Is the Autism-Spectrum Quotient a Valid Measure of Traits Associated with the Autism Spectrum? A Rasch Validation in Adults with and Without Autism Spectrum Disorders
J Autism Dev Disord
Is the Autism-Spectrum Quotient a Valid Measure of Traits Associated with the Autism Spectrum? A Rasch Validation in Adults with and Without Autism Spectrum Disorders
Lars-Olov Lundqvist 0 1
Helen Lindner 0 1
0 School of Health Sciences, Örebro University , Örebro , Sweden
1 University Health Care Research Center, Faculty of Medicine and Health, Örebro University , P.O. Box 1613, 701 16 Örebro , Sweden
2 Lars-Olov Lundqvist
The Autism-Spectrum Quotient (AQ) is among the most widely used scales assessing autistic traits in the general population. However, some aspects of the AQ are questionable. To test its scale properties, the AQ was translated into Swedish, and data were collected from 349 adults, 130 with autism spectrum disorder (ASD) and 219 without ASD, and analysed with Rasch. Several scale properties of the AQ were satisfactory but it did not meet the criterion of a unidimensional measure of autistic traits. The Rasch analysis showed that the 50-item AQ could be reduced to a 12-item subset with little loss of explanatory power, with the potential to efficiently measure the degree to which adults with and without ASD show autistic traits.
Autistic traits; Adults; Autism-Spectrum Quotient; Rasch model
Autism spectrum disorder (ASD) is characterized by
persisting deficits in social communication and interaction,
alongside repetitive, stereotyped behavior and restricted
interests (APA, 2013). The number of adults diagnosed
with ASD has increased dramatically in the past decade
and ASD now accounts for a large burden on health care
(Fombonne 2009; Keyes et al. 2012)
. The global prevalence
varies greatly but is approximately 1% (Elsabbagh et al.
2012), with 1.8% in men and 0.2% in women
(Brugha et al.
. Autistic traits have moderate to high heritability, are
highly stable, and distributed on a continuum in the general
population, where ASD is at one extreme of the population
(Hoekstra et al. 2007; Robinson et al. 2011)
Studying autistic traits can give further insight into how
they relate to mental processes
(Kuo et al. 2014)
(Rivet and Matson 2011)
, and psychiatric
disorders such as anxiety and depression
. Screening for autistic traits in the
general population may be helpful in epidemiological research
because it may provide necessary sample size to investigate
relationships between autism phenotype severity and
theoretically important factors. Furthermore, examining autistic
traits in general population samples can serve as ‘analogue
studies’ for ASD, providing access to larger, more easily
accessible samples and thus allowing more complex
statistical analyses to be conducted
(e.g. Jackson and Dritschel
2016; Kunihira et al. 2006)
Among the variety of screening tools developed to
quantify autistic traits, over the past decade the most commonly
used is probably the Autism-Spectrum Quotient
Baron-Cohen et al. 2001a)
. The AQ has been used to screen
clinical samples (Woodbury-Smith et al. 2005) and to
predict performance on cognitive tasks
(Stewart et al. 2009)
(Baron-Cohen et al. 2001b)
(Hermans et al. 2009)
, gaze preference to
social and non-social stimuli
(Bayliss and Tipper 2005)
and auditory speech perception
(Stewart and Ota 2008)
The AQ is a self-administered questionnaire for
measuring the degree to which adults with normal intelligence
show autistic traits. It consists of 50 questions, with 10
questions assessing five different domains relevant for
autistic traits (social skill, attention switching, attention
to detail, communication, and imagination). Adequate
test–retest reliability has been shown in the AQ
(BaronCohen et al. 2001a) and the AQ sum scores are normally
distributed in the general population
(Hurst et al. 2007)
Cross-cultural equivalence in Dutch and Japanese samples
has also been shown
(Hoekstra et al. 2008; Kurita et al.
2005; Wakabayashi et al. 2006)
However, some aspects of the AQ are still
questionable. Baron-Cohen et al. (2001a) originally proposed a
unidimensional structure of the AQ based on descriptive
item analysis and sum score distribution across ASD and
non-ASD groups. The sum score is by far the most
commonly used AQ result, yet Baron-Cohen et al. (2001a) only
found adequate internal consistency
(defined as Cronbach’s
alpha above 0.70; Nunnally and Bernstein 1994)
in one of
the five autism trait domains in the AQ. Low Cronbach’s
alpha indicates a lack of correlation between the items in
a scale, which suggests deviation from unidimensionality.
