ASSQ

Autism Spectrum Screening Questionnaire

Basic Characteristics

• Description

The ASSQ was designed to assess children 7 to 16 years of age with normal intelligence to mild mental retardation. From its Swedish origin, the ASSQ has been translated into several other languages, including Finnish, English, Lithuanian, and Norwegian.³

The questionnaire requires no prior training before completion, is simple enough for lay informants, and takes about 10 minutes to fill in. The ASSQ was designed as a screening instrument and not a diagnostic measure due to highly subjective and biased judgments that can be produced by lay informants. The ASSQ is simple enough for both parents and teachers to use, thus, it provides important information about the child’s social and behavioral functioning in different settings.

The ASSQ consists of 27 items rated on a 3-point scale (0, 1, or 2; 0 indicates normality, 1 some abnormality, and 2 definite abnormality) that were considered to best reflect behavioral characteristics of Asperger sundrome in children 7 to 16 years of age. Eleven of the items consider the social interaction domain, 6 cover communication problems, and 5 refer to restricted and repetitive behaviors.²

• History

The Autism Spectrum Screening Questionnaire (ASSQ) was developed as a first-stage population screening instrument for Asperger Syndrome in mainstream primary schools with teachers as target raters, but was later renamed since it efficiently screened for other ASD and found to be suitable for parents as raters as well. Several preliminary drafts were produced of the Swedish ASSQ, where items were revised or omitted if they seemed ambiguous or misunderstood by the teachers and an English version was later produced after revisions were made. The ASSQ taps into features characteristic of higher functioning individuals.

The ASSQ has shown to be both valid and reliable with good sensitivity and specificity in clinical settings. It has also been shown to have good internal consistency and a stable three-factor structure. Typically in autism screening, only one informant is used in the initial questionnaire phase. It has been suggested to use both parent and teacher assessments for improved case findings, as children may function differently in different settings. ¹

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Psychometrics (validity and reliability)

One large study on teacher scores for 7 to 16 year-old children showed the test-retest reliability, which refers to the consistency of a measurement from one time to another, of teacher ASSQ scores over an 8-month period was Pearson r = .90, and the interrater reliability, which refers to the degree to which different raters observing the same thing give consistent estimates, was Pearson r = .79. The findings indicate that the ASSQ was also able to identify children with other autistic-like conditions who were in the borderline, average, or superior range of intelligence.

One study suggests that for high sensitivity a parents rating of 13 and a teachers scores of 11 seems preferable, where 91 and 90%, respectively, of all ASDs cases in the main sample were identified. However, this relatively low cutoff score risks a high number of children with other disorders may be picked up through the ASSQ, as the study demonstrated 42% false positive for attention-deficit and disruptive behavior disorders, respectively. The corresponding likelihood ratios for ASDs are rather low. These cutoffs seem to identify socially impaired children in general, although not necessarily with autism spectrum disorders. In general psychiatric or neuropsychiatric units, a preferential cutoff with a low ratio of false positives, such as 19 for parental ratings, identified 62% of true positive cases of ASDs with a rate of 10% false positives, which demonstrated a 5.5 times more likely chance that subjects with scores of 19 or above suffer from ASDs rather than other behavior disorders. Also, a cutoff of 22 for teachers identified 70% of true positive cases and 9% of false positives with a likelihood ratio of 7, where subjects were 5 times more likely to suffer from autism spectrum disorders. For the Asperger syndrome validation sample, a cutoff of 19 for parents rating correctly identified 82% of subjects and a cutoff of 22 for teachers rating corresponded to 65% of correctly identified subjects. The study did not indicate that the ASSQ could distinguish between Asperger syndrome and other high-functioning autistic disorders.²

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References

1. Chandler et. al. Validation of the social communication questionnaire in a population cohort of children with autism spectrum disorders. J Am Acad Child Adolesc Psychiatry. 2007 Oct;46(10):1324-32. PMID 17885574

2. Ehlers et. al. A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. J Autism Dev Disord. 1999 Apr;29(2):129-41. PMID 10382133

3. Mattila et. al. When does the Autism Spectrum Screening Questionnaire (ASSQ) predict autism spectrum disorders in primary school-aged children? Eur Child Adolesc Psychiatry. 2009 Jul 14. PMID 19597920

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