Autism Rating Scales: ASRS, CARS, and M-CHAT

Autism Spectrum Rating Scales (ASRS)

The Autism Spectrum Rating Scales (ASRS) are considered the first nationally standardized autism rating scales. It is quite informative and guiding. It provides guidance in determining the autistic behaviors of individuals between the ages of 2 and 18.

The Autism Spectrum Rating Scales (ASRS) were designed and developed to measure symptoms and behaviors related to autism and autism spectrum disorders. It can be applied to children and adolescents from 2 to 18 years old. It consists of questions answered by people who care for individuals in this age range. These caregivers are usually parents or teachers.

The recognition, awareness, and prevalence of autism are increasing day by day. Accordingly, the risk of underdiagnosis or misdiagnosis increases. Correct evaluation is very important in order to avoid this mistake. The need for a valid, reliable, and rigorous evaluation emerged at this point. ASRS was designed to meet this need. It is a test that guides experts in the field. It is an evaluation that can be very useful in diagnosing, planning treatment, or improving quality of life.

ASRS Components and Scale Structure

ASRS is designed in different ways according to age groups. They are designed differently for individuals 2 to 5 years old and 6 to 18 years old. For individuals between the ages of 6 and 18, there are two different forms which are short and long. ASRS assessment tests can optionally be filled in with paper and pencil or online through the ASRS Online Assessment Center. No matter how they are filled, their scoring is done with the same method.

The Full-length ASRS Form: The full-length ASRS also differs by age group. The ASRS is suitable for children aged 2 to 5 years consisted of 70 items, while the ASRS is suitable for individuals aged 6 to 18 years consisted of 71 questions. There is also the variability of caregivers according to age groups. There are two different rating scales that both parents and teachers must answer. The result of the average of these forms is actually the most comprehensive. Therefore, it is of great importance that it is completed fully and correctly. It is recommended that the validity of the full-length forms be re-evaluated at different time intervals to be considered accurate and valid.

The ASRS Short Form: Although it does not make a big difference in the initial diagnosis, it is an evaluation test that clearly distinguishes between young people diagnosed with autism and those who are not diagnosed with autism. It is the same length for both age groups and consists of the same number of questions. It contains 15 items. It must be filled in by both parents and teachers. The test they both have to fill is the same. It is aimed at understanding in which areas individuals with autism need help and support. It is very useful in managing treatment processes and training programs.

Childhood Autism Rating Scale (CARS-2) 

CARS-2 is an updated and modern version of the Childhood Autism Rating Scale. The first developed and designed version was more aimed at individuals with mental dysfunctions and their behaviors. Since it was understood that individuals on the autism spectrum are high-functioning individuals, it was concluded that the first version was insufficient and the second version was developed.

CARS-2 was developed to be applicable to both low-functioning and high-functioning individuals on the autism spectrum. While there was not much change in the version which is applicable to low-functioning individuals, more visible changes were made to the version which is applicable to high-functioning individuals.

While CARS continues to be used as a questionnaire to be filled in by parents generally, CARS-2 is filled in by experts in the field. These experts observe the behaviors of individuals thought to be on the autism spectrum and complete this assessment scale according to their observations. In short, it can be said that it was designed as a clinician scale. Information that can be obtained from parents can be obtained not only with CARS but also with the CARS2-QPC (Parental Concerns Questionnaire). On the other hand, there is no equivalent of CARS-2.

As mentioned above, CARS-2 is not a parental assessment test and must be completed by professionals. It is recommended to be filled by experts who are related to autism, have worked with individuals with autism, and are knowledgeable about autism. However, in case of need, parental observation and information are needed if CARS2-ST, CARS2-HF, or CARS2-QPC is desired.

As the scoring system differs, the results obtained also differ. Full-scale scaling is guaranteed. Grades of autism-related behaviors are specified as mild, moderate, or severe. It may differ with minor changes. Since the behavior of individuals will differ from person to person, it will always be in your best interest to get an expert opinion.

