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

  • K. L. Ashwood (a1) (a2), N. Gillan (a1), J. Horder (a1), H. Hayward (a1), E. Woodhouse (a1), F. S. McEwen (a2) (a3) (a4) (a5), J. Findon (a1), H. Eklund (a1), D. Spain (a1) (a2), C. E. Wilson (a1) (a2) (a6), T. Cadman (a1), S. Young (a7), V. Stoencheva (a1) (a2), C. M. Murphy (a1) (a2), D. Robertson (a2), T. Charman (a8), P. Bolton (a4), K. Glaser (a9), P. Asherson (a4), E. Simonoff (a3) and D. G. Murphy (a1) (a2)...

Abstract

Background

Many 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.

Method

We 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.

Results

Of 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.

Conclusions

The 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.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creative commons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: J. Horder, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. (Email: jamie.horder@kcl.ac.uk)

References

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Allison, C, Auyeung, B, Baron-Cohen, S (2012). Toward brief “red flags” for autism screening: the Short Autism Spectrum Quotient and the Short Quantitative Checklist in 1,000 cases and 3,000 controls. Journal of the American Academy of Child and Adolescent Psychiatry 51, 202212e7.
Baird, G, Simonoff, E, Pickles, A, Chandler, S, Loucas, T, Meldrum, D, Charman, T (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet 368, 210215.
Baron-Cohen, S, Scott, FJ, Allison, C, Williams, J, Bolton, P, Matthews, FE, Brayne, C (2009). Prevalence of autism-spectrum conditions: UK school-based population study. British Journal of Psychiatry 194, 500509.
Baron-Cohen, S, Wheelwright, S, Skinner, R, Martin, J, Clubley, E (2001). The Autism-Spectrum Quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders 31, 517.
Bishop, SL, Seltzer, MM (2012). Self-reported autism symptoms in adults with autism spectrum disorders. Journal of Autism and Developmental Disorders 42, 23542363.
Booth, T, Murray, AL, McKenzie, K, Kuenssberg, R, O'Donnell, M, Burnett, H (2013). Brief report: an evaluation of the AQ-10 as a brief screening instrument for ASD in adults. Journal of Autism and Developmental Disorders 43, 29973000.
Brugha, TS, McManus, S, Bankart, J, Scott, F, Purdon, S, Smith, J, Bebbington, P, Jenkins, R, Meltzer, H (2011 a). Epidemiology of autism spectrum disorders in adults in the community in England. Archives of General Psychiatry 68, 459465.
Brugha, TS, McManus, S, Smith, J, Scott, FJ, Meltzer, H, Purdon, S, Berney, T, Tantam, D, Robinson, J, Radley, J, Bankart, J (2011 b). Validating two survey methods for identifying cases of autism spectrum disorder among adults in the community. Psychological Medicine 42, 647656.
Buescher, AV, Cidav, Z, Knapp, M, Mandell, DS (2014). Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatrics 168, 721728.
Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators; Centers for Disease Control and Prevention (CDC) (2014). Prevalence of autism spectrum disorders among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010. MMWR Surveillance Summaries 63, 122.
Freeth, M, Bullock, T, Milne, E (2012). The distribution of and relationship between autistic traits and social anxiety in a UK student population. Autism 17, 571581.
Geurts, HM, Jansen, MD (2012). A retrospective chart study: the pathway to a diagnosis for adults referred for ASD assessment. Autism 16, 299305.
Horder, J, Murphy, DG (2012). Recent advances in neuroimaging in autism. Cognitive Neuropsychiatry 2, 221229.
Jones, L, Goddard, L, Hill, EL, Henry, LA, Crane, L (2014). Experiences of receiving a diagnosis of autism spectrum disorder: a survey of adults in the United Kingdom. Journal of Autism and Developmental Disorders 44, 30333044.
Ketelaars, C, Horwitz, E, Sytema, S, Bos, J, Wiersma, D, Minderaa, R, Hartman, CA (2008). Brief report: adults with mild autism spectrum disorders (ASD): scores on the Autism Spectrum Quotient (AQ) and comorbid psychopathology. Journal of Autism and Developmental Disorders 38, 176180.
