Autism Scales n5z6
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Autism Scales: Comparing the CARS-2, Gars-2 & ASRS Written by: Sarah Lipman
Overview: • When: • Published in 2005 • Who: • For ages 3-22 • What: • 1 general rating scale; 42 items, 3 subscales • Structured parent interview questions
GARS2
• When: • Published in 2009 • Who: • For ages 2-18 • What: • Long forms for age 2-5 (70 item) for both parent & teacher • Long forms for age 6-18 (71 item) for both parent & teacher • A general short form for age 2-5 (15 item) • A general short form for age 6-18 (15 item)
ASRS
• When • Published in 2010 • Who: • For ages 2+ • What • 1 scale to rate individuals <6, or 6+ w/ IQ= <79 (intended rater is clinician) • 1 scale to rate individuals 6+ or w/ an IQ= > 80 (intended rater is clinician) • 1 parent interview questions
CARS2
Psychometric Properties
Stratification variables: GARS-2
ASRS
CARS2-ST
CARS2-HF
Normed on:
1,107 diagnosed w/ 1,280 diagnosed w/ 1,034 diagnosed w/ 994 diagnosed & Autism autism Autism & IQ< 85 non-diagnosed individuals w/ IQ>85
Age:
Ages 3-10 had an N > 75 11-20 had an N > 10 21-22 had an N < 10
Ages 2-16 had an N= 80 Ages 17& 18 had combined N=80
30% age 2-5 43% age 6-10 20% age 11-15 7% age 16-36
35% age 6-10 41% age 11-15 24% age 16-57
Gender:
81% Male; 19% female
50% male; 50% female
78% male; 22% female
78% male; 22% female
Race:
84% white; 14% black; 2% other
59% white; 16% Hispanic; 15% black; 4% Asian; 5% other
60% white; 16% black; 13% Hispanic/Latino; 7% Asian; 4% other
73% white; 14% black; 6% Hispanic/Latino; 1% Native American; 3% Asian; 3% other
Geographical region:
18% northeast, 32% South, 22%
Ex. 38% Northeast; 29% Northeast; 22% Midwest; 24% 11% Midwest; 43%
20% Northeast; 21% Midwest; 48%
Reliability: Internal Consistency
GARS-2 • Stereotyped behaviors= .84 • Communication= . 86 • Social interaction= .88 • All test items= .
94
ASRS • Age 2-5: .95 parent scale; .94 teacher scale • Age 6-11: .97 parent scale; .97 teacher scale • Age 12-18: .97 parent scale; .97 teacher scale
CARS-2 • CARS2-ST: .93 • CARS-HF: .96
Reliability: Stability
GARS-2
ASRS
• 1 week testretest • Results: • stereotyped behaviors: .83
• 2-4 week testretest • Results: • 2-5 years Parent
• communication: .64 • social interaction: . 82 • full Autism index: . 84
scale: .88; Teacher scale: .80 • 6-18 years Parent scale: .94; Teacher: .81
CARS-2 • 1 year testretest • 0.88 • 2 year testretest • 0.78
Reliability: Consistency Between Raters
ASRS • Age 2-5 • Parent: 0.81 • Teacher/caregiver: N/A • Age 6-18 • Parent: .90 • Teacher:
.64
CARS-2 • CARS: .84 • CARS2-HF: .95
Validity: Content Validity
GARS2 DSM-IVTR
CARS2
ASRS Autism Society of America
DSMIV-TR
Recent Resear ch
DSM-IV
Researc h
NSAC
Validity: Concurrent Validity GARS-2 • Ability to discriminate other disorders • ID mean score= 72 • Multidisabled mean score= 76 • Nondisabled mean score= 49 • Autistic mean score= 100 • Ability to correctly identify the disorder • Correctly identified 84-85%
ASRS • Ability to discriminate other disorders • ADHD mean score= 57.9-62.5 • Other clinical mean score= 46.9-57.7 • General population mean score= 47.7-48.2 • Autism mean score= 69.8- 72.8 • Ability to correctly identify the disorder • Correctly identified .90-.91 for parent scales; .89- .91 for teacher scales
CARS-2 • Ability to correctly identify • CARS correctly identified .89 • CARS2-HF correctly identified .93
Validity: Convergent Validity GARS-2 • ABC • r= 0.64
ASRS
• GARS-2 • r= .80- .83 for Parents ratings; r= .76- .82 for Teachers rating • CARS • r= .35- .50 Parents rating; r= .06- .50 for Teachers rating • GADS • r= .63- .70 for Parents rating; r= .74- .76 for Teachers rating
CARS-2
• independent overall clinical ratings • r= .80 for CARS • ABC • r=.67 for CARS2-ST • ADOS • r= .79 for CARS2-ST • r= .77 for CARS2-HF • SRS • r=.38 for CARS2-ST • r= .47 for CARS2-HF • ADI-R • r=.81 for CARS
Validity: Utility GARS-2 • Race: White and Black • Age: 3-10 • Location: U.S • Purpose: weekly progress monitoring of Autism Symptoms
ASRS • Race: White, black, Asian, and other/mixed race • Age: 2-16 • Location: U.S • Purpose: Monthly progress monitoring of Autism Symptoms
CARS-2 • Race: White, black, Asian, native American, and other/mixed race • Location: U.S • Purpose: tool as part of a larger assessment in identifying Autism Spectrum disorder
Using the GARS-2
