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INTRODUCTION

The synonymous terms Autism spectrum disorders and Pervasive

developmental disorders refer to a wide continuum of associated cognitive and

behavioral disorders, including three core defining features: impairments in socialization,

impairment in verbal and nonverbal communication and restricted and repetitive pattern

of behaviors. (American Psychiatric Association [APA], 1994)1

Researchers had also suggested that a pattern of stereotyped and repetitive

behavior is a common feature of autism (Bailey et al., 1996)2.

Currently, Diagnostic and Statistical manual for Mental disorder-IV includes

five possible diagnoses under the ASD/PDD umbrella; include Autistic disorder,

Aspergers disorder, PDD-NOS (Pervasive developmental disorder- Not otherwise

specified), Childhood disintegrative syndrome, and Rett syndrome, which were

concordant with the International Classification of Disease, 10th

edition (ICD-10).


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The precise aetiology of Autism remains essentially unknown, despite

considerable research into the genetic, biological, pharmacological and environmental

factors involved in the development and manifestation of the disorder6.

There were many agreements that autism is caused by a dysfunction in the

central nervous system with an underlying genetic bases, there are conflicting views as to

its defining characteristics and the casual explanation linking brain dysfunction to

behavioral characteristics7.

Additionally, it was agreed that the autism can be defined at three different

interdependent levels, as a neurological disorder related to brain development, as a

psychological disorder affecting cognitive, emotional and behavioral development and

lastly as a relationship disorder to develop age appropriate socialization skills.

The agreement involves the idea of autism as a spectrum disorder, although the

spectrum cannot be clearly defined simply from mild to severe8. Different children

manifest different combinations of symptoms of varying severity although all sharing the


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The first core feature of autism is qualitative impairment of social interaction

and relationships10, 11, 12, 13

. In this infant may be exhibited as rigid, failure to seek

physical comfort from other people14

, and failure to develop normal attachment to

parents and caregivers. They fail to develop reciprocal eye contact and social smiling13.

They rarely engaged in peer play16 and all these deficits remains the same forever15.

Poor communicative skills are hallmark of autism17. In fact many children with

autism never acquire functional language skill. When speech does develop, it is often

marked with irrelevant content and stereotyped and repetitive vocalizations. Improper use

of language and inability to use language for social communication are more

characteristics of autistic language deficit16. Finally, the ability to sustain conversation

and produce spontaneous language is greatly limited in child with autism18.

Behavior impairment noted in children with autism such as hand clapping or

arm flapping whenever excited or upset. Running aimlessly, rocking, spinning, toe

walking or other odd postures are commonly seen in children with Autism. The play of


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Empirical studies of toddlers with Autism spectrum disorder had found that

intensive, specialized early intervention had resulted in quantifiable gains21, 22, 23, 24

. In

order to maximize the opportunity for specialized early intervention, the early

identification and diagnosis of ASD were especially important25. Recently, the American

Academy of Pediatrics (AAP)25, 26

even suggested that it was important for children

suspected of ASD to begin intervention services.

Early identification studies support the feasibility and validity of early diagnosis

even as early as 2 years27, 28, 29. Along with screening studies, retrospective studies of

infant videotapes30, 31, 32

, diagnostic stability studies33, 34, 35, 36, 37

, and inter rater reliability

studies) 38, 39 have supported the validity of early diagnosis and have identified symptoms

that may be present in the early developmental course of ASD.

In addition prospective studies of ASD have been useful in indentifying

symptoms present in high-risk infants (such as younger siblings of children with ASD)

later diagnosed as autism spectrum40, 41, 42. These studies, which have focused on young


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signs and symptoms of autism recognize possible indicator(Social, Communicative and

behavioral) of the need for further diagnostic evaluation43

.

There are so many Autism specific screening instrument that have been

designed for use in field. The screening of autism should do in two levels43

. The

instruments used in level I screening consist of CHAT (Checklist for Autism in Toddler),

M-CHAT (Modified Checklist for Autism in Toddler), PDDST-I (Pervasive

developmental Disorder Screening Test Stage-I), SCQ (Social Communication

Questionnaire) and STAT (Screening Tool for Autism in Two year olds).

Checklist for Autism in Toddler (CHAT)44, 45

A screening test for autism in

children from 18 to 36 months of age; it contains 9 parent questions and 5 behavioral

observation items. Absence of three items was considered critical; Protodeclarative

pointing Gaze monitoring and Pretend play. It takes 15 minute for completion. It has high

specificity but low sensitivity.

Pervasive developmental Disorder Screening Test Stage-II (PDDST-II) was


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differentiates autism from other developmental problems. It requires 20 minutes time for

administration. Its sensitivity is higher than its specificity.

When comparing with the above instruments M-CHAT is highly sensitive and

specific in the screening for Autism in age of 18-24 months. It was developed by Diana

Robins in Connecticut in 199928

.

It consist of 23 yes/no question which was filled by the parents required 5

minute for completion. It was available in so many languages which help parents to

easily understand the content.

It was important to realize that parents usually were correct in their concerns

about their childs development48, 49, 50, 51

. They may not be as accurate regarding the

qualitative and quantitative parameters surrounding the developmental abnormality, but

almost always, if there is a concern on chief complaint must be valued and lead to further

investigation.

C A i d h 9 i f h C A d dd d 14


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interview and observation instrument which is suitable for use with any child over 24

months of age. Each of the 15 items uses a 7-point rating scale to indicate the degree to

which the childs behavior deviates from an age-appropriate norm; in addition, it

distinguishes mild-to-moderate from severe autism. The CARS is widely recognized and

used as a reliable instrument for the diagnosis of Autism, and takes approximately 30 to

45 minutes to administer52.


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NEED OF THE STUDY

Autism is a disorder that affects individual across the life span. Early diagnosis

required for early intervention. For that sufficient knowledge about the autism spectrum

disorders proper screening technique were essential for all the professionals including

Physiotherapist43.

The goal of this study was to investigate the correlation between M-CHAT and

CARS. These two instruments were developed to screen the same construct Autism

spectrum disorder. If these do measure the same construct then one would expect their

measure to agree.

Understanding of the correlation between instruments was a necessary

component to effective assess. Such that physiotherapist could utilize this tool

effectively during assessment of pediatric patient and can refer to the primary care

provider for further evaluation of the same patient with autism who received

physiotherapy for delayed development


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AIMS AND OBJECTIVES

To find out the correlation between Modified checklist for autism in toddler andChildhood autism rating scale in autism spectrum disorder.

OBJECTIVES

1. To find out correlation between criteria-1 of Modified checklist for autism intoddler and Childhood autism rating scale.

2. To find out correlation between criteria-2 of Modified checklist for autism intoddler and Childhood autism rating scale.


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HYPOTHESIS

Experimental hypothesis:

1. There will be positive correlation between M-CHAT and CARS

2. There will be negative correlation between M-CHAT and CARS

Null Hypothesis:

1. There will be no correlation between M-CHAT and CARS


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REVIEW OF LITERATURE

Eaves and Milner 1993 studied the relationship between the CARS and Autism

Behavior Checklist (ABC). They obtained correlation between two scale around -0.16 to

0.73 (median=0.39) and validity co-efficient between the two total score around 0.67.

They found moderate relationship (r phi=0.54) between normal classification provided by

the two instrument. They observed that CARS correctly identified 98% of the autism

subject and it also identified 69% of the subject as an autism who were suspected as a

possibly autism. The overall result suggested that CARS can accurately diagnose the

ASD patient53

.

Robin et al., 2001 studied to validate M-CHAT, which found to be reliable and

valid tool. They obtained cut-off sensitivity around 0.87-0.97, specificity around 0.95-


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Diagnostic Observation Schedule) and he also investigated the usefulness of an

alternative scoring system for the CARS. His research provide recommendation that each

CARS item be considered individually as primary or non-primary according to the

criteria of the DSM-IV with three total score used that are total primary score, total non

primary score and total CARS score. He suggested that the new total primary score of the

CARS more accurate and reduce amount false positive and increased diagnostic utility of

CARS54.

Saemondson et al., 2003 investigated the agreement between ADI-R (Autism

diagnostic interview- Revised) and the CARS in sample of 64 children with 22 to 114

months of age. They found that the CARS accurately identified more cases o autism then

did the ADI-R. They observed agreement between the two systems was 66.7% when the

ADI-R definition for autism was applied and showed moderate correlation (k=0.40)

between two system. The result suggest that the classification of CARS is valid in


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suggests that the M-CHAT used as an initial screen followed by observation of those

children who fail the screen56

.

Eaves et al., 2006 examined the M-CHAT in a group of 84 children aged 24-48

months referred to a specialist clinic for possible diagnosis of Autism. They reported that

64% of the children who failed the M-CHAT were diagnosed with Autism, and majority

of the reminder had more than one diagnosis including developmental delay and language

disorder. They obtained sensitivity of the M-CHAT was 0.92 for total score but

specificity was low around 0.27. The result suggests that M-CHAT is highly specific for

diagnosis the Autism57.

Ventola et al., 2006 calculated agreement between the ADOS, the CARS and

the ADI and clinical judgment based on DSM-IV. The result suggests significant

f h di i f A i i di d b h A OS d h CA S


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Kamiyo et al., 2006 constructed a Japanese version of the M-CHAT and

assessed it with a sample of 659 children coming for a health screening at 18 month of

age in Japan. They obtained cut off sensitivity around 71%, specificity around 75%,

positive predictive value around 77% and Negative predictive value around 69.5%. The

result suggests that M-CHAT can be used in the Japan for as an early screening of the

Autism spectrum disorder59.

Kleinman et al., 2008 investigated the internal consistency of six critical items

and all items of M-CHAT. They obtained the Cranachs alpha for both entire screener

around 0.85 and for six critical items is 0.84. They suggested that positive predictive

value for screening and diagnosis was 0.36 for the M-CHAT alone and 0.74 for the M-

CHAT plus telephonic interview indicate that telephonic follow up is a critical step in

eliminating false positives and improving the positive predictive value. The result

suggested that the M-CHAT can be use full in detecting ASD in children 16-30 months.


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The result suggested that there is strong correlation between positive M-CHAT score and

the detection of internalizing behavioral problems and socialization and communication

deficit using other widely used instrument CBCL (Child Behavior Checklist) and VABS

respectively. They also suggested that the positive M-CHAT score and finding of

abnormal MRI of brain of Autistic children had strong correlation61.

Pandey et al., 2008 studied to validate M-CHAT which found to be reliable and

valid tool for younger toddlers than older toddlers. They obtained Positive predictive

power for and ASD diagnosis for Younger/high risk toddler around 0.79, older/high risk

around 0.74, younger/low risk 0.28 and older/low risk around 0.61. The result support the

efficacy of ASD screening in young children as recommended by the American Academy

of pediatrics, with less specificity in younger toddler62.

Pi M i l 2008 di d i f l id ifi i f


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the findings support the use of M-CHAT for all autism suspected children in conjunction

with regular standardized developmental screening63

.

Seif et al., 2008 studied M-CHAT in about of 228 children. They obtained

sensitivity around 0.86 and specificity around 0.80 and positive predictive value around

0.88. The result suggested that M-CHAT can be translated in Arabic64

.

Snow et al., 2008 investigated that the criterion of failing any three items in M-

CHAT had sensitivity around 0.88 and specificity around 0.83 and negative predictive

power around 0.50 suggested its validity. They compared two screening tools M-CHAT

and Social communication questionnaire and showed the agreement between two scales.

The result indicate that M-CHAT appear more accurately classify children with PDD

who have lower intellectual and adaptive functioning65.


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Mayes et al., 2009 studied to compare reliability and validity for three autism

instruments were compared for 190 children with low functioning autism (LFA), 190

children with high functioning autism or Aspergers disorder (HFA), 76 children with

attention deficit hyperactivity disorder (ADHD), and 64 typical children. The instruments

were the Checklist for Autism Spectrum Disorder (designed for children with LFA and

HFA), Childhood Autism Rating Scale (CARS) for children with LFA, and Gilliam

Aspergers Disorder Scale (GADS). For children with LFA or ADHD, classification

accuracy was 100% for the Checklist and 98% for the CARS clinician scores. For

children with HFA or ADHD, classification accuracy was 99% for the Checklist and 93%

for the GADS clinician scores. Clinicianparent diagnostic agreement was high (90%

Checklist, 90% CARS, and 84% GADS). The result suggested that the checklist for

Autism spectrum disorder and CARS can be used in both LFA and HFA as well as the

parent is useful in with the clinician diagnosis67

.


