Chu Jia-Hui, Bian Fang, Yan Rui-Ying, Li Yan-Lin, Cui Yong-Hua, Li Ying
Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China.
World J Clin Cases. 2022 Feb 6;10(4):1206-1217. doi: 10.12998/wjcc.v10.i4.1206.
Autism is the most common clinical developmental disorder in children. The childhood autism rating scale (CARS) and autistic autism behavior checklist (ABC) are the most commonly used assessment scales for diagnosing autism. However, the diagnostic validations and the corresponding cutoffs for CARS and ABC in individuals with suspected autism spectrum disorder (ASD) remain unclear. Furthermore, for suspected ASD in China, it remains unclear whether CARS is a better diagnostic tool than ABC. Also unclear is whether the current cutoff points for ABC and CARS are suitable for the accurate diagnosis of ASD.
To investigate the diagnostic validity of CARS and ABC based on a large Chinese sample.
A total of 591 outpatient children from the ASD Unit at Beijing Children's Hospital between June and November 2019 were identified. First, the Clancy autism behavior scale (CABS) was used to screen out suspected autism from these children. Then, each suspected ASD was evaluated by CARS and ABC. Receiver operating characteristic (ROC) curve analysis was used to compare diagnostic validations. We also calculated the area under the curve (AUC) for both CARS and ABC.
We found that the Cronbach alpha coefficients of CARS and ABC were 0.772 and 0.426, respectively. Therefore, the reliability of the CARS was higher than that of the ABC. In addition, we found that the correlation between CARS and CABS was 0.732. Next, we performed ROC curve analysis for CARS and ABC, which yielded AUC values of 0.846 and 0.768, respectively. The cutoff value, which is associated with the maximum Youden index, is usually applied as a decision threshold. We found that the cutoff values of CARS and ABC were 34 and 67, respectively.
This result indicated that CARS is superior to ABC in the Chinese population with suspected ASD.
自闭症是儿童中最常见的临床发育障碍。儿童自闭症评定量表（CARS）和自闭症行为 checklist（ABC）是诊断自闭症最常用的评估量表。然而，在疑似自闭症谱系障碍（ASD）个体中，CARS 和 ABC 的诊断效度及相应的临界值仍不明确。此外，在中国，对于疑似 ASD，CARS 是否比 ABC 是更好的诊断工具尚不清楚。ABC 和 CARS 当前的临界值是否适用于 ASD 的准确诊断也不清楚。
基于大量中国样本研究 CARS 和 ABC 的诊断效度。
确定了 2019 年 6 月至 11 月期间北京儿童医院 ASD 科的 591 名门诊儿童。首先，使用克兰西自闭症行为量表（CABS）从这些儿童中筛选出疑似自闭症患者。然后，对每个疑似 ASD 患者进行 CARS 和 ABC 评估。采用受试者工作特征（ROC）曲线分析比较诊断效度。我们还计算了 CARS 和 ABC 的曲线下面积（AUC）。
我们发现 CARS 和 ABC 的 Cronbach α 系数分别为 0.772 和 0.426。因此，CARS 的可靠性高于 ABC。此外，我们发现 CARS 和 CABS 之间的相关性为 0.732。接下来，我们对 CARS 和 ABC 进行了 ROC 曲线分析，其 AUC 值分别为 0.846 和 0.768。与最大约登指数相关的临界值通常用作决策阈值。我们发现 CARS 和 ABC 的临界值分别为 34 和 67。
该结果表明，在疑似 ASD 的中国人群中，CARS 优于 ABC。
