Research in Autism Spectrum Disorders 5 (2011) 185190

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Research in Autism Spectrum Disorders

Journal homepage: http://ees.elsevier.com/RASD/default.asp

Clinical characteristics of adults with Aspergers Syndrome assessed with

self-report questionnaires
Chieko Kanai a,*, Akira Iwanami b, Haruhisa Ota c, Hidenori Yamasue d, Eisuke Matsushima a,
Hideki Yokoi c, Kazuyuki Shinohara e, Nobumasa Kato c
a
Section of Liaison Psychiatry & Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima,
Bunkyo-ku, Tokyo 113-8519, Japan
b
Department of Psychiatry, Showa University East Hospital, 2-14-19 Nakanobe, Shinagawa-ku, Tokyo 142-8555, Japan
c
Department of Psychiatry, Showa University School of Medicine, 6-11-11 Karasuyama, Setagaya-ku, Tokyo 157-8577, Japan
d
Department of Neuropsychiatry, Graduate School of University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
e
Department of Neurobiology and Behavior Unit of Basic Medical Nagasaki University, Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki-shi,
Nagasaki 852-8523, Japan

A R T I C L E I N F O A B S T R A C T

Article history: Diagnosis of Aspergers Syndrome (AS) in adults is difcult, and clinical sample-based
Received 15 January 2010 studies that systematically illustrate the clinical characteristics of adult AS patients are
Received in revised form 14 March 2010 needed so that appropriate treatment can be provided. Here we examined the clinical
Accepted 18 March 2010 characteristics of AS in 112 adults (median age, 28.0 years [range, 1852]; 71 men and 41
women: 55 AS group (median age, 27.0 years [range, 1849]; 36 men and 19 women), 57
Keywords: control group (median age, 28.0 years [range, 2052]; 35 men and 22 women) through
Aspergers Syndrome administration of the Japanese version of the Autism-Spectrum Quotient (AQ) and the
Clinical characteristics
Japanese version of the Schizotypal Personality Questionnaire (SPQ), and the Eysenck
Self-report questionnaires
Personality Questionnaire (EPQ). Scores on the AQ, SPQ, and the Neuroticism and
Autism-Spectrum Quotient (AQ)
Schizotypal Personality Questionnaire (SPQ)
Psychoticism scores of the EPQ were signicantly higher in adults with AS than in
Eysenck Personality Questionnaire (EPQ) controls. The Extraversion and Lie scores of the EPQ were signicantly lower in adults
with AS than in controls. The total score of the AQ was correlated with 3 subscale scores
(unusual perceptual experiences, odd or eccentric behavior, and suspiciousness) of the
SPQ in the AS group, but not in the control group. The ndings demonstrated that AQ and
other personality scales could be used to elucidate the clinical characteristics of AS in
adults.
2011 Elsevier Ltd. All rights reserved.

1. Introduction

According to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994)
and the International Classication of Diseases (ICD-10; World Health Organization, 1993), Aspergers Syndrome (AS) is a
subtype of autism spectrum disorders (ASD) or pervasive developmental disorders and is dened as a syndrome in which the
individuals meet the criteria for autism but have no history of cognitive or language delay. Language delay is dened as not
using single words by the age of 2 years or phrase speech by the age of 3 years. An epidemiologic study estimated that the
population prevalence of AS is 0.7% (Ehlers & Gillberg, 1993). Adults with AS sometimes show an intense preoccupation and
elaborate internal life around a particular area of interest. They also show repetitive maladaptive behaviors, stereotyped

* Corresponding author. Tel.: +81 3 5803 5859; fax: +81 3 5803 5859.
E-mail address: chikanai1003320@gmail.com (C. Kanai).

1750-9467/$ see front matter 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.rasd.2010.03.008
186 C. Kanai et al. / Research in Autism Spectrum Disorders 5 (2011) 185190

motor mannerisms, and rigid adherence to routines (Gaus, 2007). Other reported clinical traits include loneliness
(Whitehouse, Durkin, Jaquet, & Ziatas, 2009), superior systemizing (Wakabayashi et al., 2007), problems organizing
themselves in their environment (executive function decits) (Happe, Booth, Charlton, & Hughes, 2006), understanding
other peoples feelings (theory of mind decits) (Kaland, Smith, & Mortensen, 2007), and sympathizing with others (impaired
empathy) (Baron-Cohen & Wheelwright, 2004).
Due to the relatively high population prevalence (0.7%) of AS, a precise diagnosis of AS is important in the clinical setting.
Diagnosing AS is difcult, however, especially in adults (Ritvo et al., 2008). We hypothesized that assessing the traits of
schizotypal personality disorder (SPD) might be helpful to aid in the diagnosis of AS because Gaus (2007) reported that AS
and SPD share three similar traits: odd beliefs and mannerisms, few or no friendships, and social anxiety. To date, there has
been only one published report of an association between the traits of AS and those of SPD in a large number of participants;
Hurst, Nelson-Gray, Mitchell, and Kwapil (2007) demonstrated a strong association between the interpersonal domain of
SPD and the social skills domain of AS in college students. Their nding was the rst to demonstrate a link between the traits
of the two disorders in the general population without AS. Clinical sample-based studies are needed to determine the link
between the traits of AS and SPD.
In the present study, we examined the characteristics of personalities associated with AS in a normal sample and in AS to
elucidate the clinical overlap between the autistic and schizophrenic spectrums based on administration of the Autism-
Spectrum Quotient and other self-report personality scales.
Although the use of questionnaires such as the Autism-Spectrum Quotient (AQ; Baron-Cohen, Wheelwright, Skinner,
Martin, & Clubley, 2001), Krug Aspergers Disorder Index (KADI; Krug & Arick, 2003), and Gilliam Aspergers Disorder Scale
(GADS; Gilliam, 2001) is a well-established means to assess autistic traits, there are no Japanese versions of the KADI and
GADS available. The AQ is designed to assess autistic spectrum traits in the general population. A series of validity studies for
this instrument has been published, showing that adults with AS and high-functioning autism have higher scores on the AQ
than normal controls. In addition, two other self-rated personality measurements were used to assess personality traits in
the present study. The Schizotypal Personality Questionnaire (SPQ; Raine, 1991) for screening SPD, was used to assess traits
of SPD because AS and SPD might have some clinical resemblance. The Eysenck Personality Questionnaire (EPQ; Eysenck &
Eysenck, 1975) assessing neuroticism, psychoticism, and extraversion was also used to assess whether patients with AS
show a bias in personality traits.

