Outcome Measure
Ritvo Autism Asperger Diagnostic Scale-Revised
What it measures?
- The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) is a 80-item self-report assessment measure designed to assist in the diagnosis of Autism Spectrum Disorder (ASD) amongst adults. (Ritvo et al., 2008; Ritvo et al., 2010).
- This measure assesses domains related to autism spectrum traits associated with social relatedness, circumscribed interests, language and sensory-motor symptoms.
- RAADS-R measures both the presence and the severity of the symptoms of ASD, and has been noted to be useful in differentiating between neurotypical (control) samples vs those who present with ASD (Ritvo et al., 2010).
- It is designed to be self-administered by the individual being assessed, and the results should be interpreted by a clinician with expertise in ASD.
Who is it for?
* The RAADS-R is for individuals aged 16+ to assist in the diagnosis of ASD, the questions are designed for individuals with average IQ and above. The scale is intended to capture ASD within a population with mild or subclinical ASD (Ritvo et al., 2008). * Critics argue that the test is outdated and doesn’t capture nuances as well as other psychometric measures targeted for ASD especially in outpatient settings where the RAADS-R reported a sensitivity of 0.52 and specificity of 0.73 (Conner et al., 2019). * More research needs to be conducted in cross-cultural clinical, sub-clinical settings, amongst individuals from diverse backgrounds and individuals that present with co-morbidities (Kondo, 2015) notably high-false positive rates in samples presenting with other psychiatrist samples (Picot et al., 2021).
Instrument Quality
- Mean scores for each of the questions and total mean ASD vs the comparison groups’ scores were found to be significantly different (p < .0001). Concurrent validity with Constantino Social Responsiveness Scale-Adult = 95.59%. Sensitivity = 97%, specificity = 100%, test–retest reliability r = .987. Cronbach alpha coefficients for the subscales and 4 derived factors were good, with internal and test-retest reliability being consistent across samples (Ritvo et al., 2011; Thabtah and Peebles, 2019).
- However, more recent studies conducted have also suggested that the RAADS-R has been unable to discriminate between ASD and non-ASD cohorts when used as a self-report screening tool (Jones et al., 2021), Likewise some other studies have observed low-levels of predictive validity notably in outpatient settings (Sizoo et al., 2015), and have shown a 3.03% chance of detecting the absence of ASD, and reporting high-rates of false positives (Sizoo et al., 2015) (Eriksson et al., 2013; Jones et al., 2021).
- RAADS-R also demonstrates adequate concurrent validity (Jones et al., 2021).
Structure
- The RAADS-R contains 64 symptom-based questions and 16 non-symptom based responses divided into the following sub-scales in accordance with the DSM-IV-TR criteria for Autism Spectrum Disorder (Ritvo et al., 2008; Ritvo et al., 2011):
- Social Relatedness —total of 39 questions: 1, 6, 8, 11, 14, 17, 18, 25, 37, 38, 3, 5, 12, 28, 39, 44, 45, 76, 79, 80, 20, 21, 22, 23, 26, 31, 43, 47, 48, 53, 54, 55, 60, 61, 64, 68, 69, 72, 77. Items of this subscale relate to difficulties that emerge in social interactions, situations and relationships. This includes but is not limited to focusing on challenges with understanding cues, initiating and maintaining conversation, formation of relationships, preference of solitary vs social activities, feelings of overwhelm in social settings, and difficulties understanding subtle social nuances such as jokes or sarcasm.
- Circumscribed Interests —total of 14 questions: 9, 13, 24, 30, 32, 40, 41, 50, 52, 56, 63, 70, 75, 78. Items of this subscale assesses the presence and intensity of repetitive behaviors and circumscribed interests, including but not limited to the presence and severity of engaging in repetitive movements or action, difficulties adapting to changes in routine or environment and the presence of specific, intense interests.
- Language —total of 7 questions: 2, 7, 27, 35, 58, 66, 15. Items of this subscale relate to challenges with comprehending and using language effectively, including difficulties with non-verbal cues such as recognising and interpreting body language and facial expressions, making limited use of gesture and trouble expressing emotions verbally.