Proper istration Who can use the test:
Filling out the scales:
Example of item:
• Raters should have regular sustained w/ the individual for at least 2 weeks • Protocols should be scored by a professional who can interpret quantitative and qualitative assessment & is familiar w/ autism • 3 scales with 14 items for a total of 42 items • Each item needs to be rated in order for the scale to be scored • The rater rates the frequency w/ which they observe each item on a scale from 0-3 • 0= never observed • 1= seldom observed • 2= sometimes observed • 3= frequently observed
• 29. Avoids eye ; looks away when someone looks at him or her 0 1 2 3
Scoring the Protocols Calculating raw score ex.:
Converting raw scores to standard scores
Interpreting Scores:
Using the ASRS
Proper istration Choosing the right form
Who can use the test: Filling out the scales:
Example of item:
• Full-length forms • 70 items for ages 2-5; 71 items for ages 6- 18 • 15 minutes • Recommended for use when a thorough evaluation is desired • Short forms • 15 items • 5 minutes • Recommended for monitoring treatment progress • Scale written at a 7th grade level • Raters must have known the individual for at least a month • Items rated on a scale from 0-4 • 0= never observed • 1= rarely observed • 2=occasionally observed • 3=frequently observed • 4= very frequently observed
• 9. Look at others when talking to them? 0 1 2 3 4
Scoring the Protocols: Hand-scoring Calculating raw score ex.:
Scoring the Protocols: Hand-scoring Converting raw scores to standard scores
Interpreting Scores:
Some quick notes about computer scoring: • reports can be saved in PDF format • records that can be sorted and searched • portable via usb • reports auto generate graphs tables and summary of results
Using the CARS
Proper istration General Considerations Who can use the test:
Filling out the scales:
• Compare individuals to a typically developing child • focus on degree of behavior • Well-informed professionals such as physicians, special educators, school psychologists, speech pathologists or audiologists • Items rated on a scale from 0-4 • 1= within normal limits for age • 1.5= very mildly abnormal for age • 2=mildly abnormal for age • 2.5=mildly-to-moderately abnormal for age • 3=moderately abnormal for age • 3.5=moderately-to-severely abnormal for age • 4= severely abnormal for age
Proper istration Continued… Item Example:
Scoring the Protocols Calculating raw score ex.:
Converting raw scores to standard scores
Interpreting Scores:
Comparative Strengths
GARS2
• Normed group up through age 10 • Good Internal consistency reliability • Good content validity • Correctly identified 84-85% of people • r=.64 w/ ABC • only 42 items • method for obtaining score with missing items • comes w/ parent interview questions
ASRS • Normed group up through age 16 • Excellent internal consistency reliability • Good content validity • Correctly identified 89-91% of people • r=.76-.83 w/ GARS-2 • r=.06-.50 w/ CARS • r=.63-.76 w/ GADS • allows for scoring with (some) missing items • easy hand-scoring (conversion tables on protocol) • easy scoring • easy storage • easy generation of graphs
CARS2
• Excellent internal consistency reliability • Good stability reliability even at 2 years • Correctly identified 89-93% of people • r=.80 w/ clinical ratings • r=.77- .79 w/ ADOS • r=.38-.47 w/ SRS • r=.67 w/ ABC • r=.81 w/ ADI-R • all scales filled out by examiner (more control) • easy scoring
Comparative Weaknesses
GARS-2 • Older; norms may be outdated • Very small n for age groups over age ten in normed group • Poor stability reliability; testretest only 1 week apart
ASRS • There may be a small n for age groups 17 &18 as stats were combined • Poor stability reliability; testretest only 2-4 weeks apart • Consistency between teacher raters are on the low side (r=.64) • Low correlations w/ the CARS test
CARS-2 • All age ranges may not be represented as normed group was reported in ranges • This test may be artificially sensitive to age, a quality not thought to relate to autism • Low correlations w/ the SRS • All parts of the test must be completed by the examiner, making this test more time
Summation
CARS-2 May be the most efficient tool for initial assessment
ASRS
May be the most efficient tool for progress monitoring
ALL ASD scales Should be interpreted with professional judgment
Questions or Comments?
