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A Validation Study of the CARS-2 Compared With the ADOS-2 in the Diagnosis of Autism Spectrum Disorder: A Suggestion for Cutoff Scores
J Korean Acad Child Adolesc Psychiatry
Published online November 10, 2022
© 2022 Korean Academy of Child and Adolescent Psychiatry.

Seong-In Ji1, Hyungseo Park1, Sun Ah Yoon1, and Soon-Beom Hong2,3

1Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
2Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
3Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea
Correspondence to: Soon-Beom Hong, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Tel: +82-2-2072-4208, Fax: +82-2-747-2471, E-mail:
Received September 12, 2022; Revised September 21, 2022; Accepted September 26, 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives: This study examined the validity of the Childhood Autism Rating Scale, Second Edition (CARS-2) compared with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) in identifying autism spectrum disorder (ASD).
Methods: A total of 237 children were tested using both the CARS-2 and ADOS-2. We examined the correlation using Pearson’s correlation analysis. In addition, we used a receiver operating characteristic graph to determine the optimal standard version of the CARS-2 (CARS2-ST) cutoff score for ASD diagnosis using the ADOS-2.
Results: The concurrent validity of the CARS2-ST was demonstrated by a significant correlation with the ADOS-2 (r=0.864, p<0.001). The optimal CARS2-ST cutoff scores were 30 and 28.5 for identifying autism and autism spectrum, respectively, based on the ADOS-2.
Conclusion: We suggest a newly derived CARS2-ST cutoff score of 28.5 for screening ASD and providing early intervention.
Keywords : Autism spectrum disorder; ADOS-2; CARS-2; Diagnosis; Screening

October 2022, 33 (4)
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