Geniş Otizm Fenotipi

Yıl 2018, Cilt: 10 Sayı: 2, 228 - 248, 30.06.2018

Önder Küçük , Gözde Ulaş Ferhat Yaylacı , Süha Miral

https://doi.org/10.18863/pgy.358099

Cited By: 6

Öz

Geniş otizm fenotipi otistik bireylerin yakın akrabalarında bilişsel, sosyal, iletişimsel, davranışsal ve kişilik alanlarında gözlenebilen bozulmalarla karakterizedir. Otizm üzerine yapılan ilk çalışmalardan itibaren elde edilen verilerde; otistik bireylerin kardeşlerinde ve ebeveynlerinde daha hafif derecede otistik belirtilerin gözlendiği ve bunun otizm için endofenotip olabileceği düşünülmektedir. Bu derlemede geniş otizm fenotipinin tanısal değerlendirilmesi, belirtileri, bulguları araştırılmış ve yazında yapılan çalışmalar üzerinden elde edilen veriler gözden geçirilmiştir.

Anahtar Kelimeler

geniş otizm fenotipi, otizm

Broad Autism Phenotype

Öz

Broad autism phenotype is characterized by impairments in cognitive, social, communicative, behavioral and personality domains of close relatives to autistic individuals. Initial data derived from studies conducted on autism reflect mild autistic symptoms observed in siblings and parents of autistic individuals and this might be considered as an endophenotype for autism. With this review, we have aimed to summarize and interpret the entity of broad autism phenotype, within the context of its diagnostic assessment, its symptoms and relevant studies conducted so far.

Anahtar Kelimeler

broad autism phenotype, autism

Kaynakça

• Adolphs R, Spezio ML, Parlier M, Piven J (2008) Distinct face-processing strategies in parents of autistic children. Curr Biol, 18:1090–1093.
• Amaral DG, Schumann CM, Nordahl CW (2008) Neuroanatomy of autism. Trends Neurosci, 31:137–145.
• Amaral DG, Dawson G, Geschwind GH (2011) Autism Spectrum Disorders. Oxford, Oxford University Press.
• APA (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Rev (DSM-IV-TR). Washington DC, American Psychiatric Association.
• Austin EJ (2005) Personality correlates of the broader autism phenotype as assessed by the Autism Spectrum Quotient (AQ). Pers Individ Dif, 38:451–460.
• Aydın A, Saraç T (2014) Otistik bireylerin özellikleri ile ebeveynlerinin geniş otizm fenotipi ve aleksitimik özelliklerinin incelenmesi. The Journal of Academic Social Science Studies, 24:183-209.
• Bailey A, Palferman S, Heavey L, Le Couteur A (1998) Autism: the phenotype in relatives. J Autism Dev Disord, 28:369–392.
• Barnea-Goraly N, Lotspeich LJ, Reiss AL (2010) Similar white matter aberrations in children with autism and their unaffected siblings. Arch Gen Psychiatry, 67:1052–1060.
• Baron-Cohen S (1998) Autism occurs more often in families of physicists, engineers, and mathematicians. Autism, 2:296–301.
• Baron-Cohen S (2002) The extreme male brain theory of autism. Trends Cogn Sci, 6:248–254.
• Baron-Cohen S, Hammer J (1997) Parents of children with Asperger syndrome: what is the cognitive phenotype? J Cogn Neurosci, 9:548–554.
• Baron-Cohen S, Ring H, Chitnis X, Wheelwright S, Gregory L, Williams S et al (2006) fMRI of parents of children with Asperger Syndrome: a pilot study. Brain Cogn, 61:122–130.
• Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E (2001) The Autism-Spectrum Quotient (AQ): evidence from Asperger Syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord, 31:5-17.
• Bartak L, Rutter M, Cox A (1975) A comparative study of infantile autism and specific developmental receptive language disorder: I. the children. Br J Psychiatry, 126:127–145.
• Baykara B, Gencer Ö, İlkin Z, Miral S (2008) Otistik çocukların ana babalarında frontal loba özgü nörobilişsel özellikler. Türk Psikiyatri Derg, 19:225- 234.
• Belmonte MK, Gomot M, Baron-Cohen S (2010) Visual attention in autism families: “Unaffected” sibs share atypical frontal activation. J Child Psychol Psychiatry, 51:259–276.
• Ben-Yizhak N, Yirmiya N, Seidman I, Alon R, Lord C, Sigman M (2011) Pragmatic language and school related linguistic abilities in siblings of children with autism. J Autism Dev Disord, 41:750–760.
• Best CS, Moffat VJ, Power MJ, Owens DG, Johnstone EC (2008) The boundaries of the cognitive phenotype of autism: theory of mind, central coherence and ambiguous figure perception in young people with autistic traits. J Autism Dev Disord, 38:840–847.
• Bishop DVM (1998) Development of the Children’s Communication Checklist (CCC): A method for assessing qualitative aspects of communicative impairment in children. J Child Psychol Psychiatry, 39:879–891.
• Bishop DVM (2003) The Children’s Communication Checklist version 2 (CCC-2). London, England, Psychological Corporation.
• Bishop DVM, Maybery M, Wong D, Maley A, Hallmayer J (2006) Characteristics of the broader phenotype in autism: A study of siblings using the Children’s Communication Checklist-2. Am J Med Genet B Neuropsychiatr Genet,141B:117–122.
• Bishop DVM, Maybery M, Wong D, Maley A, Hill W, Hallmayer J (2004) Are phonological processing deficits part of the broad autism phenotype? Am J Med Genet B Neuropsychiatr Genet, 128B:54–60.
• Bleuler E (1911) Dementia praecox oder gruppe der schizophrenien. In: Handbuch der Psychiatrie (Ed G.Aschaffenburg): Spezieller Teil. 4. Abteilung.1. Hälfte. Leipzig, Franz Deuticke.
• Bolton P, Macdonald H, Pickles A, Rios P, Goode S, Crowson M et al. (1994) A case-control family history study of autism. J Child Psychol Psychiatry, 35:877-900.
• Bolton P, Pickles A, Murphy M, Rutter M (1998) Autism, affective and other psychiatric disorders: patterns of familial aggregation. Psychol Med, 28: 385-395.
