Interobserver agreement in ABCD scoring between non-stroke specialists and vascular neurologists following suspected TIA is only fair

The appropriateness of use and accuracy of age, blood pressure, clinical features and duration of symptoms (ABCD) scoring by non-stroke specialists while risk-stratifying patients with suspected transient ischaemic attack (TIA) are unknown. We reviewed all available ABCD data from referrals to a specialist neurovascular clinic. ABCD scoring was defined as ‘appropriate’ in this study if an experienced vascular neurologist subsequently confirmed a clinical diagnosis of possible, probable or definite TIA, and ‘inappropriate’ if the patient had an alternative diagnosis or stroke. Interobserver agreement between the referring physician and the neurologist was calculated. One hundred and four patients had completed ABCD referral proformas available for analysis. Forty-five (43%) were deemed appropriate, and 59 (57%) inappropriate. In the entire dataset, the neurologist agreed with the referring physician’s total ABCD score in only 42% of cases [κ = 0.28]. The two most unreliable components of the scoring system were clinical features [κ = 0.51], and duration of symptoms [κ = 0.48]. ABCD scoring by non-stroke specialists is frequently inappropriate and inaccurate in routine clinical practice, emphasising the importance of urgent specialist assessment of suspected TIA patients.     

Hypertension as a risk factor for migraine chronification

Aim of this study is to verify whether there is concordance between disease’s severity, health-related quality of life (HRQoL) and disability in patients with Myasthenia gravis (MG). 102 MG patients were clustered on the basis of HRQoL and disability scores into three groups: low disability and low HRQoL decrement (51 patients), intermediate disability and HRQoL decrement (28 patients), severe disability and high HRQoL decrement (23 patients). Cross tabulation with symmetric measures (Cramer’s V and Contingency Coefficient) was used to verify the relationships between disease severity groups, based on the Myasthenia Gravis Foundation of America (MGFA) criteria, and obtained clusters. Results confirm a significant relationship between MG severity groups, HRQoL and disability profiles. In our opinion, HRQoL and disability instruments should be employed in clinical trials to match efficacy of treatments, measured on symptoms’ reductions only, with their effects on patients’ disability and HRQoL.     

GHQ increases among Scottish 15 year olds 1987–2006

Background  Increases in a number of psychosocial disorders have been identified among Western youth in the second half of the Twentieth century. However findings are not consistent, trends are complex, and comparisons over time are hampered by methodological problems. Methods  Data were drawn from three samples identical in respect of age (15 years), school year (final year of statutory schooling) and geographical location (the West of Scotland). Each sample was administered the 12-item General Health Questionnaire, a measure of self-report psychological distress, in 1987 (N = 505), 1999 (N = 2,196) and 2006 (N = 3,194). Analyses were conducted to examine changes in: GHQ ‘caseness’; individual items; and factors, derived via confirmatory factor analysis representing (a) ‘negative’ and ‘positive’ items, and (b) ‘anxiety and depression’, ‘loss of confidence or self-esteem’ and ‘anhedonia and social dysfunction’. Results  Based on the standard (2/3) cut-off, ‘caseness’ rates in 1987, 1999 and 2006 were 12.7, 15.1 and 21.5% (males) and 18.8, 32.5 and 44.1% (females). Similar increases were observed with more stringent ‘caseness’ cut-offs. Examination of individual items showed some to have increased much more markedly over time than others. There were larger increases among females for all except two items and some evidence, among both genders, of steeper increases among ‘negative’ items compared with ‘positive’ ones. However, the differences in slope were very small compared with the overall increases in both types. Conclusions  Data from three samples identical in respect of age, school year and geographical location, show marked increases in GHQ-12 ‘caseness’ among females between 1987 and 1999 and among both males and females between 1999 and 2006. Although slightly steeper increases in ‘negative’ items raise the possibility that endorsing such symptoms may have become more acceptable, these were small in comparison with increases in all dimensions of psychological distress. The next step is to identify causal explanations for the increases reported here.     

