Childhood Autism Rating Scale - 2nd Edition (CARS 2)

Purpose: To identify and classify children with autism and determine symptom severity through quantifiable ratings based on direct observation

Age: 2+ years

Time: 10-20 minutes

The Childhood Autism Rating Scale, Second Edition (CARS-2) has proven especially effective in discriminating between children with autism and those with severe cognitive deficits, and in distinguishing mild-to-moderate from severe autism.

The revised second edition expands the test’s clinical value, making it more responsive to individuals on the “high-functioning” end of the autism spectrum—those with average or higher IQ scores, better verbal skills, and more subtle social and behavioural deficits.

The CARS2 includes three forms:

1. Standard Version (CARS2-ST): Equivalent to the original CARS; for use with individuals younger than 6 years of age and those with communication difficulties or below-average estimated IQs. Includes 15 items
2. High Functioning Individuals (CARS2-HF): An alternative for assessing verbally fluent individuals, 6 years of age and older, with IQ scores above 80. Includes 15 items
3. Questionnaire for Parents or Caregivers (CARS2-QPC): An unscored scale that gathers information for use in making CARS2-ST and CARS2-HF ratings

The Standard and High Functioning Forms address the following functional areas:

• Relating to People
• Imitation (ST); Social–Emotional Understanding (HF)
• Emotional Response (ST); Emotional Expression and Regulation of Emotions (HF)
• Body Use
• Object Use (ST); Object Use in Play (HF)
• Adaptation to Change (ST); Adaptation to Change/Restricted Interests (HF)
• Visual Response
• Listening Response
• Taste, Smell, and Touch Response and Use
• Fear or Nervousness (ST); Fear or Anxiety (HF)
• Verbal Communication
• Nonverbal Communication
• Activity Level (ST); Thinking/Cognitive Integration Skills (HF)
• Level and Consistency of Intellectual Response
• General Impressions

The clinician rates the individual on each item, using a 4-point response scale. Ratings are based not only on frequency of the behaviour in question, but also on its intensity, peculiarity, and duration. While this more nuanced approach gives you greater flexibility in integrating diagnostic information, it still yields quantitative results.

The new CARS2 is extremely useful in identifying symptoms of autism because:

• It covers the entire autism spectrum, as defined by empirical research
• It assesses virtually all ages and functional levels
• It provides concise, objective, and quantifiable ratings based on direct behavioural observation
• Scores show a consistent, strong, positive, and specific relationship with autism diagnosis
• Ratings are reliable across time, settings, sources of information, and raters