Psychometric Properties of Questionnaires and Diagnostic Measures for Autism Spectrum Disorders in Adults: A Systematic Review

Background: Accurately diagnosing autism spectrum disorders (ASD) in adulthood can be challenging. Structured questionnaires (SQs) and diagnostic measures (DMs) are frequently used to assist case recognition and diagnosis.

Objectives: This study reviewed research evidence on SQs and DMs published since the UK National Institute for Health and Care Excellence evidence update (NICE; 2014).

Methods: The Cochrane library, Medline, Embase and PsycINFO were searched.

Results: Nineteen studies met inclusion criteria. Sensitivity and specificity of SQs was best for individuals with previously confirmed ASD diagnoses, and reduced in participants referred for diagnostic assessments, with discrimination of ASD from mental health disorders especially limited. For adults with intellectual disability diagnostic accuracy increased when a combination of SQs were used. Evidence suggests some utility of DMs in identifying ASD amongst clinic referrals, though specificity for diagnosis was relatively low.

Conclusions: In mental health settings the use of a single SQ is unlikely to accurately identify adults without ASD, or differentiate ASD from mental health disorders. This is important as adults seeking an ASD diagnostic assessment are likely to have co-existing mental health disorders. Robust ASD assessment tools specifically for use in adult diagnostic health services in the presence of co-occurring mental health and neurodevelopmental disorders is a research priority.