Measuring Adaptive Behavior in Patients with Mendelian Neurodevelopmental Disorders. Comparison of ABAS-3 and Dutch Vineland Scales (2024)

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Clin Neuropsychiatry
v.20(5); 2023 Oct
PMC10712295

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Clin Neuropsychiatry. 2023 Oct; 20(5): 453–461.

doi:10.36131/cnfioritieditore20230507

PMCID: PMC10712295

PMID: 38089734

Joost Kummeling,^1,² Karlijn Vermeulen-Kalk,^1,³ Veerle Souverein,¹ Linde C.M. van Dongen,^1,^2,⁴ Wouter Oomens,⁴ Joost G.E. Janzing,⁵ Monica Pop-Purceleanu,⁵ Tjitske Kleefstra,^1,^2,⁴ and Jos I.M. Egger^1,^2,^4,⁶

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Abstract

Objective

Several instruments are available for measuring (aspects of) adaptive functioning, but knowledge is lacking about which is best to use to monitor patients with etiologically hom*ogeneous neurodevelopmental disorders. In this study we compare the use of the Vineland-Z and ABAS-3 adaptive behavior scales in such a specific group.

Method

Of patients with a molecularly confirmed diagnosis of Kleefstra syndrome, 34 were assessed with both the Vineland-Z and ABAS-3 of which 12 (35,3%) males and 22 (64,7%) females. Raw scores and developmental ages were calculated and a comparison between the instruments was done via correlation analysis.

Results

Biological age ranged from 12 to 50 years old (median age of 23,1 ± 9,6 years). Pearson r correlation analyses show that the Vineland-Z and ABAS-3 assessments are highly interchangeable in this population. However, there are practical issues which require attention: (i) the use of ABAS-3 needs several versions to cover the whole adaptive spectrum, and (ii) the Vineland-Z discriminates more at the lower end of the adaptive functioning spectrum compared to the ABAS-3, but less at the higher end. An ideal instrument for this specific purpose is not yet available.

Conclusions

We recommend that either the Vineland-Z, with modification of the dated items, the abridged version of the Vineland III, or a merge of the 0-4/517 ABAS-3 versions would work best to assess the entire spectrum of adaptive functioning adequately.

Keywords: Kleefstra Syndrome, neurodevelopmental disorders, adaptive behavior, measurement, validity

Introduction

Neurodevelopmental disorders (NDDs) comprise a heterogeneous group of pathologies in patients with early-onset deficits in multiple domains of adaptive functioning (Diagnostic and statistical manual of mental disorders (5th ed.), 2013). Because the development of these patients is atypical compared to the general population and impacts their quality of life (Bertelli et al., 2020; Puka et al., 2020), it is essential to map and monitor strengths and weaknesses across the domains of functioning and over time. This provides starting points for interventions and support in order to optimize self-sustainability and improve quality of life within the capacities of the affected individual.

With the release of the fifth edition of the Diagnostic and Statistical Manual (DSM-5) in 2013 (Diagnostic and statistical manual of mental disorders (5th ed.), 2013), assessment of adaptive functioning plays a more central role in diagnosing NDDs, whereas previous editions of the DSM have focused on IQ instead of adaptive functioning. Over many decades, the Vineland Adaptive Behavior Scale (VABS) (Sparrow, S. et al., 1984; ) has been used worldwide to measure the level of adaptive functioning in patients with intellectual disabilities (ID), and more specifically, NDDs. It provides a standardized assessment of the skills and abilities of the patient in daily life situations by structured interviewing of the parents/caregivers. From 2015 onward, the Adaptive Behavior Assessment System Third Edition (ABAS-3) questionnaire was also available to assess skills of daily living in individuals with NDDs (). While the Dutch adaptation of the first edition of the VABS – the Vineland-Z – has seen continuous use since its release in 1984 – in part because the Vineland III is more extensive and time consuming – ABAS-3 seems to be increasingly used in the field of adaptive behavior (Lopata et al., 2013). Both instruments appear to be the most reliable and valid instruments to map it and are currently the most commonly used instruments internationally (Lopata et al., 2013).

