印度儿童自闭症评定量表的诊断准确性、可靠性和有效性。
Diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale in India.
机构信息
Autism Clinic, Child & Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore, 632 002, Southern India.
出版信息
World J Pediatr. 2010 May;6(2):141-7. doi: 10.1007/s12519-010-0029-y. Epub 2010 May 21.
BACKGROUND
Since there is no established measure for autism in India, we evaluated the diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale (CARS).
METHODS
Children and adolescents suspected of having autism were identified from the unit's database. Scale and item level scores of CARS were collected and analyzed. Sensitivity, specificity, likelihood ratios and predictive values for various CARS cut-off scores were calculated. Test-retest reliability and inter-rater reliability of CARS were examined. The dichotomized CARS score was correlated with the ICD-10 clinical diagnosis of autism to establish the criterion validity of CARS as a measure of autism. Convergent and divergent validity was calculated. The factor structure of CARS was demonstrated by principal components analysis.
RESULTS
A CARS score of > or =33 (sensitivity = 81.4%, specificity = 78.6%; area under the curve = 81%) was suggested for diagnostic use in Indian populations. The inter-rater reliability (ICC=0.74) and test-retest reliability (ICC=0.81) for CARS were good. Besides the adequate face and content validity, CARS demonstrated good internal consistency (Cronbach's alpha=0.79) and item-total correlation. There was moderate convergent validity with Binet-Kamat Test of Intelligence or Gessell's Developmental Schedule (r=0.42; P=0.01), divergent validity (r=-0.18; P=0.4) with ADD-H Comprehensive Teacher Rating Scale, and high concordance rate with the reference standard, ICD-10 diagnosis (82.52%; Cohen's kappa=0.40, P=0.001) in classifying autism. A 5-factor structure explained 65.34% of variance.
CONCLUSION
The CARS has strong psychometric properties and is now available for clinical and research work in India.
背景
由于印度没有自闭症的既定评估方法，我们评估了儿童自闭症评定量表（CARS）的诊断准确性、可靠性和有效性。
方法
从本单位的数据库中确定疑似自闭症的儿童和青少年。收集并分析 CARS 的量表和项目水平评分。计算各种 CARS 截断分数的敏感性、特异性、似然比和预测值。检查 CARS 的重测信度和评分者间信度。将二分类 CARS 评分与自闭症的 ICD-10 临床诊断相关联，以确定 CARS 作为自闭症评估工具的效标效度。计算了 CARS 的收敛和发散效度。通过主成分分析证明了 CARS 的因子结构。
结果
我们建议印度人群使用 CARS 评分≥33 （敏感性=81.4%，特异性=78.6%；曲线下面积=81%）作为诊断用途。CARS 的评分者间信度（ICC=0.74）和重测信度（ICC=0.81）良好。除了充分的表面和内容效度外，CARS 还表现出良好的内部一致性（克朗巴赫的α=0.79）和项目总分相关性。与 Binet-Kamat 智力测试或 Gesell 发育时间表（r=0.42；P=0.01）有中度的收敛效度，与 ADD-H 综合教师评定量表（r=-0.18；P=0.4）有发散效度，与参照标准 ICD-10 诊断（82.52%；Cohen's kappa=0.40，P=0.001）在自闭症分类方面有较高的一致性。5 个因子结构解释了 65.34%的方差。
结论
CARS 具有较强的心理测量学特性，现在可在印度用于临床和研究工作。
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