RAADS–R Test

## **The struggles autistic adults go through** Adults with autism spectrum disorder often have the same struggles as kids who have ASD, but since they are likely unaware that they have it, they very likely have learned to suppress the behaviors and characteristics of ASD as they grew up. Here are the common similarities they have with kids who have ASD: - They experience difficulties relating or communicating with others because they have a hard time understanding what and how others think and feel (leading to difficulty making friends/establishing new relationships) - They have a hard time understanding other people's perspectives - They can't read the room - They tend to withdraw and be alone - They might be easily and extremely stressed by change because they prefer following an established order and routine in their lives - They have specific interests and might be intense about it Adults with ASD are more likely to have anxiety, depression, and personality disorders, too (Levine, 2024).

## **What is a RAADS–R Test?** The RAADS-R (Ritvo Autism Asperger Diagnostic Scale-Revised) Test is a comprehensive screening tool designed to assess autism traits and the severity of autism spectrum disorder (ASD) in adults. The test includes a self-report questionnaire that can be completed online or on paper. The RAADS-R Test evaluates these four symptom areas: - Social Relatedness Problems - Circumscribed Interests - Language - Sensory Motor It is typically used in clinical settings when an individual exhibits behavioral or social communication difficulties associated with ASD. Besides assessing autistic traits, it can be used to make a formal autism diagnosis, rule out ASD, and to provide a comprehensive understanding of an individual's strengths and weaknesses. The test can be administered by healthcare professionals, including psychologists, psychiatrists, and specialists in autism. Use this assessment for these instances or settings: - Cognitive-behavioral issues were observed in an individual - Recommendation from a mental health expert - Screening for reaching an ASD diagnosis - Clinical and research settings

## **The RAADS-R Test's psychometric properties** The RAADS-R Autism Test has undergone clinical evaluations for autism research, meaning it has undergone validation by experts. The research group of this test's creator has conducted tests with a sample of 201 autistic individuals (adults) and 578 neurotypical adults (non-autistic adults) from the USA and Australia. Through this sample group, they were able to arrive at the following results (Ritvo et al., 2011): - It has a sensitivity of 97% - It has a high test-retest reliability (0.987) - It has a high concurrent validity of 96%, especially when used alongside the Social Responsiveness Scale for Adults (SRS-A) Through these tests, experts have deemed the RAADS-R Test reliable and a valuable tool for assessing autistic people during the diagnostic process. Those who are diagnosed with autism and and particlarly those who consider themselves to be autistic responded to this test similarly (Sturm et al., 2024). In 2017, approximately 2.21% of adults aged 18 years and older in the United States, totaling an estimated 5,437,988 individuals, have ASD (Centers for Disease Control and Prevention, 2020). Due to the high prevalence of autism in mental health settings and the rising frequency of referrals for adult autism diagnosis, this instrument is an effective clinical tool to assist clinicians with diagnosis. The RAADS-R works best with clinical knowledge and additional diagnostic techniques to establish a diagnosis. Despite having diagnosable autism, people with low reflective ability may perform poorly on the RAADS-R due to this assessment's self-report aspect (under clinical supervision/administration). You may also use it alongside other similar assessments in a comprehensive assessment, such as the Autism Spectrum Quotient (ASQ), Camouflaging Autistic Traits Questionnaire (CAT-Q), the SRS-A, and more to help you establish consistency when you seek to identify autistic traits to make good and informed clinical judgments and a formal diagnosis.

## **What to expect from the RAADS-R Test** The RAADS Test is a self-report questionnaire designed for a professional evaluation of certain people, particularly those who "escaped diagnosis," and those with limited interests, body movements, sensory motor symptoms, sensory sensitivities, and developmental symptoms associated with the three DSM-5 diagnostic areas of language, social relatedness, and sensorimotor development (Language, Social relatedness, and Sensory-motor). There are four options available for each of the 80 statements in this passage: - True now, and when I was young - True now only - True only when I was younger than 16 - Never true ### **What are some items that patients should expect from a RAADS-R Test?** One may feel overwhelmed before diving into the RAADS-R Test as it confronts individuals with probing questions about their behaviors and experiences. To ease this apprehension, here are 15 sample items from the test you can share with your patients, offering a glimpse into what they can expect and helping them gauge their responses. Remember to do this before conducting a formal assessment using this test. 1. I am a sympathetic person. 2. Sometimes, I have to cover my ears to block out painful noises (like vacuum cleaners or people talking too much or too loudly). 3. It can be very intimidating for me to talk to more than one person at the same time. 4. I enjoy spending time eating and talking with my family and friends. 5. I can "put myself in other people's shoes." 6. I like things to be exactly the same day after day and even small changes in my routines upset me. 7. I have been told that I have an unusual voice (for example flat, monotone, childish, or high-pitched). 8. I am often told that I ask embarrassing questions. I tend to point out other people's mistakes. 9. When I go somewhere, I have to follow a familiar route or I can get very confused and upset. 10. People tell me that I give too much detail. 11. I like to copy the way certain people speak and act. It helps me appear more normal 12. The phrase 'I've got you under my skin" makes me very uncomfortable. 13. I speak with a normal rhythm. 14. I get extremely upset when how I like to do things suddenly changes. 15. I can see in my mind in exact detail things that I am interested in.

