Contents lists available at ScienceDirect Research in Autism Spectrum Disorders journal homepage: www.elsevier.com/locate/rasd Psychometric evaluation of the revised child and family quality of life questionnaire (CFQL-2) Thomas W. Frazier a,b, *, Allison C. Hyland c,d , Leslie A. Markowitz a,e , Leslie L. Speer a , Elizabeth A. Diekroger c,d a Cleveland Clinic Center for Autism, 2801 Martin Luther King Jr. Drive CRS10, Cleveland, OH 44014, USA b Autism Speaks, 1 East 33 rd street (4 th floor), New York, NY 10016, USA c Case Western Reserve University School of Medicine, Cleveland, OH USA d UH Rainbow Babies & Children’s Hospital Division of Developmental-Behavioral Pediatrics and Psychology, Cleveland, OH USA e Regions Hospital, Department of Developmental Pediatrics & Behavioral Health, St. Paul, MN, USA ARTICLE INFO Keywords: Autism Quality of life Neurodevelopmental Sensitivity to change Behavior problems ABSTRACT Background: The revised Child and Family Quality of Life (CFQL-2) questionnaire was adapted from the original version to be shorter and more sensitive to changes in psychosocial quality of life (QoL) in families of children with Autism Spectrum Disorder (ASD) or related neurodeve- lopmental conditions. The present study examined the psychometric properties of the CFQL-2. Methods: Caregivers of 566 patients presenting to an ASD-specific diagnostic clinic completed the CFQL-2 and other behavioral measurements as part of a diagnostic evaluation. Psychometric properties, including factor structure, internal consistency reliability, reliability across the latent trait, relationships with other clinical measures, and ASD vs. non-ASD group differences were examined for the total score and each subscale. Test-retest reliability and sensitivity to change were evaluated in a separate sleep intervention trial. Results: Results indicated that the CFQL-2 reliably measured eight independent QoL domains (Child, Family, Caregiver, Financial, Social Network, Partner Relationship, Coping, and QoL Change), with good-to-excellent reliability across score ranges, good test-retest reliability, and expected relationships with other measures. The change subscale was slightly, but not sig- nificantly, more sensitive to change than the total score. Externalizing behavior problems in the child had a strong negative association with several aspects of QoL. Conclusion: The CFQL-2 is a brief, reliable scale that effectively measures psychosocial aspects of QoL and is sensitive to changes in QoL in families of children with ASD or related neurodeve- lopmental disorders. Child externalizing behavior is strongly associated with reductions in multiple aspects of child and family psychosocial QoL. 1. Introduction Autism spectrum disorder (ASD) is a prevalent and impairing condition, with a recent estimate suggesting that about 1.5 % of all children meet phenotypic criteria (Baio et al., 2018). Symptom levels can vary from severe impairments in social communication and interaction, coupled with frequent and impairing restrictive/repetitive behavior, to less frequent or impairing symptoms (American Psychiatric Association, 2013). As one might expect, behavioral problems and decreased functional ability significantly impact and https://doi.org/10.1016/j.rasd.2019.101474 Received 27 January 2019; Received in revised form 6 November 2019; Accepted 8 November 2019 ⁎ Corresponding author at: 1 East 33 rd street, 4 th floor, New York, NY 10016, USA. E-mail address: thomas.frazier@autismspeaks.org (T.W. Frazier). Research in Autism Spectrum Disorders 70 (2020) 101474 1750-9467/ © 2019 Elsevier Ltd. All rights reserved. T