The Childhood Autism Rating Scale (CARS). Jennifer Connelly Caldwell College. CARS Described. Childhood Autism Rating Scale 15-item behavior rating scale to identify and differentiate children with autism from typical or other developmentally disabled individuals
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Childhood Autism Rating Scale
15-item behavior rating scale to identify and differentiate children with autism from typical or other developmentally disabled individuals
Distinguishes placement on spectrum
Each of 15 items based on five major diagnostic systems (Kanner, Creak, Rutter, NSAC, and DSM-IV)
Can be used to evaluate across ages
Developed 20 years ago
Includes Kanner’s autism features, characteristics described by Creak
Original developed by Child Research Project at the University of NC at Chapel Hill
Originally titled “Childhood Psychosis Rating Scale”
Used initially to evaluate children referred to state-side TEACCH program
Relating to People
Adaption to Change
Taste, Smell, and Touch Response and Use
Fear or Nervousness
Level and Consistency of Intellectual Response
Psychological testing, classroom participation, parent reports, history records
Ratings should not be made until after data collection is complete
Child’s behavior should be compared to that of a typical child of the same age
Anecdotal data should be recorded on peculiarity, frequency, intensity, and duration of behaviors observed
Familiar with definitions/descriptions
Rating of 1-4 (with midpoints)
Total score by summing the 15 individual ratings (range from 15-60)
Scores place individuals within a diagnostic categorization system (NonAutistic, Mild/Moderate Autism, Severe Autism)
Definition: The child’s interest in toys/other objects and how he/she uses them
Keep in mind…
2.Use after given a model
3.Level of interest (lack of or excessive)
4.Use of toys in appropriate/inappropriate ways
Definition: How the child imitates verbal and nonverbal acts
Keep in mind…
1. Behavior to be imitated should be within child’s abilities
2. Sounds, words, motor movements, written model
3. Unwilling or unable to imitate?
4. Latency in responding
Definition: Rating of unusual visual attention patterns when required to look at objects/people
Keep in mind…
1. Avoiding eye contact or making through corners of eyes
2. How often must child be prompted to make eye contact
3. How intrusive must those prompts get to achieve eye contact
Validity under alternate conditions
Sample of 274 preschool children diagnosed with AD, PDD-NOS, MR, Delayed, and Other
1. CARS scores vs. DSM-IV clinical diagnosis
2. CARS scores between different diagnostic groups
65 children (18 months – 11 years) diagnosed with autism
1. CARS and ABC correspondence with diagnosis made with DSM-IV criteria
According to the NY State Department of Health there is evidence to support:
CARS as a useful part of the assessment of children with possible autism in a variety of settings: early intervention programs, preschool developmental programs, and developmental diagnostic centers.
CARS possesses an acceptable combination of practicality and research support, despite the limited research on its use in children under 3 years of age.
According to the NY State Department of Health there is no evidence to support:
That the CARS may be useful for periodic monitoring of children with autism or for assessing long-term outcomes.
That professionals using the CARS have experience in assessing children with autism or have adequate training in administering and interpreting the CARS.
That the instrument (CARS) is practical, is supported by research, or is useful for collecting information to assist with estimating the prevalence of autism or assessing functional outcomes.
Agreement with DSM-IV diagnoses of AD
Easy to train
Can be done quickly
Useful with wide age range
Does not include peer relationships, joint attention, or symbolic play
Does not differentiate between individuals with other ASDs
Arguments for and against the use of CARS as a diagnostic tool
Some level of subjectivity is involved
Other measures have been developed as the field advances (ADOS)
Perry, A., Condillac, R. A., Freeman N. L., Dunn-Geier, J., & Belair J. (2005). Mulit-site study of the Childhood Autism Rating Scale (CARS) in five clinical groups of young children. Journal of Autism and Developmental Disorders, 35, 625-634.
Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004). Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist correspondence and conflicts with DSM-IV criteria in diagnosis of autism. Journal of Autism and Developmental Disorders, 34, 703-708.
Stella, J., Mundy, P., & Tuchman R. (1999). Social and nonsocial factors in the Childhood Autism Rating Scale. Journal of Autism and Developmental Disorders, 29, 307-317.
New York State Department of Health. (1999). Autism/Pervasive Developmental Disorders. Clinical practice guideline technical report. New York: Author.