• Briskman J, Happé F, Frith U (2001) Exploring the cognitive phenotype of autism: weak “central coherence” in parents and siblings of children with autism: II. Real-life skills and preferences. J Child Psychol Psychiatry, 42:309–316.
• Cassel TD, Messinger DS, Ibanez LV, Haltigan JD, Acosta SI, Buchman AC (2007) Early social and emotional communication in the infant siblings of children with autism spectrum disorders: an examination of the broad phenotype. J Autism Dev Disord, 37:122–132.
• Christensen L, Hutman T, Rozga A, Young GS, Ozonoff S, Rogers SJ et al. (2010) Play and developmental outcomes in infant siblings of children with autism. J Autism Dev Disord, 40:946-957.
• Constantino JN (2002) The Social Responsiveness Scale. Los Angeles, CA, Western Psychological Services.
• Constantino JN, Lajonchere C, Lutz M, Gray T, Abbacchi A, McKenna K (2006) Autistic social impairment in the siblings of children with pervasive developmental disorders. Am J Psychiatry, 163:294–296.
• Constantino JN, Przybeck T, Friesen D, Todd RD (2000) Reciprocal social behavior in children without pervasive developmental disorders. J Dev Behav Pediatr, 21:2–11.
• Constantino JN, Todd RD (2003) Autistic traits in the general population: a twin study. Arch Gen Psychiatry, 60:524–530.
• Constantino JN, Todd RD (2005) Intergenerational transmission of subthreshold autistic traits in the general population. Biol Psychiatry, 57:655–660.
• Constantino JN, Majmudar P, Bottini A, Arvin M, Virkud Y, Simons P et al. (2010) Infant head growth in male siblings of children with and without autism spectrum disorders. J Neurodev Disord, 2:39-46.
• Courchesne E, Pierce K, Schumann CM, Redcay E, Buckwalter JA, Kennedy DP et al. (2007) Mapping early brain development in autism. Neuron, 56:399–413.
• Dalton KM, Nacewicz BM, Alexander AL, Davidson RJ (2007) Gaze-fixation, brain activation, and amygdala volume in unaffected siblings of individuals with autism. Biol Psychiatry, 61:512–520.
• Daniels JL, Forssen U, Hultman CM, Cnattingius S, Savitz DA, Feychting M et al. (2008) Parental psychiatric disorders associated with autism spectrum disorders in the offspring. Pediatrics, 121:1357-1362.
• Dawson G, Estes A, Munson J, Schellenberg G, Bernier R, Abbott R (2007) Quantitative assessment of autism symptom-related traits in probands and parents: broader phenotype autism symptom scale. J Autism Dev Disord, 37:523–536.
• Dawson G, Webb SJ, Wijsman E, Schellenberg G, Estes A, Munson J et al. (2005) Neurocognitive and electrophysiological evidence of altered face processing in parents of children with autism: implications for a model of abnormal development of social brain circuitry in autism. Dev Psychopathol, 17:679–697.
• Demir N (2016) Dikkat eksikliği/ hiperaktivite bozukluğu, öğrenme bozukluğu ve otistik spektrum bozukluğu tanılı çocukların yaş ve cinsiyet açısından eşlenmiş sağlıklı kardeşlerinde sözel olmayan iletişim becerileri, empati düzeyleri, çevresel belirteçleri ile ilişkilerinin araştırılması: kontrollü bir araştırma (Uzmanlık tezi). Bolu, Abant İzzet Baysal Üniversitesi.
• Demir T, Doğangün B, Karaçetin G (2009) Psychiatric disorder and symptoms in mothers of children with autistic disorder. Neurol Psychiatry Brain Res, 15:191-196.
• Elder LM, Dawson G, Toth K, Fein D, Munson J (2008) Head circumference as an early predictor of autism symptoms in younger siblings of children with autism spectrum disorder. J Autism Dev Disord, 38:1104–1111.
• Elsabbagh M, Volein A, Csibra G, Holmboe K, Garwood H, Tucker L et al. (2009) Neural correlates of eye gaze processing in the infant broader autism phenotype. Biol Psychiatry, 65:31–38.
• Fidler DJ, Bailey JN, Smalley SL (2000) Macrocephaly in autism and other pervasive developmental disorders. Dev Med Child Neurol, 42:737–740.
• Folstein S, Rutter M (1977) Infantile autism: a genetic study of 21 twin pairs. J Child Psychol Psychiatry, 18:297–321.
• Fombonne E, Bolton P, Prior J, Jordan H, Rutter M (1997) A family study of autism: cognitive patterns and levels in parents and siblings. J Child Psychol Psychiatry, 38:667–683.
• Gamliel I, Yirmiya N, Jaffe DH, Manor O, Sigman M (2009) Developmental trajectories in siblings of children with autism: cognition and language from 4 months to 7 years. J Autism Dev Disord, 39:1131–1144.
