Tuesday, November 23, 2010

Test Review: The Childhood Autism Rating Scale, Second Edition (CARS 2)

The Childhood Autism Rating Scale, second edition (CARS 2), consists of two 15-item rating scales completed by the practitioner and a Parent/Caregiver Questionnaire. The Standard Version Rating Booklet (CARS 2-ST) is equivalent to the original CARS and is used with children younger than 6 years of age and those with communication difficulties or below-average cognitive ability. The High-Functioning Version Rating Booklet (CARS 2-HF) is an alternative for assessing verbally fluent children and youth, 6 years of age and older, with average or above intellectual ability. The Questionnaire for Parents or Caregivers (CARS 2-QPC) is an unscored questionnaire designed to obtain pertinent developmental information from parents or caregivers. 

The CARS 2-ST and CARS 2-HF each include 15 items addressing 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
Items on the Standard form duplicate those on the original CARS, while items on the HF form have been modified to reflect current research on the characteristics of higher functioning children and youth with autism (HFA) or Asperger Syndrome. To complete the ratings on the CARS 2-HF, the professional must have convergent information from MULTIPLE sources such as direct observation, parent and teacher interviews, prior assessments of cognitive functioning and adaptive behavior, and information from the Questionnaire for Parents or Caregivers (CARS 2-QPC). Ratings are based not only on frequency of the behavior in question, but also on its intensity, atypicality, and duration. Rating values for all items are summed to produce a Total Raw Score. Each form includes a graph that allows the practitioner quickly convert the Total Raw Score to a standard score or percentile rank (based on a clinical sample of individuals diagnosed with autism spectrum disorders). 
The psychometric properties of the CARS 2-HF indicate a high degree of internal consistency and good interrater reliability. Validity information reports an overall discrimination index value of .93, with sensitivity and specificity values of .81 and .87, respectively. The HF form also demonstrates a relatively strong relationship with the “gold standard” Autism Diagnostic Observation Schedule (ADOS).
The following are critical features of the CARS 2-HF.
1. Parents and teachers should NOT be asked to complete the CARS 2 forms. Only well-informed professionals should complete the ratings.
2. The CARS 2 should NOT be used for screening in the general school-age population.
3. The practitioner must have a good understanding of the criteria for making the ratings and be in a position to collect information from multiple sources (direct observation, parent and teacher reports, prior assessments and clinical impressions).
4. The ratings from the CARS 2 should be considered as only one part of a multimodal, multidisciplinary decision-making process in the identification of children with ASD.
5. Direct observation and a developmental history MUST always be included in the assessment process.
6. Scores on the CARS 2 are interpreted relative to the level (severity) of autism-related behaviors compared to a clinical sample of individuals diagnosed with autism, NOT the typical individual.
In summary, The CARS 2-HF represents an important alternative that will be welcomed by school-based professionals such as school psychologists and speech/language pathologists. It is a sensitive and reliable instrument that will find a place in the school-based professional’s assessment “Tool Box.” Given the dramatic increase in the numbers of students being referred for screening and assessment, the CARS 2-HF is a useful instrument that helps quantify the level of symptom severity and importantly, assist with intervention and program planning. The CARS 2-HF scores are particularly helpful in identifying more capable children on the autism spectrum. Of course, the CARS 2 is not intended to be and should not be used as the sole instrument in making diagnostic or classification decisions. An example of a comprehensive assessment battery can be found in A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools, (2nd Edition).
Schopler, E, Van Bourgondien, M. E., Wellman, G. J., & Love, S. R. (2010). Childhood autism rating scale, second edition. Los Angeles, CA: Western Psychological Services.



A New Approach to Teaching Youth With Autism

Source: Medical News Today
As the number of children diagnosed with autism spectrum disorders continues to increase, the one thing that won’t change is the need for those children to develop social skills. Statistics show that if these students are able to communicate effectively, they can achieve success in the classroom, and later, in the workplace. In addition to the challenges facing each individual student, educators find themselves facing dwindling resources. Now, researchers at the University of Missouri are developing an effective social competence curriculum, with a virtual classroom component, that could help educators meet the demand of this growing population.

Janine Stichter, a professor of special education at the MU College of Education, and her team have developed a curriculum that has shown success in an after-school format and is now being tested during daily school activities, with help from two three-year grants from the Institute of Educational Sciences in the U.S. Department of Education. The key factors in Stichter’s curriculum focus on specific needs and behavioral traits within the autism spectrum. By doing this, the instructor is able to deliver a more individualized instruction within a small group format and optimize the response to intervention.

Sunday, November 21, 2010

Regressive Autism


 The topic of regressive autism has attracted considerable research interest in last 15 years, in part due to the interest in the link to vaccines. Other terms used to describe regression in children with autism are autism with regression, autistic regression, late-onset autism, and acquired autistic syndrome. Studies suggest that nearly 25 % of children with autism have experienced some level of developmental regression. Unfortunately, there is no standard definition for regression, and the prevalence of regression varies depending on the definition used.

In general, regressive autism is evident when a child appears to develop typically but then begins to lose language and/or social skills, typically between the ages of 15 and 30 months, and is subsequently diagnosed with autism. Some children lose social development rather than language, while some lose both. Therefore, language might be preserved but social interaction significantly impaired. Skill loss may be quite rapid or slow and preceded by an extended period of minimal skill progression. The loss may be accompanied by markedly reduced social play and interaction, repetitive behaviors, or increased irritability. Following the onset of regression, the child follows the standard pattern of autistic neurological development.

There is some research to suggest that regressive autism is early-onset autism that was recognized at a later date and that if there is a regressive phenotype of ASD, it is not characterized by normal or near-normal pre-loss development. In fact, research suggests that many children identified with regressive autism had some delay in communication and social skills prior to onset. Likewise, there was is no evidence that the onset of autistic symptoms or regression is related to measles-mumps-rubella vaccination. However, there might be an early vulnerability in the development of the nervous system and that these children weren't developing normally. Although the phenomenon of regressive autism is poorly understood, best practice requires that any child who presents with the “red flags” of autism be screened and if indicated, provided with a comprehensive developmental assessment. A complete guide to screening and assessment for ASD is available from A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools.

© Lee A. Wilkinson, PhD



Follow by Email

Top 10 Most Popular Posts

Search BestPracticeAutism.com

Blog Archive

Best Practice Books

Total Pageviews