Ashwood K L, Gillan N, Horder J, Hayward H, Woodhouse E, McEwen F S, Findon J, Eklund H, Spain D, Wilson C E, Cadman T, Young S, Stoencheva V, Murphy C M, Robertson D, Charman T, Bolton P, Glaser K, Asherson P, Simonoff E, Murphy D G
Department of Forensic and Neurodevelopmental Sciences,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK.
South London and Maudsley National Health Service Foundation Trust (SLAM),Maudsley Hospital,London,UK.
Psychol Med. 2016 Sep;46(12):2595-604. doi: 10.1017/S0033291716001082. Epub 2016 Jun 29.
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.
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.
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.
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.
许多患有自闭症谱系障碍（ASD）的成年人仍未得到诊断。专科评估诊所能够检测出这些病例，但此类服务往往不堪重负。有人提出，通过优先考虑那些在自闭症谱系商数（AQ）上得分较高的个体，可以减少对这些服务的不必要转诊，AQ是一种用于测量自闭症特征的自我报告问卷。然而，AQ预测成年人中哪些人会最终被诊断为ASD的能力尚不清楚。
我们研究了476名成年人，他们在一家全国性的ASD诊断转诊服务机构因疑似ASD而连续就诊。我们将AQ得分作为专家临床医生根据国际疾病分类（ICD）-10标准做出的ASD诊断的预测指标，诊断依据为自闭症诊断观察量表通用版（ADOS-G）和自闭症诊断访谈修订版（ADI-R）评估。
在参与者中，73%获得了ASD的临床诊断。自我报告的AQ得分并不能显著预测是否会获得诊断。虽然AQ得分具有较高的灵敏度，为0.77[95%置信区间（CI）0.72 - 0.82]和阳性预测值0.76（95% CI 0.70 - 0.80），但其特异性为0.29（95% CI 0.20 - 0.38），阴性预测值为0.36（95% CI 0.22 - 0.40）较低。因此，64%得分低于AQ临界值的人是“假阴性”，实际上他们患有ASD。共病数据显示，广泛性焦虑症可能“模拟”ASD并使AQ得分升高，导致假阳性。
在这个样本中，AQ在筛选转诊方面的效用有限。支持AQ在成人ASD评估中作用的建议，例如英国国家卫生与临床优化研究所（NICE）的指南，可能需要重新考虑。
