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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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the childhood autism rating scale cars

The Childhood Autism Rating Scale (CARS)

Jennifer Connelly

Caldwell College

cars described
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

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

cars development history and relationship to other scales
CARS Development, History, and Relationship to Other Scales

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

behavioral items assessed
Behavioral Items Assessed

Relating to People

Imitation

Emotional Response

Body Use

Object Use

Adaption to Change

Visual Response

Listening Response

Taste, Smell, and Touch Response and Use

Fear or Nervousness

Verbal Communication

Nonverbal Communication

Activity Level

Level and Consistency of Intellectual Response

General Impressions

how to observe and rate
How to Observe and Rate

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)

interpretation of scores
Interpretation of Scores

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)

practice object use timmy
Practice: Object Use (Timmy)

Definition: The child’s interest in toys/other objects and how he/she uses them

Keep in mind…

1.Unstructured times

2.Use after given a model

3.Level of interest (lack of or excessive)

4.Use of toys in appropriate/inappropriate ways

practice imitation timmy
Practice: Imitation (Timmy)

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

practice visual response timmy
Practice: Visual Response (Timmy)

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

evaluation of cars reliability and validity
Evaluation of CARS: Reliability and Validity

Internal consistency

Inter-rater agreement

Test-retest stability

Criterion-related validity

Validity under alternate conditions

perry a condillac r a freeman n l dunn geier j belair j 2005
Perry, A., Condillac, R. A., Freeman N. L., Dunn-Geier, J., & Belair J. (2005)
  • Participants:

Sample of 274 preschool children diagnosed with AD, PDD-NOS, MR, Delayed, and Other

  • Objectives:

1. CARS scores vs. DSM-IV clinical diagnosis

2. CARS scores between different diagnostic groups

perry a condillac r a freeman n l dunn geier j belair j 20051
Perry, A., Condillac, R. A., Freeman N. L., Dunn-Geier, J., & Belair J. (2005)
  • Findings:
  • High degree of concordance between CARS and clinical diagnoses (DSM-IV)
  • Negative correlation using CARS between autism severity and cognitive level
  • Clinically defined groups differed in scores in significant/sensible ways, however autistic disorder vs. PDD-NOS still some overlap
rellini e tortolani d trillo s carbone s montecchi f 2004
Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004)
  • Participants:

65 children (18 months – 11 years) diagnosed with autism

  • Objectives:

1. CARS and ABC correspondence with diagnosis made with DSM-IV criteria

rellini e tortolani d trillo s carbone s montecchi f 20041
Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004)
  • Findings:
  • CARS distinguishes individuals with AD from other developmental disorders
  • CARS does not clearly differentiate individuals with other ASDs
nys dept of health evidence to support
NYS Dept of Health: Evidence to Support

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.

nys dept of health no evidence to support
NYS Dept of Health: No Evidence to Support

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.

cars pros and cons
CARS: Pros and Cons

PROS

CONS

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

Dated (terminology)

Somewhat subjective

summary
Summary

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)

references
References

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.