Box 1

Kleefstra syndrome is a rare genetic disorder caused by either a pathogenic variant in the euchromatic histone-lysine N-methyltransferase 1 (EHMT1) gene or a microdeletion in the chromosome region 9q34.3 (Kleefstra et al., 2006) with a prevalence of approximately 1 in 25.000-35.000 individuals. The syndrome is characterized by a distinctive facial appearance, childhood hypotonia, autism spectrum disorder, and ID. The majority of affected individuals function in the moderate-to-severe spectrum of ID. In addition to autism spectrum disorder, the behavioral phenotype at a younger age may also include obsessive compulsive disorder, anxiety, and sleep disturbances.

Objective assessment of adaptive functioning is primarily applied in NDD patients with a broad range of IDs. Within (the realm of) NDD care, traditionally, a distinction was made based on the level of intellectual functioning, which created etiologically heterogeneous groups of patients. With the advance of genetic techniques, a genetic cause can be demonstrated in increasing numbers of patients with NDDs (Wright et al., 2015; Wright et al., 2018). Classifying these groups based on genetic cause therefore provides more biologically hom*ogeneous cohorts to assess levels of functioning (Verhoeven et al., 2008; Vermeulen, 2018). Patients belonging to the same hom*ogeneous genetic syndrome often have different levels of functioning. Although the level of functioning may vary, the same kind of obstacles are often experienced within such a genetically hom*ogeneous group. For example, specific problems with communication skills or social skills. There is a challenge to properly map this whole adaptive spectrum across the levels of functioning to (i) learn about natural course in this group, (ii) to monitor functioning over time and (iii) to develop and evaluate tailored interventions. Kleefstra Syndrome (KS) forms an example of such an etiological hom*ogeneous group, with patients functioning in the range of severe ID to borderline and normal IQ levels (Bock et al., 2016; Kleefstra & de Leeuw, 2010; Samango-Sprouse et al., 2016). Because there are indications of episodes where individuals with Kleefstra syndrome may show a decline of functioning, it is essential to have an objective measure to estimate adaptive functioning over time and across the boundaries of levels of functioning.

The aim of the present paper is to compare the VABS – in the form of the Vineland-Z – with the ABAS-3 to evaluate convergent validity and investigate which best fits the needs of the population with etiologically hom*ogeneous neurodevelopmental disorders, using Kleefstra syndrome patients as an example.

Materials and Methods

Participants and procedure

Thirty-four children and adults with a molecular diagnosis of Kleefstra syndrome were included. Participants were 12 years or older. Written informed consent was obtained from their legal guardians. From each participant, sex, age, and results from both adaptive behavior assessment tools (Vineland-Z and ABAS-3 for children aged 5-17 or adults aged 18-80) were recorded. The Vineland-Z interviews were conducted by J.K. in a (care) home setting or via videoconference, after which the informant was handed the appropriate ABAS-3 version to fill out. To aid uniformity and consistency between patient groups, the order of test administration was the same for every participant. The acquired data was anonymized and entered into Castor Electronic Data Capture (Castor EDC©).

The study was approved by CMO Region Arnhem-Nijmegen under number NL65650. 091.18.

Instruments

Vineland-Z. The Vineland-Z (Sparrow, S. et al., 1984) is a semi-structured interview. It is the Dutch adaptation of the ‘Vineland interview edition – Survey form’ and widely used in the Dutch population of children and young people with IDs. It was published in 1984. This original publication uses the same norm scores as the American version it was derived from. Dutch norm scores were eventually established in the year 2000 and were based on 1436 Dutch children aged 4 to 18. The Vineland-Z had its most recent (albeit textual) update in 2009, this is the version used in this study (Sparrow, S. S., 2009). The Vineland-Z assesses adaptive behavior via 450 items that are part of three domains with each of these domains consisting of three subdomains (see table 1). Conducting the interview usually takes between 20 to 60 minutes. The highest seven consecutive items where a ‘2 – yes or usually’ are scored is considered by the publishers as the lower bound, where the lowest seven consecutive items where a ‘0 – no or never’ are scored is considered the upper bound.

Table 1.

Vineland-Z and ABAS-3 domains with associated subdomains

Vineland-Z Adaptive Behavior Domains
Communicati on (Com)	Daily living skills (Day)	Socializati on (Soc)
Receptive	Personal	Interpersonal Relati onships
Expressive	Domestic	Play and Leisure
Written Language	Community	Social skills
ABAS-3 Adaptive Behavior Domains
Conceptual skills (Con)	Practi cal skills (Prac)	Social skills (Soc)
Communication	Self-Care	Leisure
Functional (Pre-)Academics	Home Living	Social
	Community Use	Self-Direction
	Health and Safety
	Work¹

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¹ The ‘work’ subdomain is only assessed in the 18-80 version of the ABAS-3.

