"These Questions Are Geared Towards Male Autistics, Not Female I Found They Never Quite Reflected My Experience": Assessing The Efficacy of Autism Questionnaires in Identifying Adult Autistic Women

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"These questions are geared towards male autistics, not female… I found they
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“These questions are geared towards male autistics, not female… I found they never
quite reflected my experience”: Assessing the Efficacy of Autism Questionnaires in
Identifying Adult Autistic Women
Caitlin H. Parsons & Margaret C. Jackson
School of Psychology, University of Aberdeen, UK
This is a draft paper under preparation for journal submission1. The work is Cait Parsons’
undergraduate thesis project.
10th July 2023
1
Status: Not submitted
Assessing the Efficacy of Autism Questionnaires in identifying Autistic Women
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder which has been found to
present differently in males and females. For example, autistic females more commonly tend
to hide their autistic traits, or ‘camouflage’. Original theories of autism such as the ‘extreme
male brain’ theory have a male bias in diagnosing the condition, creating a significant
underdiagnosis of females on the spectrum. Little research has been conducted into whether
the assessment questionnaires may be partially to blame for this, as they may not identify
these differences in traits between genders. The current study examined this by having
autistic (self and professionally diagnosed) and non-autistic adult women complete three
questionnaires: the Autism Quotient (AQ50); Girls Questionnaire of Autism Spectrum
Conditions (GQ-ASC); and Camouflaging Autistic Traits Questionnaire (CAT-Q).
Participants were also asked to rate each questionnaire on its relevance, meaningfulness, and
clarity and an optional comments box was provided. It was hypothesised that (1) autistic
participants will score higher in all questionnaires than non-autistic participants and (2) the
GQ-ASC will be more sensitive in identifying autistic women than the AQ50. The findings
show that both hypotheses were supported. Evaluative comments suggest that participants
preferred the GQ-ASC despite some questions not feeling age appropriate, the CAT-Q felt
repetitive, and the AQ50 felt stereotyped and male-biased. Development of future
questionnaires should focus closely on the age demographic and research proven traits of
ASD, ensuring they are not repetitive. Further suggestions for research are discussed.
Note: This study uses identity first language as this is language the majority of autistic people
prefer (Botha, Hanlon, and Williams, 2021). Additionally, the lead author is autistic and this
is the language she prefers to use.
i
Acknowledgments
Sincere thanks to the various charities and people who supported and shared my study.
Many thanks to the Scottish Women’s Autism Network (SWAN), The Ehlers Danlos Society,
Autism Initiatives Scotland, Grampian Autistic Society, and Number 6 One Stop Shop. To
everyone who shared the study with friends, family, and anyone you knew, thank you. This
study would not have been possible without participants and the vast number of you who took
part helped so incredibly much. Thank you all.
ii
Introduction
Autism. A word many people are familiar with. Around 700,000 people in the United
Kingdom are diagnosed with an autism spectrum disorder (ASD) (National Autistic Society,
2023). ASD is defined by the World Health Organisation (WHO) as ‘persistent deficits in the
ability to initiate and to sustain reciprocal social interaction and social communication, and by
a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that
are clearly atypical or excessive for the individual’s age and sociocultural context’ (WHO,
2023). In essence, ASD is a neurodevelopmental disorder which impacts the way individuals
with the condition interact with the world around them. This includes, but is not limited to
social difficulties, sensory sensitivities, and repetitive behaviours or interests. ASD is a lifelong
condition, not something young children can ‘grow out’ of (Loomes & Mandy, 2017).
Autism was first diagnosed in 1943 by Leo Kanner (Kanner, 1943). In his paper, Kanner
studied a 4:1 ratio of boys to girls. Shortly afterwards, Hans Asperger conducted another study
to examine the characteristics of children with autism. Asperger believed that in autistic people
male traits are exaggerated and that it was unclear if autism in females only became present
after puberty (Asperger, 1944). These initial studies surrounding autism started a chain
reaction, creating a historical underdiagnosis of women on the spectrum (Lai et al., 2011). After
Asperger’s comments and Kanner’s male-biased study, research mainly focussed on young
boys, making it ungeneralisable to other populations. This led to the development of ASD
assessment holding a bias towards men, making it challenging for women with the condition
to seek diagnosis, and meet diagnostic criteria as traits between genders can differ (Lai &
Baron-Cohen, 2015). This bias has many aspects, given the systemic bias towards men in
research (Beery & Zucker, 2011), and the biases towards men which women face in daily life
(Perez, 2020).
Loomes and Mandy (2017) conducted a meta-analysis to assess the ratio of male-to-
female ASD diagnosis. The meta-analysis found that in 2017, the ratio was 3:1. While an
improvement from the previous estimation of 16:1 (National Autistic Society, 2023), this
number is inaccurate if current assessment measures remain male biased, and women display
different characteristics making it harder to identify.
There is increasing evidence that ASD traits present differently in women and men (Lai,
2011). This occurs in various ways. For example, autistic females are more likely to have a
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more ‘normal’ or ‘typical’ special interest for their age than autistic males (Simcoe et al., 2022).
This could be an obsession with makeup, a boy band, or others which are stereotypically
feminine. As these obsessions can be more common among women, this is often ignored by
professionals despite these being traits of ASD. Gould and Ashton-Smith (2011) raised many
key points regarding areas of the spectrum where women presented differently than men.
According to Gould and Ashton-Smith (2011), autistic females are innately more social than
autistic males, finding that females are more likely to observe how others make friends and try
to model their behaviour on this. However, sustaining these friendships is challenging as issues
such as miscommunication can lead to friendships failing (Tierney, Burns, & Kilbey, 2016). It
is currently unclear why this occurs, but one theory is the ‘double empathy problem’. This
theory proposes autistic and non-autistic individuals struggle to communicate due to different
lived experiences, different ways of conveying empathy, and fundamentally perceiving the
other’s intentions in a different way than they were intended (Mitchell, Sheppard & Cassidy,
2021). Conversely, autistic males are less socially inclined, and many have few, if any, friends.
Autistic women may copy the way other women dress and use observed mannerisms to try and
‘fit in’ (Gould & Ashton-Smith, 2011). As autistic women get older, many use a skill known
as camouflaging, or masking, to hide their autistic traits (Simcoe et al., 2022). Part of
camouflaging can be modelling behaviour from peers to ‘fit in’. This occurs more commonly
in females than males and is known to cause mental health problems due to the toll pretending
to be someone else can take on an individual (Cook et al., 2021). Rynkiewicz et al. (2016)
found that many autistic women could be seen to be more determined and self-aware of
learning social nuances than autistic men. Upon further observation, during a diagnostic tool,
‘Autism Diagnostic Observation Schedule—Revised (ADOS-2)’ (which can be used in
children and adults), autistic females were observed to use more gestures than men
demonstrating camouflaging in action. Autistic people frequently use camouflaging to cope
socially, so they can present as non-autistic (Radulski, 2022). Autistic women camouflage so
frequently, it can lead to their traits going undetected, leaving them undiagnosed (Gould &
Ashton-Smith, 2011). However, if masking has led to mental health difficulties, many of these
women may be misdiagnosed with conditions such as eating disorders, personality disorders
(namely borderline personality disorder), selective mutism, separation anxiety, schizophrenia,
