CARS - Childhood Autism Rating Scale

 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.