Standardized scores, deciles, and a developmental age are determined for each of the three domains and the total score. The possible developmental age outcomes range from “below 11 months” to “above 12 years”.

Adaptive Behavior Assessment System Third Edition (ABAS-3). The ABAS-3 (Harrison & Oakland, 2017) is a proxy questionnaire, filled out typically by parents/ caregivers of the patient. The Dutch adaptation was published in 2020 (Harrison et al, 2020). It has three versions: for young children aged 0-4, for children and adolescents from the age of 5 up to 17, and for adults (aged 18 up to 80 years old) of which we used the latter two since all participants were aged 12 years or older. ABAS-3 assesses ten skill areas, subdomains, which are part of the three core domains of adaptive functioning, i.e., conceptual skills, social skills, and practical skills (table 1) (Harrison & Oakland, 2015a). Norm scores of each of the subdomains are determined, which in turn provides a sum score, norm score, 95%-confi dence interval, and percentile score for the core domains and the total score. Age equivalents are only available for the subdomains of the 5-17 version and range from “<5(,1) years” to “>15,5 years”.

Data processing and statistical analysis

For data processing, raw scores and developmental ages were calculated according the procedure in the accompanying manuals (Bildt AAd, 2003; ). Thereafter, raw data was transferred to a CSV data file to make it suitable for analysis in RStudio™ (Team, 2019). To assess the convergent validity between the ABAS-3 and the Vineland-Z, comparison of the raw scores in all the subdomains of the adaptive behavior instruments was done by Pearson’s correlation analysis in SPSS™ version 25.0 (Corp., 2017). A scatter plot to visualize the correlation between the instruments using the total raw scores was made. Since the ABAS-3 does not provide age equivalents for the total score, the function fi t of the scatter plot was used to establish a formula and corresponding table that makes it possible to convert total ABAS-3 raw scores to total Vineland-Z scores and corresponding developmental ages. Lastly, to visualize the distribution of ABAS-3 total raw scores, a boxplot was made.

Results

Participants and age equivalents

Thirty-four KS patients participated: 12 (35,3%) males and 22 (64,7%) females. Biological age ranged from 12 to 50 years old (median age of 23,1 ± 9,6 years, skewness 1,055).

When comparing the total scores of the Vineland-Z and the ABAS-3 between the sexes, it becomes apparent that the female participants significantly score better on both adaptive behavior assessment instruments. See figure 1.

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Figure 1.

Boxplots visualizing the differences on adaptive behavior scores between the sexes of the participants for both instruments. Vineland-Z – Mean: Females: 201,36; Males: 70,00 (p<0,001). ABAS-3 – Mean: Females 241,27; Males 56,67. (p<0,001)

We were able to determine age equivalents for all participants with the Vineland-Z. However, in some (27 out of 152; 17,8%) cases the score did not fall within the measuring range of the instrument, meaning that the age equivalent would be determined at ‘≤11 months or ≥12 years and 1 month’. Using the ABAS-3, only the 5-17 year version provides age equivalents, therefore for only of the 8 participants who were 17 years old or younger age equivalents could be determined. 54 out of 72 (75%) scores were below the measuring threshold of ‘<5(,1)’. A complete overview of the developmental ages/age equivalents can be found in ‘Supplementary data - Overview of developmental ages & age equivalents of the Vineland-Z and ABAS-3’. Table 2 shows information on the points scored per instrument and per domain.

In 52,9% of the cases (n=18), multiple informants were interviewed for the Vineland-Z, whereas this number dropped to 8,8% (n=3) in the case of the ABAS-3. A further breakdown of the informants per instrument can be found in table 3.

Table 3.

Breakdown of the informants involved in the completion of the assessments

	Vineland-Z	ABAS-3
Both parents/multiple informants	18 (52,9%)	3 (8,8%)
Mother only	11 (32,4%)	20 (58,8%)
Father only	1 (2,9%)	3 (8,8%)
Professional caregiver	4 (11,8%)	8 (23,5%)
Total	34	34

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Convergent validity of the instruments

Pearson’s correlation analysis (see table 4) shows that there is a high correlation between total scores and the score on the separate domains of the ABAS-3 and the Vineland-Z across the different versions used.

Table 4.