depression, and many more (Rynkiewicz & Łucka, 2018). Furthermore, most autistic females
receive a late diagnosis of ASD, particularly when compared to the age most males are
diagnosed. The main explanations for underdiagnosis, late diagnosis, and misdiagnosis are a
lack of general knowledge about the ways women can present on the spectrum, gendered traits,
2
and the continued use of assessment questionnaires which were designed to identify autistic
males and aren’t sensitive to identifying autistic females (Zener, 2019).
As the understanding of autism in women and how it presents grows, more women are
now being identified as autistic (Russell et al., 2021). A key questionnaire used in both research
and assessment is the Autism Quotient (Baron-Cohen et al., 2001; Woodbury-Smith et al.,
2005). The AQ50, first developed in 2001 by Baron-Cohen et al., was the first autism
assessment tool which was brief, self-report, and designed for autistic individuals with no
additional learning disability. The questionnaire was originally tested in adults with a diagnosis
of Asperger syndrome (or high-functioning autism) an outdated diagnosis, randomly selected
controls, students from the University of Cambridge, and winners of the UK Mathematics
Olympiad. Baron-Cohen et al., (2001) presented this new assessment tool and reported about
it in the same paper, meaning information regarding the reliability and validity of the AQ50
was readily available. They stated the purpose of the AQ50 was to be able to assess ‘where any
given individual is situated on the continuum from autism to normality’ (p. 5). Whilst the
autistic community dislike being compared to ‘normal’, the AQ50 has proven itself to be a
beneficial tool in quickly assessing, with good reliability, if an individual is on the autism
spectrum. In the paper by Baron-Cohen et al. (2001), the findings report that no female controls
scored ‘extremely high’ (above 34) and 21% of women received a ‘medium’ score (above 20),
whereas 40% of men did. The researchers concluded that there are significantly more autistic
men than women. However, an alternative explanation currently being debated in the autistic
community is that the AQ questionnaire struggled to identify autistic women. This may be due
to the lack of understanding and awareness surrounding autism in women and how traits can
differ between genders. The AQ50 is a heavily used questionnaire in research and initial
clinical assessment but is believed to have a male bias. There are no questions regarding traits
which autistic women experience more commonly, such as masking, which could impact who
it is identifying as autistic. This raises the question, how effective are current questionnaires in
assessing adult women for autism?
In recent years, research surrounding autism in women has gained substantial traction.
To account for these biases seen in assessment tools, various questionnaires have been
developed, two examples are the Girls Questionnaire of Autism Spectrum Conditions (GQ-
ASC) (Brown et al., 2020), and the Camouflaging Autistic Traits Questionnaire (CAT-Q). The
first example, the GQ-ASC (originally named the ‘Questionnaire for Autism Spectrum
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Conditions’) was initially developed in 2011 by Attwood, Garnett, and Rynkiewicz, making it
the first autism assessment tool created specifically for women. The questionnaire was
originally used in children and young women aged 13 – 19, hence the name ‘girls’ rather than
‘women’. Brown et al. (2020) endeavoured to use this questionnaire to assess adult women
with autism. Minor adjustments were made in the questionnaire to account for the fact it was
now assessing adults, this could be seen in statements such as ‘I am well behaved in school’
changing to ‘I was well behaved in school’. There has been quantitative research using the GQ-
ASC in adult women, showing that it is effective at identifying autistic women, but that further
refinement and research is needed (Brown et al., 2020). However, there is limited qualitative
research regarding how women feel regarding the questionnaire. The second example is the
CAT-Q. The CAT-Q was developed by Hull et al. (2018) to provide a self-report measure of
camouflaging, making it the first of its kind. The questionnaire has various statements such as
‘In social situations, I feel like I am pretending to be ‘normal’’ which are used to assess an
individual’s feelings regarding whether they do or do not camouflage. Both questionnaires are
relatively new, especially their use in clinical settings. However, the AQ50 was not designed
with female traits in mind, suggesting the GQ-ASC and CAT-Q may be more effective in
identifying autism in adult women.
The study presented in this report focuses on the efficacy of current autism
questionnaires in identifying autistic women. This is an important area of research as so many
women have been left undiagnosed, misdiagnosed, or late diagnosed. This study aims to
compare and contrast a traditional autism questionnaire with two questionnaires that align
better with traits seen more commonly in women. The study used three questionnaires: the
AQ50, GQ-ASC, and CAT-Q, which were administered online to autistic and non-autistic
women. The AQ50 was chosen due to its male bias and continued use in research and clinical
settings. The GQ-ASC and CAT-Q were chosen as they focus on traits of autism observed in
women. Scores on each questionnaire will be compared between autistic and non-autistic
groups to confirm the questionnaires’ general effectiveness of identifying autism. In addition,
the study will compare the sensitivity and specificity of the AQ50, GQ-ASC, and CAT-Q.
Sensitivity refers to the proportion of autistic people who score above or below the threshold
of the questionnaire which indicates autistic traits. The more sensitive a questionnaire, the
better it is at identifying autistic women. Specificity refers to the proportion of non-autistic
people who score above or below the threshold of the questionnaire. The more specific a
questionnaire, the better it is at correctly identifying non-autistic people as non-autistic. It is
4
hypothesised that: (1) autistic participants will score higher in all questionnaires than non-
autistic participants and (2) the GQ-ASC will be more sensitive in identifying autistic women
than the AQ50. The CAT-Q was used in an exploratory manner as it is useful to expand beyond
the other questionnaires when asking this research question. There are no specific hypotheses
related to the CAT-Q, but in line with hypothesis one, it is expected that the autistic groups
will score higher than the non-autistic group.
Methods
Participants
Eight hundred and seven female participants were recruited through word of mouth,
social media, charities (Autism Initiatives Scotland, Scottish Women’s Autistic Network, and
Ehlers Danlos UK), and the University of Aberdeen School of Psychology (in return for partial
course credit on a voluntary basis). Demographic data was used to exclude any participants
who identified as male, non-binary, other, or preferred not to say, resulting in the exclusion of
41 participants. A further nine participants were excluded as they could not confirm if they
were or were not autistic. Throughout the study, attention checks were conducted, where any
participants who failed to give the correct response in less than 75% of these were excluded,
thus excluding a further 43 participants. Attention checks were conducted by asking
participants once per questionnaire to respond on a certain point on the scale, for example
‘Please select ‘definitely agree’ to show you are reading the questions.’ Finally, participants
were welcome to skip any questions they felt uncomfortable answering, but to give a more
accurate reflection of the questionnaire’s efficacy, anyone who skipped more than three
questions was excluded from data analysis, however, any comments they left were included.
This left a final total of 688 participants whose data was included in the final analysis. Of these
participants, 343 were autistic with a mean age of 35.65 (SD = 12.57), ranging from 18-76, and
345 non-autistic with a mean age of 36.19 (SD = 13.26) ranging from 18-73. Of the 343 autistic
participants, 169 held a professional diagnosis, whilst 174 were self-diagnosed. Participants
were made aware of what the study would ask them to do and that they could withdraw at any
point, then asked to give informed consent. The study was approved by the School of
Psychology ethics committee at the University of Aberdeen.
5
Materials
AQ50
The Autism-Spectrum Quotient (Baron-Cohen et al., 2001) was administered as the

