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The Autism Spectrum Quotient (AQ) quantifies autistic traits in adults. This paper adapted
the AQ for children (age 9.8–15.4 years). Three groups of participants were assessed: Group 1:
n=52 adolescents with Asperger Syndrome (AS) or high-functioning autism (HFA); Group 2:
n=79 adolescents with classic autism; and Group 3, n=50 controls. The adolescents with AS/
HFA did not differ significantly from the adolescents with autism but both clinical groups
scored higher than controls. Approximately 90% of the adolescents with AS/HFA and autism
scored 30+, vs. none of the controls. Among the controls, boys scored higher than girls. The
AQ can rapidly quantify where an adolescent is situated on the continuum from autism to
normality.
343
0162-3257/06/0400-0343/0 Ó 2006 Springer ScienceþBusiness Media, Inc.
344 Baron-Cohen, Hoekstra, Knickmeyer, and Wheelwright
a significantly higher cut-off would need to be individuals are grouped together, rather than attempt-
employed to keep false-positives to a minimum. ing to separate them into AS vs. HFA. The final sample
Given the usefulness of the AQ, it is of interest to of 52 comprises those who responded from a larger
test a revised version of this instrument with adoles- sample of 63. All participants were regarded as
cents. In this paper, we test (1) whether similar results independent, in being genetically unrelated.
are found on an adolescent version of the AQ, and (2) Group 2 comprised n=79 adolescents with clas-
whether similar results are found in classic autism as in sic autism (63 males, 16 females). Again, this sex ratio
AS. Whereas the adult AQ (for ages 16+) entails self- of 3.9:1 is similar to that found in other samples. All
report, the adolescent AQ requires a parent/carer to participants in this group had been diagnosed by
complete it, but otherwise retains the same items and psychiatrists using established criteria for autism
structure as the adult version. The adolescent AQ was (APA, 1994). They too were recruited via the
designed to be short, easy to use, and easy to score. National Autistic Society (UK), specialist clinics
The adolescent version is shown in Appendix 1. carrying out diagnostic assessments, and adverts in
It comprises 50 questions, made up of 10 questions newsletters/web-pages for children with autism. Their
assessing 5 different areas: social skill (items mean age was 12.5 years (SD=1.7, range 9.8–16.0).
1,11,13,15,22,36,44,45,47,48); attention switching They all attended special schools for autism or
(items 2,4,10,16,25,32,34,37,43,46); attention to detail learning difficulties, and by parental report, had an
(items 5,6,9,12,19,23,28,29,30,49); communication IQ below the normal range. See below for a check of
(items 7,17,18,26,27,31,33,35,38,39); and imagination this. The final sample of 79 comprised those who
(items 3,8,14,20,21,24,40,41,42,50). Each of the items responded from a larger sample of 85.
listed above scores 1 point if the respondent records Group 3 comprised 50 adolescents selected at
the abnormal or autistic-like behaviour either random (n=25 males and 25 females). They were
mildly or strongly (see below for scoring each item; drawn from 200 adolescents. They were all attending
Abnormality—poor social skill, poor communication mainstream schools (2 primary and 2 secondary) in
skill, poor imagination, exceptional attention to the East Anglia area. Questionnaires were distributed
detail, poor attention-switching/strong focus of atten- by the schoolteachers via the childrenÕs school class.
tion). Approximately half the items were worded to Their mean age was 13.6 years (SD=1.8, range 10.1--
produce a ‘disagreeÕ response, and half an ‘agreeÕ 16.5). The 3 groups did not differ significantly at the
response, in a high scoring person with AS/HFA. p=.05 level for age.
This was to avoid a response bias either way. In Groups 1 and 2, 15 individuals were randomly
Following this, items were randomized with respect selected from the individuals who had returned an
to both the expected response from a high-scorer, and AQ and invited into the lab to check pro-rated IQ,
with respect to their domain. using 4 subtests of the WAIS-R (see below). These
parents were also asked to complete a second AQ as a
Participants measure of test–retest reliability.
