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 OptionalI 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.