No abstract

BackgroundMany adults with autism spectrum disorder (ASD) remain undiagnosed. Specialist assessment clinics enable the detection of these cases, but such services are often overstretched. It has been proposed that unnecessary referrals to these services could be reduced by prioritizing individuals who score highly on the Autism-Spectrum Quotient (AQ), a self-report questionnaire measure of autistic traits. However, the ability of the AQ to predict who will go on to receive a diagnosis of ASD in adults is unclear.MethodWe studied 476 adults, seen consecutively at a national ASD diagnostic referral service for suspected ASD. We tested AQ scores as predictors of ASD diagnosis made by expert clinicians according to International Classification of Diseases (ICD)-10 criteria, informed by the Autism Diagnostic Observation Schedule-Generic (ADOS-G) and Autism Diagnostic Interview-Revised (ADI-R) assessments.ResultsOf the participants, 73% received a clinical diagnosis of ASD. Self-report AQ scores did not significantly predict receipt of a diagnosis. While AQ scores provided high sensitivity of 0.77 [95% confidence interval (CI) 0.72–0.82] and positive predictive value of 0.76 (95% CI 0.70–0.80), the specificity of 0.29 (95% CI 0.20–0.38) and negative predictive value of 0.36 (95% CI 0.22–0.40) were low. Thus, 64% of those who scored below the AQ cut-off were ‘false negatives’ who did in fact have ASD. Co-morbidity data revealed that generalized anxiety disorder may ‘mimic’ ASD and inflate AQ scores, leading to false positives.ConclusionsThe AQ's utility for screening referrals was limited in this sample. Recommendations supporting the AQ's role in the assessment of adult ASD, e.g. UK NICE guidelines, may need to be reconsidered.

A 2004 meta‐analysis reported good validity for the observer attachment Q‐sort (AQS), but poor validity for the parental self‐report version. Despite this, the self‐report AQS is still widely used, with researchers arguing that providing additional training can improve its validity. The aim of this study was to update the 2004 meta‐analysis. Two hundred forty‐five studies from 1987 to 2016 were included (n = 32,426). Separate meta‐analyses were conducted to examine validity and reliability. The observer AQS showed moderate convergent validity with the Strange Situation Procedure (r = .25; r = .39 for long observation periods) and good predictive validity in terms of associations with sensitivity (r = .32). It showed a relatively weak association with infant temperament (r = .21), suggesting some discriminant validity. The self‐report version showed comparable convergent validity with Strange Situation Procedure (r = .18), but significantly weaker correlations with sensitivity (r = .25) and stronger correlations with temperament (r = .33). There was no evidence that providing additional training improved the validity of the self‐report version. This study corroborates the previous finding that the observer AQS is a valid measure of infant attachment, especially after long periods of observation. The self‐report version showed significantly weaker discriminant and predictive validity. Highlights The aim of the study was to update the 2004 meta‐analysis assessing the validity of the attachment Q‐Sort (AQS). This study broadly replicated the findings of the previous meta-analysis, showing that the observer AQS is a valid measure of attachment. Caution should be shown in using the self-report AQS due to its comparatively weaker predictive and discriminate validity.

The potential etiological role of early acetaminophen exposure on Autism Spectrum Conditions (ASC) and Attention-Deficit/Hyperactivity Disorder (ADHD) is inconclusive. We aimed to study this association in a collaborative study of six European population-based birth/child cohorts. A total of 73,881 mother–child pairs were included in the study. Prenatal and postnatal (up to 18 months) acetaminophen exposure was assessed through maternal questionnaires or interviews. ASC and ADHD symptoms were assessed at 4–12 years of age using validated instruments. Children were classified as having borderline/clinical symptoms using recommended cutoffs for each instrument. Hospital diagnoses were also available in one cohort. Analyses were adjusted for child and maternal characteristics along with indications for acetaminophen use. Adjusted cohort-specific effect estimates were combined using random-effects meta-analysis. The proportion of children having borderline/clinical symptoms ranged between 0.9 and 12.9% for ASC and between 1.2 and 12.2% for ADHD. Results indicated that children prenatally exposed to acetaminophen were 19% and 21% more likely to subsequently have borderline or clinical ASC (OR = 1.19, 95% CI 1.07–1.33) and ADHD symptoms (OR = 1.21, 95% CI 1.07–1.36) compared to non-exposed children. Boys and girls showed higher odds for ASC and ADHD symptoms after prenatal exposure, though these associations were slightly stronger among boys. Postnatal exposure to acetaminophen was not associated with ASC or ADHD symptoms. These results replicate previous work and support providing clear information to pregnant women and their partners about potential long-term risks of acetaminophen use.