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      Protocol for the development and testing of the schiZotypy Autism Questionnaire (ZAQ) in adults: a new screening tool to discriminate autism spectrum disorder from schizotypal disorder

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          Abstract

          Background

          Autism spectrum disorder (ASD) and schizotypal disorder (SD) both have a heterogenous presentation, with significant overlaps in symptoms and behaviour. Due to elevated recognition and knowledge of ASD worldwide, there is a growing rate of referrals from primary health professionals to specialised units. At all levels of assessment, the differential diagnostic considerations between ASD and SD exert major challenges for clinicians. Although several validated screening questionnaires exist for ASD and SD, none have differential diagnostic properties. Accordingly, in this study, we aim to develop a new screening questionnaire, the schiZotypy Autism Questionnaire (ZAQ), which provides a combined screening for both conditions, while also indicating the relative likelihood of each.

          Methods

          We aim to test 200 autistic patients and 100 schizotypy patients recruited from specialised psychiatric clinics and 200 controls from the general population (Phase 1). The results from ZAQ will be compared to the clinical diagnoses from interdisciplinary teams at specialised psychiatric clinics. After this initial testing phase, the ZAQ will be validated in an independent sample (Phase 2).

          Conclusions

          The aim of the study is to investigate the discriminative properties (ASD vs. SD), diagnostic accuracy, and validity of the schiZotypy Autism Questionnaire (ZAQ).

          Funding

          Funding was provided by Psychiatric Centre Glostrup, Copenhagen Denmark, Sofiefonden (Grant number: FID4107425), Trygfonden (Grant number:153588), Takeda Pharma.

          Trial registration

          Clinical Trials, NCT05213286, Registered 28 January 2022, clinicaltrials.gov/ct2/show/NCT05213286?cond = RAADS&draw = 2&rank = 1.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12888-023-04690-3.

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          Most cited references49

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          Applied Logistic Regression

          David Hosmer, Stanley Lemeshow (2000)
          Book 0 comments Cited 1951 times – based on 0 reviews
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            The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians.

            S. Baron-Cohen, S Wheelwright, R. Skinner … (2001)
            Currently there are no brief, self-administered instruments for measuring the degree to which an adult with normal intelligence has the traits associated with the autistic spectrum. In this paper, we report on a new instrument to assess this: the Autism-Spectrum Quotient (AQ). Individuals score in the range 0-50. Four groups of subjects were assessed: Group 1: 58 adults with Asperger syndrome (AS) or high-functioning autism (HFA); Group 2: 174 randomly selected controls. Group 3: 840 students in Cambridge University; and Group 4: 16 winners of the UK Mathematics Olympiad. The adults with AS/HFA had a mean AQ score of 35.8 (SD = 6.5), significantly higher than Group 2 controls (M = 16.4, SD = 6.3). 80% of the adults with AS/HFA scored 32+, versus 2% of controls. Among the controls, men scored slightly but significantly higher than women. No women scored extremely highly (AQ score 34+) whereas 4% of men did so. Twice as many men (40%) as women (21%) scored at intermediate levels (AQ score 20+). Among the AS/HFA group, male and female scores did not differ significantly. The students in Cambridge University did not differ from the randomly selected control group, but scientists (including mathematicians) scored significantly higher than both humanities and social sciences students, confirming an earlier study that autistic conditions are associated with scientific skills. Within the sciences, mathematicians scored highest. This was replicated in Group 4, the Mathematics Olympiad winners scoring significantly higher than the male Cambridge humanities students. 6% of the student sample scored 32+ on the AQ. On interview, 11 out of 11 of these met three or more DSM-IV criteria for AS/HFA, and all were studying sciences/mathematics, and 7 of the 11 met threshold on these criteria. Test-retest and interrater reliability of the AQ was good. The AQ is thus a valuable instrument for rapidly quantifying where any given individual is situated on the continuum from autism to normality. Its potential for screening for autism spectrum conditions in adults of normal intelligence remains to be fully explored.
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              Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders

              Catherine Lord, Michael Rutter, Ann Le Couteur (1994)
              Describes the Autism Diagnostic Interview-Revised (ADI-R), a revision of the Autism Diagnostic Interview, a semistructured, investigator-based interview for caregivers of children and adults for whom autism or pervasive developmental disorders is a possible diagnosis. The revised interview has been reorganized, shortened, modified to be appropriate for children with mental ages from about 18 months into adulthood and linked to ICD-10 and DSM-IV criteria. Psychometric data are presented for a sample of preschool children.
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                Author and article information

                Contributors
                Rizwan Parvaiz:
                ORCID: http://orcid.org/0000-0002-9328-9020
                rizwan.parvaiz@regionh.dk
                Journal
                Journal ID (nlm-ta): BMC Psychiatry
                Journal ID (iso-abbrev): BMC Psychiatry
                Title: BMC Psychiatry
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-244X
                Publication date (Electronic): 28 March 2023
                Publication date PMC-release: 28 March 2023
                Publication date Collection: 2023
                Volume: 23
                Electronic Location Identifier: 200
                Affiliations
                [1 ]GRID grid.466916.a, ISNI 0000 0004 0631 4836, Department of ADHD and Autism, , Mental Health Services, Capital Region of Denmark, ; Copenhagen, Denmark
                [2 ]Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark
                [3 ]GRID grid.61971.38, ISNI 0000 0004 1936 7494, Department of Biological Sciences, , Simon Fraser University, ; Burnaby, BC V5A 1S6 Canada
                [4 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, , Psychology & Neuroscience, King’s College London, ; London, UK
                [5 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Psychiatry and Neuropsychology, , Maastricht University, ; Maastricht, Netherlands
                [6 ]GRID grid.1002.3, ISNI 0000 0004 1936 7857, Centre for Developmental Psychiatry and Psychology, , Monash University, ; Melbourne, Australia
                [7 ]GRID grid.466916.a, ISNI 0000 0004 0631 4836, Center for Neuropsykiatrisk Depressionsforskning Psykiatrisk Center Glostrup, ; Nordstjernevej 41, Glostrup, Copenhagen, 2600 Denmark
                [8 ]GRID grid.18098.38, ISNI 0000 0004 1937 0562, School of Psychological Sciences, , University of Haifa, ; 3498838 Haifa, Israel
                Author information
                http://orcid.org/0000-0002-9328-9020
                Article
                Publisher ID: 4690
                DOI: 10.1186/s12888-023-04690-3
                PMC ID: 10044373
                SO-VID: 293bca57-e816-4e4a-92dc-ada90b839a7e
                Copyright © © The Author(s) 2023
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 12 August 2022
                Date accepted : 14 March 2023
                Funding
                Funded by: Sofiefonden
                Award ID: IWOV-Legal.FID4107425
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100007437, Trygfonden;
                Award ID: 153588
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100016469, Takeda Pharmaceuticals International;
                Categories
                Subject: Study Protocol
                Custom metadata
                issue-copyright-statement © The Author(s) 2023

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: autism spectrum disorder (we prefer autism spectrum condition),schizotypal disorder,questionnaire,diagnostics
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: autism spectrum disorder (we prefer autism spectrum condition), schizotypal disorder, questionnaire, diagnostics

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