- Sensory Motor —total of 20 questions: 10, 19, 4, 33, 34, 36, 46, 71, 16, 29, 42, 49, 51, 57, 59, 62, 65, 67, 73, 74. Items of this subscale relate to hypersensitivity, sensory overload and difficulties with fine motor-coordination. Including but not limited to sensitivity to loud noises, bright lights, difficulties with dexterous tasks such as handwriting, or expressing discomfort with textures/fabrics.
- There are threshold scores for each of the subscales (Language, Social Relatedness, Sensory-Motor, Circumscribed Interests) as well as a total threshold score that suggests a clinical level of ASD features.
- Respondents indicate to what extent (3 = “True now and when I was young”; 0 = “Never true”) each statement (e.g: “I don’t like to be hugged or held”) each statement has been characteristic of them throughout their life.
Scoring instructions
- Each question on the RAADS-R is rated on a scale, with the respondent indicating how true each statement is for them currently and retrospectively (before age 16).
- Each question is rated on a Likert scale with the following 4 statements: The scoring of most of the statements (63) is as follows:
- True now and when I was young (3 points)
- True now only (2 points)
- True only when I was younger than 16 (1 point)
- Never true (0 points) However, the point value is reversed for the 17 normative questions:
- True now and when I was young (0 points)
- True now only (1 point)
- True only when I was younger than 16 (2 points)
- Never true (3 points) These 17 questions are identified on the scale by an asterisk next to their question number.
- A score of 65 or above on the RAADS-R assessment aligns with a clinical diagnosis of Autism Spectrum Disorder (ASD). Conversely, a score of 64 or below suggests that a diagnosis of ASD is unlikely (with a sensitivity of 97% and a specificity of 100%).
- Clinical judgment on the presence of ASD should take precedence, If individuals present with a score of 64 or lower, but signs of ASD are present (Ritvo et al., 2011)
| Subscale | Item number |
|---|---|
Sensory Motor (RAADS-R) |
4,10,16,19,29,33,34,36,42,46,49,51,57,59,62,65,67,71,73,74 |
Language (RAADS-R) |
2,7,15,27,35,58,66 |
Circumscribed Interests (RAADS-R) |
9,13,24,30,32,40,41,50,52,56,63,70,75,78 |
Social Relatedness (RAADS-R) |
1,3,5,6,8,11,12,14,17,18,20,21,22,23,25,26,28,31,37,38,39,43,44,45,47,48,53,54,55,60,61,64,68,69,72,76,77,79,80 |
Full-scale (RAADS-R) |
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80 |
Score Interpretation
What higher scores mean?
- The scoring range of the RAADS–R is 0–240. A score of 65+ indicates individuals are likely autistic, as no neurotypical individual has scored above 64 in the original research (Ritvo et al., 2011), with a score of <65. The users who gain an overall score below 65 are identified as the controls and the users who score above 65 are directed to further evaluations and clinical diagnosis for ASD (Thabtah and Peebles, 2019).
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Below ASD mean | 0 | |
| ASD mean | 32.82 | |
| Autism Spectrum Disorder | >=16 | Provisional Diagnosis |
| 1 SD above ASD mean | 45.07 | |
| 2 SD above ASD mean | 57.32 | |
| Maximum | 60 |
| Description | Score Range | |
|---|---|---|
| Below ASD mean | 0 | |
| ASD mean | 11.08 | |
| Autism Spectrum Disorder | >=4 | Provisional Diagnosis |
| 1 SD above ASD mean | 15.62 | |
| 2 SD above ASD mean | 20.16 | |
| Maximum | 21 |
Severity ranges
* A score of 65 or greater suggests a clinical diagnosis of ASD. Individuals scoring below 65 are generally considered to be neurotypical or may have other psychiatric conditions but not ASD; Ritvo et al., 2011). *Clinical judgment should always be prioritised if an individual presents with symptoms of ASD but scores 64 or lower on the scale. This is due to the limitations of self-report measures. Higher scores reflect a greater number of traits associated with autism, while lower scores indicate fewer or no traits.
