NDIA Accountability Project

This project is in DRAFT

Evaluation of CANS, ABAS-3 and LSP-16 outcome measures

‹ PrevPage 1 of 12 · Source p. 35Next ›

FOI 24/25- 0013 DOCUMENT 35

Evaluation of CANS, ABAS-3 and LSP-16 outcome measures

The content of this document is OFFICIAL. Please note: The research and literature reviews collated by our TAB Research Team are not to be shared external to the Branch. These are for internal TAB use only and are intended to assist our advisors with their reasonable and necessary decision-making. Delegates have access to a wide variety of comprehensive guidance material. If Delegates require further information on access or planning matters, they are to call the TAPS line for advice. The Research Team are unable to ensure that the information listed below provides an accurate & up-to-date snapshot of these matters

Research question: For each functional outcome measure (CANS; ABAS-3; LSP-16):

  • What is the intended population?
  • What populations is the measure reliable and valid for?
  • How can the measure be used to maximise utility in prediction of care needs?
  • What are the limitations?
  • What are the risks and benefits of using the measure:
    • as a stand alone tool?
    • as part of a more comprehensive assessment?
    • by a therapist who is unfamiliar with the client?

Date: 23/1/24 Requestor: Sarah redacted: s22(1)(a)(ii) - irrelev Endorsed by: Shannon redacted: s22(1)(a)(ii) - irrelev Researcher: Aaron redacted: s22(1)(a)(ii) - irrelevant ma Cleared by: Aaron redacted: s22(1)(a)(ii) - irrelevant ma

Page 379 of 425

FOI 24/25- 0013

1. Contents

Evaluation of CANS, ABAS-3 and LSP-16 outcome measures …………………………………………. 1

  1. Contents ……………………………………………………………………………………………………….. 2
  2. Summary ………………………………………………………………………………………………………. 2
  3. Care and Needs Scale …………………………………………………………………………………….. 3
  4. Adaptive Behavior Assessment System, 3rd Edition …………………………………………….. 3
  5. Abbreviated Life Skills Profile (LSP-16) ……………………………………………………………… 4
  6. Summary of outcome measure features …………………………………………………………….. 6
  7. References ……………………………………………………………………………………………………. 9

2. Summary

This paper examines the scope, psychometric properties and other features of three commonly used outcome measures: Care and Needs Scale (CANS), Adaptive Behavior Assessment System, 3rd Edition (ABAS-3) and Abbreviated Life Skills Profile (LSP-16).

The outcome measures vary from narrow to general in scope. CANS is intended to assess support needs for people over 16 years with moderate to severe traumatic brain injury. LSP-16 is designed for adults with severe or chronic mental health conditions. ABAS-3 is more general and developers suggest it can be used to assess adaptive behaviours for anyone under 89 years.

None of the three outcome measures are intended to be a standalone tool. It is intended that all three are used in combination with other measures, assessments and information gathering methods to generate a fuller picture of a person’s functional capacity or support needs.

The source of the information used to completed the assessments varies. ABAS-3 can be completed by parents, teachers, co-workers, friends or clinicians familiar with the client and it is recommended that information is collected from multiple sources. LSP-16 is usually completed by a clinician but preference should be given to the treating professional or support person with the greatest understanding of the client’s situation. CANS is completed by a clinician but familiarity may be gained through an informal interview with the client or their carer/proxy, or by sufficiently detailed medical records.

Results are further summarised in 6. Summary of outcome measure features.

