The Test of Grocery Shopping Skills and Its Correlation to Metacognition Among Adolescents With Autism Spectrum Disorder

PURPOSE AND BACKGROUND: The purpose of this study was to identify correlations between a performance-based assessment tool and a computerized neuropsychological test among adolescents with autism spectrum disorder (ASD). ASD is a broad neurodevelopmental disorder characterized by social deficits and stereotypical behaviors (American Psychiatric Association, 2013). Adolescents with ASD show severe difficulties in community participation in various aspects of daily life, leading to dependence on their parents or other caregivers. There is a need for adequate assessments and services that focus on transition to mature, independent life for them.

Metacognition is thinking at a high level that includes awareness and executive functions (EF). Metacognition includes neural processes that manage prioritization, combine and balance various cognitive functions, and enable successful independent behavior. Impairment in metacognition has been found in people with ASD using standard diagnostic tools. However, such diagnostic tools assess specific mental functions but do not necessarily reflect difficulties in performing daily activities.

This quantitative study examined correlations between the Test of Grocery Shopping Skills (TOGSS; Brown et al., 2009) and WebNeuro (Silverstein et al., 2007) among 61 adolescents with ASD aged 11–19 (M = 14.56, SD = 1.61). The TOGSS is a performance-based assessment of the ability to carry out a shopping task in a real supermarket, and WebNeuro is a web-based cognitive assessment tool that consists of several known neuropsychological assessments.

Pearson tests were conducted to measure correlations between the tools. Linear and binary logistic regression tests were conducted to measure whether the metacognitive indexes from WebNeuro predicted accuracy, efficiency, and strategy use in the shopping task.

RESULTS: Significant correlations were found between TOGSS accuracy and the WebNeuro EF index (r = .40, p < .01), between TOGSS efficiency and EF (time, r = –.48, p < .01; redundancy, r = –.43, p < .001), and between TOGSS strategy use and EF (r = .32, p < .05). Significant stepwise linear regression equations indicate that the WebNeuro EF index predicted TOGSS accuracy, F(1, 57) = 12.28, p < .001, R = .55, R ² adjusted = .28, β = .49, with R ² = .31; TOGSS time, F(1, 57) = 16.91, p < .001, R = .48, R ² adjusted = .22, β = –.48, with R ² = .23; and TOGSS redundancy, F(1, 57) = 13.05, p < .01, R = .43, R ² adjusted = .17, β = –.43, with R ² = .19. Significant binary regression equations indicate that EF predicted the strategy of marking list items, χ²(1) = 7.66, p < .01, B = .58, SEB = .23, Wald = 6.43.

CONCLUSION: Adolescence is a critical stage in preparing for independent living for people with ASD. This reality, in addition to the metacognitive difficulties that accompany the ASD diagnosis, emphasizes the need for occupational therapy practitioners to assess metacognitive skills in the context of complex daily activities in the community environment. Enhancing the independent abilities of people with ASD will increase their participation in the community and may decrease their need for human and financial resources. Development of performance-based assessment tools is important to enable assessment both of performance abilities in daily tasks and of metacognitive skills underlying these tasks.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Brown, C., Rempfer, M., & Hamera, E. (2009). The Test of Grocery Shopping Skills. Bethesda, MD: AOTA Press.

Silverstein, S. M., Berten, S., Olson, P., Paul, R., Williams, L. M., Cooper, N., & Gordon, E. (2007). Development and validation of a World-Wide-Web–based neurocognitive assessment battery: WebNeuro. Behavior Research Methods, 39, 940–949. https://doi.org/10.3758/BF03192989