Overview: • When: • Published in 2005 • Who: • For ages 3-22 • What: • 1 general rating scale; 42 items, 3 subscales • Structured parent interview questions
GARS2
• When: • Published in 2009 • Who: • For ages 2-18 • What: • Long forms for age 2-5 (70 item) for both parent & teacher • Long forms for age 6-18 (71 item) for both parent & teacher • A general short form for age 2-5 (15 item) • A general short form for age 6-18 (15 item)
ASRS
• When • Published in 2010 • Who: • For ages 2+ • What • 1 scale to rate individuals <6, or 6+ w/ IQ= <79 (intended rater is clinician) • 1 scale to rate individuals 6+ or w/ an IQ= > 80 (intended rater is clinician) • 1 parent interview questions
CARS2
Psychometric Properties
Stratification variables: GARS-2
ASRS
CARS2-ST
CARS2-HF
Normed on:
1,107 diagnosed w/ 1,280 diagnosed w/ 1,034 diagnosed w/ 994 diagnosed & Autism autism Autism & IQ< 85 non-diagnosed individuals w/ IQ>85
Age:
Ages 3-10 had an N > 75 11-20 had an N > 10 21-22 had an N < 10
Ages 2-16 had an N= 80 Ages 17& 18 had combined N=80
30% age 2-5 43% age 6-10 20% age 11-15 7% age 16-36
35% age 6-10 41% age 11-15 24% age 16-57
Gender:
81% Male; 19% female
50% male; 50% female
78% male; 22% female
78% male; 22% female
Race:
84% white; 14% black; 2% other
59% white; 16% Hispanic; 15% black; 4% Asian; 5% other
60% white; 16% black; 13% Hispanic/Latino; 7% Asian; 4% other
73% white; 14% black; 6% Hispanic/Latino; 1% Native American; 3% Asian; 3% other
Geographical region:
18% northeast, 32% South, 22%
Ex. 38% Northeast; 29% Northeast; 22% Midwest; 24% 11% Midwest; 43%
20% Northeast; 21% Midwest; 48%
Reliability: Internal Consistency
GARS-2 • Stereotyped behaviors= .84 • Communication= . 86 • Social interaction= .88 • All test items= .
94
ASRS • Age 2-5: .95 parent scale; .94 teacher scale • Age 6-11: .97 parent scale; .97 teacher scale • Age 12-18: .97 parent scale; .97 teacher scale
CARS-2 • CARS2-ST: .93 • CARS-HF: .96
Reliability: Stability
GARS-2
ASRS
• 1 week testretest • Results: • stereotyped behaviors: .83
• 2-4 week testretest • Results: • 2-5 years Parent
• communication: .64 • social interaction: . 82 • full Autism index: . 84
scale: .88; Teacher scale: .80 • 6-18 years Parent scale: .94; Teacher: .81
CARS-2 • 1 year testretest • 0.88 • 2 year testretest • 0.78
Reliability: Consistency Between Raters
ASRS • Age 2-5 • Parent: 0.81 • Teacher/caregiver: N/A • Age 6-18 • Parent: .90 • Teacher:
.64
CARS-2 • CARS: .84 • CARS2-HF: .95
Validity: Content Validity
GARS2 DSM-IVTR
CARS2
ASRS Autism Society of America
DSMIV-TR
Recent Resear ch
DSM-IV
Researc h
NSAC
Validity: Concurrent Validity GARS-2 • Ability to discriminate other disorders • ID mean score= 72 • Multidisabled mean score= 76 • Nondisabled mean score= 49 • Autistic mean score= 100 • Ability to correctly identify the disorder • Correctly identified 84-85%
ASRS • Ability to discriminate other disorders • ADHD mean score= 57.9-62.5 • Other clinical mean score= 46.9-57.7 • General population mean score= 47.7-48.2 • Autism mean score= 69.8- 72.8 • Ability to correctly identify the disorder • Correctly identified .90-.91 for parent scales; .89- .91 for teacher scales
CARS-2 • Ability to correctly identify • CARS correctly identified .89 • CARS2-HF correctly identified .93
Validity: Convergent Validity GARS-2 • ABC • r= 0.64
ASRS
• GARS-2 • r= .80- .83 for Parents ratings; r= .76- .82 for Teachers rating • CARS • r= .35- .50 Parents rating; r= .06- .50 for Teachers rating • GADS • r= .63- .70 for Parents rating; r= .74- .76 for Teachers rating
CARS-2
• independent overall clinical ratings • r= .80 for CARS • ABC • r=.67 for CARS2-ST • ADOS • r= .79 for CARS2-ST • r= .77 for CARS2-HF • SRS • r=.38 for CARS2-ST • r= .47 for CARS2-HF • ADI-R • r=.81 for CARS
Validity: Utility GARS-2 • Race: White and Black • Age: 3-10 • Location: U.S • Purpose: weekly progress monitoring of Autism Symptoms
ASRS • Race: White, black, Asian, and other/mixed race • Age: 2-16 • Location: U.S • Purpose: Monthly progress monitoring of Autism Symptoms
CARS-2 • Race: White, black, Asian, native American, and other/mixed race • Location: U.S • Purpose: tool as part of a larger assessment in identifying Autism Spectrum disorder
Using the GARS-2
Proper istration Who can use the test:
Filling out the scales:
Example of item:
