Healthcare practitioners are seeing more patients with autism than ever, thanks to increased awareness about the condition, especially among adults, females, and higher-functioning individuals (Russel et al., 2021). Scientific and clinical understanding of autism has evolved rapidly in recent years, and much is now known about how to reliably diagnose the condition, its causes, its effects, and the effectiveness of potential interventions. Yet challenges remain, especially because autism is a heterogeneous condition, with a variety of possible difficulties that may require intervention or treatment, each manifesting differently for each patient.
Despite autism’s increased presence in many healthcare specialties, the ability to meet a patient’s specific needs is often compromised because individual characteristics affect outcomes (Howlin, 2021), yet are rarely measured.
The Autism Spectrum Quotient (AQ) fills this data gap with a quick measure of traits associated with autism. Alongside the cognitive testing and mental health questionnaires included in CBS Health, practitioners can efficiently get a complete picture of a patient’s autistic traits and comorbidities in one seamless assessment.
What is the AQ?
The Autism Spectrum Quotient (AQ) questionnaire was created by Simon Baron-Cohen and colleagues in 2001 to address shortcomings in existing instruments for quantifying autistic traits. It is short, self-administered, and suitable for both research and clinical usage. The AQ is particularly valuable as a screening tool when autism is suspected, to assist in the decision to administer a full diagnostic assessment or refer to a specialist.
The scale is designed for young adults and adults ages 16 and up with normal intelligence, to measure traits associated with the autism spectrum, including Asperger syndrome and high-functioning autism. The instrument is likely not appropriate for individuals with low IQ (e.g., below 70 on IQ tests or standard scores like the ones provided in CBS Health cognitive reports), because it assumes reading comprehension skills.
Fifty questions make up the AQ, with ten questions within each of five domains: social skill, attention switching, attention to detail, communication, and imagination. Patient indicate their agreement with each item on a 4-point scale:
The CBS Health version of the AQ automatically tallies the results and provides guidance on cutoff scores that maximize distinction between individuals diagnosed with high-functioning autism or Asperger Syndrome and individuals from the general population:
Note that clinical judgment should always be used when interpreting an individual’s AQ scores. Baron-Cohen et al. (2001) also noted: “the AQ is not diagnostic, but may serve as a useful instrument in identifying the extent of autistic traits shown by an adult of normal intelligence.”
How is autism related to cognition?
Impairments in intellectual function may accompany autism spectrum disorders, but the association is not inevitable (Howlin, 2021). Asperger syndrome, in particular, is defined by patterns of autism-like traits, but unimpaired cognitive function.
The AQ is designed primarily for adults with autistic traits who are not severely intellectually impaired. The cognitive tasks at the core of CBS Health may be used to assess how individuals compare to peers of the same age in terms of cognitive functioning.
Some individuals high in autistic traits may actually have an advantage in certain cognitive tasks that require visual processing or attention to detail (Jolliffe & Baron-Cohen, 1997; van der Helm, 2016). It may not be unexpected, then, for individuals with high AQ scores to have unimpaired or even above average scores in CBS tasks such as Polygons and Feature Match. This can lead to certain traits being seen as advantageous to some autistic adults (Russell et al., 2019).
Collecting data on both cognition and autism traits allows healthcare practitioners to get a fuller picture of a patient’s condition that helps drive decisions about treatment. Researchers have suggested that effective treatment for individuals with the overall condition of autism spectrum disorder involves tailoring interventions to the individual’s characteristics, such as the degree of intellectual impairment accompanying the condition (Loth, Murphy, & Spooren, 2016).
What types of healthcare providers should measure autism traits with the AQ?
Autism is related to a range of physical and mental health conditions. In a study of almost all of Scotland’s population, comorbidities of autism included hearing loss, sight loss, other physical disabilities, intellectual disabilities, and mental health conditions (Rydzewska et al., 2018). Anxiety and depression are the most common conditions experienced by adults with an autism spectrum disorder, and experts have proposed that traditional mental health services often fall short of meeting the needs of these patients (Lake, Perry, & Lunksy, 2014).
Because autism may be playing a role so many conditions, nearly any healthcare provider may benefit from having the AQ available for any patients where autism is suspected, even if the focus of the practice is not autism itself. Providers working at the intersection of cognitive and mental health, such as psychiatrists and neurologists, may find the AQ particularly valuable for better serving patients for whom high-functioning autism may be a common link between various symptoms.
CBS Health includes objective cognitive assessments as well as other common mental health assessments, such as the GAD-7 to measure anxiety symptoms, the PHQ-9 to measure depression symptoms, and the ASRS to measure adult ADHD. Treating mental or physical health can have positive effects on more than one type of symptom. By measuring multiple relevant outcomes over time, healthcare providers and their patients will better understand the full impact of their work, and demonstrate the impact to patients with tangible reports. Long-term post-treatment monitoring of cognitive and mental health also assists in identifying any changes that could become a concern, justifying the need for revisiting or continuing treatment.
How to administer a computerized version of the Autism Spectrum Quotient in CBS Health
Including the AQ in a CBS Health protocol is simple. It can be sent on its own, or as part of a series of cognitive tasks and other health questionnaires. When creating a protocol within CBS Health, click the Questionnaires section, then check off the Autism Spectrum Quotient (AQ). You can include additional questionnaires or a set of cognitive tasks within the protocol for a seamless patient experience that can be completed in an integrated flow.
For detailed instructions on administering questionnaires within CBS Health, please see our previous blog post on administering a computerized PHQ-9.
The version of the AQ included in CBS Health takes advantage of the strengths of digital assessments. The questionnaire can be administered with just a few clicks, and requires no special training, as it is self-administered. The AQ can also be added to a CBS Health schedule, allowing you to automatically send this assessment (and any others) via email at predefined times. The results are scored instantly, and if a patient completes the questionnaire more than once, results are added to the patient’s report to track changes in response to treatments or to monitor for variations over time. For the patient, completing the ASRS only takes ten minutes and can be taken in the clinic or at home with one click—no registration or login are required. With minimal effort, you as the healthcare provider and the patient both benefit from the valuable information provided by a standardized measure of traits associated with autism.
Need more digital health questionnaires and checklists?
If there are any questionnaires you would like in CBS Health, such as those you are currently administering in pen-and-paper form, please do not hesitate to let us know by commenting on this blog post or contacting us directly by email. We are always happy to hear your feedback.
Thanks, as always,
— The Cambridge Brain Sciences Team