• Gerdts J, Bernier R (2011) The broader autism phenotype and its implications on the etiology and treatment of autism spectrum disorders. Autism Res Treat, 2011:545901.
• Goldberg WA, Jarvis, KL, Osann K, Laulhere TM, Straub C, Thomas E et al. (2005) Brief report: early social communication behaviors in the younger siblings of children with autism. J Autism Dev Disord, 35:657–664.
• Happe F, Briskman J, Frith U (2001) Exploring the cognitive phenotype of autism: Weak central coherence in parents and siblings of children with autism: I. Experimental tests. J Child Psychol Psychiatry, 42:299–307.
• Hoekstra RA, Bartels M, Cath DC, Boomsma DI (2008) Factor structure, reliability and criterion validity of the Autism-Spectrum Quotient (AQ): a study in Dutch population and patient groups. J Autism Dev Disord, 38:1555–1566.
• Hollander E, King A, Delaney K, Smith CJ, Silverman JM (2003) Obsessive-compulsive behaviors in parents of multiplex autism families. Psychiatry Res, 117:11–16.
• Holmboe K, Elsabbagh M, Volein A, Tucker LA, Baron-Cohen S, Bolton P et al. (2010) Frontal cortex functioning in the infant broader autism phenotype. Infant Behav Dev, 33:482–491.
• Hughes C, Leboyer M, Bouvard M (1997) Executive function in parents of children with autism. Psychol Med, 27:209–220.
• Hurley RSE, Losh M, Parlier M, Reznick JS, Piven J (2007) The broad autism phenotype questionnaire. J Autism Dev Disord, 37:1679–1690.
• Hurst RM, Nelson-Gray RO, Mitchell JT, Kwapil TR (2007) The relationship of Asperger’s characteristics and schizotypal personality traits in a non-clinical adult sample. J Autism Dev Disord, 37:1711–1720.
• Ingersoll B, Hopwood CJ, Wainer A, Brent Donnellan M (2011) A comparison of three self-report measures of the broader autism phenotype in a non-clinical sample. J Autism Dev Disord, 41:1646–1657.
• Ingersoll B, Meyer K, Becker MW (2011) Increased rates of depressed mood in mothers of children with ASD associated with the presence of the broader autism phenotype. Autism Res, 4:143-148.
• Jobe LE, White SW (2007) Loneliness, social relationships, and a broader autism phenotype in college students. Pers Individ Dif, 42:1479–1489.
• Kadak MT (2011) Otistik spektrum bozukluğu tanısı almış çocukların ebeveynlerinde kişilik özellikleri, emosyonel yüz ifadelerini tanıma ve geniş otizm fenotip ilişkisi (Uzmanlık tezi). İstanbul, İstanbul Üniversitesi.
• Kanner L (1943) Autistic disturbances of affective contact. Nervous Child, 2:217-250.
• Kates WR, Burnette CP, Eliez S, Strunge LA, Kaplan D, Landa R et al. (2004) Neuroanatomic variation in monozygotic twin pairs discordant for the narrow phenotype for autism. Am J Psychiatry,161:539–546.
• Köse S, Bora E, Erermiş S, Aydın C (2010) Otizm-Spektrum Anketi Türkçe formunun psikometrik özellikleri. Anadolu Psikiyatri Derg, 11:253-260.
• Kunihira Y, Senju A, Dairoku H, Wakabayashi A, Hasegawa T (2006) “Autistic” traits in non-autistic Japanese populations: relationships with personality traits and cognitive ability. J Autism Dev Disord, 36:553–566.
• Landa R, Piven J, Wzorek MM, Gayle JO, Chase GA, Folstein SE (1992) Social language use in parents of autistic individuals. Psychol Med 22:245–254.
• Le Couteur A, Bailey A, Goode S, Pickles A, Robertson S, Gottesman I et al. (1996) A broader phenotype of autism: the clinical spectrum in twins. J Child Psychol Psychiatry, 37:785-801.
• Lindgren KA, Folstein SE, Tomblin JB, Tager-Flusberg H (2009) Language and reading abilities of children with autism spectrum disorders and specific language impairment and their first-degree relatives. Autism Res, 2:22–38.
• Losh M, Adolphs R, Poe MD, Couture S, Penn D, Baranek GT et al. (2009) Neuropsychological profile of autism and the broad autism phenotype. Arch Gen Psychiatry, 66:518–526.
• Losh M, Adolphs R, Piven J (2011) The broad autism phenotype. In Autism spectrum disorders (Eds G Dawson, D Amaral, D Geschwind):457-476. Oxford, England, Oxford University Press.
• Mason O, Claridge, G, Jackson, M (1995) New scales for the assessment of schizotypy. Pers Individ Dif, 18:7–13.
• Merin N, Young GS, Ozonoff S, Rogers SJ (2007) Visual fixation patterns during reciprocal social interaction distinguish a subgroup of 6-month-old infants at-risk for autism from comparison infants. J Autism Dev Disord, 37:108–121.
