Investigating diagnostic bias in autism spectrum conditions: An item response theory analysis of sex bias in the AQ-10.
The AQ-10 treats men and women equally, so you can screen adult clients without sex adjustments.
01Research in Context
What this study did
Murray et al. (2017) checked if the short Autism Spectrum Quotient (AQ-10) favors one sex.
They used item-response math on adults with and without autism. The goal was to see if boys or girls score higher for reasons other than autism.
What they found
The total AQ-10 score showed no sex bias. A few single items leaned one way, but the pulls canceled out.
Clinicians can keep using the ten-item screen as-is for both men and women.
How this fits with other research
Booth et al. (2013) had already shown the AQ-10 catches autism as well as the long 50-item form. Louise adds the fairness check.
Two toddler studies seem to clash. Kocher et al. (2015) and Andersson et al. (2013) found no sex gap in preschoolers, while many clinicians say girls are missed. The gap is age: Louise looked at adults, the others at tiny kids.
Frazier et al. (2023) later stretched the same tool to Hong Kong Chinese adults and still kept the accuracy, showing the neutral score travels across cultures.
Why it matters
You can trust the AQ-10 total for any adult client. No need to lower the cut score for women or raise it for men. Keep the screen in your intake packet and spend your energy on the clinical interview, not on re-weighting items.
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02At a glance
03Original abstract
Diagnostic bias is a concern in autism spectrum conditions (ASC) where prevalence and presentation differ by sex. To ensure that females with ASC are not under-identified, it is important that ASC screening tools do not systematically underestimate autistic traits in females relative to males. We evaluated whether the AQ-10, a brief screen for ASC recommended by the National Institute of Clinical Excellence in cases of suspected ASC, exhibits such a bias. Using an item response theory approach, we evaluated differential item functioning and differential test functioning. We found that although individual items showed some sex bias, these biases at times favored males and at other times favored females. Thus, at the level of test scores the item-level biases cancelled out to give an unbiased overall score. Results support the continued use of the AQ-10 sum score in its current form; however, suggest that caution should be exercised when interpreting responses to individual items. The nature of the item level biases could serve as a guide for future research into how ASC affects males and females differently. Autism Res 2017, 10: 790-800. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
Autism research : official journal of the International Society for Autism Research, 2017 · doi:10.1002/aur.1724