Page 380 of 425

FOI 24/25- 0013

3. Care and Needs Scale

CANS was developed to assess support needs for people over 16 years with moderate to severe traumatic brain injury (TBI) (Honan et al, 2019; Tate, 2017; Soo et al, 2007). A version for younger people (PCANS) was also developed (Tate et al, 2014; Soo et al, 2010). CANS can be completed in an interview format with the client or proxy or by a clinician with sufficient knowledge of the client (Tate, 2017). The manual also notes:

the CANS can be completed on the basis of information derived from the patient’s medical record, scales of disability and so forth. In situations where the clinician has knowledge of the patient/client and direct interview is not required, the CANS will only take a few minutes to complete. Interview format with an informant generally takes somewhat longer (10-15 mins).“ (Tate, 2017, p.11)

Few studies have examined the psychometric properties of the CANS. The only studies found were authored by the developers. Existing evidence indicates excellent inter-rater and test- retest reliability as well as adequate convergent and criterion validity (Tate, 2017; Soo et al, 2007; Tate, 2004).

There are some sources of potential bias which may impact reliability. For example, Honan et al (2019) note that the assessment depends on subjective judgement of the clinician and that training is required in order to achieve high levels of inter-rater reliability. Further, the manual states that it is not advised to separate out the support needs that may be due to conditions other than TBI, such as support needs due to health conditions or aging (Tate, 2017). However, this may impact reliability given that CANS has only been validated for TBI populations and not general or other clinical cohorts.

4. Adaptive Behavior Assessment System, 3rd Edition

ABAS-3 was originally designed for people with intellectual and developmental conditions. It has been standardised on a large scale and developers now suggest it can be used for anyone under the age of 89 years, including:

persons who exhibit the effects of trauma, display attention-deficit/hyperactivity disorder (ADHD), disruptive behaviors, anxiety disorders, mood disorders, neurocognitive impairments, autism spectrum disorder (ASD), developmental delays and disorders, eating disorders, health impairment, language disorders, learning disabilities and disorders, neurobehavioral and neurodevelopmental disorders, motor impairment, physical disabilities, personality disorders, psychotic and thought disorders, sensory impairments, sleep disorders, substance-related disorders, or traumatic brain injury (Harrison & Oakland, 2015, p.57).

Most evidence of psychometric properties of ABAS-3 comes from studies conducted by the tool’s developers (Hayden-Evans et al, 2022). There is evidence of excellent internal consistency, test-retest reliability and adequate to excellent inter-rater reliability and alternate-

Page 381 of 425

FOI 24/25- 0013

forms reliability. There is evidence of excellent content, construct and criterion validity (Hayden-Evans et al, 2022; Harrison & Oakland, 2015.

Validity studies targeted at specific populations were conducted for autism, intellectual disability, and ADHD. In addition, validity studies were conducted for the second edition (ABAS-II) for people with:

developmental delay, low birth weight, perinatal respiratory distress, chromosomal abnormalities, fetal alcohol syndrome and prenatal drug exposure, Down syndrome, motor and physical disorders, expressive and receptive language disorders, behavioural and emotional issues, learning disabilities, and hearing impairments; adults with Alzheimer’s and unspecified neuro-psychological disorders (Harrison & Oakland, 2015, p.127).

The developers argue that ABAS-II is sufficiently similar to ABAS-3 for the previous version’s evidence to stand in favour of the current version (Harrison & Oakland, 2015). However, there are some notable differences. For example, ABAS-3 scores are generally higher than ABAS-II scores (von Buttlar et al, 2021; Harrison & Oakland, 2015).

Some limitations were described in the literature. Despite evidence of good psychometric properties, Hayden-Evans et al (2022) note that ABAS-3 does not have very good coverage against the International Classification of Functioning, Disability and Health (ICF) codes deemed most relevant to children with autism. Further, while efforts were made to ensure ABAS-3 was comprehensive, it should not be relied on as the sole instrument of assessment. Clinicians should also look to other data such as “information derived from concurrent or former assessments; detailed interviews and history taking; developmental, school, or work records; and direct observations“ (Harrison & Oakland, 2015, p.7).

5. Abbreviated Life Skills Profile

LSP-16 is a measure of community functioning and disability for people with severe or chronic mental health conditions (Little, 2013; Kightley et al, 2010; Pirkis et al, 2005a; Rosen et al, 2001). It was developed for Australian public mental health services to reduce the rating burden on clinicians (NMHIDEAP, 2013; Little, 2013; Pirkis et al, 2005a). As part of the National Outcome Casemix Collection (NOCC), LSP-16 is now required to be used at certain points in the treatment cycle for adults receiving specialised public sector mental health services across Australia (AMHOCN, 2021a; Little, 2013; Rosen et al, 2001).

