Why Are Only Some Children with Autism Spectrum Disorder Misclassified by the Social Communication Questionnaire? An Empirical Investigation of Individual Differences in Sensitivity and Specificity in a Clinic-Referred Sample

Abstract

Background The Social Communication Questionnaire (SCQ) is a screening checklist for autism spectrum disorder (ASD) commonly used in research and clinical practice. While the original validation study suggested that the SCQ was an accurate ASD screener with satisfactory sensitivity and specificity, subsequent studies have yielded mixed results, with some revealing low sensitivity, low specificity, and low utility as a screening tool. However, it is unknown for whom the SCQ is effective versus ineffective as a screening tool. Method The present study examined the psychometric properties of the SCQ as well as the individual difference characteristics of 187 individuals with and without autism spectrum disorder (ASD) who were misclassified or accurately classified by the SCQ in a clinical-referred sample. Results The SCQ showed suboptimal sensitivity and specificity, regardless of age and sex. Compared to true positives, individuals classified as false positives displayed greater externalizing and internalizing problems, whereas individuals classified as false negatives displayed better social communication and adaptive skills. Conclusions The findings suggest non-autistic developmental and behavioral individual difference characteristics may explain high rates of misclassification using the SCQ. The SCQ may be less useful as a screener for young children with internalizing and externalizing symptoms and other more complex clinical presentations.