Convergent validity of the Vineland-Z and ABAS-3 via Pearson r correlation across the different versions of the ABAS-3

	ABAS-3
Version	5-17 years	N=8			18-80 years	N=26			All	N=34
	Total	Conc	Prac	Soc	Total	Conc	Prac	Soc	Total	Conc	Prac	Soc
Vineland-Z
Total	,982	,985	,949	,997	,964	,963	,974	,948	,967	,968	,966	,958
Com	,964	,994	,908	,963	,966	,976	,969	,945	,965	,978	,953	,950
Dai	,989	,959	,990	,975	,959	,951	,972	,941	,964	,950	,976	,944
Soc	,870	,890	,815*	,944	,920	,918	,934	,915	,907	,913	,901	,921

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Note. All correlations are significant at the <0,01 level, except the comparison marked with an asterisk (*), which is significant at the <0,05 level (2-tailed). Conc = Conceptual domain; Prac = Practical domain; Soc = Socialization (Vineland-Z)/social skills(ABAS-3); Com = Communication; Dai = Daily living skills. Correlations between conceptually similar domains are indicated in bold.

Table 2.

Minimum, maximum, and mean scores of the Vineland-Z and ABAS-3 domains and totals with corresponding standard deviations. The asterisk (*) denotes the maximum possible score when using the 5-17 (Children & Adolescents) version of the ABAS-3, the double asterisk (**) denotes the maximum possible score when using the 18-80 (Adults) version

	N	Lower bound	Upper bound	Maximum	Mean	σ	Median
Vineland-Z
Total score	34	17	413	450	155,00	112,12	128
Communication	34	2	125	134	50,32	37,79	42
Daily living skills	34	4	170	184	59,06	44,87	44
Socialization	34	5	118	132	45,62	31,69	36,5
ABAS-3
Total score	34	9	552	696/714*	176,12	173,34	99,5
Conceptual skills	34	0	114	141/147*	37,15	37,48	26,5
Practical skills	34	0	254	279	70,53	73,26	42,5
Socialization	34	2	190	213/216*	59,94	55,48	37,5

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However, when comparing the higher functioning with the lower functioning participants by means of splitting the scores based on the 50th percentile of the Vineland-Z total score, the correlation between the Vineland-Z and the ABAS-3 in the lower functioning group is much less compared to the higher functioning counterparts (table 5). Figure 2a shows that there is a linear correlation between the raw scores of both instruments in a scatter plot. Using this linear correlation, a conversion table was established. This conversion table can be found in ‘Supplementary data - Vineland-Z/ABAS-3 conversion table’. Figure 2b shows a clustering of the raw ABAS-3 scores below the 25th percentile in a boxplot.

Table 5.

Comparison of Pearson r correlations of the Vineland-Z and ABAS-3 based on the median score (=128) of the Vineland-Z

	ABAS-3
	Below median	N=17			Above median	N=17
	Total	Conc	Prac	Soc	Total	Conc	Prac	Soc
Vineland-Z
Total	,873	,772	,696	,847	,926	,932	,946	,914
Com	,850	,888	,598*	,846	,937	,961	,938	,899
Dai	,635	,385**	,731	,461**	,928	,909	,964	,905
Soc	,730	,642	,471**	,828	,792	,809	,806	,822

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Note. Correlations marked with an asterisk (*) are significant at the <0,05 level (2-tailed), the correlations marked with a double asterisk (**) are not significant. The rest of the correlations are significant at the <0,01 level.

Discussion

To the best of our knowledge, this is the first report in which the Vineland-Z and ABAS-3 are compared in an etiologically hom*ogeneous group of patients with a rare genetic (Mendelian) NDD. We aimed to address whether they are both usable on the timeline in the monitoring and description of the neurodevelopmental process, within as well as between individuals.

It is important that an assessment fits with the specific characteristics of the subject group – e.g. range of developmental age – and can be used for follow-up for research and in a clinical setting. Although both instruments already have been shown to be adequate in assessing adaptive functioning in heterogeneous ID groups (; Tassé et al., 2012), they have not been validated for this exact use.

Our findings confirm that both the ABAS-3 and the Vineland-Z are usable in KS patients. Though they have a similar genetic cause, still a variety in sex, biological and developmental age was present. Therefore we expect that using either of these instruments in etiologically similar patient groups – e.g. in patients with Wiedemann-Steiner- or Kabuki syndrome – is valid as well. The scores on both instruments are strongly correlated allowing comparison and conversion of the total results. This makes it possible to provide developmental ages in all cases where the ABAS-3 was used, and to convert older Vineland-Z scores to ABAS-3 scores.