• Micali N, Chakrabarti S, Fombonne E (2004) The broad autism phenotype: findings from an epidemiological survey. Autism, 8: 21–37.
• Miles JH, Hadden LL, Takahashi TN, Hillman RE (2000) Head circumference is an independent clinical finding associated with autism. Am J Med Genet, 95:339-350.
• Minton J, Campbell M, Green WH (1982) Cognitive assessment of siblings of autistic children. J Am Acad Child Psychiatry, 21:315–321.
• Murphy M, Bolton PF, Pickles A, Fombonne E, Piven J, Rutter M (2000) Personality traits of the relatives of autistic probands. Psychol Med, 30:1411–1424.
• Neumarker KJ (2003) Leo Kanner: his years in Berlin, 1906-24: the roots of autistic disorder. Hist Psychiatry, 14:205-218. Palmen SJ, Hulshoff Pol HE, Kemner C, Schnack HG, Sitskoorn MM, Appels MC et al. (2005) Brain anatomy in non-affected parents of autistic probands: a MRI study. Psychol Med; 35:1411-1420.
• Parr JR, Wittemeyer K, Le Couteur AS (2011) Commentary: The broader autism phenotype implications for research clinical practice. In Autism Spectrum Disorders (Eds D Amaral, D Geschwind, G Dawson):521-524. New York, Oxford University Press.
• Peterson E, Schmidt GL, Tregellas JR, Winterrowd E, Kopelioff L, Hepburn S et al. (2006) A voxel-based morphometry study of gray matter in parents of children with autism. Neuroreport; 17:1289-1292.
• Pilowsky T, Yirmiya N, Gross-Tsur V, Shalev RS (2007) Neuropsychological functioning of siblings of children with autism, siblings of children with developmental language delay, and siblings of children with mental retardation of unknown genetic etiology. J Autism Dev Disord, 37:537–552.
• Piven J, Wzorek M, Landa R, Lainhart J, Bolton P, Chase GA et al. (1994) Personality characteristics of the parents of autistic individuals. Psychol Med, 24:783–795.
• Piven J, Palmer P (1999) Psychiatric disorder and the broad autism phenotype: evidence from a family study of multiple-incidence autism families. Am J Psychiatry; 156:557–563.
• Piven J, Palmer P, Jacobi D, Childress D, Arndt S (1997a) Broader autism phenotype: evidence from a family history study of multiple-incidence autism families. Am J Psychiatry, 154:185–190.
• Piven J, Palmer P, Landa R, Santangelo S, Jacobi D, Childress D (1997b) Personality and language characteristics in parents from multiple-incidence autism families. Am J Med Genet, 74:398–411.
• Piven J (2001) The broad autism phenotype: a complementary strategy for molecular genetic studies of autism. Am J Med Genet, 105:34–35.
• Presmanes AG, Walden TA, Stone WL, Yoder PJ (2007) Effects of different attentional cues on responding to joint attention in younger siblings of children with autism spectrum disorders. J Autism Dev Disord, 37:133–144.
• Rajendran G, Mitchell P (2007) Cognitive theories of autism. Dev Rev, 27:224–260.
• Rojas DC, Smith J, Benkers TL, Camou SL, Reite ML, Rogers SJ (2004) Hippocampus and amygdala volumes in parents of children with autistic disorder. Am J Psychiatry, 161:2038–2044.
• Ronald A, Happe F, Plomin R (2008) A twin study investigating the genetic and environmental aetiologies of parent, teacher and child ratings of autistic-like traits and their overlap. Eur Child Adolesc Psychiatry, 17:473–483. Ronald A, Hoekstra RA (2011) Autism spectrum disorders and autistic traits: a decade of new twin studies. Am J Med Genet B Neuropsychiatr Genet, 156B:255–274.
• Roth I (2010) The Autism Spectrum in the 21st Century: Exploring Psychology, Biology and Practice. Philadelphia, PA, Jessica Kingsley Publishers.
• Ruser TF, Arin D, Dowd M, Putnam S, Winklosky B, Rosen-Sheidley B et al. (2007) Communicative competence in parents of children with autism and parents of children with specific language impairment. J Autism Dev Disord, 37:1323–1336. Rutter M (2000) Genetic studies of autism: from the 1970s into the millennium. J Abnorm Child Psychol, 28:3-14.
• Santangelo SL, Folstein SE (1995) Social deficits in the families of autistic probands. Am J Hum Genet, 57:89.
• Schumann CM, Bloss CS, Barnes CC, Wideman GM, Carper RA, Akshoomoff N et al. (2010) Longitudinal magnetic resonance imaging study of cortical development through early childhood in autism. J Neurosci, 30:4419–4427.
