Abstract
An empirically based 78 question self-rating scale based on DSM-IV-TR and ICD-10 criteria was developed to assist clinicians’ diagnosis of adults with autism and Asperger’s Disorder-the Ritvo Autism and Asperger’s Diagnostic Scale (RAADS). It was standardized on 17 autistic and 20 Asperger’s Disorder and 57 comparison subjects. Both autistic and Asperger’s groups scored significantly higher than comparison groups with no overlap; sensitivity, specificity, and content validity equaled one. Cronbach’s alpha coefficients of internal consistency of three subscales were satisfactory. Gender, age, and diagnostic categories were not significantly associated factors. The RAADS can be administered and scored in less than an hour and may be useful as a clinical scale to assist identification of autism and Asperger’s Disorder in adults. The RAADS does not distinguish between autism and Asperger’s Disorder.
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Acknowledgments
We wish to express our gratitude to David Allen, PhD; Anne Panofsky, PhD; Victoria Ritvo; Stephen Shore; Temple Grandin, PhD; Roger N. Meyer; Colleen Clegg and Alan Slifka for their invaluable contributions and support.
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Appendix
Appendix
The Ritvo Autism Asperger’s Diagnostic Scale (RAADS) and Instructions for Scoring
The scale contains two types of questions: (a) 60 “positively worded questions” describing specific symptoms of autism and Asperger’s Disorder, and (b) 18 “negatively worded questions” to elicit “normally expected responses.” The longer a symptom has been present, it is considered more serious and will receive a higher score. To assess longevity and severity, each question can be answered: “True now and when I was young,” “True only now,” “True only when I was young,” or “Never true.” The “negatively worded questions” are identified by an asterisk by their number and are scored in reverse order, reflecting acquired social and language skills in the “True Only Now” column. Scores for each answer are:
Determining a patient’s score: In order to identify the 60 positively worded questions and the 18 that are negatively worded, we have devised a simple code:
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1.
Each of the 60 positively worded questions has a regular period after its number on the scale (e.g., 70. I cannot tell if someone is interested or bored with what I am saying).
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2.
Each of the 18 negatively worded questions has an asterisk (*) after its number (e.g., 1* I am a sympathetic person).
To score the scale, first write a number from 0 to 3 by the side of each question, depending on which box the patient checked. Second, enter the total for that page on the bottom of the page. Third, add the totals of each page to determine the total score for all 78 questions.
Clinical implications of a patient’s total score: Based on the statistical parameters described in the results section, the following conclusions can be drawn as shown in the following table.
It will take you about an hour to answer all these questions.
Please stop if you become tired and start again when you are rested.
It is important to read each question completely and think of the answer carefully before checking only one of the four columns headed with these words:
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1.
This is true or describes me now and when I was young.
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2.
This was true or describes me only now (refers to skills acquired, applies to negatively worded questions).
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3.
This was true only when I was young (16 years or younger).
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4.
This was never true and never describes me.
Please answer the questions according to what is true for you and only what you feel is true and correct, not what you think others expect you to say or taught you to say.
Check only one column.
