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Factor Analysis of the Childhood Autism Rating Scale in a Sample of Two Year Olds with an Autism Spectrum Disorder

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Abstract

The Childhood Autism Rating Scale (CARS), (Schopler et al. in J Autism Dev Disord 10(1):91–103, 1980) is a 15-item observation-based rating scale that yields a total score reflective of autism symptom severity. This study investigated the factor structure of the CARS in a sample of 2-year-old children with DSM-IV-TR (American Psychiatric Association in Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Publishing, Washington, 2000) diagnoses of AD or PDD-NOS. Following a preliminary internal cross-validation, principal axis factor analysis was completed (N = 282). The results indicate a three-factor solution: Social Communication, Stereotyped Behaviors and Sensory Sensitivities, and Emotional Reactivity. The factors are meaningful, with the first two reflective of DSM-5 symptom domains. This study supports the continued relevance of the CARS in ASD assessment, and extends its utility in 2-year-old children.

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References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn.). Washington: American Psychiatric Publishing.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  • Bartlett, M. S. (1954). A note on the multiplying factors for various chi square approximations. Journal of the Royal Statistical Society, 16 (Series B), 296–298.

    Google Scholar 

  • Barton, M. L., Boorstein, H., Dumont-Mathieu, T., Herlihy, L. E., & Fein, D. (2012). Toddler ASD symptom interview (TASI). Self-published.

  • Barton, Marianne, L., Robins, Diana, L., Jashar, D., Brennan, L., & Fein, D. (2013). Sensitivity and specificity of proposed DSM-5 criteria for autism spectrum disorder in toddlers. Journal of Autism and Developmental Disorders, 43(5), 1184–1195.

    Article  Google Scholar 

  • Breidbord, J., & Croudace, T. J. (2013). Reliability generalization for childhood autism rating scale. Journal of Autism and Developmental Disorders, 43, 2855–2865. doi:10.1007/s10803-013-1832-9.

    Article  PubMed  Google Scholar 

  • Carter, A., & Briggs-Gowan, M. (2006). Manual for the infant-toddler social and emotional assessment (ITSEA), version 2. San Antonio: Psychological Corporation, Harcourt Press.

    Google Scholar 

  • Cattell, R. B. (1966). The Scree Test for the number of factors. Multivariate Behavioral Research, 1(2), 245–276.

    Article  Google Scholar 

  • Center (CDC). (2016). Prevalence and characteristics of autism spectrum disorder among children aged 8 years: Autism and developmental disabilities monitoring network, 11 Sites, United States, 2012. Morbidity and Mortality Weekly Reports (MMWR), 65(SS-3), 1–23.

    Google Scholar 

  • Charman, T., Jones, C. R. G., Pickles, A., Simonoff, E., Baird, G., & Happe ́, F. (2011). Defining the cognitive phenotype of autism. Brain Research, 1380(1943), 10–21. doi:10.1016/j.brainres.2010.10.075.

    Article  PubMed  Google Scholar 

  • Chawarska, K., Klin, A., Paul, R., Macari, S., & Volkmar, F. (2009). A prospective study of toddlers with ASD: Short-term diagnostic and cognitive outcomes. Journal of Child Psychology and Psychiatry and Allied Disciplines, 50(10), 1235–1245. doi:10.1111/j.1469-7610.2009.02101.x.

    Article  Google Scholar 

  • Chlebowski, C., Green, J. A., Barton, M. L., & Fein, D. (2010). Using the childhood autism rating scale to diagnose autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(7), 787–799. doi:10.1007/s10803-009-0926-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, I. L., Schmidt-Lackner, S., Romanczyk, R., & Sudhalter, V. (2003). The PDD behavior inventory: A rating scale for assessing response to intervention in children with pervasive developmental disorder. Journal of Autism and Developmental Disorders, 33(1), 31–45.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd edn.). Hillsdale: Lawrence Earlbaum Associates.

    Google Scholar 

  • Costello, A. B., & Osborne, J. W. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research and Evaluation, 10(7), 1–9.

  • Dawkins, T., Meyer, A. T., & Van Bourgondien, M. E. (2016). The relationship between the childhood autism rating scale: Second edition and clinical diagnosis utilizing the DSM-IV-TR and the DSM-5. Journal of Autism and Developmental Disorders, 667. doi:10.1007/s10803-016-2860-z.

  • DiLalla, D. L., & Rogers, S. J. (1994). Domains of the childhood autism rating scale: Relevance for diagnosis and treatment. Journal of Autism and Developmental Disorders, 24(2), 115–128. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8040157.

  • Eaves, L. C., & Ho, H. H. (2004). The very early identification of autism: Outcome to age 4 1/2–5. Journal of Autism and Developmental Disorders, 34(4), 367–378. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15449513.