The low degree of internal consistency in the AQ has been
(e.g., Austin 2005; Hoekstra et al.
2008; Hurst et al. 2007; Kloosterman et al. 2011; Stewart
and Austin 2009)
To date, studies using more advanced statistical
methods, such as factor analysis, have demonstrated that the AQ
may consists of five
(Kloosterman et al. 2011; Lau et al.
(Stewart and Austin 2009)
Hurst et al. 2007)
or two (Hoekstra et al. 2008) dimensions.
The two-factor model (actually two higher-order factors
and four primary factors) was confirmed in a validation of a
28-item short form of the AQ
(Hoekstra et al. 2011)
the unidimensional structure assumed by Baron-Cohen
et al. (2001a) has not been replicated.
A common feature of previous studies is that the
psychometric analyses are mostly based on non-ASD samples.
The choice of mainly student samples may be reasonable,
given that the AQ is directed towards autistic traits in the
general population. However, the feasibility of the AQ and
the theoretical basis of an autistic trait continuum require
that the properties of the AQ are similar among those with
and without ASD.
Another common feature of these studies is that they
apply classical test theory techniques, such as principal
component analysis, exploratory factor analysis or
confirmatory factor analysis. As shown by
factor analysis on ordinal data, if treated as interval data,
can result in spurious factors. In addition, item
distributions may differ from each other and therefore items will
tend to load on the same factor as other items with similar
distributions. One will thus make erroneous conclusions
about the scale, especially when sum score, as in AQ, is
used to define the degree of an underlying trait. Consistent
Stewart and Austin (2009)
noted that their initial
exploratory factor analysis suggested a large number of
poorly defined factors. Consequently, these numerous
factors may possibly reflect distribution properties and not the
underlying construct being measured. Therefore, we will
take a different approach in the present study and examine
the dimensionality of AQ using Rasch analysis.
have currently been applied
in the development and validation of unidimensional scales
with interval scale properties based on frequency questions
or Likert items. They facilitate calibration of the observed
test values with the underlying latent property
. Rasch analysis can thus determine the degree to
which items in the AQ accurately characterize autistic
traits. Rasch models facilitate analysis of whether an
instrument meets the requirements of invariance; for instance
whether the scale works in a similar manner among men
and women with and without ASD. Finally, the Rasch
model is a method to validate the interval properties of a
scale. An advantage of Rasch analysis is that it makes no
assumptions about the distribution of the latent property,
whereas in classical test theory techniques, normally
distributed latent variables are required. Hence, the aim of the
study was to test the scale properties of the Swedish AQ
using Rasch analysis.
Two samples, an ASD group and a non-ASD group, were
recruited for this study. The ASD group was recruited from
the Centre for Adult Habilitation, Region Örebro County,
Sweden. A total of 401 adults diagnosed with ASD and
without intellectual impairment (i.e., IQ > 70) were invited
to participate and 130 of them volunteered (68 men and 62
women, age 18–62, mean = 29.3 years, SD = 9.9). No age
difference was found between the participants and the
nonparticipants; however, the proportion of participating men
(28%) was significantly lower than the proportion of
participating women (40%) (χ2 = 6.25, p < 0.05).
The non-ASD group consisted of 219 university students
recruited from various departments at Örebro University
(93 men and 126 women, age 18–55 years, mean = 23.8
years, SD = 5.7). None of them reported having an ASD
diagnosis. No age difference was found between men and
women (t(217) = 0.68, p = 0.50) and the sex ratio of the
sample was equivalent to that of the university (i.e., 60%
The ASD and non-ASD groups differed in regard to
sex and age. The ASD group had significantly more men
than the non-ASD group (χ2 = 9.43, p < 0.01) and the
ASD group was on average older than the non-ASD group
(t(347) = 9.06, p < 0.001).
