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ISAA, TARS, CARS, CARS 2, ADOS2, ADI-R,
Dr. Saroj Arya, our course development Advisor at the India Autism Center Training Academy, received the prestigious National Award in the category of 'Divyangata Ke Kshetra Mein Karyarat Sarvshresth Punarvas Peshewar' by our President Smt Draupadi Murmu at Vigyan Bhavan, New Delhi.
Study by Laxmi Rao
Author is an educator who works in the area of Autism and a consultant with Leadership for Equity
Dr. Saroj Arya, researcher of ISAA is honored with the National Award for Individual Excellence 2024
The Indian Scale for Assessment of Autism (ISAA) represents a landmark shift in the clinical landscape of neurodevelopmental disorders in India. Developed by the National Institute for Mentally Handicapped (now NIEPID (Formely NIMH) in 2009, it was commissioned by the Ministry of Social Justice and Empowerment to address a critical gap: the lack of a culturally sensitive, objective tool for diagnosing autism and quantifying disability for government certification.
The ISAA is an objective clinical assessment tool specifically designed for the Indian population. It consists of 40 items divided into six domains: Social Relationship and Reciprocity, Emotional Responsiveness, Speech-Language and Communication, Behavior Patterns, Sensory Aspects, and Cognitive Component.
Unlike many Western tools that rely on a binary (yes/no) or a 3-point scale, the ISAA uses a 5-point Likert scale. This allows clinicians to capture the frequency of behaviors (from "rarely" to "always"), which provides a more granular view of the child's symptom profile.
The final score ranges from 40 to 200, classifying the individual into categories of Mild (70â106), Moderate (107â153), or Severe (>153) autism.
Dr. Saroj Arya, a distinguished clinical psychologist, has dedicated over 30 years to empowering individuals with intellectual disabilities. At the National Institute for Empowerment of Persons with Intellectual Disabilities (NIEPID), Secunderabad, she has spearheaded impactful initiatives, including the development of key assessment tools like the NIEPID Indian Test of Intelligence and the Indian Scale for Autism Assessment.
Her invaluable contributions to research, human resource development, and community outreach have revolutionized rehabilitation services across India.
For her exceptional work, Dr. Saroj Arya is honored with the National Award for Individual Excellence 2024 in the category of Divyangata Ke Kshetra Mein Karyarat Sarvshresth Punarvas Peshewar.
| Feature | ISAA (India) | CARS-2 (West/Global) | ADOS-2 (West/Global) | TARS (India) |
|---|---|---|---|---|
| Primary Use | Diagnosis & Disability % | Diagnosis & Severity | Diagnostic Gold Standard | Community Screening |
| Items | 40 Items | 15 Items | Activity-based Modules | 28 Items |
| Scoring | 5-point Likert | 4-point Scale | Complex Algorithm | 3-point Scale |
| Sensitivity | High for Indian Context | High Global Utility | Very High | Moderate (Screening) |
| Government Recognition | Mandatory in India | Accepted Clinically | Research Standard | Regional Recognition |
The Childhood Autism Rating Scale (CARS) and its updated version, CARS-2, are the most frequent points of comparison for ISAA.
CARS was developed in a Western context. While it is highly reliable, some of its items can be misinterpreted in an Indian setting due to cultural differences in eye contact, social proximity, and parenting styles. The ISAA was standardized across Indian cities, ensuring that the behaviors being measuredâsuch as specific social interactions or response to regional sensory environmentsâare relevant to the local context.
CARS and CARS-2 are primarily diagnostic tools used to identify autism and distinguish it from other developmental delays. However, in India, the ISAA is the legally mandated tool for issuing disability certificates. While CARS provides a severity index, the ISAA is specifically calibrated to correlate its scores with a "Disability Percentage," which is a requirement for accessing government schemes, school accommodations, and travel concessions under the Rights of Persons with Disabilities Act.
CARS-2 offers two versions: the Standard Version (ST) for children under 6 and those with lower IQs, and the High-Functioning Version (HF). The ISAA is a single, unified scale. While this makes ISAA simpler to administer across a broad age range, critics argue it may lack the nuance CARS-2 provides for highly verbal or "high-functioning" individuals on the spectrum.
When placed alongside the "Gold Standard" Western toolsâthe Autism Diagnostic Observation Schedule (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R)âdistinct differences emerge:
The Trivandrum Autism Rating Scale (TARS) is another indigenous tool developed at the Child Development Centre (CDC) in Kerala.
The ISAA has successfully democratized autism assessment in India. By providing a clear, quantifiable link between behavior and disability percentage, it has empowered thousands of families to access legal support. However, as our understanding of neurodiversity evolves, there is ongoing discussion about updating the ISAA to better capture the "female phenotype" of autism and those with high-masking abilities, similar to the transitions seen from CARS to CARS-2.
For a clinician in India, the ISAA is not just a scale; it is the bridge between a clinical observation and a child's legal right to support.
The ISAA is considered an objective assessment tool for the Indian context, aimed at ensuring culturally appropriate diagnosis. It is widely used for determining eligibility for educational and social support services.
The Sensory Processing Measure (SPM) and its updated successor, the SPM-2, are standardized behavior rating scales designed to assess sensory processing, praxis, and social participation across multiple environments. Grounded in Ayres Sensory Integration theory, these tools are frequently utilized in the clinical evaluation of individuals with Autism Spectrum Disorder (ASD) to identify sensory under-reactivity, over-reactivity, seeking behaviors, and perceptual difficulties.
Both versions evaluate performance across eight primary domains:
The SPM-2 (2021) expanded significantly on the original version, which focused primarily on preschool (SPM-P) and school-aged children. Key enhancements include: