Red Flags for Autism
Type of research
Implementation phase of CLAHRC CP project
Background & Scientific Rationale:
The Autism Act (2009), the Autism Strategy (Department of Health, 2010) and the NICE Guidelines (2012) all recommend improved screening and diagnosis of autism spectrum conditions (ASC) in both childhood and adulthood. To facilitate this policy, 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. In CLAHRC CP we identified 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 (Allison, Auyeung, & Baron-Cohen, 2012). A clinical sample of over 1000 individuals with ASC and a population sample of 3000 controls completed full-length versions of the measures. The 10 best items were selected on each instrument to produce short versions. In CLAHRC-EoE we implemented these short measures on a website to make them available to patients and frontline clinicians, to aid in their decision-making to refer or self-refer for a full diagnostic assessment. We offered individuals the option to take the ‘red flag’ tests anonymously or to opt into research where they identified themselves. We then followed up 5,000 individuals who took the tests and were happy to be followed up, to see (a) if time from screening to diagnosis is faster than controls and (b) if screening accurately predicts diagnosis.
Research questions / aims:
The aim of the study was to identify 10 items with good test accuracy, on autism screening tools for four different age groups: the Autism Spectrum Quotient (AQ) in the Adult, Adolescent and Child versions, and the Quantitative Checklist for Autism in Toddlers (Q-CHAT).
Participants – those people who agreed to take part in research and for follow up and who took any of the 4 autism Red Flags were included in this study. Minimum n = 5,000 patients/carers/professionals.
A case sample of more than 1,000 individuals with ASC and a control sample of 3,000 with no ASC diagnosis, participated. Participants completed full-length versions of the screening tools.Ten items were selected in each screening tool for each age group to produce the AQ-10. 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. These short measures have potential to aid referral decision-making for specialist assessment and should be further evaluated in the context in which they are intended to be used.
This study developed four short and reliable tools to identify people at risk for autism. There is one checklist for each of the four age groups: toddlers (Quantitative Checklist for Autism in Toddlers; Q-CHAT), children, adolescents, and adults (Autism Spectrum Quotient; AQ-10, different versions)
Each checklists provides a quick and accurate tool for GPs to determine if a patient presenting with concerns or symptoms of autism needs referral to a specialist service for a full diagnostic assessment.
Output of Research / Impact and added value:
- Scientific journal articles
- Novel tools for parents, professionals and adult patients for screening for autism
- NICE guidelines for autism in Adults recommend using the AQ-10 Adult
- There is also evidence that the Red Flags tools are being used in services for children and young people
- Allison C, Auyeung B, Baron-Cohen S. 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. J Am Acad Child Adolesc Psychiatry [Internet]. 2012;51(2):202–12. Available from: http://dx.doi.org/10.1016/j.jaac.2011.11.003 (PDF)
For a ‘BITE’ sized summary of the research, please see:
For more information on this project, contact Simon Baron-Cohen, Professor of Developmental Psychopathology, Director, Autism Research Centre, Cambridge University, email: firstname.lastname@example.org