The Autism-Spectrum Quotient
The Autism-Spectrum Quotient
(AQ; Baron-Cohen et al.
is a 50-item self-report questionnaire for measuring
the degree to which an adult with normal intelligence has
the traits associated with the autistic spectrum. The items,
which are given in Table 3, assess five different domains
(10 items per domain): social skill, attention switching,
attention to detail, communication, and imagination. All
items are scored on a four-point rating scale ranging from
1 = definitely agree to 4= definitely disagree. The scorings
are reversed (from 4 = definitely agree to 1= definitely
disagree) for the items in which an “agree” response indicates
an autistic trait. The following items were reversed: 2, 4, 5,
6, 7, 9, 12, 13, 16, 18, 19, 20, 21, 22, 23, 26, 33, 35, 39, 41,
42, 43, 45, and 46. All item scores are summed; thus, AQ
sum score can vary between 50 (at the lowest extreme of
the autistic trait continuum) and 200 (at the highest extreme
of the autistic trait continuum).
The AQ was translated into Swedish after permission
from Professor Simon Baron-Cohen. The translation was
performed independently by two professional translators.
The two translations were compared and the few minor
discrepancies that emerged, which consisted of different
choices of synonymous words or sentence structure, were
discussed with the translators. Subsequently, a third
professional translator translated the Swedish version back into
English to confirm equivalence with the original. Hence,
the Swedish version of AQ is linguistically similar to the
English original. The Swedish translation is available from
the first author.
The adults with ASD received the study information, the
study consent form, the AQ questionnaire, and a prepaid
envelope by post. The students (non-ASD group) were
informed verbally about the study and completed the
AQ questionnaire during lectures. No course credit was
IBM SPSS Statistics version 22 (IBM Corp, Armonk, NY)
was used to summarize participant characteristics and to
evaluate group differences using t-tests. A p value below
0.05 was regarded as significant. The AQ rank-ordered
scores were analyzed using Rasch rating scale model with
. Detailed explanation of
Rasch models is given elsewhere
brief, Rasch analysis converts rank-ordered data into
interval logit measures, giving each person and each item a logit
measure. Logit stands for Log-Odds Unit and form an equal
interval linear scale. The logit scale is unaffected by
variations in the distribution of measures and independent of
the particular items included in a test or the particular
samplings of people
. Thus, an ‘AQ person
measure’ represents the degree to which a person shows autistic
traits (the higher the logits, the higher the degree of autistic
traits). An ‘AQ item measure’ represents how difficult any
particular item may be to endorse given a specific degree
of autistic traits (the higher the logits, the more difficult to
endorse). Rasch analysis enables the researchers to identify
whether any items are misleading and whether the rating
categories have been used as intended by the instrument
The four rating categories were examined according to
: (i) there should be at least 10
responses in each rating category, (ii) the average AQ
person measure should be lower in a category representing low
AQ than in one representing high AQ, (iii) the transition
point between each two categories (threshold) should
follow an increasing level of the underlying autistic trait, and
(iv) the category outfit mean square should be less than 2.0.
The rating scale graphs generated by Winsteps were used
to examine the ordering of thresholds and how the rating
categories were positioned along the latent variable.
Point–measure correlations, local item independence, and
fit statistics were used to examine the item properties.
Point–measure correlation of each item reports the
relationship between the group’s performance on the item and the
group’s performance on the whole instrument. All items
are expected to correlate positively in the direction of the
latent variable, if any items show negative correlations it
is assumed that these items are considered invalid. Local
item independence assessed whether responses to any item
were unrelated to any other item when trait level was
controlled; thus, the endorsement of any item should not affect
the probability of endorsement of the other items. Violation
of local item independence may affect parameter estimates.
An item residual correlation of at least 0.7 (i.e., common
variance approximately 0.50) was set as a criterion for item
. Fit statistics detect the extent
to which the response pattern observed in the data matches
the one expected by the model. In this study, an item was
considered as misfit if infit and outfit mean square was
greater than 1.50.
