The Childhood Autism Rating Scale Second Edition (CARS2) and Its Applicability in an Iranian Sample.
Sayyed Ali Samadi, Ameneh Mahmoodizadeh, Mehdi Foladgar and 3 others
PMID 39901456WHAT IT FOUND
The CARS2 accurately identified autism in Iranian children, but the standard cut-off score missed many cases.
Lowering the threshold to 27 for the standard version and 22 for the high-functioning version caught more autistic individuals, though it also flagged some children with intellectual disabilities as having autism.
Key findings
01The standard CARS2 cut-off score of 30 had low sensitivity for younger children, missing a significant number of autistic individuals.
02Lowering the cut-off scores to 27 for the standard version and 22 for the high-functioning version increased the correct identification of autism.
03The revised cut-off scores for the standard version reduced specificity, meaning some children with intellectual disabilities were incorrectly classified as having autism.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Participants and assessors knew the diagnosis of autism beforehand, which may have biased ratings and inflated reliability scores. Test-retest reliability was assessed by the same raters who had previously evaluated the children, potentially affecting their scoring due to memory or familiarity. The study used historical data from other diagnostic tools (ADI-R or GARS2) rather than concurrent gold-standard assessments for all participants. All participants were from urban areas, so results may not apply to rural populations.
The easy way to misread this
Do not assume the lower cut-off scores are a perfect solution. While they catch more autistic children, the revised standard version cut-off of 27 also incorrectly identifies 13% of children with intellectual disabilities as having autism. This tool alone cannot reliably distinguish between autism and intellectual disability in this sample.