The Signposting Questionnaire for Autism-2 (SQ-A-2):   using input from autistic adults to inform questionnaire development

Lucy A Livingston; Susan R Leekam; Gareth Davies; Punit Shah; Olujolagbe Layinka; Sarah J Carrington; Catherine R G Jones

doi:10.1186/s13229-026-00714-3

The Signposting Questionnaire for Autism-2 (SQ-A-2): using input from autistic adults to inform questionnaire development

Lucy A Livingston
, Susan R Leekam
, Gareth Davies
, Punit Shah
, Olujolagbe Layinka
, Sarah J Carrington
, Catherine R G Jones

King's College London
Cardiff University
University of Bath

Research output: Contribution to journal › Article › peer-review

Abstract

Background
Brief questionnaires help clinicians to identify people who may require in-depth assessment for Autism Spectrum Disorder (hereafter autism) and also facilitate research. However, many current questionnaires do not map onto the latest DSM-5 criteria for autism and were developed by researchers and/or clinicians, with limited input from autistic people. The Signposting Questionnaire for Autism (SQ-A) is a caregiver-report questionnaire for measuring autism signs in children, based on DSM-5 criteria. Here, we developed a revised lifespan version, the SQ-A-2, with input on wording from autistic adults. We tested the SQ-A-2 as a self-report measure in autistic and non-autistic adults, and assessed the impact of the adapted wording on both the psychometric properties and the acceptability of the measure.

Methods
The SQ-A, containing highly discriminating DSM-5 items from a valid clinical interview, was revised to form the 18-item SQ-A-2, with self- and informant-report options. Following input from a team of four autistic consultants and six autism professionals, item wording on the SQ-A-2 was adapted, thus forming Original and Adapted versions. Subsequently, a sample of autistic and non-autistic adults (N = 302), matched on age, sex, and general cognitive ability, completed both versions of the new SQ-A-2, as well as the widely-used 10-item Autism-Quotient (AQ-10). Autistic participants also rated their preferences for Original versus Adapted items, and provided qualitative responses for their reasoning.

Results
Overall, the self-report version of the SQ-A-2 demonstrated excellent internal reliability and convergent validity with the AQ-10, and autistic adults scored significantly higher than non-autistic adults. This group difference was greater for the Adapted compared to the Original version of the SQ-A-2, suggesting autistic consultation may facilitate the development of clinically-useful measures. Additionally, autistic participants preferred the wording of the Adapted versus Original items, both quantitatively and qualitatively.

Limitations
Our findings may not generalise to autistic people with intellectual disability. Ethnicity data was not collected.

Conclusions
The adapted version of the SQ-A-2 has the potential to be a valid, clinically useful questionnaire for measuring DSM-5 signs of autism across the lifespan. Our findings also highlight the utility of incorporating autistic input into measure development. Further psychometric testing of the SQ-A-2 in larger, more diverse samples, including the informant-report version, is now required.

Original language	English
Number of pages	51
Journal	Molecular Autism
Early online date	15 Apr 2026
DOIs	https://doi.org/10.1186/s13229-026-00714-3
Publication status	E-pub ahead of print - 15 Apr 2026

Bibliographical note

© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Keywords

Signposting
Diagnosis
Autism
Adults
Autistic traits

Access to Document

10.1186/s13229-026-00714-3

The sign-posting for Autism 2 SQ A 2 Molecular Autism 2026
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Accepted author manuscript, 876 KBLicence: CC BY 4.0

Cite this

@article{2bf9fe92ba014252a6fd6ba818e6305a,

title = "The Signposting Questionnaire for Autism-2 (SQ-A-2): using input from autistic adults to inform questionnaire development",

abstract = "Background Brief questionnaires help clinicians to identify people who may require in-depth assessment for Autism Spectrum Disorder (hereafter autism) and also facilitate research. However, many current questionnaires do not map onto the latest DSM-5 criteria for autism and were developed by researchers and/or clinicians, with limited input from autistic people. The Signposting Questionnaire for Autism (SQ-A) is a caregiver-report questionnaire for measuring autism signs in children, based on DSM-5 criteria. Here, we developed a revised lifespan version, the SQ-A-2, with input on wording from autistic adults. We tested the SQ-A-2 as a self-report measure in autistic and non-autistic adults, and assessed the impact of the adapted wording on both the psychometric properties and the acceptability of the measure. Methods The SQ-A, containing highly discriminating DSM-5 items from a valid clinical interview, was revised to form the 18-item SQ-A-2, with self- and informant-report options. Following input from a team of four autistic consultants and six autism professionals, item wording on the SQ-A-2 was adapted, thus forming Original and Adapted versions. Subsequently, a sample of autistic and non-autistic adults (N = 302), matched on age, sex, and general cognitive ability, completed both versions of the new SQ-A-2, as well as the widely-used 10-item Autism-Quotient (AQ-10). Autistic participants also rated their preferences for Original versus Adapted items, and provided qualitative responses for their reasoning. Results Overall, the self-report version of the SQ-A-2 demonstrated excellent internal reliability and convergent validity with the AQ-10, and autistic adults scored significantly higher than non-autistic adults. This group difference was greater for the Adapted compared to the Original version of the SQ-A-2, suggesting autistic consultation may facilitate the development of clinically-useful measures. Additionally, autistic participants preferred the wording of the Adapted versus Original items, both quantitatively and qualitatively. Limitations Our findings may not generalise to autistic people with intellectual disability. Ethnicity data was not collected. Conclusions The adapted version of the SQ-A-2 has the potential to be a valid, clinically useful questionnaire for measuring DSM-5 signs of autism across the lifespan. Our findings also highlight the utility of incorporating autistic input into measure development. Further psychometric testing of the SQ-A-2 in larger, more diverse samples, including the informant-report version, is now required. ",

keywords = "Signposting, Diagnosis, Autism, Adults, Autistic traits",

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note = "{\textcopyright} The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article{\textquoteright}s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article{\textquoteright}s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.",

year = "2026",

month = apr,

day = "15",

doi = "10.1186/s13229-026-00714-3",

language = "English",

journal = "Molecular Autism",

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TY - JOUR

T1 - The Signposting Questionnaire for Autism-2 (SQ-A-2)

