영유아기 자폐스펙트럼장애와 기타 신경발달장애의 변별 진단에서 K-CARS2-ST의 유용성 분석

초록

Background/Objectives: Early and accurate identification of autism spectrum disorder (ASD) during infancy is essential for timely intervention and improved developmental outcomes. However, differentiating ASD from other neurodevelopmental disorders in very young children remains clinically challenging because of the their overlapping behavioral features. This study aimed to evaluate the diagnostic utility of the Korean Childhood Autism Rating Scale, Second Edition–Standard Version (K-CARS2-ST), focusing on its total score and two empirically derived subscales, to distinguish infants with ASD from those with other neurodevelopmental conditions. Methods: Participants were infants diagnosed with ASD or any other neurodevelopmental disorders based on comprehensive clinical evaluations. Receiver operating characteristic (ROC) analyses were conducted to examine the discriminative validity of the K-CARS2 -ST total score and its subscales assessing “Social Communication and Interaction Impairments(Factor 1)” and “Restricted, Repetitive Behaviors and Sensory Processing Difficulties(Factor 2)”. Diagnostic accuracy was evaluated using the area under the curve (AUC), and the optimal cutoff scores were determined by identifying the best balance between sensitivity and specificity. Results: The K-CARS2-ST total score demonstrated excellent diagnostic accuracy for differentiating ASD from other neurodevelopmental disorders, with an optimal cutoff score of 28.25 (AUC=.937) and high sensitivity (.969). Subscale analyses further revealed optimal cutoff scores of 12.75 for Factor 1 and 15.75 for Factor 2. Factor 2 indicated strong discriminative performance. These findings indicate that the subscales capture distinct yet complementary dimensions relevant to early ASD identification. Conclusion/Implications: Overall, the results support the clinical utility of the K-CARS2-ST as a reliable screening and differential diagnostic tool for ASD in infancy. Incorporating subscale scores along with the total score may enhance diagnostic precision, particularly in cases with borderline total scores, thereby supporting more nuanced clinical judgment and informed decision-making in early childhood assessments.

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