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					10.177/0145445503259828 SKILLS ASSESSMENT
Bielecki, Swender / SOCIAL
BEHAVIOR MODIFICATION / September 2004




                                             The Assessment of Social Functioning in
                                              Individuals With Mental Retardation
                                                                                    A Review


                                                                              JOANNE BIELECKI
                                                                               Louisiana State University

                                                                           STEPHEN L. SWENDER
                                                                            Pinecrest Developmental Center



                                            Social skills deficits and excesses are a defining aspect of mental retardation (MR). Research
                                            indicates that there is an established relationship between social skills and maladaptive behav-
                                            iors. A number of studies demonstrate that the social competence of individuals with MR and
                                            comorbid psychopathology can be enhanced with social skills training. However, to design an
                                            effective training package, an accurate assessment of adaptive and social functioning must first
                                            be conducted. Unique problems arise when assessing social skills in individuals with severe and
                                            profound MR (i.e., individuals often have limited verbal repertoires). Thus, a clinician must often
                                            rely on observable behavior and caregiver report rather than self-report. The three most common
                                            methods for assessing social skills are behavioral observations, role-playing, and checklists.
                                            These assessment strategies will be discussed, as well as suggestions for future research.

                                            Keywords: social skills; mental retardation; developmental disability; adaptive behavior
                                                      scales; behavior checklists



                                            A universally accepted definition of social skills does not exist but
                                            major themes are reflected in the literature. Bellack (1983) defined
                                            social skills as observable and measurable interpersonal behaviors
                                            that promote independence, social acceptability, and quality of life.
                                            These skills are crucial to adjustment and normal functioning. They
                                            enable a person to obtain healthy social relationships, avoid interper-
                                            sonal conflict, and cope with stressful situations (Guralnick, 1986;
                                            Matson & Swiezy, 1994). Social skills are learned behaviors that are

                                            BEHAVIOR MODIFICATION, Vol. 28 No. 5, September 2004 694-708
                                            DOI: 10.177/0145445503259828
                                            © 2004 Sage Publications

                                            694
                       Bielecki, Swender / SOCIAL SKILLS ASSESSMENT   695


both situation-specific and context-dependent. Context is important
because different social skills are important in different situations and
for different tasks (La Greca, Stone, & Bell, 1982). Matson and
Ollendick (1988) indicated that a socially skilled person adapts well
to various situations because he or she is able to recognize social cues
and appropriately respond to them. These individuals exhibit behav-
iors that are reinforced and refrain from exhibiting behaviors that are
punished (Libet & Lewinsohn, 1973).
   Individuals with developmental disabilities are generally deficient
across a broad spectrum of social behaviors. As a result, mental retar-
dation (MR) has become associated with social skill deficits (i.e., poor
eye contact) and/or social excesses (i.e., holding onto others and not
letting go); Duncan, Matson, Bamburg, Cherry, & Buckley, 1999). A
positive correlation has been found between severity of MR and social
impairment, with deficits greatest among those diagnosed with severe
and profound MR (Wing & Gould, 1979). In persons with autistic dis-
order, the social skill deficits appear to be even more pronounced than
in people with other developmental disorders (Njardvik, Matson, &
Cherry, 1999), and specific mental disorders such as psychosis are
well known for their relationship to social behavior (Nihira, Price-
Williams, & White, 1988). Matson, Smiroldo, and Bamburg (1998)
investigated the relationship between psychopathology and social
skills in 846 individuals with severe and profound MR. Their linear
regression analysis indicated that increases in symptoms of
psychopathology predicted increases in negative social behaviors. In
addition, social impairments have been closely linked to behavior
problems such as aggression and self-injury (Duncan et al., 1999).
The results of the Duncan et al. (1999) study indicated that individuals
displaying maladaptive behaviors exhibited a restricted range of
social behaviors compared to those in the control group.
   Research demonstrates that there is an established relationship
between social skills and maladaptive behaviors, but because the data
is correlational, it is unclear if social skill deficits result in problem
behaviors or if the presence of maladaptive behaviors results in social
impairments. Social skills training procedures have been applied to
enhance the social competence of persons with schizophrenia, perva-
sive developmental disorders, social anxiety, depression, hearing and
696   BEHAVIOR MODIFICATION / September 2004