Provisional diagnosis
* A score of 65 or higher suggests that an individual may have ASD. This threshold was determined based on the original validation study which reported high levels of sensitivity and specificity (Sensitivity = 97%, specificity = 100%), (Ritvo et al., 2011). * Subsequent research has further demonstrated this within a sample of 50 individuals referred for ASD diagnosis. RAADS-R demonstrated 100% sensitivity in detecting the presence of ASD in those having received a diagnosis, and 3.03% specificity in detecting the absence of ASD in those who did not receive a diagnosis (N=50; Jones et al., 2021).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 11.08 | A statistical analysis of the RAADS-R subscales demonstrated in a clinical sample (N=66) that M = 11.08 and SD = 4.54, meeting the threshold requirements for a provisional diagnosis of ASD. (Ritvo et al., 2011) This was further observed in clinical samples (N=75) where M= 8.7 and SD = 4.8 on the Language subscale (Andersen et al., 2011) |
| Normative | 1.86 | The original validation study demonstrated that in normative samples (N=276) the M =1.86 and SD = 2.46, in line with the minimum threshold requirements of an ASD diagnosis (Ritvo et al., 2011). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 4.54 | A statistical analysis of the RAADS-R subscales demonstrated in a clinical sample (N=66) that M = 11.08 and SD = 4.54, meeting the threshold requirements for a provisional diagnosis of ASD. (Ritvo et al., 2011) This was further observed in clinical samples (N=75) where M= 8.7 and SD = 4.8 on the Language subscale (Andersen et al., 2011) |
| Normative | 2.46 | The original validation study demonstrated that in normative samples (N=276) the M =1.86 and SD = 2.46, in line with the minimum threshold requirements of an ASD diagnosis (Ritvo et al., 2011). |
| Description | Score Range | |
|---|---|---|
| Below ASD mean | 0 | |
| ASD mean | 28.11 | |
| Autism Spectrum Disorder | >=15 | Provisional Diagnosis |
| 1 SD above ASD mean | 36.65 | |
| 1.5 SD above ASD mean | 40.92 | |
| Maximum | 42 |
Severity ranges
* A score of 65 or greater suggests a clinical diagnosis of ASD. Individuals scoring below 65 are generally considered to be neurotypical or may have other psychiatric conditions but not ASD; Ritvo et al., 2011). *Clinical judgment should always be prioritised if an individual presents with symptoms of ASD but scores 64 or lower on the scale. This is due to the limitations of self-report measures. Higher scores reflect a greater number of traits associated with autism, while lower scores indicate fewer or no traits.
Provisional diagnosis
* A score of 65 or higher suggests that an individual may have ASD. This threshold was determined based on the original validation study which reported high levels of sensitivity and specificity (Sensitivity = 97%, specificity = 100%), (Ritvo et al., 2011). * Subsequent research has further demonstrated this within a sample of 50 individuals referred for ASD diagnosis. RAADS-R demonstrated 100% sensitivity in detecting the presence of ASD in those having received a diagnosis, and 3.03% specificity in detecting the absence of ASD in those who did not receive a diagnosis (N=50; Jones et al., 2021).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 28.11 | A statistical analysis of the RAADS-R subscales demonstrated in a clinical sample (N=66) that M = 28.11 and SD = 8.54, meeting the threshold requirements for a provisional diagnosis of ASD. (Ritvo et al., 2011) This was further observed in clinical samples (N=75) where M= 57.4 and SD = 19.7 on the Social Relatedness subscale (Andersen et al., 2011) |
| Normative | 5.03 | The original validation study demonstrated that in normative samples (N=276) the M =5.03 and SD = 4.44, in line with the minimum threshold requirements of an ASD diagnosis (Ritvo et al., 2011). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 8.54 | A statistical analysis of the RAADS-R subscales demonstrated in a clinical sample (N=66) that M = 28.11 and SD = 8.54, meeting the threshold requirements for a provisional diagnosis of ASD. (Ritvo et al., 2011) This was further observed in clinical samples (N=75) where M= 57.4 and SD = 19.7 on the Social Relatedness subscale (Andersen et al., 2011) |
| Normative | 4.44 | The original validation study demonstrated that in normative samples (N=276) the M =5.03 and SD = 4.44, in line with the minimum threshold requirements of an ASD diagnosis (Ritvo et al., 2011). |
| Description | Score Range | |
|---|---|---|
| Below ASD mean | 0 | |
| ASD mean | 67.89 | |
| Autism Spectrum Disorder | >=31 | Provisional Diagnosis |
| 1 SD above ASD mean | 89.34 | |
| 2 SD above ASD mean | 110.79 | |
| Maximum | 117 |
Severity ranges
* A score of 65 or greater suggests a clinical diagnosis of ASD. Individuals scoring below 65 are generally considered to be neurotypical or may have other psychiatric conditions but not ASD; Ritvo et al., 2011). *Clinical judgment should always be prioritised if an individual presents with symptoms of ASD but scores 64 or lower on the scale. This is due to the limitations of self-report measures. Higher scores reflect a greater number of traits associated with autism, while lower scores indicate fewer or no traits.
