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Autistic Traits in Individuals with NormalAutistic Traits in Individuals with Normal
Intellectual Level and AssociatedIntellectual Level and Associated
Psychological Distress:Psychological Distress:
A Pilot Study in an Arabic CultureA Pilot Study in an Arabic Culture
Dr Omaima A DaoudDr Omaima A Daoud
Lecturer of Psychiatry, Faculty of Medicine, Zagazig University, Egypt.Lecturer of Psychiatry, Faculty of Medicine, Zagazig University, Egypt.
Dr Mick LoughrenDr Mick Loughren
Consultant Forensic Nurse, Runwell Hospital, Essex, UK.Consultant Forensic Nurse, Runwell Hospital, Essex, UK.
Dr K MansourDr K Mansour
Locum Consultant Psychiatrist, Runwell Hospital, Essex, UK.Locum Consultant Psychiatrist, Runwell Hospital, Essex, UK.
Professor Abdulshafi KhashabaProfessor Abdulshafi Khashaba
Professor of Psychiatry, Faculty of Medicine, Zagazig University, Egypt.Professor of Psychiatry, Faculty of Medicine, Zagazig University, Egypt.
20062006
Concept of AutismConcept of Autism
 Kanner’s SyndromeKanner’s Syndrome (Kanner, 1943)(Kanner, 1943)
 New concept different from MRNew concept different from MR
 Specific syndrome with narrow definitionsSpecific syndrome with narrow definitions
(social aloofness and insistence on(social aloofness and insistence on
sameness & impairment in languagesameness & impairment in language
development).development).
 Associated concepts e.g. deviant patternsAssociated concepts e.g. deviant patterns
of parenting & related to schizophreniaof parenting & related to schizophrenia
Concept of AutismConcept of Autism
 Asperger syndromeAsperger syndrome: ‘autistic: ‘autistic
psycho­pathy’ (Asperger, 1944)psycho­pathy’ (Asperger, 1944)
 Marked social problems, unusualMarked social problems, unusual
perseverative interests, and motorperseverative interests, and motor
clumsinessclumsiness
 Preserved verbal abilitiesPreserved verbal abilities
 Tendency for the condition to run inTendency for the condition to run in
familiesfamilies
 Wing’s re­introduction of the syndromeWing’s re­introduction of the syndrome
Concept of AutismConcept of Autism
 Potential overlap with other diagnostic conceptsPotential overlap with other diagnostic concepts
(e.g. schizoid personality (Wolff & Barlow, 1979),(e.g. schizoid personality (Wolff & Barlow, 1979),
semantic–pragmatic disorder (Bishop, 1989),semantic–pragmatic disorder (Bishop, 1989),
and right hemisphere learning problems (Ellis etand right hemisphere learning problems (Ellis et
al, 1994).al, 1994).
 Heller (1908), [dementia infantilis; Heller’sHeller (1908), [dementia infantilis; Heller’s
syndrome, disintegrative psychosis, or childhoodsyndrome, disintegrative psychosis, or childhood
disintegrative disorder (Volkmar & Rutter,disintegrative disorder (Volkmar & Rutter,
1995)].1995)].
 Rett (1966), syndrome in girls; featuresRett (1966), syndrome in girls; features
suggestive of autism were present.suggestive of autism were present.
Concept of AutismConcept of Autism
 Pervasive Developmental Disorders:Pervasive Developmental Disorders:
 WHO and APA: “Pervasive DevelopmentalWHO and APA: “Pervasive Developmental
Disorders” (PDD). (WHO, 1993 & APA, 1994).Disorders” (PDD). (WHO, 1993 & APA, 1994).
 Both systems included separate subcategoriesBoth systems included separate subcategories
of Rett’s Asperger and Heller’s syndromesof Rett’s Asperger and Heller’s syndromes
(CDD).(CDD).
 ‘‘Pervasive developmental disorder not otherwisePervasive developmental disorder not otherwise
specified’ (PDD­NOS): a residual diagnosticspecified’ (PDD­NOS): a residual diagnostic
category.category.
