The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural validity are lacking. This study evaluated the cross-cultural measurement invariance of the CARS among children with ASD from six countries, for whom data were aggregated from previous studies in India (n = 101), Jamaica (n = 139), Mexico (n = 72), Spain (n = 99), Turkey (n = 150), and the United States of America (n = 186). We analyzed the approximate measurement invariance based on Bayesian structural equation modeling. The model did not fit the data and its measurement invariance did not hold, with all items found non-invariant across the countries. Items related to social communication and interaction (i.e., relating to people, imitation, emotional response, and verbal and nonverbal communication) displayed lower levels of cross-country non-invariance compared to items about stereotyped behaviors/sensory sensitivity (i.e., body and object use, adaptation to change, or taste, smell, and touch response). This study found that the CARS may not provide cross-culturally valid ASD assessments. Thus, cross-cultural comparisons with the CARS should consider first which items operate differently across samples of interest, since its cross-cultural measurement non-invariance could be a source of cross-cultural variability in ASD presentations. Additional studies are needed before drawing valid recommendations in relation to the cultural sensitivity of particular items.

中文翻译：

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六个国家儿童自闭症评定量表 (CARS) 的测量不变性

儿童自闭症评定量表 (CARS) 是一种用于自闭症谱系障碍 (ASD) 评估的简单且廉价的工具，具有来自不同国家的有证据的心理测量数据。然而，目前尚不清楚使用该工具在不同社会和世界地区是否以相同方式测量 ASD 症状，因为缺乏有关其跨文化有效性的数据。本研究评估了来自六个国家的 ASD 儿童的 CARS 跨文化测量不变性，这些国家的数据汇总了之前在印度 ( n  = 101)、牙买加 ( n  = 139)、墨西哥 ( n  = 72)、西班牙 ( n  = 99)、土耳其 ( n  = 150) 和美国 ( n = 186）。我们分析了基于贝叶斯结构方程模型的近似测量不变性。该模型不适合数据，其测量不变性不成立，所有项目在各个国家/地区均非不变。与关于刻板行为/感官敏感性（即，身体和物体使用、适应变化或味觉、嗅觉和触觉反应）。本研究发现 CARS 可能无法提供跨文化有效的 ASD 评估。因此，与 CARS 的跨文化比较应首先考虑哪些项目在感兴趣的样本中操作不同，因为它的跨文化测量非不变性可能是 ASD 演示中跨文化可变性的一个来源。在针对特定项目的文化敏感性得出有效建议之前，还需要进行额外的研究。