DOI QR코드

DOI QR Code

A Validation Study of the CARS-2 Compared With the ADOS-2 in the Diagnosis of Autism Spectrum Disorder: A Suggestion for Cutoff Scores

  • Seong-In Ji (Department of Psychiatry, Seoul National University Hospital) ;
  • Hyungseo Park (Department of Psychiatry, Seoul National University Hospital) ;
  • Sun Ah Yoon (Department of Psychiatry, Seoul National University Hospital) ;
  • Soon-Beom Hong (Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine)
  • Received : 2022.09.12
  • Accepted : 2022.09.26
  • Published : 2023.01.01

Abstract

Objectives: This study examined the validity of the Childhood Autism Rating Scale, Second Edition (CARS-2) compared with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) in identifying autism spectrum disorder (ASD). Methods: A total of 237 children were tested using both the CARS-2 and ADOS-2. We examined the correlation using Pearson's correlation analysis. In addition, we used a receiver operating characteristic graph to determine the optimal standard version of the CARS-2 (CARS2-ST) cutoff score for ASD diagnosis using the ADOS-2. Results: The concurrent validity of the CARS2-ST was demonstrated by a significant correlation with the ADOS-2 (r=0.864, p<0.001). The optimal CARS2-ST cutoff scores were 30 and 28.5 for identifying autism and autism spectrum, respectively, based on the ADOS-2. Conclusion: We suggest a newly derived CARS2-ST cutoff score of 28.5 for screening ASD and providing early intervention.

Keywords

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Association;2013.
  2. Maenner MJ, Shaw KA, Bakian AV, Bilder DA, Durkin MS, Esler A, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2018. MMWR Surveill Summ 2021;70:1-16. https://doi.org/10.15585/mmwr.ss7011a1
  3. Kim YS, Leventhal BL, Koh YJ, Fombonne E, Laska E, Lim EC, et al. Prevalence of autism spectrum disorders in a total population sample. Am J Psychiatry 2011;168:904-912. https://doi.org/10.1176/appi.ajp.2011.10101532
  4. Gerhardt PF, Lainer I. Addressing the needs of adolescents and adults with autism: a crisis on the horizon. J Contemp Psychother 2011;41:37-45. https://doi.org/10.1007/s10879-010-9160-2
  5. Volkmar FR, Pauls D. Autism. Lancet 2003;362:1133-1141. https://doi.org/10.1016/S0140-6736(03)14471-6
  6. Schopler E, Reichler RJ, Renner BR. CARS: the childhood autism rating scale. Los Angeles, CA: Western Psychological Services;1988.
  7. Ponde MP, Rousseau C, Carlos MA. Pervasive developmental disorder in the children of immigrant parents: comparison of different assessment instruments. Arq Neuropsiquiatr 2013;71:877-882. https://doi.org/10.1590/0004-282X20130091
  8. Ozonoff S, Goodlin-Jones BL, Solomon M. Evidence-based assessment of autism spectrum disorders in children and adolescents. J Clin Child Adolesc Psychol 2005;34:523-540. https://doi.org/10.1207/s15374424jccp3403_8
  9. National Collaborating Centre for Women's and Children's Health (UK). Autism: Recognition, Referral and Diagnosis of Children and Young People on the Autism Spectrum. London: RCOG Press; 2011 Sep. (NICE Clinical Guidelines, No. 128.)
  10. Akshoomoff N, Corsello C, Schmidt H. The role of the autism diagnostic observation schedule in the assessment of autism spectrum disorders in school and community settings. Calif School Psychol 2006;11:7-19. https://doi.org/10.1007/BF03341111
  11. Park HS, Yi SY, Yoon SA, Hong SB. Comparison of the autism diagnostic observation schedule and childhood autism rating scale in the diagnosis of autism spectrum disorder: a preliminary study. J Korean Acad Child Adolesc Psychiatry 2018;29:172-177. https://doi.org/10.5765/jkacap.180015
  12. Reszka SS, Boyd BA, McBee M, Hume KA, Odom SL. Brief report: concurrent validity of autism symptom severity measures. J Autism Dev Disord 2014;44:466-470. https://doi.org/10.1007/s10803-013-1879-7
  13. Rellini E, Tortolani D, Trillo S, Carbone S, Montecchi F. Childhood autism rating scale (CARS) and autism behavior checklist (ABC) correspondence and conflicts with DSM-IV criteria in diagnosis of autism. J Autism Dev Disord 2004;34:703-708. https://doi.org/10.1007/s10803-004-5290-2
  14. Schopler E, Van Bourgondien ME, Wellman GJ, Love SR. The childhood autism rating scale (CARS2). 2nd ed. Los Angeles, CA: Western Psychological Services;2010.
  15. Mayes SD, Calhoun SL, Murray MJ, Pearl A, Black A, Tierney CD. Final DSM-5 under-identifies mild autism spectrum disorder: agreement between the DSM-5, CARS, CASD, and clinical diagnoses. Res Autism Spectr Disord 2014;8:68-73. https://doi.org/10.1016/j.rasd.2013.11.002
  16. Dawkins T, Meyer AT, Van Bourgondien ME. The relationship between the childhood autism rating scale: second edition and clinical diagnosis utilizing the DSM-IV-TR and the DSM-5. J Autism Dev Disord 2016;46:3361-3368. https://doi.org/10.1007/s10803-016-2860-z
  17. Geier DA, Kern JK, Geier MR. A comparison of the autism treatment evaluation checklist (ATEC) and the childhood autism rating scale (CARS) for the quantitative evaluation of autism. J Ment Health Res Intellect Disabil 2013;6:255-267. https://doi.org/10.1080/19315864.2012.681340
  18. Lee S, Yoon S, Shin M. Korean childhood autism rating scale. 2nd ed. Seoul: Inpsyt;2019.
  19. Lee N, Hong Y, Kim Y. Screening instruments for autism spectrum disorder: mini review. J Korean Neuropsychiatr Assoc 2019;58: 192-201. https://doi.org/10.4306/jknpa.2019.58.3.192
  20. Lord C, Rutter M, DiLavore P, Risi S, Gotham K, Bishop S. Autism diagnostic observation schedule, 2nd edition (ADOS-2). Los Angeles, CA: Western Psychological Services;2012.
  21. Sanchez MJ, Constantino JN. Expediting clinician assessment in the diagnosis of autism spectrum disorder. Dev Med Child Neurol 2020;62:806-812. https://doi.org/10.1111/dmcn.14530
  22. Kwon HJ, Yoo HJ, Kim JH, Noh DH, Sunwoo HJ, Jeon YS, et al. Re-adjusting the cut-off score of the Korean version of the childhood autism rating scale for high-functioning individuals with autism spectrum disorder. Psychiatry Clin Neurosci 2017;71:725-732. https://doi.org/10.1111/pcn.12540
  23. Mayes SD, Calhoun SL, Murray MJ, Morrow JD, Yurich KK, Mahr F, et al. Comparison of scores on the checklist for autism spectrum disorder, childhood autism rating scale, and Gilliam Asperger's disorder scale for children with low functioning autism, high functioning autism, Asperger's disorder, ADHD, and typical development. J Autism Dev Disord 2009;39:1682-1693. https://doi.org/10.1007/s10803-009-0812-6