Meta-analysis of initial seizure thresholds in electroconvulsive therapy

In electroconvulsive therapy (ECT), electrical dosage is determined using ‘fixed-dose’, ‘age-based’ dose, or empirical titration methods. Estimation of initial seizure threshold (IST) has been claimed to be imperative for suprathreshold dosing. This systematic review aimed to determine common levels of IST, to define cut-off values for high IST, and to summarize reported IST associated factors. Medline and PsycINFO were searched from 1966 to January 2008 and relevant references were cross-checked. Subject headings including ECT, seizure threshold, dosage, and dosing were used. All articles reporting on levels of IST and/or associated factors were included. Of 395 potentially relevant reports, 46 studies on 70 samples concerning 3,023 patients were selected. Nine samples (n = 306 patients) without available standard deviation and four samples (n = 275 patients) treated with mixed electrode placement were excluded. Meta-analysis was done on 30 unilaterally treated samples (n = 1,326 patients) and 27 bilaterally treated samples (n = 1,116 patients). In unilateral ECT, weighted mean of IST was 68.2 milliCoulombs (mC; 95% CI 63.2–73.3 mC), and in bilateral ECT 111.6 mC (95% CI 103.7–119.4 mC). Calculated cut-off values for high IST were 121 mC for unilateral ECT and 221 mC for bilateral ECT. According to the literature, male gender and use of bilateral electrode placement appeared to increase IST most prominently. In conclusion, calculated electrical doses for ‘suprathreshold’ right unilateral ECT and for ‘moderate above threshold’ bilateral ECT, using commonly reported IST levels, were in the same though narrower ranges as provided in ‘fixed-dose’ and ‘half-age’ based strategies, respectively.     

How do different diagnostic criteria, age and gender affect the prevalence of attention deficit hyperactivity disorder in adults? An epidemiological study in a Hungarian community sample

The goal of the study was twofold: (1) to investigate the effect of different diagnostic criteria on prevalence estimates of adult attention deficit hyperactivity disorder (ADHD), and (2) to provide prevalence estimates of adult ADHD for the first time in a Hungarian sample. Subjects between 18 and 60 years were included in the screening phase of the study (N = 3,529), conducted in 17 GP practices in Budapest. Adult self-report scale 6-item version was used for screening. Out of 279 positively screened subjects 161 subjects participated in a clinical interview and filled out a self-report questionnaire to confirm the diagnosis. Beside DSM-IV diagnostic criteria, we applied four alternative diagnostic criteria: ‘No-onset’ (DSM-IV criteria without the specific requirement for onset); full/Sx (DSM-IV “symptoms only” criteria); and reduced/Sx (DSM-IV “symptoms only” criteria with a reduced threshold for symptom count). Crude prevalence estimates adjusted for the specificity and sensitivity data of the screener were 1.35% in the ‘DSM-IV’ group, 1.64% in the ‘No-onset’ group, 3.65% in the ‘Sx/full’ group and 4.16% in the ‘Sx/reduced’ group. Logistic regression analysis showed that ADHD was significantly more prevalent with younger age and male gender [χ² = 14.46; P = 0.0007]. Prevalence estimates corrected for the ‘not-interviewed’ subsample and adjusted for specificity and sensitivity data of the screener was 2.3% in males, 0.91% in females; 2.02% in the ≤40 years age group and 0.70% in the >40 years age group, based on DSM-IV diagnostic criteria. Prevalence rates found in this study are somewhat lower, but still are in line with those reported in the literature.     

