Autism Spectrum Screening Questionnaire (ASSQ)

The Autism Spectrum Screening Questionnaire (ASSQ) yields a total score between 0 and 54, with higher scores indicating greater differences in social and behavioural functioning from other young people.

The total ASSQ score is expressed as a community percentile based on normative data for young people in the general population (Posserud et al., 2006) and as a clinical percentile based on data for Autistic young people (Ehlers et al., 1999). These percentiles are informant-specific, derived from either parent- or teacher-rated ASSQ data. When the informant type is “Other” or unknown, percentiles derived from parent-rated ASSQ data are used. The percentiles contextualise the young person’s score relative to the typical scores of young people overall and Autistic young people specifically.

The scoring approach uses established cut-off scores to categorise the young person’s score as either “Moderately Consistent with Autism” or “Strongly Consistent with Autism” (Ehlers et al., 1999).

• Moderately Consistent with Autism: 11 or above. About 4-7% of young people overall score 11 or above (Posserud et al., 2006). Scores in this range indicate developmental differences in social and behavioural functioning, which may be consistent with Autism but could also reflect other neurodevelopmental or psychological conditions, such as ADHD or disorders within the Disruptive, Impulse-Control, and Conduct Disorders category (e.g., Oppositional Defiant Disorder or Conduct Disorder).
• Strongly Consistent with Autism: 19 or above. About 1-2% of young people overall, and 75-80% of Autistic young people, score 19 or above (Ehlers et al., 1999; Posserud et al., 2006). Scores in this range suggest significant developmental differences in social and behavioural functioning consistent with Autism.

Scores are also provided for the four factors (subscales) identified by Junttila and colleagues (2023):

• Formal Style (Items 1, 2, and 6), which reflects a formal or old-fashioned way of thinking, appearance, or communication style.
• Contextual Understanding and Routines (Items 4, 5, 7, 10, 11, 13, 23, and 24), which reflects the ability to understand context and meaning, alongside a preference for routines.
• Socio-Emotional Reciprocity (Items 12, 15, 16, 17, 18, 19, and 25), which reflects engagement in social interactions and emotional exchanges.
• Vocalisation, Movement, and Appearance (Items 3, 8, 9, 14, 20, 21, 22, 26, and 27), which reflects unique vocalisations, behaviours, and physical characteristics.

The average score for each subscale is calculated by dividing the subscale’s score by the number of items in the subscale, which standardises the scores and enables direct comparisons between subscales. A higher average score suggests that the young person shows greater differences in a particular area compared to other areas. Clients assessed on NovoPsych typically score highest on the Contextual Understanding and Routines subscale and the Socio-Emotional Reciprocity subscale, followed by the Vocalisation, Movement, and Appearance subscale, and lowest on the Formal Style subscale.

The scoring approach also uses qualitative descriptors to categorise ASSQ subscale scores based on average score thresholds that correspond to the total ASSQ cut-off scores. These thresholds are calculated by dividing the total cut-off scores by the number of items in the scale (i.e., 27). Specifically:

• The “Moderately Consistent with Autism” cut-off score (i.e., 11) corresponds to an average score of 0.41.
• The “Strongly Consistent with Autism” cut-off score (i.e., 19) corresponds to an average score of 0.70.

These thresholds are used to categorise the average score for each subscale as follows.

• “Elevated” corresponds to an average score of 0.41–0.69, indicating differences consistent with the total scale’s “Moderately Consistent with Autism” range.
• “High” corresponds to an average score of 0.70–2, indicating differences consistent with the total scale’s “Strongly Consistent with Autism” range.

Graphs are presented showing the young person’s total ASSQ score and the young person’s average score for each subscale. A graph is also presented comparing the young person’s total ASSQ score to the normative distribution of scores among Autistic young people and young people in the general population, with shaded areas corresponding to scores between the 25th and 75th percentile (Ehlers et al., 1999; Posserud et al., 2006). This graph contextualises the young person’s score relative to the typical scores of Autistic young people and young people overall.

The 27-item Autism Spectrum Screening Questionnaire (ASSQ) demonstrates strong reliability and validity as a screening tool for Autism in young people (Ehlers et al., 1999). Reliability evidence includes high test-retest reliability over both 2-week interval (r = .96 for parent ratings) and an 8-month interval (r = .90 for teacher ratings), as well as good inter-rater reliability between teachers (r = .79), suggesting stability of scores over time and across raters.

Convergent validity is demonstrated by strong correlations with the Rutter scales, which assess general emotional and behavioural symptoms (r = 0.75 for parent ratings and r = 0.77 for teacher ratings). Criterion validity is supported by the ASSQ’s ability to discriminate between Autistic young people, those with other neurodevelopmental or psychological conditions, such as ADHD, and neurotypical young people.

The ASSQ was designed to be completed by different informants, including parents and teachers, with different cut-off scores recommended for each type of informant. Ehlers and colleagues (1999) proposed the following cut-off scores:

• 13 for parents and 11 for teachers, to identify young people with developmental differences in social and behavioural functioning (though not necessarily Autism).
• 19 for parents and 22 for teachers, to identify Autistic young people.

For consistency and interpretability, NovoPsych uses the lower of the two cut-off scores for each category — 11 as the “Moderately Consistent with Autism” cut-off score and 19 as the “Strongly Consistent with Autism” cut-off score — regardless of the informant. This conservative approach prioritises identifying young people who may benefit from further, comprehensive assessment for Autism or other (neuro)developmental differences.

Confirmatory factor analysis of 37,036 ASSQ responses on NovoPsych validated a four-factor structure proposed by Junttila and colleagues (2023), which demonstrated the best model fit among competing models (Baker et al., 2025). NovoPsych renamed these factors to enhance interpretability as follows:

• Formal Style (formerly Formal Speech and Communication, as named by Juntilla et al. (2023))
• Contextual Understanding and Routines (formerly Social Cognition, Utilization of Context, and Repetitive Behavior)
• Socio-Emotional Reciprocity (formerly Impairment in Socio-Emotional Reciprocity)
• Vocalisation, Movement, and Appearance (formerly Deviant Style of Speech, Use of Sound, and Special Physical Appearances)

The ASSQ was originally validated on two clinical samples (Ehlers et al., 1999). The main sample included 110 6- to 17-year-olds (87 boys and 23 girls) with various (neuro)developmental differences. The other sample included 34 6- to 16-year-old boys diagnosed with Asperger’s Syndrome whose mean parent-rated and teacher-rated total ASSQ scores were 25.1 (SD = 7.3) and 26.4 (SD = 11.7), respectively. These scores were similar to those of the autism spectrum disorder group within the main sample. These means and standard deviations are used to convert the young person’s total ASSQ score to the presented clinical percentile, providing useful information about the young person’s level of social and behavioural functioning relative to Autistic young people.

Percentiles for the general population are from a study by Posserud, Lundervold, and Gillberg (2006, p. 170), which included 6,229 parent-rated and 9,149 teacher-rated ASSQs for 7- to 9-year old children attending all schools in Bergen, Norway in 2002. Their mean parent-rated and teacher-rated total ASSQ scores were 3.29 (SD = 4.49) and 1.99 (SD = 4.07), respectively. These percentiles are presented to contextualise the young person’s score relative to typical scores among young people in the general population, offering a clearer perspective on how the young person’s level of social and behavioural functioning compares to that of young people overall.

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