‘male biased’ questionnaire within the study. The questionnaire was developed as a way to
assess autistic traits in individuals who did not have a comorbid learning disability. The AQ50
includes 50 questions with five subscales assessing social skills, attention switching, attention
to detail, communication, and imagination. Examples from subsections include: ‘I find making
up stories easy’ for imagination, and ‘I notice patterns in things all the time’ for attention to
detail. Participants answered on a four-point Likert scale: definitely agree, slightly agree,
slightly disagree, and definitely disagree. Answers were scaled at one point for definitely agree
and slightly agree, with slightly disagree and strongly disagree receiving zero points. Some
questions in this questionnaire were reverse scored according to scoring guidelines. The total
score was out of 50, and the average score among non-autistic individuals is 15.5, with
participants who score above 32 meeting the threshold where autism is indicated.
GQ-ASC
The Girls Questionnaire for Autism Spectrum Conditions (GQ-ASC) was modified for
use in adult women (Brown, Attwood, Garnett, & Stokes, 2020) and administered as the
questionnaire highlighting ‘female traits’. The questionnaire was originally developed for use
in girls and young adults aged 13-19 (but could be extended to age 25) but has been amended
by Brown et al. (2020) for use in adult women. This was achieved by making small adjustments
such as ‘I am well behaved at school’ being changed to ‘I was well behaved at school’. The
questionnaire consists of 58 questions with five subscales assessing imagination,
camouflaging, sensory sensitivities, socialising, and interests. Examples from subsections
include: ‘I am attached to certain objects or toys which I carry, rub, or touch to calm myself’
for sensory sensitivities, and ‘I copy or ‘clone’ myself on other females’ for camouflaging.
Participants answered on a four-point Likert scale: definitely agree, slightly agree, slightly
disagree, and definitely disagree. Answers were scaled from one to four, with one being
definitely disagree and four being definitely agree, with question 18 using reversed scaling.
The total score was out of 84, with participants scoring above 57 meeting the threshold and
autism is indicated.
6
CAT-Q
The Camouflaging Autistic Traits Questionnaire (CAT-Q) (Hull et al., 2018) was
administered to assess levels of camouflaging autistic traits. The questionnaire was developed
after camouflaging autistic traits was added to the International Classification of Diseases in
2017 as a trait of autism (Zeldovich as cited by Hull et al., 2018). Camouflaging appears to be
more common in individuals who do not have an intellectual disability. The questionnaire
consists of 25 questions with three subscales assessing compensation, masking, and
assimilation. Examples from subsections include: ‘I have researched the rules of social
interactions to improve my own social skills’ for compensation, and ‘In social situations, I feel
like I’m ‘performing’ rather than being myself’ for assimilation. Participants answered on a
seven-point Likert scale: strongly disagree, disagree, somewhat disagree, neither agree nor
disagree, somewhat agree, agree, and strongly agree. Answers were scaled from one to seven,
with one being strongly disagree and seven being strongly agree. The total score was out of
175, with participants scoring above 100 meeting the threshold and camouflaging is indicated.
Evaluation Questions
After each questionnaire, participants were given the opportunity to give feedback on
the questionnaire they just completed. Participants were asked three questions about the
questionnaire: (1) To what degree did you feel that the questions were relevant to you and
reflected you and your experiences? (2) To what degree did you find the questions easy to
choose an answer for? (3) To what degree were the questions clear to interpret? A five-point
Likert scale was used to answer each question; not at all, a little, quite a bit, a lot, extremely.
Answers were scaled from one to five, with one being not at all, and five being extremely.
After this, an optional open comments box was included for any comments participants may
have about each questionnaire they completed.
Design and Procedure
The study was conducted online through ‘Testable’ and participants completed the
study on Google Chrome with a laptop or smartphone. A within-subjects design was chosen
meaning each participant saw the same questionnaires, but the order was randomised to account
for any impacts this may have on findings. The order of the questions within each questionnaire
7
remained the same for each participant. The between-group independent variable was autistic
status (autistic or non-autistic), and the dependant variable was questionnaire scores.
Prior to undertaking the study, participants completed a consent form which outlined
what taking part entailed, explained that participation was voluntary and anonymous, gave the
researchers contact information, and explained that consent could be revoked at any time by
simply exiting the questionnaire. After this, informed consent was obtained. Participants then
filled in their demographic data, including their self-reported autism status. When reporting
autism status, participants could choose autistic (professional diagnosis), autistic (self-
diagnosis), or non-autistic. The study took roughly 15 minutes in which participants were asked
to answer the three questionnaires regarding autistic traits.
Each questionnaire had the title of the questionnaire and a brief description of what it
was assessing before participants answered the questions. The AQ50 read ‘This questionnaire
measures autistic-like traits. Your task is to indicate to what extent you agree with each of the
following 50 statements. Please note that you have the option to skip any question you don’t
want to answer’. The GQ-ASC read ‘This questionnaire is designed to identify behaviours and
abilities in cisgender and trans adult women that could be associated with autistic
characteristics. Please read each question and statement very carefully and rate how strongly
you agree or disagree with it’. The CAT-Q read ‘Please read each statement below and choose
the answer that best fits your experiences during social interactions. Please note that you have
the option to select 'prefer not to answer' to any statement you do not wish to answer’. In each
questionnaire there was an attention check, asking participants to select a specific answer in
order to prove they were paying attention to what they were reading. After this, the
questionnaire was completed. At the end of each questionnaire, a sentence in bold read ‘Now
we would like to ask you some evaluation questions about this questionnaire’ at which point
the three evaluative questions and optional open comments box was shown. Finally,
participants were debriefed after completing their final questionnaire. This also included a list
of ways to access support if a participant may be questioning their autism status or for further
information about autism.
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Results
Questionnaire Scores Comparison across groups
Questionnaire scores and evaluation ratings were compared across groups using an
independent t-test.
Autistic vs Non-Autistic
The first stage of analysis required assessing the summed scores on each questionnaire
across the autistic and non-autistic groups (see figures 1, 2, and 3). On all questionnaires
autistic participants scored significantly higher than non-autistic participants: AQ50 (t(686) =
30.28, p < .001; d = 2.31), GQ-ASC (t(686) = 18.18, p < .001; d = 1.39), and CAT-Q (t(686) =
27.31, p < .001; d = 2.08).The effect size for each questionnaire was found to exceed Cohen’s
(1988) convention for a large effect (d = 0.80) (see table 1 for mean scores).
Autistic Self Diagnosed (Autistic-SD) vs. Autistic Professionally Diagnosed (Autistic-PD)
On the AQ50 and CAT-Q the autistic-PD group scored significantly higher: AQ50
(t(341) = 3.78, p < .001; d = 0.41) and CAT-Q (t(341) = , p = .003; d = 0.30). There was no
significant difference between groups on the GQ-ASC (t(341) = -5.90, p = .28; d = 0.064). The
effect sizes for the AQ50 and CAT-Q were medium (d = 0.20 - 0.50).
These significant results raise questions regarding the validity of self-diagnosis

