Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Susann M. Farberman, DNP


Susann Farberman

Jean Bachman

Dawn Garzon

Rick Yakimo

John Constantino


Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that starts in early childhood. It is characterized by impairments in reciprocal social behavior, impaired language, and stereotypic behavior/restricted interests (Pine, Luby, Abbacchi, & Constantino, 2006). One in 68 children is affected by ASD (Centers for Disease Control and Prevention, 2014). The prevalence of ASD is rapidly increasing. New estimates show a 23% increase in the number of cases since 2009 and a 78% increase in case numbers since 2007 (CDC, 2013). The purposes of this project were to: (a) establish normative parameters of reciprocal social behaviors, among toddlers aged 18 to 24 months, (b) assess the validity and reliability of the quantitative instrument, the Video- Referenced Rating of Reciprocal Social Behavior (vrRSB) to quantitatively measure changes in reciprocal social behavior, among toddlers aged 18 to 24 months and (c) to assess for changes in reciprocal social behaviors in toddlers aged 18 to 24 months. Identification of these behavioral parameters, serves as a foundation for measuring incremental changes in reciprocal social behavior, imperative for clinical diagnosis and management of ASD. This project used existing data from a longitudinal study, from within a greater longitudinal study conducted through a private university in St. Louis. The utilization of the vrRSB allowed researchers to quantitatively measure incremental changes in reciprocal social behavior over time. The normative values of reciprocal social behaviors of 64 toddlers at 18 and 24 months total vrRSB scores were examined. Higher scores on the vrRSB are indicative of more social impairment. Significant improvement in reciprocal social behavior between 18 and 24 months based on a mean of 23.2 at 24 months and 27.4 at 18 months indicated an improvement in social behavior within a 6 month range. The vrRSB effectively captured quantitative incremental changes in reciprocal social behavior among toddlers aged 18 to 24 months. These results indicated that the vrRSB is a valid and reliable instrument. The utilization of this measurement instrument is significant for pediatric clinicians involved in screening, diagnosing and managing ASD.

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