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Autism Scales:

Comparing the CARS-2, Gars-2 & ASRS


Written by: Sarah Lipman

Overview:
When:
Published in 2005
Who:
For ages 3-22
What:
1 general rating scale; 42 items, 3
subscales
Structured parent interview
questions

GARS2

When:
Published in 2009
Who:
For ages 2-18
What:
Long forms for age 2-5 (70 item) for both
parent & teacher
Long forms for age 6-18 (71 item) for
both parent & teacher
A general short form for age 2-5 (15
item)
A general short form for age 6-18 (15
item)

ASRS

When
Published in 2010
Who:
For ages 2+
What
1 scale to rate individuals <6, or
6+ w/ IQ= <79 (intended rater is
clinician)
1 scale to rate individuals 6+ or w/
an IQ= > 80 (intended rater is
clinician)
1 parent interview questions

CARS2

Psychometric
Properties

Stratification variables:
GARS-2

ASRS

CARS2-ST

CARS2-HF

Normed on:

1,107 diagnosed w/ 1,280 diagnosed w/ 1,034 diagnosed w/ 994 diagnosed &


Autism
autism
Autism & IQ< 85
non-diagnosed
individuals w/
IQ>85

Age:

Ages 3-10 had an N


> 75
11-20 had an N >
10
21-22 had an N <
10

Ages 2-16 had an


N= 80
Ages 17& 18 had
combined N=80

30% age 2-5


43% age 6-10
20% age 11-15
7% age 16-36

35% age 6-10


41% age 11-15
24% age 16-57

Gender:

81% Male; 19%


female

50% male; 50%


female

78% male; 22%


female

78% male; 22%


female

Race:

84% white; 14%


black; 2% other

59% white; 16%


Hispanic; 15%
black; 4% Asian;
5% other

60% white; 16%


black; 13%
Hispanic/Latino;
7% Asian; 4%
other

73% white; 14%


black; 6%
Hispanic/Latino;
1% Native
American; 3%
Asian; 3% other

Geographical
region:

18% northeast,
32% South, 22%

Ex. 38% Northeast; 29% Northeast;


22% Midwest; 24% 11% Midwest; 43%

20% Northeast;
21% Midwest; 48%

Reliability: Internal Consistency

GARS-2
Stereotyped
behaviors= .84
Communication= .
86
Social
interaction= .88
All test items= .

94

ASRS
Age 2-5: .95
parent scale; .94
teacher scale
Age 6-11: .97
parent scale; .97
teacher scale
Age 12-18: .97
parent scale; .97
teacher scale

CARS-2
CARS2-ST: .93
CARS-HF: .96

Reliability: Stability

GARS-2

ASRS

1 week testretest
Results:
stereotyped
behaviors: .83

2-4 week testretest


Results:
2-5 years Parent

communication: .64
social interaction: .
82
full Autism index: .
84

scale: .88; Teacher


scale: .80
6-18 years Parent
scale: .94;
Teacher: .81

CARS-2
1 year testretest
0.88
2 year testretest
0.78

Reliability: Consistency Between


Raters

ASRS
Age 2-5
Parent: 0.81
Teacher/caregiver: N/A
Age 6-18
Parent: .90
Teacher:

.64

CARS-2
CARS: .84
CARS2-HF: .95

Validity: Content Validity

GARS2
DSM-IVTR

CARS2

ASRS
Autism
Society
of
America

DSMIV-TR

Recent
Resear
ch

DSM-IV

Researc
h

NSAC

Validity: Concurrent Validity


GARS-2
Ability to discriminate other disorders
ID mean score= 72
Multidisabled mean score= 76
Nondisabled mean score= 49
Autistic mean score= 100
Ability to correctly identify the disorder
Correctly identified 84-85%

ASRS
Ability to discriminate other disorders
ADHD mean score= 57.9-62.5
Other clinical mean score= 46.9-57.7
General population mean score= 47.7-48.2
Autism mean score= 69.8- 72.8
Ability to correctly identify the disorder
Correctly identified .90-.91 for parent scales; .89- .91 for teacher scales

CARS-2
Ability to correctly identify
CARS correctly identified .89
CARS2-HF correctly identified .93

Validity: Convergent Validity


GARS-2
ABC
r= 0.64

ASRS

GARS-2
r= .80- .83 for Parents ratings; r= .76- .82 for Teachers rating
CARS
r= .35- .50 Parents rating; r= .06- .50 for Teachers rating
GADS
r= .63- .70 for Parents rating; r= .74- .76 for Teachers rating

CARS-2

independent overall clinical ratings


r= .80 for CARS
ABC
r=.67 for CARS2-ST
ADOS
r= .79 for CARS2-ST
r= .77 for CARS2-HF
SRS
r=.38 for CARS2-ST
r= .47 for CARS2-HF
ADI-R
r=.81 for CARS