2. Methods

2.1. Participants and procedure

Participating patients and normal individuals provided written consent prior to completing the questionnaires and
testing in the study, which was approved by the ethics committee of the Faculty of Medicine of Showa University.
The clinical group of this study comprised 55 outpatients at Showa University Hospital (median age, 27.0 years [range,
1849]; 36 men and 19 women) attending a diagnostic outpatient clinic for adults aged 18 and over suspected of having ASD.
All patients were referred by physicians from other clinics. Inclusion criteria were age of 1865 years, no current use of
psychotropic medications, and formal diagnosis of AS based on the DSM-IV. Exclusion criteria were a history of
electroconvulsive therapy, alcohol or other drug abuse or dependence, or any neurologic illness affecting the central nervous
system.
To evaluate the screening properties of the Japanese version of the AQ and other instruments, all patients were asked to
complete an interview sheet and the AQ before clinical examination at the initial visit. The interview sheet comprised ve
main questionnaires: (1) major complaint; (2) history of visit to medical and educational organizations/consultation
services; (3) problems in fetal and newborn period; (4) developmental delays (walking and language); (5) education and
occupation of the patient and their parents. The patients were also required to bring records from elementary school to high
school and a maternal and child health handbook. The maternal and child health handbook includes records of pregnancy,
childbirth, and the neonatal and infant periods, and are provided by the local government ofce in Japan.
To conrm the diagnosis of patients being high-functioning, intellectual ability was assessed by experienced
psychologists using the Japanese version of the National Adult Reading Test developed by Nelson and Willison (1991), which
is composed of 25 Japanese irregular words as an estimate of pre-morbid or prior ability (JART-25). The JART-25 was used as
an equivalent of the IQ test, because JART-25 has IQ prediction validity (IQ mean, 109.4 [10.1]) (Mastuoka & Kim, 2006).
Further diagnostic assessment was subsequently performed for all patients irrespective of the AQ scores. A team of three
experienced psychiatrists and two clinical psychologists performed the assessment. The assessment consisted of two detailed
interviews of the patients about development and behavior from their infancy to adolescence ((1) developmental history; (2)
present illness; (3) past history), and family history performed independently by a psychiatrist and a clinical psychologist in the
team. The patients were also asked to bring suitable informants who knew the patient in early childhood. At the end of the
clinical interview, the patients were diagnosed by the psychiatrist according to the DSM-IV diagnostic criteria for AS based on
consensus between the psychiatrist and the clinical psychologist. Approximately 3 h were required for the diagnostic process.
After clinical examination, patients diagnosed with AS were asked by the psychologist to complete the SPQ and EPQ.
The normal control group comprised 57 adults, who were recruited by email, announcements, and acquaintances
through Showa University Hospital, several drug companies, and Seishin Womens College (median age, 28.0 years [range,
 C. Kanai et al. / Research in Autism Spectrum Disorders 5 (2011) 185190 187

2052]; 35 men and 22 women). All subjects volunteered to participate in the study after receiving an adequate explanation
about the study from an experienced clinical psychologist at Showa University Hospital. The subjects were asked to complete
the AQ and other personality questionnaires. When all participants who completed the questionnaires were interviewed by
the clinical psychologist based on assessment with the Japanese version of the Mini-International Neuropsychiatric
Interview (MINI; Otsubo & Kamijima, 2000), people with other psychiatric disorders were excluded from this study. The
Japanese version of MINI is a short structured diagnostic interview for the DSM-IV and ICD-10, which has satisfactory
reliability and validity (Otsubo et al., 2005). The AS group and the normal control group did not differ signicantly in age
(z = 0.73, P = 0.464), sex ratio (X2 = 0.20, P = 0.698), or the duration of education (AS: median, 16.0 years [range, 1118];
control: median, 16.0 years [range, 1318]; z = 1.38, P = 0.169).

2.2. Instruments

2.2.1. The Autism-Spectrum Quotient (AQ)

The AQ, developed by Baron-Cohen et al. (2001), is a 50-item self-administered measure for adults with normal
intelligence to assess for the presence of autistic traits. The 50 items are split evenly among ve domains: social skill,
attention switching, attention to detail, communication, and imagination. Each AQ item is a brief statement followed by four
possible ratings: denitely agree, slightly agree, slightly disagree, and denitely disagree. Each item is scored as 0 or 1 and
the highest score is 50. A higher score indicates more autistic traits. Baron-Cohen et al. (2001) showed that a cut-off of 32
discriminates between AS/high-functioning autism and normal controls. The Japanese version of the AQ is standardized for
use in Japan (Wakabayashi, Baron-Cohen, & Wheelwright, 2006) and is reported to have good internal consistency reliability
(Cronbachs a > 0.70), testretest reliability, and discriminant validity [i.e., the AQ score was signicantly higher in the
adults with AS/high-functioning autism than the controls] (Kurita, Koyama, & Osada, 2005; Wakabayashi, Baron-Cohen,
Wheelwright, & Tojo, 2006). Wakabayashi, Baron-Cohen, Wheelwright, and Tojo (2006) reported that a cut-off of 33
discriminates between AS/high-functioning autism and normal controls. The internal consistency reliability in the present
study was high for AS group (Cronbachs a = 0.71) and the control group (Cronbachs a = 0.70).