T2 - using input from autistic adults to inform questionnaire development

AU - Livingston, Lucy A

AU - Leekam, Susan R

AU - Davies, Gareth

AU - Shah, Punit

AU - Layinka, Olujolagbe

AU - Carrington, Sarah J

AU - Jones, Catherine R G

N1 - © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

PY - 2026/4/15

Y1 - 2026/4/15

N2 - Background Brief questionnaires help clinicians to identify people who may require in-depth assessment for Autism Spectrum Disorder (hereafter autism) and also facilitate research. However, many current questionnaires do not map onto the latest DSM-5 criteria for autism and were developed by researchers and/or clinicians, with limited input from autistic people. The Signposting Questionnaire for Autism (SQ-A) is a caregiver-report questionnaire for measuring autism signs in children, based on DSM-5 criteria. Here, we developed a revised lifespan version, the SQ-A-2, with input on wording from autistic adults. We tested the SQ-A-2 as a self-report measure in autistic and non-autistic adults, and assessed the impact of the adapted wording on both the psychometric properties and the acceptability of the measure. Methods The SQ-A, containing highly discriminating DSM-5 items from a valid clinical interview, was revised to form the 18-item SQ-A-2, with self- and informant-report options. Following input from a team of four autistic consultants and six autism professionals, item wording on the SQ-A-2 was adapted, thus forming Original and Adapted versions. Subsequently, a sample of autistic and non-autistic adults (N = 302), matched on age, sex, and general cognitive ability, completed both versions of the new SQ-A-2, as well as the widely-used 10-item Autism-Quotient (AQ-10). Autistic participants also rated their preferences for Original versus Adapted items, and provided qualitative responses for their reasoning. Results Overall, the self-report version of the SQ-A-2 demonstrated excellent internal reliability and convergent validity with the AQ-10, and autistic adults scored significantly higher than non-autistic adults. This group difference was greater for the Adapted compared to the Original version of the SQ-A-2, suggesting autistic consultation may facilitate the development of clinically-useful measures. Additionally, autistic participants preferred the wording of the Adapted versus Original items, both quantitatively and qualitatively. Limitations Our findings may not generalise to autistic people with intellectual disability. Ethnicity data was not collected. Conclusions The adapted version of the SQ-A-2 has the potential to be a valid, clinically useful questionnaire for measuring DSM-5 signs of autism across the lifespan. Our findings also highlight the utility of incorporating autistic input into measure development. Further psychometric testing of the SQ-A-2 in larger, more diverse samples, including the informant-report version, is now required.

AB - Background Brief questionnaires help clinicians to identify people who may require in-depth assessment for Autism Spectrum Disorder (hereafter autism) and also facilitate research. However, many current questionnaires do not map onto the latest DSM-5 criteria for autism and were developed by researchers and/or clinicians, with limited input from autistic people. The Signposting Questionnaire for Autism (SQ-A) is a caregiver-report questionnaire for measuring autism signs in children, based on DSM-5 criteria. Here, we developed a revised lifespan version, the SQ-A-2, with input on wording from autistic adults. We tested the SQ-A-2 as a self-report measure in autistic and non-autistic adults, and assessed the impact of the adapted wording on both the psychometric properties and the acceptability of the measure. Methods The SQ-A, containing highly discriminating DSM-5 items from a valid clinical interview, was revised to form the 18-item SQ-A-2, with self- and informant-report options. Following input from a team of four autistic consultants and six autism professionals, item wording on the SQ-A-2 was adapted, thus forming Original and Adapted versions. Subsequently, a sample of autistic and non-autistic adults (N = 302), matched on age, sex, and general cognitive ability, completed both versions of the new SQ-A-2, as well as the widely-used 10-item Autism-Quotient (AQ-10). Autistic participants also rated their preferences for Original versus Adapted items, and provided qualitative responses for their reasoning. Results Overall, the self-report version of the SQ-A-2 demonstrated excellent internal reliability and convergent validity with the AQ-10, and autistic adults scored significantly higher than non-autistic adults. This group difference was greater for the Adapted compared to the Original version of the SQ-A-2, suggesting autistic consultation may facilitate the development of clinically-useful measures. Additionally, autistic participants preferred the wording of the Adapted versus Original items, both quantitatively and qualitatively. Limitations Our findings may not generalise to autistic people with intellectual disability. Ethnicity data was not collected. Conclusions The adapted version of the SQ-A-2 has the potential to be a valid, clinically useful questionnaire for measuring DSM-5 signs of autism across the lifespan. Our findings also highlight the utility of incorporating autistic input into measure development. Further psychometric testing of the SQ-A-2 in larger, more diverse samples, including the informant-report version, is now required.

KW - Signposting

KW - Diagnosis

KW - Autism

KW - Adults

KW - Autistic traits

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U2 - 10.1186/s13229-026-00714-3

DO - 10.1186/s13229-026-00714-3

M3 - Article

C2 - 41987220

SN - 2040-2392

JO - Molecular Autism

JF - Molecular Autism

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