- Ages: 2 years and older
- Testing Time: 5 to 10 minutes
- Administration: Individual
- Norm-referenced: percentiles, T-scores, raw scores, and standard scores
- CARS 2 Complete kit: 25 Standard Version Rating Booklets (CARS 2-ST); 25 High-Functioning Version Rating Booklets (CARS 2-HF); 25 Questionnaires for Parents or Caregivers (CARS 2-QPC); and a Manual. (2010)
- Qualification Level: B
The Childhood Autism Rating Scale–Second Edition (CARS 2) is a 15-item rating scale used to identify children with autism and distinguishing them from those with developmental disabilities. Empirically validated, CARS 2 provides concise, objective, and quantifiable ratings based on direct behavioral observation and normed on a sample of 1,034 individuals with autism spectrum disorders.
The clinician rates the individual on each item using a 4-point response scale. Ratings not only reflect the frequency of the behaviors in question, but also their intensity, peculiarity, and duration. While this more nuanced approach gives you greater flexibility in integrating diagnostic information, it still yields quantitative results. Physicians, special educators, school psychologists, speech pathologists, and audiologists will all find the CARS 2 easy to give and score.
The CARS 2 includes three forms:
- Standard Version Rating Booklet (CARS 2-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
- High-Functioning Version Rating Booklet (CARS 2-HF) – An alternative for assessing verbally fluent individuals, 6 years of age and older, with IQ scores above 80
- Questionnaire for Parents or Caregivers (CARS 2-QPC) – An unscored scale that gathers information for use in making CARS 2-ST and CARS 2-HF ratings
The Standard and High-Functioning Forms
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 modified items on the High-Functioning form reflect current research on the characteristics of people with high-functioning autism or Asperger’s Syndrome.
The Rating Booklets for both the Standard and High-Functioning versions are particularly convenient. They include space for clinical note taking and documentation. They briefly describe each area rated, providing a reminder of rating criteria and a framework for explaining results to parents. The list of cutoff values allow you to see at a glance whether further evaluation is justified.
The sum of rating values for all items produce a Total Raw Score. Each form includes a graph that allows you to quickly convert the Total Raw Score to a standard score or percentile rank (based on a clinical sample of 1,034 individuals with autism spectrum disorders). The Manual provides guidelines for score interpretation, suggestions for intervention, and case examples.
The Questionnaire for Parents or Caregivers
The CARS 2-QPC is an unscored form completed by the parent or caregiver about the individual the clinician will assess. Its purpose is to give the clinician more information on which to base CARS 2-ST or CARS 2-HF ratings. Often the questionnaire serves as the framework for a follow-up interview, during which the clinician can clarify and interpret the responses provided by the parent or caregiver.
The areas covered by the CARS 2-QPC include the individual’s early development; social, emotional, and communication skills; repetitive behaviors; play and routines; and unusual sensory interests.
The CARS 2 is extremely useful in identifying symptoms of autism.
- It covers the entire autism spectrum, as defined by empirical research.
- Decades of use with thousands of referred individuals establishes its credibility.
- It assesses virtually all ages and functional levels.
- It provides concise, objective, and quantifiable ratings based on direct behavioral observation.
- Scores show a consistent, strong, positive, and specific relationship with autism diagnosis.
- Ratings are reliable across time, settings, sources of information, and raters.