Even when our son was a baby, my husband and I felt something wasn’t right. His hands and feet moved in constant circular motion, and he never babbled in his crib. Eventually, the Childhood Autism Rating Scale helped confirm what my instincts had long suspected: our son is autistic.
At first, our concerns were brushed off. Our doctor told me to relax and stop being overly vigilant. I trusted my gut and kept pushing for answers.
Early identification of autism is critical. It opens the door to services and support that can make a lasting difference. Tools like the Childhood Autism Rating Scale (CARS) help clinicians assess autism in children as young as two.
What is the Childhood Autism Rating Scale (CARS)?
First published in 1980 and since updated, the CARS is a standardized assessment tool that helps identify and classify autism symptoms. It assesses a child’s behaviors and characteristics against developmental norms and is only administered by clinicians.
Dr. Jessica Brian, Senior Clinician Scientist and Co-Lead of the Autism Research Centre at Holland Bloorview Kids Rehabilitation Hospital in Toronto, explains that clinicians directly observe each child.
They try to gather information from other sources, such as:
- clinical settings
- home settings
- educational settings
How does the Childhood Autism Rating Scale work?
The CARS assesses children on 15 items that focus on developmental characteristics commonly associated with autism.
These encompass:
- Communication
- Social interaction
- Imitative behavior
- Emotional response
- Body and object use
- Adaptation to change
- Sensory response and use
- Visual and listening skills
- Fear and nervousness
- Activity level
- Intellectual response
- General impulsivity
Clinicians rate each child on a scale of 1 (“within normal limits for that age”) to 4 (“severely abnormal for that age”).
The child’s primary caregivers, including parents and teachers, provide additional input through a questionnaire.
The child is then assigned a total score ranging from 15 to 60 that identifies the level of autism symptom “severity”:
- 15-29.5: non-autistic
- 30-36.5: mild to moderate autism
- 37-60: severe autism
Many professionals and advocates no longer use the “mild, moderate, severe” terminology. As Dr. Brian notes, there are different reasons for a child’s support needs, and they can change throughout the day depending on their environment.
For example, a child with a high IQ but significant sensory aversions or social communication challenges may have low academic support needs. However, they may require high levels of support in other areas of the school or community.
When and why is the Childhood Autism Rating Scale used?
Dr. Brian explained that the CARS was developed as a clinician rating scale to inform diagnosis and treatment planning.
It is not a stand-alone diagnostic tool but part of a comprehensive assessment process. It incorporates behavioral observations and caregiver input with detailed developmental, family, and medical histories.
Benefits and limitations of the CARS
The CARS helps facilitate the early identification of autism. Benefits include:
- Being easy to use, straightforward, relatively quick, and inexpensive
- Covering a wide range of behaviors and developmental areas
- Integrating direct clinician observation and caregiver input
- Being reliable, valid, and dependable for assessing autism in children
- Allowing for the identification of autism as young as age two
- Ability to administer in different settings
- Having a standardized scoring system that bolsters consistent evaluations
For parents and caregivers, it offers clarity and a foundation upon which a personalized treatment plan can be developed.
The CARS also has its limitations, including:
- It is not a stand-alone diagnostic tool.
- Clinical observations can be subjective, so a trained and experienced clinician should handle them.
- A clinician must have a good understanding of neurotypical developmental progress since scores are tied to developmental norms.
- Its accuracy can vary, particularly in very young children, children with intellectual disabilities, or those with co-occurring conditions.
- It may not provide cross-culturally valid assessments, as various societies may measure autism symptoms differently.
Dr. Brian emphasizes that clinicians should consider input from caregivers and others to get a full picture of the child. This helps ensure a child isn’t wrongly included or excluded from an autism diagnosis based on score alone.
What to do if your child scores high
Usually, the CARS will not be conducted outside of a diagnostic assessment. Should your child score high on the CARS outside of a diagnostic assessment setting, ensure they undergo a comprehensive assessment.
