Evidence of item bias in a national flourishing measure for autistic youth.

Researchers studied a national survey that measures how well children are thriving (called 'flourishing'). They found that many questions in this survey may not work fairly for autistic children, especially questions about social skills. While the survey shows autistic children appear to be doing less well than other children, the unfair questions make it hard to know if this is really true or just because the questions aren't suitable for autistic kids.

This study examined whether a national flourishing measure used in the National Survey of Children's Health shows measurement bias when applied to autistic youth. Using data from 41,691 US children aged 6-17, researchers found that 6 out of 10 items in the flourishing measure showed differential item functioning, particularly those measuring social competence. While the study confirmed that caregivers report lower flourishing outcomes for autistic children compared to non-autistic peers, the measurement bias raises concerns about the validity of these comparisons. The findings suggest standard flourishing measures may not appropriately capture wellbeing in autistic populations.

Standard flourishing measures may inadequately assess wellbeing in autistic children, particularly regarding social competence. Clinicians should use caution when interpreting results from such measures. Development of autism-appropriate wellbeing measures is needed for accurate assessment and service planning.

Cross-sectional design prevents causal inferences. Relies on caregiver reports which may introduce bias. Sample composition and response rates not detailed. Measurement bias findings require validation in other samples before definitive conclusions about measure inappropriateness can be drawn.

Flourishing is a positive health indicator that aligns with strengths-based perspectives and measures within autism research. Flourishing indicators were recently included in the National Survey of Children's Health (NSCH) and have been used to evidence disparities in flourishing experienced by autistic children compared to non-autistic peers. Yet, little has been done to examine the utility of standard flourishing items for this population. This study examined the NSCH caregiver-reported flourishing items for measurement item bias.

A cross-sectional, representative sample of autistic and non-autistic US children aged 6-17 years (n = 41,691) was drawn from the 2018-2019 NSCH public dataset. A confirmatory factor analysis using a multiple indicators and multiple causes model (MIMIC-CFA) was conducted to (1) test for differential item functioning (DIF; i.e., measurement bias); and (2) estimate latent mean group differences after controlling for DIF. Findings supported a 3-factor (social competence, school motivation, and behavioral control), 10-item model structure consistent with past literature, yet measurement bias was evident for 6 of the 10 items. Persistent group differences, after accounting for DIF and covariates, indicates that caregivers of autistic children perceive their children are experiencing meaningfully lower flourishing outcomes compared to caregivers of non-autistic children.

However, evidence of measurement bias for items related to the social competence dimension calls into question the applicability of this measure for autistic children. Further interpretation of group differences and use of this measure should be approached with caution.