Psychometric properties of a screening tool for autism in the community—The Indian Autism Screening Questionnaire (IASQ)

Abstract

Introduction Currently available screening questionnaires for Autism spectrum disorders were tested in developed countries, but many require additional training and many are unsuitable for older individuals, thus reducing their utility in lower/ middle- income countries. We aimed to derive a simplified questionnaire that could be used to screen persons in India. Methods We have previously validated Indian Scale for Assessment of Autism (ISAA), that is now mandated for disability assessment by the Government of India. This detailed tool requires intensive training and it is time consuming. It was used to derive a new screening questionnaire: 1) items most frequently scored as positive by participants with autism in original ISAA validation study were modified for binary scoring following expert review. 2) In a new sample, clinically diagnosed individuals with/without autism were administered the screening tool and ISAA following written informed consent. Its psychometric properties were determined. Results A 10-item scale named Indian Autism Screening Questionnaire (IASQ) was prepared in Hindi and English. Thereafter 145 parents/caregivers of participants (autism, n = 90, other psychiatric disorders, n = 55) (ages 3–18), were administered IASQ and ISAA (parents/caregivers plus observation) by separate interviewers, blind to each other and to diagnosis. At a cutoff of 1, sensitivity was 99%, specificity 62%, Positive Predictive Value 81%, and Negative Predictive Value 95%. Test-retest reliability was r = 0.767 (CI = 0.62–0.86) and interrater reliability- Krippendorff”s-alpha was 0.872. The area under Receiver Operating Characteristic Curve (ROC) was 95%. There was a significant difference on IASQ-scores between participants with and without a clinical diagnosis of Autism (t = 14.57, p<0.0001). Discussion The IASQ is a simple, easy to use screening tool with satisfactory reliability and validity, that can be administered to caregivers in 15 minutes and provides information about DSM 5 criteria for autism. It may be applicable outside India, following additional adaptation, for community-based studies.

Comparing the Indian Autism Screening Questionnaire (IASQ) and the Indian Scale for Assessment of Autism (ISAA) with the Childhood Autism Rating Scale–Second Edition (CARS2) in Indian settings

“…Our earlier manuscript reported that at a cut-off of 1, sensitivity was 99%, specificity 62%, Positive Predictive Value 81%, and Negative Predictive Value 95%. In the present, more diverse sample, sensitivity and specificity are 97.5% and 83.7% respectively [ 11 ]. Although the current samples were different from our earlier clinic sample, results remained fairly consistent and acceptable.…”

“…Sociodemographic data sheet, developmental milestones information sheet (both from the ISAA manual), Indian Autism Screening Questionnaire (IASQ) [ 11 ], the Indian Scale for the Assessment of Autism (ISAA) [ 19 ] and Childhood Autism Rating Scale 2 (CARS2) [ 14 ] were administered to all the participants.…”

“…Indian Autism Screening Questionnaire (IASQ) [ 11 ] is a 10-item simple, easy to use screening tool to identify possible cases in the community. It was developed as a part of the ICMR Task Force Capacity Building projects and is designed for individuals aged 3 to 18 years.…”

“…The Indian Autism Screening Questionnaire (IASQ) was developed and tested in the Department of Psychiatry of a tertiary care teaching hospital. It was derived from and compared to the Indian Scale for Assessment of Autism (ISAA-the validated tool for detailed assessment of autism in India) [9][10][11]. The IASQ is a 10-item questionnaire with yes/no answers, specificity and sensitivity at cut off 1 are 99% and 62%, and at cut off 2 are 98% and 71%.…”

Adaptation of autism spectrum screening questionnaire (ASSQ) for use in Georgian school settings

“…The autism spectrum screening questionnaire (ASSQ) is one of the screening tools for ASD (Bernie et al, 2021;Chakraborty et al, 2021;DuBay et al, 2021;Lord et al, 2022;Scott et al, 2021;Yan et al, 2021). It was originally designed by Ehlers and Gillberg, with further refinement in collaboration with Lorna Wing for the purpose of estimating prevalence of Asperger's syndrome (Ehlers et al, 1999).…”