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2012 Wakabayashi Autism-Traits.Pdf Research in Autism Spectrum Disorders 6 (2012) 717–725 Contents lists available at SciVerse ScienceDirect Research in Autism Spectrum Disorders Journal homepage: http://ees.elsevier.com/RASD/default.asp Do the traits of autism-spectrum overlap with those of schizophrenia or obsessive-compulsive disorder in the general population? Akio Wakabayashi a,b,*, Simon Baron-Cohen b, Chris Ashwin b,c a Department of Psychology, Chiba University, Chiba 263-8522, Japan b Autism Research Centre, Department of Experimental Psychology and Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge CB2 2AH, UK c Department of Psychology, University of Bath, Bath BA2 7AY, UK ARTICLE INFO ABSTRACT Article history: Social and communicative deficits, restricted interests and repetitive behaviors are Received 25 August 2011 diagnostic features of autism spectrum disorders (ASD). The present study examined the Received in revised form 18 September 2011 relationship between autistic characteristics and schizophrenia-spectrum traits as well Accepted 20 September 2011 as between autistic characteristics and obsessive-compulsive traits in typically developed young adults. The Autism-Spectrum Quotient (AQ) was given separately to Keywords: two large samples. In addition, one sample (N = 662) was given the Schizotypal Autism-spectrum Personality Questionnaire (SPQ) to assess schizophrenia-spectrum traits, whereas the Schizophrenia othersample(N =347) was given the Padua Inventory (PI) to assess obsessive- Obsessive-compulsive disorder (OCD) compulsive disorder (OCD) traits. The results revealed a moderate correlation between Autism-Spectrum Quotient (AQ) Schizotypal Personality Questionnaire (SPQ) the AQ and the SPQ total scores; however, multiple regression analyses showed that the Padua Inventory (PI) ‘‘Cognitive-Perceptual’’ factor did not predict the autism-spectrum degree, although autistic characteristics and schizophrenia-spectrum traits had common social–emo- tional difficulties. Similarly, there was a moderate correlation between the AQ and PI total scores, which suggests that they had common problems in cognitive aspects; however, autism-spectrum and OCD traits differed with regard to other behavioral characteristics including repetitive or impulsive behaviors. Therefore, there was not a large overlap of the autism-spectrum and either the schizophrenia- or obsessive- compulsive spectrums, although certain traits were correlated with each other. ß 2011 Elsevier Ltd. All rights reserved. 1. Introduction 1.1. Autism and schizophrenia Autism (or autism spectrum disorders; ASD) is defined as abnormalities in social development and communication as well as strong displays of restricted interests and repetitive behaviors (American Psychological Association, 2000; World Health Organization, 1992). Although autism is an independent diagnostic category, some researchers have suggested that there is some resemblance between autism and schizophrenia (Petty, Ornitz, Michelman, & Zimmerman, 1984; Volkmar & Cohen, 1991), including recent work by Hurst, Nelson-Gray, Mitchell, and Kwapil (2007) and Konstantareas and Hewitt (2001). In the past, autism was considered to be an early form of schizophrenia. This belief reflected an awareness of the behavioral characteristics common to both conditions. Kanner’s (1943) use of the term ‘autism’ was applied to connect * Corresponding author at: Department of Psychology, Chiba University, Chiba 263-8522, Japan. Tel.: +81 43 290 2282. E-mail address: [email protected] (A. Wakabayashi). 1750-9467/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.rasd.2011.09.008 718 A. Wakabayashi et al. / Research in Autism Spectrum Disorders 6 (2012) 717–725 autism to schizophrenia. Bleuler (1911) coined ‘autism’ to describe the thought processes of people with schizophrenia such as self-centered thinking, rather than the absence of social relatedness. However, because both autism and schizophrenia show types of social impairment and their non-social, detached symptoms are obvious, it is not surprising that the label ‘schizophrenic’ was also formerly used to refer to people with autism. Although some people become psychotic in early childhood, their symptoms do not resemble those of autism. Furthermore, children with autism are easily distinguished from those with psychotic conditions in most cases. Autism and schizophrenia are readily distinguishable diagnostic entities; however, the surface behaviors of some adults with autism resemble those of people with negative symptoms of schizophrenia. Specifically, these people have little or no social communication ability or facial/emotional expression and have a tendency to withdraw from social situations. They also often exhibit simple