visual impairments, and MR (Coe, Matson, & Fee, 1990; Matson et
al., 1988; Matson, Fee, Coe, & Smith, 1991; Matson, Zeiss, Zeiss, &
Bowman, 1980; Raymond & Matson, 1989). However, effective treat-
ments are unlikely unless clinicians and researchers can reliably and
validly assess social skills in the mentally retarded population
(Bellack, 1983). Accurate assessment of adaptive and social skills is
important because identification of common deficits may lead to
training packages tailored to the special needs of persons with specific
diagnoses and/or maladaptive behaviors. Such programs may dramat-
ically affect the lives of persons with severe and profound MR and
lead to more successful community integration.


                            ASSESSMENT

   Unique problems arise when assessing social skills in individuals
with severe and profound MR. These individuals often have very lim-
ited verbal repertoires, which prevent the use of self-report assess-
ment techniques. Persons with MR may have difficulties in reliable
self-reporting even if the retardation is mild (Reiss, 1994). For exam-
ple, researchers have demonstrated that persons with MR often look
for outside approval (Zigler & Burack, 1989) and may readily agree
with an interviewer’s leading questions. For these reasons, a clinician
must often rely on observable behavior and caregiver report rather
than self-report. The three most common methods for assessing social
skills are behavioral observations, role-playing, and checklists
(Bellack, 1979).

BEHAVIORAL OBSERVATIONS

   Observation techniques can be conducted in either naturalistic or
analogue conditions. The most direct form of assessment is the obser-
vation of behavior within the actual environment (Shapiro &
Browder, 1990). Naturalistic observation involves several raters who
assess the individual on discrete social responses determined prior to
the assessment (i.e., eye contact, use of gestures). Observing the indi-
vidual in a naturalistic setting is often preferred because it allows cli-
                       Bielecki, Swender / SOCIAL SKILLS ASSESSMENT   697


nicians to sample behavior in the actual environment in which it
occurs, surrounded by the people typically interacting with the indi-
vidual and affecting relevant contingencies. Because this type of
assessment occurs in the natural environment, results are usually more
generalizable across setting and time (Gettinger & Kratochwill,
1987). There are some problems with this procedure. First, it is both
costly and time-consuming, especially if the target behavior occurs
infrequently. Second, the presence of an observer can cause reactivity
with participants who may not exhibit their normal behavior. When
observation of an individual in the natural setting is not possible,
analogue settings may be used.

ROLE-PLAYING

   Analogue observation often involves presentation of a role-play or
simulated situation to which the individual responds. Typically, the
experimenter provides a description of a scene and the individual acts
out how he or she would respond in the situation. Role-playing allows
the clinician to evaluate normally low-frequency behavior in a cost-
effective manner. Several techniques have been developed to assess
the interpersonal problem-solving skills of individuals with MR.
They include the Behavioral Social Skills Assessment (BSSA) (Cas-
tles & Glass, 1986), the Social Problem Solving Test (SPST) (Castles
& Glass, 1986), and the Means-End Problem Solving Procedure
(MEPS) (Platt & Spivack, 1975).
   The BSSA consists of 12 problem vignettes that were developed
for use with role-play scenarios. The participant is read a description
of the problem situation and shown an accompanying videotaped
enactment. The individual is then asked to respond to the TV actors
just as he or she would if the scenario were actually occurring. The
measure has high interrater reliability (r = .93) but low test-retest reli-
ability (r = .70). The MEPS and SPST also consist of problem
vignettes but they are written in an open-middle format. Rather than
working out the solution to a problem, the participant is given a prob-
lem situation and its resolution and is then asked to provide a story that
will connect the beginning with the end. Several probes are given to
encourage the generation of different solutions. Responses are
698   BEHAVIOR MODIFICATION / September 2004