It is a shortened form of the 39 item Life Skills Profile (LSP-39). Rosen et al (1989) developed the original LSP-39 to assess the daily functioning of people with schizophrenia and it has since been applied generally for people with mental health or psychiatric conditions (Burgess et al, 2017; Deady et al, 2005; Pirkis et al, 2005a). The developers note that only a few of the items in the Communication subscale of LSP-39 related directly to features specific to schizophrenia (Rosen et al, 1989). The Communication subscale was removed in the development of LSP-16 (Deady et al, 2005; Rosen et al, 2001).

Page 382 of 425

FOI 24/25- 0013

Few studies have investigated the psychometric properties of LSP-16. There is equivocal evidence of concurrent and predictive validity. It was shown to correlate with Health of the Nation Outcome Scale and LSP-39 but not with the Behaviour and Symptom Identification Scale (Burgess et al, 2017). There is some evidence that LSP-16 can predict clinical outcomes such as hospital admission and length of stay, though other studies were not able to find significant correlations (Parker et al, 2020; Burgess et al, 2017; Deady, 2009). There is evidence of poor construct validity (Little, 2013). Studies have found moderate to good inter- rater reliability and test-retest reliability (Burgess et al, 2017). Some studies suggest potential problems for LSP-16’s sensitivity to change but no study has investigated this directly (Sammels et al, 2022; NMHIDEAP, 2013).

More research has been conducted on the psychometric properties of LSP-39. The longer version has been shown to be a valid and reliable measure for people with schizophrenia and severe mental health issues. There is evidence that LSP-39 has moderately good content, construct, concurrent and predictive validity, adequate inter-rater reliability, high test-retest reliability and good sensitivity to change (Burgess et al, 2017; Deady, 2009; Pirkis et al, 2005a).

Some argue that evidence for LSP-39 can be used to support the validity and reliability of LSP- 16 as all 16 items of the abbreviated form are included in the longer version (Pirkis et al, 2005a; Rosen et al, 2001). And LSP-16 has been shown to correlate with LSP-39 (Burgess et al, 2017; Rosen et al, 2001). However, there are some important differences between the two forms. For example, LSP-39 is a strengths-based scale with higher scores indicating greater functioning in a particular task, whereas LSP-16 is an impairment-based scale with higher scores indicating greater impairment (Pirkis et al, 2005a; Rosen et al, 2001).

Several limitations of LSP-16 have been identified. A review of the NOOC in 2013 recommended removing the LSP-16 from the collection due to its reported limitations. Despite the measure being mandatory, the 3-month period between reviews meant that it was not administered to most service users, who are in community rehabilitation settings for less than 3 months. While its use in capturing some information around daily living skills in adults was seen as useful, it was found to be inappropriate for children and adolescents, older people and those in a forensic setting. In addition:

Issues were noted in relation to particular items, including domains that are not captured, the glossary and the language of the measure. Participants consistently raised concerns regarding items 10, 11 and 16, which they thought required clarification in the glossary. Some participants suggested that the tool does not capture fluctuations in functioning between reviews, which they thought was of particular clinical relevance. The language was felt to be outdated, not strengths based and not supporting the recovery agenda… Participants suggested that there were more useful types of information to collect, including capturing aspects of social inclusion (NMHIDEAP, 2013, p.130).

Page 383 of 425

FOI 24/25- 0013

6. Summary of outcome measure features

Tool Population Psychometric properties Benefits and limitations Used as a standalone tool Rater
ABAS-3 Originally designed for people with intellectual and developmental disabilities. Developers now suggest it can be used for anyone under 89 years (Harrison and Oakland, 2015).

