Matthew J Sanchez1,2, John N Constantino3,4. 1. Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA. 2. University Hospitals Cleveland Medical Center, Cleveland, OH, USA. 3. Departments of Psychiatry and Pediatrics, Washington University in St Louis, St Louis, MO, USA. 4. St Louis Children's Hospital, St Louis, MO, USA.
Abstract
AIM: To investigate a novel observational rating protocol designed to expedite clinical diagnosis of autism spectrum disorder (ASD). METHOD: Two hundred and forty patients referred to a tertiary autism center (median age 8y 9mo, range 2y 6mo-34y 8mo; 188 males, 52 females) were rated using an adaptation of the Childhood Autism Rating Scale, Second Edition (CARS-2) based exclusively on patient observation (CARS-2obs ). Scores were compared to expert diagnosis of ASD, parent-reported Social Responsiveness Scale, Second Edition (SRS-2) and, in a selected subset of patients, the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). RESULTS: CARS-2obs distinguished patients with a clinical diagnosis of ASD from those with non-ASD neuropsychiatric disorders (mean score=18 vs 11.7, p<0.001). Severity ratings on the CARS-2obs correlated with the ADOS-2 (r=0.68, ρ=0.64) and SRS-2 (r=0.31, ρ=0.32). A CARS-2obs cutoff point equal to or greater than 16 demonstrated 95.8% specificity and 62.3% sensitivity in discriminating individuals with ASD from individuals without ASD in a specialty referral setting. INTERPRETATION: The CARS-2obs allows the rapid acquisition of quantitative ratings of autistic severity by direct observation. Coupled with parent/teacher-reported symptoms and developmental history, the measure may contribute to a low-cost diagnostic paradigm in clinical and public health settings, where positive results might help reduce delays in diagnosis, and negative results could prompt further specialty assessment. WHAT THIS PAPER ADDS: The Childhood Autism Rating Scale, Second Edition based on patient observation distinguished individuals with versus without autism spectrum disorder (ASD). A score equal to or greater than 16 on this assessment showed high specificity for a diagnosis of ASD.
AIM: To investigate a novel observational rating protocol designed to expedite clinical diagnosis of autism spectrum disorder (ASD). METHOD: Two hundred and forty patients referred to a tertiary autism center (median age 8y 9mo, range 2y 6mo-34y 8mo; 188 males, 52 females) were rated using an adaptation of the Childhood Autism Rating Scale, Second Edition (CARS-2) based exclusively on patient observation (CARS-2obs ). Scores were compared to expert diagnosis of ASD, parent-reported Social Responsiveness Scale, Second Edition (SRS-2) and, in a selected subset of patients, the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). RESULTS: CARS-2obs distinguished patients with a clinical diagnosis of ASD from those with non-ASD neuropsychiatric disorders (mean score=18 vs 11.7, p<0.001). Severity ratings on the CARS-2obs correlated with the ADOS-2 (r=0.68, ρ=0.64) and SRS-2 (r=0.31, ρ=0.32). A CARS-2obs cutoff point equal to or greater than 16 demonstrated 95.8% specificity and 62.3% sensitivity in discriminating individuals with ASD from individuals without ASD in a specialty referral setting. INTERPRETATION: The CARS-2obs allows the rapid acquisition of quantitative ratings of autistic severity by direct observation. Coupled with parent/teacher-reported symptoms and developmental history, the measure may contribute to a low-cost diagnostic paradigm in clinical and public health settings, where positive results might help reduce delays in diagnosis, and negative results could prompt further specialty assessment. WHAT THIS PAPER ADDS: The Childhood Autism Rating Scale, Second Edition based on patient observation distinguished individuals with versus without autism spectrum disorder (ASD). A score equal to or greater than 16 on this assessment showed high specificity for a diagnosis of ASD.
Authors: Andrea Trubanova Wieckowski; Ashley de Marchena; Yasemin Algur; Lashae Nichols; Sherira Fernandes; Rebecca P Thomas; Leslie A McClure; Sarah Dufek; Deborah Fein; Lauren B Adamson; Aubyn Stahmer; Diana L Robins Journal: Autism Res Date: 2021-05-22 Impact factor: 4.633
Authors: Alaina S Berruti; Roseann C Schaaf; Emily A Jones; Elizabeth Ridgway; Rachel L Dumont; Benjamin Leiby; Catherine Sancimino; Misung Yi; Sophie Molholm Journal: Trials Date: 2022-08-19 Impact factor: 2.728