audiotaped and later transcribed for scoring. Researchers have dem-
onstrated the scales have moderate to high reliability (MEPS:
interrater r = .96, test-retest r = .69; SPST: interrater r = .93, test-retest
r = .61) (Mathias & Nettlebeck, 1992; Castles & Glass, 1986) but
questions have been raised regarding the validity of these behavioral
role-play tests.
   Castles and Glass (1986) estimated the discriminant validity of the
BSSA, the SPST, and the Interpersonal Self-Efficacy Scale (ISES) by
calculating the intercorrelations among the three measures and corre-
lating each of the three measures with IQ. Correlations were modest (r
ranging from .06 to .47). Matson et al. (1986) also demonstrated that
role-play measures correlate poorly with other social skills assess-
ment techniques. These tests do not correlate with appropriate or inap-
propriate social interactions, peer or staff measures of social behavior,
or scores on self-report measures.
   An additional weakness of role-play assessments such as the
BSSA, MEPS, and SPST is they are verbally demanding measures.
Role-play situations are difficult to do with persons with severe dis-
abilities because such simulations require complex communication.
An individual with severe MR would not have the cognitive capacity
to generate a number of solutions much less be able to articulate the
steps involved in solving the problem. For this reason, the most com-
monly used source of information regarding the social skills of men-
tally retarded people is an informant who is familiar with that individ-
ual’s typical behavior.

CHECKLISTS

   Behavior checklists and rating scales are the simplest and most fre-
quently used tools to summarize skills that have been observed in per-
sons with severe and profound MR (Browder & West, 1992). They are
relatively quick and inexpensive, and they allow a clinician to obtain a
wide range of information from a variety of informants with little dif-
ficulty. As such they are often the only practical way to systematically
assess social skills in applied settings. However, informant-based
evaluations have been criticized because they lack psychometric
soundness (e.g., problems with reliability between raters and across
                      Bielecki, Swender / SOCIAL SKILLS ASSESSMENT   699


time), they lack precise terminology, and informant biases can affect
the results (Marchetti & Campbell, 1990). A number of rating scales
have been developed for assessing social skills. However, only a few
have been designed to assess deficits and excesses of social skills, at
least in part, in individuals with MR. They include adaptive behavior
scales such as the American Association of Mental Deficiency's
(AAMD) Adaptive Behavior Scale and Vineland Adaptive Behavior
Scales (VABS), and social skills measures such as the Social Perfor-
mance Survey Schedule (SPSS), the Matson Evaluation of Social
Skills for Individuals with Severe Retardation (MESSIER), and the
Assessment of Social Competence (ASC).

   Adaptive behavior scales. Measures of adaptive behavior generally
place considerable emphasis on social skills and therefore contain
domains with items designed to measure behaviors linked to this con-
struct. However, these scales only contain a limited number of items
pertaining to social skills and they reflect only social abilities rather
than social deficits or inappropriate behavioral excesses. Overall,
measures of adaptive behavior are most useful in providing a global
picture of an individual’s social skills functioning (Marchetti &
Campbell, 1990), but less useful in identifying specific social skills
deficits to target for remediation (Bellack, 1979), or for measurement
of treatment efficacy (Matson & Hammer, 1996; Perry & Factor,
1989). Despite these limitations, two of the most widely used adaptive
behavior scales, the VABS and the AAMD Adaptive Behavior Scale,
will be considered.
   The VABS consists of three editions: the Interview Expanded Form
(Sparrow, Galla, & Cecchetti, 1984a), the Interview Survey Form
(Sparrow, Galla, & Cecchetti, 1984b), and the Classroom Edition
(Sparrow, Galla, & Cecchetti, 1985). The Expanded and Survey forms
are normed for use with persons with MR. The tests must be adminis-
tered by someone with a graduate degree and specific training in test
administration and interpretation. The respondent is an adult who is
familiar with the person being evaluated. The interviewer uses a
semistructured interview method in which general questions are
asked within each domain. More specific questions are asked as
needed. The Expanded and Survey forms both contain Communica-
700   BEHAVIOR MODIFICATION / September 2004