Validity: Utility
GARS-2
Race: White and Black
Age: 3-10
Location: U.S
Purpose: weekly progress monitoring of Autism Symptoms

ASRS
Race: White, black, Asian, and other/mixed race
Age: 2-16
Location: U.S
Purpose: Monthly progress monitoring of Autism Symptoms

CARS-2
Race: White, black, Asian, native American, and other/mixed race
Location: U.S
Purpose: tool as part of a larger assessment in identifying Autism Spectrum disorder

Using the GARS-2

Proper Administration
Who can use the
test:

Filling out the


scales:

Example of item:

Raters should have regular sustained contact w/ the individual for at least 2
weeks
Protocols should be scored by a professional who can interpret quantitative
and qualitative assessment & is familiar w/ autism
3 scales with 14 items for a total of 42 items
Each item needs to be rated in order for the scale to be scored
The rater rates the frequency w/ which they observe each item on a scale
from 0-3
0= never observed
1= seldom observed
2= sometimes observed
3= frequently observed

29. Avoids eye contact; looks away when someone looks at him or her 0 1
2 3

Scoring the Protocols


Calculating raw score
ex.:

Converting raw scores to standard


scores

Interpreting Scores:

Using the ASRS

Proper Administration
Choosing the
right form

Who can use the


test:
Filling out the
scales:

Example of item:

Full-length forms
70 items for ages 2-5; 71 items for ages 6- 18
15 minutes
Recommended for use when a thorough evaluation is desired
Short forms
15 items
5 minutes
Recommended for monitoring treatment progress
Scale written at a 7th grade level
Raters must have known the individual for at least a month
Items rated on a scale from 0-4
0= never observed
1= rarely observed
2=occasionally observed
3=frequently observed
4= very frequently observed

9. Look at others when talking to them? 0 1 2 3 4

Scoring the Protocols: Hand-scoring


Calculating raw score
ex.:

Scoring the Protocols: Hand-scoring


Converting raw scores to standard
scores

Interpreting Scores:

Some quick notes about computer


scoring:
reports can be saved in PDF
format
records that can be sorted and
searched
portable via usb
reports auto generate graphs
tables and summary of results

Using the CARS

Proper Administration
General
Considerations
Who can use the
test:

Filling out the


scales:

Compare individuals to a typically developing child


focus on degree of behavior
Well-informed professionals such as physicians,
special educators, school psychologists,
speech pathologists or audiologists
Items rated on a scale from 0-4
1= within normal limits for age
1.5= very mildly abnormal for age
2=mildly abnormal for age
2.5=mildly-to-moderately abnormal for age
3=moderately abnormal for age
3.5=moderately-to-severely abnormal for age
4= severely abnormal for age

Proper Administration Continued


Item Example:

Scoring the Protocols


Calculating raw score
ex.:

Converting raw scores to standard


scores

Interpreting Scores:

Comparative Strengths

GARS2

Normed group up through


age 10
Good Internal consistency
reliability
Good content validity
Correctly identified 84-85%
of people
r=.64 w/ ABC
only 42 items
method for obtaining score
with missing items
comes w/ parent interview
questions

ASRS
Normed group up through
age 16
Excellent internal
consistency reliability
Good content validity
Correctly identified 89-91%
of people
r=.76-.83 w/ GARS-2
r=.06-.50 w/ CARS
r=.63-.76 w/ GADS
allows for scoring with
(some) missing items
easy hand-scoring
(conversion tables on
protocol)
easy scoring
easy storage
easy generation of graphs

CARS2

Excellent internal
consistency reliability
Good stability reliability
even at 2 years
Correctly identified 89-93%
of people
r=.80 w/ clinical ratings
r=.77- .79 w/ ADOS
r=.38-.47 w/ SRS
r=.67 w/ ABC
r=.81 w/ ADI-R
all scales filled out by
examiner (more control)
easy scoring

Comparative
Weaknesses

GARS-2
Older; norms may
be outdated
Very small n for age
groups over age ten
in normed group
Poor stability
reliability; testretest only 1 week
apart

ASRS
There may be a
small n for age
groups 17 &18 as
stats were
combined
Poor stability
reliability; testretest only 2-4
weeks apart
Consistency
between teacher
raters are on the
low side (r=.64)
Low correlations w/
the CARS test

CARS-2
All age ranges may
not be represented
as normed group
was reported in
ranges
This test may be
artificially sensitive
to age, a quality not
thought to relate to
autism
Low correlations w/
the SRS
All parts of the test
must be completed
by the examiner,
making this test
more time

Summation

CARS-2
May be the most efficient tool for initial assessment

ASRS

May be the most efficient tool for progress


monitoring

ALL ASD scales


Should be interpreted with professional judgment

Questions or Comments?