Diurnal and nocturnal drooling in Parkinson’s disease

Drooling as symptom of Parkinson’s disease (PD) has thus far been poorly defined. This uncertainty is reflected by high variations in published prevalence rates. The aim of this study was to investigate the prevalence of saliva loss versus accumulation of saliva as a possible preliminary stage, and diurnal drooling versus nocturnal drooling. In addition, we evaluated the association between drooling severity and the severity of facial and oral motor disorders. We collected age, disease duration, UPDRS III and Hoehn & Yahr stage from 104 consecutive outpatients with PD. Diurnal and nocturnal drooling was evaluated with a validated questionnaire (ROMP-saliva). A speech pathologist, blinded for drooling severity, rated facial expression, involuntary mouth opening and difficulty with nose breathing and also interviewed patients about sleeping position and nose-breathing during the night. Thirty patients (29%) had no complaints with saliva control (‘non-droolers’), 45 patients (43%) experienced accumulation of saliva or only nocturnal drooling (‘pre-droolers’), and 29 (28%) had diurnal drooling (24 of which also drooled during the night; ‘droolers’). The droolers had longer disease duration (10 vs. 7 years, p = 0.01) and drooling was independently associated with involuntary mouth opening (OR = 2.0; 95% CI 1.02–3.99) and swallowing complaints (OR = 1.2; 95% CI 1.03–1.31). Diurnal drooling—defined as dribbling of saliva while awake—is present in about 28% of PD patients. This is less than usually reported. Diurnal drooling typically appeared later in the disease course. The association with oral motor behavior should encourage the development of behavioral treatment approaches.     

Elevated serum level of interleukin-32α in the patients with myasthenia gravis

A new cytokine, interleukin-32 (IL-32), has been implicated in the pro-inflammatory immune responses in several autoimmune disorders, such as rheumatoid arthritis and inflammatory bowel diseases. Myasthenia gravis (MG) is a well-characterized autoimmune disease directed at the postsynaptic acetylcholine receptor (AChR) or end plate of the neuromuscular junction. IL-32 is a cytokine that induces tumor necrosis factor (TNF)-α, IL-6, IL-1β, and chemokine. IL-6, TNF-α, and IL-2 are related to the pathogenesis and immunoregulation of MG. The gene expression of IL-32 is increased in human natural killer (NK) cells and T lymphocytes when stimulated by IL-2 or mitogen. NK cells influence the development of experimental autoimmune MG (EAMG) and possibly MG. The aim of this study was to examine whether IL-32α levels are increased in patients with MG and to investigate the relationship between IL-32α levels and disease activity in human MG. Serum IL-32α levels were significantly higher in the MG patients (p = 0.03): 460.07 ± 192.30 pg/mL in MG patients and 248.45 ± 188.42 pg/mL in the healthy control group. Although there was no significant statistical difference, serum IL-32α levels of patients with both anti-AChR binding and blocking antibodies trended to be higher than those without either antibodies (521.56 ± 212.92 pg/mL vs. 339.52 ± 182.78 pg/mL, p = 0.16). IL-32α serum levels tended to decrease with clinical improvement in generalized MG. This study suggests the possibility that IL-32 might contribute to MG pathogenesis or immunoregulation.     

The relationship between health, disability and quality of life in Myasthenia Gravis: results from an Italian study

Myasthenia gravis (MG) produces long term disability and affects health-related quality of life (HRQoL). This paper reports the relationship between HRQoL and disability in a group of patients with MG. Adult patients with MG were consecutively enrolled at the Neurological Institute “Carlo Besta”. The World Health Organization Disability Assessment Schedule II (WHO-DAS II) and the Medical Outcome Survey 36-Item Short-Form Health Survey (SF-36) were employed, and non-parametric analysis (Spearman’s rank correlation and Mann–Whitney U test) performed. One hundred and two consecutive adult patients with MG (70 female; mean age 47.2, sd 15.7) were recruited. The majority of WHO-DAS II and SF-36 scales were significantly correlated; WHO-DAS II summary score correlated better with SF-36 Physical Composite Score (PCS), than with mental composite score (MCS). Significant differences are also reported between patients with different muscle involvement in PCS and WHO-DAS II scores, while no difference was observed in MCS. The impact of MG on disability and HRQoL increases consistently with the disease’s severity. Our study highlights that measurements of HRQoL and disability in patients with MG are correlated and sensitive enough to capture different clinical profiles’ features. They measure different clinical and psychosocial facets, therefore we recommend employing specific assessments both for quality of life and disability in public health and clinical research on myasthenia gravis.     