Some life experiences and personality characteristics that may apply to you | True now and when I was young | True only now | True only when I was young | Never true |
|---|---|---|---|---|
1* I am a sympathetic person. | 0 | 1 | 2 | 3 |
2. I keep many exact words and phrases from movies and television in my memory. | 3 | 2 | 1 | 0 |
3* I understand when friends need to be comforted, and I always try to be helpful. | 0 | 1 | 2 | 3 |
4. Sometimes I talk too loudly or too softly, and I am not aware of it. | 3 | 2 | 1 | 0 |
5. I often don’t know how to act in social situations. | 3 | 2 | 1 | 0 |
6* I can “put myself in other people’s shoes.” | 0 | 1 | 2 | 3 |
7. I have a hard time understanding the meaning of the phrase: “He has skeletons in his closet.” | 3 | 2 | 1 | 0 |
8. I don’t remember people’s faces. I am more likely to remember something about them that others may consider peculiar (like a person’s scent). | 3 | 2 | 1 | 0 |
9* I would rather tell a “little white lie” than hurt someone’s feelings. | 0 | 1 | 2 | 3 |
10. I always notice how food feels in my mouth. This is just as important to me as how it tastes. | 3 | 2 | 1 | 0 |
11* I miss my best friends or family when we are apart for a long time. | 0 | 1 | 2 | 3 |
12. Sometimes I offend others by saying what I am thinking. I am not aware that I am doing that, and I am surprised when others tell me that I have been rude. | 3 | 2 | 1 | 0 |
13* I like to have close friends. | 0 | 1 | 2 | 3 |
14. I’d rather go out to eat in a restaurant by myself than with someone I know. | 3 | 2 | 1 | 0 |
15. I cannot imagine what it would be like to be someone else. | 3 | 2 | 1 | 0 |
16. I have been told that I am clumsy and that my posture and gait are awkward. | 3 | 2 | 1 | 0 |
17. I am very sensitive to the way my clothes feel when I touch them. How they feel is more important to me that how they look. | 3 | 2 | 1 | 0 |
18. I like to copy the way certain people speak and act. It helps me appear more normal. | 3 | 2 | 1 | 0 |
19. It can be very intimidating for me to talk to more than one person at the same time. | 3 | 2 | 1 | 0 |
20. I have been told that sometimes I speak too loudly or too softly, even when my voice sounds fine to me. | 3 | 2 | 1 | 0 |
21. I have to “act normal” to please other people and make them like me. | 3 | 2 | 1 | 0 |
22* Meeting new people is usually easy for me. | 0 | 1 | 2 | 3 |
23. I get highly confused when someone interrupts me when I am talking about something I am very interested in. | 3 | 2 | 1 | 0 |
24. It is difficult for me to understand how other people are feeling when we are talking. | 3 | 2 | 1 | 0 |
25* I don’t mind having a conversation with several people at the same time, for instance, around a dinner table, at school, or at work. | 0 | 1 | 2 | 3 |
26. I have a hard time figuring out what some phrases mean, like: “You are the apple of my eye.” | 3 | 2 | 1 | 0 |
27. It is very difficult for me to understand some emotions (like lust, infatuation, empathy, or embarrassment). | 3 | 2 | 1 | 0 |
28. I am more sensitive to smells than anyone I know. | 3 | 2 | 1 | 0 |
29. Some ordinary textures that do not bother others feel very offensive when they touch my skin. | 3 | 2 | 1 | 0 |
30. I get extremely upset when the way I like to do things is suddenly changed. | 3 | 2 | 1 | 0 |
31. I never wanted or needed to have what other people call an “intimate relationship.” | 3 | 2 | 1 | 0 |
32. It is difficult for me to start and stop a conversation. I need to keep going until I am finished. | 3 | 2 | 1 | 0 |
33* I usually speak in a normal tone. | 0 | 1 | 2 | 3 |
34* I can chat and make small talk with friends and when I meet new people. | 0 | 1 | 2 | 3 |
35* I speak with a normal rhythm and tone. | 0 | 1 | 2 | 3 |
36. My sensations can suddenly change from very sensitive to very dull. | 3 | 2 | 1 | 0 |
37. When I am shopping, I get very nervous at the checkout. I have calculated the amount of what I bought in my head, and I worry it will not come out right. | 3 | 2 | 1 | 0 |
38. Sometimes the sound of a word or a high-pitched noise can be painful to my ears. | 3 | 2 | 1 | 0 |
39. The phrase “I’ve got you under my skin” makes me very uncomfortable. | 3 | 2 | 1 | 0 |
40* I am an understanding type of person. | 0 | 1 | 2 | 3 |
41. I do not connect with characters in movies and cannot feel what they feel. | 3 | 2 | 1 | 0 |
42. I cannot tell when someone is flirting with me. | 3 | 2 | 1 | 0 |
43. I can see in my mind a whole page that I have read, recall an entire long conversation, or remember travel routes in detail, even if these occurred years ago. | 3 | 2 | 1 | 0 |
44. I memorize lists of things that interest me, even when they have no practical use (for example, sports statistics, train schedules, calendar dates, historical facts and dates). | 3 | 2 | 1 | 0 |