tion, Daily Living Skills, Socialization, Motor Skills, and Mal-
adaptive Behavior domains and an Adaptive Behavior Composite. Of
these domains, the Socialization Domain and, to a much lesser extent,
the Communication and Maladaptive Behavior domains contain
items that fall under the rubric of social skills, depending on the defi-
nition being used. The Socialization Domain consists of 134
(Expanded), 66 (Survey), and 53 (Classroom) items that are further
classified into the subdomains of Interpersonal Relationships, Play
and Leisure Time, and Coping Skills. Items range from very basic
(e.g., looks at face of caregiver) to more complex (e.g., apologizes for
unintentional mistakes) behaviors. The Communication Domain con-
tains the subdomains Receptive, Expressive, and Written. Although
this domain consists of items that primarily reflect behaviors related
to basic communication skills, there are some items that can also be
seen to overlap with social skills (e.g., spontaneously relates experi-
ences in simple terms, listens attentively to instructions, smiles in
response to a caregiver). Similarly, the Maladaptive Behavior Domain
contains items that are also related to social skills (e.g., shows lack of
consideration, swears in inappropriate situations, has poor eye con-
tact). Each item on the VABS is rated 0 (no, never), 1 (sometimes or
partially), 2 (yes, usually), or DK (don’t know), although some items
may be rated N (no opportunity). Standard Score, National Percentile
Rank, Adaptive Level, and Age Equivalent Score are calculated.
   The VABS has supplementary norms for Ambulatory and
Nonambulatory mentally retarded people in residential facilities and
mentally retarded adults in nonresidential facilities (Sparrow et al.,
1984a, 1984b). Supplementary norms for persons with autism have
also been published (Carter et al., 1998). The VABS is considered to
have good test-retest reliability, interrater reliability, subscale
intercorrelations, and construct and criterion validity. The test manu-
als can be consulted for more details regarding reliability and validity.
In addition, standard errors of prediction and confidence intervals
have been published that can be used by clinicians when interpreting
changes in obtained scores across repeated administration (Atkinson,
1990).
   The American Association of Mental Retardation (AAMR) Adap-
tive Behavior Scale–Residential and Community, Second Edition
                      Bielecki, Swender / SOCIAL SKILLS ASSESSMENT   701


(ABS-RC:2) (Nihira, Leland, & Lambert, 1993), is an adaptive behav-
ior scale designed and normed for use with developmentally disabled
persons through 79 years of age. The scale contains 356 items and is
completed in an interview format with a respondent who knows the
individual being examined. The test is divided into two parts: (a) Indi-
vidual Responsibility and Daily Living and (b) Social Behaviors. Part
1 contains the subdomains of Independent Functioning, Physical
Development, Economic Activity, Language Development, Numbers
and Time, Domestic Activity, Prevocational/Vocational Activity,
Self-Direction, Responsibility, and Socialization. Part 2 consists of
Social Adjustment, and Personal and Social Responsibility. Part 2’s
subdomains are Social Behavior, Conformity, Trustworthiness, Ste-
reotyped and Hyperactive Behavior, Self-Abusive Behavior, Social
Engagement, and Disturbing Interpersonal Behavior. Items are scored
yes/no or statement that best applies is selected. Domain and
Subdomain age, percentile, and standard scores are calculated. The
ABC:RC-2 does not have a total score. The unidimensionality of the
five factors proposed in the AAMR Adaptive Behavior Scales manual
has been questioned and a two-factor model proposed (Stinnett,
Fuqua, & Coombs, 1999).

   Social skills measures. The SPSS was developed by Lowe and
Cautela in 1978 (Lowe & Cautela, 1978). It is a 100-item measure
used to assess positive and negative social behaviors. Items are scored
on a 5-point Likert-type scale (0 = not at all, 1 = a little, 2 = a fair
amount, 3 = much, 4 = very much). Typical items include the follow-
ing: has eye contact, shows enthusiasm for others’good fortune, inter-
rupts others, threatens others verbally or physically, and knows when
to leave people alone. The scale was developed for adults of normal
intelligence and could be used as a self-report or significant-other rat-
ing scale. Numerous studies have demonstrated the scale has adequate
psychometric properties (internal consistency, r = .88; test-retest reli-
ability, r = .87). The SPSS has also been shown to correlate with
other’s ratings of a patient’s social skills (Lowe & D’Ilio, 1985).
   Matson, Helsel, Bellack, and Senatore (1983) revised the SPSS for
use with individuals with mild and moderate MR. The resulting scale
is a multidimensional measure that is completed by a family member
702   BEHAVIOR MODIFICATION / September 2004