Direct switch from levodopa/benserazide or levodopa/carbidopa to levodopa/carbidopa/entacapone in Parkinson’s disease patients with wearing-off: efficacy, safety and feasibility—an open-label, 6-week study

The study objective was to assess the efficacy, safety and feasibility of switching from levodopa/benserazide (LB) or levodopa/carbidopa (LC) to levodopa/carbidopa/entacapone (LCE) in Parkinson’s disease (PD) patients with wearing-off. This was a multicenter, open-label, 6-week study; the primary outcome was success rate based on the patient-assessed Clinical Global Impression of Change (P-CGI-C). Secondary outcomes included investigator-assessed CGI-C (I-CGI-C), change from baseline in Unified Parkinson’s Disease Rating Scale (UPDRS), motor/non-motor wearing-off symptoms and quality of life–visual analog scale (QoL-VAS). After switching to LCE, 77% of patients reported an ‘improvement’ (p < 0.0001 vs. patients reporting ‘no change or worsening’). Significant improvements were seen in I-CGI-C, UPDRS and QoL-VAS, regardless of prior therapy. Oral levodopa dosing was increased in 28% of patients; the primary outcome remained significant when these patients were excluded. The data suggest that switching from LB/LC to LCE provided a significant benefit in PD patients with wearing-off.     

Prognosis of thymectomy in myasthenia gravis patients with thymus hyperplasia

Purpose: To compare the post-thymectomy prognosis in different conditions of myasthenia gravis (MG) patients with thymus hyperplasia. Materials and methods: Collecting medical record and carrying out the follow-up study of 123 myasthenia gravis patients with thymus hyperplasia who have underwent thymectomy during the period between 2003 and 2013. Dividing into different groups based on gender, age of onset, duration of disease and Myasthenia Gravis Association of America (MGFA) clinical classification to analyze different prognosis in different groups. Results: Complete stable remission (CSR) was achieved in 71 of 123 patients (59.5%). There is no gender-related difference in achieving CSR. Patients with early onset of MG (≤40 years old) or disease duration less than 12 months had significantly higher CSR rates than those with late onset of MG (>40 years old) or disease duration more than 12 months respectively, while no difference was found in remission rate between MGFA clinical classification I and MGFA II. Conclusion: Myasthenia gravis patients with thymus hyperplasia who had thymectomy are proved to possess greater chance of achieving CSR. The onset age of disease and duration are the prognostic factors.     

The Patient Assessment of Chronic Illness Care Questionnaire: Evaluation in Patients with Mental Disorders in Primary Care

The Chronic Care Model provides evidence-based recommendations to improve the care for patients with chronic conditions. The Patient Assessment of Chronic Illness Care questionnaire (PACIC) is an instrument to evaluate the patient’s perspective on receipt of care delivered in the five domains patient activation, delivery system, goal setting, problem solving, and follow-up. The aim of this study was to assess the psychometric characteristics of the PACIC in 442 primary care patients with major depression. The psychometric properties were good. We found possible ceiling effects in the two subscales ‘patient activation’ (12.9%) and ‘problem solving/contextual’ (8.9%), as well as floor effects in ‘goal setting/tailoring’ (4.6%). The Cronbach’s α coefficient for the total scale was excellent (0.91). We found two major factors, which we labeled according to the PACIC domains as composite factors ‘patient activation and problem solving’ as well as ‘goal setting and coordination’. The perspective of patients with mental disorders, such as depression, on primary chronic illness care can be assessed adequately by the PACIC.     

