Abstract
Objectives
To compare diagnosis of childhood autism using CARS cut off scores of ≥30 and the new Indian cut off scores of ≥33 against the gold standard DSM-IV-TR criteria available during the study period 2009–10.
Methods
The study was conducted at the autism clinic of Child Development centre (CDC), Kerala. Two hundred consecutive children between 2 and 6 y with symptoms suggestive of autism were administered both CARS by a trained developmental therapist and DSM-IV-TR by a developmental pediatrician on the same day, both blind to the test results of each other. Diagnosis of autism using CARS cut off scores 30 and above, as suggested in original tool administration manual and 33 and above, as suggested for diagnostic use in Indian population was compared with DSM-IV-TR diagnosis. Data was analyzed using SPSS (version 19.0) software.
Results
Against DSM-IV-TR diagnosis as gold standard, the new CARS cut off scores ≥33 had a higher Specificity (74.3 %), Positive predictive value (PPV) (81.9 %), Positive likelihood ratio (LR) (2.66) and Negative LR (0.43), but had a lower Sensitivity (68.3 %), Negative predictive value (NPV) (57.9 %) and accuracy (70.5 %), as compared to the cut off scores of ≥30.
Conclusions
The CARS prevalence of autism for cut off points ≥30 and ≥33 was 71.5 and 52.5 % respectively against 63 % prevalence by DSM-IV-TR.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lai DC, Tseng YC, Hou YM, Guo HR. Gender and geographic differences in the prevalence of autism spectrum disorders in children: analysis of data from the national disability registry of Taiwan. Res Dev Disabil. 2012;33:909–15.
Amr M, Bu Ali W, Hablas H, Raddad D, El-Mehesh F, El-Gilany AH, et al. Sociodemographic factors in arab children with autism spectrum disorders. Pan Afr Med J. 2012;13:65.
Mandell DS, Novak MM, Zubritsky CD. Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics. 2005;116:1480–6.
American Psychiatric Association. Pervasive developmental disorders. In: Diagnostic and Statistical Manual of Mental Disorders, 2000. 4th ed---text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; p. 69–70.
DSM5 Autism Spectrum Disorder. URL: http://depts.washington.edu/dbpeds/Screening%20Tools/DSM-5 (ASD.Guidelines) Feb2013.pdf Accessed on 24/02/2014.
Schopler E, Reichler R, Rochen-Renner B. The childhood autism rating scale (CARS). Los Angeles (CA): Western Psychological Services; 1988.
Russell PS, Daniel A, Russell S, Mammen P, Abel JS, Raj LE, et al. Diagnostic accuracy, reliability and validity of childhood autism rating scale in India. World J Pediatr. 2010;6:141–7.
Jensen CM, Steinhausen HC, Lauritsen MB. Time trends over 16 years in incidence-rates of autism spectrum disorders across the lifespan based on nationwide Danish register data. J Autism Dev Disord. 2014 Feb 20. [Epub ahead of print]
Stenberg N, Bresnahan M, Gunnes N, Hirtz D, Hornig M, Lie KK, et al. Identifying children with autism spectrum disorder at 18 months in a general population sample. Paediatr Perinat Epidemiol. 2014. doi:10.1111/ppe.12114.
Maenner MJ, Schieve LA, Rice CE, Cunniff C, Giarelli E, Kirby RS, et al. Frequency and pattern of documented diagnostic features and the age of autism identification. J Am Acad Child Adolesc Psychiatry. 2013;52:401–13. e8.
Kulage KM, Smaldone AM, Cohn EG. How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis. J Autism Dev Disord. 2014 Feb 16. [Epub ahead of print].
García-López C, Narbona J. Clinical usefulness of IDEA and CARS: concordance with DSM-IV-TR in children and adolescents with suspicion of PDD. An Pediatr (Barc). 2014;80:71–6.
Tachimori H, Osada H, Kurita H. Childhood autism rating scale–Tokyo version for screening pervasive developmental disorders. Psychiatry Clin Neurosci. 2003;57:113–8.
Acknowledgments
The authors gratefully acknowledge the cooperation and support received from staff of Child Development Centre, Kerala, specially Dr. G. Suresh Kumar, Registrar; Ms. Prasanna G.L, Developmental Therapist; Ms. Deepa NR, PS to Director; Mr. Asokan N, PA to Director; Ms. Suja S, Junior Programmer; CDC, Medical College, Thiruvananthapuram, in conduction of this study.
Conflict of Interest
None.
Source of Funding
This study is supported by Child Development Centre, Thiruvananthapuram.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
George, B., Padmam, M.S.R., Nair, M.K.C. et al. CDC Kerala 11: Diagnosis of Autism Among Children Between 2 and 6 y - Comparison of CARS against DSM-IV-TR. Indian J Pediatr 81 (Suppl 2), 125–128 (2014). https://doi.org/10.1007/s12098-014-1625-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-014-1625-y