Are items from current self-report measures adequate for assessing autistic traits in women? Insights from a modified Delphi study with autistic women and professional experts

Mol Autism. 2026 Jul 17. doi: 10.1186/s13229-026-00724-1. Online ahead of print.

ABSTRACT

BACKGROUND: Sex/gender-related measurement bias in autism measures has been proposed as a factor contributing to the underdiagnosis of autistic women, yet research in this area remains limited. This study builds on a small but growing body of work addressing this gap by using a modified Delphi methodology to reach consensus among autistic women and academics/clinicians on the most relevant items from five measures of autistic traits: Autism Spectrum Quotient (AQ-50), Broad Autism Phenotype Questionnaire (BAPQ), Comprehensive Autistic Trait Inventory (CATI), Girls Questionnaire for Autism Spectrum Condition (GQ-ASC), and Ritvo Autism and Asperger Diagnostic Scale-14 (RAADS-14), and to evaluate each measure’s suitability for autistic women in their current form.

METHODS: Thirty-three autistic women and thirty-three academics/clinicians participated in the study. Each participant was asked to rate the relevance of individual items to the experiences of autistic women and to indicate whether each measure comprehensively captured experiences relevant to this group. Agreement was calculated separately for each group using item-level content validity indices, from which scale-level indices were derived for each measure.

RESULTS: The RAADS-14 was rated as the most relevant measure for assessing autistic traits in women, followed by the CATI, while the remaining questionnaires were associated with lower perceived relevance. However, none fully captured experiences relevant to autistic women, indicating construct underrepresentation. Items assessing masking were identified as valuable for inclusion to enhance the relevance of measures for women, whereas items related to attention to detail and imagination appeared less useful for assessing autism more broadly or for capturing more nuanced presentations of autistic traits.

LIMITATIONS: The sample was predominantly Western, White, and highly educated, limiting the generalisability of findings. Furthermore, the expert groups lacked sufficient homogeneity, as academics and clinicians were combined and participants evaluated different subsets of measures.

CONCLUSIONS: Although the RAADS-14 and CATI were identified as the most relevant measures for autistic women, all instruments demonstrated incomplete coverage of the autism construct in this population. Items reaching consensus as most relevant across the five measures provide a foundation for refining existing scales to better capture the experiences of individuals with more nuanced presentations of autistic traits.

PMID:42469909 | DOI:10.1186/s13229-026-00724-1