2.2.2. Schizotypal Personality Questionnaire (SPQ)

The SPQ developed by Raine (1991) is a 74-item self-report measure designed to be useful in screening for SPD. The SPQ
comprises nine factors: (1) ideas of reference, (2) excessive social anxiety, (3) odd beliefs or magical thinking, (4) unusual
perceptual experiences, (5) odd or eccentric behavior, (6) no close friends, (7) odd speech, (8) constricted affect, and (9)
suspiciousness. SPQ items are answered yes or no, and the highest score is 74. A higher score indicates higher schizotypal
personality traits. The Japanese version of the SPQ, developed by Someya, Sasaki, and Takahashi (1994), was administered to
258 college students with reported good internal consistency reliability (Cronbachs a = 0.90) and concurrent validity [i.e.,
the SPQ score was correlated with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II;
Takahashi & Osone, 2002)]. The internal consistency reliability in the present study was high for the AS group (Cronbachs
a = 0.88) and the control group (Cronbachs a = 0.76).

2.2.3. Eysenck Personality Questionnaire (EPQ)

The EPQ developed by Eysenck and Eysenck (1975) is a 100-item self-report measure to assess personality traits. The EPQ
consists of three personality scores (Psychoticism [P], Extraversion [E], and Neuroticism [N]) and Lie (L) score. The EPQ items
are answered yes or no. Psychoticism (P) is associated with the likelihood of having psychotic behavior such as being
unsympathetic and egocentric. Extraversion (E) is characterized by being outgoing, sociable, and uninhibited. Neuroticism
(N) is characterized by high levels of negative affect, such as anxiety and depression. Lie (L) is designed to detect socially
desirable responses. The Japanese version of the EPQ, developed by Tsuji, Kano, and Shinno (1990), was administered to 305
students. The subscales of the EPQ have a reported internal consistency reliability of moderate to high (Cronbachs a = 0.65
0.80) and reasonable factorial validity. The internal consistency reliability in the present study was high in AS group
(Cronbachs a = 0.71) and in the control group (Cronbachs a = 0.70).

2.3. Statistical analysis

We compared the duration of education, age, and the scores of the AQ, SPQ, and EPQ, between the AS and control
groups using the MannWhitney U-test. We compared the sex ratio of the two groups using Fishers exact test. We
examined the relationships between the scores of the AQ, SPQ, and EPQ using Spearmans correlation coefcient, with a P-value
of less than 0.05 (two-tailed test) considered to be signicant. We analyzed the data using SPSS version 17.0 (SPSS, Tokyo,
Japan).

3. Results

The total scores and the subscale scores of both the AQ and SPQ, and the N and P scores of the EPQ were signicantly
higher among adults with AS than among controls. The E and L scores of the EPQ were signicantly lower among adults with
AS than among controls (Table 1).
188 C. Kanai et al. / Research in Autism Spectrum Disorders 5 (2011) 185190

Table 1
Comparison between AS and control groups.

Scales AS (n = 55) Lowest/highest values Control (n = 57) Lowest/Highest values z P

Median Median

AQ
Total 38.0 2149 16.0 430 8.971 0.000
Social skills 9.0 410 3.0 09 8.470 0.000
Attention switching 8.0 310 4.0 08 8.350 0.000
Attention to detail 6.0 110 2.0 07 5.093 0.000
Communication 9.0 210 3.0 07 8.463 0.000
Imagination 7.0 310 3.0 09 7.778 0.000