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Russel P et al., 2010 studied to validate the CARS in India. They obtained cut-

off test-retest reliability with interclass correlation coefficient (ICC) around 0.81,

interrater reliability ICC=0.74, for internal consistency Cronbachs alpha () around

0.79, item-total correlation around 0.26 to 0.75, sensitivity around 81.4%, specificity

around 78.6%, positive predictive value around 95.9% and negative predictive value

around 40.7%. They also found high concordance 82.52% [Cohen's =0.40 (95%

CI=0.15-0.65); P=0.001] between the CARS and reference standard of ICD-10 diagnosis

in identifying autism among the children. The result suggests that CARS has strong

psychometric properties in a high-risk sample of children for autism. Although CARS

development predates the ICD-10 and many newer measures are available, its brevity,

good psychometric properties, conceptual relevance, and flexible administration

procedures lend support to the measure being used in India for screening procedures 69.


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METHODOLOGY

Sampling: - sample of convenience

Study design: - cross-sectional observational study

Sample collection:-

30 children with autism spectrum disorder in age group of 24-36 months of

both sexes were taken for the study from schools of special need.

Method of collection of data:-

30 subjects were selected who fulfilled the inclusion and exclusion criteria, the

details and purpose of the study were explained to all parents of subjects for maximum

co-operation and written consent was taken from them.

Inclusion Criteria:-

1. Age group: 24-36 months


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3. The child who was suffering from associated problems such as deafness andblindness.

4. Children with epilepsy.5. The child who was under neuron epileptic and neuron depressant drugs was

excluded.

Materials: -

I. Assessment paperII. Pencil

III.

Rubber

Testing Procedure:-

Written consent was taken from parents of subjects who fulfilled the inclusion

and exclusion criteria. They were randomly selected. Subjects age and sex was recorded

prior to the test. The form of Modified checklist for Autism in toddler had given to

parents and explained in detail to them The childhood Autism rating scale had taken by


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Figure-II shows the CARS taken by the therapist in school of special need


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Modified check list for Autism in toddler (M-CHAT):-

The modified checklist for autism in toddlers developed by Diana Robins as a

more sensitive, brief and simple application parent report used in autism spectrum

disorder28

.

It contains 23 yes/no questions to assess developmental domain such as sensory

and motor abnormalities, social referencing, imitation and orientation to name. M-CHAT

has two criteria; criteria-1 consists of six questions so called critical questions. This six

questions of the M-CHAT addressed areas of social relatedness (interest in other children

and imitation), joint attention (protodeclarative pointing and gaze monitoring), bringing

objects to show parents and response to name. Child who failed to any two questions out

of six considered to be high risk of autism spectrum disorder. Whereas criteria-2 has 23

questions, child who failed to any three questions out of twenty three considered to be

risk of autism spectrum disorder, more the questions failed higher risk of having autism

spectrum disorder.


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Childhood Autism rating scale:-

The CARS was developed by Schopler et al., 1988 which consists of a 15-

item of behavioral rating scale which can be utilized by professionals, parents or

caregivers to observe about their child. It was coined to identify children with autism

and to distinguish them from other developmentally delayed children. CARS ratings

can be made from different sources, such as psychological testing, classroom

participation, parental reports, and history records. Reliability and validity findings

suggest that the CARS are an effective tool for research and diagnosis of autism

(Schopler, Reichler, & Renner, 1988)20.

The 15 items of the CARS are 1) Relating to people; 2) Imitation; 3) Emotional

response; 4) Body use; 5) Object use; 6) Adaptation to change; 7) Visual response; 8)

Listening response; 9) Taste, smell, and touch response and use; 10) Fear for

nervousness; 11) Verbal communication; 12) Nonverbal communication; 13) Activity

level; 14) Level and consistency of intellectual response; and 15) General impressions.


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STATASTICAL ANALYSIS

1. ARITHMETIC MEAN:-

N

XX

Where, X = Arithmetic

x = Sum of the variable

N = the total number of variables

2. STANDARD DEVIATION (SD):-


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3.

SPEARMANS RANK ORDER CORRELATIONCOEFFICIENT:-

Where, =Spearmans correlation coefficient.

= sum of the square of differences between the ranks.

n = total number of variables.

n2

= square of the total number of variables.


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DATA ANALYSIS AND RESULTS

Table 5.1: Distribution of different age groups

Age

(in months)Frequency Percent

Valid

Percent

24 8 26.6 26.6

30 10 33.4 33.4

36 12 40.0 40.0

Total 30 100.0 100.0

Interpretation: - The above table shows the different age groups taken in the study

and frequency of each subject in each age group.

