Assessing general and autism-relevant quality of life in autistic adults: A psychometric investigation using item response theory.
Zachary J Williams, Katherine O Gotham
PMID 33876550WHAT IT FOUND
The ASQoL measure produced biased results for autistic women compared to men, falsely suggesting lower quality of life.
The 4-item WHOQOL-4 was stable across groups and accurately measured global quality of life, making it a better choice for clinical assessment.
Key findings
01The ASQoL showed differential item functioning by sex and gender, causing autistic women to appear to have lower quality of life than men due to statistical bias rather than true differences.
02The 4-item WHOQOL-4 demonstrated strong reliability and no differential item functioning across any subgroup, including sex, gender, and mental health status.
03Researchers should not use the ASQoL total score until it is revised, but the WHOQOL-4 is a viable option for assessing global quality of life.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample was predominantly non-Hispanic White, college-educated, and diagnosed with autism in adulthood, which may not represent the wider autistic population. The ASQoL was administered independently rather than alongside the full WHOQOL-BREF and WHOQOL-DIS modules as originally intended, which might affect how items are interpreted. The study focused on verbal autistic adults, so findings may not apply to those with limited verbal ability.
Declared interests
Zachary Williams has served as a consultant for Roche and participates in advisory committees for Autism Speaks and the Autism Intervention Research Network on Physical Health. Katherine Gotham has no conflicts of interest to disclose.
The easy way to misread this
Do not interpret lower ASQoL scores in autistic women as evidence of poorer quality of life. The measure exhibits differential item functioning by sex and gender, creating a statistical artifact that biases scores downward for women compared to men at the same true level of well-being.