However, when comparing the correlation of the instrument scores of the higher and lower functioning individuals, the convergent validity of the instruments is overall much less significant in the lower functioning individuals as opposed to the higher scoring individuals. This might be because of the clustering of the results of the ABAS-3 near the minimum score of 0 (floor effect) while this clustering is not present in the Vineland-Z. Although most importantly, correlation between the conceptually similar domains remains high.

According to the data from the convergent validity analysis, it might even be redundant to assess KS subjects with the complete ABAS-3 or Vineland-Z, as the scores of several subdomains correlate heavily with the eventual total scores. It is certainly not advised to use the assessments this way, especially when one implements them to map the different subdomains and their development over time. They have not been validated for this, and it will result in missing valuable developmental information.

Important to note is the main difference between the instruments: the assessment with the Vineland-Z is done via a semi-structured interview, whereas the ABAS-3 score is established via self-report of the parents/caregivers. We have seen that this influences the composition of the informant group. The most notable difference is that the results of the ABAS-3 are usually based on the answers of just one informant. Although the use of multiple informants is advised in these situations, it has been shown that in similar cases the answers of a sole informant may be fair (De Los Reyes, 2013; Möricke et al., 2016). However, when encountering discrepancies between results, it is possible that these might be attributed to this difference in assessment approach of the instruments.

The ABAS-3 is being used extensively in recent research regarding adaptive functioning in several NDD’s, and as it is a proxy-questionnaire, it takes the researcher virtually no time to administer (; Tamm et al., 2021). However, there are some issues when using the ABAS-3: There are no age equivalents available when using the version meant for adults, and there are no norm scores or age equivalents available for people with a developmental age lower than 5 years. Therefore, before selecting the biologically age appropriate ABAS-3 version, ironically an estimation of developmental age must be performed to get an insight if there will be norm scores available when assessing the subject with the ABAS-3. Secondly, for follow-up it is important to assess patients with the same instrument at each timepoint. Although it is technically the same instrument, an inherent part of the ABAS-3 is that a different version should be used for each life stage. Therefore, in the case of following up a child/adolescent into adulthood – as there are no correlations between the two versions available – it is unclear what choice is best: whether to switch to a new version that is more appropriate to the new age group, or to use the exact same version of the questionnaire for continuity.

Deficits in adaptive functioning should be measured with culturally appropriate tests (Diagnostic and statistical manual of mental disorders (5th ed.), 2013). As some aspects of the Vineland-Z are not are not adapted to the expectations within the current (Dutch) society – since the most recent update of the Vineland-Z took place in 2009 – it does not fully meet this condition. This may affect the overall score, and the scores on the subdomains, especially when assessing people with a moderate to high level of adaptive functioning, as these ‘dated’ items address relatively more advanced skills. In some cases, interpreting some items diferently may circumvent some of these issues. E.g. changing “Watches or listens to TV or radio to follow the news.” to “Watches or listens to TV or radio or uses the internet to follow the news.” This also brings it more in line with the items of the Vineland III (the most recent version of the English Vineland Adaptive Behavior Scores). However, using an addendum for all the items is not possible.

These results indicate that none of the instruments are specifically tailored for the aforementioned purposes. Although the Vineland-Z takes more time than the ABAS-3 to administer, it has shown to be applicable to all levels of functioning within the example of the hom*ogeneous KS group – including the patients with more severe ID– therefore it fits our needs best. The interview is usable at all biological ages and is for that reason appropriate for follow-up with increasing biological age.

Parallel to the ABAS-3 and Vineland-Z there are currently multiple tools available for the assessment of adaptive behavior, such as the Vineland III, the BDI-3, the ABS-S:2, the SIB-R and the EFA-DI (Bruininks et al., 1996; Lambert et al., 1993; Newborg, 2020; Selau et al., 2020; Sparrow, S.S. et al., 2016). However, for different reasons these assessments seem to be not ideal for use in our study population. The language and item content do not match the spirit, the standards and values held in the present – with the latest version of the ABS-S:2 and the SIB-R dating from 1993 and 1996 respectively –, tailored for a specific population (EFA-DI) useful for a limited age range (BDI-3), or far more extensive and time consuming than the ABAS-3/ Vineland-Z (Vineland III). The abridged version of the Dutch translation of the Vineland III seems promising in this regard, however, presently there are no Dutch norm scores available.

