Childhood Autism Rating Scale Second Edition (CARS-2)

Overview
The purpose of the Childhood Autism Rating Scale Second Edition (CARS-2; Schopler, Van Bourgondien, Wellman, &
Love (2010) is to identify the presence of autism in children and to determine the severity of symptoms. The CARS-2 has
two versions: the Standard form, CARS-2-ST, for individuals less than 6 years of age and those with communication
difficulties or below-average estimated IQs; and the CARS-2-HF for those 6 years and over who are verbally fluent and
have IQ scores over 80. The CARS-2-HF is designed to identify the more subtle characteristics of those with high-
functioning forms of ASD. The CARS2 also includes a third form, the Questionnaire for Parents or Caregivers (CARS-2-
QPC), for collecting information for use in making CARS-2-ST and CARS-2-HF ratings.

Fifteen domains are rated on a 4-point scale. Based on informant or clinician observation, the clinician assigns ratings in
each domain related to frequency, peculiarity, intensity, and duration. The CARS-2 yields cutoff scores, standard scores,
and percentiles.

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 Childhood Autism Rating Scale Second Edition (CARS-2)

Summary
Name of Screening Age Range* Method of Approximate Subscales
Tool/Author / Administration/Format Time to
Diagnosis Administer
Childhood D CARS-2-ST: Two 15-item rating 5-10 min. to Relating to People;
Autism Rating 2 years to < 6 scales completed by rate items Imitation (ST); Social-
Scale Second and those with clinician on a 7-point (after Emotional Understanding
Edition communication scale based on gathering the (HF);
(CARS-2) difficulties or observation, parent information Body Use Object Use (ST);
Schopler, Van below report, and other needed) Object Use in Play (HF)
Bourgondien, average records Adaptation to Change
Wellman, estimated IQs (ST); Adaptation to
& Love (2010). Questionnaire for Change/Restricted
CARS-2-HF: Parents or Caregivers Interests (HF);
6+ years for (CARS-2-QPC), for Visual Response;
verbally fluent collecting information Listening Response;
individuals with for use in making Taste, Smell, & Touch
IQ scores over CARS-2-ST and CARS- Response and Use;
80 2-HF. Fear or Nervousness (ST);
Fear or Anxiety (HF);
Yields cutoff scores, Verbal Communication;
standard scores, and Activity Level (ST);
percentiles Thinking/Cognitive
Integration Skills (HF);
Level and Consistency of
Intellectual Response;
General Impressions

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 Childhood Autism Rating Scale Second Edition (CARS-2)

Questionnaire D For parent or Unscored form: 5-10 min. to Early Development;

for Parents or caregiver of an questionnaire rate items Social; Emotional and
Caregivers individual of completed by parent or (after Communication;
(CARS-2-QPC) any age. caregiver. These gathering the Repetitive Behaviors;
responses become the information Play and Routines;
framework for follow- needed) Unusual Sensory
up interview Interests.
information.

*In years except where noted. Availability: Western Psychological Services, http://bit.ly/1Fo5FUW

Research
Author (Year) Age Range Sample Size Topic Addressed Outcome
(in years) r = correlation
Rellini, 1.511 65 Criterion validity Sensitivity for AU = 100% False
Tortolani, Trillo, negatives = 0
Carbone, &
Montecchi
(2004)
DiLalla & Rogers 26 69 Factor analysis Yields three factors: social
(1994) impairment, negative emotionality,
and distorted sensory response
Pilowsky, 1.53.4 83 Concurrent validity Agreement with ADI-R = 85.7%
Yirmiya,
Shulman, &
Dover (1998)
Saemundsen, 1.89.5 54 Concurrent validity Agreement with ADI-R = 66.7% when
Magnsson, ADI-R AU definition is used
Smri, &
Sigurdardttir
(2003)
Magyar & 1.56.5 164 Factor analysis Four factors identified: social
Pandolfi (2007) communication, social interaction,
stereotypes and sensory
abnormalities, emotional regulation

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 Childhood Autism Rating Scale Second Edition (CARS-2)

Perry, Condillac, 26 274 Discriminative 88% agreement between CARS

Freeman, Dunn- validity and clinical diagnosis;
Geier, & Belair Sensitivity = 0.94; Specificity = 0.85;
(2005) CARS negatively correlated with
cognitive (r = -0.67) and adaptive
(r = -0.69);
ANOVA = 157.97;
AU group mean> PDD-NOS>MR>
Developmental delay and other
groups
Stella, Mundy, AU mean of 90 Factor analysis Five-factor structure: disturbances in
& Tuchman 71.32 social orienting, communication and
(1999) months; PDD- behavioral flexibility, emotional
NOS reactivity, consistency of cognitive
mean of 50.54 performance and response to
environment, odd sensory experiences

References
DiLalla, D. L., & Rogers, S. J. (1994). Domains of the Childhood Autism Rating Scale: Relevance for diagnosis and treatment.
Journal of Autism and Developmental Disorders, 24(2), 115128.

Magyar, C. I., & Pandolfi, V. (2007). Factor structure evaluation of the Childhood Autism Rating Scale. Journal of Autism and
Developmental Disorders, 37(9), 17871794.

Perry, A., Condillac, R. A., Freeman, N. L., Dunn-Geier, J., & Belair, J. (2005). Multi-site study of the Childhood Autism Rating
Scale (CARS) in five clinical groups of young children. Journal of Autism and Developmental Disorders, 35(5), 625
634.

Pilowsky, T., Yirmiya, N., Shulman, C., & Dover, R. (1998). The Autism Diagnostic Interview Revised and the Childhood
Autism Rating Scale: Differences between diagnostic systems and comparison between genders. Journal of Autism
and Developmental Disorders, 28(2), 143151.

Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004). Childhood Autism Rating Scale (CARS) and Autism
Behavior Checklist (ABC) correspondence and conflicts with DSM-IV criteria in diagnosis of autism. Journal of
Autism and Developmental Disorders, 34(6), 703708.

Saemundsen, E., Magnsson, P., Smri, J., & Sigurdardttir, S. (2003). Autism Diagnostic Interview- Revised and the
Childhood Autism Rating Scale: Convergence and discrepancy in diagnosing autism. Journal of Autism and
Developmental Disorders, 33(3), 319328.

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 Childhood Autism Rating Scale Second Edition (CARS-2)

Schopler, E., Van Bourgondien, M.E., Wellman, G.J., & Love, S.R. (2010). Childhood Autism Rating Scale (2nd ed.). Los Angeles, CA:
Western Psychological Services.

Stella, J., Mundy, P., & Tuchman, R. (1999). Social and nonsocial factors in the Childhood Autism Rating Scale. Journal of
Autism and Developmental Disorders, 29(4), 307317.

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