Subtle deficits of cognitive theory of mind in unaffected first-degree relatives of schizophrenia patients

Alterations of theory of mind (ToM) and empathy were implicated in the formation of psychotic experiences, and deficits in psychosocial functioning of schizophrenia patients. Inspired by concepts of neurocognitive endophenotypes, the existence of a distinct, potentially neurobiologically based social-cognitive vulnerability marker for schizophrenia is a matter of ongoing debate. The fact that previous research on social-cognitive deficits in individuals at risk yielded contradictory results may partly be due to an insufficient differentiation between qualitative aspects of ToM. Thirty-four unaffected first-degree relatives of schizophrenia patients (21 parents, 8 siblings, 5 children; f/m: 30/4; mean age: 48.1 ± 12.7 years) and 34 controls subjects (f/m: 25/9; mean age: 45.9 ± 10.9 years) completed the ‘Movie for the Assessment of Social Cognition’—a video-based ToM test—and an empathy questionnaire (Interpersonal Reactivity Index, IRI). Outcome parameters comprised (1) ‘cognitive’ versus ‘emotional’ ToM, (2) error counts representing ‘undermentalizing’ versus ‘overmentalizing’, (3) empathic abilities and (4) non-social neurocognition. MANCOVA showed impairments in cognitive but not emotional ToM in the relatives’ group, when age, gender and neurocognition were controlled for. Relatives showed elevated error counts for ‘undermentalizing’ but not for ‘overmentalizing’. No alterations were detected in self-rated dimensions of empathy. Of all measures of ToM and empathy, only the IRI subscale ‘fantasy’ was associated with measures of psychotic risk, i.e. a history of subclinical delusional ideation. The present study confirmed subtle deficits in cognitive, but not emotional ToM in first-degree relatives of schizophrenia patients, which were not explained by global cognitive deficits. Findings corroborate the assumption of distinct social-cognitive abilities as an intermediate phenotype for schizophrenia.     

Predicting fatigue 1 year after aneurysmal subarachnoid hemorrhage

Fatigue is an important contributor to quality of life in patients who survive aneurysmal subarachnoid hemorrhage (SAH), but the determinants of this fatigue are unclear. We assessed the occurrence of fatigue 1 year after SAH and its relation to physical or cognitive impairment, passive coping, and emotional problems, measured 3 months after SAH. This was a prospective cohort study of 108 patients who visited our SAH outpatient clinic 3 months after SAH and who were living independently in the community 1 year after SAH. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Analysis of variance was used to analyze the data. Fatigue (FSS ≥4) was present in 77 patients (71%). Mean FSS scores were 4.1 (SD 1.6) in the group of patients having ‘neither physical nor cognitive impairment,’ 5.2 (1.4) having ‘either physical or cognitive impairment,’ and 5.9 (0.9) having ‘both physical and cognitive impairments.’ Mean FSS scores were higher in patients scoring high on passive coping (85 vs. 58%; RR 1.46, 95% CI 1.13–1.87), anxiety (84 vs. 55%; RR 1.53, 95% CI 1.17–2.02), or depression (85 vs. 62%; RR 1.36, 95% CI 1.08–1.72) than in patients without these complaints. Relationships between these complaints and FSS scores were higher in patients having neither physical nor cognitive impairments than in patients having physical or cognitive impairments. Fatigue is common after SAH and is related to physical and cognitive impairments. In patients with neither physical nor cognitive impairments, passive coping style and emotional problems are important predictors of fatigue.     