SPQ
Total 42.0 868 9.0 033 8.323 0.000
Ideas of reference 4.0 09 0.0 04 7.246 0.000
Excessive social anxiety 7.0 09 3.0 07 6.946 0.000
Odd beliefs or magical thinking 2.0 07 0.0 04 3.570 0.000
Unusual perceptual experiences 2.0 09 0.0 04 4.698 0.000
Odd or eccentric behavior 5.0 07 0.0 04 8.066 0.000
No close friends 5.0 09 0.0 05 7.609 0.000
Odd speech 8.0 29 2.0 08 7.620 0.000
Constricted affect 6.0 18 1.0 05 7.985 0.000
Suspiciousness 5.0 08 0.0 07 6.980 0.000

EPQ
P-scale 16.0 422 6.0 023 7.617 0.000
E-scale 4.0 012 14.0 221 7.180 0.000
N-scale 7.0 013 4.0 011 4.588 0.000
L-scale 9.0 317 11.0 221 2.045 0.041

Note: AQ = Japanese Version of Autism-Spectrum Quotient; SPQ = Japanese Version of Schizotypal Personality Questionnaire; EPQ = Japanese Version of
Eysenck Personality Questionnaire, AS = Aspergers syndrome; P, Psychoticism; E, Extraversion; N, Neuroticism; L, Lie.

Table 2
Correlations between AQ and personality scales of the AS and control groups.

AS (n = 55) Control (n = 57)

AQ total P AQ total P

SPQ total 0.53 0.000 0.51 0.000

Ideas of reference 0.34 0.011 0.33 0.011
Excessive social anxiety 0.65 0.000 0.45 0.000
Odd beliefs or magical thinking 0.26 0.058 0.12 0.357
Unusual perceptual experiences 0.32 0.018 0.08 0.534
Odd or eccentric behavior 0.34 0.011 0.02 0.882
No close friends 0.51 0.000 0.47 0.000
Odd speech 0.40 0.002 0.42 0.001
Constricted affect 0.43 0.001 0.35 0.008
Suspiciousness 0.27 0.043 0.18 0.175

EPQ
P-scale 0.24 0.077 0.24 0.072
E-scale 0.57 0.000 0.33 0.014
N-scale 0.17 0.225 0.09 0.529
L-scale 0.07 0.610 0.05 0.700

Note: AQ = Japanese Version of Autism-Spectrum Quotient; SPQ = Japanese Version of Schizotypal Personality Questionnaire; EPQ = Japanese Version of
Eysenck Personality Questionnaire, AS = Aspergers syndrome; P, Psychoticism; E, Extraversion; N, Neuroticism; L, Lie. The total score of the AQ was
correlated with shaded subscale scores in the AS group.

In the AS group, the total score of the AQ was correlated with the total and 8 subscale scores of the SPQ (ideas of reference,
excessive social anxiety, unusual perceptual experiences, odd or eccentric behavior, no close friends, odd speech, constricted
affect, and suspiciousness), and the E score of the EPQ. In the control group, the total score of the AQ was correlated with the
total and 5 subscale scores (ideas of reference, excessive social anxiety, no close friends, odd speech, and constricted affect) of
the SPQ, and the E score of the EPQ. The total score of the AQ was correlated with 3 subscale scores (unusual perceptual
experiences, odd or eccentric behavior, and suspiciousness) of the SPQ in the AS group, but not in the control group (Table 2).

4. Discussion

This is the rst study to examine clinical characteristics of adults with AS using self-report questionnaires in a clinical
setting. In the present study, the scores of the AQ and personality scales differed signicantly between the AS and control
groups. The total score of the AQ was correlated with eight subscale scores of the SPQ in AS group, and there was no
 C. Kanai et al. / Research in Autism Spectrum Disorders 5 (2011) 185190 189