Provisional diagnosis
* A score of 65 or higher suggests that an individual may have ASD. This threshold was determined based on the original validation study which reported high levels of sensitivity and specificity (Sensitivity = 97%, specificity = 100%), (Ritvo et al., 2011). * Subsequent research has further demonstrated this within a sample of 50 individuals referred for ASD diagnosis. RAADS-R demonstrated 100% sensitivity in detecting the presence of ASD in those having received a diagnosis, and 3.03% specificity in detecting the absence of ASD in those who did not receive a diagnosis (N=50; Jones et al., 2021).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 67.89 | * Mean and sd values derive from a sample of individuals with confirmed ASD (N = 66; Ritvo et al., 2011). * Comparable findings were obtained by Anderson and colleagues (2011; N=75; M= 57.4 and SD = 19.7) |
| Normative | 9.24 | The original validation study demonstrated that in normative samples (N=276) the M =9.24 and SD = 7.70, in line with the minimum threshold requirements of an ASD diagnosis (Ritvo et al., 2011). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 21.45 | * Mean and sd values derive from a sample of individuals with confirmed ASD (N = 66; Ritvo et al., 2011). * Comparable findings were obtained by Anderson and colleagues (2011; N=75; M= 57.4 and SD = 19.7) |
| Normative | 7.7 | The original validation study demonstrated that in normative samples (N=276) the M =9.24 and SD = 7.70, in line with the minimum threshold requirements of an ASD diagnosis (Ritvo et al., 2011). |
| Description | Score Range | |
|---|---|---|
| Below ASD mean | 0 | |
| ASD mean | 133.83 | |
| Autism Spectrum Disorder | >=65 | Provisional Diagnosis |
| 1 SD above ASD mean | 171.57 | |
| 2 SD above ASD mean | 209.31 | |
| Maximum | 240 |
Severity ranges
* A score of 65 or greater suggests a clinical diagnosis of ASD. Individuals scoring below 65 are generally considered to be neurotypical or may have other psychiatric conditions but not ASD; Ritvo et al., 2011). *Clinical judgment should always be prioritised if an individual presents with symptoms of ASD but scores 64 or lower on the scale. This is due to the limitations of self-report measures. Higher scores reflect a greater number of traits associated with autism, while lower scores indicate fewer or no traits.
