Childhood Autism Rating Scale (CARS) Test

Example Questions From the Test

• 1Relating to People
  • No evidence of difficulty relating to people. The child’s behavior is appropriate for age. Some shyness, fussiness, or anxiety may be seen when the child is asked to do something, but it is not atypical.
  • 5
  • Mildly abnormal relationships. The child may avoid the adult’s eye contact, avoid the adult, or become distressed if interaction is imposed; may be excessively shy, may not respond to the adult in the usual way, or may be more dependent on the adult than children of the same age (may be “clingy”).
  • 5
  • Moderately abnormal relationships. The child shows aloofness (at times seems unaware of the adult). Sometimes strong and persistent efforts are needed to get the child’s attention. The child initiates contact to a minimal degree.
  • 5
  • Severely abnormal relationships. The child is completely aloof or unaware of what the adult is doing. He or she almost never responds to or initiates contact with an adult. Only very persistent attempts may gain any response and get the child’s attention.
• 2Imitation
  • Imitation is age-appropriate. The child can imitate sounds, words, and movements that match their level of skill development.
  • 5
  • Mild impairment in imitation. Most of the time, the child imitates simple behaviors such as clapping or individual speech sounds; occasionally imitates only after some prompting from an adult or after a delay.
  • 5
  • Moderate impairment in imitation. The child imitates only some of the time, or requires a considerable degree of persistence and assistance from an adult; often imitates only after a delay.
  • 5
  • Severe impairment in imitation. The child almost never imitates sounds, words, or movements, even with help or support.
• 3Emotional response
  • Emotional response is age-appropriate and appropriate to the situation. The child shows the appropriate type and degree of emotional response, reflected in changes in facial expression, posture, or behavior.
  • 5
  • Emotional response is mildly abnormal. The child unexpectedly shows an emotional response that is inappropriate in type or intensity. At times, the child’s reactions are unrelated to objects or events occurring around them.
  • 5
  • Emotional response is moderately abnormal. The child shows definite signs of an emotional response that is inappropriate in type or degree. Reactions may be delayed or excessive and unrelated to the situation; the child may grimace, laugh, or show rigidity without showing any emotion toward objects or events.
  • 5
  • Emotional response is severely abnormal. Responses rarely fit the situation; if the child is in a particular mood, it is very difficult to change that mood. Conversely, the child may show a wide range of emotions when nothing is happening.