Autism Treatment Evaluation Checklist (ATEC)

Abstract

The Autism Treatment Evaluation Checklist (ATEC) is a standardized, 77-item assessment tool developed in 1999 by Bernard Rimland and Stephen Edelson at the Autism Research Institute. Designed primarily as a comparative measure, the ATEC evaluates changes in individuals diagnosed with Autism Spectrum Disorder (ASD) resulting from various therapeutic interventions. It achieves this by contrasting baseline scores with scores obtained post-intervention. The checklist is typically completed by parents, teachers, or caregivers who regularly observe the individual’s behavior, generally requiring 10 to 15 minutes. It is validated for use with children, specifically those aged 5 to 12 years, and provides scores across four critical domains of functioning and symptom severity.

Keywords

Autism Treatment Evaluation Checklist, ATEC, ASD, Intervention outcome, Treatment evaluation, Behavioral assessment, Rimland, Edelson, CARS.

Authors

Bernard Rimland, Stephen Edelson.

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Purpose

The core purpose of the Autism Treatment Evaluation Checklist (ATEC) is to serve as a quantifiable metric for assessing the effectiveness and progress of various interventions administered to individuals with Autism Spectrum Disorder (ASD). Unlike purely diagnostic tools, the ATEC is fundamentally a comparative subscale designed to track longitudinal change. By comparing an individual’s initial (baseline) scores to subsequent scores taken after a period of treatment, clinicians and researchers can objectively evaluate the impact of the intervention.

Furthermore, the ATEC functions as a valuable screening tool for monitoring overall progress and severity over time. The output provides domain-specific scores alongside a total score, allowing for a detailed understanding of where an individual’s symptoms are improving or remaining static. Its ease of administration, requiring only 10 to 15 minutes to complete, and quick interpretation enhance its utility in clinical and research settings where repeated measures are necessary for tracking therapeutic efficacy.

Construct

The ATEC is structured to measure the severity of behaviors and symptoms typically associated with ASD across four distinct psychological and physical domains. These domains reflect the multifaceted nature of the disorder, capturing core deficits as well as associated physical and sensory issues. The scale utilizes a total of 77 items distributed across these four subscales, which collectively define the overall construct of autism severity and impairment.

The four primary constructs measured are:

• Scale I: Speech/Language/Communication: Focuses on verbal and non-verbal communication skills, encompassing 14 items.
• Scale II: Sociability: Measures interpersonal engagement, social responsiveness, and reciprocal interaction, encompassing 20 items.
• Scale III: Sensory/Cognitive Awareness: Assesses atypical sensory responses, cognitive flexibility, and general awareness, encompassing 18 items.
• Scale IV: Health/Physical Behavior: Captures physical symptoms, health issues, hyperactivity, and specific behavioral concerns, encompassing 25 items.

Validity

Support for the validity of the ATEC has been established through research comparing its results with other highly regarded assessment instruments for autism. Specifically, the ATEC demonstrates high correlations, indicative of strong concurrent validity, with the Childhood Autism Rating Scale (CARS). A study by Geier, Kern, and Geier (2013) reported a significant correlation coefficient (ρ = .71, p < .0001) between the ATEC and CARS total scores, confirming that the ATEC measures similar dimensions of autism severity as the established CARS.

Furthermore, this comparative study provided detailed metrics on the tool’s ability to correctly classify individuals (criterion validity). The analysis showed high sensitivity (0.96), moderate specificity (0.67), and good overall accuracy (0.82) when comparing the total ATEC domain scores against CARS classifications (Geier et al., 2013). The clinical utility is also reinforced by high correlations observed between ATEC scores and objective measures, such as physical symptoms and biomarkers associated with ASD (Adams et al., 2011; Kern et al., 2010).

Reliability

The psychometric properties of the ATEC demonstrate strong evidence of internal consistency reliability. An evaluation conducted on a large sample of 1,358 participants revealed high Pearson split-half coefficients across all four subscales, indicating that the items within each scale consistently measure the same underlying construct. The uncorrected r values for the subscales were robust:

• Scale I. Speech/Language/Communication: r = .92
• Scale II. Sociability: r = .84
• Scale III. Sensory/Cognitive Awareness: r = .88
• Scale IV. Health/Physical Behaviour: r = .82

The overall internal consistency reliability for the ATEC total score is exceptionally high, reported at r = .94, confirming that the 77 items function coherently as a unified measure of impairment severity. A recognized limitation of the scale, however, is the need for more extensive, published research regarding its long-term test-retest reliability and applicability following the introduction of the DSM-5 criteria.

