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Autistic Traits and Psychological Distress in Arab Individuals: A Pilot Study

This pilot study explores the presence of autistic traits and associated psychological distress in individuals with normal intellectual levels in an Arabic culture. The study uses the Autism Spectrum Quotient questionnaire and the General Health Questionnaire to measure these traits and distress.

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Autistic Traits and Psychological Distress in Arab Individuals: A Pilot Study

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  1. Autistic Traits in Individuals with Normal Intellectual Level and Associated Psychological Distress: A Pilot Study in an Arabic Culture’ Dr Omaima A Daoud Lecturer of Psychiatry, Faculty of Medicine, Zagazig University, Egypt. Dr Mick Loughren Consultant Forensic Nurse, Runwell Hospital, Essex, UK Dr K Mansour Locum Consultant Psychiatrist, Runwell Hospital, Essex, UK. Professor Abdulshafi Khashaba Professor of Psychiatry, Faculty of Medicine, Zagazig University, Egypt.

  2. Concept of Autism • Kanner’s Syndrome (Kanner, 1943) • New concept different from MR • Specific syndrome with narrow definitions (social aloofness and insistence on sameness & impairment in language development). • Associated concepts e.g. deviant patterns of parenting & related to schizophrenia

  3. Concept of Autism • Asperger syndrome: ‘autistic psycho­pathy’ (Asperger, 1944) • marked social problems, unusual perseverative interests, and motor clumsiness • Preserved verbal abilities • tendency for the condition to run in families • Wing’s re-introduction of the syndrome

  4. Concept of Autism • potential overlap with other diagnostic concepts (e.g. schizoid personality (Wolff & Barlow, 1979), semantic–pragmatic disorder (Bishop, 1989), and right hemisphere learning problems (Ellis et al, 1994). • Heller (1908), [dementia infantilis; Heller’s syndrome, disintegrative psychosis, or childhood disintegrative disorder (Volkmar & Rutter, 1995)]. • Andreas Rett (1966), syndrome in girls; features suggestive of autism were present.

  5. Concept of Autism • Pervasive Developmental Disorders: • WHO and APA: “Pervasive Developmental Disorders” (PDD). (WHO, 1993 & APA, 1994). • Both systems included separate subcategories of Rett’s Asperger and Heller’s syndromes (CDD). • ‘Pervasive developmental disorder not otherwise specified’ (PDD-NOS): a residual diagnostic category.

  6. Concept of Autism • Wing’s ASD • Epidemiologic work on autism in Camberwell (Wing & Gould, 1979). • No link between autism and schizophrenia, but rather, between autism and mental retardation. • Triad of impairments—in social skills, social communication and imagination (Wing and Gould, 1979). • Continuum of autistic disorders (Wing,1988). • Increased in prevalence rate in recent reviews (5-60 per 10,000)(Tonge, 2002).

  7. Concept of Autism • The Broader Autism Phenotype (BAP) • A sub-clinical set of personality and other features that appear to be increased in relatives of probands with PDDs) (Lainhart et al, 2002). • E.g. lack of affection, social dysfunction, impaired friendships, odd behaviour and impaired conversation, circumscribed interests, rigidity, obsessions/compulsions and repetitive interests and activities (Bailey et al., 1998; Murphy et al., 2000).

  8. Concept of Autism • Widening the concept: • A bigger spectrum of social-communication disability where Asperger Syndrome lies as a “bridge” between Autism and Normality (Baron-Cohen, 1995; Frith, 1991; Wing, 1981; Wing, 1988). • This approach allows to identify “autistic traits” in normally functioning individual e.g. relatives of autistic patients.

  9. This study: Autistic Quotient • Baron-Cohen et al (2001): the Autism-Spectrum Quotient (AQ). A self-administered instruments for measuring the degree to which an adult with normal intelligence has the traits associated with the autistic spectrum Individuals. • Baron-Cohen et al (2001) assessed Asperger patients; controls; students in Cambridge University; and winners of the UK Mathematics Olympiad. • Bishop et al (2004): assessed features of the broad phenotype in parents of people with autism. • Wakabayashi et al (2004) report on a Japanese version of the AQ instrument (AQ-J) which was used in a big Japanese study by Kurita et al (2005)

  10. This study: Design • 202 students from Zagazig University in Egypt (scientific & theoretical colleges). • Completed the Autistic-Spectrum Quotient Questionnaire (AQ). • Completed the Arabic version of the General Health Questionnaire (GHQ-30) as a measure of any associated psychological distresses (El-Rufaie & Daradkeh 1996) (Goldberg, 1972) .

  11. This study: Results • (AQ) mean total score is 22.72 (SD= 4.44) which followed normal distribution. • (GHQ) mean total score is 34.43 (SD= 13.09). • A positive correlation (1-tailed) between the AQ and GHQ total scores (P = 0.036).

  12. SEX COLLEGE Mean Std. Deviation N Male Science colleges 23.1161 4.63777 112 Theoretical colleges 23.0556 3.47211 18 Total 23.1077 4.48295 130 Female Science colleges 22.0000 4.51591 62 Theoretical colleges 22.2000 2.78089 10 Total 22.0278 4.30189 72 Total Science colleges 22.7184 4.61288 174 Theoretical colleges 22.7500 3.21599 28 Total 22.7228 4.43890 202 This study: Results • Table (11) Cross-table of AQ total score by college by sex

  13. SEX COLLEGE Mean Std. Deviation N Male Science colleges 34.3036 11.95927 112 Theoretical colleges 27.2778 8.85707 18 Total 33.3308 11.80421 130 Female Science colleges 36.9355 15.53196 62 Theoretical colleges 33.1000 11.38664 10 Total 36.4028 15.01610 72 Total Science colleges 35.2414 13.35766 174 Theoretical colleges 29.3571 10.03407 28 Total 34.4257 13.08628 202 This study: Results • Table (19) Cross-tables of GHQ total scores by sex by college:

  14. Correlations ATOT GTOT ATOT Pearson Correlation 1 .126 * Sig. (1-tailed) . .036 N 202 202 GTOT Pearson Correlation .126 * 1 Sig. (1-tailed) .036 . N 202 202 *. Correlation is significant at the 0.05 level (1-tailed). This study: Results • Correlation between AQ total score (Atot) and GHQ total score (Gtot):

  15. This study: Discussion • The Cambridge students mean AQ=17.6 (SD=6.4) Baron-Cohen et al, 2001), Egyptian students=22.72 (SD=4.44), the Japanese students=20.7 (SD=6.38) (Wakabayashi et al, 2004) • ? Cultural bias. • ? Forms of education: encourage quantitative knowledge at the expense of imagination and creativity and solitary work at the expense of group socialised work (the mean AQ score of the Mathematics Olympiad Students=24.5 (SD=5.7) in Baron-Cohen et al, 2001).

  16. This study: Discussion • AQ in science colleges=22.72 (SD=4.6) & in theoretical colleges=22.75 (SD=3.2). • GHQ in science colleges=35.24 (SD=13.36) & in theoretical colleges: 29.36 (SD=10.03). • AQ questionnaire might not be influenced by IQ or socioeconomic status or by the level of stress affecting subjects as agreed by Baron-Cohen et al, 2001).

  17. This study: Discussion • AQ total score: a statistically significant correlation to GHQ total score (p=0.036). • The GHQ significantly different between science colleges=35.24 (SD=13.36) and theoretical colleges=29.36 (SD=10.34) (P=0.027). • The GHQ higher in females=36.4 (SD=15.02) than in males=33.33 (SD=11.8) (not statistically significant). • ? high AQ score increases vulnerability to social stresses like career related stresses specially in females.

  18. This study: Conclusion • AQ is a potentially useful tool to assess autistic traits in highly functional individuals in Egyptian subjects. • Tracing such traits in individuals can be of significant clinical importance.

  19. Recommendations • Egyptian and Arabic researchers need to give more attention to ASD and encourage its use in psychiatry and other disciplines e.g. education. • Further research is needed to investigate the possible connection between poor social skills in highly functioning individuals and psychological suffering. • It is not necessary for a diagnosis of autism to be there for such line of inquiry to develop.

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