Table 5.2: Mean age

Number of subjects 30

30 80


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Graph 5.1: Shows the distribution of age groups.

24

30

36

Age(months)


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Table 5.3: Gender Proposition

Frequency Percent

Male 27 90.0

Female 3 10.0

Total 30 100.0

Interpretation: -The above table shows the number of male and number of female

participating in the study.

Graph 5.2 describe the gender proportion of the study

3

Male


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Table 5.4 Correlation of criteria-1 of M-CHAT with CARS

MeanStd.

Deviation

Std.

Error

Mean

df p

Criteria-1 of

M-CHAT3.37 1.129 .206

+ 0.56 28 < 0.05

CARS score 39.90 5.665 1.034

Interpretation:-The above table shows the mean of Criteria 1 of M-CHAT i.e. 3.37

1.129 (SD) and CARS score i.e. 39.90 5.665 for the present study. The result shows

significant positive correlation for criteria 1 of M-CHAT with CARS score ( = +

0.56, p < 0.05).

Graph-5.3 Shows correlation between Criteria-1 of M-CHAT and CARS score


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Table 5.5 Correlation of criteria 2 of M-CHAT with CARS

MeanStd.

Deviation

Std.

Error

Mean

df p

Criteria 2 of

M-CHAT12.17 2.705 .494

+ 0.72 28 < 0.05

CARS score 39.90 5.665 1.034

Interpretation:The above table shows the mean of criteria 2 of M-CHAT i.e. 12.17

2.705 (SD) and CARS score i.e. 39.90 5.665 for the present study. The result shows

significant positive correlation for criteria2 of M-CHAT with CARS score

( = + 0.72, p < 0.05).

Graph 5.4 Shows Correlation between Criteria 2 of M-CHAT and CARS score


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DISCUSSION

From the above result the present study supports experimental hypothesis which

show a partial positive correlation between Modified checklist of autism for toddler (M-

CHAT) and Childhood Autism Rating Scale (CARS). The result show partial positive

correlation between criteria 1 of M-CHAT and CARS ( = 0.56, p < 0.05) and between

criteria 2 of M-CHAT and CARS ( = 0.72, p < 0.05).

In present study the M-CHAT was used as parental report and the CARS was

used for clinical observation. The purpose of this study was to find out the correlation

between the M-CHAT and CARS and shows the concordance between two tools widely

used for the screening of the Autism.

In present study the sample of 30 subjects were taken from schools of the special

need. All subjects were diagnosed by the primary health care professionals, in which 90%

were male and 10% were female. The 40% subject were with age of 36 months, 33.4%

were age of 30 months and 24 6% with age of 24 months with the mean age of the


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socialization45

than normal female, in people with autism are even more delayed in

language and social development. Normal males have a smaller corpus callosum than the

normal females73

and in child with autism has a smaller one. Above explanation suggest

the high probability to develop autism spectrum disorder in male than female.

In present study the M-CHAT were administrated to the children with autism

and it has two criteria for the screening. The criteria-1 was about child who failed with 2

questions out of 6 critical questions. Criteria-2 was about child who failed with 3 out of

23 questions. All subjects were follow the both the criteria. The mean score of criteria-1

was 3.37 1.129 and for criteria-2 was 12.17 2.705.

In this study 80% subject failed in the question 13 Does your child imitate you?

generally child with left frontal lobe lesion may shows imitative dyspraxia74

. This child

who were unable to repeat an action performed by other though demonstrating adequate

motor control of their limb. It was also suggested that in the development of human child,

mirror neuron may be key elements facilitating the early imitating actions, the


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Question-23 Does your child look at your face to check your reaction when

faced with something unfamiliar? suggest about the social referencing. In this study

80% subject failed in this area of socialization, which detect the joint attention ability of

the child.

In total, these joint attention skills can be considered building blocks for a

formation of a Theory of mind, which includes utilizing pragmatic information, being

aware of ones own mental state, and being able to monitor others intention. Children

with autism have a general deficit in attaining a theory of mind76, 77. Essentially any task

related to theory of mind, such as those examining the appearance, reality distinction,

gaze following, intention tracking, false belief, reveals rebus deficits observed in children

with ASD.

The CARS was used as a clinical observation by therapist. The CARS was also

applied in the same subject. The mean CARS score was 39.905.665. The classification

of the autism spectrum disorder was based on the CARS score. If CARS score less than


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as others. And it only measures the more cognitive traits than the social and adaptive

behavior

70

.

