Error in UK screening guidelines reported

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Reporting in the Lancet Psychiatry today, psychologists at the University of Bath highlight that a widely used technique for autism screening is being misused, which may have prevented many people from receiving an autism diagnosis over the past decade.

When individuals with suspected autism are assessed by a GP, a decision to refer them to a specialist for diagnosis is informed by using the Autism Spectrum Quotient. This ten-point scale, known as the 'AQ-10’ is an internationally used technique, whereby individuals agree or disagree with statements such as 'I find it difficult to work out people's intentions'. The maximum score is ten, and higher scores represent more autistic traits.

A score of six or above on this scale should signal that an individual needs to be referred to a specialist psychologist or psychiatrist. However, through this new research, psychologists have uncovered that for almost ten years the NICE guidelines have incorrectly been recommending a score of 'more than 6 out of 10'. This error may have consequently prevented people who scored '6' from receiving proper support.

Because it is so widely used among GPs and other healthcare professionals, this issue will be contributing to missed autism referrals, diagnoses, and opportunities for intervention and support. Although clinicians are not solely reliant on AQ-10 scores to make referrals, it factors into their decision-making process. As the NICE AQ-10 guidelines have been in place for almost a decade, the consequences of this mistake will be considerable.

Until the erroneous guidelines are corrected by NICE, the psychologists are calling for an urgent review into this matter, so that pending diagnoses are not missed and that any errors in previous screening can be rectified. In their paper, they recommend that clinicians and researchers use the cut-off score of "6 or above" (≥6) instead of NICE's "more than 6 out of 10" (≥7) to inform their work.

Lucy Waldren, lead author of the article also of the Department of Psychology at Bath, suggests the findings have implications for autism and psychiatry research. She says: "Our examination of the literature has discovered that the erroneous NICE guidelines have caused major confusion amongst researchers on which cut-off scores to use. We have found several examples of the incorrect value being applied. Participants in studies have also been inappropriately excluded based on their scores. And, even when the correct value was used, it has been incorrectly attributed to the NICE guidance. If researchers have followed the incorrect NICE guidelines and used the AQ-10 incorrectly in their studies, they may need to reanalyse and republish, or even consider retracting their findings."