Interestingly, the results show that females with KS have a higher level of adaptive functioning compared to the males. This finding gives a novel insight in the KS phenotype as this phenomenon has not been described before in this specific population. The exact reason for this discrepancy between the sexes is as of yet unclear, although it might be that the ‘female protective efect’ contributes to this (Jacquemont et al., 2014).

For this study we have included individuals with Kleefstra syndrome as an exemplary genetic NDD. To our best knowledge, we expect that our results can be translated to other genetic NDD’s.

Conclusions

According to our knowledge, this is the first report on the comparison between the ABAS-3 and Vineland-Z in an etiologically hom*ogeneous group of patients. This report focuses on the use of these instruments to obtain data on adaptive functioning on inter- and intra-individual level. Further research is needed to see if similar hom*ogeneous NDD’s yield similar results, and may provide information on the correlation between the different versions of the ABAS-3, giving insight in the appropriate way to follow-up these patient groups.

There is a need for an instrument that maps adaptive functioning across the levels of functioning, ranging from severe ID to normal functioning and at diferent biological ages. The instruments under study, ABAS-3 and Vineland-Z, are psychometrically sound, comparable and interchangeable. However, each has its limitations. Compared to the ‘Child/Adolescent’ and ‘Adult’ versions of the ABAS-3, our results show that the Vineland-Z discriminates more at the lower levels of adaptive functioning. Conversely, due to outdated items, it might be that it actually discriminates less at the higher levels of development. An ideal instrument for the assessment of the whole adaptive spectrum within an etiological hom*ogeneous patient group is not yet available. We think that either the Vineland-Z, with modification of the dated items, the abridged version of the Vineland III, or a merge of the 0-4/5-17 ABAS-3 versions would do most justice to the entire spectrum of adaptive functioning.

Supplementary data - Overview of developmental ages & age equivalents of the Vineland-Z and ABAS-3

		Vineland-Z developmental age				ABAS-3 age equivalent
	Age (years)	Total	Communication	Daily living skills	Socialization	Communication	Community use	Functional Pre- Academics	Home Living	Health and Safety	Leisure	Self- Care	Self- Direction	Social
Patient
1	12,03	1;8-1;10	3;4	1;6-1;8	l;10-2;0	<5;0	<5;0	<5;0	<5;0	<5;1	<5;1	<5;0	<5;0	<5;0
2	12,03	2;4-2;6	3;6	2;10-3;0	2;4	<5;0	<5;0	<5;0	<5;0	<5;1	<5;1	<5;0	<5;0	<5;0
3	12,94	>12; 1	12;0	>12; 1	11;9	8;6	10;6	11;11	11;7	12;9	9;8	15; 6	15;6	8;0
4	13,84	1;4-1;6	1;8	1;2-1;4	1;10	<5;0	<5;0	<5;0	<5;0	<5;1	<5;1	<5;0	<5;0	<5;0
5	15,64	1;4-1;6	1;2-1;4	1;8-1;10	1;6-1;8	<5;0	<5;0	<5;0	<5;0	<5;1	<5;1	<5;0	<5;0	<5;0
6	16,05	1;6-1;8	l;10-2;0	1;10	1;4-1;6	<5;0	<5;0	<5;0	<5;0	<5;1	<5;1	<5;0	<5;0	<5;0
7	16,51	5;6-5;8	8;2	5;4-5;6	4;8-4;10	7; 6	9; 6	8;0	5;7	6; 6	<5;1	6; 7	7;1	<5;0
8	16,53	4;6-4;8	4;10-5;0	3;2	7;0	<5;0	<5;0	5,50	<5;0	<5;1	5,08	<5;0	<5;0	<5;0
9	18,34	1;0-1;2	1;4-1;6	1;4-1;6	1;0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
10	18,64	2;4-2;6	2;8	3;0-3;2	3;0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
11	18,66	6; 6	9;2	7;10-8;0	4;8-4;10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
12	19,01	7;0-7;2	7;8	6;0	8;0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
13	19,24	2;8-2;10	3;10-4;0	3;6-3;8	1;6-1;8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
14	19,78	<0;11	<0;11	1;4-1;6	<0;11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
15	19,91	1;0-1;2	1;4-1;6	1;6-1;8	1;0	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
16	20,42	1;0-1;2	1;0-1;2	1;0-1;2	1;0-1;2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
17	20,75	l;10-2;0	2;6-2;8	2;4	2;2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
18	22,62	l;10-2;0	2;0	2;6-2;8	2;2	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
19	23,63	3;4-3;6	3;6-3;8	3; 10	3;8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
20	24,19	5;6-5;8	6; 10	5;0-5;2	5;8-5;10	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
21	25,00	1;2	1;4-1;6	1;2	1;4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
22	25,33	5;6-5;8	7; 2	5; 2	5;4-5;6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
23	25,80	1;2-1;4	1;4-1;6	1;6-1;8	<0;11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
24	26,40	4; 4	4; 10	4; 10	3;2-3;4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
25	28,24	1;8-1;10	2; 6	2;2-2;4	1;6-1;8	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
26	30,21	>12; 1	>12; 1	>12;1	>12;1	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
27	30,86	1;4	l;10-2;0	1;0-1;2	1;6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
28	31,38	<0;11	<0;11	<0;11	<0;11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
29	32,01	1;0-1;2	1;0-1;2	1;4-1;6	<0;11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
30	33,12	9;0-9;2	>12; 1	7;8	8;4	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
31	37,02	<0;11	<0;11	<0;11	<0;11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
32	45,49	1;0-1;2	1;0-1;2	1;8-1;10	<0;11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
33	45,81	<0;11	<0;11	<0;11	<0;11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
34	49,85	<0:11	1;0	1:0-1:2	<0:11	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A