May not be the most appropriate instrument for moderate to severe TBI (Wearne et al, 2020; von Buttlar et al, 2021; Honan et al, 2019)		 Evidence of adequate to excellent validity, and internal consistency, standard error of measurement, test-retest reliability, interrater reliability, cross-form consistency, and alternative-forms reliability (Tamm et al, 2022; Hayden-Evans et al, 2022; von Buttlar et al, 2021; Hansen et al, 2019; Harrison & Oakland, 2015). Can incorporate multiple sources of information (Harrison & Oakland, 2015).

May be particularly useful in assessing activity and performance in ADHD and early neurodevelopmental conditions (Darcy et al, 2022).

Standardised on a large sample. However, it is an entirely US-based sample that skews to higher socio-economic status and educational achievement.

May require adjustment to achieve cross-cultural validity (Prokopiak & Kirenko, 2020; Emam et al, 2020).		 Should be used as one in a battery of measures and different information gathering tools (Darcy et al, 2022; Harrison & Oakland, 2015). Can be used as a self-report tool or by parents, teachers, clinicians or anyone familiar with the client.

Results are more useful if multiple sources are used to gather information (Harrison & Oakland, 2015).
CANS Adults over 16 years with moderate-severe traumatic brain injury (Hunter, 2021; Honan et al, 2019; Tate, 2017; Tate, 2004). Excellent inter-rater and test-retest reliability and evidence of criterion and convergent validity (Honan et al, 2019; Tate, 2017; Soo et al., 2007) Provides information on both type and level of support needs (Soo et al, 2007). Recommended as a measure of support needs and not functional capacity. Other tools should be used alongside CANS to provide detail of client’s support needs Can be completed by clinician with thorough knowledge of the patient, in interview format with client or proxy, or with access to comprehensive

Page 384 of 425

FOI 24/25- 0013

Tool Population Psychometric properties Benefits and limitations Used as a standalone tool Rater
CANS (cont.) Relies on clinical, subjective judgment which can affect reliability.

Training required for rater to achieve high interrater reliability.		 (Hunter, 2021; Honan et al, 2019). medical records (Tate, 2017).

Suitable for use by clinicians from different disciplines (Soo et al, 2007).
LSP-16 Adults with severe or chronic mental health conditions (Rosen et al, 1989; Rosen et al, 2001).

May not be appropriate for older people (>65 years), children/adolescents or patients in a forensic setting (AMHOCN, 2021a-b; NMHIDEAP, 2013).		 Some equivocal evidence for concurrent and predictive validity (Parker et al, 2020; Burgess et al, 2017; Deady, 2009).

Single study looking at construct validity found poor performance (Little, 2013).

Moderate to good inter-rater reliability and test-retest reliability (Burgess et al, 2017).

No studies found showing sensitivity to change. Some evidence that LSP-16 is not sensitive to change (Sammels et al, 2022; NMHIDEAP, 2013).

More evidence of good psychometric properties for LSP-39 and some evidence that LSP-16 correlates with LSP-39		 Brief and generally considered easy to use and understand with minimal jargon (AMHOCN, 2021a-b; Rosen et al, 2001; Rosen et al, 1989). Though some studies suggest difficulties in understanding key terms (NMHIDEAP, 2013).

Equivocal evidence that LSP-16 is useful in predicting clinical outcomes (Parker et al, 2020; Burgess et al, 2017; Deady, 2009).

May be particularly useful for assessing daily living skills (Leifker et al, 2011; NMHIDEAP, 2013).

Aim of LSP-39 is to emphasise strengths rather than weaknesses (Rosen et al, 1989; Rosen et al, 2001). This feature is		 Due to limitations, AMHOCN (2021a) suggest LSP-16 should only be used as part of a more comprehensive assessment. Rater must be familiar with the client (Sammels et al, 2023; Kightley et al, 2010; Eagar et al, 2000).

Usually administered by a clinician (doctor, therapist or case manager) (Sammels et al, 2023; Parker et al, 2020; Burgess et al, 2015; Little, 2013; Burgess et al, 2005; Pirkis et al, 2005a; Eagar et al, 2000).