• Scott FJ, Baron-Cohen S, Bolton P, Brayne C. (2002) The CAST (childhood Asperger syndrome test): preliminary development of a UK screen for mainstream primary-school age children. Autism, 6:9-31.
• Seidman I, Yirmiya N, Milshtein S, Ebstein RP, Levi S (2012) The broad autism phenotype questionnaire: mothers versus fathers of children with an autism spectrum disorder. J Autism Dev Disord, 42:837–846.
• Shaked M, Gamliel I, Yirmiya N (2006) Theory of mind abilities in young siblings of children with autism. Autism, 10:173–187.
• Skuse DH, Mandy WPL, Scourfield J (2005) Measuring autistic traits: heritability, reliability and validity of the social and communication disorders checklist. Br J Psychiatry, 187:568-572.
• Smalley S, McCracken J, Tanguay P (1995) Autism, affective disorders, and social phobia. Am J Med Genet, 60:19–26.
• Spencer MD, Holt RJ, Chura, LR, Suckling J, Calder AJ, Bullmore ET et al. (2011) A novel functional brain imaging endophenotype of autism: the neural response to facial expression of emotion. Transl Psychiatry, 1:e19.
• Stone WL, McMahon CR, Yoder PJ, Walden TA (2007) Early social-communicative and cognitive development of younger siblings of children with autism spectrum disorders. Arch Pediatr Adolesc Med, 161:384–390.
• Sucksmith E, Roth I, Hoekstra RA (2011) Autistic traits below the clinical threshold: re-examining the broader autism phenotype in the 21st century. Neuropsychol Rev, 21:360–389.
• Sugihara G, Tsuchiya KJ, Takei N (2008) Distinguishing broad autism phenotype from schizophrenia-spectrum disorders. J Autism Dev Disord, 38:1998–1999.
• Szatmari P, MacLean JE, Jones MB, Bryson SE, Zwaigenbaum L, Bartolucci G et al. (2000) The familial aggregation of the lesser variant in biological and non-biological relatives of PDD probands a family history study. J Child Psychol Psychiatry, 41,579–586.
• Toth K, Dawson G, Meltzoff AN, Greenson J, Fein D (2007) Early social, imitation, play, and language abilities of young non-autistic siblings of children with autism. J Autism Dev Disord, 37:145-157.
• Tyrer P (1988) Personality Assessment Schedule. London, England, Butterworth.
• Van Engeland H, Buitelaar JK (2008) Autism spectrum disorders. In Rutter’s Child and Adolescent Psychiatry, 5th edition (Eds M Rutter, DVM Bishop, DS Pine):759-781. Massachusetts, Blackwell Publishing.
• Virkud YV, Todd RD, Abbacchi A, Zhang Y, Constantino JN (2009) Familial aggregation of quantitative autistic traits in multiplex versus simplex autism. Am J Med Genet B Neuropsychiatric Genet, 50B:328–334.
• Wainer AL, Block N, Donnellan MB, Ingersoll B (2013) The broader autism phenotype and friendships in non-clinical dyads. J Autism Dev Disord, 43:2418-2425.
• Wainer AL, Ingersoll BR, Hopwood CJ (2011) The structure and nature of the broader autism phenotype in a non-clinical sample. J Psychopathol Behav Assess, 33:1646–1657.
• Warren ZE, Foss-Feig JH, Malesa EE, Lee EB, Taylor JL, Newsom CR et al. (2012) Neurocognitive and behavioral outcomes of younger siblings of children with autism spectrum disorder at age five. J Autism Dev Disord, 42:409–418.
• Wheelwright S, Auyeung B, Allison C, Baron-Cohen S (2010) Defining the broader, medium and narrow autism phenotype among parents using the Autism Spectrum Quotient (AQ). Mol Autism, 1:1-10.
• Whitehouse AJO, Barry JG, Bishop DVM (2007) The broader language phenotype of autism: a comparison with specific language impairment. J Child Psychol Psychiatry, 48:822-830.
• Whitehouse AJO, Bishop DVM (2009) The Children’s Communication Checklist-Adult Version (CC-A). London, England, Pearson. Whitehouse AJO, Coon H, Miller J, Salisbury B, Bishop DV (2010) Narrowing the broader autism phenotype: a study using the Communication Checklist-Adult Version (CC-A). Autism, 14:559-574.
• Wolff S (2004) The history of autism. Eur Child Adolesc Psychiatry, 13:201-208.
• Wolff S, Narayan S, Moyes B (1988) Personality characteristics of parents of autistic children: a controlled study. J Child Psychol Psychiatry, 29:143-153.
• Woodbury-Smith MR, Robinson J, Wheelwright S, Baron-Cohen S. (2005) Screening adults for Asperger syndrome using the AQ: A preliminary study of its diagnostic validity in clinical practice. J Autism Dev Disord, 35:331-335.