Spearmans rank order correlation coefficient was calculated to find out the

correlation between two criteria of M-CHAT and CARS independently. The result

showed that there was partial positive correlation between criteria-1 and CARS

( = +0.56, p < 0.05)) as well as criteria-2 and CARS ( = +0.72, p < 0.05)).

Some factor affecting the outcome of the both the scale M-CHAT and CARS.

Firstly the homogeneity of the both the instrument resulted in the some positive

correlation. Both the scale measures the same characteristics of the ASD. CARS was

different in the measurement of the adaptive characteristics because in M-CHAT no

question was related to the adaptive behavior. So it is suggested that the mild difference

in the content of the both scale leads to partial positive correlation than full positive

correlation.

Secondly, the M-CHAT was a parental report while the CARS was an objective


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concern are often found to be justified. studies comparing parent report of concurrent

symptoms and expert clinical observation suggest that parents tend to be accurate in

reporting negative symptoms, they do never worse as far as the positive symptom are

concerned48

.

On the other hand parental in experience, cultural expectation or attitude about

reported problems, and the emotional bias (denial or over concern) can distort the reports.

The high level of stress experienced by parents results in more autistic behavior and less

adaptive skill reporting than observer which was commonly seen in mothers. These

measures accounted for 10 to 29 percent of the variance in each case79, 49

.

In contrast to parental report clinical observation would have the advantage of

large base for normative comparison and more objective attitude. Parents have more

difficulties in judging deficit in joint attention behavior and pretend play, the most

prototypical symptoms, in second and third year of life. Whereas observer has significant

role in assessment of the cognitive and emotional or behavioral disorder in young child 49.


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than screening. These findings show important differences between parental report and

clinical observation in screening of autism

78

.

The environmental concern is the third factor as it is important because

different behaviors appear in different environments. It can put the more stress on

parents. The children infect behaved differently at home and school because of that most

parents felt that there was a true discrepancy between parental report and clinical

observation. Sometimes parents unable to monitors and control the behavior of their

child at home because of lack of some resources which are available at school79.

However removing clinical observation from the screening process has

significant cost implementation for a population based screener and may makes screening

more feasible for a wider range of children. Only screening cannot diagnose the ASD but

wide knowledge about normal development and other disorder is also required to

diagnose the ASD.

In summary of above discussion the parental report and clinical observation


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assessment from which the parental observation towards the child will be clearer without

missing a single criteria.


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Limitations of the study

Limitations of present study are first only the age group between 24- 36 month

was taken because according to eaves et al., the diagnostic stability for autism is better at

the age between 2 to 3 years.

Secondly there was only brief assessment taken for the autistic child. There

should be through evaluation of the autistic child required to find out the intelligent

quation as well as developmental quation. Because of time constrain and the policy of the

school from where the subject was recruited it was not too possible to take through

assessment of the child.

In present study the subject had chosen from the wide spectrum the autism

spectrum, which can be given the variability in the result. But according to the Filipek et

al., the symptoms of the disease in spectrum is similar but the severity is differ from the

each other in the specific disorder e.g. the autistic disorder has severe symptoms while

the Aspergers disease has mild symptoms of the autism43.


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Further recommendation

1. The validation of M-CHAT is required in more number of samples with the otherage group (18-24 months).

2. The specificity and sensitivity of M-CHAT should be identified in Indianpopulation.


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Conclusion and Clinical implication

The result suggest that in the age group of 24-36 month with in autism has more

symptoms of deficit in joint attention and imitation than the repetitive behavior and the

sensory behavior also the male are more affected than the female with autism spectrum

disorder.

The present study shows the partial positive correlation between the M-CHAT

and the CARS, which suggest that the M-CHAT can be used in the early detection of the

autism, also it was easy to apply and taken less time to complete, so that it can be used

along with the physiotherapy assessment of other neurological condition in child.


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SUMMURY

Autism spectrum disorder (ASD) is characterized by disturbances in

socialization, communication and behavioral aspect of the child with onset of the early

years of life. Early screening and diagnosis of ASD has crucial role in initiation of early

intervention. Childhood Autism Rating Scale (CARS) is commonly used to detect ASD

by clinicians where as Modified Checklist for Autism in Toddler (M-CHAT) is a parental

report about the observation of the child.