Concept of AutismConcept of Autism
 Wing’s ASD:Wing’s ASD: Epidemiologic Work on Autism inEpidemiologic Work on Autism in
Camberwell (Wing & Gould, 1979).Camberwell (Wing & Gould, 1979).
 No link between autism and schizophrenia, butNo link between autism and schizophrenia, but
rather, between autism and mental retardation.rather, between autism and mental retardation.
 Triad of impairmentsTriad of impairments—in social skills, social—in social skills, social
communication and imagination (Wing andcommunication and imagination (Wing and
Gould, 1979).Gould, 1979).
 Continuum of autistic disorders (Continuum of autistic disorders (Wing,1988).Wing,1988).
 Increased in prevalence rate in recent reviewsIncreased in prevalence rate in recent reviews
(5-60 per 10,000)(5-60 per 10,000) (Tonge, 2002).(Tonge, 2002).
Concept of AutismConcept of Autism
 The Broader Autism Phenotype (BAP)The Broader Autism Phenotype (BAP)
 A sub-clinical set of personality and otherA sub-clinical set of personality and other
features that appear to be increased in relativesfeatures that appear to be increased in relatives
of probands with PDDs) (Lainhart et al, 2002).of probands with PDDs) (Lainhart et al, 2002).
 E.g. lack of affection, social dysfunction,E.g. lack of affection, social dysfunction,
impaired friendships, odd behaviour andimpaired friendships, odd behaviour and
impaired conversation, circumscribed interests,impaired conversation, circumscribed interests,
rigidity, obsessions/compulsions and repetitiverigidity, obsessions/compulsions and repetitive
interests and activities (Bailey et al., 1998;interests and activities (Bailey et al., 1998;
Murphy et al., 2000).Murphy et al., 2000).
Concept of AutismConcept of Autism
 Widening the concept:Widening the concept:
 A bigger spectrum of social-communicationA bigger spectrum of social-communication
disability where Asperger Syndrome lies as adisability where Asperger Syndrome lies as a
“bridge” between Autism and Normality (Baron-“bridge” between Autism and Normality (Baron-
Cohen, 1995; Frith, 1991; Wing, 1981; Wing,Cohen, 1995; Frith, 1991; Wing, 1981; Wing,
1988).1988).
 This approach allows to identify “autistic traits” inThis approach allows to identify “autistic traits” in
normally functioning individual e.g. relatives ofnormally functioning individual e.g. relatives of
autistic patients.autistic patients.
ASPERGER
SYNDROME
RETT
SYNDROME
ATYPICAL
AUTISM
HELLERS
SYNDROME
PDD
NOS
AUTISM
KAMMER’S
SYNDROME
ASD (PDD) – (ICD-10 & DSM-IV) model
ASPERGERS SEVERE
AUTISM
ASD – Wing’s model
NORMALITY
ASPERGER
SEVERE
AUTISM
ASD – new model
This study: Autistic QuotientThis study: Autistic Quotient
 Baron-Cohen et al (2001): the Autism-SpectrumBaron-Cohen et al (2001): the Autism-Spectrum
Quotient (AQ). A self-administered instrumentsQuotient (AQ). A self-administered instruments
for measuring the degree to which an adult withfor measuring the degree to which an adult with
normal intelligence has the traits associated withnormal intelligence has the traits associated with
the autistic spectrum Individuals.the autistic spectrum Individuals.
 Baron-Cohen et al (2001) Cambridge UniversityBaron-Cohen et al (2001) Cambridge University
study.study.
 Bishop et al (2004): relatives of patients withBishop et al (2004): relatives of patients with
autism.autism.
 Wakabayashi et al (2004) Japanese version ofWakabayashi et al (2004) Japanese version of
the AQ instrument (AQ-J) Japanese study bythe AQ instrument (AQ-J) Japanese study by
Kurita et al (2005)Kurita et al (2005)
This study: DesignThis study: Design
 202 students from Zagazig University in202 students from Zagazig University in
Egypt (scientific & theoretical colleges).Egypt (scientific & theoretical colleges).
 Autistic-Spectrum Quotient QuestionnaireAutistic-Spectrum Quotient Questionnaire
(AQ).(AQ).
