1. The Childhood Autism Rating Scale (CARS)
Jennifer Connelly
Caldwell College

2. CARS Described Childhood Autism Rating Scale
15-item behavior rating scale to identify and differentiate children with autism from typical or other developmentally disabled individuals
Distinguishes placement on spectrum
Each of 15 items based on five major diagnostic systems (Kanner, Creak, Rutter, NSAC, and DSM-IV)
Can be used to evaluate across ages

3. CARS Development, History, and Relationship to Other Scales
Developed 20 years ago
Includes Kanner’s autism features, characteristics described by Creak
Original developed by Child Research Project at the University of NC at Chapel Hill
Originally titled “Childhood Psychosis Rating Scale”
Used initially to evaluate children referred to state-side TEACCH program

4. Behavioral Items Assessed
Relating to People
Imitation
Emotional Response
Body Use
Object Use
Adaption to Change
Visual Response
Listening Response
Taste, Smell, and Touch Response and Use
Fear or Nervousness
Verbal Communication
Nonverbal Communication
Activity Level
Level and Consistency of Intellectual Response
General Impressions

5. How to Observe and Rate
Psychological testing, classroom participation, parent reports, history records
Ratings should not be made until after data collection is complete
Child’s behavior should be compared to that of a typical child of the same age
Anecdotal data should be recorded on peculiarity, frequency, intensity, and duration of behaviors observed
Familiar with definitions/descriptions
Rating of 1-4 (with midpoints)

6. Interpretation of Scores
Total score by summing the 15 individual ratings (range from 15-60)
Scores place individuals within a diagnostic categorization system (NonAutistic, Mild/Moderate Autism, Severe Autism)

7. Practice: Object Use (Timmy)
Definition: The child’s interest in toys/other objects and how he/she uses them
Keep in mind…
1.Unstructured times
2.Use after given a model
3.Level of interest (lack of or excessive)
4.Use of toys in appropriate/inappropriate ways

8. Practice: Object Use (Matty)

9. Practice: Imitation (Timmy)
Definition: How the child imitates verbal and nonverbal acts
Keep in mind…
1. Behavior to be imitated should be within child’s abilities
2. Sounds, words, motor movements, written model
3. Unwilling or unable to imitate?
4. Latency in responding

10. Practice: Imitation (Matty)

11. Practice: Visual Response (Timmy)
Definition: Rating of unusual visual attention patterns when required to look at objects/people
Keep in mind…
1. Avoiding eye contact or making through corners of eyes
2. How often must child be prompted to make eye contact
3. How intrusive must those prompts get to achieve eye contact

12. Practice: Visual Response (Matty)

13. Evaluation of CARS: Reliability and Validity
Internal consistency
Inter-rater agreement
Test-retest stability
Criterion-related validity
Validity under alternate conditions

14. 1. CARS scores vs. DSM-IV clinical diagnosis
Perry, A., Condillac, R. A., Freeman N. L., Dunn-Geier, J., & Belair J. (2005)
Participants:
Sample of 274 preschool children diagnosed with AD, PDD-NOS, MR, Delayed, and Other
Objectives:
1. CARS scores vs. DSM-IV clinical diagnosis
2. CARS scores between different diagnostic groups

15. Perry, A. , Condillac, R. A. , Freeman N. L. , Dunn-Geier, J
Perry, A., Condillac, R. A., Freeman N. L., Dunn-Geier, J., & Belair J. (2005)
Findings:
High degree of concordance between CARS and clinical diagnoses (DSM-IV)
Negative correlation using CARS between autism severity and cognitive level
Clinically defined groups differed in scores in significant/sensible ways, however autistic disorder vs. PDD-NOS still some overlap

16. 65 children (18 months – 11 years) diagnosed with autism Objectives:
Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004)
Participants:
65 children (18 months – 11 years) diagnosed with autism
Objectives:
1. CARS and ABC correspondence with diagnosis made with DSM-IV criteria

17. CARS does not clearly differentiate individuals with other ASDs
Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004)
Findings:
CARS distinguishes individuals with AD from other developmental disorders
CARS does not clearly differentiate individuals with other ASDs

18. NYS Dept of Health: Evidence to Support
According to the NY State Department of Health there is evidence to support:
CARS as a useful part of the assessment of children with possible autism in a variety of settings: early intervention programs, preschool developmental programs, and developmental diagnostic centers.
CARS possesses an acceptable combination of practicality and research support, despite the limited research on its use in children under 3 years of age.

19. NYS Dept of Health: No Evidence to Support
According to the NY State Department of Health there is no evidence to support:
That the CARS may be useful for periodic monitoring of children with autism or for assessing long-term outcomes.
That professionals using the CARS have experience in assessing children with autism or have adequate training in administering and interpreting the CARS.
That the instrument (CARS) is practical, is supported by research, or is useful for collecting information to assist with estimating the prevalence of autism or assessing functional outcomes.

20. CARS: Pros and Cons PROS CONS Agreement with DSM-IV diagnoses of AD
Easy to train
Can be done quickly
Useful with wide age range
Does not include peer relationships, joint attention, or symbolic play
Does not differentiate between individuals with other ASDs
Dated (terminology)
Somewhat subjective

21. Summary Arguments for and against the use of CARS as a diagnostic tool
Some level of subjectivity is involved
Other measures have been developed as the field advances (ADOS)

22. References
Perry, A., Condillac, R. A., Freeman N. L., Dunn-Geier, J., & Belair J. (2005). Mulit-site study of the Childhood Autism Rating Scale (CARS) in five clinical groups of young children. Journal of Autism and Developmental Disorders, 35,
Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004). Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist correspondence and conflicts with DSM-IV criteria in diagnosis of autism. Journal of Autism and Developmental Disorders, 34,
Stella, J., Mundy, P., & Tuchman R. (1999). Social and nonsocial factors in the Childhood Autism Rating Scale. Journal of Autism and Developmental Disorders, 29,
New York State Department of Health. (1999). Autism/Pervasive Developmental Disorders. Clinical practice guideline technical report. New York: Author.