Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries

Abstract

The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural validity are lacking. This study evaluated the crosscultural measurement invariance of the CARS among children with ASD from six countries, for whom data were aggregated from previous studies in India (n = 101), Jamaica (n = 139), Mexico (n = 72), Spain (n = 99), Turkey (n = 150), and the United States of America (n = 186). We analyzed the approximate measurement invariance based on Bayesian structural equation modeling. The model did not fit the data and its measurement invariance did not hold, with all items found non-invariant across the countries. Items related to social communication and interaction (i.e., relating to people, imitation, emotional response, and verbal and nonverbal communication) displayed lower levels of cross-country noninvariance compared to items about stereotyped behaviors/sensory sensitivity (i.e., body and object use, adaptation to change, or taste, smell, and touch response). This study found that the CARS may not provide cross-culturally valid ASD assessments. Thus, cross-cultural comparisons with the CARS should consider first which items operate differently across samples of interest, since its cross-cultural measurement non-invariance could be a source of cross-cultural variability in ASD presentations. Additional studies are needed before drawing valid recommendations in relation to the cultural sensitivity of particular items.

The Impact of the Urban Built Environment on the Play Behavior of Children with ASD

“…Marcus also discussed children’s communication behaviors in People Places: Design Guidelines for Urban Open Space, and divided children’s play behaviors in the urban built environment: observation-participation-avoidance-concealment [ 6 ]. However, due to regional differences, urban built environment impacts vary widely between developed and developing countries [ 7 ], and due to differences in cultural backgrounds, diagnoses of children with ASD in other countries may not provide cross-culturally valid results [ 8 ]. Therefore, this study uses the Autism Diagnostic Scale ( Table 1 ), which is suitable for China’s national conditions, as a reference and combines the Autism Children’s Development Assessment Scale ( Table 2 ) issued by the China Disabled Persons’ Federation to describe the play behavior of children with ASD.…”

Salivary oxytocin in autistic patients and in patients with intellectual disability

“…The Cronbach’s alpha coefficient for CARS was 0.772, and the degree of correlation with the Autism Behavior Checklist (ABS)—0.732 ( 39 ). Information that CARS may not provide a cross-cultural valid assessment of ASD ( 40 ), pointed out the need to use a proven adapted version of the test ( 41 ). The adapted Russian version showed fairly high reliability values of r = 0.9 ( p < 0.001) and correlations with the scale of the CARS r = 0.8 ( p < 0.001) ( 41 ).…”

Evaluating psychometric properties of common autism educational identification measures through a culturally and linguistically responsive lens

“…McClain and colleagues (2020, 2021) found measurement noninvariance in that both item‐ and test‐level bias and factor structure differences across race and ethnicity of clients on the Autism Spectrum Rating Scales (ASRS). Stevanovic et al (2020) found noninvariance with the Childhood Autism Rating Scale (CARS) across six countries, with items related to social communicaton and interaction displaying the lowest levels of cross‐country noninvariance. Direct observation autism measures are likely more culturally responsive due to more flexibility of administration if professionals interpret behaviors with culturally and linguistically responsive lenses (Harris et al, 2014).…”