The association between scabies and myasthenia gravis: A nationwide population-based cohort study

Scabies is an infectious inflammatory pruritic skin disease. Cytokine-mediated inflammatory processes contribute to the pathologic mechanism in scabies. Myasthenia gravis (MG) is also an autoimmune disease that is mediated by cytokines. The study aimed to investigate the association between scabies and myasthenia gravis. We conducted a nationwide population-based cohort study utilized data from the National Health Insurance Research Database (NHIRD) of Taiwan. Patients with scabies (n = 5429) and control subjects without scabies (n = 20,176) were enrolled. We tracked the subjects in both groups for a 7-year period to identify new onset MG. Cox regression analysis was performed to calculate the hazard ratio (HR) for MG. A total of 25,605 patients were enrolled in the study, including 5429 patients in the scabies group and 20,176 in the control group. There were 40 (0.7%) patients from the scabies group and 84 (0.4%) subjects from the control group who were newly diagnosed with MG during the 7-year follow-up period. The scabies patients had a significantly increased risk of MG, with an adjusted HR of 1.27 (95% confidence interval [CI] 1.01–1.89). As such, prompt diagnosis and treatment of scabies may decrease the risk of subsequent MG.     

Excessive use of Massively Multi-Player Online Role-Playing Games: A Pilot Study

Massively multiplayer online role-playing games (MMORPGs) are one of the most interesting innovations in the area of online computer gaming. This pilot study set out to examine the psychological and social effects of online gaming using an online questionnaire with particular reference to excessive and ‘dependent’ online gaming. A self-selecting sample of 119 online gamers ranging from 18 to 69 years (mean = 28.5 years) completed the questionnaire. The results showed that 41% of gamers played online to escape and 7% of gamers were classified as ‘dependent’ individuals who were at risk of developing a psychological and behavioural dependence for online gaming using an adapted ‘addiction’ scale. Further analysis showed that excessive online gaming was significantly correlated with psychological and behavioural ‘dependence’. It was also found that ‘dependent’ gamers appear to possess some core components of addiction to MMORPGs (e.g., mood modification, tolerance and relapse).     

Validation of the German version of the Vertigo Symptom Scale (VSS) in patients with organic or somatoform dizziness and healthy controls

Objective   The objective of this study was to validate the German version of the Vertigo Symptom Scale (VSS) and to determine its ability to differentiate the type, frequency, and severity of balance disorders. The scale (34 items) was designed by Yardley and coworkers and has been already validated in its English and Spanish versions. Methods   98 patients with organic vertigo syndromes, 90 patients with somatoform (psychogenic) dizziness and 56 healthy controls were evaluated with the VSS and additional standardized questionnaires regarding distress (SCL-90R), quality of life (SF-36), anxiety and depression (HADS). In order to differentiate organic from somatoform dizziness all patients underwent detailed clinical neurological and vestibular neurophysiological testing. Results   The two identified subscales ‘vertigo and related symptoms’ (VER) and ‘somatic anxiety and autonomic arousal’ (AA) had good internal consistencies (Cronbach’s alpha: VER 0.79; AA 0.89). Test-retest correlations were r = 0.75 for VER and r = 0.75 for AA. VER could discriminate well between dizziness patients and healthy controls. AA discriminated moderately between somatoform and organic dizziness. We found close relations between the AA scale and different measures of emotional distress. Correlations between VER and measures of emotional distress were weaker. Conclusion   The German version of the VSS has good reliability and validity in the detection of different vertigo syndromes. Measurement of anxiety symptoms can be helpful to identify patients with somatoform dizziness.     

Reactivity of Brain Tissue Oxygen to Change in Cerebral Perfusion Pressure in Head Injured Patients

