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The Flexibility Scale: Development and Preliminary Validation of a Cognitive Flexibility Measure in Children with Autism Spectrum Disorders

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Abstract

Flexibility is a key component of executive function, and is related to everyday functioning and adult outcomes. However, existing informant reports do not densely sample cognitive aspects of flexibility; the Flexibility Scale (FS) was developed to address this gap. This study investigates the validity of the FS in 221 youth with ASD and 57 typically developing children. Exploratory factor analysis indicates a five-factor scale: Routines/rituals, transitions/change, special interests, social flexibility, and generativity. The FS demonstrated convergent and divergent validity with comparative domains of function in other measures, save for the Generativity factor. The FS discriminated participants with ASD and controls. Thus, this study suggests the FS may be a viable, comprehensive measure of flexibility in everyday settings.

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Notes

  1. The following specialists reviewed and commented on the Flexibility Scale: Michael G. Aman, PhD (Ohio State University); Gabriel Dichter, PhD (University of North Carolina at Chapel Hill); Hilde M. Geurts, PhD (University of Amsterdam); Susan L. Hepburn, PhD (University of Colorado Denver); Cara Pugliese, PhD (Children’s National Health System); Judith A. Reaven, PhD (University of Colorado Denver); Michael Rosenthal, PhD (Child Mind Institute); Marjorie Solomon, PhD (UC Davis MIND Institute); Mikle South, PhD (Brigham Young University); Susan White, PhD (Virginia Polytechnic Institute and State University).

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Acknowledgments

Funding was provided by the Isadore and Bertha Gudelsky Family Foundation (P30H0040677).

Author Contributions

JFS conceived of the study and its design, performed the statistical analyses, interpreted the data and drafted the manuscript; LGA conceived of the study, participated in its design, helped to interpret the statistical analyses, and co-authored the initial item set of the Flexibility Scale; BEY conceived of the study, participated in its design, helped to interpret the statistical analyses, and co-authored the initial item set of the Flexibility Scale; KKH participated in the study design and provided specialized support for factor analytic techniques employed in the study; GLW participated in the study design, helped to interpret the statistical analyses, and co-authored the inital item set of the Flexibility Scale; ACA supported data collection and performed some of the statistical analyses; KD supported recruitment and data collection and performed some of the statistical analyses; LK conceived of the study, participated in its design, helped to interpret the statistical analyses, and co-authored the initial item set of the Flexibility Scale. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Center for Autism Spectrum Disorders, Children’s National Health System, Washington, DC, USA

    John F. Strang, Laura G. Anthony, Anna C. Armour, Katerina Dudley & Lauren Kenworthy

  2. Children’s Research Institute, Children’s National Health System, Washington, DC, USA

    John F. Strang, Laura G. Anthony, Kristina K. Hardy & Lauren Kenworthy

  3. Division of Pediatric Neuropsychology, Children’s National Health System, Washington, DC, USA

    John F. Strang, Laura G. Anthony, Kristina K. Hardy & Lauren Kenworthy

  4. Center for Autism Research, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Benjamin E. Yerys

  5. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Benjamin E. Yerys

  6. Department of Speech and Hearing Sciences, The George Washington University, Washington, DC, USA

    Gregory L. Wallace

  7. Children’s National Medical Center, 15245 Shady Grove Road Suite 350, Rockville, MD, 20850, USA

    John F. Strang

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  1. John F. Strang
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  8. Lauren Kenworthy
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Correspondence to John F. Strang.

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Conflict of interest

John F. Strang, Laura G. Anthony, Benjamin E. Yerys, Kristina K. Hardy, Gregory L. Wallace, Anna C. Armour, Katerina Dudley and Lauren Kenworthy declare that they has no conflict of interest.

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All 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 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants in the study.

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Strang, J.F., Anthony, L.G., Yerys, B.E. et al. The Flexibility Scale: Development and Preliminary Validation of a Cognitive Flexibility Measure in Children with Autism Spectrum Disorders. J Autism Dev Disord 47, 2502–2518 (2017). https://doi.org/10.1007/s10803-017-3152-y

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