Differential Item Functioning
Differential item functioning (DIF) was used to examine
whether an item performed differently for the ASD group
than for the non-ASD group. For this study, item DIF was
considered present if the difference between two groups on
an item measure was 0.5 logits or more and reached
significance (p < 0.05) in a t test
Scale reliability was evaluated in terms of person
reliability, an index similar to Cronbach’s alpha: for the range 0–1,
coefficients above 0.70 are considered as a minimum for
group use and coefficients above 0.85 for individual use
(Tennant and Conaghan 2007)
Principal components analysis of residuals was used to
examine whether the five AQ domains measure
different dimensions or work together to measure one
dimension. We used two criteria: at least 50% of the total
variance should be explained by the first latent variable and any
additional factor should explain less than 5% of the
remaining variance after removal of the first latent variable
We explored the potential use of the AQ to measure a
clinical population by examining the targeting of item difficulty
(not too easy, not too hard) to the individual’s trait level
in the person–item map. The map orders person and item
measures along the same scale, which enables us to
examine whether the AQ has enough items to discriminate
people with different levels of autistic traits. The item difficulty
range is expected to match the range of autistic trait
levels in the ASD group. A value around zero thus indicates
that the items are well targeted for the people in the sample
(Tennant and Conaghan 2007)
Sensitivity and Specificity
Sensitivity and specificity of the AQ as a screening tool
for ASD was evaluated using the receiver operating
characteristic (ROC) curve and area under the curve (AUC)
calculated for the full AQ scale and the five AQ domains.
The Youden index
, which is the point
at which the tangent to the ROC curve is parallel to the
chance line, was used to find the optimal cut-off scores.
This index has been used in the development of
diagnostic assessments for ASD
(Cohen et al. 2010)
regarded as one of the most stringent statistical method
to identify a cut-off or threshold in diagnostic measures.
Mean AQ person measure for the ASD group was
significantly higher (t(347) = 15.02, p < 0.01) than the mean AQ
person measure for the non-ASD group (Table 1). No
significant differences between men and women were found
in either group.
Both groups fulfilled the rating scale criteria (Table 2).
That is, there were more than 10 responses in each rating
category, average person AQ measure increased with the
rating category, thresholds were ordered, and category
outfit mean square was below 2.0. The probability that
an individual with a given autistic trait level will select a
response category is shown in Fig. 1. For any given point
along the x-axis (representing autistic trait continuum),
the category most likely to be chosen by an individual is
shown by the category curve with the highest
probability. An optimally functioning scale should have each
category most likely to be selected for an equal interval on
the scale, which the AQ demonstrated.
Frequency of use’: the number of persons rated in that category. ‘Average AQ person measure’: observed mean person measure (in logits) in
each rating category. ‘Threshold measure’: the difficulty measure between every two adjacent categories. Infit mean square and outfit mean
square examine the consistency of use of each rating category; this should not exceed 2.0. (AQ = Autism-Spectrum Quotient, ASD = autism
Three items, 29 “I am not very good at remembering
phone numbers”, 30 “I don’t usually notice small changes
in a situation, or a person’s appearance”, and 49 “I am
not very good at remembering people’s date of birth”,
had point–measure correlations lower than zero (−0.02,
−0.18, and −0.01, respectively). The negative
correlations suggest that people with high scores on these
items had a lower autistic trait level, not higher as was
Local Item Independence
All items showed standardized residual correlations below
0.7. The greatest standardized residual correlations were
between items 17 and 38 (0.58) and between items 44 and
As shown in Table 3, the logit measures of the 50 items
ranged from 0.99, most difficult to endorse (item 09 “I am
fascinated by dates”), to −1.11, easiest to endorse (item
30 “I don’t usually notice small changes in a situation, or
a person’s appearance”), both in the domain Attention to
detail. Five items were misfit: item 21 in Imagination and
items 9, 29, 30, and 49 in Attention to detail.
