INSTRUCTIONS FOR COMPLETING THE AAA

Fill out the name, sex, date of birth and date of appointment in the Patient Details box by overwriting
(for the name and dates) or deleting as appropriate (for the sex) the text that is already in the cells.
The age of the patient will be calculated automatically and given in years (e.g. 20.5 corresponds to 20
years and 6 months). It does not matter if the name of the patient does not fit in one cell.

Select the AQ, EQ & RQ sheets from the tabs at the bottom of the window and enter the data from the
questionnaires.
N.B. A systematic investigation of the effect of missing responses has not been carried out. It is
therefore a matter for each individual clinician to decide the number of missing responses they are
willing to allow, however this number is unlikely to be greater than 5 on either instrument. To score
missing responses, a conservative approach is taken. The respondent is assumed to have given the
non-AS response, so they will score 0 points on the AQ and 1 point on the EQ.
Once the scores are entered in the AQ & EQ sheets, any items endorsed will be shown in upper
section of the appropriate boxes on the main AAA sheet.
If you have enabled macros then you can click the button below ("Confirm Data") to lock the entries on
the questionnaire sheets but allow the boxes on the AAA to be edited normally.

Save the clinical report as a new file. There is space to write in additional examples of how the
symptoms apply to the patient during the clinical interview. These examples can then be added to the
electronic report.

Page 1 of 25

ADULT ASPERGER ASSESSMENT (AAA)

PATIENT DETAILS
Name:
Sex:
Date of birth:
Appointment:
Age (in years):

XXXXXXXX
male/female
day/month/year
day/month/year
#VALUE!

SCREENING INSTRUMENT SCORES

Autism Spectrum Quotient (AQ) score:
Max = 50, and 80% of AS patients score 32 or more

Blank/Invalid

50

Reference: Baron-Cohen, S., Wheelwright, S., et al (2001) The Autism -Spectrum Quotient: a new instrument for screening AS and H FA in
adults of normal intelligence. Journal of Autism and Developmental Disorders, 31, 5 -17

Empathy Quotient (EQ) score:

Max = 80, and 80% of AS patients score 30 or less

Blank/Invalid

40

Reference: Baron-Cohen, S, & Wheelwright, S, (2004) The Empathy Quotient (EQ). An investigation of adults with Asperger Syndrome
or High Functioning Autism, and normal sex differences. Journal of Autism and Developmental Disorders, 34, 163 -175

Relatives Questionnaire (RQ) score:

Max = 31, and 87.5% of children with AS scored 15 or more

Blank/Invalid

31

Reference: Scott, F., Baron-Cohen, S., Bolton, P., Brayne, C. (2002) The CAST (Childhood Asperger Syndrome Test): Preliminary
development of a UK screen for mainstream primary-school age children. Autism 6(1), 9-31

CLASS CLINIC DIAGNOSTIC CRITERIA

In order to receive a diagnosis of AS, patients must have 3 or more symptoms in each of Sections A
- C, at least 1 symptom from Section D and meet all 5 prerequisites in Sections
E - I.

No. of symptoms required

No. of symptoms observed

Section

Domain

A (max = 5)

Social

B (max = 5)

Obsessions

C (max = 5)

Communication

10
5

0
0

D (max = 3)
Imagination
Total (max = 18)
E - I (max = 5)
Prerequisites

DIAGNOSIS

Page 2 of 25

NOTES

This is a computer-generated clinical report, designed by Baron-Cohen & Wheelwright (2000),

updated by Bradley (2011). It links electronically with the AQ, EQ and RQ* screening
instruments (see references above), showing which of the questionnaire items in the AQ and EQ
this patient has endorsed.

The AAA was developed in the CLASS (Cambridge Lifespan Asperger Syndrome Service) clinic,
which provides a specialist diagnostic evaluation. During the clinical interview, we check for the
presence of symptoms relevant to a diagnosis of Asperger Syndrome (AS) or High Functioning
Autism (HFA), as well as exploring if AQ & EQ items were endorsed in a valid way.
Note that the above criteria are CLASS criteria, which are more stringent than the internationally
recommended guidelines in DSM-IV. Therefore, anyone meeting CLASS criteria would also
meet DSM-IV criteria.
The DSM-IV criteria for AS is that patients need only have 2 or more symptoms from section A
and 1 or more symptoms from section B, as well as meeting the prerequisite conditions in
sections F - I. Symptoms that CLASS has included but which are not part of DSM-IV are
asterisked.

