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Autistic-like Traits Associated with Elevated Prenatal Androgens« Back to Volume 22, Issue 4, December 2006 - Table of Contents Substantial experimental literature in animals, including nonhuman primates, indicates early exposure to androgens masculinizes both reproductive and nonreproductive behaviors via their influence on sex-dimorphic brain development. Autism spectrum conditions (ASCs) are characterized by impairments in social interaction, verbal and nonverbal communication, and imaginative play and by strong repetitive behavior and narrow interests. The spectrum includes classic autism, as well as the less severe diagnosis, Asperger’s syndrome (AS). Prevalence estimates for ASCs are as high as 1 in 200, and are substantially more common in males than in females (4:1 for classic autism, 9:1 for AS). In the present study, the investigators examined the hypothesis that autistic traits are increased following prenatal exposure to abnormally high levels of testosterone caused by congenital adrenal hyperplasia (CAH). Sixty participants with classical CAH (34 females, 26 males; n = 53 with 21-OH deficiency salt-wasting CAH), and 49 unaffected relatives (24 females, 25 males), ages 12 to 45 years, were recruited through pediatric endocrinology clinics and a CAH support group in the UK. Information regarding participation rates was not recorded. Autism spectrum traits were assessed with the Autism Spectrum Quotient (AQ). The AQ is a self administered 50-item questionnaire assessing 5 areas: social skills, communication, imagination, attention to detail, and attention switching. Higher scores indicate increased endorsement of characteristics classified as “autistic.” The AQ validation studies suggest that autistic traits are distributed normally in the general population, with males scoring higher (17.8, SD = 6.8) than females (15.4, SD = 5.7). Individuals with high functioning autism (HFA) or AS have a mean score of 35.8 (SD = 6.5; maximum possible score = 50), a highly significant difference from the general population. The recommended cutoff scores for further evaluation are 32 in the general population, and 26 in individuals referred for clinical evaluation due to suspected HFA/AS. Study participants completed and returned the questionnaires by mail. Additional evaluations occurred at university based offices. Replicating previous findings for the general population, unaffected males in this study had significantly higher total AQ scores than unaffected females. In addition, females with CAH scored higher (ie, in the male direction) on total AQ than unaffected females. In contrast, total AQ scores of males with and without CAH did not differ. T-tests indicated females with CAH had significantly higher scores on the social skills and imagination subscales than unaffected female relatives. The reverse was true on the attention to detail subscale (ie, unaffected females > females with CAH). Furthermore, the direction was consistent with the direction of the sex difference, in that unaffected males scored somewhat, though not significantly, lower than unaffected females on attention to detail scale. For males, there were no significant differences on any of the individual subscales for participants with CAH versus without CAH. With regard to clinical significance, only 2 participants had total AQ scores of 32 or above, and these were brothers, one of whom had CAH and one of whom did not. Eight participants had scores of 26 or above, including 4 control males, one male with CAH and 3 females with CAH. The authors concluded that elevated androgen levels predispose individuals to developing autistic traits. However, they acknowledged that additional genetic or other characteristics must be present to produce clinically diagnosed ASC. Editor’s CommentAny parent of a child with CAH with access to the internet and interest in learning about psychological development in this condition would, before long, come across this paper with the charged title “Androgens and autistic traits: A study of individuals with congenital adrenal hyperplasia.” It would be obvious to any researcher in the area, but not to parents who are uninitiated to the procedures and language of science, that the study demonstrates a subtle shift in behavioral characteristics falling within the range for the general population. The researchers reported that females with CAH showed AQ scores comparable to that of males (CAH-affected and unaffected), not that they qualitatively behaved like individuals with autistic spectrum disorders. An analogy might help here: it would be misleading to characterize someone who has stolen a pack of gum, without exhibiting multiple other forms of violating the rights of others, as showing traits of conduct disorder or antisocial personality disorder.1 Autism and AS fall under the umbrella category of Pervasive Developmental Disorders and are characterized by impairments in social communication and interactions that result in clinically significant psychosocial morbidity.1 I do not claim that the authors were suggesting that higher AQ scores in the CAH females than control group participants are tantamount to them more likely experiencing these debilitating syndromes. However, this paper can sensitize all those who are involved in research and clinical care to the fact that audiences are usually broader than those we intend and, because of this, our words are prone to misinterpretation. For this reason, it might be a wise practice for scholars, as a final step prior to submission of manuscripts for peer review, to consider the reactions of parents or affected individuals. This is not a suggestion to sugarcoat findings or the interpretation of data; instead, it is warning of how words can be misinterpreted and in ways that result in unintended confusion, alarm and harm. David E. Sandberg, PhD References - (linked to
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Volume 24 Number 1
May 2008
www.GGHjournal.com
ISSN 1932-9032
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