Journal of Autism and Developmental Disorders

, Volume 48, Issue 5, pp 1566–1578 | Cite as

Psychometric Properties of Spanish Adaptation of the PDD-MRS Scale in Adults with Intellectual Developmental Disorders: The EVTEA-DI Scale

  • Maria José CortésEmail author
  • Carmen Orejuela
  • Gemma Castellví
  • Annabel Folch
  • Lluís Rovira
  • Luis Salvador-Carulla
  • Marcia Irazábal
  • Silvia Muñoz
  • Josep Maria Haro
  • Elisabet Vilella
  • Rafael Martínez-Leal
Original Paper


Strategies for the early detection of autism spectrum disorders (ASD) in people with intellectual developmental disorder (IDD) are urgently needed, but few specific tools have been developed. The present study examines the psychometric properties of the EVTEA-DI, a Spanish adaptation of the PDD-MRS, in a large randomized sample of 979 adults with IDD. Factorial solution analysis suggested a three-factor solution (stereotyped behavior, communication, and social behavior). The EVTEA-DI showed good reliability and convergent validity when compared to the Childhood Autism Rating Scale. Discriminative validity analysis resulted in an acceptable global sensitivity of 70% and a high specificity of 90%. The EVTEA-DI proved to be a valid screening tool in ASD assessment of the adult Spanish population with IDD.


Intellectual developmental disorder Autism spectrum disorders Screening diagnoses Psychometric values 



We are grateful to all the professionals who participated in the POMONA-ESP recruitment and in evaluating the study sample, and to all the participants, parents and volunteers who took part in the study.

Author Contributions

MJC, CO, SM: conceptualization and design. RML and LR translated the scale. AF, GC and MI collected data. MJC: methodology and statistical analyses. MJC and CO wrote the original draft. JH, EV and RML: interpretation and critical revisions of the article. RML and LS: funding acquisition. All the authors read and approved the final manuscript.


This study was supported in part by grants from the Fondo de Investigación en Salud—Instituto de Salud Carlos III (FIS PI12/01237) and from Fundació Port Aventura.

Compliance with Ethical Standards

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethical Approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


