The Effectiveness Of The Childhood Autism Rating Scale Second Edition In Assessing And Diagnosing Autism Cases In A Saudi Sample
European Autism Congress
Ruwida Muhammad Al.atawi
Posters & Accepted Abstracts: Autism Open Access
Abstract :
Biography :
Ruwida Muhammad Al.atawi is a Faculty Member in the Department of Special Education, Faculty of Education and Arts in Tabuk University of Jordan in 2013. He has six scientific journals. Currently, he is working as a Vice Dean of the Faculty of Business Administration at Tabuk University, Kingdom of Saudi Arabia.
How To Diagnose Autism
The Childhood Autism Rating Scale is a behavior rating scale intended to help identify children 2 years and older children with Autism, specifically, distinguishing them from developmentally handicapped children who are not Autistic. In addition, it distinguishes between mid-to-moderate and severe Autism. Since its original publication, the CARS has become one of the most widely used and empirically validated autism assessment techniques. It has proven effective in discriminating between children with autism and those with severe cognitive deficits, and in distinguishing mild-to-moderate from severe autism.
The Childhood Autism Rating Scale is a 15 item behavioral rating scale developed to identify children with autism and to categorize these behaviors from mild to moderate to severe. Each item covers a particular characteristic, ability of behavior. The total CARS score may range from a low of 15 to a high of 60 . The score represents placement on a continuum: the lower the score, the fewer autistic behaviors the child exhibits the higher the score, the more autistic behaviors the child exhibits.
The scores are given as follows:
Relating to People XX
Level & Consistency of Intellectual Response XX
General Impression XX
–
Total Score XX
Cars Cutoff For Autistic Disorder Diagnosis
In order to assess the ideal CARS cutoff score for a diagnosis of autistic disorder in samples of toddler and pre-school children, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for cutoffs distinguishing an autistic disorder diagnosis from a PDD-NOS diagnosis. Positive predictive value refers to the proportion of children who were correctly classified as receiving a diagnosis of autistic disorder by the CARS cutoff and negative predictive value refers to the proportion of children who are correctly classified as not having autistic disorder .
ROC curves for cutoffs for an autistic disorder diagnosis in both age samples
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Efficacy In Asd Trials
A majority of SGA trials for treatment of ASDs examine response on the ABC irritability subscale as the primary outcome measure, with most studies reporting positive treatment effects, often with large effect sizes . Treatment response on core symptoms of ASD as measured by other ABC subscales was more variable. Trials using the CARS and GARS rating scales as primary outcome measures are difficult to compare to the trials using the ABC-I scale, since the CARS and GARS appear to measure more of the core autism symptoms, as opposed to irritability symptoms alone.
Of the ASDs trials, the RUPPAN risperidone trial and the Owen et al. aripiprazole trial were the most comparable in terms of design: approximately 100 subjects, more than 80% males, mean age of approximately 9 years of age, flexible dose, 8-week duration, and use of ABC-I as the primary outcome measure. The reported effect size was numerically larger in the risperidone trial than the reported effect size in the aripiprazole trial . However, there was a potentially significant difference at baseline, as patients had higher baseline symptom scores in the aripiprazole trial than the risperidone trial . It is possible that treatment with aripiprazole in a population with more severe symptoms at baseline caused the effect size to appear smaller and underestimated what it might have been in a less severely ill cohort of patients, like those enrolled in the risperidone trial.
Dong Ik Park, in, 2020
The Questionnaire For Parents Or Caregivers
The CARS2-QPC is an unscored form completed by the parent or caregiver of the individual being assessed. Its purpose is to give the clinician more information on which to base CARS2-ST or CARS2-HF ratings. Often the questionnaire serves as the framework for a follow-up interview, during which the clinician can clarify and interpret the responses provided by the parent or caregiver.
The areas covered by the CARS2-QPC include the individuals early development social, emotional, and communication skills repetitive behaviors play and routines and unusual sensory interests.
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Comparison Of Cars Scores By Age And Diagnostic Group
Mean CARS total scores were calculated for each diagnostic group. In order to assess whether differences in autism severity varied across diagnostic groups, a one-way ANOVA was conducted for each age group. In the 2-year-old sample, the analysis produced a main effect of diagnostic group = 286.89, p< 0.001), indicating that mean CARS scores differed significantly by diagnostic group. Post hoc comparisons indicated that the autistic disorder sample had the highest mean CARS score , which was significantly higher than the mean CARS score of the PDD-NOS group , which was significantly higher than the mean CARS score of the non-ASD group , which in turn was significantly higher than the mean CARS score of the no diagnosis group .
