title: Diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale in India.
abstract: 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.
  
  
  CONCLUSIONS
  The CARS has strong psychometric properties and is now available for clinical and research work in India.
authors.affiliation: Autism Clinic, Child & Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore, 632 002, Southern India. russell@cmcvellore.ac.in
authors.forename: Paul S S
authors.initials: PS
authors.lastname: Russell
authors.forename: Anna
authors.initials: A
authors.lastname: Daniel
authors.forename: Sushila
authors.initials: S
authors.lastname: Russell
authors.forename: Priya
authors.initials: P
authors.lastname: Mammen
authors.forename: Julie S
authors.initials: JS
authors.lastname: Abel
authors.forename: Lydia E
authors.initials: LE
authors.lastname: Raj
authors.forename: Satya Raj
authors.initials: SR
authors.lastname: Shankar
authors.forename: Naveen
authors.initials: N
authors.lastname: Thomas
mesh_terms: D001321:Autistic Disorder / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D011237:Predictive Value of Tests; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires