Predicting the diagnosis of autism in adults using the Autism-Spectrum Quotient (AQ) questionnaire

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.

Dorsal‐movement and ventral‐form regions are functionally connected during visual‐speech recognition

“…In addition, both groups showed comparable concentration performances (d2 test of attention; Brickenkamp, 2002; Table 1). It is suitable to discriminate between individuals diagnosed with ASD and typically developing controls (e.g., Baron-Cohen et al, 2001;Wakabayashi, Baron-Cohen, Wheelwright, & Tojo, 2006), but it does not significantly predict a positive ASD diagnosis (Ashwood et al, 2016). All reported normal hearing abilities and we confirmed these reports by means of pure tone audiometry Table 1).…”

“…The AQ is a self-assessment screening instrument for measuring the degree of autistic traits, but it does not serve as a diagnostic tool. It is suitable to discriminate between individuals diagnosed with ASD and typically developing controls (e.g., Baron-Cohen et al, 2001;Wakabayashi, Baron-Cohen, Wheelwright, & Tojo, 2006), but it does not significantly predict a positive ASD diagnosis (Ashwood et al, 2016). None of the control participants reported a history of psychiatric disorders or a family history of ASD.…”

Impact of ASD Traits on Treatment Outcomes of Eating Disorders in Girls

“…Recent research in adult clinical populations has highlighted that Generalised Anxiety Disorder can lead to false positives on the adult AQ (Ashwood et al, 2016). This may introduce a bias towards overreporting of symptoms in a subset of participants, although it is noteworthy that clinical measures are not all inter-correlated suggesting that participants were able to differentiate between symptoms associated with different disorders.…”

“…This may introduce a bias towards overreporting of symptoms in a subset of participants, although it is noteworthy that clinical measures are not all inter-correlated suggesting that participants were able to differentiate between symptoms associated with different disorders. Recent research in adult clinical populations has highlighted that Generalised Anxiety Disorder can lead to false positives on the adult AQ (Ashwood et al, 2016). It is not possible to fully delineate whether the elevation of ASD traits and subsequent levels of service augmentation reflect over-reporting of all symptoms or differential effects on treatment outcome of ASD or depressive symptomatology.…”

A systematic PRISMA review of individuals with autism spectrum disorder in secure psychiatric care: prevalence, treatment, risk assessment and other clinical considerations

“…Moreover, some items in the AQ are difficult for many individuals to directly relate to (Murphy, 2011). There is also a growing concern over the clinical utility of the AQ and not just in forensic settings (e.g., Ashwood et al, 2016). This suggests the need for the development of an ASD screening tool for use in forensic settings and one for use in community settings".…”