needed an objective assessment tool designed to be conducted by the child’s caregivers that would enable us to establish baseline severity and variability data for each subject prior to starting treatment, and then monitor progress, if any.
Key criteria for measurement system selection
Established Autism specific rating scale, generally accepted, validated with supporting studies.
Freely available to the caregivers
Can be performed by non-professionals, i.e the caregiver
Specifically designed to evaluate the efficacy of treatments by measuring the changes in the individual over time.
After an extensive search we found the Autism Treatment Evaluation Checklist (ATEC). The ATEC was developed in the 1990’s by doctors Rimland and Edelson of the Autism Research Institute (ARI) and is available free of charge on their website. (www.autism.org). The ATEC consists of seventy-seven questions presented in four subscales and uses a scoring system to monitor the child’s progress.
The subscales are:
Speech, language, and communication
Sensory and cognitive awareness
Health, physical, and behaviour
For all scores, the higher the value, the more severe the autism. The scores in each subscale are combined to produce a total score, with the highest possible score being 179. The higher the score, the more severely that individual is impacted by autism. A score of 30 or less is associated with mild autism, a score of 31 to 103 is associated with moderate to severe autism, a score of 104 or higher is associated with severe autism.
All our subjects had baseline ATEC scores well into the moderate to severe range when they entered our pilot study. In each case, Managed-Oxygen therapy produced a hitherto unseen degree of positive change.
The detailed results of our first five studies were published in the online journal Autism-Open Access (Peterson, Allen 2018). Read that paper here
ATEC validated by multiple studies
The efficacy of the ATEC as a monitoring and assessment tool has been independently validated in five studies ([Magiati 2011 , Klaveness 2013 , Whitehouse 2017 , Mahapatra 2018 , Mahapatra 2020) and, in each case, found to have a high level of consistency and reliability.
As stated by Geir, Kern and Geir in their 2013 paper :- A Comparison of the Autism Treatment Evaluation Checklist (ATEC) and the Childhood Autism Rating Scale (CARS) for the Quantitative Evaluation of Autism
"In conclusion, the results of this study revealed a significant correlation between total ATEC and CARS scores. It was also observed that there were significant correlations between the ATEC domains and the CARS total score. The findings from the study validate the parent-completed ATEC in comparison with the CARS, an established, professional-related measure of autism."
Magiati J, Moss R, Charman T, Howlin P. Is the Autism Treatment Evaluation Checklist a useful tool for monitoring progress in children with autism spectrum disorders? J. Intel Dis Res. 2011;55(3):302-312. doi:10.1111/j.1365-2788.2010.01359.x
Klaveness J, Bigam J, Reichelt KL. The varied rate of response to dietary intervention in autistic children. Open Journal of Psychiatry, 2013;3:56-60. Doi:10.4236/ojpsych.2013.32A009
Whitehouse AJ, Granich J, Alvares G, Busacca M, Cooper MN, Dass A et al. A randomised controlled trial of an iPad-based application to complement early behavioural intervention in Autism Spectrum Disorder. Journal of Child Psychology and Psychiatry. 2017;58(9):1042-1052. doi: 10.1111/jcpp.12752.
Mahapatra S, Vyshedskiy D, Martinez S, Kannel B, Braverman J, Edelson SM, Vyshedskiy A. Autism Treatment Evaluation Checklist (ATEC) Norms: A “Growth Chart” for ATEC Score Changes as a Function of Age. Children 2018;5(2):25. doi.org/10.3390/children5020025
Mahapatra S, Khokhlovich E, Martinez S, Kannel B, Edelson SM, Vyshedskiy A. Longitudinal Epidemiological Study of Autism Subgroups Using Autism doi: Treatment Evaluation Checklist (ATEC) Score. J Autism Dev Disord. 2020 May;50(5):1497-1508. 10.1007/s10803-018-3699-2.
David A. Geier, Janet K. Kern & Mark R. Geier (2013) A Comparison of the Autism Treatment Evaluation Checklist (ATEC) and the Childhood Autism Rating Scale (CARS) for the Quantitative Evaluation of Autism, Journal of Mental Health Research in Intellectual Disabilities, 6:4, 255-267, DOI: 10.1080/19315864.2012.681340
Once a caregiver is familiar with it, the ATEC assessment can normally be completed in less than 20 minutes. Caregivers participating in our pilot studies were required to provide an ATEC every two to three weeks coupled with a short subjective review, providing perhaps a paragraph or two, of the child’s status over the reporting period. The subjective reviews were provided voluntarily and in practice often ran on to several pages. They gave us a unique and often highly emotional insight into the changes occurring in the child from the caregiver’s perspective and how this was impacting the family dynamic.
The chart below summarises the sequence and key timeline of this pilot study. Treatment for 5 days per week was conducted for 550 days in total (approximately 18 months) during which time the dramatic changes occurred. In the period afterwards ATECs were taken on a regular basis, becoming more spaced from around 2 years in. Thereafter occasional ATECs have been provided giving us long term insight in to how the change is lasting. As can be seen from the data - 8 years later the same low scores (hence improved function) continue to be sustained, and the clock is still running.