Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2022; 10(4): 1206-1217
Published online Feb 6, 2022. doi: 10.12998/wjcc.v10.i4.1206
Comparison of diagnostic validity of two autism rating scales for suspected autism in a large Chinese sample
Jia-Hui Chu, Fang Bian, Rui-Ying Yan, Yan-Lin Li, Yong-Hua Cui, Ying Li
Jia-Hui Chu, Fang Bian, Rui-Ying Yan, Yan-Lin Li, Yong-Hua Cui, Ying Li, Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
Author contributions: Li Y contributed to conceptualization; Chu JH contributed to draft writing; Li YL Bian F and Yan RY contributed to data collection; Cui YH contributed to supervision; Cui YH and Li Y contributed equally to this study; all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: Written informed consent will be obtained from the participant and/or their guardian before they were included in this study. The ethics committees of Capital Medical University and Beijing Children's Hospital authorized the protocols used in the present study. The Institutional Review Board (IRB) number is 2019-k-396.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All of the authors declare that they have no competing interests.
Data sharing statement: No additional data are available in the manuscript. Data can be available from the corresponding author on request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying Li, Doctor, PhD, Assistant Professor, Department of Psychiatry, Beijing Children's Hospital, No. 56 Nanlishi Road, Beijing 100045, China. liying@bch.com.cn
Received: July 25, 2021
Peer-review started: July 25, 2021
First decision: November 8, 2021
Revised: November 17, 2021
Accepted: December 23, 2021
Article in press: December 23, 2021
Published online: February 6, 2022
Abstract
BACKGROUND

Autism is the most common clinical developmental disorder in children. The childhood autism rating scale (CARS) and autistic autism behavior checklist (ABC) are the most commonly used assessment scales for diagnosing autism. However, the diagnostic validations and the corresponding cutoffs for CARS and ABC in individuals with suspected autism spectrum disorder (ASD) remain unclear. Furthermore, for suspected ASD in China, it remains unclear whether CARS is a better diagnostic tool than ABC. Also unclear is whether the current cutoff points for ABC and CARS are suitable for the accurate diagnosis of ASD.

AIM

To investigate the diagnostic validity of CARS and ABC based on a large Chinese sample.

METHODS

A total of 591 outpatient children from the ASD Unit at Beijing Children’s Hospital between June and November 2019 were identified. First, the Clancy autism behavior scale (CABS) was used to screen out suspected autism from these children. Then, each suspected ASD was evaluated by CARS and ABC. Receiver operating characteristic (ROC) curve analysis was used to compare diagnostic validations. We also calculated the area under the curve (AUC) for both CARS and ABC.

RESULTS

We found that the Cronbach alpha coefficients of CARS and ABC were 0.772 and 0.426, respectively. Therefore, the reliability of the CARS was higher than that of the ABC. In addition, we found that the correlation between CARS and CABS was 0.732. Next, we performed ROC curve analysis for CARS and ABC, which yielded AUC values of 0.846 and 0.768, respectively. The cutoff value, which is associated with the maximum Youden index, is usually applied as a decision threshold. We found that the cutoff values of CARS and ABC were 34 and 67, respectively.

CONCLUSION

This result indicated that CARS is superior to ABC in the Chinese population with suspected ASD.

Keywords: Suspected autism spectrum disorder, Children, Childhood autism rating scale, Autism behavior checklist, Receiver operating characteristic curve, Cutoff value

Core Tip: This study compared the diagnostic validities of childhood autism rating scale (CARS) and autism behavior checklist (ABC) based on a large Chinese sample. We found that the CARS was superior to the ABC in terms of its diagnostic validity for assessing suspected autism spectrum disorder (ASD) cases in children. In the clinical evaluation for suspected ASD, our findings suggest that the cutoff values of CARS and ABC were 34 and 67, respectively.