Published online Feb 6, 2022. doi: 10.12998/wjcc.v10.i4.1206
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
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.
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.
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.
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.
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.
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.
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.