There were 30 children who suffering from ASD taken from the schools of

special needs. Around 90% male and 10% female were noted with mean age of 30.80

4.916 months. In the single session M-CHAT was filled by parents where as CARS was

taken by therapist. To find out correlation between M-CHAT and CARS, Spearmans

rank order correlation coefficient ( ) was calculated with spearmans rank order

correlation test.

The result shows significant partial positive correlation between criteria 1 of the


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ANNEXURE 10.1

MEASUREMENT TOOL

Name : _________________________________

Age : __________________________________

Gender : __________________________________

Referred by : __________________________________

School name : __________________________________

Duration of illness : __________________________________

Informant : __________________________________

Address : __________________________________

__________________________________


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ANNEXURE 10.2

MODIFIED CHECKLIST FOR AUTISM IN TODDLER (ENGLISH)


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ANNEXURE 10.3

MODIFIED CHECKLIST FOR AUTISM IN TODDLER (GUJARATI)


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ANNAXURE 10.4

CHILD HOOD AUTISM RATING SCALEName:-______________________________________________________________________________

Age:-_____ sex:-_____ name of school:-________________________________

Date of assessment:-____________ referred by:-_____________________________________

characteristics 1 1.5 2 2.5 3 3.5 4 Total

Relating to

people

Imitation

Emotional

response

Body use

Object use

Adaptation tochange

Visual

response

Listening

response

Test, smell,

and touch

response anduse

Fear to

nervousness


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CLASSIFICATION ACCORDING TO CARS TOTAL SCORE

CARS TOTAL SCORE CLASSIFICATION

15-29.5 Non-autistic

30-36.5 Mildly-moderately autistic

37-60 Severely autistic


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ANNEXURE 10.5

CONSENT FORM

STUDY TITLE: To find out correlation between modified checklist for autism in

toddler and childhood autism rating scale in autism spectrum

disorder

Name of Investigator: Raval Hardik Hareshbhai

Guide: Dr. Sarla Bhatt

I was explained in

detail about the study and the problems to be faced by me in my own language and was

given freedom to withdraw at any moment during the course of the study .I have

understood the information stated by the investigator and with a clear understanding I am

willing to participate in the study on my own risk and my sign at the bottom of this form

indicates that I am participating in the study on own interest but not on any bodys


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ANNEXURE 10.6

MASTER CHART

N0.

AGE

(MONTHS)

SEX

CARS M-CHAT

TOTAL

SCORECLASSIFICATION CRITERIA 1 CRITERIA 2

QUESTION

NO.PERCENTAGE

1 36 M 36 MODERATE 3 11 13 80

2 30 M 46 SEVERE 5 16 17 80

3 24 M 38 SEVERE 3 14 23 80

4 36 M 44 SEVERE 3 12 5 76.6

5 24 M 47 SEVERE 6 18 21 73.3

6 30 M 36 MODERATE 4 13 7 70

7 30 F 54 SEVERE 4 17 15 70

8 24 M 40 SEVERE 1 10 4 66.6

9 36 M 36 MODERATE 2 9 19 66.6

10 36 F 52 SEVERE 4 14 6 66.3

11 24 M 41 SEVERE 2 10 2 60

12 30 M 32 MODERATE 1 6 10 60

13 24 M 49 SEVERE 5 14 8 56.6

14 36 M 39 SEVERE 4 13 12 46.6


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15 24 M 35 MODERATE 3 11 22 43.3

16 30 M 35 MODERATE 3 10 9 36.6

17 36 M 45 SEVERE 4 14 11 36.618 36 M 31 MODERATE 3 9 18 36.6

19 36 M 34 MODERATE 3 12 3 33.3

20 24 M 39 SEVERE 4 16 14 26.6

21 36 M 40 SEVERE 3 12 1 16.6

22 30 F 45 SEVERE 4 14 20 16.6

23 36 M 35 MODERATE 3 11 16 0

24 30 M 43 SEVERE 5 14

25 30 M 38 SEVERE 2 926 36 M 35 MODERATE 3 9

27 30 M 34 MODERATE 4 10

28 24 M 36 MODERATE 3 13

29 36 M 39 SEVERE 3 13

30 30 M 43 SEVERE 4 11

M-CHAT = Modified Checklist for Autism in Toddler

CARS = Childhood Autism Rating Scale

M = Male, F = Female

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