Similar results were found in the 4-year-old sample. There was a main effect of diagnostic group = 216.37, p< 0.001) and post hoc comparisons indicated that the autistic disorder sample had the highest mean CARS score , which was significantly higher that the mean CARS score of the PDD-NOS group , which was significantly higher than the mean CARS score of the non-ASD group , which was significantly higher than the mean CARS score of the no diagnosis group .
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Childhood Autism Rating Scale
There is a lot of assessment tools to help in the diagnosis of autism available. One of them is the Childhood Autism Rating Scale .
CARS was developed by Eric Schopler, Robert Reichier and Barbara Rochen Renner. Just like any other autism assessment tool, it was made to help in the diagnosis of autism in children. The difference CARS has from other behavior rating tools is that it actually can tell the difference if your child has autism or other developmental delay disorders like mental retardation. It makes it easier for healthcare providers, educators, and parents to identify and classify children with autism.
PRICE: $19.99
How it Works
CARS works by rating your childs behavior, characteristics, and abilities against the expected developmental growth of a typical child.
As stated in the CARS, these characteristics are evaluated:
- Relationship to people
- Level and consistency of intellectual response
- General impressions
References:
Caldwell College. faculty.caldwell.edu: The Childhood Autism Rating Scale . Retrieved March 19, 2011, from faculty.caldwell.edu/sreeve/PS%20571%20The
20Childhood%20Autism%20Rating%20Scale%20.ppt#259,2,CARS Described
No part of this article may be reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles and reviews. For information, contact Special Learning Inc., at:
Childhood Autism Rating Scale Second Edition
Eric Schopler, Ph.D., Mary E. Van Bourgondien, Ph.D., Glenna JanetteWellman, Ph.D., & Steven R. Love, Ph.D.
Age Range 2 and olderAdministration Time510 minutesQualification Level B
DescriptionThe Childhood Autism Rating Scale helps to identify children (2 years and older with Autism, specifically, distinguishing them from developmentally handicapped children who are not Autistic. In addition, it distinguishes between mid-to-moderate and severe Autism. Its brevity makes it a very useful tool to help you recognize and classify Autistic children.
Now the CARS2 expands the tests clinical value, making it more responsive to individuals on the high functioning end of the Autism Spectrumthose with average or higher IQ scores, better verbal skills, and more subtle social and behavioural deficits. While retaining the simplicity, brevity, and clarity of the original test, the CARS2 adds forms and features that help you integrate diagnostic information, determine functional capabilities, provide feedback to parents, and design targeted intervention.
How to Use the AssessmentItems on the Standard form duplicate those on the original CARS, while items on the High Functioning form have been modified to reflect current research on the characteristics of people with high functioning autism or Aspergers Syndrome.
Scales & Forms
High-Functioning Version Rating Booklet An alternative for assessing verbally fluent individuals, 6 years of age and older, with IQ scores above 80
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The Best Way To Inform And Support Diagnosis
The CARS2 is extremely useful in identifying symptoms of autism.
- It covers the entire autism spectrum, as defined by empirical research.
- It is based on decades of use with thousands of referred individuals.
- It assesses virtually all ages and functional levels.
- It provides concise, objective, and quantifiable ratings based on direct behavioral observation.
- Scores show a consistent, strong, positive, and specific relationship with an autism diagnosis.
- Ratings are reliable across time, settings, sources of information, and raters.
With a new form for higher functioning individuals, a structured way to gather caregiver information, and guidelines linking scores to intervention, the CARS2 remains one of the best autism assessments available.
Conclusions And Future Directions In The Biomarker And Therapy Discovery Based On
While -omics and big data analysis have profoundly advanced ASD research by providing information on affected biosignatures and pathways , none has been validated as reliable clinical biomarkers and therapy targets. This may be the result of the current clinical diagnosis strategy based on standard tests including the Diagnostic and Standard Manual of Mental Disorders, the Childhood Autism Rating Scale, the ABC, the Gilliam Autism Rating Scale, the ADI-R and the Checklist for Autism in Toddlers. Since the standard tests are only based on phenotypic and behavioral traits, underlying biological mechanisms need to be considered for more precise diagnosis and treatment. Therefore, Research Domain Criteria has been suggested to be an alternative framework for biological classification system. The RDoC can address more biological and functional domains related to ASD. For instance, Hennessey et al. attempted to classify amygdala dysfunction in ASD using five RDoC domains including Negative Valence Systems, Positive Valence Systems, Cognitive Systems, Social Processes and Arousal and Regulatory Systems.133 Systemic molecular profiling using -omics and big data analysis will strongly assist RDoC-based diagnosis strategy.
