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Childhood Autism Rating Scale™ – Second Edition (CARS-2)

The purpose of the Childhood Autism Rating Scale™ – Second Edition (CARS™-2; Schopler, Van Bourgondien, Wellman, & Love (2010) is to identify the presence of autism in children and to determine the severity of symptoms.

Overview

The CARS™-2 has two versions: the Standard form, CARS™-2-ST, for individuals less than 6 years of age and those with communication difficulties or below-average estimated IQs; and the CARS™-2-HF for those 6 years and over who are verbally fluent and have IQ scores over 80. The CARS™-2-HF is designed to identify the more subtle characteristics of those with “high-functioning” forms of ASD. The CARS™2 also includes a third form, the Questionnaire for Parents or Caregivers (CARS™-2-QPC), for collecting information for use in making CARS™-2-ST and CARS™-2-HF ratings. Fifteen domains are rated on a 4-point scale. Based on informant or clinician observation, the clinician assigns ratings in each domain related to frequency, peculiarity, intensity, and duration. The CARS™-2 yields cutoff scores, standard scores, and percentiles.

Summary

Author (yr) Age Range (yrs) Method of Administration/Format Approx. Time to Administer Subscales
Childhood Autism Rating Scale – Second Edition (CARS-2) Schopler, Van Bourgondien, Wellman, & Love (2010). CARS-2-ST: 2 years to < 6 and those with communication difficulties or below average estimated IQs CARS-2-HF: 6+ years for verbally fluent individuals with IQ scores over 80

Two 15-item rating scales completed by clinician on a 7-point scale based on observation, parent report, and other records

Questionnaire for Parents or Caregivers (CARS-2-QPC), for collecting information for use in making CARS-2-ST and CARS-2-HF.

Yields cutoff scores, standard scores, and percentiles

5-10 min. to rate items (after gathering the information needed)

Relating to People; Imitation (ST); Social- Emotional Understanding (HF); Body Use Object Use (ST); Object Use in Play (HF) Adaptation to Change (ST); Adaptation to Change/Restricted Interests (HF); Visual Response; Listening Response; Taste, Smell, & Touch Response and Use; Fear or Nervousness (ST); Fear or Anxiety (HF); Verbal Communication; Activity Level (ST); Thinking/Cognitive Integration Skills (HF); Level and Consistency of Intellectual Response; General Impressions

Screening/Diagnosis: D

Availability: Western Psychological Services, http://bit.ly/1Fo5FUW

Author (yr) Age Range (yrs) Method of Administration/Format Approx. Time to Administer Subscales
Questionnaire for Parents or Caregiver™s (CARS-2-QPC™) For parent or caregiver of an individual of any age.

Unscored form: questionnaire completed by parent or caregiver. These responses become the framework for follow-up interview information.

5-10 min. to rate items (after gathering the information needed)

Early Development; Social; Emotional and Communication; Repetitive Behaviors; Play and Routines; Unusual Sensory Interests.

Screening/Diagnosis: D

Availability: Western Psychological Services, http://bit.ly/1Fo5FUW

Research

Author (yr) Sample Size Topic(s) Addressed Outcome
Rellini, Tortolani, Trillo, Carbone, & Montecchi (2004) 65 - Age Range: 1.5–11 years Criterion validity

Sensitivity for AU = 100% False negatives = 0

Author (yr) Sample Size Topic(s) Addressed Outcome
DiLalla & Rogers (1994) 69 - Age Range: 2-6 years Factor analysis

Yields three factors: social impairment, negative emotionality, and distorted sensory response

Author (yr) Sample Size Topic(s) Addressed Outcome
Pilowsky, Yirmiya, Shulman, & Dover (1998) 83 - Age Range:1.5–3.4 years Concurrent validity

Agreement with ADI-R = 85.7%

Author (yr) Sample Size Topic(s) Addressed Outcome
Saemundsen, Magnússon, Smári, & Sigurdardóttir (2003) 54 - Age Range:1.8–9.5 years Concurrent validity

Agreement with ADI-R = 66.7% when ADI-R AU definition is used

Author (yr) Sample Size Topic(s) Addressed Outcome
Magyar & Pandolfi (2007) 164 - Age Range:1.5–6.5 years Factor analysis

Four factors identified: social communication, social interaction, stereotypes and sensory abnormalities, emotional regulation

Author (yr) Sample Size Topic(s) Addressed Outcome
Perry, Condillac, Freeman, Dunn-Geier, & Belair (2005) 274 - Age Range: 2-6 years Discriminative validity

r = correlation

88% agreement between CARS and clinical diagnosis;

Sensitivity = 0.94; Specificity = 0.85;

CARS negatively correlated with cognitive (r = -0.67) and adaptive

(r = -0.69);

ANOVA = 157.97;

AU group mean> PDD-NOS>MR> Developmental delay and other groups

Author (yr) Sample Size Topic(s) Addressed Outcome
Stella, Mundy, & Tuchman (1999) 90 - Age Range: AU mean of 71.32 months; PDD- NOS mean of 50.54 Factor analysis

Five-factor structure: disturbances in social orienting, communication and behavioral flexibility, emotional reactivity, consistency of cognitive performance and response to environment, odd sensory experiences

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