Some sources state carers and family members can administer LSP-16 (Puig et al, 2013; Deady, 2009; Eagar et al, 2000).

Rater must use all available sources of information (AMHOCN, 2021a).

Page 385 of 425

FOI 24/25- 0013

Tool Population Psychometric properties Benefits and limitations Used as a standalone tool Rater
LSP-16 (cont.) (Burgess et al, 2017; Purkis et al, 2005a; Rosen et al, 2001).

Minimal evidence of validity and reliability in adolescents with early onset schizophrenia (Puig et al, 2013).		 lost in LSP-16, which may use language that is out-dated and not strengths based (Burgess et al, 2017; NMHIDEAP, 2013).

Page 386 of 425

FOI 24/25- 0013

7. References

Australian Mental Health Outcomes and Classification Network. (2021a). National Outcomes and Casemix Collection (NOCC) basic training manual: adult services 2nd Edition. https://www.amhocn.org/__data/assets/pdf_file/0003/731019/Adult-Basic-NOCC- Training-Manual.pdf Australian Mental Health Outcomes and Classification Network. (2021b). National Outcomes and Casemix Collection (NOCC) basic training manual: child and adolescent services. https://www.amhocn.org/ data/assets/pdf file/0019/731026/Child-Adolescent-Basic- NOCC-Training-Manual.pdf Australian Mental Health Outcomes and Classification Network. (2021c). Rater and clinical utility training manual: Adult. Rev. ed. Sydney: Australian Mental Health Outcomes and Classification Network. https://www.amhocn.org/ data/assets/pdf file/0004/694030/Adult Rater Clinical Utilit y Training Manual 100523.pdf Australian Mental Health Outcomes and Classification Network. (2021d). Rater and clinical utility training manual: Child and adolescent. Rev. ed. Sydney: Australian Mental Health Outcomes and Classification Network. https://www.amhocn.org/ data/assets/pdf file/0009/694467/CA Rater-and-Clinical- Utility-Manual-100523.pdf Burgess, P. M., Harris, M. G., Coombs, T., & Pirkis, J. E. (2017). A systematic review of clinician-rated instruments to assess adults’ levels of functioning in specialised public sector mental health services. The Australian and New Zealand journal of psychiatry, 51(4), 338–354. https://doi.org/10.1177/0004867416688098 Burgess, P., Pirkis, J., & Coombs, T. (2015). Routine outcome measurement in Australia. International review of psychiatry, 27(4), 264–275. https://doi.org/10.3109/09540261.2014.977234 Burgess, P., Coombs, T., Clarke, A., Dickson, R., & Pirkis, J. (2012). Achievements in mental health outcome measurement in Australia: Reflections on progress made by the Australian Mental Health Outcomes and Classification Network (AMHOCN). International journal of mental health systems, 6(1), 4. https://doi.org/10.1186/1752- 4458-6-4 D’Arcy, E., Wallace, K., Chamberlain, A., Evans, K., Milbourn, B., Bölte, S., Whitehouse, A. J., & Girdler, S. (2022). Content validation of common measures of functioning for young children against the International Classification of Functioning, Disability and Health and Code and Core Sets relevant to neurodevelopmental conditions. Autism : the international journal of research and practice, 26(4), 928–939. https://doi.org/10.1177/13623613211036809