Objective  It has been reported recently that correlation between brain tissue oxygen (PbtO₂) and cerebral perfusion pressure (CPP) may serve as an indicator of cerebral autoregulation after subarachnoid hemorrhage. We aimed to compare similar indices describing interaction between changes in intracranial pressure (ICP), arterial blood pressure (ABP), and brain tissue oxygen to verify their clinical utility in patients after traumatic brain injury. Materials and Methods  Retrospective analysis of multimodal monitoring of 32 patients suffering from head injury, admitted in the Neurosciences Critical Care Unit, Addenbrooke’s Hospital, Cambridge, UK. Initial 24 h intervals of continuous ABP, ICP, and PbtO₂ recordings were analyzed. Index of tissue oxygen reactivity ORx was evaluated as the correlation coefficient between PbtO₂ and CPP over a period of 60 min and compared to the index of pressure reactivity PRx. “Optimal CPP” and a hypothetical “optimal PbtO₂” were defined as the ranges of CPP and PbtO₂ at which PRx or ORx were indicating best cerebrovascular milieu. Results  PRx and ORx mean values did not show any correlation with each other (R = 0.012; P = 0.95) between patients. There was also no correlation between ORx and PbtO₂ (R = 0.098; P = 0.61) and between PRx and PbtO₂ (R = 0.019; P = 0.923). No clear and consistent value of “optimal CPP” minimizing ORx or of hypothetical “optimal PbtO₂” were found analyzing PbtO₂ or ORx trend over the 24 h of monitoring. However, in most of patients ‘optimal CPP’ has been found for PRx index. The same has been confirmed when the data from whole monitoring period were analyzed. There was no correlation between values of ‘optimal CPP’ assessed using ORx and ‘optimal CPP’ assessed with PRx. Conclusion  The relationships between PbtO₂, ORx, and CPP in head injury appear less useful than reported before for patients after subarachnoid hemorrhage.     

‘Free’ copper in serum of Alzheimer’s disease patients correlates with markers of liver function

Summary Non-ceruloplasmin bound copper (‘free’) seems slightly elevated in Alzheimer’s disease (AD) patients. To test the hypothesis of a correlation between ‘free’ copper and liver function in AD. We evaluated 51 AD patients and 53 controls through typical tests for chronic liver disease (AST, ALT, γ-GT, Albumin, prothrombin time – PT-, bilirubins), along with copper, ceruloplasmin, iron, cholesterol in the serum and apolipoprotein E epsilon4 (APOE4) genotype. Absolute serum copper and ‘free’ copper were higher, albumin was lower and PT longer in AD patients than in controls. ‘Free’ copper correlated negatively with markers of liver function, in that albumin and albumin/PT ratio (r = −0.43, p = 0.004), and positively with direct bilirubin. Copper and ‘free’ copper were higher in the APOE4 carriers. These results suggest that abnormalities in copper metabolism might have an effect on liver function in AD.     

Personal Pronouns and Communicative Engagement in Autism

In three experimental conditions, we tested matched children with and without autism (n = 15 per group) for their comprehension and use of first person plural (‘we’) and third person singular (‘he’) pronouns, and examined whether such linguistic functioning related to their social interaction. The groups were indistinguishable in their comprehension and use of ‘we’ pronouns, although within each group, such usage was correlated with ratings of interpersonal connectedness with the collaborator. On the other hand, participants with autism were less likely to use third person pronouns or to show patterns of eye gaze reflecting engagement with an interlocutor’s stance vis-à-vis a third person. In these settings, atypical third person pronoun usage seemed to reflect limited communicative engagement, but first person pronouns were relatively spared.     

The Autism-Spectrum Quotient—Italian Version: A Cross-Cultural Confirmation of the Broader Autism Phenotype

The Autism Spectrum Quotient (AQ) has been used to define the ‘broader’ (BAP), ‘medium’ (MAP) and ‘narrow’ autism phenotypes (NAP). We used a new Italian version of the AQ to test if difference on AQ scores and the distribution of BAP, MAP and NAP in autism parents (n = 245) versus control parents (n = 300) were replicated in a Sicilian sample. Parents of children with autism spectrum conditions scored higher than the control parents on total AQ, social skills and communication subscales, and exhibited higher rates of BAP, MAP and NAP. We conclude that the Italian AQ is a cross-culturally reliable measure of these different phenotypes, and can be used to identify a phenotypic gradient of severity of autistic traits in families. To understand the molecular basis of these phenotypes will require its use in genetic association studies.