Abstract
ObjectivesAutism is difficult to identify in adults due to lack of validated self‐report questionnaires. We compared the effectiveness of the autism‐spectrum quotient (AQ) and the Ritvo autism–Asperger's diagnostic scale‐revised (RAADS‐R) questionnaires in adult mental health services in two English counties.MethodsA subsample of adults who completed the AQ and RAADS‐R were invited to take part in an autism diagnostic observation schedule (ADOS Module 4) assessment with probability of selection weighted by scores on the questionnaires.ResultsThere were 364 men and 374 women who consented to take part. Recorded diagnoses were most commonly mood disorders (44%) and mental and behavioural disorders due to alcohol/substance misuse (19%), and 4.8% (95% CI [2.9, 7.5]) were identified with autism (ADOS Module 4 10+). One had a pre‐existing diagnosis of autism; five (26%) had borderline personality disorders (all female) and three (17%) had mood disorders. The AQ and RAADS‐R had fair test accuracy (area under receiver operating characteristic [ROC] curve 0.77 and 0.79, respectively). AQ sensitivity was 0.79 (95% CI [0.54, 0.94]) and specificity was 0.77 (95% CI [0.65, 0.86]); RAADS‐R sensitivity was 0.75 (95% CI [0.48, 0.93]) and specificity was 0.71 (95% CI [0.60, 0.81]).ConclusionsThe AQ and RAADS‐R can guide decisions to refer adults in mental health services to autism diagnostic services.
Highlights
IntroductionSocial and communication disorders, including autism spectrum disorders (ASDs), contribute to substantial societal burden (Knapp et al, 2009) and can be challenging for adults and carers involved in providing and accessing support (Commission for Social Care Inspection, 2008, Department of Health, 2006)
The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.Social and communication disorders, including autism spectrum disorders (ASDs), contribute to substantial societal burden (Knapp et al, 2009) and can be challenging for adults and carers involved in providing and accessing support (Commission for Social Care Inspection, 2008, Department of Health, 2006)
Using Bland–Altman plots (Figure 3,b), we found no significant differences between the mean values for the two administrations of either the autism-spectrum quotient (AQ) or Ritvo autism–Asperger's diagnostic scale-revised (RAADS-R) and no evidence of systematic bias (AQ: mean difference = −0.80; 95% confidence intervals (CIs) [−2.83, 1.23]; p = .42, and RAADS-R: mean difference = −5.19; 95% CI [−16.89, 6.51]; p = .37)
Summary
Social and communication disorders, including autism spectrum disorders (ASDs), contribute to substantial societal burden (Knapp et al, 2009) and can be challenging for adults and carers involved in providing and accessing support (Commission for Social Care Inspection, 2008, Department of Health, 2006). Many high-functioning adults with ASD have not been diagnosed (National Audit Office, 2009; Brugha et al, 2011). Such recognition can be valuable because a diagnosis opens up a range of autism services, such as social groups, support to live independently, and support with finding and remaining in employment. Many adults with ASD can live and work independently, and lead fulfilling and rewarding lives
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