 Arabic version of the General HealthArabic version of the General Health
Questionnaire (GHQ-30)Questionnaire (GHQ-30) (El-Rufaie &(El-Rufaie &
Daradkeh 1996) (Goldberg, 1972)Daradkeh 1996) (Goldberg, 1972) ..
This study: ResultsThis study: Results
 (AQ) total = 22.72 (SD= 4.44) -(AQ) total = 22.72 (SD= 4.44) -
followed normal distribution.followed normal distribution.
 (GHQ) total = 34.43 (SD= 13.09).(GHQ) total = 34.43 (SD= 13.09).
 Positive correlation (1-tailed)Positive correlation (1-tailed)
between the AQ and GHQ (P =between the AQ and GHQ (P =
0.036).0.036).
This study: ResultsThis study: Results
 Table (11) Cross-table of AQ total score by college by sexTable (11) Cross-table of AQ total score by college by sex
23.1161 4.63777 112
23.0556 3.47211 18
23.1077 4.48295 130
22.0000 4.51591 62
22.2000 2.78089 10
22.0278 4.30189 72
22.7184 4.61288 174
22.7500 3.21599 28
22.7228 4.43890 202
COLLEGE
Science colleges
Theoretical colleges
Total
Science colleges
Theoretical colleges
Total
Science colleges
Theoretical colleges
Total
SEX
Male
Female
Total
Mean Std. Deviation N
This study: Results
 Table (19) Cross-tables of GHQ total scores by sex by college:
34.3036 11.95927 112
27.2778 8.85707 18
33.3308 11.80421 130
36.9355 15.53196 62
33.1000 11.38664 10
36.4028 15.01610 72
35.2414 13.35766 174
29.3571 10.03407 28
34.4257 13.08628 202
COLLEGE
Science colleges
Theoretical colleges
Total
Science colleges
Theoretical colleges
Total
Science colleges
Theoretical colleges
Total
SEX
Male
Female
Total
Mean Std. Deviation N
This study: Results
 Correlation between AQ total score (Atot) and GHQ total score (Gtot):
Correlations
1 .126*
. .036
202 202
.126* 1
.036 .
202 202
Pearson Correlation
Sig. (1-tailed)
N
Pearson Correlation
Sig. (1-tailed)
N
ATOT
GTOT
ATOT GTOT
Correlation is significant at the 0.05 level (1-tailed).*.
This study: DiscussionThis study: Discussion
 The Cambridge students AQ=17.6 (SD=6.4)The Cambridge students AQ=17.6 (SD=6.4)
Baron-Cohen et al, 2001),Baron-Cohen et al, 2001), Egyptian students=22.72Egyptian students=22.72
(SD=4.44), Japanese students=20.7 (SD=6.38)(SD=4.44), Japanese students=20.7 (SD=6.38)
(Wakabayashi et al, 2004)(Wakabayashi et al, 2004)
 ? Cultural bias.? Cultural bias.
 ? Forms of education: quantitative knowledge at? Forms of education: quantitative knowledge at
the expense of use of imagination and solitarythe expense of use of imagination and solitary
work at the expense of group workwork at the expense of group work ((the mean AQthe mean AQ
score of the Mathematics Olympiad Students=24.5 (SD=5.7) inscore of the Mathematics Olympiad Students=24.5 (SD=5.7) in
Baron-Cohen et al, 2001Baron-Cohen et al, 2001).).
This study: ConclusionThis study: Conclusion
 AQ is a potentially useful tool toAQ is a potentially useful tool to
assess autistic traits in highlyassess autistic traits in highly
functional individuals in Egyptianfunctional individuals in Egyptian
subjects.subjects.
 Tracing such traits in individualsTracing such traits in individuals
can be of significant clinicalcan be of significant clinical
importance.importance.
RecommendationsRecommendations
 Egyptian and Arabic researchers need to giveEgyptian and Arabic researchers need to give
more attention to ASD and encourage its usemore attention to ASD and encourage its use
in psychiatry and other disciplines e.g.in psychiatry and other disciplines e.g.
education.education.