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Note: Developmental ages (Vineland-Z) and age equivalents (ABAS-3) are displayed in the ‘years;months’ format. All cases where the score did not fall within the measuring range of the instrument are highlighted.

Supplementary data - Vineland-Z/ABAS-3 conversion table

Using the linear fit-line from figure 2 (a) from the main text – the scatterplot comparing the raw scores of the Vineland-Z and the ABAS-3 – the following conversion formula was determined:

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Figure 2.

(a) Scatter plot to visualize the correlation between the total raw scores obtained from the Vineland-Z versus the ABAS-3 (R2 = 0,936 ; p< 2,2e-16.) Skewness: Vineland-Z 0,822; ABAS-3 0,930. The maximum score of the ABAS-3 5-17 years and 18-80 years version are 696 and 717 respectively.

(b) Overview to visualize the distribution of ABAS-3 total raw scores. Box plot from the ABAS-3 scores obtained by the participants showing the 34 datapoints, the 25th percentile, 50th percentile, and 75th percentile. A scatter plot was added to visualize the correlation between the scores obtained from the Vineland-Z versus the ABAS-3. The color of the dots represent the ABAS-3 version that was used: Red for the 5-17 years (Children & Adolescents) version, green for the 18-80 years (Adults) version

V=(A+29)/1,35

Where V represents the raw Vineland-Z score and A represents the raw ABAS-3 score. The conversion table below was derived from mentioned formula.

Supplementary table

Vineland-Z/ABAS-3 conversion table

Age equivalent (according to Vineland-Z)	Vineland-Z score	ABAS-3 score
<0;11	50	39
1;0	51	40
1;2	69	64
1;4	86	87
1;6	100	106
1;8	119	132
1;10	132	149
2;0	144	165
2;2	150	174
2;4	155	180
2;6	160	187
2;8	165	194
2;10	171	202
3;0	177	210
3;2	181	215
3;4	187	223
3;6	192	230
3;8	197	237
3;10	203	245
4;0	209	253
4;2	215	261
4;4	225	275
4;6	233	286
4;8	241	296
4;10	250	309
5;0	257	318
5;2	262	325
5;4	267	331
5;6	274	341
5;8	282	352
5;10	285	356
6;0	289	361
6;2	293	367
6;4	299	375
6;6	305	383
6;8	306	384
6;10	308	387
7;0	313	394
7;2	315	396
7;4	321	404
7;6	323	407
7;8	327	412
7;10	332	419
8;0	334	422
8;2	335	423
8;4	337	426
8;6	340	430
8;8	342	433
8;10	346	438
9;0	347	439
9;2	350	444
9;4	352	446
9;6	354	449
9;9	355	450
10;0	358	454
10;3	360	457
10;6	363	461
10;9	365	464
11;0	369	469
11;3	371	472
11;6	375	477
11;9	378	481
12;0	382	487
>12;1	384	489

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