Klin, A, Saulnier, CA, Sparrow, SS, Cicchetti, DV, Volkmar, FR, Lord, C (2007). Social and communication abilities and disabilities in higher functioning individuals with autism spectrum disorders: the Vineland and the ADOS. Journal of Autism and Developmental Disorders 37, 748759.
Koegel, LK, Koegel, RL, Ashbaugh, K, Bradshaw, J (2014). The importance of early identification and intervention for children with or at risk for autism spectrum disorders. International Journal of Speech and Language Pathology 16, 5056.
Lijmer, JG, Mol, BW, Heisterkamp, S, Bonsel, GJ, Prins, MH, van der Meulen, JH, Bossuyt, PM (1999). Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 282, 10611066.
Lord, C, Risi, S, Lambrecht, L, Cook, EH Jr., Leventhal, BL, DiLavore, PC, Pickles, A, Rutter, M (2000). The Autism Diagnostic Observation Schedule-Generic: a standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders 30, 205223.
Lord, C, Rutter, M, Le Couteur, A (1994). Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders 24, 659685.
Mathews, A, MacLeod, C (2005). Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology 1, 167195.
Murphy, DG, Beecham, J, Craig, M, Ecker, C (2011). Autism in adults. New biologicial findings and their translational implications to the cost of clinical services. Brain Research 1380, 2233.
NICE (2012). Autism: Recognition, Referral, Diagnosis and Management of Adults on the Autism Spectrum. NICE Clinical Guideline CG142. National Institute for Clinical Excellence: London (https://www.nice.org.uk/guidance/cg142). Accessed June 2016.
Nylander, L, Gillberg, C (2001). Screening for autism spectrum disorders in adult psychiatric out-patients: a preliminary report. Acta Psychiatrica Scandinavica 103, 428434.
Nylander, L, Holmqvist, M, Gustafson, L, Gillberg, C (2013). Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in adult psychiatry. A 20-year register study. Nordic Journal of Psychiatry 67, 344350.
Rutjes, AW, Reitsma, JB, Di Nisio, M, Smidt, N, van Rijn, JC, Bossuyt, PM (2006). Evidence of bias and variation in diagnostic accuracy studies. CMAJ 174, 469476.
Simonoff, E, Pickles, A, Charman, T, Chandler, S, Loucas, T, Baird, G (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry 47, 921929.
Sizoo, BB, Horwitz, EH, Teunisse, JP, Kan, CC, Vissers, C, Forceville, E, Van Voorst, A, Geurts, HM (2015). Predictive validity of self-report questionnaires in the assessment of autism spectrum disorders in adults. Autism 19, 842849.
Tebartz van Elst, L, Pick, M, Biscaldi, M, Fangmeier, T, Riedel, A (2013). High-functioning autism spectrum disorder as a basic disorder in adult psychiatry and psychotherapy: psychopathological presentation, clinical relevance and therapeutic concepts. European Archives of Psychiatry and Clinical Neurosciences 263, 189196.
Wakabayashi, A, Baron-Cohen, S, Wheelwright, S, Tojo, Y (2006). The Autism-Spectrum Quotient (AQ) in Japan: a cross-cultural comparison. Journal of Autism and Developmental Disorders 36, 263270.
Wing, L, Leekam, SR, Libby, SJ, Gould, J, Larcombe, M (2002). The Diagnostic Interview for Social and Communication Disorders: background, inter-rater reliability and clinical use. Journal of Child Psychology and Psychiatry 43, 307325.
Woodbury-Smith, MR, Robinson, J, Wheelwright, S, Baron-Cohen, S (2005). Screening adults for Asperger syndrome using the AQ: a preliminary study of its diagnostic validity in clinical practice. Journal of Autism and Developmental Disorders 35, 331335.
Youden, WJ (1950). Index for rating diagnostic tests. Cancer 3, 3235.

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

  • K. L. Ashwood (a1) (a2), N. Gillan (a1), J. Horder (a1), H. Hayward (a1), E. Woodhouse (a1), F. S. McEwen (a2) (a3) (a4) (a5), J. Findon (a1), H. Eklund (a1), D. Spain (a1) (a2), C. E. Wilson (a1) (a2) (a6), T. Cadman (a1), S. Young (a7), V. Stoencheva (a1) (a2), C. M. Murphy (a1) (a2), D. Robertson (a2), T. Charman (a8), P. Bolton (a4), K. Glaser (a9), P. Asherson (a4), E. Simonoff (a3) and D. G. Murphy (a1) (a2)...

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