amongst autistic individuals. As self-diagnosed participants scored significantly lower than
professionally diagnosed participants, it could be interpreted that they score lower due to the
fact their traits aren’t picked up by these questionnaires, hence missing a professional
diagnosis, or that there is an inaccuracy surrounding self-diagnosis in autism. The non-
significant difference in GQ-ASC scores between professionally and self-diagnosed autistic
individuals suggests it is important to investigate why this is and if this helps to validate self-
diagnosed autistic adults’ experiences.
It can be seen that autistic self-diagnosed (autistic-SD) and professionally diagnosed

(autistic-PD) groups scored above the threshold on each questionnaire, while the non-autistic
group scored below the threshold on the AQ50 and CAT-Q, but scored 1.72 above the threshold
on the GQ-ASC (see table 1).
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Table 1:
Mean Scores on Each Questionnaire Across Autistic-SD, Autistic-PD, and Non-Autistic Groups
AQ50 GQ-ASC CAT-Q

Autistic-SD 34.70 71.72 129.63
Autistic-PD 37.27 71.24 134.86
Non-Autistic 18.57 58.72 87.99
Figure 1:
Bar Chart of Total Scores on the AQ50 Between Autistic-SD, Autistic-PD and Non-Autistic Participants
10
Figure 2:
Bar Chart of Total Scores on the GQ-ASC Between Autistic-SD, Autistic-PD and Non-Autistic
Participants
Figure 3:
Bar Chart of Total Scores on the CAT-Q Between Autistic-SD, Autistic-PD and Non-Autistic Participants
11
Sensitivity and Specificity
The sensitivity and specificity of all questionnaires was tested for autistic and non-
autistic groups, as well as for autistic-PD and autistic-SD participants. Sensitivity refers to the
amount of autistic people who score above or below a suggested questionnaire threshold for
indicating autistic traits. This can be separated into ‘hits’ and ‘misses’. A hit refers to an autistic
person who was correctly identified as autistic by the questionnaire (scores above the
threshold). A miss refers to an autistic person who was not identified as autistic by the
questionnaire (scores below the threshold). Specificity refers to the amount of non-autistic
people who score above or below a suggested questionnaire threshold for indicating autistic
traits. This can be separated into ‘false alarms’ and ‘correct rejections’. A false alarm refers to
a non-autistic person who was incorrectly identified as autistic by the questionnaire (scores
above the threshold). A correct rejection refers to a non-autistic person who was correctly
identified as not autistic by the questionnaire (scores below the threshold). The thresholds are:
AQ50 = 32, G-ASC = 57, CAT-Q = 100. Sensitivity is calculated as a / (a + c) x 100 =
sensitivity percentage. Specificity was calculated as b / (b + d) x 100 = specificity percentage
(see table 2).
Table 2:
Chart Outlines Sensitivity and Specificity, and How Autistic vs. Non-Autistic Groups Fall Into These
Categories. It Also Outlines the Algebraic Letter Assigned to Each Section of the Algebraic Formula
Used to Calculate Sensitivity and Specificity.
Sensitivity Specificity
Above Threshold Hit (a) False Alarm (b)
Below Threshold Miss (c) Correct Rejection (d)
Autistic Group Non-Autistic Group
The GQ-ASC was found to be the most sensitive in correctly identifying previously
professionally or self-diagnosed autistic individuals in 95.63% of cases. Followed by the CAT-
Q = 94.17%, then the AQ50 = 77.89%. In autistic-PD participants, the GQ-ASC is the most
sensitive at 97.04%, however the AQ50 is higher at 83.43%. The CAT-Q remained similar at
95.27%. In autistic-SD participants, the results are more similar to the overall analysis of
sensitivity: GQ-ASC = 94.25%; CAT-Q = 93.10%; AQ50 = 62.64% (see table 3).
12
The AQ50 was the most specific at identifying people who said they were non-autistic
as non-autistic in 95.07% of cases. Followed by the CAT-Q = 67.25%, then GQ-ASC =
44.64%.
Table 3:
Sensitivity and Specificity Scores Across Autistic-SD, Autistic-PD, and Non-Autistic Participants
Sensitivity Specificity
Overall Autistic-SD Autistic-PD Non-Autistic
AQ50 77.89% 62.64% 83.43% 95.07%
GQ-ASC 95.63% 94.25% 97.04% 44.64%
CAT-Q 94.17% 93.10% 95.27% 67.25%
Questionnaire Evaluation Ratings and Comments
In the evaluation section, comments and ratings from 715 participants were included.
This increase from the final number of participants is due to the comments of participants who
chose to skip more than three questions or failed the attention check being included. Evaluation
was separated into numerical ratings for relevance, meaningfulness, and clarity, alongside an
optional comments box.
Relevance
Participants were asked ‘To what degree did you feel that the questions were relevant
to you and reflected you and your experiences?’. The autistic group rated the AQ50 (t(713) =
9.39, p < .001; d = .70) and GQ-ASC (t(713) = 12.78, p < .001; d = .96) as significantly more
relevant than the non-autistic group. However, the non-autistic group rated the CAT-Q (t(713)
= 16.80, p < .001; d = 1.36) as significantly more relevant than the autistic group.
A further t-test was conducted to assess the difference in the mean scores between the
autistic SD and PD groups. The t-test was not significantly different for the AQ50 (t(363) = -
.25, p = .40), GQ-ASC (t(363) = -.56, p = .29), or CAT-Q (t(363) = .77, p = .22) showing no
significant difference between the ratings for relevance between the autistic-SD and autistic-
PD groups across questionnaires (see table 4).
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Meaningfulness
Participants were asked ‘To what degree did you find the questions easy to choose an
answer for?’. The autistic group rated the AQ50 as significantly more meaningful (t(713) = -
3.48, p < .001; d = .26). However, the non-autistic group rated the GQ-ASC as significantly
more meaningful than the autistic groups (t(713) = -2.66, p = .004; d = .20) and similarly with
the CAT-Q (t(713) = -1.82, p = .035; d = .14).
autistic SD and PD groups. The t-test was not significantly different for the AQ50 (t(363) =
.09, p = .46), GQ-ASC (t(363) = -.75, p = .23), and CAT-Q (t(363) = 1.01, p = .16). This shows
there is not a significant difference between the ratings for meaningfulness between the autistic-
SD and autistic-PD groups across questionnaires.
Clarity
Participants were asked ‘To what degree were the questions clear to interpret?’. The
autistic group rated the AQ50 (t(713) = 9.39, p < .001; d = .70), GQ-ASC (t(713) = 12.78, p <
.001; d = .96), and CAT-Q (t(713) = 16.80, p < .001; d = 1.36) as significantly less clear than
the non-autistic group.
autistic SD and PD groups. The t-test was not significantly different for the AQ50 (t(363) =
.19, p = .42), GQ-ASC (t(363) = .22, p = .4)1, and CAT-Q (t(363) = .53, p = .30). This
demonstrates there is no significant difference between the ratings for clarity between the
autistic-SD and autistic- PD groups across questionnaires.
14
Table 4:
Average Rating and Standard Deviations in Brackets of Results From Evaluative Questions Within
Each Group
Average Ratings (and standard deviations)
AQ50
Autistic Autistic-SD Autistic-PD Non-Autistic
Relevance 3.60 (1.01) 3.61 (1.02) 3.60 (1.00) 2.93 (0.91)
Meaningfulness 3.40 (1.03) 3.39 (1.04) 3.40 (1.03) 3.67 (1.03)
Clarity 3.68 (1.07) 3.67 (1.04) 3.70 (1.1) 4.07 (0.95)
GQ-ASC
Relevance 3.59 (1.01) 3.62 (0.96) 3.56 (1.06) 2.64 (0.97)
Meaningfulness 3.59 (0.98) 3.64 (0.98) 3.55 (1.10) 3.79 (0.93)
Clarity 3.87 (1.04) 3.86 (1.04) 3.89 (1.04) 4.13 (0.92)
CAT-Q
Relevance 3.63 (1.02) 3.59 (0.96) 3.67 (1.08) 2.42 (0.89)
Meaningfulness 3.45 (1.07) 3.40 (1.07) 3.51 (1.07) 3.60 (1.03)
Clarity 3.82 (1.05) 3.80 (1.08) 3.85 (1.02) 4.12 (0.89)
Comments
Using a contextualist thematic analysis, comments left by autistic participants were

analysed and the following themes were generated across questionnaires:
• Theme one: Questions are too ambiguous, lacking context, and leaving room for
interpretation.
• Theme two: Need for a neutral or situation dependant answer.
These are broad themes which are common across all questionnaires.
Theme one: Questions are too ambiguous, lacking context, and leaving room for
interpretation.
Participants felt that each questionnaire lacked context and was ambiguous in the way
questions were worded. This left room for interpretation which may mean questions have not
been answered in the way they were intended to be. Participants acknowledged that having
15
more context would benefit them in giving more accurate responses which reflect their
experience better.
“All these statements are so generalised. ‘I prefer objects to people’. What people, what
objects? Everyone has people they like and dislike. Library vs Party - what kind of party? I
find it disappointing that we are still using such generalised questions.” – Participant 750
“Many of the questions are hard to answer as they are too general. Sometimes my answer
would be opposites at the same time depending on various factors.” – Participant 182
Theme two: Need for a neutral or situation dependant answer.
Participants emphasised they felt in all three questionnaires they would rather have an
answer option be ‘it depends’, a comments box where they could explain how they had
interpreted the question and come to their answer, or simply an option which outlines that the
type of situation impacts the way they feel about this. They found it difficult to choose with a
lack of context.
“With this one I wish there was a neutral answer. Some of them are too simple. Sometimes I
like social situation sometimes I do not. Depends on what they are, who I'm with etc. I find it
hard sometimes to know if the answer I'm choosing is correct in that.” – Participant 786
“I find it hard to answer questions like this with no room for further comments. A lot depends
on how I am in the moment, who I'm with and the context of situation so answers could be
quite different.” – Participant 157
AQ50 Specific Themes
Comments left by autistic individuals on the AQ50 were analysed and the following
specific themes were generated in addition to themes one and two:
• Theme three: Stereotypical views of autism that don’t reflect the autistic experience.
• Theme four: Unsuitable for adult women and people who ‘mask’.
16
Theme three: Stereotypical views of autism that don’t reflect the autistic
experience.
Participants stated they felt the AQ50 focussed on autistic stereotypes rather than the
actual autistic experience. Many comments highlighted there was a focus on trains, museums,
and libraries which are not their specific ‘special interests’. However, these all depended on
the context. For example, is the library busy or is it quiet? Is the party full of new people or is
it just close friends? This may change participants’ answers to these questions. Interestingly, a
few participants mentioned they struggled to answer the questions due to these stereotypes as
they felt there was a ‘correct’ answer to identify autism which they did not fall into. This was
not something that had been considered prior to the experiment but further highlights the
importance of questionnaires being an accurate representation of the autistic experience.
“I hate this questionnaire. It is such a narrow neurotypical view of what it means to be

autistic. And is so skewed to how men and boys typically present. There is not enough context
to answer eg theatre v museum - depends on the show and which theatre and who I'm with.
Some would be a nightmare and others would be brilliant. Same with museums…” –
Participant 203
“Some of the questions seem based on stereotype. I wasn't able to answer some in a clear-cut
way because I feel like I needed to provide explanation for my answer. I equally enjoy the
theatre and museum and don't understand why being autistic would mean I didn't like the
theatre.” – Participant 350
Theme four: Unsuitable for adult women and people who ‘mask’.
Participants felt this questionnaire was unsuitable for many of them as they are adults
who have ‘masked’ for a long time. Some questions directly refer to interacting with other
children, which is something many adults do not do regularly. A few participants commented
that it was difficult to answer as although they felt one way, they had spent so long learning to
‘mask’ and behave in a more neurotypical fashion that it no longer applied to them outwardly,
despite feeling the same. This was not something that had been considered prior to the study
17
but is interesting to note that even commonly used questionnaires, such as the AQ50, may not
be the most accessible for autistic people to understand and answer.
“Q50 - as an adult the need to play imaginary games with children is irrelevant” –
Participant 718
“Perhaps because I am older, I have had many years to make rules and discover tricks for
myself that make things easier. For example, I know to keep my intense interest to myself so
that I don't bore people with it. I actively try not to talk about it, even though I would love
to… I think these coping strategies are an important part of my experience of autism, and
definitely part of what makes socialising exhausting, but when I answer questions about my
behaviour I sometimes feel I misrepresent myself. When I answer a question like "People
often tell me that I keep going on and on about the same thing" based on my behaviour, it
glosses over all my careful, proactive rule-keeping to make sure that doesn't happen.” –
Participant 282
GQ-ASC Specific Themes
Comments left by autistic individuals on the GQ-ASC were analysed and the following
themes were generated in addition to themes one and two:
• Theme five: Not appropriate for adults or people diagnosed in adulthood.

