The diagnosis of autism and autism spectrum disorder in low- and middle-income countries: Experience from Jamaica.

The study included only children already assessed as having autism by the CARS, so it cannot show how the CARS performs in children without autism or with milder symptoms. Children with possible milder symptoms, including CARS scores of 25 to 29.5, were not included, and no non-ASD comparison group was available to determine specificity or concordance across instruments. The methods report CARS scores available for 143 children, but agreement results are reported for 149 children, so the exact CARS-score basis is unclear. The CARS was administered by a single highly experienced professional, so the findings may not apply to less experienced users. The psychologist administering ADOS and ADI-R was not blinded to the study, which can influence classification. The time between CARS and ADOS or ADI-R assessments averaged 17.4 months, with a range of 0 to 77 months, so intervening development or services could affect scores. The instruments were not fully culturally adapted; only language changes were made where needed, and culturally adapted instruments might have different norms or cut-off points. Participation was limited by refusals: 42.9% refused, mainly because of required blood samples, the 4-5 hour assessment time, and no incentive. The sample came from a university referral center clinical database, not a general population, so it may not represent all Jamaican children.

The supplied text does not include a funding statement or author conflict of interest declaration. The publication types list N.I.H. extramural research support.

Do not read the high agreement as proof that the CARS accurately diagnoses autism in all Jamaican children. The study compared only children already classified as having autism by the CARS, and it did not include children without autism or children with milder symptoms.