  1. American Psychiatry Association. (2014). Manual de diagnóstico y estadístico de los trastornos mentales (DSM-5®). Madrid: Editorial Médica Panamericana.Google Scholar
  2. Bertelli, M., Scuticchio, D., Ferrandi, A., Lassi, S., Mango, F., Ciavatta, C., et al. (2012). Reliability and validity of the SPAID-G checklist for detecting psychiatric disorders in adults with intellectual disability. Research in Developmental Disabilities, 33(2), 382–390. Scholar
  3. Bradley, E. A., Summers, J. A., Wood, H. L., & Bryson, S. E. (2004). Comparing rates of psychiatric and behavior disorders in adolescents and young adults with severe intellectual disability with and without autism. Journal of Autism and Developmental Disorders, 34(2), 151–161. Scholar
  4. Canal-Bedia, R., García-Primo, P., Martín-Cilleros, M. V., Santos-Borbujo, J., Guisuraga-Fernández, Z., Herráez-García, L., et al. (2011). Modified checklist for autism in toddlers: Cross-cultural adaptation and validation in Spain. Journal of Autism and Developmental Disorders, 41(10), 1342–1351. Scholar
  5. Cervantes, P. E., & Matson, J. L. (2015). Comorbid symptomology in adults with autism spectrum disorder and intellectual disability. Journal of Autism and Developmental Disorders, 45(12), 3961–3970. Scholar
  6. Chlebowski, C., Green, J. A., Barton, M. L., & Fein, D. (2010). Using the childhood autism rating scale to diagnose autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(7), 787–799. Scholar
  7. Choueiri, R., & Wagner, S. (2015). A new interactive screening test for autism spectrum disorders in toddlers. The Journal of Pediatrics, 167(2), 460–466. Scholar
  8. Cicchetti, D. V., Volkmar, F., Klin, A., & Showalter, D. (1995). Diagnosing autism using ICD-10 criteria: A comparison of neural networks and standard multivariate procedures. Child Neuropsychology, 1(1), 26–37. Scholar
  9. de Bildt, A., Mulder, E. J., Hoekstra, P. J., van Lang, N. D. J., Minderaa, R. B., & Hartman, C. A. (2009). Validity of the children’s social behavior questionnaire (CSBQ) in children with intellectual disability: Comparing the CSBQ with ADI-R, ADOS, and clinical DSM-IV-TR classification. Journal of Autism and Developmental Disorders, 39(10), 1464–1470. Scholar
  10. de Bildt, A., Sytema, S., Kraijer, D., & Minderaa, R. (2005). Prevalence of pervasive developmental disorders in children and adolescents with mental retardation. Journal of Child Psychology and Psychiatry, 46(3), 275–286. Scholar
  11. de Vaan, G., Vervloed, M., Peters-Scheffer, N. C., van Gent, T., Knoors, H., & Verhoeven, L. (2016). Behavioural assessment of autism spectrum disorders in people with multiple disabilities. Journal of Intellectual Disability Research, 60(2), 101–112. Scholar
  12. Eaves, R., & Williams, T. Jr. (2006). Exploratory and confirmatory factor analyses of the pervasive developmental disorders rating scale for young children with autistic disorder. The Journal of Genetic Psychology, 167(1), 65–92. Scholar
  13. Falkmer, T., Anderson, K., Falkmer, M., & Horlin, C. (2013). Diagnostic procedures in autism spectrum disorders: A systematic literature review. European Child & Adolescent Psychiatry, 22(6), 329–340. Scholar
  14. García-Primo, P., Hellendoorn, A., Charman, T., Roeyers, H., Dereu, M., Roge, B., et al. (2014). Screening for autism spectrum disorders: State of the art in Europe. European Child & Adolescent Psychiatry, 23(11), 1005–1021. Scholar
  15. Glascoe, F. P. (2005). Screening for developmental and behavioral problems. Mental Retardation and Developmental Disabilities Research Reviews, 11(3), 173–179. Scholar
  16. Halladay, A. K., Bishop, S., Constantino, J. N., Daniels, A. M., Koenig, K., Palmer, K., et al. (2015). Sex and gender differences in autism spectrum disorder: Summarizing evidence gaps and identifying emerging areas of priority. Molecular Autism, 6(1), 36. Scholar
  17. Hampton, J., & Strand, P. S. (2015). A review of level 2 parent-report instruments used to screen children aged 1.5–5 for autism: A meta-analytic update. Journal of Autism and Developmental Disorders, 45(8), 2519–2530.
  18. Hartley, S. L., & Sikora, D. M. (2009). Sex differences in autism spectrum disorder: An examination of developmental functioning, autistic symptoms, and coexisting behavior problems in toddlers. Journal of Autism and Developmental Disorders, 39(12), 1715–1722. Scholar
  19. Hattier, M. A., Matson, J. L., Tureck, K., & Horovitz, M. (2011). The effects of gender and age on repetitive and/or restricted behaviors and interests in adults with autism spectrum disorders and intellectual disability. Research in Developmental Disabilities, 32(6), 2346–2351. Scholar
