Likelihood of identifying autistic traits with the autism spectrum quotient (AQ) in male juveniles with autism spectrum disorder (ASD) and severe behavioral problems (SBPs)

BACKGROUND: When screening for autism spectrum disorders (ASD), the Autism Spectrum Quotient (AQ) is generally considered to be useful. Whether the AQ is also a suitable screener for ASD in juveniles with severe behavioral problems (SBPs) is unknown. Due to the overlap of symptoms between ASD and SBPs, particularly in juveniles low on empathy, the screening capacity of the AQ might be constrained. The aim of the present study was to investigate whether (comorbid) SBPs affect the screening capacity of the AQ. The hypothesis is that male juveniles with SBPs - but without a diagnosis of ASD - will score higher than male juveniles without both SBPs and ASD. METHOD: The AQ was completed by 216 male juveniles aged 15–18 years treated at an outpatient department of child and adolescent psychiatry. The 216 participants were categorized into four groups according to a clinical diagnosis of ASD and SBPs (defined as disruptive behavior disorder and/or delinquent behavior). Using multinomial logistic regression, we investigated whether the four identified groups, based on a diagnosis of ASD and SBPs, scored differently for the total score and subscales of the AQ. RESULTS: Participants in the group with ASD (ASD(+)) but without SBPs (SBP(-)) were more likely to report higher levels of autistic traits than the reference group without both ASD and SBPs (ASD(-)SBP(-)), except for the subscale on attention to detail (ASD(+)SBP(-) OR = 1.04; 95%CI = 0.98–1.11). Participants in the group with both ASD and SBPs were more likely to report higher levels for the total AQ score (ASD(+)SBP(+) OR = 1.03; 95%CI = 1.00–1.05) and the communication subscale of the AQ (ASD(+)SBP(+) OR = 1.18; 95%CI = 1.07–1.31) than the reference group without both ASD and SBPs. CONCLUSION: In outpatient male juveniles, SBPs do not affect the screening capacity of the AQ for autistic traits. In spite of the well-known overlap of symptoms between ASD and SBPs, male juveniles with SBPs but without a diagnosis of ASD do not score higher on the AQ than male juveniles without SBPs and without a diagnosis of ASD.