The symptoms in sections C and D are not required for an AS diagnosis in DSM-IV. However,
unless asterisked, they are part of the DSM-IV autistic disorder diagnosis.
* The RQ is an adapted form of the Childhood Autism Spectrum Test (CAST), not yet formally
assessed for retrospective use in an adult population. The indicative cut-off is taken from the
study in children reported in the reference above.

Page 3 of 25

A. Qualitative impairment in social interaction

1. Marked impairment in the use of multiple nonverbal behaviours such as eyeto-eye gaze, facial expression, body postures, and gestures to regulate social
interaction.

2. Failure to develop peer relationships appropriate to developmental level.

3. No interest in pleasing others; no interest in communicating his/her experience to

others, including:- lack of spontaneous seeking to share enjoyment, interests or
achievements with other people; lack of showing, bringing or pointing out objects of
interest.

YES

NO

YES

NO

YES

NO

Page 4 of 25

4. Lack of social or emotional reciprocity (e.g. not knowing how to comfort

someone; and/or lack of empathy).

YES

NO

YES

NO

*5. Difficulties in understanding social situations and other people's thoughts

and feelings.

Page 5 of 25

B. Restricted repetitive and stereotyped patterns of behaviour, interests, and activities

1. Encompassing preoccupation with one or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus.

2. Apparently inflexible adherence to specific, nonfunctional routines or rituals.

3. Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or

twisting, or complex whole-body movements).

YES

NO

YES

NO

YES

NO

Page 6 of 25

YES

NO

YES

NO

4. Persistent preoccupation with parts of objects/systems.

*5. Tendency to think of issues as being black and white (e.g. in politics or
morality), rather than considering multiple perspectives in a flexible way.

Page 7 of 25

C. Qualitative impairments in verbal or non-verbal communication

*1. Tendency to turn any conversation back on to self or own topic of interest.

*2. Marked impairment in the ability to initiate or sustain a conversation with others.
Cannot see the point of superficial social contact, niceties, or passing time with others,
unless there is a clear discussion point/debate or activity.

YES

NO

YES

NO

YES

NO

*3. Pedantic style of speaking, or inclusion of too little or too much detail.

Page 8 of 25

YES

NO

YES

NO

*4. Inability to recognise when the listener is interested or bored. Even if the
person has been told not to talk about their particular obsessive topic for too
long, this difficulty may be evident if other topics arise.

*5. Frequent tendency to say things without considering the emotional impact on
the listener (faux pas).

Page 9 of 25

D. Impairments in imagination
1. Lack of varied, spontaneous make believe play appropriate to developmental
level.

*2. Inability to tell, write or generate spontaneous, unscripted or unplagiarised fiction.

*3. Either lack of interest in fiction (written, or drama) appropriate to

developmental level or interest in fiction is restricted to its possible basis in fact
(e.g. science fiction, history, technical aspects of film).

YES

NO

YES

NO

YES

NO

Page 10 of 25

*E. Delays or abnormal functioning in each of A - D occur across development.

YES

NO

The problems noted above have all been present across the lifespan.

F. The disturbance causes clinically significant impairment in social, occupational, or other

important areas of functioning.

YES

NO

The problems noted above have interfered with the patient's life by
causing depression, social isolation, difficulties at work and school,
and an inability to attain life goals.

G. There is no clinically significant general delay in language (e.g. single words used by age 2
years, communicative phrases used by age 3 years)

YES

NO

The patient spoke on time.

H. There is no clinically significant delay in cognitive development or in the development of ageappropriate self-help skills, adaptive behaviour (other than in social interaction or skills linked
to social awareness e.g. personal hygiene).

YES

NO

There are no signs of any general learning disability.

I. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

YES

NO

The patient does not show any psychotic features.