or direct-care staff member who knows the individual well and has
worked with him or her for at least 6 months. The scale consists of 57
of the original 100 SPSS items. These items were retained based on
Pearson product-moment correlations of .30 or greater with the total
score. A principal components factor analysis was performed on the
SPSS scores of 207 adults with MR (Matson et al., 1983). Four factors
emerged from the data: Appropriate Social Skills, Communication
Skills, Inappropriate Assertion, and Sociopathic Behavior. The pri-
mary limitation of the revised scale is the lack of research examining
the reliability and validity of the measure. The SPSS also lacks norms
for the MR population, and its applicability has only been studied with
regard to individuals in the mild and moderate ranges of MR.
   The MESSIER (Matson, 1994) was specifically designed to assess
social skills in persons with severe and profound MR. It consists of 85
items generated from a review of existing social skills measures for
children and adults, items from the social and communication
domains of adaptive behavior scales, and items nominated by experts.
The items are grouped into six clinically derived subscales: (a) posi-
tive verbal, (b) positive nonverbal, (c) positive general, (d) negative
verbal, (e) negative nonverbal, and (f) general negative. Each item is
rated on frequency using a 4-point Likert-type scale: 0 (never), 1
(rarely), 2 (sometimes), and 3 (often). The MESSIER is administered
by a trained examiner in a semistructured interview format. The
respondent should be a caregiver who has worked for the individual
for at least 6 months. Items endorsed are then transcribed onto a
scoring profile under their respective subscales.
   The psychometric properties of the MESSIER have been studied.
Internal consistency as measured by coefficient alpha was high for the
MESSIER (r = .94). The test-retest reliability, as measured by a
Pearson product-moment correlation, was also quite high (r = .86),
indicating that peoples’ ratings remained fairly consistent over short
periods of time. Good correlations were also found between raters for
the total MESSIER score (r = .73) and for all positive (r = .79) and
negative MESSIER items (r = .71). These numbers support the utility
of the MESSIER for making consistent social skills ratings (Matson,
LeBlanc, & Weinheimer, 1999).
                       Bielecki, Swender / SOCIAL SKILLS ASSESSMENT    703


    The convergent validity of the MESSIER was evaluated by com-
paring it to (a) the Socialization domain of the VABS and (b)
sociometric ratings. Significant positive correlations were found
between corresponding MESSIER subscales and VABS subdomains
on social behaviors. Sociometric ratings also correlated highly with
total MESSIER scores for 80% of raters, suggesting that the ratings on
the MESSIER seem to accurately reflect a person’s social status.
    Although the MESSIER and VABS (Socialization Domain) seem
to measure similar constructs, the MESSIER has several advantages
over the VABS in measuring social skills in persons with severe or
profound MR. First, the MESSIER has a larger number of social-
skills-specific questions than the VABS. Second, the MESSIER can
be used to illustrate an individual’s social skills and deficits, as well as
maladaptive behavior excesses, whereas the VABS is limited to pro-
viding information about social abilities only. This information can be
useful when developing treatment and habilitation plans.
    The ASC (Meyer et al., 1985) was designed to assess social skills at
all levels of intellectual functioning. It contains 252 discrete behaviors
that are organized into 11 dimensions of social competence. Within
each of the 11 dimensions, the items are grouped into eight levels rep-
resenting a hierarchy of increasing social ability. Items include behav-
iors that may be referred to as behavior problems. The ASC is to be
completed by someone who knows the individual well. Each item is
given one of three scores: “no evidence of the behavior,” “someone
else’s report of the behavior only,” and “direct observation of the
behavior.” A person passes a level if at least one item is passed within
that level. A total score on the ASC consists of the sum of the scores
for each of the 11 functions. Overall scores range from 11 to 87.
    The initial psychometric properties of the ASC have been studied.
The measure proved to be internally consistent when administered to
a sample of children and young adults diagnosed with MR (children, r
= .93; young adults, r = .95). The ASC has also demonstrated good
test-retest reliability (r = .90) and adequate interrater reliability (r =
.70) within a school-age population of students with severe and pro-
found MR. Convergent validity was assessed by examining correla-
tions between the ASC and AAMR diagnoses. Scores on the total
ASC correlated moderately with overall levels of MR (r = .51). These
704   BEHAVIOR MODIFICATION / September 2004


results indicate the ASC shows promise as a valid and reliable mea-
sure of social competence, but a weakness is its apparent ceiling effect
for young adults.


