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An Item Response Theory analysis of the Childhood Autism Rating Scale, Second Edition (CARS-2)

Conference Paper · May 2015

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 AN ITEM RESPONSE THEORY ANALYSIS OF THE CHILDHOOD
AUTISM RATING SCALE, SECOND EDITION (CARS-2)
Cody Davis, M.S., Michael D. Toland, Ph.D., & Jonathan Campbell, Ph.D.1

Laura Murphy, Ph.D. & Lauren Gardner, Ph.D. 2

1Department
of Educational, School, and Counseling Psychology, University of Kentucky
2Boling Center for Developmental Disabilities and Department of Psychiatry, University of Tennessee Health Science Center

Background Table 1
Results
IRT results for each CARS-2 scale examined.
 The Childhood Autism Rating Scale, Second Edition  All 15 items on the CARS-2-ST fit to a Generalized Partial
(CARS-2; Schopler et al., 2010) is a commonly used autism- 9-item (7-pt.;
15-item (7-pt.)
14-item (7-pt.;
Minus items 4, 6, 9,
Collapsed 15- Credit Model (GPC) indicated that items were locally
specific rating scale with established evidence of internal Minus item 10)
10, 13, & 14)
item (4-pt.) independent based on the standardized LD-χ χ2(i.e., |LD| < 2
consistency, interrater reliability, specificity, sensitivity, and for all items).
concurrent correlations. # of misfit
9/15 1/14 2/9 0/15
items
 Inspection of step parameters and option response
 The CARS-2-ST is a ASD diagnostic aid for children below
-2LL 7,451.58 7,022.20 4,345.32 4,567.67 functions (ORFs) for each item shows that only item 15 has a
six years of age and those with cognitive and/or language
unique curve for each response category, while most items
impairments. BIC 7,977.21 7,516.92 4,664.82 4,861.41 show fewer than the suggested number of categories are used
 Although some studies have examined the CARS (Schopler as expected. 6 items (4, 6, 9, 10, 13, and 14) had poor
AIC 7,655.58 7,214.20 4,469.32 4,681.67 discrimination (i.e., a < .5), indicating little contribution to
et al., 1988) using item response theory (IRT), no studies to
date have used IRT to examine the psychometric properties the differentiation between children with varying degrees of
M2(df) 27.12 (18) 19.51(9)* na 103.61(63) ASD. Item 10 (i.e., Fear or Nervousness) performed
of the CARS-2.
RMSEA .05 .08 na .06
particularly poorly.
 IRT can be used to estimate how much unique information
or discrimination each item of a scale contributes across the # of pairs of  The S-χ2 item-fit statistic for polytomous data was used to
items flagged 0 0 0 0
entire range of a latent variable being measured. determine absolute fit of the model to each item indicating
with LD
that 4 items (1, 2, 8, and 14) had poor fit.
Marginal
reliability .93 .93 .92 .90
Focus of this Study  Marginal reliability for response item scores was deemed
acceptable at .93. Consequently, a revised 15 item scale
Note. # of misfit items = number of items that misfit model based on Benjamini-
  Test whether a reduced number of categories is optimal for Hochberg adjusted P values; -2LL = -2loglikelihood; AIC = Akaike Information collapsing items down to 4 response categories reduced the
assessing level of autism Criterion; BIC = Bayesian Information Criterion number of unclear ORF’s, improved item discrimination,
* p < .05 showed good fit across items, and an acceptable marginal
  Investigate the distribution of CARS-2 items across the reliability at .90.
ASD continuum

  Determine the level of measurement precision across the

construct continuum Discussion
 Mid-point ratings (e.g., 1.5) may not be as helpful as
Method
Information

expected at discriminating among children on the ASD

  173 participants (81.5% male; Mage = 44.19 months; SD =
12.9 months; 50.9% African-American) with a diagnosis of
ASD-only (35.8%; n = 62), ID-only (13.3%; n = 23), or ASD
and ID (50.9%; n = 88)
  The CARS-2 is a 15-item scale reflecting individual areas
that are likely related to ASD. Each item is on a 1 (within
normal limits) to 4 (severe/abnormal behavior) rating scale
with midpoint scores available for examiner use.
View publication stats
Θ
Figure 1. Total Information Curves for each CARS-2 scale indicating where along
the ASD continuum the criteria measure the disorder well.
continuum.
 Investigators should examine the discriminatory
capabilities of the CARS-2-ST items for distinguishing
between individuals with ASD, intellectual disability (ID), or
ASD with comorbid ID using differential item functioning
(DIF) techniques.
Author’s contact information: Matthew C. Davis, 236 Dickey Hall, University of
Kentucky, Lexington, KY 40506-0017. Electronic mail:
matthewcody.davis@uky.edu