PB/SBC/SW, University of Cambridge / CPFT, Nov 2011

Page 11 of 25

Item

Score
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39

40
41
42
43
44
45
46
47
48
49
50

Autism Spectrum Quotient Sheet

Enter the score from 1-4, 1 = definitely agree, 4 = definitely disagree
Put a 9 for any item for which there is not a clear endorsement (e.g. more than one item marked or no mark)

Text
I prefer to do things with others rather than on my own.
I prefer to do things the same way over and over again.
If I try to imagine something, I find it very easy to create a picture in my mind.
I frequently get so strongly absorbed in one thing that I lose sight of other things.
I often notice small sounds when others do not.
I usually notice car number plates or similar strings of information.
Other people frequently tell me that what I've said is impolite, even though I think it is polite.
When I'm reading a story, I can easily imagine what the characters might look like.
I am fascinated by dates.
In a social group, I can easily keep track of several different people's conversations.
I find social situations easy.
I tend to notice details that others do not.
I would rather go to a library than a party.
I find making up stories easy.
I find myself drawn more strongly to people than to things.
I tend to have very strong interests which I get upset about if I can't pursue.
I enjoy social chit-chat.
When I talk, it isn't always easy for others to get a word in edgeways.
I am fascinated by numbers.
When I'm reading a story, I find it difficult to work out the characters' intentions.
I don't particularly enjoy reading fiction.
I find it hard to make new friends.
I notice patterns in things all the time.
I would rather go to the theatre than a museum.
It does not upset me if my daily routine is disturbed.
I frequently find that I don't know how to keep a conversation going.
I find it easy to "read between the lines" when someone is talking to me.
I usually concentrate more on the whole picture, rather than the small details.
I am not very good at remembering phone numbers.
I don't usually notice small changes in a situation, or a person's appearance.
I know how to tell if someone listening to me is getting bored.
I find it easy to do more than one thing at once.
When I talk on the phone, I'm not sure when it's my turn to speak.
I enjoy doing things spontaneously.
I am often the last to understand the point of a joke.
I find it easy to work out what someone is thinking or feeling just by looking at their face.
If there is an interruption, I can switch back to what I was doing very quickly.
I am good at social chit-chat.
People often tell me that I keep going on and on about the same thing.

When I was young, I used to enjoy playing games involving pretending with other children.
I like to collect information about categories of things (e.g. types of car, types of bird, types of train, types of plant, etc.).
I find it difficult to imagine what it would be like to be someone else.
I like to plan any activities I participate in carefully.
I enjoy social occasions.
I find it difficult to work out people's intentions.
New situations make me anxious.
I enjoy meeting new people.
I am a good diplomat.
I am not very good at remembering people's date of birth.
I find it very easy to play games with children that involve pretending.

in, types of plant, etc.).

EQ40 Item EQ Item Score

1
1
2
3
2
4
5
3
6
7
4
8
9
5
10
6
11
7
12
13
8
14
9
15
16
17
10
18
11
19
20
12
21
13
22
23
24
14
25
15
26
16
27
17
28
18
29
30
31
19
32
33
20
34
21
35
22
36
23
37
24
38
25
39
40
26
41
27
42
28
43
29
44
45

30
31
32
33
34
35
36
37
38
39
40

46
47
48
49
50
51
52
53
54
55
56
57
58
59
60

Empathy Quotient Sheet

Enter the score from 1-4, 1 = definitely agree, 4 = definitely disagree
Put a 9 for any item for which there is not a clear endorsement (e.g. more than one item marked or no mark)
The item numbers for the abbreviated 40-item version of the EQ are given in Column B.
Text
I can easily tell if someone else wants to enter a conversation.
I prefer animals to humans.
I try to keep up with the current trends and fashions.
I find it difficult to explain to others things that I understand easily, when they don't understand it first time.
I dream most nights.
I really enjoy caring for other people.
I try to solve my own problems rather than discussing them with others.
I find it hard to know what to do in a social situation.
I am at my best first thing in the morning.
People often tell me that I went too far in driving my point home in a discussion.
It doesn't bother me too much if I am late meeting a friend.
Friendships and relationships are just too difficult, so I tend not to bother with them.
I would never break a law, no matter how minor.
I often find it difficult to judge if something is rude or polite.
In a conversation, I tend to focus on my own thoughts rather than on what my listener might be thinking.
I prefer practical jokes to verbal humour.
I live life for today rather than the future.
When I was a child, I enjoyed cutting up worms to see what would happen.
I can pick up quickly if someone says one thing but means another.
I tend to have very strong opinions about morality
It is hard for me to see why some things upset people so much.
I find it easy to put myself in somebody else's shoes.
I think that good manners are the most important thing a parent can teach their child.
I like to do things on the spur of the moment.
I am good at predicting how someone will feel.
I am quick to spot when someone in a group is feeling awkward or uncomfortable.
If I say something that someone else is offended by, I think that that's their problem, not mine.
If anyone asked me if I like their haircut, I would reply truthfully, even if I didn't like it.
I can't always see why someone should have felt offended by a remark.
People often tell me that I am very unpredictable.
I enjoy being the centre of attention at any social gathering.
Seeing people cry doesn't really upset me.
I enjoy having discussions about politics.
I am very blunt, which some people take to be rudeness, even though this is unintentional.
I don't tend to find social situations confusing
Other people tell me I am good at understanding how they are feeling and what they are thinking.
When I talk to people, I tend to talk about their experiences rather than my own.
It upsets me to see animals in pain.
I am able to make decisions without being influenced by people's feelings.
I can't relax until I have done everything I had planned to do that day.
I can easily tell if someone else is interested or bored with what I am saying.
I get upset if I see people suffering on news programmes.
Friends usually talk to me about their problems as they say I am very understanding.
I can sense if I am intruding, even if the other person doesn't tell me.
I often start new hobbies but quickly become bored with them and move on to something else.

