Rapporten - SBU
Rapporten - SBU
Rapporten - SBU
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Table 3.1.15 CARS.<br />
Author<br />
Year<br />
Reference<br />
Country<br />
Chlebowski et al<br />
2010<br />
[25]<br />
USA<br />
Aim Study design<br />
Population characteristics<br />
Setting<br />
Disease prevalence<br />
Drop-out<br />
Diagnostic<br />
assessment<br />
accuracy<br />
To investigate<br />
the use of the<br />
CARS in clinically<br />
referred sample<br />
of young children<br />
with ASD.<br />
Replicate studies<br />
assessing the ideal<br />
CARS cut-off for<br />
diagnosis of autism<br />
in samples of toddlers<br />
and preschool aged<br />
children<br />
Calculate the<br />
optimal CARS<br />
cut-off for an<br />
ASD diagnosis.<br />
Diagnostic agree-<br />
ment between<br />
the CARS and<br />
clinical judgment<br />
based on DSM-IV<br />
criteria<br />
Study design<br />
Case-control<br />
Population characteristics<br />
N=606<br />
Children clinically referred<br />
for possible ASD according<br />
to screening with M-CHAT<br />
The 2-year sample<br />
N=376<br />
Age range: 21–30 months<br />
Gender: 79% male<br />
The 4-year sample<br />
N=230<br />
Age range: 42–66 months<br />
Gender: 80% male<br />
Setting<br />
Tertiary clinic<br />
Disease prevalence<br />
Autism: 41%<br />
PDD-NOS: 24%<br />
Drop-out<br />
None reported<br />
122 Autismspektrumtillstånd – diAgnostik och insAtser,<br />
KAPITEL 3 • sysTEmATIsK LITTErATurövErsIKT –<br />
123<br />
vårdens orgAnisAtion och pAtientens delAktighet<br />
Index test Reference test Main findings Study quality Comments<br />
CARS<br />
Diagnosis of:<br />
Not autism<br />
(37)<br />
The autism group met<br />
DSM-IV criteria as<br />
per best clinical diag-<br />
nosis based on ADOS<br />
and ADI-R and direct<br />
observation<br />
The PDD-NOS group<br />
diagnosis per best clinical<br />
estimate based on<br />
ADOS, parent interview,<br />
and direct observation<br />
The non-ASD diagnosis<br />
group based on other<br />
DSM-IV diagnosis<br />
No diagnosis group<br />
fulfilled, no DSM-IV<br />
diagnosis, and was<br />
judged typically<br />
developing<br />
Evaluations were conducted<br />
by experienced<br />
clinicians<br />
The 2-year sample:<br />
Autism diagnosis,<br />
cut-off 30:<br />
Se: 0.93<br />
Sp: 0.49<br />
Cut-off 32:<br />
Se: 0.79<br />
Sp: 0.81<br />
PDD-NOS diagnosis,<br />
cut-off 25.5<br />
Se: 0.92<br />
Sp: 0.89<br />
The 4-year sample:<br />
Autism diagnosis,<br />
cut-off 30:<br />
Se: 0.86<br />
Sp: 0.80<br />
PDD-NOS diagnosis,<br />
cut-off 25.5:<br />
Se: 0.82<br />
Sp: 0.95<br />
Strong internal<br />
consistency and<br />
inter-rater reliability<br />
The main findings<br />
continues on the<br />
next page<br />
InsTrumEnT för uTrEdnIng Av AsT<br />
Moderate Limitations:<br />
No control<br />
group<br />
Clinical diagnosis<br />
was not<br />
made independently<br />
from<br />
CARS scores.<br />
The clinician<br />
who completed<br />
the CARS also<br />
made the diagnosis<br />
based on<br />
DSM-IV criteria<br />
Clinicians using<br />
the CARS in<br />
a setting that<br />
does not allow<br />
for extensive<br />
behavioural<br />
observations<br />
yield consistent<br />
result with this<br />
study<br />
The table continues on the next page
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