Three Quick Clues, One Big Decision: How Screening Tools Can Speed Up Adult Autism Assessments

When a Diagnosis Takes Years, Smart Triage Can Save Months

Many adults wait months—or years—for a formal autism assessment, all while living with uncertainty, limited support, and stress in work and relationships. Clinics are overwhelmed by rising referrals, and clinicians must balance thoroughness with the reality of long queues. A new research paper, Investigating the role of three screening measures to support clinical decision-making in adult autism assessments, asks a practical question: can a small set of well-tested questionnaires help teams prioritize who is most likely to receive an autism diagnosis and streamline the assessment process?

This study looked back at four years of cases (2011–2014) in a UK specialist service, focusing on three brief tools: the Autism Spectrum Quotient (AQ), the Empathy Quotient (EQ), and a brief questionnaire completed by a family member about childhood traits, the Childhood Autism Spectrum Test—Relatives’ Questionnaire (CAST-RQ). These tools don’t diagnose autism; instead, they offer structured clues about autistic traits, social-emotional style, and early-life patterns. The key insight is simple but powerful: when all three measures were positive—meaning they crossed their recommended cut-offs—the likelihood of ultimately receiving an autism diagnosis was extremely high.

Why does this matter? Because triage isn’t about skipping care—it’s about matching the depth of assessment to the level of certainty. The study found that positive screens on all three measures predicted a diagnosis in 98.3% of cases. Used thoughtfully, this “triple-check” can help clinics offer briefer, targeted assessments to those highly likely to be autistic, freeing time for more complex cases and shortening waits for everyone. In a crowded system, that’s not just efficient—it’s humane.

What Three Quick Checklists Can Tell Clinicians in Minutes

The researchers analyzed 422 adults who completed all three screening tools before their full assessment. Overall, 89% received an autism diagnosis—reflecting the reality that specialist clinics see people already pre-screened by referrers. Here’s the headline: people who scored above the cut-off on the AQ, below the cut-off on the EQ (suggesting lower typical empathy as measured by the scale), and had a positive CAST-RQ from a relative had a 98.3% chance of getting a diagnosis. The finding also echoed results from an independent clinic sample, lending confidence that it wasn’t a one-off.

What does this look like in real life? Think of a 34-year-old who reports lifelong difficulty with small talk and sensory overload at open-plan offices (captured by the AQ), tends to miss subtle social cues (reflected in a low EQ score), and whose parent recalls early childhood routines and intense interests (documented in the CAST-RQ). When all three screens line up, the clinical picture is consistent and clear. In such cases, the study suggests a briefer diagnostic appointment might be appropriate—still careful, but more focused—allowing those individuals to move on to planning and support sooner.

The team also examined AQ subscales—such as social skill, attention switching, attention to detail, communication, and imagination—to see how specific traits related to diagnoses. While details are more technical, the broader aim was to understand whether certain patterns on the AQ add extra clarity to decision-making. Importantly, the study does not argue that people who don’t meet all three cut-offs should be rejected. Rather, the three tools act as a decision support system, not a gatekeeper.

Why Layering Measures Beats Guesswork in Adult Autism Clinics

In busy services, relying on one measure—or on a single clinical impression—can lead to bottlenecks and uncertainty. This study shows that layering measures taps into different angles of autistic presentation: self-reported traits (AQ), social-emotional style (EQ), and evidence of childhood differences (CAST-RQ). Together, they reduce ambiguity. Psychologically, this aligns with the idea of convergent validity: when different tools point to the same conclusion, we can be more confident in that conclusion.

Compared to earlier work showing that the AQ alone can be elevated by anxiety, ADHD, or stress, this approach adds balance. The EQ offers context for social-emotional tendencies, and the CAST-RQ anchors the picture in development, which is crucial because autism is defined by lifelong patterns, not sudden changes in adulthood. By confirming the triple-positive result in another clinic, the research supports the idea that the combination is robust in specialized settings.

There are caveats. The clinic’s base rate of diagnosis was high (89%), which naturally boosts the likelihood that a positive screen predicts a true diagnosis. In general practice, where fewer referred adults may be autistic, the numbers would look different. The data were retrospective and from one UK service a decade ago; cultural differences, masking strategies (especially among women and nonbinary people), and increased awareness since 2014 may shift how the tools perform today. Also, not everyone has a relative available or willing to complete the CAST-RQ, and self-report measures can be influenced by mood, insight, or social desirability. Still, as a practical, clinic-based decision aid, the findings add credible evidence to a growing case: smart triage can speed care without sacrificing quality.

From Waiting Lists to Wise Triage: Turning Scores into Better Care

What can clinics, referrers, and individuals do with this? First, services can build a pre-assessment pack that includes the AQ, EQ, and CAST-RQ. Scores should be interpreted by a clinician, not as a DIY diagnosis. If all three are positive, schedule a briefer, targeted diagnostic appointment focused on confirming key criteria, co-occurring conditions, and immediate support planning. If two are positive or results are mixed, book the standard comprehensive assessment. If scores are low but concerns remain high (for instance, due to masking, strong family history, or complex mental health), proceed with a full evaluation—screens are guides, not gates.

Referrers (e.g., GPs, mental health providers) can use the triple screen to write more informative referral letters: “AQ above cut-off, EQ below cut-off, positive CAST-RQ, lifelong sensory sensitivities and social fatigue.” This helps clinics triage more accurately. For families, offering to complete the CAST-RQ can meaningfully contribute to a loved one’s assessment pathway. For adults seeking answers, being prepared to share concrete examples—such as needing noise-cancelling headphones at work, struggling to shift plans without stress, or organizing life around intense interests—can make screening tools more accurate.

Administratively, services can integrate these measures into electronic health records and create simple rules for scheduling. Training staff to explain that screening tools support clinical decision-making—they do not replace a diagnosis—builds trust. Finally, pay special attention to equity: ensure screens are accessible, validate use across genders and cultures, and offer alternatives when a relative report isn’t possible. Done well, the result is a fairer, faster system that prioritizes need and clarity.

A Faster Path Without Cutting Corners

The core message from the research paper Investigating the role of three screening measures to support clinical decision-making in adult autism assessments is striking: when the AQ, EQ, and CAST-RQ all indicate autism, a diagnosis is highly likely—98.3% in this clinic sample. Used ethically, this “triple-check” can justify briefer appointments for those most likely to be autistic, making room for complex cases and cutting waiting times without cutting quality. The bigger question now is how to scale this approach across diverse services while protecting equity and nuance. If clinics commit to using screens as decision support—never as a shortcut—then smart triage can turn long waits into timely, tailored care.

Data in this article is provided by PLOS.

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