Provisional diagnosis
* A score of 65 or higher suggests that an individual may have ASD. This threshold was determined based on the original validation study which reported high levels of sensitivity and specificity (Sensitivity = 97%, specificity = 100%), (Ritvo et al., 2011). * Subsequent research has further demonstrated this within a sample of 50 individuals referred for ASD diagnosis. RAADS-R demonstrated 100% sensitivity in detecting the presence of ASD in those having received a diagnosis, and 3.03% specificity in detecting the absence of ASD in those who did not receive a diagnosis (N=50; Jones et al., 2021).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 133.83 | * Reported clinical mean and sd values were derived from a sample of individuals with Autism Spectrum Disorder (Ritvo et al., 2011). Mean scores for each of the questions and total mean ASD vs. the comparison groups’ scores were significantly different (p< .0001) across various studies, as well as the original validation study (N=201; Ritvo et al., 2011). The same finding has been observed in other clinical samples (N=75; M= 118.7 and SD = 38.8; Andersen et al., 2011). |
| Normative | 25.95 | * Mean scores for each of the questions and total mean ASD vs. the comparison groups’ scores were significantly different (p< .0001) across various studies, in the original validation study (N=578; Ritvo et al., 2011). The same finding has been observed in clinical samples (N=197; M= 33.8 and SD = 27.6; Andersen et al., 2011). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 37.74 | * Reported clinical mean and sd values were derived from a sample of individuals with Autism Spectrum Disorder (Ritvo et al., 2011). Mean scores for each of the questions and total mean ASD vs. the comparison groups’ scores were significantly different (p< .0001) across various studies, as well as the original validation study (N=201; Ritvo et al., 2011). The same finding has been observed in other clinical samples (N=75; M= 118.7 and SD = 38.8; Andersen et al., 2011). |
| Normative | 16.04 | * Mean scores for each of the questions and total mean ASD vs. the comparison groups’ scores were significantly different (p< .0001) across various studies, in the original validation study (N=578; Ritvo et al., 2011). The same finding has been observed in clinical samples (N=197; M= 33.8 and SD = 27.6; Andersen et al., 2011). |
Reliability
| Value | Comments |
|---|---|
| 0.987 | RAADS-R has demonstrated high-levels of test-retest reliability in a small samples (N=15; r = .987; Ritvo et al., 2011). Studies conducted in cross-cultural populations have also demonstrated high-levels of test-retest reliability, as evidenced by recent research employing a Swedish version of the scale (r = .80; N=12; Andersen et al., 2011). |
Instrument developers
- Ritvo, R.A., Ritvo, E.R., Guthrie, D. et al. The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): A Scale to Assist the Diagnosis of Autism Spectrum Disorder in Adults: An International Validation Study. J Autism Dev Disord 41, 1076–1089 (2011). https://doi.org/10.1007/s10803-010-1133-5
Refrences
* Conner, C. M., Cramer, R. D., & McGonigle, J. J. (2019). Examining the Diagnostic Validity of Autism Measures Among Adults in an Outpatient Clinic Sample. Autism in adulthood : challenges and management, 1(1), 60–68. https://doi.org/10.1089/aut.2018.0023 * Eriksson, J.M., Andersen, L.M. & Bejerot, S. RAADS-14 Screen: validity of a screening tool for autism spectrum disorder in an adult psychiatric population. Molecular Autism 4, 49 (2013). https://doi.org/10.1186/2040-2392-4-49 * Jones, S. L., Johnson, M., Alty, B., & Adamou, M. (2021). The Effectiveness of RAADS-R as a Screening Tool for Adult ASD Populations. Autism research and treatment, 2021, 9974791. https://doi.org/10.1155/2021/9974791 * Nisticò, V., Goeta, D., Iacono, A., Tedesco, R., Giordano, B., Faggioli, R., Priori, A., Gambini, O., & Demartini, B. (2022). Clinical overlap between functional neurological disorders and autism spectrum disorders: a preliminary study. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 43(8), 5067–5073. https://doi.org/10.1007/s10072-022-06048-1
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Severity ranges
* A score of 65 or greater suggests a clinical diagnosis of ASD. Individuals scoring below 65 are generally considered to be neurotypical or may have other psychiatric conditions but not ASD; Ritvo et al., 2011). *Clinical judgment should always be prioritised if an individual presents with symptoms of ASD but scores 64 or lower on the scale. This is due to the limitations of self-report measures. Higher scores reflect a greater number of traits associated with autism, while lower scores indicate fewer or no traits.
Provisional diagnosis
* A score of 65 or higher suggests that an individual may have ASD. This threshold was determined based on the original validation study which reported high levels of sensitivity and specificity (Sensitivity = 97%, specificity = 100%), (Ritvo et al., 2011). * Subsequent research has further demonstrated this within a sample of 50 individuals referred for ASD diagnosis. RAADS-R demonstrated 100% sensitivity in detecting the presence of ASD in those having received a diagnosis, and 3.03% specificity in detecting the absence of ASD in those who did not receive a diagnosis (N=50; Jones et al., 2021).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
Standard Deviation