Autism Assessment from Home: Evaluating the Remote Childhood Autism Rating Scale, Second Edition (rCARS2) Observation for Tele-Assessment of Autism

Since the start of the COVID-19 pandemic, tele-based methods of autism assessment have been relied upon to a previously unparalleled degree; however, the need for such advancements is not new. Observation-based measures are a crucial component of face-to-face autism diagnostic evaluations, but few validated observation tools exist for remotely assessing autism across childhood, particularly for older children and adolescents, providing minimal guidance in this arena. Sanchez and Constantino (2020) previously validated a brief, face-to-face, clinician-facilitated observation coded according to the Childhood Autism Rating Scale, Second Edition (CARS-2). During the pandemic, this measure was adapted as a remote observation (rCARS2 Observation), but has yet to be validated in this format. The current study validated the rCARS2 Observation against the "gold-standard," in-person Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). In this sample of 30 children ages 1.97 to 16.66 years (M = 7.35, SD = 4.00), ADOS-2 and rCARS2 Observation total scores were highly correlated (ρ = .644, p < .001). Receiver operating characteristic (ROC) curves optimized rCARS2 Observation cutoff scores to maximize sensitivity and specificity in predicting possible diagnostic classification (88.9% sensitivity, 80% specificity) and ADOS-2 classification (83.3% sensitivity, 70.6%, specificity). At optimal cutoffs, the rCARS2 Observation predicted the correct diagnosis in 82.8% of cases and the same classification as the ADOS-2 in 75.9% of cases. Validation of this instrument provides support for an accessible and efficient remote autism observation. This is crucial in ensuring uniform training and clinical procedures for tele-assessment of autism, to help mitigate long-standing barriers to service access (e.g., geography, cost, availability).