• Theme six: Difficulty comparing self to ‘normal’ young girls.
• Theme seven: Better than other questionnaires in the study.
Theme five: Not appropriate for adults or people diagnosed in adulthood.
Participants felt this questionnaire was not age appropriate for adult women, and that it
was difficult to answer if you were diagnosed in adulthood. As the GQ-ASC was originally
developed to assess younger girls and was modified for adult women, this highlights that it
may need further amendments to make it suitable for those over 18 years old. Furthermore,
participants struggled with the back and forth of ‘when you were aged five – 12’ to current
traits or if they were meant to compare themselves at their current age to five – 12-year-olds.
This proved to be confusing when trying to understand what was being asked.
18
“The questions were more relevant to how I was as a child and a teenager, but not so much
as a 36 year old woman.” – Participant 397
“2 years post diagnosis - it's hard to understand my childhood through new eyes” –
Participant 411
Theme six: Difficulty comparing self to ‘normal’ young girls.
Participants commented that it was difficult to compare their childhood behaviour to

other girls as there was no barometer of what was ‘typical’. They reported that it was difficult
to know how to answer the questions as what was ‘normal’ for them may not be ‘normal’ for
everyone else, but it was for them at the time. This is interesting to note as it links to the lack
of self-awareness and autistic people’s understanding of their behaviour in comparison to
others.
“Question 3, as Imaginatively as other girls, is confusing for me to answer. Imaginatively

needs to be defined in the context of this question for consistency.” – Participant 524
“Not sure what constitutes girl toys and boy toys also I don't know how imaginatively other
girls played so hard to compare with an unknown” – Participant 389
Theme seven: Better than other questionnaires in the study.
Participants felt that this questionnaire was the most accurate representation of their
experiences. This is interesting as this is what was expected by comparing a female orientated
questionnaire compared to the AQ50, and despite its limitations, participants still felt it was the
best. It was also noted that overall, this questionnaire was more straightforward and easier to
understand than the rest.
“Felt like it was written by someone who understands as opposed to most tests that feel very
nt oriented” – Participant 545 (nt refers to ‘neurotypical’ people, e.g. non-autistic people)
19
“A lot easier to interpret and answer these questions. I liked how some questions were age
categorised, how we present when younger is different than when you're an adult… I enjoyed
the questions more and didn't need input from elsewhere.” – Participant 765
CAT-Q Specific Themes
Comments left by autistic individuals on the CAT-Q were analysed and the following
themes were generated in addition to themes one and two:
• Theme eight: Repetitive questions.

• Theme nine: Difficult to understand what is being asked or answer.
• Theme ten: Self-awareness required to answer questions.
Theme eight: Repetitive questions.
The most common comment left on the CAT-Q was how repetitive the questions were.
Participants felt the questionnaire was trying to ‘catch them out’ by the repetition. This was not
something considered prior to the study, however, when re-reading the questionnaire it is easy
to understand where participants’ feelings about repetition arose from.
“Too many repetitive questions felt like they are trying to catch you out.” – Participant 566
“It's a little stressful to be asked questions twice in different wording, I was doubting myself a
lot and my answers.” – Participant 72
Theme nine: Difficult to understand what is being asked or answer.
Participants reported that some questions in the CAT-Q were difficult to understand
what was being asked. A common comment was that whilst it stated ‘social situation’ this was
too vague as behaviours would differ from family and close friends compared to a large group
of strangers. This is not a uniquely autistic experience, as even neurotypical people tend to
behave differently in these two situations, which the CAT-Q does not consider. They found it
difficult to answer without clear information on what they were answering.
20
“Personally I had to read the questions several times and think about them before answering
as on several I didn't understand the meaning.” – Participant 449
“Difficult to answer some of the questions as the social situations in my life are ones I have
chosen so I feel comfortable. New social situations feel different. Hard to give an answer as
my responses feel different in different contexts.” – Participant 610
Theme ten: Self-awareness required to answer questions.
Participants commented that they struggled to answer some questions as it required an