  • Garfin, D. G., & McCallon, D. (1988). Validity and reliability of the childhood autism rating scale with autistic adolescents. Journal of Autism and Developmental Disorders, 18(3), 367–378.

    Article  Google Scholar 

  • Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705. doi:10.1007/s10803-008-0674-3.

    Article  PubMed  Google Scholar 

  • Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The autism diagnostic observation schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37(4), 613–627. doi:10.1007/s10803-006-0280-1.

    Article  PubMed  Google Scholar 

  • Guthrie, W., Swineford, L. B., Nottke, C., & Wetherby, A. M. (2013). Early diagnosis of autism spectrum disorder: Stability and change in clinical diagnosis and symptom presentation. Journal of Child Psychology and Psychiatry and Allied Disciplines, 54(5), 582–590. doi:10.1111/jcpp.12008.

    Article  Google Scholar 

  • Harrop, C., McConachie, H., Emsley, R., Leadbitter, K., & Green, J. (2014). Restricted and repetitive behaviors in autism spectrum disorders and typical development: Cross-sectional and longitudinal comparisons. Journal of Autism and Developmental Disorders, 44(5), 1207–1219. doi:10.1007/s10803-013-1986-5.

    Article  PubMed  Google Scholar 

  • Hus, V., Gotham, K., & Lord, C. (2014). Standardizing ADOS domain scores: Separating severity of social affect and restricted and repetitive behaviors. Journal of Autism and Developmental Disorders, 44, 2400–2412. doi:10.1007/s10803-012-1719-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Johnson, C., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215. doi:10.1542/peds.2007-2361.

    Article  Google Scholar 

  • Kaiser, H. F. (1960). The application of electronic computers to factor analysis. Educational and Psychological Measurement, 20, 141–151.

    Article  Google Scholar 

  • Kaiser, H. F. (1974). An index of factorial simplicity. Pyschometrika, 39, 31–36.

    Article  Google Scholar 

  • Kerns, C. M., & Kendall, P. C. (2012). The presentation and classification of anxiety in autism spectrum disorder. Clinical Psychology: Science and Practice, 19(4), 323–347. doi:10.1111/cpsp.12009.

    Article  Google Scholar 

  • Kim, S. H., Macari, S., Koller, J., & Chawarska, K. (2015). Examining the phenotypic heterogeneity of early autism spectrum disorder: Subtypes and short-term outcomes. Journal of Child Psychology and Psychiatry, 57(1), 93–102. doi:10.1111/jcpp.12448.

    Article  PubMed  Google Scholar 

  • Kleinman, J. M., Robins, D. L., Ventola, P. E., Pandey, J., Boorstein, H. C., Esser, E. L., … Fein, D. (2008). The modified checklist for autism in toddlers: A follow-up study investigating the early detection of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(5), 827–839. doi:10.1007/s10803-007-0450-9.

  • Klin, A., Lang, J., Cicchetti, D. V., & Volkmar, F. R. (2000). Brief report: Interrater reliability of clinical diagnosis and DSM-IV criteria for autistic disorder: Results of the DSM-IV autism field trial. Journal of Autism and Developmental Disorders, 30(2), 163–167. doi:10.1023/A:1005415823867.

    Article  PubMed  Google Scholar 

  • Leekam, S., Tandos, J., McConachie, H., Meins, E., Parkinson, K., Wright, C., … Le Couteur, A. (2007). Repetitive behaviours in typically developing 2-year-olds. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 48(11), 1131–1138. doi:10.1111/j.1469-7610.2007.01778.x.

    Article  Google Scholar 

  • Levy, S. E., Mandell, D. S., & Schultz, R. T. (2009). Autism. Lancet, 374(9701), 1627–1638. doi:10.1016/S0140-6736(09)61376-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lloyd, M., MacDonald, M., & Lord, C. (2013). Motor skills of toddlers with autism spectrum disorders. Autism, 17(2), 133–146. doi:10.1177/1362361311402230.

  • Lord, C. (1995). Follow-up of two-year-olds referred for possible Autism. Journal of Child Psychology and Psychiatry, 36(8), 1365–1382.

    Article  Google Scholar 

  • Lord, C., Luyster, R., Gotham, K., & Guthrie, W. (2012). Autism diagnostic observation schedule, 2nd edition (ADOS-2) Manual (Part II): Toddler module. Torrence: Western Psychological Services.

    Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H. J., Leventhal, B. L., DiLavore, P. C., … Rutter, M. (2000). The Autism diagnostic schedule-generic: A standard measures of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.

    Article  Google Scholar 

  • Macdonald, M., Lord, C., & Ulrich, D. (2013). The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders. Research in Autism Spectrum Disorders, 7, 1383–1390.

