Comments on "Knowledge and Beliefs About Autism Spectrum Disorders in Indian Healthcare Professionals".

Jain et al.[1] examined knowledge and beliefs about autism spectrum disorders (ASD) in healthcare professionals in India. These authors used an instrument that was adapted from an instrument developed by an Israeli team.[2] The adapted version excluded the self-efficacy component of the original instrument because participants were not comfortable with the section, particularly with the section on self-competence. However, self-efficacy is important because knowledge and beliefs are likely to influence self-efficacy, and discomfort in answering questions about self-efficacy suggests lack of self-competence. It would have been more important to revise the section to match the comfort and understanding level of participants than to remove the section from the adapted version.

Further, the authors replaced the self-efficacy section with a 26-item section testing knowledge about DSM-5 criteria for ASD. DSM-5 separates social deficit criteria from repetitive behavior criteria; so, the 26-item section of the study instrument was not unidimensional. Since internal consistency as a measure of reliability of an instrument assumes unidimensionality, when the assumption is violated, reliability will be low. This is the likely reason why the authors obtained a low Cronbach’s alpha for the section. It would have been more appropriate for the authors to have examined Cronbach’s alpha separately for the social deficit items and for the repetitive behavior items.[3]