awareness of your own behaviour which they lacked. To answer questions about camouflaging,
participants must be aware of what they did and, in many cases, they were not. It is fascinating
that some participants felt they ‘masked’ without conscious effort, so they could not report on
their behaviour, however, others felt they put a significant amount of effort into ‘masking’ but
were still unsure if their behaviour was ‘right’.
“I don't deliberately change my behaviours, mirror them to reflect others… I find it almost
impossible to know what my body language and facial expressions are like to be able to
monitor and change them...” – Participant 667
“I was unsure how to answer the question 'I am always aware of the impression I make on
other people' as I am always aware of it in the sense I am always thinking about it but I am
not very aware of it in the sense that I often appear to get it wrong.” – Participant 418
Discussion
The current study assessed the efficacy of autism questionnaires in identifying autistic
adult women. The study had three main aims: to compare and contrast traditional autism
questionnaires with questionnaire’s focused on traits more commonly seen in women; compare
the scores between autistic and non-autistic groups to confirm each questionnaires general
effectiveness of identifying autism; and compare the sensitivity and specificity of the AQ50,
21
GQ-ASC, and CAT-Q. It was hypothesised that: (1) autistic participants will score higher in
all questionnaires than non-autistic participants and (2) the GQ-ASC will be more sensitive in
identifying autistic women than the AQ50. When assessing the results, hypothesis one was
supported by the summed scores of each questionnaire being higher in the autistic groups than
the non-autistic groups (see table 1). Upon further analysis, hypothesis two was supported by
the sensitivity score of the GQ-ASC compared to the AQ50 (see table 3). Interestingly, the
specificity in the AQ50 was substantially higher than the GQ-ASC which was markedly low.
The CAT-Q was included to measure autistic traits frequently observed in women. This showed
how well it could identify autistic women given their suggested levels of camouflaging and
levels of under-diagnosis. The CAT-Q was included for exploratory analysis. Due to the vast
number of participants, only comments from the autistic group were analysed and included in
the results section. This provided much needed insight into autistic women’s opinions on these
questionnaires. The study aimed to further current research and understand if the questionnaires
being used to assess autism are effective at identifying autism in women. The findings suggest
they are not, and that significant changes must be made as a matter of urgency to account for
the number of undiagnosed autistic women not only in the United Kingdom, but across the
world.
Previous research regarding the efficacy of the AQ50, GQ-ASC, CAT-Q in assessing
autism in women is scarce at best. This research is exploratory due to this lack of research in
this area. Many discussion points contain directions for further research or unanswered
questions from the study.
Hypothesis One: Autistic Participants Will Score Higher in All Questionnaires Than
Non-Autistic Participants.
The first hypothesis was supported, as can be seen in the results. Findings show that
overall, the questionnaires are good at ensuring autistic participants score above the threshold,
and non-autistic participants score below. On all three questionnaires autistic participants
scored significantly higher than non-autistic participants. Interestingly, on the GQ-ASC, the
average score of non-autistic participants was one point above the threshold. This raises
questions regarding the validity and reliability of the questionnaire. While the original study
(Brown et al., 2020) comments on the reliability of the questionnaire, which was calculated
using McDonald’s omega, as being ‘low or approaching adequate levels’, there are no
comments regarding validity. There is limited research and critique on this questionnaire,
22
making it hard to assess its credibility. One critique of the GQ-ASC is that there is no current
research assessing if the questionnaire assesses traits of autism in females, or if it is assessing
general traits of femininity. In contrast, the AQ50 has had much research surrounding its use
in research and clinical settings. Woodbury-Smith et al. (2005) found that the AQ50 is valid in
clinical settings, correctly identifying autistic people in a general practitioner setting 83% of
the time. The CAT-Q was assessed for internal consistency and reliability in the initial study
(Hull et al., 2018) and both were found to be adequate. Further research should investigate the
reliability and validity of the GQ-ASC to ensure its suitability for use in research and clinical
settings. Furthermore, evaluating the threshold of the questionnaire may be worthwhile given
the findings of the current study suggest it may be slightly too low.
Further analysis showed a significant difference in scores between autistic-SD and

