The identification and measurement of autistic features in children with septo-optic dysplasia, optic nerve hypoplasia and isolated hypopituitarism.

Doctors gave the Social Communication Questionnaire (SCQ) to the children with septo-optic dysplasia or optic nerve hypoplasia. These kids have small or missing optic nerves and often can't see well.

The team also tested IQ and asked parents about autism traits. They wanted to know how many kids met ASD cut-offs and whether vision loss changed the scores.

Half the children scored above the ASD cutoff on the SCQ, but most of those also had severe intellectual disability. When IQ was low, the SCQ almost always said "possible autism," even if the child did not act autistic in daily life.

Vision level mattered too. Kids who were nearly blind missed SCQ questions that depend on seeing (like "does he point at planes?"). The tool called them autistic when the real problem was poor eyesight.

Amaral et al. (2017) saw the same pattern in Down syndrome: screening tools flag many kids, but social scores are milder than in typical ASD. Both studies warn us—syndrome plus low IQ can fake an ASD screen.

Smit et al. (2019) used the same SCQ in youth prisons and also found high false-positives. Together the papers show the SCQ works best when kids have average vision and no major cognitive delay.

Posserud et al. (2009) proved the SCQ is accurate in the general population. Jagjeet et al. now show that promise breaks down once vision or IQ drops—an apparent contradiction that disappears when you check the child's context.

If you assess a child with SOD/ONH, still screen for ASD, but never trust the SCQ alone. Add parent interview, direct observation, and a note about visual ability. When IQ is below 55, expect a high SCQ and gather extra evidence before you label—or treat—the child as autistic.