{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:51:26Z","timestamp":1791316286805,"version":"4.3.1"},"reference-count":15,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this randomized feasibility study, 75 children aged 6 to 17 years with\n DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition])<\/jats:italic>\n 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\u2019s 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.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The overall ICC for CARS2 total scores between face-to-face and telepsychiatry assessments was 0.582 (95% CI 0.407\u20100.717), 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/82784","type":"journal-article","created":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T19:30:06Z","timestamp":1785699006000},"page":"e82784-e82784","source":"Crossref","is-referenced-by-count":0,"title":["Reliability of Childhood Autism Rating Scale, Second Edition, Assessments Using Telepsychiatry for Children With Neurodevelopmental Disorders and Their Caregivers: Randomized Feasibility Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6451-5263","authenticated-orcid":false,"given":"Shunya","family":"Kurokawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1118-2128","authenticated-orcid":false,"given":"Kensuke","family":"Nomura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8543-1103","authenticated-orcid":false,"given":"Nana","family":"Hosogane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3380-6206","authenticated-orcid":false,"given":"Takashi","family":"Nagasawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9829-047X","authenticated-orcid":false,"given":"Yuko","family":"Kawade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5439-685X","authenticated-orcid":false,"given":"Yu","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4018-8997","authenticated-orcid":false,"given":"Shuichi","family":"Morinaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2161-6968","authenticated-orcid":false,"given":"Yuriko","family":"Kaise","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7268-8953","authenticated-orcid":false,"given":"Ayana","family":"Higuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9196-8536","authenticated-orcid":false,"given":"Akiko","family":"Goto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8203-783X","authenticated-orcid":false,"given":"Naoko","family":"Inada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9186-5058","authenticated-orcid":false,"given":"Masaki","family":"Kodaira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0557-8648","authenticated-orcid":false,"given":"Taishiro","family":"Kishimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"R1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013. 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Autism assessment from home: evaluating the remote Childhood Autism Rating Scale, Second Edition (rCARS2) observation for tele-assessment of autism [Dissertation]. Virginia Polytechnic Institute and State University; 2024. URL: https:\/\/vtechworks.lib.vt.edu\/items\/7b0c1ea7-0473-4ae5-9c5e-9055f86adca5 [Accessed 10-07-2025]"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.2196\/51749","article-title":"Reliability of telepsychiatry assessments using the Attention-Deficit\/Hyperactivity Disorder Rating Scale-IV for children with neurodevelopmental disorders and their caregivers: randomized feasibility study","volume":"26","author":"Kurokawa","journal-title":"J Med Internet Res"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","journal-title":"Biometrics"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1007\/s10803-024-06524-x","article-title":"Use of telehealth in autism spectrum disorder assessment in children: evaluation of an online diagnostic protocol including the brief observation of symptoms of autism","volume":"56","author":"Stroupkov\u00e1","journal-title":"J Autism Dev Disord"},{"issue":"7","key":"R13","doi-asserted-by":"publisher","DOI":"10.2196\/37901","article-title":"Telehealth autism diagnostic assessments with children, young people, and adults: qualitative interview study with England-wide multidisciplinary health professionals","volume":"9","author":"Spain","journal-title":"JMIR Ment Health"},{"issue":"8","key":"R14","doi-asserted-by":"publisher","first-page":"2519","DOI":"10.1007\/s10803-017-3166-5","article-title":"\u201cPutting on my best normal\u201d: social camouflaging in adults with autism spectrum conditions","volume":"47","author":"Hull","journal-title":"J Autism Dev Disord"},{"issue":"5","key":"R15","doi-asserted-by":"publisher","first-page":"1932","DOI":"10.1007\/s10803-023-05986-9","article-title":"Evaluating the efficiency and equity of autism diagnoses via telehealth during COVID-19","volume":"55","author":"Micheletti","journal-title":"J Autism Dev Disord"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:11:42Z","timestamp":1791313902000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e82784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":15,"URL":"https:\/\/doi.org\/10.2196\/82784","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"article-number":"v10i5e82784"}}