## **How to use the RAADS-R Test** Assuming you have explained what the RAADS-R Test is, and they have given their consent for a further investigation of their potential ASD through a comprehensive evaluation, then you can use the RAADS-R Test to help you make a definitive diagnosis! ### **Step 1: Download our template** Once you're set to use this test, you can download our template by clicking "Use Template" or "Download" above. The PDF file is interactive, so you can use this digitally if your practice has gone paperless, or you can still choose to print it. ### **Step 2: Have your patient answer the test** This is a self-assessment tool/self-report questionnaire, so you can simply hand them a copy of this test for them to answer on their own, but you can also opt to conduct this like an interview. If you choose to do the latter, make sure that you've already given them a glimpse of what to expect from the test (items and answer options). Take note that you must inform them to answer the whole test to get accurate results and avoid false positives. While they might gain a deeper understanding of themselves while thinking about their answers, please tell them they can't make a self-diagnosis. Also, make sure the person's age must be within the range that they are considered adults. ### **Step 3: Calculate the scores and proceed with the next steps** After you receive a fully answered RAADS-R Test, what you can do is to use other diagnostic tools to get consistent results and cross-check everything with the current version of the DSM. Then, you can make an official diagnosis.

## **RAADS–R Test scoring** The RAADS-R Test Scoring is a useful clinical tool in ASD assessment. Developed by Riva Ariella Ritvo, Edward R. Ritvo, and their colleagues, this self-report questionnaire is designed to help clinicians, researchers, and individuals better understand and evaluate the presence and severity of autistic traits and behaviors in adults. The test consists of 80 questions that cover various aspects of social interaction, communication, and repetitive behaviors—core domains associated with ASD. Respondents rate their agreement with each statement on a 4-point scale. Higher scores on the RAADS-R indicate a higher likelihood of autism-related traits or behaviors. The questions are structured to assess the presence and degree of these traits, making it a valuable tool for diagnosing and evaluating the severity of ASD. The scoring process involves summing the individual responses to each question to obtain a total score ranging from 0 to 240. Additionally, the test provides subscale scores for social relatedness, language, sensory/motor issues, and circumscribed interests. These subscales help clinicians better understand the specific areas where an individual may exhibit autistic traits. ### **RAADS-R Test scoring interpretation** Interpreting RAADS-R Test Scores is crucial in understanding an individual's likelihood of having autistic traits and behaviors. The interpretation process involves analyzing the total and subscale scores to gain a comprehensive understanding. Here's how to interpret RAADS-R scores: The total score on the RAADS-R can range from 0 to 240, with higher (average) scores indicating a higher likelihood of autistic traits. Interpretation of the total score typically follows these guidelines: - **0-65**: A cutoff score of 65 is generally considered within the typical scoring range, suggesting fewer autistic traits. - **66-90**: A RAADS-R score in this range may indicate mild to moderate autistic traits. - **91 and above**: Higher scores often suggest a significant presence of autistic traits, which may warrant further evaluation by a healthcare professional. - **Subscale scores**: RAADS-R provides subscale scores in four domains: social relatedness, language, sensory/motor issues, and circumscribed interests. These  scores offer insights into specific areas of concern: - **Social relatedness**: High scores in this domain may indicate social interaction and communication challenges. - **Language**: Elevated scores suggest difficulties in understanding and using language effectively. - **Sensory/motor control issues**: Higher scores may indicate heightened sensitivities or motor coordination challenges. - **Circumscribed interests**: Elevated scores in this area imply a strong focus on specific, often repetitive, interests.

## **References** Centers for Disease Control and Prevention. (2020, April 27). CDC releases first estimates of the number of adults living with ASD. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/autism/features/adults-living-with-autism-spectrum-disorder.html Levine, H. (2024, December 3). Autism: The challenges and opportunities of an adult diagnosis - Harvard Health. Harvard Health. https://www.health.harvard.edu/mind-and-mood/autism-the-challenges-and-opportunities-of-an-adult-diagnosis ‌Ritvo, R. A., Ritvo, E. R., Guthrie, D., Ritvo, M. J., Hufnagel, D. H., McMahon, W., Tonge, B., Mataix-Cols, D., Jassi, A., Attwood, T., & Eloff, J. (2011). 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. Journal of Autism and Developmental Disorders, 41(8), 1076–1089. https://doi.org/10.1007/s10803-010-1133-5   Sturm, A., Huang, S., Bal, V., & Schwartzman, B. (2024). Psychometric exploration of the RAADS-R with autistic adults: Implications for research and clinical practice. Autism, 28(9), 2334–2345. https://doi.org/10.1177/13623613241228329