 Further research is needed to investigate theFurther research is needed to investigate the
possible connection between poor social skillspossible connection between poor social skills
in highly functioning individuals andin highly functioning individuals and
psychological suffering.psychological suffering.
 It is not necessary for a diagnosis of autism toIt is not necessary for a diagnosis of autism to
be there for such line of inquiry to develop.be there for such line of inquiry to develop.

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autistic traits in individuals with normal intelligence

  • 1. Autistic Traits in Individuals with NormalAutistic Traits in Individuals with Normal Intellectual Level and AssociatedIntellectual Level and Associated Psychological Distress:Psychological Distress: A Pilot Study in an Arabic CultureA Pilot Study in an Arabic Culture Dr Omaima A DaoudDr Omaima A Daoud Lecturer of Psychiatry, Faculty of Medicine, Zagazig University, Egypt.Lecturer of Psychiatry, Faculty of Medicine, Zagazig University, Egypt. Dr Mick LoughrenDr Mick Loughren Consultant Forensic Nurse, Runwell Hospital, Essex, UK.Consultant Forensic Nurse, Runwell Hospital, Essex, UK. Dr K MansourDr K Mansour Locum Consultant Psychiatrist, Runwell Hospital, Essex, UK.Locum Consultant Psychiatrist, Runwell Hospital, Essex, UK. Professor Abdulshafi KhashabaProfessor Abdulshafi Khashaba Professor of Psychiatry, Faculty of Medicine, Zagazig University, Egypt.Professor of Psychiatry, Faculty of Medicine, Zagazig University, Egypt. 20062006
  • 2. Concept of AutismConcept of Autism  Kanner’s SyndromeKanner’s Syndrome (Kanner, 1943)(Kanner, 1943)  New concept different from MRNew concept different from MR  Specific syndrome with narrow definitionsSpecific syndrome with narrow definitions (social aloofness and insistence on(social aloofness and insistence on sameness & impairment in languagesameness & impairment in language development).development).  Associated concepts e.g. deviant patternsAssociated concepts e.g. deviant patterns of parenting & related to schizophreniaof parenting & related to schizophrenia
  • 3. Concept of AutismConcept of Autism  Asperger syndromeAsperger syndrome: ‘autistic: ‘autistic psycho­pathy’ (Asperger, 1944)psycho­pathy’ (Asperger, 1944)  Marked social problems, unusualMarked social problems, unusual perseverative interests, and motorperseverative interests, and motor clumsinessclumsiness  Preserved verbal abilitiesPreserved verbal abilities  Tendency for the condition to run inTendency for the condition to run in familiesfamilies  Wing’s re­introduction of the syndromeWing’s re­introduction of the syndrome
  • 4. Concept of AutismConcept of Autism  Potential overlap with other diagnostic conceptsPotential overlap with other diagnostic concepts (e.g. schizoid personality (Wolff & Barlow, 1979),(e.g. schizoid personality (Wolff & Barlow, 1979), semantic–pragmatic disorder (Bishop, 1989),semantic–pragmatic disorder (Bishop, 1989), and right hemisphere learning problems (Ellis etand right hemisphere learning problems (Ellis et al, 1994).al, 1994).  Heller (1908), [dementia infantilis; Heller’sHeller (1908), [dementia infantilis; Heller’s syndrome, disintegrative psychosis, or childhoodsyndrome, disintegrative psychosis, or childhood disintegrative disorder (Volkmar & Rutter,disintegrative disorder (Volkmar & Rutter, 1995)].1995)].  Rett (1966), syndrome in girls; featuresRett (1966), syndrome in girls; features suggestive of autism were present.suggestive of autism were present.
  • 5. Concept of AutismConcept of Autism  Pervasive Developmental Disorders:Pervasive Developmental Disorders:  WHO and APA: “Pervasive DevelopmentalWHO and APA: “Pervasive Developmental Disorders” (PDD). (WHO, 1993 & APA, 1994).Disorders” (PDD). (WHO, 1993 & APA, 1994).  Both systems included separate subcategoriesBoth systems included separate subcategories of Rett’s Asperger and Heller’s syndromesof Rett’s Asperger and Heller’s syndromes (CDD).(CDD).  ‘‘Pervasive developmental disorder not otherwisePervasive developmental disorder not otherwise specified’ (PDD­NOS): a residual diagnosticspecified’ (PDD­NOS): a residual diagnostic category.category.