Five items showed DIF between the ASD and non-ASD
groups: items 13 (−1.09 logits), 22 (−0.93 logits), and
44 (0.79 logits) in the domain Social skill, item 14 (0.81
logits) in Imagination and item 19 (−0.91 logits) in
Attention to detail. Note that items 13, 19, and 22 have reversed
scoring. Given identical levels of autistic traits, items 13 “I
would rather go to a library than a party”, 19 “I am
fascinated by numbers”, and 22 “I find it hard to make new
friends” were thus more likely to be endorsed by those in
the ASD than those in the non-ASD group, whereas items
14 “I find making up stories easy” and 44 “I enjoy social
occasions” were more likely to be endorsed by those in the
The principal components analysis of all 50 items showed
that the AQ instrument did not fulfill the
unidimensionality criteria. The raw variance explained by the measures
*Designates a reverse-scored item. Bold designates misfit items. Higher item logits denotes a more “difficult” item. Higher mean raw score
denotes higher degree of autistic traits. (Logit log-odd unit, ASD autism spectrum disorder)
(which should be above 50%) was 26.2% and the
unexplained variance in first contrast (which should be below
5%) was 7.7%. Three clusters were formed and we repeated
the analyses with each cluster of items. Only one cluster
fulfilled both criteria, showing a raw variance explained
by the measures of 52.8% and an unexplained variance in
first contrast of 2.7%. This cluster consisted of 12 items:
11, 13, 22, 44, and 47 in the domain Social skill, 10, 32,
34, and 46 in Attention switching, and 17, 26, and 38 in
The range of AQ items targeted well, showing person
means and item means close to each other, with a mean
measure of −0.31. The targeting in the ASD group was
excellent, with a mean measure of 0.04 (Fig. 2) whereas
it was acceptable in the non-ASD group, as indicated by a
mean measure of −0.61 (Fig. 3).
Person separation was 2.52 and person reliability was 0.86.
Item separation was 7.29 and item reliability was 0.98.
Fig. 2 Person–item map for the ASD group: AQ person measures in
relation to AQ item measures in logits. (M mean, S 1 standard
deviation (SD) from the mean, T 2 SD from the mean, AQ
Autism-Spectrum Quotient, ASD autism spectrum disorder)
The ROC curves for the full AQ scale and the five AQ
domains are shown in Fig. 4. The AUC was significant for
all domains, the sensitivity varied between 48 and 75%, and
specificity varied between 66 and 93% (Table 4). A sum
raw score of 118 was identified as the optimal screening
cut-off score for the full AQ scale, where Youden’s index
was 0.65 (95% CI 0.55–0.71). The correct classification
was 85.2% (95% CI 80.6–88.1%), the positive predictive
value was 0.85 (95% CI 0.79–0.91), and the negative
predictive value was 0.85 (95% CI 0.82–0.87). The AQ sum
score distribution for ASD and non-ASD participants is
shown in Fig. 5.
The study tested the scale properties of the Swedish AQ
using the Rasch rating scale model, with mixed results:
several scale properties were good to excellent whereas
others were poor. On the one hand, the AQ fulfilled the rating
scale criteria, had minimal DIF, adequate item properties,
adequate item and person separation and reliability, and
excellent targeting for the ASD group; on the other hand,
the AQ did not meet the criteria for a unidimensional scale.
In regard to item properties, five items were misfit and
thus did not fit the expected model: item 21 in the domain
Imagination and items 9, 29, 30, and 49 in Attention to
detail. Three of the items (29, 30, and 49) had negative
point–measure correlations, with the scoring orientation
on these items opposite to the orientation of the latent
variable (the degree of autistic traits). Reasons for
negative point–measure correlations can, for instance, be
person-specific knowledge, guessing, or reverse scoring. It is
notable that all three items are negatively worded and that
these items were also scored higher by the non-ASD group
than the ASD group, suggesting that the items do not
represent a measure of autistic traits and need revision. This is in
line with previous studies finding low or negative domain
loadings for these items
(Austin 2005; Hoekstra et al. 2008;
Hurst et al. 2007; Stewart and Austin 2009)
. It should be
noted that in the development of the AQ, Baron–Cohen
(Baron–Cohen et al. 2001a)
items 29 and 30 were scored higher by controls than adults
with Asperger’s syndrome or high-functioning autism, but
nevertheless were retained in order to reduce the group
No item pair was locally dependent, although item
residuals were moderately correlated between “I enjoy social
chit-chat” (item 17) and “I am good at social chit-chat”
(item 38), and between “I enjoy social occasions” (item
44) and “I enjoy meeting new people” (item 47). In both
pairs, the items are similar in meaning. Even if they fit the
model, use of highly similar worded items will boost the
items’ correlation with the total score while providing no
unique information about the responder. In the presence of
local dependency, it is recommended that one of the similar
items should be excluded due to potential redundancy.