Have a deeper conversation with your clinician about the results to better understand your child’s profile and recommended next steps, including obtaining advice on autism resources in your area.
A high score doesn’t mean something is wrong beyond help. On the contrary, it means that your concerns have been validated, and you can start getting your child the help they need.
A helpful guide on the path to support
The earlier you can obtain clarity about your child’s behavior and symptomology, the earlier you can obtain those needed services and supports. I cannot overemphasize the value of early screening.
Even if your child is older, tools like the CARS can help to better understand your child’s needs. They serve as a foundation upon which to optimize your child’s functioning, step by step.
Reach out to professionals for guidance. Ensure they listen to and value your input, or find another healthcare provider.
Remember, an entire community of like-minded parents and caregivers is waiting to embrace you, help guide you, and provide empathy and understanding. You are not alone!
FAQs
Q: What is a childhood autism rating of 30?
A: On the CARS, a score of 30 is the cutoff for a diagnosis of “mild to moderate autism.” Scores below 30 usually suggest that a child is not autistic based on this tool alone. However, a clinician may still diagnose autism with a lower score if other evidence supports it, since the final decision is based on a full evaluation.
Q: What are the levels of autism rating?
A: The Childhood Autism Rating Scale (CARS) assigns scores ranging from 15 to 60 to indicate the severity of autism symptoms. A score between 15 and 29.5 suggests the child is non-autistic, while a score from 30 to 36.5 indicates mild to moderate autism. Scores between 37 and 60 fall into the range of severe autism.
Q: Can levels of autism change?
Levels of autism can appear to change over time due to development, interventions, or changes in support. However, autism itself is lifelong, and shifts in level typically reflect how much support a person currently requires rather than a change in the condition.
Q: What score is high for autism?
A: Scores of 37 to 60 indicate “severe autism”. However, a child’s score during a brief single-point-in-time assessment will never tell the full story about that child.
Other articles you may be interested in:
- Self-Diagnosed Autism: Is It a Valid Diagnosis?
- Who Can Diagnose Autism Spectrum Disorders?
- Autism Assessment: What Parents Should Know
- How to Get My Child Tested for Autism
- What is the Autistic Diagnostic Observation Schedule (ADOS)?
- How Does Autism Evaluation Work?
- What is the Average Age of Autism Diagnosis?
- Can an Autism Brain Scan Be Used for Diagnosis?
- What is the DSM-5 Criteria for Autism Diagnosis?
- Late Autism Diagnosis: Understanding the Impact
- What is the Gilliam Autism Rating Scale?
- Who Is Qualified to Diagnose Autism in Adults?
References
Schopler E, Reichler RJ, DeVellis RF, Daly K. Toward Objective Classification of Childhood Autism: Childhood Autism Rating Scale (CARS) Journal of Autism and Developmental Disorders. 1980;10(1):91–103, https://pubmed.ncbi.nlm.nih.gov/6927682/
Stevanovic, D., Costanzo, F., Fucà, E., Valeri, G., Vicari, S., Robins, D. L., … & Knez, R. (2021). Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries. Autism Research, 14(12), 2544-2554. https://onlinelibrary.wiley.com/doi/abs/10.1002/aur.2586
Flores-Rodríguez, Y., Ceballos, O. R., & Albores-Gallo, L. (2022). Assessing autism with DSM-IV and DSM-5 criteria using the Childhood Autism Rating Scale (CARS). Salud mental, 45(1), 3-10. https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=103969
Moon, S. J., Hwang, J. S., Shin, A. L., Kim, J. Y., Bae, S. M., Sheehy‐Knight, J., & Kim, J. W. (2019). Accuracy of the Childhood Autism Rating Scale: A systematic review and meta‐analysis. Developmental medicine & child neurology, 61(9), 1030-1038. https://onlinelibrary.wiley.com/doi/abs/10.1111/dmcn.14246