  20. Holtmann, M., Bölte, S., & Poustka, F. (2007). Autism spectrum disorders: Sex differences in autistic behaviour domains and coexisting psychopathology. Developmental Medicine and Child Neurology, 49(5), 361–366. Scholar
  21. Hove, O., & Havik, O. E. (2010). Developmental level and other factors associated with symptoms of mental disorders and problem behaviour in adults with intellectual disabilities living in the community. Social Psychiatry and Psychiatric Epidemiology, 45(1), 105–113. Scholar
  22. Howlin, P., & Asgharian, A. (1999). The diagnosis of autism and Asperger syndrome: Findings from a survey of 770 families. Developmental Medicine & Child Neurology, 41(12), 831–839. Scholar
  23. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. Scholar
  24. Kopp, S., & Gillberg, C. (2011). The autism spectrum screening questionnaire (ASSQ)-revised extended version (ASSQ-REV): An instrument for better capturing the autism phenotype in girls? A preliminary study involving 191 clinical cases and community controls. Research in Developmental Disabilities, 32(6), 2875–2888. Scholar
  25. Kraijer, D. (2005). PDD-MRS. Pervasive developmental disorder in mental retardation, (2nd edn.). Leiden: PITS Test Publishers.Google Scholar
  26. Kraijer, D., & de Bildt, A. (2005). The PDD-MRS: An instrument for identification of autism spectrum disorders in persons with mental retardation. Journal of Autism and Developmental Disorders, 35(4), 499–513. Scholar
  27. Krug, D. A., Arick, J., & Almond, P. (1980). Behavior checklist for identifying severely handicapped individuals with high levels of autistic behavior. Journal of Child Psychology and Psychiatry, 21(3), 221–229. Scholar
  28. La Malfa, G., Lassi, S., Bertelli, M., Salvini, R., & Placidi, G. F. (2004). Autism and intellectual disability: A study of prevalence on a sample of the Italian population. Journal of Intellectual Disability Research, 48(Pt 3), 262–267. Scholar
  29. Lecavalier, L. (2005). An evaluation of the gilliam autism rating scale. Journal of Autism and Developmental Disorders, 35(6), 795–805. Scholar
  30. Lewis, L. F. (2016). Exploring the experience of self-diagnosis of autism spectrum disorder in adults. Archives of Psychiatric Nursing, 30(5), 575–580. Scholar
  31. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685. Scholar
  32. Magyar, C. I., Pandolfi, V., & Dill, C. A. (2012). An initial evaluation of the social communication questionnaire for the assessment of autism spectrum disorders in children with Down syndrome. Journal of Developmental & Behavioral Pediatrics, 33(2), 134–145. Scholar
  33. Maljaars, J., Noens, I., Scholte, E., & van Berckelaer-Onnes, I. (2012). Evaluation of the criterion and convergent validity of the diagnostic interview for social and communication disorders in young and low-functioning children. Autism, 16(5), 487–497. Scholar
  34. Matson, J. L., & Dempsey, T. (2009). The nature and treatment of compulsions, obsessions, and rituals in people with developmental disabilities. Research in Developmental Disabilities, 30(3), 603–611. Scholar
  35. Matson, J. L., & Rivet, T. T. (2008). Characteristics of challenging behaviours in adults with autistic disorder, PDD-NOS, and intellectual disability. Journal of Intellectual and Developmental Disability, 33(4), 323–329. Scholar
  36. Matson, J. L., Wilkins, J., Boisjoli, J. A., & Smith, K. R. (2008). The validity of the autism spectrum disorders-diagnosis for intellectually disabled adults (ASD-DA). Research in Developmental Disabilities, 29(6), 537–546. Scholar
  37. McLennan, J. D., Lord, C., & Schopler, E. (1993). Sex differences in higher functioning people with autism. Journal of Autism and Developmental Disorders, 23(2), 217–227.CrossRefPubMedGoogle Scholar
  38. Mutsaerts, C. G., Heinrich, M., Sterkenburg, P. S., & Sappok, T. (2016). Screening for ASD in adults with ID-moving toward a standard using the DiBAS-R and the ACL. Journal of Intellectual Disability Research, 60(5), 512–522. Scholar
  39. Nicholas, J. S., Charles, J. M., Carpenter, L. A., King, L. B., Jenner, W., & Spratt, E. G. (2008). Prevalence and characteristics of children with autism-spectrum disorders. Annals of Epidemiology, 18(2), 130–136. Scholar
  40. Park, E.-Y., & Kim, J. (2016). Factor structure of the childhood autism rating scale as per DSM-5. Pediatrics International, 58(2), 139–145. Scholar
  41. Robins, D. L., Casagrande, K., Barton, M., Chen, C.-M. A., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the modified checklist for autism in toddlers, revised with Follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37–45. Scholar
