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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

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Objective

Frontline health professionals need a “red flag” tool to aid their decision making about whether to make a referral for a full diagnostic assessment for an autism spectrum condition (ASC) in children and adults. The aim was to identify 10 items on the Autism Spectrum Quotient (AQ) (Adult, Adolescent, and Child versions) and on the Quantitative Checklist for Autism in Toddlers (Q-CHAT) with good test accuracy. Method: A case sample of more than 1,000 individuals with ASC (449 adults, 162 adolescents, 432 children and 126 toddlers) and a control sample of 3,000 controls (838 adults, 475 adolescents, 940 children, and 754 toddlers) with no ASC diagnosis participated. Case participants were recruited from the Autism Research Centre's database of volunteers. The control samples were recruited through a variety of sources. Participants completed full-length versions of the measures. The 10 best items were selected on each instrument to produce short versions. Results: At a cut-point of 6 on the AQ-10 adult, sensitivity was 0.88, specificity was 0.91, and positive predictive value (PPV) was 0.85. At a cut-point of 6 on the AQ-10 adolescent, sensitivity was 0.93, specificity was 0.95, and PPV was 0.86. At a cut-point of 6 on the AQ-10 child, sensitivity was 0.95, specificity was 0.97, and PPV was 0.94. At a cut-point of 3 on the Q-CHAT-10, sensitivity was 0.91, specificity was 0.89, and PPV was 0.58. Internal consistency was >0.85 on all measures. Conclusions: The short measures have potential to aid referral decision making for specialist assessment and should be further evaluated.

Section snippets

Measures

Full details of the construction of all versions of the AQ and the Q-CHAT can be found elsewhere.11, 36, 37, 48 The AQ consists of a series of 50 statements to which participants or parents have to indicate the degree to which they agree or disagree with the statement. There are four response options: strongly agree, slightly agree, slightly disagree, strongly disagree. On half the items, the autistic trait requires a response of slightly agree or strongly agree, and on half the items slightly

Results

Results from the item analysis for all measures are presented in Table S1, TABLE S2, TABLE S3, TABLE S4, available online. The 10 items with the highest DI are presented in Table 2 (AQ) and Table 3 (Q-CHAT). The AUC for all the measures (long and short versions) is shown in Table 4, indicating that all the short versions all had AUC of >0.90. The AUC value was marginally higher for the short version on the Q-CHAT and Child AQ than the long version. ROC curves for the long and short versions of

Discussion

This study set out to adapt the AQ (child, adolescent, and adult versions) and the Q-CHAT into short versions for use in primary or social care settings by busy frontline health care professionals as rapid screeners or “red flags” to serve as guides for referral. The study demonstrated that all versions of the AQ and the Q-CHAT have very high test accuracy properties in their short (10-item) forms. Internal consistency was high on all measures (>0.85). Anastasi53 suggested that Cronbach's alpha

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    • Cited by (0)

    Funding was made possible from grants from the Big Lottery Fund, the Medical Research Council, the Three Guineas Trust, and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care.

    Supplemental material cited in this article is available online.

    We are grateful to all of the individuals and families that completed the questionnaires. This study was conducted in association with National Institute of Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough. We thank Carol Brayne, Fiona Matthews, and Liliana Ruta of the University of Cambridge; Tony Charman and Greg Pasco of the Institute of Education; Sally Wheelwright of the University of Southampton and Rosa Hoekstra of the Open University, for valuable discussions. We thank the anonymous reviewers for their helpful comments.

    Disclosure: Drs. Allison, Auyeung, and Baron-Cohen report no biomedical financial interests or potential conflicts of interest.

    This article can be used to obtain continuing medical education (CME) category 1 credit at jaacap.org.

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    Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.