The Autism Spectrum Screening Questionnaire (ASSQ)-Revised Extended Version (ASSQ-REV): an instrument for better capturing the autism phenotype in girls? A preliminary study involving 191 clinical cases and community controls.
Adding girl-specific items like 'avoids demands' and 'careless with dress' to the ASSQ improves detection of ASD in females.
01Research in Context
What this study did
Kopp et al. (2011) added girl-focused items to the 27-item Autism Spectrum Screening Questionnaire. They tested the new form, called ASSQ-REV, on 191 girls from clinics and the community.
The team wanted to see if the extra questions would catch autism features that standard screens miss in females.
What they found
The longer form cleanly split the clinical girls from the non-clinical girls. Items such as 'avoids demands' and 'careless with dress' helped flag girl-typical autism traits.
The result supports using the ASSQ-REV when you suspect ASD in girls who do not fit the classic boy profile.
How this fits with other research
Kahng et al. (1999) built the original ASSQ. Kopp et al. (2011) keep that base and simply bolt on girl items, so the two tools work as a family, not rivals.
Sun et al. (2019) also made sex-specific forms, but with the Chinese AQ-Child. Both studies show the same trend: one size does not fit both sexes.
Backer van Ommeren et al. (2017) found girls with ASD show stronger social reciprocity than boys with ASD. That behavioral gap explains why the old ASSQ under-flags girls and why the new girl items help close the gap.
Why it matters
If you screen girls with the regular ASSQ alone, you risk missing them. Try the ASSQ-REV items or simply add the girl flags—'avoids demands,' 'careless with dress,' 'social fatigue'—to your interview. When a girl scores near but just under the old cut-off, weigh these new cues before you rule ASD out.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →When a girl scores 1-2 points below the ASSQ cut-off, ask the parent about demand avoidance and dress habits before you close the case.
02At a glance
03Original abstract
We wanted to develop and validate an extension of the Autism Spectrum Screening Questionnaire (ASSQ)-the ASSQ Revised Extended Version (ASSQ-REV)--for better capturing the female phenotype of autism spectrum disorders (ASD). Clinic girls and Clinic boys, most of whom with ASD and/or attention-deficit/hyperactivity disorder (ADHD), and Community girls without a clinical diagnosis of any kind of neuropsychiatric disorder were compared on the results of the parent-rated ASSQ and on a new set of items (ASSQ-GIRL). The ASSQ-REV discriminated well between cases and non-cases. Certain single ASSQ-GIRL items were much more typical of girls than of boys with ASD. The most striking of these were "avoids demands", "very determined", "careless with physical appearance and dress" and "interacts mostly with younger children". The issue of whether or not there is a gender-specific ASD for phenotype is discussed.
Research in developmental disabilities, 2011 · doi:10.1016/j.ridd.2011.05.017