CARS

CHILDHOOD AUTISM
RATING SCALE
 What is Autism?

⚫ It is a brain-based disorder characterized by

social-communication challenges and restricted
repetitive behaviors, activities, and interests.

⚫ Such behaviors include repetitive motor behaviors (hand

flapping, body rocking), insistence on sameness,
resistance to change and, in some cases, aggression or
self-injury.
 Purpose

⚫ CARS was developed to identify children with autism

and to distinguish them from mentally handicapped
children without the autism syndrome.

⚫ It also distinguishes children in the autism mild to

moderate range from children with autism in the
moderate to severe range.
 Background

⚫ CARS was developed by staff of the Treatment and

Education of Autistic and related
Communication-handicapped Children
program(TEACCH), and was published in 1980.

⚫ Over a period of fifteen years, TEACCH staff used a

database of over 1,500 cases to develop this
comprehensive autism diagnostic tool.
 Assessment areas covered:

•Taste, Smell, and Touch

•Relating to People
•Imitation Response and Use
•Emotional Response •Fear or Nervousness
•Body Use •Verbal Communication
•Object Use (Object Use in •Nonverbal
Play)
Communication
•Adaptation to Change
•Activity Level
•Visual Response
•Listening Response •Level and Consistency
of Intellectual Response
•General Impressions
 Development overtime

⚫ This second edition of CARS(CARS-2) makes it

more responsive to individuals on the “high
functioning” end of autism spectrum disorders.
 Development overtime
The CARS-2 includes three forms:
⚫ Standard Version Rating Booklet (CARS2-ST):
Equivalent to the original CARS; for use with individuals
younger than 6 years of age and those with
communication difficulties or below-average IQs,
⚫ High-Functioning Version Rating Booklet (CARS2-HF):
An alternative for assessing verbally fluent individuals, 6
years of age and older, with IQ scores above 80
⚫ Questionnaire for Parents or Caregivers (CARS2-QPC):
An unscored scale that gathers information for use in
making ratings.
 Format

⚫ Presented in questionnaire form, this scale is

completed based on direct behavior observation by a
professional as well as reports from parents,
teachers, or caretakers.
 Administration

⚫ Age group: 2 years & older

⚫ Mode of administration is individual
⚫ Administration time: 5–10 minutes (after the
information needed to make the ratings has been
collected)
 Instructions:

⚫ For each category, use the space provided below

each scale for taking notes concerning the behaviors
relevant to each scale.
⚫ After you have finished observing the child, rate the
behaviors relevant to each item of the scale.
⚫ For each item, circle the number which corresponds
to the statement that best describes the child.
 Scoring

⚫ The clinician rates the individual on each item,

using a 4-point response scale. Ratings are based
not only on frequency of the behavior but also on
its intensity, peculiarity, and duration.
 Scoring

⚫ Each of the fifteen criteria listed above is rated

with a score of:
1 = normal for child’s age
2 = mildly abnormal
3 = moderately abnormal
4 = severely abnormal

⚫ Midpoint scores of 1.5, 2.5, and 3.5 are also used

⚫ Total CARS scores range from a 15 to 60, with a

minimum score of 30 serving as the cutoff for a
screening of autism.
Scoring
 Interpretation

⚫ Scores between 30 and 37 indicate mild to

moderate autism and scores between 38 and 60
indicate severe autism.
 Validity, reliability & consistency

⚫ Internal Consistency: High, Coefficient alpha of 0.94

⚫ Average Reliability: 0.71

⚫ Criterion Related Validity: 0.80

⚫ Accuracy: Clinical setting: 96% , Parent setting: 72%

 Advantages

⚫ Important first step in identifying children with

autism at an early age.

⚫ Identifying clinical clues of possible autism may be

an important first step that then triggers further
screening and assessment.

⚫ In determining if a deficiency in a specific behavior is

a clinical clue for autism, it is necessary to know
when these specific behaviors are first seen in
typically developing children.
 Limitations

⚫ No single clinical clue will perfectly identify children

with autism.

⚫ Relying on any particular abnormal or deficient

behavior (or clinical clue) to identify persons with
autism will result in both false positive and false
negative results.