Five of the 50 items showed DIF, three from the Social
skill domain, one from the Imagination domain, and one
from the Attention to detail domain. Interestingly, the DIF
indicated that these items exaggerated the group
differences in the expected direction. That is, people with ASD
are expected to be less socially skilled and imaginative and
more attentive to details than those without ASD; these
items thus highlight the group differences more distinctly
than the other items in the AQ. Absence of DIF is crucial
for an adequate scale
(Tennant and Conaghan 2007)
given this overestimation bias—that only five out of 50
items showed DIF and that all but one of these items were
below 1 logit—it would appear that the AQ items, for all
practical purposes, are adequate for people with as well as
The AQ items targeted well at the individuals with ASD.
However, as shown in the person–item maps, most of the
non-ASD respondents were clustered at the lower end of
the measures, indicating a low position on the autistic
continuum, while many of the items were concentrated at the
higher end of the continuum. This would suggest that the
set of AQ items is less appropriate for measuring degree
of autistic traits in the non-ASD group. Furthermore, the
result is reasonable given that the AQ was developed to
screen adults with Asperger’s syndrome or
high-functioning autism, who are more likely to endorse many of the
items. During piloting of the AQ, Barron-Cohen (2001a)
excluded the items (except items 29 and 30) if non-ASD
people selected ‘definitely disagree’ or ‘slightly disagree’
more often than did people with Asperger’s syndrome or
high-functioning autism. Consequently, non-ASD
respondents would be less likely to endorse items on the AQ and
they will thus show worse targeting.
The Rasch analysis supported most of AQ scaling
properties but failed to support Barron-Cohen et al.’s (2001a)
assumption that AQ measures a single latent variable,
namely, the degree of autistic traits. This result is in line
with previous research using factor analysis
Hoekstra et al. 2008; Hurst et al. 2007; Stewart and
and Mokken scaling
(Stewart et al. 2015)
hypothesized single latent variable is not consistent with
the multidimensional nature of ASD, as expressed in the
Diagnostic and Statistical Manual of Mental Disorders,
(American Psychiatric Association 2013)
, or with
the fact that Barron-Cohen (2001a) selected the AQ items
from the domains in the “triad” of autistic symptoms. The
use of a single AQ sum score may therefore not adequately
express the multifaceted aspect of ASD.
By reducing the AQ to 12 items from the Social skill,
Attention switching, and Communication domains, we
were able to meet both criteria for unidimensionality.
Intriguingly, nine of these items (11, 13, 17, 22, 26, 34, 38,
44, and 47) are among the ten items that passed the
Mokken scaling test on people with ASD
(Stewart et al. 2015)
Hoekstra et al. (2008), using CFA, found that the AQ
consisted of two second-order factors, one of them including
Social skill, Attention switching and Communication. Using
different evaluation methods we thus converged on a
similar conclusion: the AQ measures more than one latent
variable and consists of an unnecessarily large number of items
in order to measure a unidimensional autistic trait. Despite
this, a majority of empirical studies use the AQ sum score
as the sole measure of an autistic tendency. If the AQ
measures a set of (somewhat related) constructs, what exactly
does an AQ sum score mean and what consequences does
this have for our understanding of autism?
According to the psychometric literature, if the
assumption of unidimensionality is violated, any statistical
analysis based on it would be misleading. Specifically, estimates
of the latent variables and item parameters will generally
be biased because of model misspecification, which in
turn leads to incorrect decisions on subsequent statistical
analysis, such as testing group differences and correlations
between latent variables
(e.g., Horton et al. 2013)
It should be noted that unidimensionality is a relative
matter. The judgment of whether a scale is sufficiently
unidimensional should ultimately come from outside the data
and be driven by the purpose of measurement, clinical, and
(Andrich 1988; Cano et al. 2011;
A pragmatic way to salvage a situation like this would
be to treat the AQ sum score as an index, in other words,
a formative latent variable (see
overview). A formative latent variable is defined by a
number of non-interchangeable composite indicators, such as
income, education, and occupation in the variable
socioeconomic status, or weight and height in the variable body
mass index. Consequently, a formative latent variable does
not exist at a deeper conceptual level than its defining
(Law et al. 1998)
. Following this path, AQ
sum score will lose content validity and serve as a mere
observable outcome and predictor variable.
To what extent, then, can the AQ predict presence of
ASD? The person reliability and separation indices of the
AQ were adequate, as were the item reliability and
separation indices. The AQ has the potential to classify three
groups of people (low, average, and high degree of autistic
traits) and is at a level of sensitivity required for both group
and individual use
(Tennant and Conaghan 2007)
. The AQ
may also be able to separate more than ten item difficulty
levels, which confirms its item difficulty hierarchy, in other
words, its construct validity. The AQ sum score
differentiated well between the ASD group and the non-ASD group.
