Autism Spectrum Screening Questionnaire (ASSQ)

Abstract

The Autism Spectrum Screening Questionnaire (ASSQ) is a 27-item instrument developed by Ehlers, Gillberg, and Wing (1999) designed for the initial identification and screening of high-functioning individuals for characteristics associated with Autism Spectrum Disorder (ASD), particularly those historically classified under Asperger syndrome. The questionnaire is typically completed by parents or teachers of children and adolescents aged 6 to 17 years. It is specifically calibrated for subjects possessing normal to high IQ or only mild intellectual disability, making it a targeted tool for the milder end of the autism spectrum. A total score ranging from 0 to 54 is generated, where a score of 13 or higher suggests a probable diagnosis of ASD.

Keywords

Autism Spectrum Screening Questionnaire, ASSQ, Autism Spectrum Disorder, ASD, Asperger syndrome, screening tool, high-functioning autism, child assessment, psychological scale

Authors

S. Ehlers, C. Gillberg, L. Wing

Purpose

The primary purpose of the ASSQ is to serve as a quick and efficient screening measure to identify school-age children and adolescents (6–17 years) who may exhibit traits consistent with high-functioning autism spectrum disorders. It functions as an initial filter in clinical and educational settings, indicating the need for a more comprehensive diagnostic evaluation.

Crucially, the scale focuses on characteristics typical of individuals with high cognitive abilities or mild intellectual impairments who are on the spectrum. The developers intentionally excluded individuals with moderate or severe intellectual disability, as the 27 items of the ASSQ are not designed to capture the specific features characteristic of lower-functioning subjects. The use of the scale is rooted in the historical conceptualization of Asperger syndrome, focusing on the social, communication, and restricted interest patterns seen in these populations.

Construct

The ASSQ measures a specific profile of behaviors and characteristics related to deficits in social interaction, communication, and the presence of restricted, repetitive patterns of behavior, interests, or activities, consistent with the definition of Asperger syndrome (DSM-IV criteria at the time of development). The 27 items cover various domains, including peculiar language use, social naiveté, lack of empathy, idiosyncratic interests, motor clumsiness, and adherence to routines.

The items reflect observable behaviors that differentiate the child from their peers. Examples include having restricted idiosyncratic intellectual interests, displaying a literal understanding of language, lacking empathy, and struggling with peer relationships. The scoring system (0 = No, 1 = Somewhat, 2 = Yes) captures the severity or frequency of these distinguishing characteristics, contributing to a total score that reflects the overall presence of ASD symptomatology.

Validity

Validation efforts demonstrated strong empirical support for the ASSQ’s utility in identifying the target population. In the initial study by Ehlers, Gillberg, and Wing (1999), a validation sample of 87 boys and 23 girls (aged 6 to 17) independently diagnosed with ASD (specifically, DSM-IV Asperger’s) achieved an average score of 25.1 (Standard Deviation 7.3). These scores were comparable to those found in the main autism spectrum disorder group.

The diagnosis for the validation sample was confirmed independently by both a psychologist specializing in the disorder and a child psychiatrist, ensuring robust criterion validation. Furthermore, Convergent validity was established by correlating parent ratings on the ASSQ with scores from the Rutter scale, yielding a strong positive Pearson correlation coefficient of r = .75 (n = 107; p < .0001). This high correlation suggests that the ASSQ measures similar underlying constructs to established behavioral scales.

Reliability

Interrater reliability was assessed by comparing scores derived from different informants (parents versus teachers). The mean interrater difference on the ASSQ, calculated using a paired t-test, was found to be -1.96 (t(104) = -2.39; p = .0188). While statistically significant, this difference is relatively small, suggesting a generally high level of consistency in reporting across different observational contexts (home and school).

Additionally, the study found no significant differences in the mean total score on the ASSQ based on gender or across subjects classified as normally developing versus those with mild intellectual disabilities. This stability suggests that the instrument performs reliably across these demographic subgroups within the intended population range.

Factor Analysis

While the source content does not explicitly detail a formal factor analysis structure (e.g., number of factors or specific factor loadings), the 27 items are conceptually grouped to reflect the core diagnostic areas of Autism Spectrum Disorder: deficits in social interaction, communication anomalies, and restricted/repetitive behaviors and interests. Subsequent research often suggests that screening instruments like the ASSQ tend to yield a strong general factor related to autism severity, though specific subscales (e.g., social difficulties, language peculiarities) are often implied by the item content.

Instrument

Test Type: Screening Questionnaire/Rating Scale

Format: 27-item questionnaire rated on a 3-point Likert scale (0=No, 1=Somewhat, 2=Yes).

Language Available: English (Original development language). Translations may exist in various academic settings.

Population Group: Children and adolescents suspected of having Autism Spectrum Disorder, particularly high-functioning profiles.

Age Group: 6 to 17 years.

Population Details: Appropriate for those with high or normal IQ, or those with only mild intellectual disability. Not recommended for individuals with moderate or severe intellectual disability.

Test Methodology: Informant report (Parent or Teacher) screening tool. The total score ranges from 0 to 54. A cutoff score of 13 or above indicates probable ASD, achieving a true positive rate of 90%.

Keywords

Psychometrics, screening tool, child development, high-functioning ASD, parent report, teacher report, cutoff score, Ehlers, Gillberg, Wing

Authors

Author ORCID Identifier: Not specified in the primary reference.

Affiliation Email addresses: Not specified in the primary reference.

Correspondence Address: Not specified in the primary reference.

Permissions & Fee and Test Year

Test Year: 1999 (Year of primary validation study and publication).

Permissions and Fees: Information regarding current licensing and fees is not provided in the primary source document. The scale is widely used in academic research and clinical practice, often available for non-commercial use.

Reference’s

• Ehlers, S., Gillberg, C., & Wing, L. (1999). A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. Journal of autism and developmental disorders, 29(2), 129-141.

Items of the Autism Spectrum Screening Questionnaire (ASSQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Please read the statement below and indicate by tapping, no, Somewhat, or Yes if this child stands out as different from other children of his/her age in the following ways: