Unlike the AQ-10, however, the RAADS-14 is positioned by its creators for use in outpatient psychiatric screening. The validation study for the RAADS-14 was conducted on people who had a pre-existing diagnosis of autism, ADHD, anxiety disorder, psychotic disorder, borderline personality disorder, or mood disorder.
The goal of the study appears to be positioning the RAADS-14 as a front line tool for differentiating between autism and other psychiatric diagnoses whose traits might make an autism diagnosis in adults more difficult.
As with other shortened versions of screening instruments, the creators attempted to choose questions representative of the lengthier test. A pilot version was created by Swedish researchers using 18 questions distributed proportionately across the 4 domains of the RAADS-R (language, social relatedness, sensory-motor and circumscribed interests). After testing, four questions were dropped because they failed to accurately discriminate between autism and other psychiatric diagnoses.
The resulting 14 questions are organized into 3 domains: mentalizing deficits, sensory reactivity, and social anxiety. You can see which questions belong to which domain here. Honestly, the way these categories are named feels like a step backwards. The domains for the RAADS-R have fairly generic names while these new domains feel judgmental in a negative way.
In particular, mentalizing deficits groups together dubiously related traits and assumes they occur due to difficulty with perspective taking (or theory of mind*, mentalizing, empathy, etc.). Things like attachment to routine and knowing when it’s my turn to talk have little to do with my ability to understand what other people are thinking. Grouping these traits together under a mentalizing heading indicates a lack of insight into why they happen. For example, questions 1, 4, 9, 11 and 13 are primarily related to difficulties with pragmatics (social use of language), including reading nonverbal cues and being able to detect subtle nuances of prosody.
The social anxiety domain has a similar weakness–the framing of autistic traits as pathological rather than rooted in neurological differences. I don’t have difficulty making small talk because I have social anxiety. I have difficulty making small talk because I think it’s pointless, boring and confusing. Making friends, socializing, and working in groups are all difficult for similar reasons. I struggle with the practical and technical aspects of these things–and sometimes that leads to anxiety. But anxiety is not the cause of my difficulties. (All of this is alluded to in the study discussion, so it’s perplexing why the domain is named “social anxiety” instead of the more neutral “social relatedness” classification used in the RAADS-R domains.)
The previous two paragraphs may seem nitpicky to some, but the way we talk about autistic traits can significantly contribute to stigma, especially in an academic context where those who read the study and use the screening instrument will come in contact with many autistic people and their families.
Like the write-up I did last week on the revised Aspie Quiz, I’ve focused here on elements of the RAADS-14 that are different from the RAADS-R. For detailed information about the types of questions, the scoring system, and the pros and cons of the RAADS tests in general, please check out the RAADS-R Take a Test Tuesday post. (Also, it’s important to note that while the RAADS-14 uses the RAADS-R questions, answer choices, and scoring method, it was developed by a different team of researchers.)
Taking the Test
You can take the RAADS-14 at Psych Central.
Like the 80 question version, the shortened version asks you to rate each statement as (1) true now and when you were younger, (2) true only now, (3) true only when you were younger, or (4) never true. For the purposes of the test, “younger” is characterized as 16 and under.
Before you begin, the quiz asks you to supply an age and gender. Gender choices are restricted to the binary. I was able to successfully submit the test and get a score without filling in any of this information so feel free to skip it if you prefer.
The 14 questions are all on one page and take a couple of minutes to complete. When you’re done, click the “Score My Autism Screening Quiz”. You’ll be taken to a new page where you’ll see a single numerical score.
Scoring the Test
I scored a 39, having ticked the box for true now and when I was younger for all of the questions but two (and one of those was the small talk question, in which a “never” answer scores positive). In looking at the validation study of the RAADS-14, it’s interesting to see that 39 is the most common score among those with a pre-existing diagnosis of autism.
I’m curious to see who else gets a 39 and would love to know which question you didn’t answer positively. For me, the reason I didn’t answer the painful noises question positively is because I don’t actually cover my ears to block out noises, though I do find some noises almost unbearable and impossible to mentally block out. If the question had been worded more broadly, I probably would have checked the “true now and when I was younger” box. But my auditory sensitivities aren’t as severe as the question implies, so I check “never true”.
There are three scoring categories given on the results page:
- 31 & up Autism found
- 14 – 30 Autism likely
- 0 – 13 No autism symptoms
It’s potentially confusing that on one hand the site repeatedly states that the quiz is not a diagnostic tool and on the other hand a score of 31 and higher is graded as “autism found”. I assume the outcome wording was chosen by Psych Central. More accurate descriptors would be “unlikely”, “likely” and “very likely”.
The academic paper discussing the RAADS-14 positions the test as a psychiatric outpatient screening tool, in situations where comorbid conditions might make diagnosis difficult. The study concluded that the RAADS-14 identified most autistic patients while excluding approximately 50% of non-autistic patients.
One interesting thing to note about the cutoff score of 14, is that autistic males in the validation study had a median score of 30 and autistic females had a median score of 34. Both males and females with ADHD had a median score of 15. If you look at the scores charted by diagnosis, you’ll see that a significant number of people with ADHD scored above the cutoff of 14. This seems to indicate that there is a great deal of overlap between autism and ADHD for the particular traits that the RAADS-14 focuses on or that some of the participants with an ADHD diagnosis had been misdiagnosed. The curious part is that the RAADS-14 doesn’t have any questions that directly address executive functioning, which is where the main overlap between autism and ADHD usually lies.
The Bottom Line
The RAADS-14 is a good alternative to the AQ-10 as a brief screening instrument, though its more complex question structure may make it harder for some people to accurately complete in a short time frame. The move toward developing a differential screening instrument for psychiatric patients is much needed.
A/N: Thank you to Nat (@quarridors) for the heads up about this test and for locating the academic paper about it.
* If there was any doubt about how the authors of the study came up with the domain grouping theory, it was quickly erased when I got the “Gender Differences” section of the discussion where they promote the extreme male brain theory and break down ToM capabilities along the exact same gender lines as Simon Baron-Cohen’s studies.