autistic-PD participants on the AQ50 and CAT-Q. While both groups scored above the
threshold on each questionnaire, this was an unexpected finding. One reason autistic-SD
participants may have struggled to access a professional diagnosis is because they score close
to the threshold on current questionnaires. This would further support the idea that the AQ50
is male biased and not sensitive to identifying autistic women. However, this would require
significant further research, as there is no gold standard questionnaire which will be perfect for
everyone.
Hypothesis Two: The GQ-ASC Will be More Sensitive in Identifying Autistic Women
than the AQ50.
The second hypothesis was also supported, as seen in the sensitivity and specificity
scores. Of the three questionnaires, the AQ50 had the lowest sensitivity, but highest specificity.
Previous research assessing the sensitivity and specificity of the AQ50 found sensitivity ranged
from 48% to 75%, and specificity ranged from 66% to 93% (Lundqvist & Lindner, 2017).
Despite being observed to be within the ‘normal’ range from previous analysis, the AQ50’s
low sensitivity score suggests it is not as sensitive in identifying autistic women as newer
questionnaires. The GQ-ASC had the highest sensitivity with the CAT-Q closely following.
However, the GQ-ASC had the lowest specificity, meaning it is not good at identifying non-
autistic participants as non-autistic. There are two possible explanations for this: (1) the
questionnaire is not specific enough and frequently mis-classifies autism in non-autistic
women, or (2) some of the women who report as non-autistic could be autistic, so the
questionnaire identifying them is actually a positive sign. The GQ-ASC may be very good at
23
identifying autism in women, but since these women identified as non-autistic, scoring above
the threshold created false alarms. However, this can only be inferred from the results and
current available research. The current study did not expect the specificity score to be so low
and cannot answer why it is so low. The findings suggest that a slightly higher threshold may
be required. Comments left on the GQ-ASC highlighted that the questions did not feel age
appropriate. This suggests the questions which were changed require further amendments to be
more appropriate for adult women. Further research should aim to address the lack of critique
of the GQ-ASC, and why the specificity is so low. Furthermore, the CAT-Q had relatively low
specificity. There are various explanations for this. Hull et al. (2017) stated that the rate of
camouflaging within the autistic community is still unknown. This could be linked to the
underdiagnosis of women on the spectrum. If a woman in the non-autistic category has been
camouflaging for most of their life, they may score highly on the CAT-Q, not realising they’re
autistic. The CAT-Q was found to have high internal consistency and good test-retest reliability
(Hull et al., 2018) making it unlikely reliability or validity are reasons the specificity is so low.
There are theories about why there may be issues with specificity linked to the underdiagnosis
of women on the spectrum (Lai et al., 2011) but these need to be investigated further before it
can be fully understood.
Evaluative Findings
Within the evaluation section of the study, both the autistic and non-autistic groups
responses stayed relatively close to the middle (three), however, there were interesting
significant differences between the groups. The autistic group felt the AQ50 and GQ-ASC were
significantly more relevant than the non-autistic group, who felt the CAT-Q was significantly
more relevant. This is interesting, as it was expected the AQ50 would be the least relevant to
the autistic groups as it is, in theory, the more male biased questionnaire and not as relevant to
female traits. Furthermore, the autistic groups rated the AQ50 as significantly more meaningful
than the non-autistic group, who felt the GQ-ASC and CAT-Q were significantly more
meaningful. Therefore, the autistic group feels the AQ50 is the most relevant and meaningful
questionnaire. This was not what the researchers anticipated with the evaluation section. Of
further interest are the comments left on the AQ50 as they were the most negative, whereas the
GQ-ASC was ‘better than other questionnaires in the study’. This raises questions regarding
how much thought participants put into their answers on the evaluation questions compared to
their comments and how trustworthy either is in analysing participants feelings around each
24
questionnaire. Finally, autistic participants found all three questionnaires significantly less
clear than the non-autistic group. This is unsurprising given it is known autistic people may
have difficulties in understanding the written word (Nguyen et al., 2015).
Comments were left by both autistic and non-autistic participants, however, only
comments by autistic people were included in the analysis to focus on the autistic perspective
of these questionnaires. In total, 436 comments were left across the three questionnaires, with
the GQ-ASC receiving the most comments. Of this, 315 comments were included in analysis
which helped generate themes. It is important to note that in terms of reflexivity, the lead
researcher/author herself is autistic and this may have influenced decisions on themes
generated.
Strengths and Limitations
The current study has various strengths and limitations. Some limitations are: not
knowing ethnicity; all self-report measures; new area of research; questionnaire reliability and
validity is uncertain; and no answers from males for comparison. For this study, participants
were not asked their ethnicity. Uono and Hietanen (2015) reported that in countries such as
Japan, children are taught not to maintain eye contact as a form of respect. However, in the
West, this could be seen as a trait of autism (Senju & Johnson, 2009). Only online self-report
questionnaires were used in this study meaning there is room for participant bias when
answering. As it was online, each participant was in a different environment when answering
which may have impacted a participant’s response. Furthermore, if participants wanted to be
perceived in a certain way (autistic or not-autistic) this could have impacted their answers.
Whilst researching autism in women has been gaining traction in recent years, the specific idea
of assessing the efficacy of current questionnaires is relatively new. Thus, making it difficult
to build upon previous literature and relying heavily on future research to answer the
outstanding questions. Additionally, the reliability and validity of some questionnaires is sound
and proven, whilst others do not yet have data surrounding reliability or validity. This makes
it difficult to compare the questionnaire’s effectiveness, as with one questionnaire the ability
to reliably and validly assess for autism is known, whilst for the other it is not. Finally, the use
of these questionnaires being compared to each other for their effectiveness at identifying
autism in women is a new idea. It would be beneficial to complete this study with men to assess
25
the differences in answers between males and females across questionnaires designed for
females, and questionnaires with a male bias. Going forward, it would be beneficial to ask
participant’s ethnicity, and to potentially expand the study using diagnostic tools such as the
ADOS.
The study has a number of strengths such as: large sample size; diverse age range;
multiple methods of data collection to analyse; multiple types of analysis; and a new area of
research. The sample size, before exclusions was 807, which is much higher than expected and
makes the study more generalisable to the general population. Furthermore, with an age range
of 18 – 76, the findings of this study are generalisable to many age groups, providing insight
into what being autistic is like at various stages of adult life. The study used a combination of
quantitative and qualitative approaches which provided numerical data to be analysed and gave
participants an opportunity to share how females feel about autism assessment questionnaires.
This continued into analysis where different statistical analyses were ran, creating a fuller
image from the study. Finally, while it can be a limitation to have little previous research on a
specific area, it can be a strength insomuch as this study is addressing an area not studied to
date.
Further Research
As previously stated, this is a new area of research meaning there are many ways to
build on the current research and findings. The first option to validate these results is to conduct
this study with men. This would provide further evidence to show if the AQ50 is male biased,
and show if the GQ-ASC detects traits of autism in women or simply traits of femininity.
Another important area to be researched is the biases seen in the AQ50. After analysing the
comments left by participants, some felt it was male biased, others felt it was stereotypical.
Whilst these may be intertwined (condition believed to only occur in males, became
stereotypically male, now the stereotype is male biased), it could be beneficial to identify what
parts of the questionnaire feel male biased or stereotypical. In future, questionnaire
development should focus on traits of ASD which are supported by research rather than
stereotype. As mentioned previously, the GQ-ASC was modified from being for teenagers to
being for adults, however, many women in the current study did not feel it accurately
represented their experience. Greater analysis of the questions and their relevance to the adult
autistic experience could shed light on which questions need to be adapted. This questionnaire
focussed on adult autistic women, although, there is little research regarding how the autistic
26
experience is different between children, adolescents, and adults. This area has much room for
growth. It would be interesting to investigate how children, adolescents, and adults respond to
different questionnaires and determine the most effective questionnaires for each age group. In
terms of development, children and adolescents are different from adults, but are also different
from each other (Shiner & Caspi, 2002). Given this fact, it would be beneficial to conduct
research surrounding the efficacy of diagnostic tools in adults, and adolescents. Finally, the
validity and reliability of the GQ-ASC must be investigated in order to prove if it is a valid
measure of assessment.
Conclusion
Overall, the findings of the current study provides evidence that autism questionnaires
are not as effective as they could be at identifying autistic women. The study shows that newer
questionnaires, developed with autistic women in mind, are more specific than older male-
biased questionnaires. It also qualitatively found that women preferred the GQ-ASC to the
AQ50 or CAT-Q. These findings build on previous research by addressing the gap in the
literature of what screening tools are best at identifying autism in women, and what
questionnaires autistic women feel best represents their experience. Further research should be
conducted as discussed to provide a fuller view of this interesting area.
27
28
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"These Questions Are Geared Towards Male Autistics, Not Female I Found They Never Quite Reflected My Experience": Assessing The Efficacy of Autism Questionnaires in Identifying Adult Autistic Women

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quite reflected my experience”: Assessing the Efficacy of Autism Questionnaires in

Identifying Adult Autistic Women

Caitlin H. Parsons & Margaret C. Jackson

School of Psychology, University of Aberdeen, UK

10th July 2023

The Autism-Spectrum Quotient (Baron-Cohen et al., 2001) was administered as the

Design and Procedure

Questionnaire Scores Comparison across groups

Autistic Self Diagnosed (Autistic-SD) vs. Autistic Professionally Diagnosed (Autistic-PD)

These significant results raise questions regarding the validity of self-diagnosis

It can be seen that autistic self-diagnosed (autistic-SD) and professionally diagnosed

AQ50 GQ-ASC CAT-Q

Sensitivity and Specificity

Questionnaire Evaluation Ratings and Comments

Using a contextualist thematic analysis, comments left by autistic participants were

Theme two: Need for a neutral or situation dependant answer.

AQ50 Specific Themes

“I hate this questionnaire. It is such a narrow neurotypical view of what it means to be

GQ-ASC Specific Themes

• Theme five: Not appropriate for adults or people diagnosed in adulthood.

Theme five: Not appropriate for adults or people diagnosed in adulthood.

Theme six: Difficulty comparing self to ‘normal’ young girls.

Participants commented that it was difficult to compare their childhood behaviour to

“Question 3, as Imaginatively as other girls, is confusing for me to answer. Imaginatively

Theme seven: Better than other questionnaires in the study.

CAT-Q Specific Themes

• Theme eight: Repetitive questions.

Theme eight: Repetitive questions.

Theme nine: Difficult to understand what is being asked or answer.

Theme ten: Self-awareness required to answer questions.

Participants commented that they struggled to answer some questions as it required an

Further analysis showed a significant difference in scores between autistic-SD and

Strengths and Limitations

Asperger, H. (1944). Die "Autistischen Psychopathen" Im Kindesalter. Archiv Für Psychiatrie

Lewis, L. F. (2016). Exploring the experience of self-diagnosis of autism spectrum disorder in

Radulski, E. M. (2022). Conceptualising autistic masking, camouflaging, and neurotypical

computerized ADOS-2, and a test of sex/gender differences. Molecular Autism, 7(1),

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