This video provides a detailed guide on the administration and scoring of the Childhood Autistic Rating Scale, 2nd Edition (CARS-2), for diagnosing Autism Spectrum Disorder (ASD). Key points include:
CARS-2 is a diagnostic tool, not a screening tool, used to categorize autism severity (mild, moderate, severe) and correlates with DSM-5 functional criteria.
The scale comprises 15 items, each rated on a 1-4 scale (with .5 increments) based on direct observation and caregiver input.
Ratings consider the peculiarity, frequency, intensity, and duration of observed behaviors.
Scores from the 15 items are totaled to determine a raw score, which is then mapped to T-scores and percentile ranks.
The total raw score helps classify the child into three functional levels of autism as per DSM-5: requiring support (Level 1), requiring substantial support (Level 2), or requiring very substantial support (Level 3).
The lecture uses a case example of a 4-year-old child to illustrate the scoring process for several key items.
CARS2 Administration and Scoring in Clinical Practice
[
00:00:10
]
The Childhood Autistic Rating Scale (CARS) is a diagnostic tool, not intended for screening.
It helps in diagnosing Autism Spectrum Disorder (ASD) and categorizing its severity.
It classifies children into mild, moderate, or severe categories based on their scores.
The latest version, CARS-2, correlates directly with DSM-5 criteria, which classifies autism into functional levels (partial dependent, substantial support, very substantial support).
CARS has been in use since the 1970s and was developed by Schopler.
CARS-2 includes three basic components:
Rating booklet with scoring system.
CARS-2 Standard Version (CARS-2-ST) for individuals under 6 or above 6 with IQ of 79 or lower.
CARS-2 High Functioning (CARS-2-HF) for individuals aged 6 and above with IQ of 80 or higher (used for Asperger's or PDD-NOS).
A questionnaire for parents and caregivers to gather information.
Considerations: Child's reaction to strangers, parents, physical contact (resisting vs. liking affection), attempts required to gain attention, social awareness.
Michael's Observation: Ignored name, didn't always respond to engagement attempts, initiated interactions for snacks/videos but not play, found it hard to sustain reciprocal interaction or initiate interaction.
Score: 3 (Moderately abnormal relationship): Requires persistent effort to gain attention, minimal self-initiated contact.
Considerations: Range of emotions, appropriateness of reactions (e.g., laughing at something funny, crying when hurt), responsiveness to others' emotions, and excessive/under-sensitivity to stimuli (e.g., pain).
Michael's Observation: Narrow range of emotions, showed pleasure in high-interest activities, little change in facial expressions, became upset/cried without clear reason.
Score: 2 (Mildly abnormal emotional response): Occasionally displays inappropriate emotional responses, sometimes unrelated to surrounding events.
Considerations: How child plays with objects (functional play vs. repetitive/stimming), interest in toys, lining up objects, flushing toilets repeatedly, tapping faucets.
Michael's Observation: Little interest in toys, no exploration during free play, evaluator showed repetitive play with a toy.
Score: 3.5 (Moderately to severely abnormal object use): More severe than typical moderate abnormality (score 3), but not extreme. Child showed no interest in toys and engaged in continuous repetitive play.
Considerations: Resistance to changes in routine, materials, food textures, activities.
Degree of resistance and effort required to facilitate change.
Michael's Observation: Actively resisted changes in materials, resisted placing finished materials off table, but was able to shift to a new item in another situation.
Score: 2.5 (Mildly to moderately abnormal adaptation): Resisted changes in some situations but adapted in others.
Considerations: Normal eye use, eye contact, avoidance of eye contact, visual stimming (staring at lights/fans, looking from corners of eyes).
Michael's Observation: Inconsistent eye contact, often not directed at evaluator, distracted by looking at self in mirror, looked at things very closely, often looked from corners of eyes.
Score: 3 (Moderately abnormal visual response): Requires frequent reminding to look at tasks, avoids eye contact, looks at objects from unusual angles or very close.
Considerations: Response to name call, reaction to loud/soft sounds, sensitivity to everyday noises (pressure cooker, washing machines, horns).
Michael's Observation: No immediate response to name call, didn't turn to face person calling, required multiple calls before responding, sometimes no response to unacceptable noises, other times startled by them.
Score: 2 (Mildly abnormal listening response): Some lack of response or mild overreaction to certain sounds, delayed responses, easily distracted by extraneous sounds.
Item 9: Taste, Smell, and Touch Response and Use [00:49:50]
Considerations: Excessive avoidance or interest in certain tastes/smells/textures, mouthing inedible objects, tactile issues (touching everything), reactions to pain.
Michael's Observation: Nothing atypical noted.
Score: 1 (Within normal limits): Reactions were comparable to typically developing children of similar age.
Considerations: Echolalia (immediate and delayed), jargon speech (meaningless words), tone, loudness, volume, and quality of sounds.
Distinguish between speech (vocabulary) and language (contextual use).
Michael's Observation: Used 2-3 word meaningful phrases, spontaneous comments, labels, and refusals. Repeated lines from cartoons/videos (echolalia), mixed with jargon.
Score: 2.5 (Mildly to moderately abnormal verbal communication): Has meaningful speech but also displays echolalia and jargon, placing him between mild and moderate abnormality.
Considerations: Ability to meet needs non-verbally (e.g., hand leading, pointing), gestures, facial expressions, understanding others' gestures.
Michael's Observation: Points to nearby objects to respond to questions, occasionally points to distant objects when excited, no descriptive/emphatic gestures, doesn't look at person when gesturing, doesn't understand others' gestures, unable to read facial expressions.
Score: 3 (Moderately abnormal non-verbal communication): Inconsistent use of gestures, doesn't understand others' gestures, limited facial expressions.
Considerations: Overall impression of the child based on all 14 items, history, and evaluation.
Michael's Observation: Language delays, echolalia, repetitive/restricted social interest, limited social reciprocity, repetitive play, resistance to change, difficulty with imitation, unusual play with toys.
Score: 3 (Moderately abnormal general impression): Displays a number of moderate autism symptoms, but not extreme severity.
CARS-2 provides a reliable and valid tool for evaluating autism spectrum disorder, offering a comprehensive assessment that aligns with current diagnostic criteria. Practical experience and careful observation are crucial for accurate scoring.
