Reliability of Childhood Autism Rating Scale, Second Edition, Assessments Using Telepsychiatry for Children With Neurodevelopmental Disorders and Their Caregivers: Randomized Feasibility Study.

Bibliographic Details
Title:	Reliability of Childhood Autism Rating Scale, Second Edition, Assessments Using Telepsychiatry for Children With Neurodevelopmental Disorders and Their Caregivers: Randomized Feasibility Study.
Authors:	Kurokawa S; Center for the Promotion of Interdisciplinary Research in Medicine and Life Science, Keio University School of Medicine, Mori JP Tower F7, 1-3-1, Azabudai, Minato-ku, Tokyo, Japan, 81 3-5363-3219., Nomura K; Department of Child Psychiatry, Shimada Ryoiku Medical Center for Challenged Children, Tokyo, Japan.; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan., Hosogane N; Department of Child and Adolescent Mental Health, Aiiku Clinic, Tokyo, Japan., Nagasawa T; Department of Child and Adolescent Psychiatry, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan., Kawade Y; Department of Child Psychiatry, Shimada Ryoiku Medical Center for Challenged Children, Tokyo, Japan.; Tsurugaoka Garden Hospital, Tokyo, Japan., Matsumoto Y; Department of Child Psychiatry, Shimada Ryoiku Medical Center for Challenged Children, Tokyo, Japan., Morinaga S; Hiratsuka City Hospital, Kanagawa, Japan., Kaise Y; Center for the Promotion of Interdisciplinary Research in Medicine and Life Science, Keio University School of Medicine, Mori JP Tower F7, 1-3-1, Azabudai, Minato-ku, Tokyo, Japan, 81 3-5363-3219., Higuchi A; Center for the Promotion of Interdisciplinary Research in Medicine and Life Science, Keio University School of Medicine, Mori JP Tower F7, 1-3-1, Azabudai, Minato-ku, Tokyo, Japan, 81 3-5363-3219., Goto A; Tsurugaoka Garden Hospital, Tokyo, Japan., Inada N; Department of Clinical Psychology, Taisho University, Tokyo, Japan., Kodaira M; Department of Child and Adolescent Mental Health, Aiiku Clinic, Tokyo, Japan., Kishimoto T; Center for the Promotion of Interdisciplinary Research in Medicine and Life Science, Keio University School of Medicine, Mori JP Tower F7, 1-3-1, Azabudai, Minato-ku, Tokyo, Japan, 81 3-5363-3219.
Source:	JMIR formative research [JMIR Form Res] 2026 Oct 06; Vol. 10, pp. e82784. Date of Electronic Publication: 2026 Oct 06.
Publication Type:	Journal Article; Randomized Controlled Trial
Language:	English
Journal Info:	Publisher: JMIR Publications Country of Publication: Canada NLM ID: 101726394 Publication Model: Electronic Cited Medium: Internet ISSN: 2561-326X (Electronic) Linking ISSN: 2561326X NLM ISO Abbreviation: JMIR Form Res Subsets: MEDLINE
Imprint Name(s):	Original Publication: Toronto, ON, Canada : JMIR Publications, [2017]-
MeSH Terms:	Caregivers/psychology , Autism Spectrum Disorder/diagnosis , Neurodevelopmental Disorders/diagnosis , Psychiatric Status Rating Scales/standards, Attention Deficit Disorder with Hyperactivity/diagnosis ; Psychometrics/instrumentation ; Humans ; Child ; Female ; Feasibility Studies ; Male ; Reproducibility of Results ; Adolescent ; Telemedicine ; Japan ; Mental Health Teletherapy
Abstract:	Background: The COVID-19 pandemic has increased the demand for telepsychiatry in neurodevelopmental assessment; however, few studies have examined the interrater reliability of clinician-rated autism scales, such as the Childhood Autism Rating Scale, Second Edition (CARS2), when used remotely. Although the feasibility and validity of telehealth assessments have been explored previously, the consistency between remote and in person CARS2 ratings by different clinicians remains underinvestigated. Objective: The objective of this study was to evaluate agreement between CARS2 total scores obtained by different evaluators using telepsychiatry and face-to-face assessments in children with autism spectrum disorder (ASD) and/or attention-deficit/hyperactivity disorder (ADHD). Methods: In this randomized feasibility study, 75 children aged 6 to 17 years with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) diagnoses of ASD, ADHD, or both were enrolled at 5 medical institutions in Japan; 73 of 75 were included in the final analysis. Each participant underwent 2 independent CARS2 evaluations, one face-to-face and the other via telepsychiatry, conducted by different evaluators who were blinded to each other's ratings. Remote assessments were conducted using a secure video platform with caregiver facilitation. Agreement was assessed using intraclass correlation coefficients (ICCs) for the overall sample and subgroups defined by primary diagnosis, sex, and age. Results: The overall ICC for CARS2 total scores between face-to-face and telepsychiatry assessments was 0.582 (95% CI 0.407-0.717), indicating moderate agreement. The ICC was 0.546 among participants with ASD as the primary diagnosis and 0.495 among those with ADHD as the primary diagnosis. Point estimates were higher among girls than boys (0.666 vs 0.495) and among children aged 11 years or older than among those aged 10 years or younger (0.676 vs 0.419). In a sensitivity analysis including all participants with an ASD diagnosis, the ICC was 0.580. Conclusions: CARS2 total scores obtained through telepsychiatry showed moderate agreement with scores obtained through face-to-face assessment when the assessments were conducted by different evaluators in different settings. Higher point estimates were observed among older children and girls, although these subgroup findings should be interpreted cautiously. Telepsychiatry-based CARS2 assessment may be considered a complementary approach rather than a replacement for comprehensive face-to-face evaluation. Larger studies using more standardized assessment protocols are needed. (© Shunya Kurokawa, Kensuke Nomura, Nana Hosogane, Takashi Nagasawa, Yuko Kawade, Yu Matsumoto, Shuichi Morinaga, Yuriko Kaise, Ayana Higuchi, Akiko Goto, Naoko Inada, Masaki Kodaira, Taishiro Kishimoto. Originally published in JMIR Formative Research (https://formative.jmir.org).)
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Contributed Indexing:	Keywords: Childhood Autism Rating Scale; attention-deficit/hyperactivity disorder; autism spectrum disorder; online assessment; telepsychiatry
Entry Date(s):	Date Created: 20261006 Date Completed: 20261006 Latest Revision: 20261008
Update Code:	20261008
PubMed Central ID:	PMC13641316
DOI:	10.2196/82784
PMID:	42837527
Database:	MEDLINE

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ISSN:	2561-326X
DOI:	10.2196/82784