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Childhood Autism rating scale (C.A.R.S)

Author and year

The Childhood Autism Rating Scale (CARS) was developed by Eric Schopler, Robert J.
Reichler, and Barbara Rochen Renner in 1980.
Introduction
The Childhood Autism Rating Scale (CARS) is a widely used tool for assessing the
severity of autism spectrum disorder (ASD) symptoms in children. CARS is designed to aid
clinicians in diagnosing ASD and determining the level of impairment.
The CARS is based on direct observation of the child's behavior, as well as information gathered
from parents, caregivers, and teachers. It consists of 15 items that cover various aspects of
behavior, communication, social interaction, and sensory processing typically affected by ASD.
Each of these 15 items is rated on a scale from 1 to 4, with higher scores indicating greater
severity of autistic symptoms. Additionally, there is a cutoff score that helps classify the child's
level of autistic impairment as non-autistic, mild to moderate autism, severe autism, or extreme
autism..
The CARS provides a standardized and systematic way to assess ASD symptoms, helping
clinicians make accurate diagnoses and develop appropriate treatment plans. It is widely used in
research settings, clinical practice, and educational settings to evaluate children with suspected
ASD and monitor their progress over time. Additionally, the CARS can be helpful for parents
and caregivers in understanding their child's strengths and challenges and accessing necessary
support and services.
Objectives
The objectives of the Childhood Autism Rating Scale (CARS) test are multifaceted,
aiming to provide a comprehensive evaluation of autism spectrum disorder (ASD) symptoms in
children. Some of the primary objectives include:
i. Diagnosis: One of the main objectives of the CARS test is to assist clinicians in
diagnosing autism spectrum disorder (ASD). By systematically assessing various
behavioral, communicative, and social aspects, the CARS helps clinicians determine
whether a child meets the criteria for ASD.
ii. Severity Assessment: The CARS test aims to assess the severity of ASD symptoms in
children. Through the rating of specific behaviors and characteristics associated with
ASD, the scale provides a quantifiable measure of the level of impairment, ranging from
mild to severe.
iii. Treatment Planning: Another objective of the CARS test is to aid in the development of
individualized treatment plans for children with ASD. By identifying the specific areas of
impairment and strengths in each child, clinicians can tailor interventions to address their
unique needs effectively.
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iv. Monitoring Progress: The CARS test facilitates the monitoring of a child's progress
over time. By conducting periodic assessments using the scale, clinicians can track
changes in symptoms, evaluate the effectiveness of interventions, and make adjustments
to treatment plans as needed.
v. Research: The CARS test is also used in research settings to study various aspects of
ASD, including prevalence, etiology, and treatment outcomes. By providing a
standardized measure of ASD symptoms, the scale allows researchers to compare
findings across studies and populations.
Response Recording
Response recording in the Childhood Autism Rating Scale (CARS) test involves trained
clinicians observing and rating a child's behaviors across various domains relevant to autism
spectrum disorder (ASD). Using a scale of 1 to 4 for each of the 15 items, observers document
the frequency, intensity, and quality of behaviors observed. These ratings are then totaled to
calculate an overall score, which aids in diagnosing ASD, assessing symptom severity, and
guiding treatment planning.
Administration
Test materials
The test materials required for conducting the Childhood Autism Rating Scale (CARS)
assessment include the CARS manual for guidance on administering the test, observation forms
for recording behaviors across the 15 items, standardized rating scales to quantify symptom
severity, consent forms for parental authorization, a suitable observation setting free from
distractions, and training materials for assessors to ensure consistency. Additionally, familiarity
with diagnostic criteria for autism spectrum disorder (ASD) is crucial for accurate interpretation
of assessment results, enabling clinicians to gather comprehensive information and make
informed diagnostic and treatment decisions.
Demographic information of the client
Name Z.K
Gender Female
Age 23
Education BS
No of Siblings 3
Scoring and interpretation
Scoring the Childhood Autism Rating Scale (CARS) involves evaluating the child's
behavior across 15 items, each rated on a 4-point scale from 1 (indicating typical behavior) to 4
(indicating severe impairment). Trained evaluators observe the child's social interactions,
communication skills, and repetitive behaviors, assigning scores based on their observations.
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After rating each item, the scores are totaled to yield an overall score reflecting the severity of
the child's autistic symptoms. Higher total scores indicate more pronounced impairment, while
lower scores suggest milder symptoms or typical development. It's essential for evaluators to
consider the child's behavior across various settings and gather information from multiple
sources, such as parents, teachers, and caregivers, to ensure a comprehensive assessment.
Quantitative Scoring
Table 1.
Sub-scales Score range Scores Severity level
Relating to people 1-4 2 Mildly abnormal
relationships
Imitation 1-4 2 Mildly abnormal
Imitation
Emotional response 1-4 3 Moderately abnormal
emotional response
Body use 1-4 3 Moderately abnormal
body use
Object use 1-4 2 Mildly inappropriate
interest in or use
objects
Adaptation to change 1-4 1 Age appropriate
response to change
Visual response 1-4 1 Age appropriate visual
response
Listening response 1-4 1 Age appropriate
listening response
Taste, smell, and 3 Moderately abnormal
touch response and use 1-4 use of and response to
taste ,smell or touch
Fear or nervousness 1-4 2 Mildly abnormal fear or
nervousness
Verbal communication 1-4 1 Normal verbal
communication
Non verbal 2 Mildly abnormal use of
communication 1-4 non verbal
communication
Activity level 1-4 2 Mildly abnormal
activity level
Level and consistency 3 Moderately abnormal
of intellectual response 1-4 intellectual functioning
General impressions 1-4 1 No Autism
Total score 15-60 29 Non Autistic

Qualitative Interpretation
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The table indicates varied scores across different sub-scales of functioning. While many
aspects such as adaptation to change, visual response, listening response, verbal communication,
and general impressions fall within the normal range, there are mild to moderate impairments in
emotional response, body use, object use, taste, smell, and touch response, as well as in non-
verbal communication and activity level. Overall, the total score falls within the normal range,
suggesting a generally functional level of behavior, but with some areas of mild to moderate
concern warranting attention and potential intervention.

Reference
1) Schopler, E., Reichler, R. J., & Renner, B. R. (1980). The Childhood Autism Rating
Scale (CARS). Los Angeles, CA: Western Psychological Services.