stereotypic or repetitive movements. On the other hand, people with positive symptoms of schizophrenia obviously differ from individuals with autism, including in their surface behaviors. The most common positive symptoms of schizophrenia are illusions such as hearing voices and delusions such as believing an unrelated event is connected to them in some important way. There have been few reports of these unusual experiences in people with autism; more importantly, most positive symptoms of schizophrenia require theory of mind (Corcoran, Mercer, & Frith, 1995), which people with autism profoundly lack (for example, paranoid delusions often contain attributions of others’ mental states). Consequently, interest in the relationship between autism and schizophrenia declined decades ago. However, some behavioral characteristics suggest that there is a link between autism and schizophrenia (Hurst et al., 2007; Konstantareas & Hewitt, 2001); moreover, this suggestion is based on a biological– neurological perspective (Cade et al., 1999; Sun & Cade, 1999). 1.2. Autism and obsessive-compulsive disorder As well as a lack of, or profound deficits in, social interactive skills, obsessional interests, and engaging in repetitive behaviors are also core features of ASD. These characteristics of ASD resemble not only those of schizophrenia but also those of obsessive-compulsive disorder (OCD). With regard to the latter relationship, although both ASD and OCD have common features such as repetitive or stereotypic behaviors, there has been little research on this subject. However, two studies have reported the experiences of obsessions and compulsions in people with ASD and OCD (McDougle et al., 1995; McDougle,Kresch,&Posey,2000;Russell,Mataix-Cols,Anson,&Murphy,2005). Both studies found that, although there were also some similarities, there were certain differences between people with autism and those with OCD with regard to their obsessions and compulsions. However, because the autistic sample in McDougle et al.’s study (1995) included 50% of people with autism with below-average IQs, it was unclear as to whether these patients were able to report their symptoms correctly. Russell et al. (2005) compared the frequency and severity of repetitive ‘obsessional’ thoughts and compulsive behaviors in 40 high-functioning adults with ASD and 45 gender-matched adults with OCD. The severity and types of obsessive- compulsive symptoms were assessed using the 10-item Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman, Price, Rasmussen, & Mazure, 1989) and its ancillary Symptom Checklist (Y-BOCS-SC), respectively. The results revealed a similar frequency of obsessions and compulsions across the two groups; however, the OCD group reported significantly higher frequencies of somatic obsessions and repeating/checking compulsions. A discrimination analysis revealed that a single type of obsession, somatic, and a single type of compulsion, repeating, predicted group membership because both symptoms were more frequent in the OCD group than the ASD group. The number of reported symptoms showed that the OCD group had more obsessions and compulsions than the ASD group. 1.3. Autism spectrum disorders and the analogue approach Regarding the research described above, determining whether the behavior of people with ASD resemble those with schizophrenia or OCD is difficult. Clarifying the similarities and differences between ASD and the other disorders is important. The present study uses an analogue approach to examine this problem. This approach assumes that people with a clinical diagnosis of psychological/psychopathological disorder are at one extreme of a continuum of related and normative individual differences or characteristics. ‘Abnormal’ behavior and experiences are assumed to be different from those in the general population only in terms of their frequency and severity. As an example of the analogue approach’s point of view regarding autistic psychological difficulties, autism and Asperger syndrome (AS) are thought to exist on a continuum of social communication (dis)ability in which AS serves as the bridge between autism and normality (Baron-Cohen, 1995; Frith, 1991; Wing, 1981, 1988). Consistent with this idea, research has shown that autistic behaviors are observed in the normal population to some degree (Baron-Cohen, Wheelwright, Skinner, Martin, & Clubley, 2001; Wakabayashi, Baron-Cohen, Wheelwright, & Tojo, 2006). Relatives of people with autism also show some of the behavioral characteristics of autism (i.e., the broader phenotype; Bailey et al., 1995). Based on this view, the Autism-Spectrum Quotient (AQ) was developed to measure the degree of autistic traits in both typical developed and clinically diagnosed people (Baron-Cohen
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