People sometimes tell me that I have gone too far with teasing.
I would be too nervous to go on a big rollercoaster.
Other people often say that I am insensitive, though I don't always see why.
If I see a stranger in a group, I think that it is up to them to make an effort to join in.
I usually stay emotionally detached when watching a film.
I like to be very organised in day to day life and often make lists of the chores I have to do.
I can tune into how someone else feels rapidly and intuitively.
I don't like to take risks.
I can easily work out what another person might want to talk about.
I can tell if someone is masking their true emotion.
Before making a decisions I always weigh up the pros and cons.
I don't consciously work out the rules of social situations.
I am good at predicting what someone will do.
I tend to get emotionally involved with a friend's problems.
I can usually appreciate the other person's viewpoint, even if I don't agree with it.

e item marked or no mark)

Item

Y/N
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37

Relatives Questionnaire (CAST)

Enter either Y or N (Yes or No) for each item
Put a 9 for any item for which there is not a clear endorsement (e.g. more than one item marked or no mark)

Text
Did s/he join in playing games with other children easily?
Did s/he come up to you spontaneously for a chat?
Was s/he speaking by 2 years old?
Did s/he enjoy sports?
Was it important to him/her to fit in with the peer group?
Did s/he appear to notice unusual details that others miss?
Did s/he tend to take things literally?
When s/he was 3 years old, did s/he spend a lot of time pretending (e.g., play-acting
being a superhero, or holding teddys tea parties)?
Did s/he like to do things over and over again, in the same way all the time?
Did s/he find it easy to interact with other children?
Could s/he keep a two-way conversation going?
Could s/he read appropriately for his/her age?
Did s/he mostly have the same interests as his/her peers?
Did s/he have an interest which takes up so much time that s/he did little else?
Did s/he have friends, rather than just acquaintances?
Did s/he often bring you things s/he was interested in to show you?
Did s/he enjoy joking around?
Did s/he have difficulty understanding the rules for polite behaviour?
Did s/he appear to have an unusual memory for details?
Was his/her voice unusual (e.g., overly adult, flat, or very monotonous)?
Were people important to him/her?
Could s/he dress him/herself?
Was s/he good at turn-taking in conversation?
Did s/he play imaginatively with other children, and engage in role-play?
Did s/he often do or say things that are tactless or socially inappropriate?
Could s/he count to 50 without leaving out any numbers?
Did s/he make normal eye-contact?
Did s/he have any unusual and repetitive movements?
Was his/her social behaviour very one-sided and always on his/her own terms?
Did s/he sometimes say you or s/he when s/he meant "I"?
Did s/he prefer imaginative activities such as play-acting or story-telling, rather than
numbers or lists of facts?
Did s/he sometimes lose the listener because of not explaining what s/he was talking
about?
Could s/he ride a bicycle (even if with stabilisers)?
Did s/he try to impose routines on him/herself, or on others, in such a way that it causes
problems?
Did s/he care how s/he was perceived by the rest of the group?
Did s/he often turn conversations to his/her favourite subject rather than following what
the other person wants to talk about?
Did s/he have odd or unusual phrases?

n one item marked or no mark)