  • 6. Concept of AutismConcept of Autism  Wing’s ASD:Wing’s ASD: Epidemiologic Work on Autism inEpidemiologic Work on Autism in Camberwell (Wing & Gould, 1979).Camberwell (Wing & Gould, 1979).  No link between autism and schizophrenia, butNo link between autism and schizophrenia, but rather, between autism and mental retardation.rather, between autism and mental retardation.  Triad of impairmentsTriad of impairments—in social skills, social—in social skills, social communication and imagination (Wing andcommunication and imagination (Wing and Gould, 1979).Gould, 1979).  Continuum of autistic disorders (Continuum of autistic disorders (Wing,1988).Wing,1988).  Increased in prevalence rate in recent reviewsIncreased in prevalence rate in recent reviews (5-60 per 10,000)(5-60 per 10,000) (Tonge, 2002).(Tonge, 2002).
  • 7. Concept of AutismConcept of Autism  The Broader Autism Phenotype (BAP)The Broader Autism Phenotype (BAP)  A sub-clinical set of personality and otherA sub-clinical set of personality and other features that appear to be increased in relativesfeatures that appear to be increased in relatives of probands with PDDs) (Lainhart et al, 2002).of probands with PDDs) (Lainhart et al, 2002).  E.g. lack of affection, social dysfunction,E.g. lack of affection, social dysfunction, impaired friendships, odd behaviour andimpaired friendships, odd behaviour and impaired conversation, circumscribed interests,impaired conversation, circumscribed interests, rigidity, obsessions/compulsions and repetitiverigidity, obsessions/compulsions and repetitive interests and activities (Bailey et al., 1998;interests and activities (Bailey et al., 1998; Murphy et al., 2000).Murphy et al., 2000).
  • 8. Concept of AutismConcept of Autism  Widening the concept:Widening the concept:  A bigger spectrum of social-communicationA bigger spectrum of social-communication disability where Asperger Syndrome lies as adisability where Asperger Syndrome lies as a “bridge” between Autism and Normality (Baron-“bridge” between Autism and Normality (Baron- Cohen, 1995; Frith, 1991; Wing, 1981; Wing,Cohen, 1995; Frith, 1991; Wing, 1981; Wing, 1988).1988).  This approach allows to identify “autistic traits” inThis approach allows to identify “autistic traits” in normally functioning individual e.g. relatives ofnormally functioning individual e.g. relatives of autistic patients.autistic patients.
  • 12. This study: Autistic QuotientThis study: Autistic Quotient  Baron-Cohen et al (2001): the Autism-SpectrumBaron-Cohen et al (2001): the Autism-Spectrum Quotient (AQ). A self-administered instrumentsQuotient (AQ). A self-administered instruments for measuring the degree to which an adult withfor measuring the degree to which an adult with normal intelligence has the traits associated withnormal intelligence has the traits associated with the autistic spectrum Individuals.the autistic spectrum Individuals.  Baron-Cohen et al (2001) Cambridge UniversityBaron-Cohen et al (2001) Cambridge University study.study.  Bishop et al (2004): relatives of patients withBishop et al (2004): relatives of patients with autism.autism.  Wakabayashi et al (2004) Japanese version ofWakabayashi et al (2004) Japanese version of the AQ instrument (AQ-J) Japanese study bythe AQ instrument (AQ-J) Japanese study by Kurita et al (2005)Kurita et al (2005)
  • 13. This study: DesignThis study: Design  202 students from Zagazig University in202 students from Zagazig University in Egypt (scientific & theoretical colleges).Egypt (scientific & theoretical colleges).  Autistic-Spectrum Quotient QuestionnaireAutistic-Spectrum Quotient Questionnaire (AQ).(AQ).  Arabic version of the General HealthArabic version of the General Health Questionnaire (GHQ-30)Questionnaire (GHQ-30) (El-Rufaie &(El-Rufaie & Daradkeh 1996) (Goldberg, 1972)Daradkeh 1996) (Goldberg, 1972) ..
