Childhood Autism Spectrum Test (CAST)

Introduction
The Childhood Autism Spectrum Test (CAST), formerly known as the Childhood Asperger Syndrome Test, is a tool designed for the early detection of Autism Spectrum Disorder (ASD) in children aged 4 to 11 years. It is structured as a parent-completed questionnaire, focusing on behaviors and abilities that are indicative of ASD. By capturing a wide range of social, communicative, and imaginative behaviors, the CAST aims to identify children who may benefit from a more detailed evaluation for ASD. This screening tool is particularly notable for its role in facilitating early identification of ASD, thereby enabling timely intervention and support.

Developed by a team of experts in the field of autism research, the CAST consists of a series of questions that parents or primary caregivers answer based on their observations of the child's behavior and interactions. The questionnaire is designed to be both comprehensive and accessible, allowing for its use in various settings, including primary care, educational environments, and within the family home. The emphasis on parent-reported observations leverages the detailed knowledge that caregivers often have about their child's behavior in a range of social contexts and situations.

One of the key strengths of the CAST is its focus on early childhood, a critical period for the development of social and communicative skills. Early detection of ASD can significantly influence the course of a child's development, offering opportunities for interventions that can improve social, communicative, and academic outcomes. By providing a structured framework for assessing behaviors associated with ASD, the CAST plays an essential role in the early diagnostic process, guiding families and professionals toward further evaluation when necessary.

The application of the CAST in screening for ASD reflects an understanding of the importance of early, accessible, and accurate identification of autism spectrum conditions. Its development and use underscore the commitment within the field of autism research to create tools that can bridge the gap between expert diagnostic services and the initial concerns of parents or educators. Through its widespread use, the CAST contributes to a broader awareness and understanding of ASD, promoting a more inclusive and supportive approach to supporting children with diverse developmental profiles.

The Childhood Autism Spectrum Test's design as a parent-completed questionnaire makes it an accessible and practical tool for the early screening of ASD. By enabling early identification and intervention, the CAST contributes to positive outcomes for children with ASD, supporting their development and integration within educational settings and the broader community.

Instructions
Please read each question carefully and select the most accurate response.

  Yes No
1. Does s/he join in playing games with other children easily?
2. Does s/he come up to you spontaneously for a chat?
3. Was s/he speaking by 2 years old?
4. Does s/he enjoy sports?
5. Is it important to him/her to fit in with the peer group?
6. Does s/he appear to notice unusual details that others miss?
7. Does s/he tend to take things literally?
8. When s/he was 3 years old, did s/he spend a lot of time pretending (e.g., play-acting being a superhero, or holding teddy's tea parties)?
9. Does s/he like to do things over and over again, in the same way all the time?
10. Does s/he find it easy to interact with other children?
11. Can s/he keep a two-way conversation going?
12. Can s/he read appropriately for his/her age?
13. Does s/he mostly have the same interests as his/her peers?
14. Does s/he have an interest which takes up so much time that s/he does little else?
15. Does s/he have friends, rather than just acquaintances?
16. Does s/he often bring you things s/he is interested in to show you?
17. Does s/he enjoy joking around?
18. Does s/he have difficulty understanding the rules for polite behavior?
19. Does s/he appear to have an unusual memory for details?
20. Is his/her voice unusual (e.g., overly adult, flat, or very monotonous)?
21. Are people important to him/her?
22. Can s/he dress him/herself?
23. Is s/he good at turn-taking in conversation?
24. Does s/he play imaginatively with other children, and engage in role-play?
25. Does s/he often do or say things that are tactless or socially inappropriate?
26. Can s/he count to 50 without leaving out any numbers?
27. Does s/he make normal eye-contact?
28. Does s/he have any unusual and repetitive movements?
29. Is his/her social behavior very one-sided and always on his/her own terms?
30. Does s/he sometimes say “you” or “s/he” when s/he means “I”?
31. Does s/he prefer imaginative activities such as play-acting or story-telling, rather than numbers or lists of facts?
32. Does s/he sometimes lose the listener because of not explaining what s/he is talking about?
33. Can s/he ride a bicycle (even if with stabilizers)?
34. Does s/he try to impose routines on him/herself, or on others, in such a way that it causes problems?
35. Does s/he care how s/he is perceived by the rest of the group?
36. Does s/he often turn conversations to his/her favorite subject rather than following what the other person wants to talk about?
37. Does s/he have odd or unusual phrases?
38. Have teachers/health visitors ever expressed any concerns about his/her development?
39. Has s/he ever been diagnosed with any of the following: Language delay, ADHD, hearing or visual difficulties, Autism Spectrum Condition (including Asperger’s Syndrome, or a physical disability?
Sources
  1. JG Williams, C Allison, FJ Scott, PF Bolton, S Baron-Cohen, FE Matthews, C Brayne. 38(9): J Autism Dev Disord 1731-9. .
  2. JG Williams, C Allison, FJ Scott, PF Bolton, S Baron-Cohen, FE Matthews, C Brayne. 9(1): Autism 45-68. .
  3. J Williams, C Allison, F Scott, C Stott, P Bolton, S Baron-Cohen, C Brayne. 10(4): Autism 415-27. .
  4. FJ Scott, S Baron-Cohen, P Bolton, C Brayne. 6(1): Autism 9-31. .