    Article  Google Scholar 

  • Magyar, C. I., & Pandolfi, V. (2007). Factor structure evaluation of the childhood autism rating scale. Journal of Autism and Developmental Disorders, 37(9), 1787–1794. doi:10.1007/s10803-006-0313-9.

    Article  PubMed  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Murray, M. J., Pearl, A., Black, A., & Tierney, C. D. (2014). Research in autism spectrum disorders final DSM-5 under-identifies mild autism spectrum disorder: Agreement between the DSM-5, CARS, CASD, and clinical diagnoses. Research in Autism Spectrum Disorders 8, 68–73.

    Article  Google Scholar 

  • Mazefsky, C. A. (2015). Emotion regulation and emotional distress in autism spectrum disorder: Foundations and considerations for future research. Journal of Autism and Developmental Disorders, 45, 3405–3408.

    Article  Google Scholar 

  • McDougle, C. J., Stigler, K. A., & Posey, D. J. (2003). Treatment of aggression in children and adolescents with autism and conduct disorder. The Journal of Clinical Psychiatry, 64(suppl 4), 16–25.

    PubMed  Google Scholar 

  • Moulton, E., Barton, M., Robins, D. L., Abrams, D. N., & Fein, D. (2016). Early characteristics of children with ASD who demonstrate optimal progress between age two and four. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-016-2745-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mullen, E. (1995). Mullen scales of early learning. Circle Pines: American Guidance Services.

    Google Scholar 

  • Osborne, J. W., & Fitzpatrick, D. C. (2012). Replication analysis in exploratory factor analysis: What it is and why it makes your analysis better. Practical Assessment, Research and Evaluation, 17(15), 1–8.

    Google Scholar 

  • Ozonoff, S., Young, G. S., Landa, R. J., Brian, J., Bryson, S., Charman, T., … Iosif, A.-M. (2015). Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. Journal of Child Psychology and Psychiatry. doi:10.1111/jcpp.12421.

    Article  PubMed  Google Scholar 

  • Perry, A., Condillac, R. A., Freeman, N. L., Dunn-Geier, J., & Belair, J. (2005). Multi-site study of the childhood autism rating scale (CARS) in five clinical groups of young children. Journal of Autism and Developmental Disorders, 35(5), 625–634. doi:10.1007/s10803-005-0006-9.

    Article  PubMed  Google Scholar 

  • Pilowsky, T., Yirmiya, N., Shulman, C., & Dover, R. (1998). The autism diagnostic interview-revised and the childhood autism rating scale: Differences between diagnostic systems and comparison between genders. Journal of Autism and Developmental Disorders, 28(2), 143–151.

    Article  Google Scholar 

  • Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004). Childhood autism rating scale (CARS) and autism behavior checklist (ABC) correspondence and conflicts with DSM-IV criteria in diagnosis of autism. Journal of Autism and Developmental Disorders, 34(6), 703–709.

  • Reszka, S. S., Boyd, B. A., Mcbee, M., Hume, K. A., & Odom, S. L. (2014). Brief report: Concurrent validity of autism symptom severity measures. Journal of Autism and Developmental Disorders, 44, 466–470. doi:10.1007/s10803-013-1879-7.

    Article  PubMed  Google Scholar 

  • Robins, D.L., Fein, D., & Barton, M. (1999). The modified checklist for autism in toddlers (M-CHAT). Self-published.

  • Robins, D.L., Fein, D., & Barton, M. (2009). The modified checklist for autism in toddlers. Revised, with follow-up (M-CHAT-R/F). Self-published.

  • Rutter M., Le Couteur A., & Lord, C. (2003). Autism diagnostic interview revised (ADI-R). Los Angeles: Western Psychological Services.

  • Saemundsen, E., Magnusson, P., Smari, J., & Sigurdardottir, S. (2003). Autism diagnostic interview-revised and the childhood autism rating scale: Convergence and discrepancy in diagnosing autism. Journal of Autism and Developmental Disorders, 33(3), 319–328. doi:10.1023/A:1024410702242.

    Article  PubMed  Google Scholar 

  • Schopler, E., Reichler, R., & Rochen Renner, B. (1995). Childhood autism rating scale (CARS). Los Angeles: Western Psychological Services.

  • Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. (1980). Toward objective classification of childhood autism: Childhood autism rating scale (CARS). Journal of Autism and Developmental Disorders, 10(1), 91–103.

    Article  Google Scholar 

  • Schopler, E., Van Bourgondien, M. E., Wellman, G. J., Love, S. R. (2010). The childhood autism rating scale, (2nd edn.). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Sparrow, S., Balla, D., & Cicchetti, D. (1984). The Vineland adaptive behavior scales. Circles Pines: American Guidance Services.

    Google Scholar 

  • Sparrow, S., Cicchetti, D., & Balla, D. (2005). Vineland-II adaptive behavior scales: Survey forms manual. Circle Pines: AGS Publishing.

    Google Scholar 

  • Steiner, A. M., Goldsmith, T. R., Snow, A. V., & Chawarska, K. (2012). Practitioner’s Guide to assessment of autism spectrum disorders in infants and toddlers. Journal of Autism and Developmental Disorders, 42, 1183–1196. doi:10.1007/s10803-011-1376-9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stella, J., Mundy, P., & Tuchman, R. (1999). Social and nonsocial factors in the childhood autism rating scale. Journal of Autism and Developmental Disorders, 29(4), 307–317. doi:10.1023/A:1022111419409.

    Article  PubMed  Google Scholar 

  • Sutera, S., Pandey, J., Esser, E. L., Rosenthal, M. A., Wilson, L. B., Barton, M., … Fein, D. (2007). Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(1), 98–107. doi:10.1007/s10803-006-0340-6.

    Article  PubMed  Google Scholar 

  • Thompson, B. (2004). Exploratory and confirmatory factor analysis: Understanding concepts and applications (1st edn.). Washington: American Psychological Association.

    Book  Google Scholar 

  • Turner, L. M., & Stone, W. L. (2007). Variability in outcome for children with an ASD diagnosis at age 2. Journal of Child Psychology and Psychiatry and Allied Disciplines, 48(8), 793–802. doi:10.1111/j.1469-7610.2007.01744.x.

    Article  Google Scholar 

  • Ventola, P. E., Kleinman, J., Pandey, J., Barton, M., Allen, S., Green, J., … Fein, D. (2006). Agreement among four diagnostic instruments for autism spectrum disorders in toddlers. Journal of Autism and Developmental Disorders, 36, 839–847. doi:10.1007/s10803-006-0128-8.

    Article  PubMed  Google Scholar 

  • Volkmar, F. R., Lord, C., Bailey, A., Schultz, R. T., & Klin, A. (2004). Autism and pervasive developmental disorders. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45(1), 135–170. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14959806.

  • Wolff, J. J., Botteron, K. N., Dager, S. R., Elison, J. T., Estes, A. M., Gu, H., … Piven, J. (2014). Longitudinal patterns of repetitive behavior in toddlers with autism. Journal of Child Psychology and Psychiatry and Allied Disciplines, 8, 945–953. doi:10.1111/jcpp.12207.

    Article  Google Scholar 

  • Zwaigenbaum, L., Bauman, M. L., Fein, D., Pierce, K., Buie, T., Davis, P. A., … Wagner, S. (2015). Early screening of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136, S41–S59.

    Article  Google Scholar 

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Acknowledgments

The authors thank the families who participated in the current study, the physicians who assisted by offering the screening study to their patients, and the research teams at the University of Connecticut and the University of Washington, especially Wendy Stone and Geraldine Dawson. Geraldine Dawson is now Professor in the Departments of Psychiatry and Behavioral Sciences, Pediatrics, and Psychology and Neuroscience and the Director of the Duke Center for Autism and Brain Development at Duke University, North Carolina. Wendy Stone is Professor of Psychology at The University of Washington. The authors also acknowledge the following funding sources: Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant R01HD039961, U.S. Department of Education Student-Initiated Research Grant, Maternal and Child Health Bureau Grant R40MC00270, the University of Connecticut’s Research Foundation Faculty Grant, the National Alliance of Autism Research, and a National Institute of Mental Health Predoctoral Fellowship F31MH12550.

Author Contributions

EM participated in conception of the study design, coordination and data collection, performed the statistical analyses and drafted sections of the manuscript; KB participated in conception of the study design, coordination and data collection, performed statistical analyses and drafted sections of the manuscript; MB participated in conception of the study design, data collection, interpretation of the data and the revising of the manuscript; DF participated in conception of the study design, data collection, interpretation of the data, and the revising of the manuscript. All authors read and approved the final manuscript.

Funding

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant R01HD039961, U.S. Department of Education Student-Initiated Research Grant, Maternal and Child Health Bureau Grant R40MC00270, the University of Connecticut’s Research Foundation Faculty Grant, the National Alliance of Autism Research, and a National Institute of Mental Health Predoctoral Fellowship F31MH12550.

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Correspondence to Emily Moulton.

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Conflict of Interest

Deborah Fein, and Marianne Barton are co-owners of M-CHAT, LLC, which receives royalties from companies that incorporate the M-CHAT into commercial products. Data reported in the current paper is from the freely available paper version of the M-CHAT. Authors Emily Moulton and Kathryn Bradbury declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Moulton, E., Bradbury, K., Barton, M. et al. Factor Analysis of the Childhood Autism Rating Scale in a Sample of Two Year Olds with an Autism Spectrum Disorder. J Autism Dev Disord 49, 2733–2746 (2019). https://doi.org/10.1007/s10803-016-2936-9

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