Autism in Adults in Romania: Challenges in Diagnosis and Screening.

Background: Due to the absence of validated screening tools for Autism Spectrum Disorder (ASD) in adults without intellectual or language deficits in Romania, clinicians often overlook ASD during evaluations, leading to frequent misdiagnoses. To screen for symptoms of comorbid pathologies in an ASD sample compared with a non-ASD sample using the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and to establish cut-off scores for the Romanian-translated versions of the Autism Quotient (AQ) and Empathy Quotient (EQ). Methods: The study included 143 participants, 31 diagnosed with ASD and 112 from the general population. Both groups completed the PDSQ, AQ, and EQ. Analyses focused on the factorial structure, reliability, criterion validity, sensitivity, and specificity of the AQ and EQ, as well as correlations between AQ/EQ scores and PDSQ scores. Results: Higher AQ scores were associated with anxiety, trauma, and obsessive-compulsive disorder (OCD) symptoms. A cut-off score of 21 on the AQ accurately classified 100% of clinically diagnosed ASD participants and correctly identified 80% of non-ASD participants, yielding an overall accuracy of 84%. For the EQ, a cut-off score of 26 achieved the highest specificity while maintaining optimal sensitivity, with an overall accuracy of 88%. Both AQ and EQ demonstrated good internal consistency and reliability. Conclusion: The Romanian versions of the AQ and EQ are highly reliable screening tools for clinical use. Correlations between AQ scores and elevated anxiety, OCD, and trauma symptoms on the PDSQ highlight the importance of assessing ASD comorbidities during clinical evaluations.