           IMPLICATIONS AND FUTURE DIRECTIONS

   Persons with MR experience varying degrees of deficits in social
skills, which can lead to isolation, stigmatization, lack of coping
skills, increased maladaptive behaviors, and increased rates of
psychopathology (Matson et al., 2000; Matson & Hammer, 1996).
Social skills deficits and excesses are a defining aspect of MR and this
fact is reflected in the amount of emphasis placed on social skills
within measures of adaptive functioning (Sparrow et al., 1984a). Spe-
cific measures of interactive social skills can be combined with more
global measures of functioning as part of an overall, individualized
social skills training program. Despite gains in assessment and treat-
ment technologies related to social skills in persons with developmen-
tal disabilities, more work needs to be done by researchers and clini-
cians in this area to help reverse the emphasis found in most
institutions and community settings on the containment of behavior
rather than on proactive skills building. Social skills training has been
shown to be effective, and should be a priority for persons with devel-
opmental disabilities (Matson & Hammer, 1996). With the advent of
measures such as the MESSIER and the SPSS, researchers and clini-
cians have at their disposal reliable and valid methods for selecting
target behaviors for intervention and for tracking treatment effective-
ness. As such, more studies that assess the effectiveness of social skills
training in persons with MR are needed to identify and develop the
most effective training methods.
   Future tasks for researchers in this area should include the estab-
lishment of scaling norms for mentally retarded persons in the com-
munity. Much of the research completed thus far has been conducted
within large, long-term residential settings. Reliability and validity
studies for the existing instruments are needed to insure the feasibility
of their use within a community setting. Research with community-
based samples may also help illuminate specific social skills compo-
                             Bielecki, Swender / SOCIAL SKILLS ASSESSMENT              705


nents that predict successful community placement. Such research
could aid in the development of socially valid interventions. Further-
more, in following Goldfried and D’Zurilla’s (1969) model of content
validity for behavioral assessment techniques, additional situations
and responses within community settings could be identified, studied,
and possibly added to future editions of these social skills measures.
Given the current political environment that emphasizes community
placement, the need for such research is past due.
   Future research should also focus on developing norms for children
with MR. Although some scales, such as the ASC (Meyer et al., 1985),
have been normed for children with MR, such norms do not exist for
MESSIER, SPSS, and other measures. Measures of adaptive behavior
generally contain norms for children with physical handicaps such as
deafness, but do not have supplementary norms for MR such as those
that exist for adults. Attention also needs to be given to the empirical
validation of a battery method for assessing social skills in mentally
retarded persons. Much work has been done within the field toward
developing different behavioral assessment techniques (behavioral
observations, checklists, behavioral interviews, etc.) and examining
their reliability, validity, and practicality, but there has not been suffi-
cient attention in the literature on standardizing a battery approach to
the assessment of social skills in this population. Such a battery could
become an important component of an overall assessment package.
Researchers could then focus on how social skills assessment inter-
faces with other types of assessment such as intellectual assessment,
assessment of problem behaviors, and assessment of psycho-
pathology. More knowledge could then be gained regarding the rela-
tionship between specific social skills variables and variables from
these other areas of assessment. Finally, research should focus on the
development of more specialized social skills assessment instru-
ments, particularly for those areas that are found to be crucial in
improving the quality of life for mentally retarded persons.


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   JoAnne Bielecki (M. A.) is currently pursuing her doctoral degree in psychology at Loui-
   siana State University under the supervision of Dr. Johnny L. Matson. She will be com-
   pleting her predoctoral internship in June of 2003 at UCLA’s Neuropsychiatric Institute
   and Hospital. JoAnne received her bachelor’s degree from the University of Connecticut
   in Storrs.

   Dr. Stephen L. Swender is the Associate Director of Psychology at Pinecrest Develop-
   mental Center, Central Louisiana State Hospital APA-Approved Internship Consortium.
   His interests include the assessment and treatment of behavior problems and psychiatric
   conditions in the developmentally disabled.

				
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