Autistic Traits in Individuals with Normal Autistic Traits in Individuals with Normal Intellectual Level and Associated Intellectual 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 DaoudLecturer of Psychiatry, Faculty of Medicine, Zagazig University, Egypt.Lecturer of Psychiatry, Faculty of Medicine, Zagazig University, Egypt.

Dr Mick Loughren Dr Mick Loughren Consultant Forensic Nurse, Runwell Hospital, Essex, UK.Consultant Forensic Nurse, Runwell Hospital, Essex, UK.

Dr K MansourDr K MansourLocum Consultant Psychiatrist, Runwell Hospital, Essex, UK.Locum Consultant Psychiatrist, Runwell Hospital, Essex, UK.

Professor Abdulshafi KhashabaProfessor Abdulshafi KhashabaProfessor 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 Syndrome Kanner’s Syndrome (Kanner, 1943) (Kanner, 1943) New concept different from MRNew concept different from MR Specific syndrome with narrow definitions Specific syndrome with narrow definitions

(social aloofness and insistence on (social aloofness and insistence on sameness & impairment in language sameness & impairment in language development).development).

Associated concepts e.g. deviant patterns Associated concepts e.g. deviant patterns of parenting & related to schizophreniaof parenting & related to schizophrenia

Concept of AutismConcept of Autism Asperger syndromeAsperger syndrome: ‘autistic psycho : ‘autistic psycho

pathy’ (Asperger, 1944) pathy’ (Asperger, 1944) Marked social problems, unusual Marked social problems, unusual

perseverative interests, and motor perseverative interests, and motor clumsiness clumsiness

Preserved verbal abilities Preserved verbal abilities Tendency for the condition to run in Tendency for the condition to run in

families families Wing’s re-introduction of the syndromeWing’s re-introduction of the syndrome

Concept of AutismConcept of Autism Potential overlap with other diagnostic concepts Potential 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 et and right hemisphere learning problems (Ellis et al, 1994). al, 1994).

Heller (1908), [dementia infantilis; Heller’s Heller (1908), [dementia infantilis; Heller’s syndrome, disintegrative psychosis, or childhood syndrome, disintegrative psychosis, or childhood disintegrative disorder (Volkmar & Rutter, disintegrative disorder (Volkmar & Rutter, 1995)]. 1995)].

Rett (1966), syndrome in girls; features Rett (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 Developmental WHO and APA: “Pervasive Developmental

Disorders” (PDD). (WHO, 1993 & APA, 1994). Disorders” (PDD). (WHO, 1993 & APA, 1994). Both systems included separate subcategories Both systems included separate subcategories

of Rett’s Asperger and Heller’s syndromes of Rett’s Asperger and Heller’s syndromes (CDD).(CDD).

‘‘Pervasive developmental disorder not otherwise Pervasive developmental disorder not otherwise specified’ (PDD-NOS): a residual diagnostic specified’ (PDD-NOS): a residual diagnostic category. category.

Concept of AutismConcept of Autism Wing’s ASD:Wing’s ASD: Epidemiologic Work on Autism in Epidemiologic Work on Autism in

Camberwell (Wing & Gould, 1979).Camberwell (Wing & Gould, 1979).

No link between autism and schizophrenia, but No 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 and communication 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 reviews Increased 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 other A sub-clinical set of personality and other

features that appear to be increased in relatives features 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 and impaired friendships, odd behaviour and impaired conversation, circumscribed interests, impaired conversation, circumscribed interests, rigidity, obsessions/compulsions and repetitive rigidity, 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-communication A bigger spectrum of social-communication

disability where Asperger Syndrome lies as a disability 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” in This approach allows to identify “autistic traits” in normally functioning individual e.g. relatives of normally 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 SEVEREAUTISM

ASD – Wing’s model

NORMALITY

ASPERGER

SEVEREAUTISM

ASD – new model

This study: Autistic QuotientThis study: Autistic Quotient Baron-Cohen et al (2001): Baron-Cohen et al (2001): the Autism-Spectrum the Autism-Spectrum

Quotient (AQ). A self-administered instruments Quotient (AQ). A self-administered instruments for measuring the degree to which an adult with for measuring the degree to which an adult with normal intelligence has the traits associated with normal intelligence has the traits associated with the autistic spectrum Individuals.the autistic spectrum Individuals.

Baron-Cohen et al (2001) Baron-Cohen et al (2001) Cambridge University Cambridge University study. study.

Bishop et al (2004): relatives of patients with Bishop et al (2004): relatives of patients with autism. autism.

Wakabayashi et al (2004) Japanese version of Wakabayashi et al (2004) Japanese version of the AQ instrument (AQ-J) Japanese study by the 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 in 202 students from Zagazig University in

Egypt (scientific & theoretical colleges). Egypt (scientific & theoretical colleges). Autistic-Spectrum Quotient Questionnaire Autistic-Spectrum Quotient Questionnaire

(AQ). (AQ). Arabic version of the General Health Arabic 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 11223.0556 3.47211 1823.1077 4.48295 13022.0000 4.51591 6222.2000 2.78089 1022.0278 4.30189 7222.7184 4.61288 17422.7500 3.21599 2822.7228 4.43890 202

COLLEGEScience collegesTheoretical collegesTotalScience collegesTheoretical collegesTotalScience collegesTheoretical collegesTotal

SEXMale

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 11227.2778 8.85707 1833.3308 11.80421 13036.9355 15.53196 6233.1000 11.38664 1036.4028 15.01610 7235.2414 13.35766 17429.3571 10.03407 2834.4257 13.08628 202

COLLEGEScience collegesTheoretical colleges

TotalScience collegesTheoretical colleges

TotalScience collegesTheoretical colleges

Total

SEXMale

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 CorrelationSig. (1-tailed)N

Pearson CorrelationSig. (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=22.72 Egyptian 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 solitary the expense of use of imagination and solitary work at the expense of group work work at the expense of group work ((the mean AQ the mean AQ score of the Mathematics Olympiad Students=24.5 (SD=5.7) in score 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 to AQ is a potentially useful tool to

assess autistic traits in highly assess autistic traits in highly functional individuals in Egyptian functional individuals in Egyptian subjects. subjects.

Tracing such traits in individuals Tracing such traits in individuals can be of significant clinical can be of significant clinical importance.importance.

RecommendationsRecommendations Egyptian and Arabic researchers need to give Egyptian and Arabic researchers need to give

more attention to ASD and encourage its use more 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 the Further research is needed to investigate the possible connection between poor social skills possible connection between poor social skills in highly functioning individuals and in highly functioning individuals and psychological suffering. psychological suffering.

It is not necessary for a diagnosis of autism to It 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.