• Raters should have regular sustained w/ the individual for at least 2 weeks • Protocols should be scored by a professional who can interpret quantitative and qualitative assessment & is familiar w/ autism • 3 scales with 14 items for a total of 42 items • Each item needs to be rated in order for the scale to be scored • The rater rates the frequency w/ which they observe each item on a scale from 0-3 • 0= never observed • 1= seldom observed • 2= sometimes observed • 3= frequently observed
• 29. Avoids eye ; looks away when someone looks at him or her 0 1 2 3
Scoring the Protocols Calculating raw score ex.:
Converting raw scores to standard scores
Interpreting Scores:
Using the ASRS
Proper istration Choosing the right form
Who can use the test: Filling out the scales:
Example of item:
• Full-length forms • 70 items for ages 2-5; 71 items for ages 6- 18 • 15 minutes • Recommended for use when a thorough evaluation is desired • Short forms • 15 items • 5 minutes • Recommended for monitoring treatment progress • Scale written at a 7th grade level • Raters must have known the individual for at least a month • Items rated on a scale from 0-4 • 0= never observed • 1= rarely observed • 2=occasionally observed • 3=frequently observed • 4= very frequently observed
• 9. Look at others when talking to them? 0 1 2 3 4
Scoring the Protocols: Hand-scoring Calculating raw score ex.:
Scoring the Protocols: Hand-scoring Converting raw scores to standard scores
Interpreting Scores:
Some quick notes about computer scoring: • reports can be saved in PDF format • records that can be sorted and searched • portable via usb • reports auto generate graphs tables and summary of results
Using the CARS
Proper istration General Considerations Who can use the test:
Filling out the scales:
• Compare individuals to a typically developing child • focus on degree of behavior • Well-informed professionals such as physicians, special educators, school psychologists, speech pathologists or audiologists • Items rated on a scale from 0-4 • 1= within normal limits for age • 1.5= very mildly abnormal for age • 2=mildly abnormal for age • 2.5=mildly-to-moderately abnormal for age • 3=moderately abnormal for age • 3.5=moderately-to-severely abnormal for age • 4= severely abnormal for age
Proper istration Continued… Item Example:
Scoring the Protocols Calculating raw score ex.:
Converting raw scores to standard scores
Interpreting Scores:
Comparative Strengths
GARS2
• Normed group up through age 10 • Good Internal consistency reliability • Good content validity • Correctly identified 84-85% of people • r=.64 w/ ABC • only 42 items • method for obtaining score with missing items • comes w/ parent interview questions
ASRS • Normed group up through age 16 • Excellent internal consistency reliability • Good content validity • Correctly identified 89-91% of people • r=.76-.83 w/ GARS-2 • r=.06-.50 w/ CARS • r=.63-.76 w/ GADS • allows for scoring with (some) missing items • easy hand-scoring (conversion tables on protocol) • easy scoring • easy storage • easy generation of graphs
CARS2
• Excellent internal consistency reliability • Good stability reliability even at 2 years • Correctly identified 89-93% of people • r=.80 w/ clinical ratings • r=.77- .79 w/ ADOS • r=.38-.47 w/ SRS • r=.67 w/ ABC • r=.81 w/ ADI-R • all scales filled out by examiner (more control) • easy scoring
Comparative Weaknesses
GARS-2 • Older; norms may be outdated • Very small n for age groups over age ten in normed group • Poor stability reliability; testretest only 1 week apart
ASRS • There may be a small n for age groups 17 &18 as stats were combined • Poor stability reliability; testretest only 2-4 weeks apart • Consistency between teacher raters are on the low side (r=.64) • Low correlations w/ the CARS test
CARS-2 • All age ranges may not be represented as normed group was reported in ranges • This test may be artificially sensitive to age, a quality not thought to relate to autism • Low correlations w/ the SRS • All parts of the test must be completed by the examiner, making this test more time
Summation
CARS-2 May be the most efficient tool for initial assessment
ASRS
May be the most efficient tool for progress monitoring
ALL ASD scales Should be interpreted with professional judgment
Questions or Comments?
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