Page 387 of 425

FOI 24/25- 0013

Deady, M. (2009). A review of screening, assessment and outcome measures for drug and alcohol settings. Drug and Alcohol and Mental Health Information Management Project. Sydney: NSW Department of Health. https://www.drugsandalcohol.ie/18266/1/NADA A Review of Screening%2C Assess ment and Outcome Measures for Drug and Alcohol Settings.pdf Eagar K, Buckingham B, Coombs T, Trauer T, Graham C, Eagar L & Callaly T. (2000). Outcome Measurement in Adult Area Mental Health Services: Implementation Resource Manual. Department of Human Services Victoria. https://www.vgls.vic.gov.au/client/en_AU/search/asset/1160101/0 Emam, M. M., Al-Sulaimani, H., Omara, E., & Al-Nabhany, R. (2019). Assessment of adaptive behaviour in children with intellectual disability in Oman: an examination of ABAS-3 factor structure and validation in the Arab context. International journal of developmental disabilities, 66(4), 317–326. https://doi.org/10.1080/20473869.2019.1587939 Hansen, L. (2019). A Concurrent validity study of the Missouri Adaptive Ability Scale and the Adaptive Behavior Assessment System, Third Edition — Teacher Form. Murray State Theses and Dissertations. 149. https://digitalcommons.murraystate.edu/etd/149 Harrison, P. L., & Oakland, T. (2015). ABAS-3. Torrance: Western Psychological Services. Hayden-Evans, M., Milbourn, B., D’Arcy, E., Chamberlain, A., Afsharnejad, B., Evans, K., … & Girdler, S. (2022). An evaluation of the overall utility of measures of functioning suitable for school-aged children on the autism spectrum: A scoping review. International Journal of Environmental Research and Public Health, 19(21), 14114. Honan, C. A., McDonald, S., Tate, R., Ownsworth, T., Togher, L., Fleming, J., Anderson, V., Morgan, A., Catroppa, C., Douglas, J., Francis, H., Wearne, T., Sigmundsdottir, L., & Ponsford, J. (2019). Outcome instruments in moderate-to-severe adult traumatic brain injury: recommendations for use in psychosocial research. Neuropsychological rehabilitation, 29(6), 896–916. https://doi.org/10.1080/09602011.2017.1339616 Hunter, S. (2021). Occupational Therapy Australia response to question taken on notice at public hearing in Melbourne on 23 April 2021. Occupational Therapy Australia. https://everyaustraliancounts.com.au/wp-content/uploads/QoN 03 IA.pdf Kightley, M., Einfeld, S., & Hancock, N. (2010). Routine outcome measurement in mental health: feasibility for examining effectiveness of an NGO. Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists, 18(2), 167–169. https://doi.org/10.3109/10398560903473660 Leifker, F. R., Patterson, T. L., Heaton, R. K., & Harvey, P. D. (2011). Validating measures of real-world outcome: the results of the VALERO expert survey and RAND panel. Schizophrenia bulletin, 37(2), 334–343. https://doi.org/10.1093/schbul/sbp044

