Comparison of diagnostic validity of two autism rating scales for suspected autism in a large Chinese sample

BACKGROUND 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.AIM To investigate the diagnostic validity of CARS and ABC based on a large Chinese sample.METHODS 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.RESULTS 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.CONCLUSION This result indicated that CARS is superior to ABC in the Chinese population with suspected ASD.

Performance of the Autism Spectrum Rating Scale and Social Responsiveness Scale in Identifying Autism Spectrum Disorder Among Cases of Intellectual Disability

The Autism Spectrum Rating Scale(ASRS) and the Social Responsiveness Scale(SRS) have been widely used for screening autism spectrum disorder(ASD) in the general population during epidemiological studies, but studies of individuals with intellectual disability(ID) are quite limited. Therefore, we recruited the parents/caregivers of 204 ASD cases, 71 ID cases aged 6–18 years from special education schools, and 402 typically developing(TD) children in the same age span from a communitybased population to complete the ASRS and SRS. The results showed that the ID group scored significantly lower on total and subscale scores than the ASD group on both scales(P \ 0.05) but higher than TD children(P \ 0.05).Receiver operating characteristic analyses demonstrated a similar fair performance in discriminating ASD from ID with the ASRS(area under the curve(AUC) = 0.709,sensitivity = 77.0%, specificity = 52.1%, positive predictive value(PPV) = 82.2%) and the SRS(AUC = 0.742,sensitivity = 59.8%, specificity = 77.5%, PPV = 88.4%).The results showed that individuals with ID had clear autistic traits and discriminating ASD from ID cases was quite challenging, while assessment tools such as ASRS and SRS, help to some degree.

Assessing the Accuracy of the Modified Chinese Autism Spectrum Rating Scale and Social Responsiveness Scale for Screening Autism Spectrum Disorder in Chinese Children

The reported prevalence of autism spectrum disorder（ASD） has been increasing rapidly in many parts of the world. However, data on its prevalence in China are largely missing. Here, we assessed the suitability of the modi？ed Chinese version of a newly-developed ASD screening tool, the Modi？ed Chinese Autism Spectrum Rating Scales（MC-ASRS） in screening for ASD in Chi nese children aged 6–12 years, through comparison with the Social Responsiveness Scale（SRS） that has been widely used for ASD screening. We recruited the par ents/caregivers of 1588 typically-developing children and190 children with ASD aged 6–12 years to complete the MC-ASRS and SRS, and evaluated the validity of both scales in discriminating children with ASD from those developing typically. The results showed that MC-ASRSperformed as well as SRS in sensitivity, speci？city, and area-under-the-curve（both [0.95） in receiver operating characteristic analysis, with a fair false-negative rate.These results suggest that MC-ASRS is a promising tool for screening for children with ASD in the general Chinese population.

Chinese Norms for the Autism Spectrum Rating Scale

This study aimed to establish norms for the modi？ed Chinese version of the Autism Spectrum Rating Scale（ASRS）. Participants were recruited from Shanghai,Harbin, Guangzhou, and Changsha, China, and their parents and teachers were invited to complete the Chinese Parent version and the Teacher version of the ASRS. In both versions, boys had signi？cantly higher sub-scale scores and total score（T-score） by 1–3 and 4–5 points respectively, than girls（both P ／ 0.001）. Age had weak correlations with some sub-scores and the T-score（r ranged from-0.1859 to 0.0738）, and some reached signi？cance（P ／ 0.03）. The correlations appeared stronger and were more common in females. The T-score based on Chinese norms ideally correlated with the score based on the United States norms in boys and girls for both versions.Norms for the Chinese version of the ASRS for children aged 6–12 years are proposed and may be helpful for screening individuals with autism spectrum disorders from the general population of children.

Prevalence of Autism Spectrum Disorder in China:A Nationwide Multi-center Population-based Study Among Children Aged 6 to 12 Years

This study aimed to obtain the first national estimate of the prevalence of autism spectrum disorder(ASD) in Chinese children.We targeted the population of 6 to 12-year-old children for this prevalence study by multistage convenient cluster sampling.The Modified Chinese Autism Spectrum Rating Scale was used for the screening process.Of the target population of 142,086 children,88.5%(n=125,806) participated in the study.A total of 363 children were confirmed as having ASD.The observed ASD prevalence rate was 0.29%(95% CI:0.26%-0.32%) for the overall population.After adjustment for response rates,the estimated number of ASD cases was867 in the target population sample,thereby achieving an estimated prevalence of 0.70%(95% CI:0.64%-0.74%).The prevalence was significantly higher in boys than in girls(0.95%;95% CI:0.87%-1.02% versus 0.30%;95%CI:0.26%-0.34%;P <0.001).Of the 363 confirmed ASD cases,43.3% were newly diagnosed,and most of those(90.4%) were attending regular schools,and 68.8% of the children with ASD had at least one neuropsychiatric comorbidity.Our findings provide reliable data on the estimated ASD prevalence and comorbidities in Chinese children.