3 groups of participants were tested:
Method
Group 1 comprised n=52 adolescents with AS/
HFA (38 males, 14 females). This sex ratio of 2.7:1 Parents were sent the AQ by post, and were
(m:f) is similar to that found in other samples (Klin, instructed to complete it as quickly as possible (to
Volkmar, Sparrow, Cicchetti, & Rourke, 1995). All avoid thinking about responses too long). To confirm
participants in this group had been diagnosed by the diagnosis of Group 1 being high-functioning and
psychiatrists using established criteria for autism or the diagnosis of Group 2 being lower-functioning, 15
AS (APA, 1994). They were recruited via several of each were randomly selected and invited into the
sources, including the National Autistic Society (UK), lab for intellectual assessment using 4 subtests of
specialist clinics carrying out diagnostic assessments, the WISC-R (Wechsler, 1958). The 4 subtests of the
and adverts in newsletters/web-pages for children with WISC-R were Vocabulary, Similarities, Block
AS/HFA. Their mean age was 13.6 years (SD=2.0, Design, and Picture Completion. On this basis, all
range 10.3–15.4). They all attended mainstream 15 participants selected from Group 1 had a prorated
schooling and by parental report, had an IQ in the IQ of at least 85, that is, in the normal range
normal range. See below for a check of this. Because we (mean=106.5, SD=8.0). These participantsÕ parents
did not collect data on age of onset of language these were also given the AQ when they came into the lab
Adolescent AQ 345
in person, in order to investigate test–retest reliability Total AQ score by GROUP and SEX, we found as
for the instrument on a small subset of children. All predicted a significant effect of GROUP (F (2,
15 of the participants selected from Group 2 had a 175)=201.49, p<.001). Post Hoc Scheffe tests
prorated IQ of below 84, that is, below the normal revealed that the two clinical groups scored signif-
range (mean=72.6, SD=8.0). Note that we have icantly higher than the control group (p<.0001), but
conservatively used an IQ of >85 as an inclusion that the two clinical groups did not differ from each
criterion for AS/HFA. other. The main effect of SEX was not significant (F
(1, 175)=2.84, p>.09), but there was a significant
Scoring the AQ two-way interaction of GROUPSEX (F (2,
175)=6.48, p=.002).
‘Definitely agreeÕ or ‘slightly agreeÕ responses
T-tests confirmed that there was a significant sex
scored 1 point, on the following items: 2, 4, 5, 6, 7, 9,
difference (t=)3.27, p=.002) in the control group
12, 13, 16, 18, 19, 20, 21, 22, 23, 26, 33, 35, 39, 41, 42,
(males scoring higher than females), confirming the
43, 45, 46. ‘Definitely disagreeÕ or ‘slightly disagreeÕ
same effect reported with the adult AQ. There were
responses scored 1 point, on the following items: 1, 3,
no significant sex differences in the clinical groups
8, 10, 11, 14, 15, 17, 24, 25, 27, 28, 29, 30, 31, 32, 34,
(group 1: t=1.90, p=.063; group 2: t=)2.0, p=.049
36, 37, 38, 40, 44, 47, 48, 49, 50. If a respondent left
(non-significant when Bonferroni correction for
more than 5 items blank, this AQ was deemed to be
multiple tests is used)). The clinical groups differed
incomplete and was omitted from the sample.
from the control group on all subdomain scores (t-
tests: see Table I). A stepwise regression analysis in
Results the control group revealed a significant effect of sex
Mean AQ scores (total) for each group, broken (F (1, 191)=23.24, p<.001, males scoring higher),
down by sex and by subdomain, are shown in but no effect of age (t=)1.45, p=.149). Figure 1
Table I. Comparing groups using an ANOVA of shows the Group and Sex differences graphically.
All t values in this row are significant at the p<.001 level except where shown (#).
a
b
None of these t values are significant at the p<.05 level.
346 Baron-Cohen, Hoekstra, Knickmeyer, and Wheelwright
40
Control girls
Control boys
35 AS/HFA/Aut boys and girls
30
Percent of subjects
25
20
15
10
0
11 to 15
16 to 20
21 to 25
26 to 30
31 to 35
36 to 40
41 to 45
46 to 50
6 to 10
0 to 5
AQ score
An item analysis (percentage of each group 32+), none of the control participants scored at this
scoring on each item) is shown in Table II. On only 2 level, whilst all girls with AS/HFA scored above this
items out of 50 (items 29, and 30) did controls score level, as do 73.7% of the boys with AS/HFA. In the
more than the clinical groups, strongly confirming the autism group, 68.8% of the girls, and 87.3% of the
value of these items for discriminating autism spec- boys scored at this level. If we decrease the cut-off
trum vs. controls. These two items were conserva- score to 30+, none of the controls score above this
tively retained in the analysis since, if anything, they level. All AS/HFA girls, and 86.8% of the AS/HFA
served to reduce the size of group differences. The boys score above this level, compared to 81.3% (girls)
internal consistency of items in each of the 5 domains and 90.5% (boys) in the autism group. A cut-off at
was also calculated, and CronbachÕs a Coefficients this point might be considered in future screening
were all high (Communication=0.82; Social=0.88; studies.
Imagination=0.81; Attention to Detail=0.66; Atten- Table III also shows that control females never
tion Switching=0.76). CronbachÕs a Coefficient for score as high as 29+, whereas 4% of control males
the AQ as a whole was also high (=0.79). CronbachÕs do. Note also that at AQ score 22+, there are almost
a Coefficients for each group were all in the range four times as many males (44%) as females (12%) in
0.6–0.9. the control group scoring at this intermediate point
The percentage of each group scoring at or on the scale. This suggests that there is not only a sex
above each AQ score is shown in Table III. A useful difference on the child AQ overall (as reflected in the
cut-off would discriminate the groups with as many male mean AQ being higher than the female mean),
true positives and as few false positives as possible. In and a sex difference at high levels on the AQ (reflected
the adults AQ, an AQ score of 32+ was chosen as a in the sex ratio in Group 1 being 3.5:1), but that
useful cut-off, since 79.3% of the AS/HFA group significantly more males than females in the general
scored at this level, whilst only 2% of controls did so. population show moderate levels of ‘‘autistic traits’’.1
32+ also seemed to be a useful cut-off for distin- Again, this pattern of results replicates that found
guishing adult females with AS/HFA (92.3% scoring with the adult AQ. No differences were found
at this point or above) vs. control adult females (1% between the autism and HFA/AS groups on the
of whom score at this point or above). Regarding the AQ. Finally, test–retest reliability was high (r=.92,
adolescent AQ, if the same cut-off score is used (of p<.001).