The AUC was above that found on similar populations in
(e.g. Woodbury-Smith et al. 2005)
but lower than
that reported in the Netherlands (Wouters and Spek 2011)
(Broadbent et al. 2013)
. Regarding the AQ
domains, the ROC indicated that the domains Social skill,
Attention switching, and Communication had adequate
AUC (above 80%), whereas the AUC of Imagination was
fair and the AUC of Attention to detail, though above
chance, was poor (below 60%). This is in line with the
large proportion (40%) of misfit items in this domain and
with previous studies showing that Attention to detail is the
poorest domain in the AQ for differentiating people with
and without ASD diagnoses
(Allison et al. 2012; Wouters
and Spek 2011)
The AQ logits and sum scores obtained for each
individual were highly correlated (r = 0.998); suggesting that
summed raw scores adequately reflected true change along
the autistic traits continuum that the AQ quantifies.
However, it should be borne in mind that the conversion to
logits would only be motivated if the sample
characteristics are similar to those of the present study. Consequently,
Rasch analyses are needed prior to using the AQ on other
Although this study provides an important contribution to
our understanding of the AQ and the assessment of
autistic traits in people with and without ASD, there are a
number of limitations that warrant discussion. First, the groups
were not matched for sex and age. The participants in the
non-ASD group were younger and included a larger
proportion of women than the ASD group. Despite sex and
age differences, the DIF analyses showed few discrepancies
between the ASD and non-ASD groups. Consistent with
previous research, there was no difference between mean
AQ sum scores of men and women with ASD
(BaronCohen et al. 2001a, 2006; Hoekstra et al. 2008)
Moreover, the sample size fulfilled the requirement of
stable calibration for Rasch analysis but the subgroups for
DIF analysis were too small
(see Linacre 2013)
to draw a
definite conclusion regarding whether, for example, sex- or
age-related DIF was present in the items in either the ASD
or the non-ASD group. Therefore, any conclusions
regarding sex or age differences between groups should be
interpreted with caution.
Furthermore, some of the ASD participants attached
comments to their questionnaires that it was somewhat
challenging for them to complete so many questions. It is
reasonable to conclude that some people with ASD,
regardless of their motivation to complete the questionnaire, may
have lacked the ability to do so. Although all people with
ASD registered in the county were invited to participate,
the results are only generalizable to those with the ability to
complete the AQ questionnaire. This may have less impact
on estimated AQ scale properties, because the reported
level of autism traits as quantified by AQ is probably an
underestimation of the true level in the ASD population. In
addition, the non-ASD sample completed the AQ
anonymously, which meant that we could not verify whether any
of them had an ASD diagnosis or would fall within that
Our findings suggest that several measurement properties
of the AQ were good and that it had adequate sensitivity
and specificity to distinguish people with ASD from those
without ASD, though the AQ sum score did not perform
better than the Social skill domain alone. Nevertheless, the
AQ cannot be described as a unidimensional measurement
of the degree to which adults with normal intelligence show
autistic traits. Thus, the AQ sum score is probably best
regarded as an index. The complementary Rasch analysis
showed that the 50-item AQ could be reduced to a 12-item
subset with little loss in explanatory power. Following
replication on a new sample, this subset of AQ items has the
potential to efficiently measure the degree to which adults
with and without ASD show autistic traits.
Acknowledgments This study was funded by the Research
Committee of Region Örebro County (Grant No. OLL-407141). We are
grateful to Agnes Österlund and Mimmi Bäckström for help with
the data collection and Dr. Gustav Jarl for valuable comments and
Author Contributions LOL and HL collectively conceived the
study, participated in its design, assisted with analysis and
interpretation of data, drafted the manuscript, and revised it for important
intellectual content. Both authors read and approved the final manuscript.
Compliance with Ethical Standards
Ethical Approval The study was approved by the Regional Ethical
Review Board in Uppsala, Sweden.
Open Access This article is distributed under the terms of the
Creative Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted
use, distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a
link to the Creative Commons license, and indicate if changes were
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