  42. Rutter, M., Bailey, A., & Lord, C. (2003). Social communication questionnaire (SCQ). Los Angeles: Western Psychological Services.Google Scholar
  43. Sappok, T., Diefenbacher, A., Gaul, I., & Bölte, S. (2015). Validity of the social communication questionnaire in adults with intellectual disabilities and suspected autism spectrum disorder. American Journal on Intellectual and Developmental Disabilities, 120(3), 203–214. Scholar
  44. Sappok, T., Heinrich, M., & Diefenbacher, A. (2014). Psychometric properties of the Autism-Checklist (ACL) in adults with intellectual disability. Psychiatrische Praxis, 41(1), 37–44. Scholar
  45. Schopler, E., Reichler, R. J., & Renner, R., B (1988). The childhood autism rating scale. Los Angeles: Western Psychological Services.Google Scholar
  46. Smith, K. R. M., & Matson, J. L. (2010). Behavior problems: Differences among intellectually disabled adults with co-morbid autism spectrum disorders and epilepsy. Research in Developmental Disabilities, 31(5), 1062–1069. Scholar
  47. Spence, S. J., Sharifi, P., & Wiznitzer, M. (2004). Autism spectrum disorder: Screening, diagnosis, and medical evaluation. Seminars in Pediatric Neurology, 11(3), 186–195. Scholar
  48. Stone, W. L. (1994). Early recognition of autism. Parental reports vs clinical observation. Archives of Pediatrics & Adolescent Medicine, 148(2), 174–179. Scholar
  49. Tonnsen, B. L., Boan, A. D., Bradley, C. C., Charles, J., Cohen, A., & Carpenter, L. A. (2016). Prevalence of autism spectrum disorders among children with intellectual disability. American Journal on Intellectual and Developmental Disabilities, 121(6), 487–500. Scholar
  50. Totsika, V., Felce, D., Kerr, M., & Hastings, R. P. (2010). Behavior problems, psychiatric symptoms, and quality of life for older adults with intellectual disability with and without autism. Journal of Autism and Developmental Disorders, 40(10), 1171–1178. Scholar
  51. Van Naarden Braun, K., Christensen, D., Doernberg, N., Schieve, L., Rice, C., Wiggins, L., et al. (2015). Trends in the prevalence of autism spectrum disorder, cerebral palsy, hearing loss, intellectual disability, and vision impairment, metropolitan Atlanta, 1991–2010. PLoS ONE, 10(4), e0124120. Scholar
  52. Volker, M. A., Dua, E. H., Lopata, C., Thomeer, M. L., Toomey, J. A., Smerbeck, A. M., et al. (2016). Factor structure, internal consistency, and screening sensitivity of the GARS-2 in a developmental disabilities sample. Autism Research and Treatment, 2016, 1–12. Scholar
  53. Wetherby, A. M., Woods, J., Allen, L., Cleary, J., Dickinson, H., & Lord, C. (2004). Early indicators of autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 34(5), 473–493. Scholar
  54. Wilson, C. E., Murphy, C. M., McAlonan, G., Robertson, D. M., Spain, D., Hayward, H., et al. (2016). Does sex influence the diagnostic evaluation of autism spectrum disorder in adults? Autism: The International Journal of Research and Practice, 20(7), 808–819. Scholar
  55. Zachor, D. A., & Curatolo, P. (2014). Recommendations for early diagnosis and intervention in autism spectrum disorders: An Italian–Israeli consensus conference. European Journal of Paediatric Neurology, 18(2), 107–118. Scholar
  56. Zwaigenbaum, L., Bauman, M. L., Fein, D., Pierce, K., Buie, T., Davis, P. A., et al. (2015). Early screening of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136(Supplement), S41–S59. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Maria José Cortés
    • 1
    • 2
    Email author
  • Carmen Orejuela
    • 1
  • Gemma Castellví
    • 1
  • Annabel Folch
    • 1
  • Lluís Rovira
    • 1
  • Luis Salvador-Carulla
    • 3
  • Marcia Irazábal
    • 4
    • 5
  • Silvia Muñoz
    • 6
  • Josep Maria Haro
    • 2
    • 4
    • 7
  • Elisabet Vilella
    • 2
    • 8
  • Rafael Martínez-Leal
    • 1
    • 2
    • 9
  1. 1.Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD) - Fundació Villablanca, IISPVUniversitat Rovira i VirgiliReusSpain
  2. 2.Centro de Investigación Biomédica en RedCIBERSAMMadridSpain
  3. 3.Faculty of Health Sciences, Centre for Disability Research and PolicyUniversity of SydneySydneyAustralia
  4. 4.Parc Sanitari Sant Joan de DéuSant Boi de LlobregatSpain
  5. 5.Faculty of EducationUniversitat de BarcelonaBarcelonaSpain
  6. 6.Plena Inclusión EspañaMadridSpain
  7. 7.Department of Psychiatry and Clinical PsychobiologyUniversitat de BarcelonaBarcelonaSpain
  8. 8.Hospital Universitari Institut Pere Mata, IISPVUniversitat Rovira i VirgiliReusSpain
  9. 9.Department of PsychologyUniversitat Rovira i VirgiliTarragonaSpain

Personalised recommendations