In brief
A screening questionnaire is an indication, not a diagnosis. The 2016 guideline stated: a diagnosis can be neither made nor ruled out on the basis of screening instruments, and none of the instruments was recommended as mandatory. [3, Rec. 15] An expert overview from 2024 names the same limit: screening instruments quickly identify people at increased risk but are not suitable for diagnosis, and their specificity in the clinical context is low. [2] For freely available online tests we have read no evaluation; the guideline named several questionnaires circulating online as not validated. [3, Ch. B.3.4.3] A conspicuous result therefore does not replace an assessment, and an inconspicuous one does not rule out autism.
This English translation was produced with AI assistance and has not yet been independently reviewed.
Status of the guideline: This article draws on the S3 guideline on diagnosis (text version 23.02.2016). It has expired: according to the overview of the DGKJP it was valid “until 04.04.2021”. [1] The document carries a note that it is currently being revised. [3] Newer studies are not taken into account. We will update the article as soon as a new version is available.
What screening is meant for
The guideline described a stepped approach: recognise symptoms, screen briefly, and if the suspicion is confirmed, assess comprehensively at a specialised service. [3, Rec. 7] Screening is meant to help decide whether a detailed assessment is necessary. Screening of the whole population (all children, adolescents or adults), by contrast, should not take place, because the rate of false positive and false negative results was high for all instruments then available in German and specialised services would otherwise be overloaded. [3, Rec. 12]
Who should be screened – and who should not
Where there are certain risk factors and at least one symptom pointing to autism, screening should be considered, for example in the case of certain genetic findings, medication exposure or viral infections in pregnancy, premature birth before the 32nd week or very low birth weight, seizures after birth or a sibling with autism. [3, Rec. 13] Screening examinations should only be carried out by health professionals who know developmental disorders and the instruments used. [3, Rec. 14]
Which questionnaires the guideline named
In an evidence-based recommendation (grade 0, “may”), the guideline named individual instruments depending on age, with restrictions: [3, Rec. 15]
- M-CHAT (two-stage) from the second year of life, to confirm a suspicion; its specificity was very low, and results had to be interpreted very cautiously.
- FSK (Social Communication Questionnaire) and SRS (Social Responsiveness Scale) from preschool age to adolescence, with different hit rates depending on the cut-off; the guideline rated them as moderate overall.
- SRS-A and AQ for adults without intellectual disability, but with very low specificity.
- Further instruments for people with intellectual disability.
“Other screening instruments should currently not be used because of poor study quality.” [3, Rec. 15] For AQ‑10, AQ‑20, PDD-MRS, EQ children and EQ adults, the guideline found no studies demonstrating their validity; their use was therefore not recommended. [3, Ch. B.3.4.3] This is the state as of 2016.
Online self-tests
The guideline justified its explicit statement on instruments that have not been tested by noting that there are numerous forums on the internet for “self” screening, mainly for adults, and that the results of this “self-assessment” are often discussed with professionals. [3, Ch. B.3.1] Which of today’s online tests have been tested how well, we have not investigated. As a rule of thumb from the editorial team: an online result can be a reason to talk to a professional, but not proof for or against autism.
What a result means
- Positive result and clinical suspicion: The person concerned should be referred to a service specialised in autism. [3, Rec. 16]
- Negative result: If autism also appears clinically unlikely and nobody reports further symptoms, the screening result can make autism unlikely; if autism appears clinically likely or symptoms are reported, the person should be seen again promptly or referred. [3, Rec. 16] A negative result does not rule out an autism spectrum disorder. [3, Ch. B.3.6.1]
- A positive result can also point to another condition. [3, Ch. B.3.6.1]
What do we know – what is still open?
Finding (2016 guideline, expert consensus and meta-analyses): Screening is not a diagnostic method; population screening is not recommended; the quality of the questionnaires is limited. [3, Rec. 12, 15]
Open:
- We have not read newer studies on questionnaires (after 2016).
- How good freely available online tests are has not been studied in the sources read.
- How questionnaires prove themselves in everyday German care is open.
What else you should know
- What next? If you have a suspicion: How an autism assessment works, Referral, costs and waiting times and ADOS-2, ADI-R and screening.
- Feelings after a test: A result can be unsettling. In acute emotional distress: TelefonSeelsorge, 0800 1110111. [4]
Note: This article offers general information. It does not replace an assessment or medical advice.
Sources and literature
- DGKJP. Aktuelle Leitlinien (Einträge 028-018 „Gültig bis 04.04.2021“ und 028-047 „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
- Höhne E, Kamp-Becker I. Diagnostik der Autismus-Spektrum-Störung. Pädiatrie 2024;(4+5):27–32. – Expert overview (in German)
- DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 1: Diagnostik. S3-Leitlinie, AWMF-Reg.-Nr. 028-018, Textstand 23.02.2016. – Guideline (in German) (expired; according to the document note under revision)
- TelefonSeelsorge Deutschland: Startseite mit Rufnummern. https://www.telefonseelsorge.de/ – Counselling service (website in German)
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