Comparison of DSM-III-R and childhood autism rating scale diagnoses of autism.
DSM-III-R can under-detect autism next to CARS and clinical judgment, so double-check with a second tool.
01Research in Context
What this study did
The team compared three ways to spot autism. They looked at DSM-III-R rules, the Childhood Autism Rating Scale (CARS), and a senior clinician’s call.
All kids were already in a clinic for help. The goal was to see which tool caught the most cases.
What they found
CARS and the clinician agreed almost every time. DSM-III-R agreed too, but it labeled a few kids as “not autistic” when the other two said they were.
In short, DSM-III-R slightly under-counted autism in this help-seeking group.
How this fits with other research
Lancioni et al. (2006) ran a near-copy study 14 years later. They added the new ADOS-G and ADI-R. CARS still held up, but ADI-R missed toddlers who had not yet built repetitive play.
Kim et al. (2012) fixed that toddler gap. They rewrote the ADI-R scoring rules for kids 12-47 months so it would stop under-diagnosing.
Hirota et al. (2018) stepped back and scanned the whole field. Only three screeners—AQ, SCQ, SRS—now show solid replication for ages 4 and up. Their review quietly covers the CARS era and shows the field keeps tightening the net.
Why it matters
If you still reference DSM-III-R for intake, know it may say “no autism” when CARS and your own eyes say “yes.” Use CARS or a modern gold-standard tool as a second check. For toddlers, pair any interview with a play-based measure so you don’t wait for repetitive behaviors to show up later.
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02At a glance
03Original abstract
The purpose of this study was to clarify the issue of whether DSM-III-R (American Psychological Association [APA], 1987) over- or underdiagnoses autism by comparing this diagnostic system to a well-established objective measure of diagnosis, the Childhood Autism Rating Scale (CARS). A secondary goal was to determine which of the 16 criteria are the best discriminators of autism. DSM-III-R, CARS, and clinical diagnoses of 138 consecutive admissions to a statewide program for the diagnosis and treatment of autistic and related communication-handicapped individuals (Division TEACCH in North Carolina) were compared. Results indicated a generally high degree of agreement on the diagnosis of autism using the three systems. Within this treatment-oriented program, the CARS and clinical ratings diagnosed a greater number of cases as autistic than did the DSM-III-R criteria, suggesting that DSM-III-R slightly underdiagnosed autism. The criteria that most strongly related to the diagnosis of autism regardless of the system were lack of awareness of others, abnormal social play, an impaired ability to make friends, abnormal nonverbal communication, stereotypic body movements, and restricted range of interests.
Journal of autism and developmental disorders, 1992 · doi:10.1007/BF01046324