CARS - Childhood Autism Rating Scale

Lexicon [Measures] - CARS

The Childhood Autism Rating Scale (CARS) a behavior observation scale intended to help diagnose autism and plan interventions/therapy. CARS is administered by a clinician through direct observation and interactions and involves structured and semi-structured activities to elicit specific behaviors. The tool is designed for children aged 2 years and older.

Limitations:
  • CARS may not be suitable for individuals with co-occurring conditions or for assessing adults with autism.
  • CARS is a subjective assessment tool that relies on the judgment of the observer which means inter-rater reliability may vary depending on the experience and training of the clinician.
  • Focuses primarily on behaviors associated with autism and may not capture the full range of a child's abilities or challenges.
  • Does not provide a definitive diagnosis of autism but rather serves as a quantitative measure of symptom severity.

15 Functional domains rated in CARS
  1. Relating to People: Ability to engage in reciprocal social interactions, such as sharing enjoyment, eye contact, and response to others' emotions.
  2. Imitation: ability to mimic the actions, expressions, or sounds of others.
  3. Emotional Response: Assesses the appropriateness and variety of the child's emotional expressions and responsiveness to emotional cues from others.
  4. Body Use: physical movements and coordination.
  5. Object Use: ability to play with toys and use objects in a 'socially appropriate' manner
  6. Adaptation to Change: Flexibility and response changes in their environment or routine.
  7. Visual Response: visual attention and responses to sounds and spoken language
  8. Listening Response: attention and reactions to auditory stimuli.
  9. Taste, Smell, and Touch Response and Use: responsiveness to different sensory stimuli
  10. Fear or Nervousness: reactions to potentially fear-inducing or anxiety-provoking situations.
  11. Verbal Communication: appropriateness and usefulness of the child's verbal communication.
  12. Non-verbal Communication: appropriateness and usefulness of the child's non-verbal communication.
  13. Activity Level: physical activity level during the assessment.
  14. Level and Consistency of Intellectual Response: problem-solving abilities and the consistency of their intellectual responses.
  15. General Impressions: observer's overall impression of the child's behavior during the assessment.
The items are scored on a scale of 1-4, with 1 representing no "abnormality" and 4 as severe abnormal (I personally cringe at this language with terms like "abnormal" which makes us sound like societal misfits and outcasts). Total score ranges from 15-60; scores below 30 suggest absence of autism or very mild symptoms; 30-36 score indicate mild-moderate autism and scores above 36 indicate severe autism. 


History: CARS was developed by Eric Schopler, Robert J. Reichler, and Barbara Rochen Renner and was first published in 1988. 

Reference:
Schopler, E., Reichler, R. J., & Renner, B. R. (1988). The Childhood Autism Rating Scale (CARS). Los Angeles: Western Psychological Services.

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