Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with the core symptoms of social communication and interaction defects and limited behavior, interest, and activity patterns . The prevalence of ASD is high in both America and China. The 2021 Centers for Disease Control and Prevention (CDC) report indicated that one out of every 44 eight-year-old children (2.3%) was diagnosed with ASD . Although representative large-scale epidemiological research on ASD in China is lacking, the latest report indicated that the prevalence of ASD among children aged six to 12 in China was approximately 0.7% in 2019, encompassing an estimated 700,000 children .
These prevalence rates indicate that many children and families in China are affected by ASD. Promoting scientific knowledge of ASD and the affected population among the general public can reduce misunderstanding and stigmatization of ASD, increase opportunities for intervention, and improve self-esteem, quality of life, and social inclusion among children with ASD. Therefore, this study aimed to introduce a comprehensive ASD knowledge scale to assess the general public’s knowledge of ASD in China, understand the deficiencies, and promote widespread scientific publicity. Disease knowledge refers to the personal understanding of the disease. These perceptions are related to the usual understanding of various aspects of the disease, including etiology, exacerbation factors, symptoms, treatment, and prognosis . Similarly, ASD knowledge, also known as beliefs about ASD, ASD awareness, and ASD understanding, refers to the individual’s understanding and knowledge of ASD.
Publicity regarding ASD knowledge in China is not sufficiently comprehensive and structured. As early as 2009 , researchers in China realized the importance of measuring ASD knowledge. From 2009 to date, research on ASD knowledge in China has gradually developed. A scale is one way to measure ASD knowledge. Chinese researchers have developed several scales, including the Mental Health Questionnaire for Children Aged 2–6 Years Old developed by Wang et al. in 2009 , the Autism-Related Information Awareness Questionnaire , the Autism-Related Information Awareness Survey edited by Zhao et al. in 2017 , the Autism-Related Information Awareness Questionnaire for Children edited by Zhang et al. in 2019 , and the Chinese version of the Autism Stigma and Knowledge Questionnaire (ASK-Q) edited by Yu et al. . In terms of disease classification, etiology, symptoms, diagnosis, prognosis, and understanding channels, these studies found that most people in China think that ASD, which is actually a neurodevelopmental disorder, is a mental disease [6, 8]. The public consider ASD being mainly due to improper education , but the cause of ASD is not currently known . The public considers ASD is wordless , but the core symptoms of ASD are social communication disorder and restricted, repetitive behaviors and interests . Fortunately, attitudes toward diagnosis and treatment are positive, and the public thinks that people should consult or seek medical treatment immediately if they find that their child has related symptoms [7, 8], which is accurate. However, the public thinks that the Department of Psychology deal with ASD , whereas it is actually the Department of Rehabilitation or the Department of Growth and Development. In addition, the public believes that early treatment and intervention of ASD can improve the condition among children , which is correct . The main channels to obtain understanding are newspapers, magazines, and books . These findings indicate that Chinese people retain many misunderstandings regarding ASD. In 2016, a scale with robust psychometric properties was proposed. The operational definition of the criteria were that the reliability and validity of the measurement should be carefully tested. The detection results of the reliability and validity were good . However, most of the above-mentioned scales, except for the ASK-Q, did not demonstrate good psychometric properties. ASD knowledge is vital to the general population . As such, it is crucial to measure the ASD knowledge of the general population, which can be done with the Chinese version of the ASK-Q. However, the Chinese version of ASK-Q is not sufficiently comprehensive to introduce relevant information about the disease. Therefore, this study aimed to screen and revise other internationally established scales.
Internationally available ASD knowledge scales for the general population with robust psychometric properties include Beliefs About Autism developed by Furnham and Buck in 2003, the ASK-Q developed by Harrison et al. in 2017 , and the Autism Spectrum Knowledge Scale-General (ASKS-G) developed by McClain et al. in 2019 . Beliefs about autism examines the causes and treatments and is inconsistent with the newly released Diagnostic and Statistical Manual DSM-5 . It describes only autism, whereas other subtypes of ASD are not included. The ASK-Q contains four subscales assessing etiology, symptoms/diagnosis, treatment, and stigma identification but does not incorporate recent epidemiological data on the etiology subscale, such as prevalence and male-to-female ratio, and the Treatment subscales describe the factors affecting treatment incompletely (only age is mentioned). However, the Autism Spectrum Disorder Knowledge Scale(ASKSG) is consistent with DSM-5 and covers a broader field of disease contents, including etiology and epidemiology, symptoms and related behaviors, evaluation and diagnosis, treatment, results and prognosis , which is in line with the comprehensive and structured introduction to disease knowledge . Based on the comprehensiveness and structural integrity of the ASKSG, we selected the ASKSG for localization revision.
McClain et al.  developed two ASD knowledge scales based on different populations: the Autism Spectrum Knowledge Scale Professional Version-Revised (ASKSP-R), which is used to measure the ASD knowledge of professionals, and the ASKSG, which is used to measure the ASD knowledge of the general population. The ASKSG contains 31 items presented as descriptive declarative sentences. The participants respond with the following options: “True”, “False”, or “Don’t know.” Points are given for correct answers, and “Don’t know” is recorded as a wrong response. Higher scores indicate higher levels of ASD knowledge level. The ASKSG meets the psychometric criteria proposed by Harrison et al. . According to item response theory, the ASKSG is unidimensional (all MSQs < 1.5) with acceptable internal consistency (α = 0.73 raw score, α = 0.75 standardized; λ6 = 0.80). It passed the review of three ASD experts in the fields of clinical and school psychology in support of face validity . In addition, the effectiveness of the ASKSG has been tested with the general American population  and the an American parent sample . Furthermore, the ASKSG has been used to test the effectiveness of an ASD knowledge video intervention , demonstrating its applicability.
The present study
This study aimed to revise a Chinese version of the ASKSG and to assess its reliability, validity, and psychometric properties. In addition, we determined the level of knowledge of ASD in a sample of the Chinese general population.