  • 14. This study: ResultsThis study: Results  (AQ) total = 22.72 (SD= 4.44) -(AQ) total = 22.72 (SD= 4.44) - followed normal distribution.followed normal distribution.  (GHQ) total = 34.43 (SD= 13.09).(GHQ) total = 34.43 (SD= 13.09).  Positive correlation (1-tailed)Positive correlation (1-tailed) between the AQ and GHQ (P =between the AQ and GHQ (P = 0.036).0.036).
  • 15. This study: ResultsThis study: Results  Table (11) Cross-table of AQ total score by college by sexTable (11) Cross-table of AQ total score by college by sex 23.1161 4.63777 112 23.0556 3.47211 18 23.1077 4.48295 130 22.0000 4.51591 62 22.2000 2.78089 10 22.0278 4.30189 72 22.7184 4.61288 174 22.7500 3.21599 28 22.7228 4.43890 202 COLLEGE Science colleges Theoretical colleges Total Science colleges Theoretical colleges Total Science colleges Theoretical colleges Total SEX Male Female Total Mean Std. Deviation N
  • 16. This study: Results  Table (19) Cross-tables of GHQ total scores by sex by college: 34.3036 11.95927 112 27.2778 8.85707 18 33.3308 11.80421 130 36.9355 15.53196 62 33.1000 11.38664 10 36.4028 15.01610 72 35.2414 13.35766 174 29.3571 10.03407 28 34.4257 13.08628 202 COLLEGE Science colleges Theoretical colleges Total Science colleges Theoretical colleges Total Science colleges Theoretical colleges Total SEX Male Female Total Mean Std. Deviation N
  • 17. This study: Results  Correlation between AQ total score (Atot) and GHQ total score (Gtot): Correlations 1 .126* . .036 202 202 .126* 1 .036 . 202 202 Pearson Correlation Sig. (1-tailed) N Pearson Correlation Sig. (1-tailed) N ATOT GTOT ATOT GTOT Correlation is significant at the 0.05 level (1-tailed).*.
  • 18. This study: DiscussionThis study: Discussion  The Cambridge students AQ=17.6 (SD=6.4)The Cambridge students AQ=17.6 (SD=6.4) Baron-Cohen et al, 2001),Baron-Cohen et al, 2001), Egyptian students=22.72Egyptian students=22.72 (SD=4.44), Japanese students=20.7 (SD=6.38)(SD=4.44), Japanese students=20.7 (SD=6.38) (Wakabayashi et al, 2004)(Wakabayashi et al, 2004)  ? Cultural bias.? Cultural bias.  ? Forms of education: quantitative knowledge at? Forms of education: quantitative knowledge at the expense of use of imagination and solitarythe expense of use of imagination and solitary work at the expense of group workwork at the expense of group work ((the mean AQthe mean AQ score of the Mathematics Olympiad Students=24.5 (SD=5.7) inscore of the Mathematics Olympiad Students=24.5 (SD=5.7) in Baron-Cohen et al, 2001Baron-Cohen et al, 2001).).
  • 19. This study: ConclusionThis study: Conclusion  AQ is a potentially useful tool toAQ is a potentially useful tool to assess autistic traits in highlyassess autistic traits in highly functional individuals in Egyptianfunctional individuals in Egyptian subjects.subjects.  Tracing such traits in individualsTracing such traits in individuals can be of significant clinicalcan be of significant clinical importance.importance.
  • 20. RecommendationsRecommendations  Egyptian and Arabic researchers need to giveEgyptian and Arabic researchers need to give more attention to ASD and encourage its usemore attention to ASD and encourage its use in psychiatry and other disciplines e.g.in psychiatry and other disciplines e.g. education.education.  Further research is needed to investigate theFurther research is needed to investigate the possible connection between poor social skillspossible connection between poor social skills in highly functioning individuals andin highly functioning individuals and psychological suffering.psychological suffering.  It is not necessary for a diagnosis of autism toIt is not necessary for a diagnosis of autism to be there for such line of inquiry to develop.be there for such line of inquiry to develop.