Autism Spectrum Disorder (ASD) is a complex developmental condition that affects how individuals interact with the world. Early and accurate diagnosis is crucial for providing timely support and intervention. The Childhood Autism Rating Scale, Second Edition (CARS2) stands out as a leading Cars Screening Tool in the field of autism assessment, offering a robust and empirically validated method for identifying and differentiating ASD across a wide range of ages and functional levels. Since its initial release, CARS has become a cornerstone in autism evaluations, particularly effective in distinguishing autism from intellectual disabilities and in differentiating between varying degrees of autism severity.
The CARS2 has been thoughtfully revised to enhance its clinical utility, especially for individuals on the higher-functioning end of the autism spectrum. This updated edition is more sensitive to the needs of those with average to above-average IQs, stronger verbal abilities, and more subtle social and behavioral challenges. While preserving the simplicity and clarity of the original CARS, the CARS2 introduces new forms and features designed to integrate diagnostic information more effectively, determine functional capabilities, offer valuable feedback to parents and caregivers, and facilitate the development of targeted intervention strategies.
The CARS2 is composed of three distinct forms, each serving a specific purpose in the assessment process:
Standard Version Rating Booklet (CARS2-ST): This form is the direct equivalent of the original CARS and is designed for use with younger individuals under 6 years of age. It is also appropriate for those of any age who have communication difficulties or are estimated to have below-average IQs.
High-Functioning Version Rating Booklet (CARS2-HF): This alternative form is specifically tailored for assessing verbally fluent individuals aged 6 years and older who have IQ scores above 80. It addresses the nuances of autism presentation in higher-functioning individuals.
Questionnaire for Parents or Caregivers (CARS2-QPC): This unscored questionnaire is designed to gather essential background information from parents or caregivers. The data collected through the CARS2-QPC is intended to enrich and inform the ratings made using both the CARS2-ST and CARS2-HF forms.
Both the CARS2-ST and CARS2-HF forms include 15 key items that evaluate functional behaviors across critical domains:
- Relating to People
- Imitation (ST) / Social-Emotional Understanding (HF)
- Emotional Response (ST) / Emotional Expression and Regulation of Emotions (HF)
- Body Use
- Object Use (ST) / Object Use in Play (HF)
- Adaptation to Change (ST) / Adaptation to Change/Restricted Interests (HF)
- Visual Response
- Listening Response
- Taste, Smell, and Touch Response and Use
- Fear or Nervousness (ST) / Fear or Anxiety (HF)
- Verbal Communication
- Nonverbal Communication
- Activity Level (ST) / Thinking/Cognitive Integration Skills (HF)
- Level and Consistency of Intellectual Response
- General Impressions
The items in the Standard form mirror those of the original CARS, ensuring continuity and comparability. In contrast, the items in the High-Functioning form have been carefully adapted to reflect contemporary research findings on the characteristics of individuals with high-functioning autism and Asperger’s Syndrome, making it a more precise cars screening tool for this population.
For each item, clinicians assign a rating based on a 4-point scale. This rating considers not just how frequently a behavior occurs, but also its intensity, peculiarity, and duration. This comprehensive approach allows for a more nuanced integration of diagnostic information while still yielding quantifiable results.
The Rating Booklets for both the Standard and High-Functioning versions are designed for ease of use. They provide dedicated space for clinical notes and documentation. Each rated area is briefly described, serving as a reminder of the rating criteria and offering a framework for explaining the assessment outcomes to parents. Crucially, the booklets include cutoff values, enabling clinicians to quickly determine if further evaluation is indicated.
The sum of the rating values across all items produces a Total Raw Score. Each form includes a graph to facilitate the conversion of the Total Raw Score into a standard score or percentile rank, based on a substantial clinical sample of 1,034 individuals diagnosed with autism spectrum disorders. The comprehensive Manual provides detailed guidelines for score interpretation, practical suggestions for intervention strategies, and illustrative case examples to aid in clinical application.
The CARS2-QPC, completed by a parent or caregiver, is an essential component of the comprehensive assessment process. This unscored form provides clinicians with valuable supplementary information to inform their ratings on the CARS2-ST or CARS2-HF. Often, the questionnaire serves as a structured basis for a follow-up interview, allowing clinicians to clarify responses and gain deeper insights from the parent or caregiver’s perspective.
The CARS2-QPC explores key areas including the individual’s developmental history, social, emotional, and communication abilities, presence of repetitive behaviors, play patterns and routines, and any unusual sensory interests. This holistic approach ensures a thorough understanding of the individual’s unique profile.
The CARS2 stands as an invaluable cars screening tool for identifying autism symptoms due to several key strengths:
- Comprehensive Spectrum Coverage: It effectively assesses the entire autism spectrum, aligning with current empirical research definitions.
- Extensive Empirical Foundation: It is built upon decades of practical application with thousands of referred individuals, ensuring a robust and reliable tool.
- Broad Applicability: It is suitable for use across virtually all ages and functional levels, making it versatile for diverse populations.
- Objective and Quantifiable Ratings: It provides concise, objective, and quantifiable ratings derived from direct behavioral observation, reducing subjectivity.
- Strong Diagnostic Relationship: Scores exhibit a consistent, strong, positive, and specific correlation with an autism diagnosis, enhancing diagnostic confidence.
- High Reliability: Ratings demonstrate reliability across different times, settings, information sources, and raters, affirming its consistency and dependability.
With the addition of a specialized form for higher-functioning individuals, a structured method for incorporating caregiver insights, and guidelines linking scores to intervention strategies, the CARS2 remains a premier autism assessment tool, essential for accurate diagnosis and effective intervention planning.
