'Worrying' Error Identified in NICE Guidance on Autism Screening

Dawn O'Shea

March 23, 2021

Psychologists at the University of Bath have identified a "worrying" error in National Institute for Clinical Excellence's (NICE) guidance on autism screening.

Writing in the  Lancet Psychiatry,  they report that they found a discrepancy between the clinical 10-item Autism Spectrum Quotient (AQ10) cut-off recommended by NICE and the research informing the guidance.

The NICE guideline based the suitability of the AQ10 for autism screening on research indicating that a cut-off score of six or higher should inform referrals for specialist diagnostic assessment. However, NICE “incorrectly” recommends that a score of seven or higher should be used.

"This discrepancy in the AQ10 cutoff scores is concerning because of its far-reaching effect on clinical practice and research,” they write, adding that the "insufficiently sensitive implementation of this screening tool will be contributing to missed referrals, diagnoses, and opportunities for intervention."

In consideration of these issues, they call for the NICE guidance on autism to be revised, emphasising the correct six or higher AQ10 cut-off.

The use of an inappropriately high cutoff score makes the AQ10 screening tool less sensitive, and therefore less accurate. Because it is so widely used among GPs and other health care professionals, this issue will be contributing to missed referrals, diagnoses and opportunities for intervention and support. Although clinicians are not solely reliant on AQ-10 scores to make referrals, it factors into the decision-making process. As the NICE AQ-10 guidelines have been in place for almost a decade, the consequences of the higher cut-off will be considerable.

Waldren LH, Clutterbuck RA, Shah P. Erroneous NICE guidance on autism screening. Lancet Psychiatry. 2021;8(4):276-277. doi: 10.1016/S2215-0366(21)00065-1. PMID: 33743877 View full text

This article originally appeared on Univadis, part of the Medscape Professional Network.

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