Fig. 1. The overview of biosignatures and pathways identified from -omics and big data analysis for autism spectrum disorder.
M.Y. Ono, … R.J. Hagerman, in, 2008
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Influence Of The Cars Cutoff On Diagnostic Agreement
To assess the influence of a CARS ASD cutoff on rates of agreement among autism diagnostic instruments and clinical judgment, kappa analyses were conducted to assess agreement for ASD diagnoses based on DSM-IV criteria, the ADOS, and the CARS using the traditional CARS cutoff of 30 and the proposed ASD cutoff score of 25.5. Kappa analyses were conducted with sub-samples of the original 2-year-old and 4-year old samples children were excluded if they did not have sufficient ADOS data available. Levels of clinical significance are defined by Cicchetti and Sparrows criteria.
Using the CARS cutoff of 30 for the children in the 2-year-old sample, there was 76% agreement and 268 cases of agreement between ASD diagnoses made by the CARS and diagnoses based on DSM-IV criteria. In the sample, 155 children received ASD diagnoses from both the CARS and clinical judgment based on DSM-IV criteria, 5 children received diagnoses from the CARS but did not receive a diagnosis based on DSM-IV criteria, 81 children met DSM-IV criteria for ASD diagnoses but did not meet criteria on the CARS, and 113 children did not receive a diagnosis from the CARS or clinical judgment. Kappa analyses revealed fair agreement between the CARS and DSM-IV criteria using a cutoff score of 30 on the CARS.
Cars Scores And Cognitive Level
Pearsons correlation coefficients were calculated to examine the relationship between CARS scores and developmental quotient , as measured by the early learning composite from the MSEL. In both the 2-year-old = 0.58) and 4-year-old = 0.72) samples there were strong negative correlations between DQ scores and CARS total scores, with large and very large effect sizes respectively . The large correlations between CARS scores and MSEL ELC scores may have been driven by between group differences and in order to assess for that influence, correlation analyses were run separately within groups . Between group differences did not appear to influence the correlations in the 2-year-old sample, but may have contributed to the lack of correlation in the No Diagnosis group in the 4-year-old sample due to restriction of range.
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The Cars2 Includes Three Forms:
Standard Version Rating Booklet
Equivalent to the original CARS for use with individuals younger than 6 years of age and those with communication difficulties or below-average estimated IQs
High-Functioning Version Rating Booklet
An alternative for assessing verbally fluent individuals, 6 years of age and older, with IQ scores above 80
Questionnaire for Parents or Caregivers
An unscored scale that gathers information for use in making CARS2-ST and CARS2-HF ratings
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Analyses Of Sample Characteristics
Two-Year-Old Sample
Of the 376 children who were evaluated at age two, 142 were in the autistic disorder group, 101 in the PDD-NOS group, 95 in the non-ASD group, and 38 were in the no diagnosis group. In the 2-year-old sample, there was a significant difference in age among the four diagnostic groups = 6, p< 0.001), with the no diagnosis group significantly younger than all other diagnostic groups. There were no significant differences among the diagnostic groups in gender = 3.19, p = 0.363) or ethnicity = 13.7, p = 0.746).
In 333 of the 376 2-year-old children, developmental level was measured by the MSEL. There were significant differences in the developmental quotient among the four diagnostic groups = 86.1, p< 0.001) the Levenes test for the equality of variances was significant, indicating that the error variance of MSEL ELC scores were not assumed to be similar across diagnostic groups. Post hoc analyses revealed that mean DQ score of the no diagnosis group was significantly higher than all other groups. The DQ score of the non-ASD group did not differ significantly from the score of the PDD-NOS group , though both scores were significantly higher than the DQ score of the autistic disorder group . However it should be noted that the developmental level of these three groups, while statistically different, are all in the very low range and do not represent clinically significant differences.
Cars And Clinical Outcomes
Reduced whole-blood, ex vivo, LPS-induced TNF- production capacity has been similarly associated with adverse outcomes from critical illness, including trauma and sepsis in adults39,40 and sepsis,41,42 MODS,23 viral infections,32,43,44 cardiopulmonary bypass,16,45 and trauma15 in children. These adverse outcomes include prolonged organ dysfunction, nosocomial infection, and death. While distinct thresholds of TNF- production capacity that are associated with these outcomes are dependent on the stimulation techniques used, standardized protocols exist that have been used successfully in single- and multicenter settings. It is unclear whether monocyte HLA-DR expression or ex vivo LPS-induced TNF- production capacity is better for defining the innate immune systems CARS response in critical illness or whether the measurement of both markers is required.
CHRIS PLAUCHÉ JOHNSON, SCOTT M. MYERS, in, 2008
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