Are items from current self-report measures adequate for assessing autistic traits in women? Insights from a modified Delphi study with autistic women and professional experts.

Sex/gender-related measurement bias in autism measures has been proposed as a factor contributing to the underdiagnosis of autistic women, yet research in this area remains limited. This study builds on the small but growing body of work addressing this gap by using a modified Delphi methodology to reach consensus among autistic women and academics/clinicians on the most relevant items from five measures of autistic traits: Autism Spectrum Quotient (AQ-50), Broad Autism Phenotype Questionnaire (BAPQ), Comprehensive Autistic Trait Inventory (CATI), Girls Questionnaire for Autism Spectrum Condition (GQ-ASC), and Ritvo Autism and Asperger Diagnostic Scale-14 (RAADS-14), and to evaluate each measure’s suitability for autistic women in their current form.Thirty-three autistic women and thirty-three academics/clinicians participated in the study. Each participant was asked to rate the relevance of individual items to the experiences of autistic women and to indicate whether each measure comprehensively captured experiences relevant to this group. Agreement on relevance was calculated separately for each group using the item-level content validity index (I-CVI) and the modified kappa statistic (k*), with scale-level content validity indices (S-CVI/Ave) derived for each measure.The findings showed broad consistency in relevance evaluations between the two groups. The RAADS-14 was rated as the most relevant measure for assessing autistic traits in women, followed by the CATI, while the remaining questionnaires were associated with lower perceived relevance. However, none fully captured experiences relevant to autistic women, indicating construct underrepresentation that warrants further investigation. Items assessing masking were identified as valuable for inclusion to enhance the relevance of autism measures for women. In contrast, items related to attention to detail and imagination appeared less useful for assessing autism more broadly or for capturing subtler presentations of autistic traits, or may not be suitably phrased for autistic women. The most relevant items identified across the five measures can be considered valid across clinical, academic, and lived-experience contexts, providing a foundation for refining existing scales to better capture the experiences of individuals with subtler presentations of autistic traits.