Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Psychiatry Clin Neurosci. 2017 Oct;71(10):725-732. doi: 10.1111/pcn.12540. Epub 2017 Jul 7.
The current cut-off score of the Korean version of the Childhood Autism Rating Scale (K-CARS) does not seem to be sensitive enough to precisely diagnose high-functioning autism. The aim of this study was to identify the optimal cut-off score of K-CARS for diagnosing high-functioning individuals with autism spectrum disorders (ASD).
A total of 329 participants were assessed by the Korean versions of the Autism Diagnostic Interview - Revised (K-ADI-R), Autism Diagnostic Observation Schedule (K-ADOS), and K-CARS. IQ and Social Maturity Scale scores were also obtained.
The true positive and false negative rates of K-CARS were 77.2% and 22.8%, respectively. Verbal IQ (VIQ) and Social Quotient (SQ) were significant predictors of misclassification. The false negative rate increased to 36.0% from 19.8% when VIQ was >69.5, and the rate increased to 44.1% for participants with VIQ > 69.5 and SQ > 75.5. In addition, if SQ was >83.5, the false negative rate increased to 46.7%, even if the participant's VIQ was ≤69.5. Optimal cut-off scores were 28.5 (for VIQ ≤ 69.5 and SQ ≤ 75.5), 24.25 (for VIQ > 69.5 and SQ > 75.5), and 24.5 (for SQ > 83.5), respectively.
The likelihood of a false negative error increases when K-CARS is used to diagnose high-functioning autism and Asperger's syndrome. For subjects with ASD and substantial verbal ability, the cut-off score for K-CARS should be re-adjusted and/or supplementary diagnostic tools might be needed to enhance diagnostic accuracy for ASD.
韩国版儿童自闭症评定量表（K-CARS）的现行截断分数似乎不够敏感，无法精确诊断高功能自闭症。本研究旨在确定 K-CARS 用于诊断高功能自闭症谱系障碍（ASD）个体的最佳截断分数。
共有 329 名参与者接受了韩国版自闭症诊断访谈修订版（K-ADI-R）、自闭症诊断观察量表（K-ADOS）和 K-CARS 的评估。还获得了智商和社会成熟度量表的分数。
K-CARS 的真阳性和假阴性率分别为 77.2%和 22.8%。言语智商（VIQ）和社会商数（SQ）是分类错误的显著预测因子。当 VIQ>69.5 时，假阴性率从 19.8%增加到 36.0%，而当 VIQ>69.5 和 SQ>75.5 时，假阴性率增加到 44.1%。此外，如果 SQ>83.5，即使参与者的 VIQ≤69.5，假阴性率也会增加到 46.7%。最佳截断分数分别为 28.5（对于 VIQ≤69.5 和 SQ≤75.5）、24.25（对于 VIQ>69.5 和 SQ>75.5）和 24.5（对于 SQ>83.5）。
当使用 K-CARS 诊断高功能自闭症和阿斯伯格综合征时，出现假阴性错误的可能性会增加。对于 ASD 且具有较强言语能力的受试者，应重新调整 K-CARS 的截断分数，或需要补充诊断工具，以提高 ASD 的诊断准确性。
