Autism Spectrum Quotient (AQ) A quick referral guide for adults with suspected autism who do not have a learning disability. Name Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Title First Last Date of Birth Day Month Year Name of Clinician Requesting Form Optional I often notice small sounds when others do not Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree I usually concentrate more on the whole picture, rather than the small details Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree I find it easy to do more than one thing at once Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree If there is an interruption, I can switch back to what I was doing very quickly Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree I find it easy to ‘read between the lines’ when someone is talking to me Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree I know how to tell if someone listening to me is getting bored Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree When I’m reading a story I find it difficult to work out the characters’ intentions Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree I like to collect information about categories of things (e.g. types of car, types of bird, types of train, types of plant etc) Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree I find it easy to work out what someone is thinking or feeling just by looking at their face Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree I find it difficult to work out people’s intentions Definitely Agree Slightly Agree Slightly Disagree Definitely Disagree Email OptionalThis field is for validation purposes and should be left unchanged.