Autism screener for adult?

[cara susanna]

Hi everyone,

I'm going to be conducting an eval for diagnostic clarification between a few diagnoses, including ADHD and autism. As you may recall, I am not a neuropsychologist and do not have access to autism assessment instruments, so the question is going to be more: does this person need a referral for a more comprehensive autism assessment, or do the other diagnostic possibilities fully explain symptoms. I will be doing a comprehensive interview, of course, but I would feel better if I had some sort of formal measure to screen for autism. Any suggestions?

Thanks!

Editing to add: I would need this measure to be free, or otherwise available through the VA.

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[oliversacks4thewin]

I will be very interested to hear other's opinions too, but the only thing I have found in the past to be somewhat helpful (and free) was the AQ. Fair warning though, it is incredibly face-valid and designed to be strictly a screening tool, as you had suggested you were looking for.

Autism Spectrum Quotient (AQ) - Psychology Tools

A psychological self-assessment measuring Autism-Spectrum Quotient (AQ for short), which is a measure of the expression of autistic traits in adults.

psychology-tools.com

 

[Doctor Eliza]

I hear TikTok is the best way to diagnose adult autism now. 🙄 If I had a nickel for everyone that came in after self-diagnosing from TIk Tok, I'd be a wealthy woman.

 

[WisNeuro]

Honestly, I think the highest yield and best use of your time is doing a thorough clinical interview and doing a good job with figuring out comorbidities and rule outs. If likely other diagnoses still don't capture the symptoms/difficulties, documenting history and symptoms consistent with ADHD and/or ASD will be helpful. For ADHD, you can use the WURS. The short version is fairly face valid, but a longer version has some, but not great, embedded validity indicators.

 

[R. Matey]

I don't know if you just mean free ones, but there's an adult form for the SRS that I've used before. I'm not the world's biggest SRS fan, but it has been useful in the past.

For ADHD, CAARS is best, IMHO, but Vandy and Wender-Utah are also fine, if you just mean free ones. I also like to give a symptom measure for comparison, but that's just me.

 

[futureapppsy2]

Seconding the AQ, but a good clinical interview being key--autism has a lot of overlap with other psychiatric conditions, especially in adults.

 

[cara susanna]

Thanks for the ADHD recs, but I was asking specifically about autism. Our clinic uses the BAARS IV, so even if I wanted to use another ADHD measure I couldn't!

So far the AQ looks good. Does the SRS require training?

 

[R. Matey]

So far the AQ looks good. Does the SRS require training?

Maybe others have had different experiences, but I read the manual and gave it under supervision during grad school like 5-10x during prac. It's norm-referenced so not too hard to interpret.

I've heard good things about the RAADS-R, but I haven't used it, so can't recommend it. But it is a free measure also.

 

[Dazen]

Maybe others have had different experiences, but I read the manual and gave it under supervision during grad school like 5-10x during prac. It's norm-referenced so not too hard to interpret.

I've heard good things about the RAADS-R, but I haven't used it, so can't recommend it. But it is a free measure also.

This has been my experience too. Our clinic primarily uses a clinical interview as a screener and (outside of specific symptoms) I’ve found asking about history and impairment most helpful. I’ve talked with a number of people who either report minimal-to-no childhood symptoms or have never experienced significant impairment outside of “I feel weird in big groups of people and struggle to make friends”

 

[AcronymAllergy]

There's also the RAADS-R

 

[iliketohelppeople]

Had a case on internship (at the VA) that had a similar referral question. The Autism-specific measures I used were the RAADS-R and AQ. Of course, did a pretty thorough interview, too. Did end up referring them for a more comprehensive autism eval after that.

 

[cara susanna]

Thank you all so much! I will plan on using the AQ and RAADS-R - in addition to my clinical interview, of course

 

[ExecutiveDysfunction]

Thank you all so much! I will plan on using the AQ and RAADS-R - in addition to my clinical interview, of course

I’ve seen these used commonly. Just a fair warning - if the patient is concerned about autism, these will almost certainly pop positive. Super nonspecific and very face valid. But for your purposes, they can definitely adequately screen.

If you have access and a reliable informant, the SCQ is also a good screener. I primarily see kids/teens, but if I remember correctly, there’s some data supporting its use as a screener in adults. Probably not worth shelling out money if you don’t though.

 

[futureapppsy2]

Thanks for the ADHD recs, but I was asking specifically about autism. Our clinic uses the BAARS IV, so even if I wanted to use another ADHD measure I couldn't!

So far the AQ looks good. Does the SRS require training?

In my experience, the SRS (which we used a lot in clinic) is pretty straightforward. It doesn't get at the other ASD criteria, though, so I wouldn't recommend it as a screener. Also, I'd be wary of thinking autism if the patient has other psychiatric conditions for which EBP hasn't been attempted--a lot of people in clinic can have red flags for ASD that go away once their depression/anxiety/PTSD/eating disorder/etc is well treated. If you have someone for who those red flags don't go away despite treating comorbidities, it's worth a look.

 

[R. Matey]

In my experience, the SRS (which we used a lot in clinic) is pretty straightforward. It doesn't get at the other ASD criteria, though, so I wouldn't recommend it as a screener. Also, I'd be wary of thinking autism if the patient has other psychiatric conditions for which EBP hasn't been attempted--a lot of people in clinic can have red flags for ASD that go away once their depression/anxiety/PTSD/eating disorder/etc is well treated. If you have someone for who those red flags don't go away despite treating comorbidities, it's worth a look.

I'd actually be interested to learn more about this (i.e., I've used it in training as a screener, but have had reservations similar to what you mentioned above)--I've read that it functions better as a severity measure, but even the invariance testing on the front is not fabulous.