Use of the Childhood Autism Rating Scale (CARS) for Children With High Functioning Autism or Asperger Syndrome

Abstract

The authors of the Childhood Autism Rating Scale (CARS) state in the manual that the best cutoff score for distinguishing low functioning autism (LFA) from intellectual disability is 30 for children and 28 for adolescents and adults. This study determined that a cutoff score of 25.5 was most accurate in differentiating between high functioning autism or Asperger syndrome (HFA; n = 197) and ADHD (n = 74) in a sample of 1- to 16-year-olds with IQs of 80 or higher. Classification accuracy was 96% using clinician scores and 72% using parent scores. Children with LFA (n = 193) had significantly higher clinician and parent scores than children with HFA, and scores were negatively correlated with IQ. None of the typical children (n = 64) earned parent scores greater than 21.

Re‐adjusting the cut‐off score of the Korean version of the Childhood Autism Rating Scale for high‐functioning individuals with autism spectrum disorder

“…Our findings support the hypothesis that HFA or Asperger patients whose language development and intelligence are relatively within the normal range are likely to be misdiagnosed as non-ASD by the K-CARS. This result is compatible with previous findings that 25% of the children with HFA or Asperger's syndrome were below the cut-off score of 30, falling into the non-autism range; 28 further, while CARS classification accuracy for low-functioning autism was 97%, accuracy for classifying participants with HFA was only 75%. 13 The CARS, Second Edition-Standard Version (CARS2-ST) also has a different cut-off score for those with autistic disorder (cut-off score: 36) and those with HFA (cut-off score: 28).…”

Theory of mind predominantly associated with the quality, not quantity, of pretend play in children with autism spectrum disorder

“…Typically, a total score of below 30 means the child does not meet the clinical threshold considered to indicate symptoms of ASD, a score of 30-36 represents mild to moderate symptoms of ASD, and a score of 37 or higher suggests having severe symptoms of ASD [27]. However, a cutoff score of 25.5 has been suggested to most accurately identify high functioning autism or Asperger syndrome in patients with IQs of 80 or higher [45]. Therefore, in this study, two cut-off points were adopted: Cut-off points of 30 and 25.5 were, respectively, used for children with IQs below 80 and for those with IQs of 80 or higher.…”

“…Therefore, in this study, two cut-off points were adopted: Cut-off points of 30 and 25.5 were, respectively, used for children with IQs below 80 and for those with IQs of 80 or higher. The reliability and validity of the CARS have been well established, including the internal consistency [27,40], test-retest reliability [27], inter-rater reliability [40], convergent validity [46], and sensitivity and specificity [45,47].…”

Prospective assessment of autism traits in children exposed to antiepileptic drugs during pregnancy

“…Our data analyses excluded one child who enrolled in our outcomes study who had a previous diagnosis of "autistic traits," and yet his high level of function placed him well below the CARS cutoff, including that published recently for use in high-functioning ASD. 38 Including that child in our analyses would show that 11.5% (3/26) of valproate monotherapy-exposed children had ASD. Accordingly, the current rate of ASD associated with prenatal AED exposure remains an estimate only; our study highlights the risk profile of this group of children and points to a need for ongoing prospective research in large samples of exposed children.…”