45* I can tell when someone says one thing but means something else. | 0 | 1 | 2 | 3 |
46* I like to talk things over with my friends. | 0 | 1 | 2 | 3 |
47. Sometimes I keep talking and do not notice when others want to say something or are getting bored. | 3 | 2 | 1 | 0 |
48. It can be very hard to read someone’s face, hand, and body movements when we are talking. | 3 | 2 | 1 | 0 |
49. The same thing (like clothes, or temperatures) can feel very different to me at different times. | 3 | 2 | 1 | 0 |
50* I feel comfortable with dating and being in social situations with others. | 0 | 1 | 2 | 3 |
51* I try to be as helpful as I can when other people tell me their personal problems. | 0 | 1 | 2 | 3 |
52. I have been told that I have an unusual voice (for example, flat, monotone, childish, or high-pitched). | 3 | 2 | 1 | 0 |
53. Sometimes a thought or a subject gets stuck in my mind and I have to talk about it even if no one is interested. | 3 | 2 | 1 | 0 |
54. I do certain things with my hands over and over again (like flapping, twirling sticks or strings, waving things by my eyes). | 3 | 2 | 1 | 0 |
55. I have never been interested in what most of the people I know consider interesting. | 3 | 2 | 1 | 0 |
56* I am considered a compassionate type of person. | 0 | 1 | 2 | 3 |
57. I get along with other people by following a set of specific rules that help me to look normal. | 3 | 2 | 1 | 0 |
58. It is almost impossible for me to work and function in groups. | 3 | 2 | 1 | 0 |
59. I am considered a loner by those who know me best. | 3 | 2 | 1 | 0 |
60. Sometimes I have to cover my ears to block out painful noises (like vacuum cleaners or people talking too much or too loudly). | 3 | 2 | 1 | 0 |
61. Sometimes things that should feel painful are not (for instance, when I hurt myself or burn my hand on a stove). | 3 | 2 | 1 | 0 |
62. Sometimes when I feel overwhelmed by my senses, I have to isolate myself to shut them down. | 3 | 2 | 1 | 0 |
63. Sometimes when talking to someone, I cannot tell when it is my turn to talk or to listen. | 3 | 2 | 1 | 0 |
64. When I am talking to someone, it is hard to change the subject. If the other person does so, I can get very upset and confused. | 3 | 2 | 1 | 0 |
65. I like things to be exactly the same day after day and even small changes in my routines upset me. | 3 | 2 | 1 | 0 |
66. How to make friends and socialize is a mystery to me. | 3 | 2 | 1 | 0 |
67. It calms me to spin around or to rock in a chair when I am feeling stressed. | 3 | 2 | 1 | 0 |
68. The phrase, “He wears his heart on his sleeve,” does not make sense to me. | 3 | 2 | 1 | 0 |
69. If I am in a place with many smells, textures to feel, noises, or bright lights; I can get overwhelmed with sensations and feel panicky, anxious, or frightened. | 3 | 2 | 1 | 0 |
70. I cannot tell if someone is interested or bored with what I am saying. | 3 | 2 | 1 | 0 |
71. I like to be by myself as much as I can. | 3 | 2 | 1 | 0 |
72. I keep my thought stacked in my memory like they are on filing cards, and I pick out the ones I need by looking through the stack and finding the right one. | 3 | 2 | 1 | 0 |
73. The same sound sometimes seems very loud or very soft, even though I know it has not changed. | 3 | 2 | 1 | 0 |
74* I enjoy spending time eating and talking with my family and friends. | 0 | 1 | 2 | 3 |
75. I can’t tolerate things I dislike (like smells, textures, sounds, or colors). | 3 | 2 | 1 | 0 |
76. I don’t like to be hugged and held. | 3 | 2 | 1 | 0 |
77. When I go somewhere, I have to follow a familiar route or I can get very confused and upset. | 3 | 2 | 1 | 0 |
78. It is difficult to figure out what other people expect of me. | 3 | 2 | 1 | 0 |
*24. Which questions did you like the best and why? Pick your three favorite questions. Write down the question number and explain what you liked best about the question:
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a.
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b.
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c.
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*25. Which questions did you dislike and why? Pick three favorite questions that you disliked most. Write down the question number and explain why you didn’t like the question:
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a.
____
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b.
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c.
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Ritvo, R.A., Ritvo, E.R., Guthrie, D. et al. A Scale to Assist the Diagnosis of Autism and Asperger’s Disorder in Adults (RAADS): A Pilot Study. J Autism Dev Disord 38, 213–223 (2008). https://doi.org/10.1007/s10803-007-0380-6
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DOI: https://doi.org/10.1007/s10803-007-0380-6