Psychometric Properties of an Arabic Modified Childhood Autism Rating Scale 2 Standard Form.

Researchers tested an Arabic version of an autism assessment tool (CARS-2) with 286 children in Iraq. The tool showed good accuracy in identifying autism, correctly identifying about 83% of autistic children and 93% of non-autistic children. The test was reliable and could be especially useful in areas where autism specialists are limited. One section about activity levels was less reliable and tended to be higher in children with ADHD.

This study evaluated an Arabic modified version of the Childhood Autism Rating Scale 2 (CARS-2) in 286 children in Iraq. The research assessed the tool's psychometric properties including structural validity, reliability, and diagnostic accuracy. The modified scale demonstrated good structural validity with multiple factor solutions, excellent internal consistency (alpha = 0.90), and strong diagnostic accuracy with 82.6% sensitivity and 93.4% specificity at a cut-off score of ≥28.5. The 'activity levels' item showed the lowest loadings and was notably elevated in children with ADHD.

The findings suggest this culturally adapted assessment tool could be valuable for autism evaluation in resource-limited settings where psychiatric expertise and IQ testing may be scarce.

The modified Arabic CARS-2 could provide a reliable autism screening tool for Arabic-speaking populations, particularly valuable in resource-limited settings. Clinicians should use caution when interpreting activity level scores in children with suspected ADHD comorbidity.

Study conducted in single geographic region (Iraq) which may limit generalizability to other Arabic-speaking populations. No comparison with gold-standard diagnostic procedures mentioned. The specific modifications made to the original CARS-2 are not detailed in the abstract.

In middle- and lower-income countries, the scarcity of psychiatric expertise and IQ testing should be considered when developing and testing assessment tools. This study aims to assess the psychometric properties of a modified Arabic version of the Childhood Autism Rating Scale 2 Standard Form. A diagnostic accuracy study, including 286 children, was conducted from December 1, 2023, to August 1, 2024, at Baghdad's National Centre and Al-Subtain Academy for Autism. Confirmatory factor analysis was utilized for structural validity, standardized alpha and the average inter-item correlation for reliability, and ROC curve analysis for diagnostic accuracy.

Good fit was demonstrated for the 1-, 2-, and 3-factor solutions. In all models, 'activity levels' had the lowest loadings and higher scores in children with ADHD (p-value = 0.0002). Excellent internal consistency was shown with a standardised alpha of 0.90 (> 0.7) and an average inter-item correlation of 0.394 (> 0.15). At the optimal cut-off (≥ 28.5), the scale had a sensitivity of 82.6%, a specificity of 93.4%, and would increase the child's odds of having ASD by 12.5.

The modified scale has good psychometric properties and might be utilised to adjust the psychiatric evaluation of children suspected of having a neurodevelopmental disorder.