M-CHAT (Modified Checklist for Autism in Toddlers)

M-CHAT consists of 23 items developed to be directed to the child’s parent or the child’s primary caregiver. Each item in the scale is answered as yes or no. The first 9 of these items were taken from CHAT; the remaining items were prepared by those who developed the scale. The second section based on the observation in CHAT was removed. There are 6 critical items related to autism in M-CHAT.

The M-CHAT screening test is the most recent screening test in the literature among level 1 screening tests because it is easy to apply, relatively short duration, can detect autistic findings between 18 months and 3 years of age, can be filled by families, and has higher sensitivity. The reliability value of the M-CHAT is very high. This value is quite reliable. As a result, the MCHAT test in children aged 18-30 months can be used. This test, which consists of 23 items in total, lasts 15 to 20 minutes on average.

M-CHAT determines whether a child has a suspicion of autism or not. As a result of this test, children who are diagnosed with autism spectrum disorder are started to be educated as soon as possible. This leads to a decrease in autism symptoms with early diagnosis. All children who fail in either of the 23 items included in the scale or any of the critical items of 6 are at risk for autism spectrum disorder.

M – Chat should be answered by the child’s mother or the child’s primary caregiver. 23 questions asked in the test should be answered by taking into consideration of the general situation of the child. If a certain behavior is very rare, the answer should be answered as if it is not done at all.

After the answers to questions, it is determined whether the child shows signs of autism. This autism test is very important for early diagnosis. At the end of the test, the child who has autism symptoms starts intensive education and training at home and at school.

  • LOW-RISK: If the total score is between 0 and 2. If the child is less than 24 months of age, the test should be repeated after the second birthday. If there is no risk for autism in screening, no further action is required.
  • MID-RISK: If the total score is between 3 and 7. To obtain additional information regarding risk-indicating responses, the observation part of the test should be completed. If the M-CHAT score is again 2 or higher, the child is considered to have autism on screening. Refer the child for diagnostic and early intervention compliance assessments.

If the score is between 0 and 1, the child is considered to be autism negative in the scan. If there is no risk for autism in screening, no further action is required. The child should be re-screened for subsequent child examinations.

  • HIGH-RISK: If the total score is between 8 and 20. By skipping the observation part, the child can be referred for diagnostic and early intervention assessment.

The Importance of Autism Rating Scales

The autism rating scales performed at an early stage are of great importance. Think about that your child is behaving in a disturbing manner and obviously you want to know what the problem is. Autism spectrum disorder can be recognized from some specific behavior.

One of the most important steps in child health monitoring is the evaluation of development. For this reason, in the assessment of child evaluation; the child’s gross motor, fine motor movements, understanding what is said, expressing their wishes, speaking and social communication skills should be evaluated whether they are appropriate for their age.

During completing rating scales, the development process should be evaluated in detail by taking into consideration the observations of the doctor about the child, history and physical examination findings, and the concerns of the family about the development of the child. However, actually, there is no specific screening test in routine use for early detection of autism spectrum disorder.

In some tests, experts and parents can compare the child’s behavior with the typical behavior of children with autism. The result of the test is not diagnostic. On the other hand, thanks to this test, parents can see if there is a reason to do more detailed research.

The attention of families is very important for the diagnosis of autism. Let’s think that there is a family with 12 months old child, there are some points that a family with a child of 12 months should pay attention to. For example, The fact that the child never rips, does not have any hand signals, does not say a single word when the child is 16 months, cannot speak two words spontaneously when he/she comes to 24 months, etc. When such cases occur, parents can go to a professional in order to take and advice and to ensure the early diagnosis of autism spectrum disorder. Therefore, parents should observe the different behaviors that exist in their children.

  • Although it is thought that there are no adequate autism rating scales for preschoolers, nowadays sound screening measures exist for them. Most of the scales measures have sensitivities. Their specificities are greater than 70%.
  • Requirements for training and education are not extensive for rating scales. Paraprofessionals can administer many of them.
  • Contrary to popular belief, which is rating scales take a lot of time, many tests take less than 15 minutes to complete. And even some of them take only about 2 minutes to complete.
  • Parent’s concerns are predictive of developmental delays. That’s why their concerns are generally valid and essential. According to some researches, parental concerns detect up to 80% of children with disabilities.

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