Factor Analysis

While explicit details regarding confirmatory or exploratory factor analysis (CFA/EFA) are not provided in the source material, the design of the ATEC inherently relies on a four-factor structure established by the developers (Rimland & Edelson, 1999). This structure separates the broad symptoms of ASD into distinct, measurable domains, which function as separate subscales. These four factors—Communication, Sociability, Sensory/Cognitive Awareness, and Health/Physical Behavior—are intended to provide a nuanced profile of the individual’s functional status rather than relying solely on a single global score.

The distinct scoring ranges and item counts for each subscale suggest that these factors are treated as independent components contributing to the overall severity score. This domain-specific approach enhances the clinical utility by allowing clinicians and researchers to pinpoint areas of greatest need or improvement following intervention, aligning with the observed high internal consistency within each factor.

Instrument

Test Type: Behavioral checklist; Comparative outcome measure; Screening tool

Format: 77-item questionnaire completed by proxy (parent, teacher, or regular caregiver)

Language Available: English (Other languages may be available through the Autism Research Institute but are not specified in the source content).

Population Group: Individuals diagnosed with Autism Spectrum Disorder (ASD)

Age Group: Children aged 5 to 12 years

Population Details: The scale is designed for administration by non-professionals (caregivers, educators) who observe the individual’s behavior regularly, making it highly accessible for monitoring treatment response in home and educational settings.

Test Methodology: Rater-completed questionnaire. Scoring involves summing item responses within four subscales to generate subscale scores, which are then summed for a total severity score (ranging from 0 to 180). Lower scores indicate less impairment and higher scores indicate greater severity.

Keywords

Treatment efficacy, Biomarkers, Severity monitoring, Internal consistency, Rimland & Edelson, Psychometric assessment.

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Authors

Author ORCID Identifier: Unavailable

Affiliation Email addresses: Unavailable

Correspondence Address: Autism Research Institute; 1999. 4812 Adams Avenue, San Diego, CA 92116 (Based on original publication reference).

Permissions & Fee and Test Year

The Autism Treatment Evaluation Checklist (ATEC) was developed and first published in 1999 by Bernard Rimland and Stephen Edelson. It is administered under the auspices of the Autism Research Institute (ARI).

The ATEC is widely recognized for its accessibility; it is generally available for free use by researchers and clinicians, and a free online version with automated scoring capabilities is accessible. The original PDF can be downloaded via the Autism Research Institute website. For specific permissions regarding large-scale commercial use or adaptation, users should consult the Autism Research Institute directly. The free and easy availability of the tool contributes significantly to its widespread clinical utility in monitoring treatment outcomes.

Reference’s

• Adams J. B., Johansen L. J., Powell L. D., Quig D., Rubin R. A. Gastrointestinal flora and gastrointestinal status in children with autism: Comparisons to typical children and correlation with autism severity. (2011). BMC Gastroenterology. 11, 22.
• Geier, D.A., Kern, J.K., & Geier, M.R. (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, Vol. 6, No. 4, pp 255-267.
• Jarusiewicz B. Efficacy of neurofeedback for children in the autism spectrum: A pilot study. (2012). Journal of Neurotherapy. 6 pp 39–49.
• Kern J. K., Geier D. A., Adams J. B., Geier M. R. A biomarker of mercury body-burden correlated with diagnostic domain-specific clinical symptoms of autism spectrum disorder. (2010). Biometals. 23, pp 1043–1051.
• Lonsdale D., Shamberger R. J., Audhya T. Treatment of autism spectrum children with thiamine tetrahydrofurfuryl disulfide: A pilot study. (2002) Neuroendocrinology Letters. 23, pp 303–308.
• Magiati I., Moss J., Yates R., Charman T., Howlin P. Is the Autism Treatment Evaluation Checklist a useful tool for monitoring progress in children with autism spectrum disorders? (2011). Journal of Intellectual & Disabilities Research. 55, pp 302–312.
• Rimland B., Edelson M. Autism Treatment Evaluation Checklist. Autism Research Institute; 1999. 4812 Adams Avenue, San Diego, CA 92116. Retrieved from https://www.autismeval.com/ari-atec/report1.html.

External Links:

• Autism Research Institute Website: http://www.autism.com/ind_atec_survey.asp
• ATEC with online scoring and results: http://www.surveygizmo.com/s3/1329619/Autism-Treatment-Evaluation-Checklist-revised

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Items of the Autism Treatment Evaluation Checklist (ATEC)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The ATEC is composed of four subtest scales, totaling 77 items. The scoring for each subscale is designed such that higher scores indicate greater impairment.

• Scale I. Speech/Language/Communication: (14 items – score range 0 – 28)
• Scale II. Sociability: (20 items – score range 0 – 40)
• Scale III. Sensory/Cognitive Awareness: (18 items – score range 0 – 36)
• Scale IV. Health/Physical Behavior: (25 items – score range 0 – 75)

The total possible score across all 77 items ranges from 0 to 180.