The Autism Spectrum Quotient: A Guide

Getting diagnosed with autism as an adult can be daunting. If you’re considering pursuing a diagnosis, you probably already know resources for autistic adults are limited, especially when it comes to getting diagnosed. For many, self-screening tools fill a gap, providing some information when a formal assessment isn’t accessible.

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Self-assessments like the Autism Spectrum Quotient can’t offer a formal diagnosis, but they may serve as a valuable early step for individuals wondering if they’re autistic. Read on to see how a self-screening tool could be useful for you, as well as a few things to keep in mind about self-screening tests.

The Autism Spectrum Quotient (AQ) is a self-assessment tool that screens for traits and behaviors associated with autism spectrum disorder (ASD). It is not a diagnostic tool and is not used by clinicians in formal autism evaluations.

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The AQ is commonly self-administered, but it may also be administered by a clinical provider such as a psychologist to determine whether a patient should be referred for an autism assessment.

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The Autism Spectrum Quotient consists of a series of prompts evaluating five characteristics associated with autism:

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• Social skills
• Ability to shift attention
• Attention to detail
• Communication 
• Imagination

The AQ was originally designed for individuals over the age of 16 who do not have an intellectual disability. It has since been adapted for children and adolescents as well. These versions are intended for a parent or caretaker to take on behalf of the child.

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The Autism Spectrum Quotient is scored out of 50, meaning each prompt can correspond to one point. An autism quotient score of 25 is considered the threshold; scores of 26 and over are considered possible indicators of autistic characteristics. Higher scores indicate that an individual may have a greater prevalence of autistic traits, and lower scores indicate a lower likelihood of autistic characteristics.

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While AQ scores are a helpful indicator for many, they do not offer a conclusive answer as to whether an individual is autistic or not. An autism assessment is far more comprehensive than the AQ, and is the only way to receive a formal diagnosis.

The Autism Spectrum Quotient consistently returns higher scores for autistic individuals than allistic people, meaning it is successful in discerning between these two groups. It also shows test-retest reliability, meaning individuals score consistently with their previous results when they retake the AQ. Though its results are not conclusive and cannot provide a diagnosis, the AQ is often considered a reliable preliminary screening tool.

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Although it’s not a formal diagnostic tool, the Autism Spectrum Quotient can be a meaningful step for many individuals who may be wondering if they are autistic. The AQ is a widely available self-screening tool that’s relatively quick to complete, making it a popular preliminary step for individuals considering an autism assessment. For these individuals, taking the AQ may guide or reinforce their decision to seek a formal diagnosis.

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The AQ is also administered by professionals, often mental healthcare providers like psychologists, to help determine whether to make a referral for assessment. Before I found Prosper Health on my journey to get diagnosed, my former therapist completed the AQ with me. He did this to help me further explore whether I might be autistic and to help him understand the traits and behaviors that led me to believe I may be. It’s one of the things that encouraged me to get back on the difficult road towards diagnosis.

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Some individuals also use the Autism Spectrum Quotient to validate a self-diagnosis. Though AQ results do not constitute a formal diagnosis, individuals who choose to forgo a formal diagnosis or have not sought one yet may find the AQ affirms the autistic traits and behaviors they have identified in themselves.

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Diagnoses aside, the AQ can also provide new scaffolding for introspection. For some, this can be a valuable tool for self-awareness, discovery and compartmentalization. This work is often an important part of an individual’s mental health journey, regardless of whether they seek a formal autism diagnosis.

Since its publication in 2001, the AQ has met some important criticism, mainly around gender bias and its prompts feeling unclear or lacking nuance.

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Gender bias

The Autism Spectrum Quotient, along with other screening tools for autism, has been criticized as unresponsive to different presentations of autism across genders. Autism is widely believed to present differently in women, girls and nonbinary people than in men and boys. Because popular beliefs about autism are largely constructed around how autism presents in boys and men, so are many of the diagnostic tools available to us.

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This appears to be the case with the AQ, which research suggests women tend to score lower on than men. One of the AQ’s major biases around gender emerges in questions that assess for lack of social intuition, a trait that autistic girls and women are more likely to become hyper-aware of and learn to mask. Autistic women may be more likely to respond affirmatively to statements like “I am good at social chitchat,” or “I know how to tell if someone listening to me is getting bored,” but this does not mean they find these skills come naturally or feel comfortable.

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Ambiguity of prompts

Many advocates have also critiqued the AQ for using prompts that are open for interpretation. 

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Questions that allistic (non-autistic) people may interpret one way can be read differently, or ambiguously, by autistics. For example, the AQ includes the statement, “I am fascinated by dates.” While some autistic people do gravitate towards numbers and numerical dates, others may read this question and feel unsure of whether it refers to a romantic evening, a fruit or a day on the calendar.

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In attempting to offer concrete scenarios, the AQ actually presents a number of ambiguous possibilities. The AQ asks respondents to consider whether they would rather go to a party or a library, but is the library crowded? Does it have fluorescent lighting or strong smells? Is the party a small gathering in a familiar place? Are my close friends there, and do I have to mask or be “on” the whole time? Autistic individuals completing the AQ can find themselves wanting an open text box below each question to explain their answers.

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Characterizing autism without nuance

Others still have pointed out that some AQ test prompts flatten autistic experiences, or even rely on tired tropes about autism. These advocates argue that the creators of the AQ misunderstood how autistic individuals would interpret and respond to the test’s prompts.

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For instance, the statement “I would rather go to the theater than to a museum” scores one point when the respondent answers “Definitely disagree” or “Slightly disagree.” However, many autistic people (myself included) find museums overstimulating. Of course, theaters can be rife with sensory triggers—but personally, I tend to prefer going to a theater where I can put in my earplugs, sit back and watch a show in an otherwise quiet, still room where I don’t have to make any decisions.

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Other prompts still have been called into question for leaning on autistic stereotypes. The prompt “When I’m reading a story, I find it difficult to work out the characters’ intentions,” is one example. This question circles around an autistic person’s social intuition, but assumes that autistic individuals can’t learn to understand people’s intentions, nor can they exercise empathy. These presumptions, of course, are not true for all autistic people.

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Perhaps the flattening of the autistic experience is an inherent downfall of a test intended to be quick and accessible. These critiques highlight the limits of a self-screening tool in contrast with a truly comprehensive assessment with a mental healthcare professional.

Self-screening and preliminary screening tools like the Autism Spectrum Quotient are imperfect, but illuminating. They are a helpful tool for many on the road towards an autism diagnosis, or for those who do not wish to or cannot pursue a formal diagnosis.

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If you are curious about your self-screen score and want to discuss it with someone, Prosper Health is here to help. Prosper Health provides telehealth autism assessments covered by insurance and 100% virtual. Our psychologists are experienced in working with autistic adults, and use the most up-to-date, evidence-based practices to diagnose autism in adults. 

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Plus, our clinicians offer neurodiversity-affirming therapy, helping you navigate common challenges related to autism. Propser Health therapists are prepared to meet you where you are and can help you work towards your individual mental health goals and truly thrive after receiving an autism diagnosis.