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
Processing time: 182 Days and 20.5 Hours
ARTICLE HIGHLIGHTS
Research background

Autism is the most common clinical developmental disorder in children. The childhood autism rating scale (CARS) and 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.

Research motivation

According to previous studies on various assessments of ASD, CARS exhibits better diagnostic validation than ABC. However, the diagnostic validations and the corresponding cutoff values for CARS and ABC on individuals with suspected ASD remain unclear. Furthermore, for suspected ASD in China, it remains unclear whether CARS is a better diagnostic tool than ABC. Furthermore, it is unclear whether the current cutoff points for ABC and CARS are suitable for the accurate diagnosis of ASD.

Research objectives

The purpose of this study was to compare the diagnostic validities of CARS and ABC for suspected ASD, as well as to obtain more updated and appropriate cutoff scores for each assessment scale. Our present findings provide insights into the usage of optimal assessment scales for suspected ASD in Chinese mental health hospitals.

Research methods

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

Research results

In this study, we found that the CARS is better than the ABC in terms of its diagnostic validity for suspected ASD. Furthermore, we verified that the diagnostic reliability of the CARS is better than the ABC in terms of the Cronbach alpha coefficient for suspected ASD. We also found that the cutoff scores of the CARS and ABC for suspected ASD were 34 and 67, respectively. These findings suggest that the CARS may be more suitable for diagnosing suspected ASD. However, there are three specific limitations were need to be addressed. First, the adult ASD group was not included in this study, and future studies should clarify the diagnostic validation of ABC and CARS in different age groups. Second, although a total of 474 outpatients were included in this study, the sample was still small. A large sample of ASD is needed to confirm these results in future studies. Third, CARS-2 has been well developed, but there is currently no Chinese version of CARS-2. More new tools for the assessments of ASD in China are needed, especially the original tools which designed by Chinese researcher in a Chinese setting.

Research conclusions

This study demonstrated that the CARS was superior to the ABC in terms of its diagnostic validity in assessing suspected 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. Based on our results, we recommend that the CARS could be used for assessments of suspected ASD cases in Chinese hospitals.

Research perspectives

First, future studies should clarify the diagnostic validation of ABC and CARS in different age groups as the adult ASD group was not included in this study. Furthermore, CARS-2 (normalized form) is the same as the original CARS, whereas CARS-2-HF (high-functioning form) is a newly developed optional diagnostic for evaluating ASD in children over a certain age and with IQ scores above 80. We can introduce and verify the reliability and validity of CARS-2 for its further usage in diagnosing suspected ASD in China. More new tools for the assessments of ASD in China are needed, especially the original tools which designed by Chinese researcher in a Chinese setting.