Page 388 of 425

FOI 24/25- 0013

Little J. (2013). Multilevel confirmatory ordinal factor analysis of the Life Skills Profile-16. Psychological assessment, 25(3), 810–825. https://doi.org/10.1037/a0032574 National Mental Health Information Development Expert Advisory Panel. (2013). Mental Health National Outcomes and Casemix Collection: NOCC Strategic Directions 2014 – 2024. Commonwealth of Australia, Canberra. https://www.amhocn.org/training-and-service- development/special-projects/nocc-strategic-directions-2014-2024 Parker, S., Arnautovska, U., Siskind, D., Dark, F., McKeon, G., Korman, N., & Harris, M. (2020). Community-care unit model of residential mental health rehabilitation services in Queensland, Australia: Predicting outcomes of consumers 1-year post discharge. Epidemiology and Psychiatric Sciences, 29, E109. https://doi.org/10.1017/S2045796020000207 Pirkis, J., Burgess, P., Kirk, P., Dodson, S., & Coombs, T. (2005a). Review of standardised measures used in the National Outcomes and Casemix Collection (NOCC). New South Wales Institute of Psychiatry. http://hdl.handle.net/10536/DRO/DU:30073558 Pirkis, J., Burgess, P., Coombs, T., Clarke, A., Jones-Ellis, D., & Dickson, R. (2005b). Routine measurement of outcomes in Australia’s public sector mental health services. Australia and New Zealand health policy, 2(1), 8. https://doi.org/10.1186/1743-8462-2-8 Prokopiak, A. & Kirenko, J. (2020). ABAS-3 – an instrument for assessing adaptive skills in people with an intellectual disability. Hrvatska revija za rehabilitacijska istraživanja, 56(2), 154-168. https://doi.org/10.31299/hrri.56.2.9 Puig, O., Penadés, R., Baeza, I., De la Serna, E., Sánchez-Gistau, V., Lázaro, L., Bernardo, M., & Castro-Fornieles, J. (2013). Assessment of real-world daily-living skills in early- onset schizophrenia trough the Life Skills Profile scale. Schizophrenia research, 145(1- 3), 95–100. https://doi.org/10.1016/j.schres.2012.12.026 Rosen, A., Hadzi-Pavlovic, D., & Parker, G. (1989). The life skills profile: a measure assessing function and disability in schizophrenia. Schizophrenia bulletin, 15(2), 325–337. https://doi.org/10.1093/schbul/15.2.325 Rosen, A., Trauer, T., Hadzi-Pavlovic, D., & Parker, G. (2001). Development of a brief form of the Life Skills Profile: the LSP-20. The Australian and New Zealand journal of psychiatry, 35(5), 677–683. https://doi.org/10.1080/0004867010060518 Sammells, E., Logan, A., & Sheppard, L. (2023). Participant Outcomes and Facilitator Experiences Following a Community Living Skills Program for Adult Mental Health Consumers. Community mental health journal, 59(3), 428–438. https://doi.org/10.1007/s10597-022-01020-x Soo, C., Tate, R. L., Anderson, V., & Waugh, M.-C. (2010). Assessing care and support needs for children with acquired brain injury: Normative data for the Paediatric Care and Needs Scale (PCANS). Brain Impairment, 11(2), 183–196. https://doi.org/10.1375/brim.11.2.183

Page 389 of 425

FOI 24/25- 0013

Soo, C., Tate, R., Hopman, K., Forman, M., Secheny, T., Aird, V., Browne, S., & Coulston, C. (2007). Reliability of the care and needs scale for assessing support needs after traumatic brain injury. The Journal of head trauma rehabilitation, 22(5), 288–295. https://doi.org/10.1097/01.HTR.0000290973.01872.4c Tate, R.L. (2017). Manual for the Care and Needs Scale (CANS). Unpublished manuscript. John Walsh Centre for Rehabilitation Research, University of Sydney. Updated version 2. https://www.sydney.edu.au/content/dam/corporate/documents/faculty-of-medicine- and-health/research/centres-institutes-groups/Care-and-needs-scale-manual.pdf Tate, R. L. (2004). Assessing support needs for people with traumatic brain injury: the care and needs scale (CANS), Brain Injury, 18(5), 445-460, https://doi.org/10.1080/02699050310001641183 Tamm, L., Day, H. A., & Duncan, A. (2022). Comparison of Adaptive Functioning Measures in Adolescents with Autism Spectrum Disorder Without Intellectual Disability. Journal of autism and developmental disorders, 52(3), 1247–1256. https://doi.org/10.1007/s10803- 021-05013-9 von Buttlar, A. M., Zabel, T. A., Pritchard, A. E., & Cannon, A. D. (2021). Concordance of the Adaptive Behavior Assessment System, second and third editions. Journal of intellectual disability research : JIDR, 65(3), 283–295. https://doi.org/10.1111/jir.12810 Wearne, T., Anderson, V., Catroppa, C., Morgan, A., Ponsford, J., Tate, R., Ownsworth, T., Togher, L., Fleming, J., Douglas, J., Docking, K., Sigmundsdottir, L., Francis, H., Honan, C., & McDonald, S. (2020). Psychosocial functioning following moderate-to- severe pediatric traumatic brain injury: recommended outcome instruments for research and remediation studies. Neuropsychological rehabilitation, 30(5), 973–987. https://doi.org/10.1080/09602011.2018.1531768

Page 390 of 425