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Pervasive Developmental Disorder Behavior Inventory (PDDBI): Applied Behavior Analysis (ABA) Provider Education

Friday, October 23, 2020

Under TRICARE’s Autism Care Demonstration (ACD), applied behavior analysis (ABA) providers must use the Pervasive Developmental Disorder Behavior Inventory (PDDBI) scores as one measure of treatment effectiveness for beneficiaries between the ages of two and 18.5 years. Health Net Federal Services, LLC (HNFS) offers the following information to inform and clarify those requirements, and assist ABA providers with using the PDDBI in their treatment and discharge planning.

What is the PDDBI? 
The PDDBI is an assessment designed to measure the effectiveness of treatments for children with significant developmental disabilities, including autism spectrum disorder (ASD). The test is an informant-based ratings scale that focuses on behavioral challenges, key skills and abilities. 

Why is the PDDBI used?
Standardized assessments give families and provider teams clear, consistent measurements of progress over time when compared against treatment plan goal progress. TRICARE has selected the PDDBI as it focuses on the core deficits of autism based on the DSM-V criteria. 

Why are both parent and teacher PDDBI rating forms necessary?
The requirement for submitting both the parent and teacher (or Board Certified Behavior Analyst (BCBA)) PDDBI scores allows ABA supervisors and caregivers to better understand a beneficiary’s skills and challenges. Discrepancies of more than 15% between the parent and teacher PDDBI AUTISM scores must undergo a clinical review as advised by the publisher and be documented in the treatment plan, including a plan to resolve those differences. The ABA provider must make certain the parent and teacher PDDBI rating forms are completed accurately and the scores are reliable.

How is the PDDBI scored?
The PDDBI scores are standardized by comparing characteristics of a large sample population of children with an ASD diagnosis who are grouped by age. To make comparisons possible, the PDDBI converts all raw scores into T scores. Important PDDBI scoring notes include:

  • With 50 as the mean, a child with a T score of 50 is considered equivalent to the rest of the sample set of people (of similar age) with ASD.
  • The three scores generated by the Standard Edition of the PDDBI are the:
    • REPRIT/C (a composite measure of behavioral challenges or problems)
    • EXSCA/C (a composite measure of social and communicative abilities)
    • AUTISM (a composite measure that provides a summation by measuring how the beneficiary’s social and communicative ability scores offset the beneficiary’s behavioral challenges or problems) 

How must ABA providers use PDDBI scores under the Autism Care Demonstration?
ABA providers are required to integrate PDDBI scores into their comprehensive analysis of beneficiary progress:

  • Use PDDBI scores, along with other tools, to guide every aspect of treatment, behavior intervention and discharge planning for beneficiaries between two and 18.5 years of age. 
  • Use the PDDBI as one measure to analyze beneficiary progress, monitor areas of stagnation and/or regression and inform treatment-planning decisions based on the expected and actual amount of change for each comparison period. 

When do PDDBI scores indicate the need for a treatment plan modification?  
ABA providers may need to modify the treatment approach, goals or recommendations when there is:  

  • No improvement in the scores over time (every six-month comparison and/or annual comparison)
  • An increase in REPRIT/C and AUTISM scores and/or
  • A decrease in EXSCA/C scores. 

All scores, and sub domain scores, should be carefully analyzed. Modifications must be clearly documented in the six-month reassessment and treatment plan update. 

What is the relationship between PDDBI scores and treatment plan changes?
ABA providers are encouraged to identify and document a direct relationship between score changes and treatment plan changes to address no improvement or regression. When no progress is reflected on treatment goals in the PDDBI (or other standardized assessments), ABA providers must explain the reason and identify contributing factors within the treatment plan.

Additionally, the level of progress within the treatment plan goals and assessment scores can directly relate to the beneficiary’s’ rendered hours. Therefore, when the hours authorized for direct therapy, program modifications and family training (CPT® 97153, 97155 and 97156) do not coincide with the hours actually delivered, the discrepancy must be documented in the report. Be sure to specify any change in hours, the reason (i.e., lack of behavior technicians (BTs), parent availability, etc.), analysis and documentation related to PDDBI score changes, and an action plan to address the deficit. 

For additional information about TRICARE’s ABA benefit, visit our Applied Behavior Analysis benefit page.