Adolescent AQ 347
Table III. Percent of Participants in Groups 1 and 2 Scoring at or Above each AQ Score—Overleaf
AQ AS/HFA AS boys AS/HFA Autism Autism boys Autism girls Controls Control Control
Score (n=52) (n=38) girls (n=14) (n=79) (n=63) (n=16) (n=50) boys (n=25) girls(n=25)
0 100 100 100 100 100 100 100 100 100
1 100 100 100 100 100 100 100 100 100
2 100 100 100 100 100 100 100 100 100
3 100 100 100 100 100 100 100 100 100
4 100 100 100 100 100 100 100 100 100
5 100 100 100 100 100 100 98.0 100 96.0
6 100 100 100 100 100 100 98.0 100 96.0
7 100 100 100 100 100 100 98.0 100 96.0
8 100 100 100 100 100 100 98.0 100 96.0
9 100 100 100 100 100 100 92.0 100 84.0
10 100 100 100 100 100 100 90.0 100 80.0
11 100 100 100 100 100 100 88.0 100 76.0
12 100 100 100 100 100 100 84.0 100 68.0
13 100 100 100 100 100 100 80.0 96.0 64.0
14 100 100 100 100 100 100 74.0 88.0 60.0
15 100 100 100 100 100 100 72.0 88.0 56.0
16 100 100 100 100 100 100 70.0 84.0 56.0
17 100 100 100 100 100 100 60.0 72.0 48.0
18 100 100 100 100 100 100 52.0 64.0 40.0
19 100 100 100 100 100 100 48.0 60.0 36.0
20 100 100 100 100 100 100 44.0 56.0 32.0
21 100 100 100 100 100 100 34.0 48.0 20.0
22 100 100 100 100 100 100 28.0 44.0 12.0
23 100 100 100 100 100 100 22.0 36.0 8.0
24 98.1 97.4 100 100 100 100 14.0 24.0 4.0
25 98.1 97.4 100 98.7 100 93.8 14.0 24.0 4.0
26 98.1 97.4 100 98.7 100 93.8 6.0 12.0 0
27 98.1 97.4 100 96.2 96.8 93.8 4.0 8.0 0
28 94.2 92.1 100 93.7 95.2 87.5 4.0 8.0 0
29 92.3 89.5 100 92.4 93.7 87.5 2.0 4.0 0
30 90.4 86.8 100 88.6 90.5 81.3 0 0 0
31 88.5 84.2 100 87.3 90.5 75.0 0 0 0
32 80.8 73.7 100 83.5 87.3 68.8 0 0 0
33 76.9 68.4 100 83.5 87.3 68.8 0 0 0
34 71.2 65.8 85.7 75.9 77.8 68.8 0 0 0
35 65.4 60.5 78.6 73.4 74.6 68.8 0 0 0
36 63.5 57.9 78.6 68.4 71.4 56.3 0 0 0
37 59.6 52.6 78.6 64.6 69.8 43.8 0 0 0
38 57.7 52.6 71.4 60.8 66.7 37.5 0 0 0
39 46.2 39.5 64.3 53.2 57.1 37.5 0 0 0
40 38.5 31.6 57.1 49.4 54.0 31.3 0 0 0
41 32.7 26.3 50.0 43.0 46.0 31.3 0 0 0
42 30.8 26.3 42.9 38.0 41.3 25.0 0 0 0
43 21.2 18.4 28.6 30.4 34.9 12.5 0 0 0
44 17.3 15.8 21.4 19.0 22.2 6.3 0 0 0
45 9.6 7.9 14.3 13.9 17.5 0 0 0 0
46 3.8 2.6 7.1 10.1 12.7 0 0 0 0
47 1.9 2.6 0 5.1 6.3 0 0 0 0
48 0 0 0 3.8 4.8 0 0 0 0
49 0 0 0 2.5 3.2 0 0 0 0
50 0 0 0 0 0 0 0 0 0
interest in future studies to test how many cases of between adolescent AQ score and severity of
AS each of these instruments correctly identifies (true symptoms.
positive rate) as well as the rate of false negatives. We wish to underline that the AQ is not
Future work could also examine any relationship diagnostic, but may serve as a useful instrument in
Adolescent AQ 349
Appendix 1. (Continued)