correlation between the total score of the AQ and three of these subscales in the control group, indicating that the correlation
was specic to AS.
In the present study, approximately 80% of the adults with AS scored above the critical minimum of 33 on the Japanese
version of the AQ, whereas 0% of control groups scored this high. This ndings was consistent with that of a previous study in
the UK, in which 80% of the AS/high-functioning autism group scored above the cut-off of 32, whereas 2% of the control group
scored that high (Baron-Cohen et al., 2001). The AQ in the present study had good internal consistency reliability (Cronbachs
a > 0.70) and discriminant validity, consistent with the AQ in the UK study.
As hypothesized, the scores of the AQ were signicantly higher in adults with AS than in the control group. The AQ was
investigated by Baron-Cohen et al. (2001) in patients with AS or high-functioning autism and subgroups in the general
population, and was tested in 2005 for AS (Woodbury-Smith, Robinson, Wheelwright, & Baron-Cohen, 2005). The AQ was
able to differentiate patients with AS and high-functioning autism from healthy controls, and AS patients from non-AS
patients. Our results are consistent with the ndings of Baron-Cohen et al. (2001): the mean total scores of the AQ in AS
patients and healthy controls in Britain (AS: 35.6, control: 16.017.0) were almost the same values as in our sample (AS: 36.6,
control: 15.1). Based on Baron-Cohen et al. (2001), the present results are reasonable given the fact that the AQ assesses the
presence of autistic traits.
The subscale scores (N and P scores) of the EPQ were signicantly higher in the AS group than in the control group, and the
subscale scores (E and L scores) of the EPQ were signicantly lower in the AS group than in the control group. EPQ test scores in
the control group in the present study were similar to those in a previous study using the EPQ and other instruments for patients
with schizophrenia and normal controls in Spain (Herran, Sierra-Biddle, Cuesta, Sandoya, & Vazquez-Barquero, 2006). In both
studies, the P and N scores were higher in the clinical groups than in the control groups (in the Spanish study, schizophrenia: P
score 4.0, N score 14.6 vs. control: P score 2.1, N score 9.3; in our study, AS: P score 16.0, N score 7.0 vs. control: P score 6.0, N score
4.0). On the other hand, the E and L scores were lower in the clinical groups than in the control groups in both studies (in the
Spanish study, schizophrenia: E score 9.1, L score 8.6 vs. control: E score 11.2, L score 12.4; in our study, AS: E score 4.0, L score 9.0
vs. control: E score 14.0, L score 11.0). Comparing the score tendency in the present study with that reported by Herran et al.
(2006), the personality traits of the control group in this study were adequate. The ndings of the EPQ were consistent with
those in a previous study on autistic traits and personality dimensions using the AQ and personality scales of 320 students in
Japan, in which the prole of those with higher AQ scores included high Neuroticism and low Extraversion (i.e., Introversion)
(Wakabayashi, Baron-Cohen, & Wheelwright, 2006). Previous studies also showed that obsessions, compulsions, depression,
and anxiety are associated with a higher N score, social withdrawal is associated with a lower E score, and empathic decits are
associated with a higher P score, which are common clinical features of high-functioning autism/AS patients (Baron-Cohen &
Wheelwright, 2004; Hurtig et al., 2009; Russell, Mataix-Cols, Anson, & Murphy, 2005; Stewart, Barnard, Pearson, & OBrien,
2006). Cummine, Leach, and Stephenson (2001) reported that unawareness of evaluation from other people is associated with a
lower L score, which is also characteristic of people with AS.
SPQ scores were signicantly higher in the AS group than in the controls. Hurst et al. (2007) reported descriptive similarities
between AS and SPD on the basis of the DSM-IV. Consistently, the present ndings indicated a clinical resemblance between the
two disorders. To elucidate the overlap between the autistic and schizophrenic spectrum disorders, we compared our results to
those of Raine, who reported SPD traits based on the SPQ scores (Raine, 1991). In Raines report, the subscale scores (excessive
social anxiety [SPD: 4.8, AS: 6.1], odd or eccentric behavior [SPD: 3.5, AS: 4.7], odd speech [SPD: 5.2, AS: 6.7], constricted affect
[SPD: 2.7, AS: 5.3], and suspiciousness [SPD: 4.2, AS: 4.6]) of the SPQ were higher in the AS group than in the SPD group, although
the total score (SPD: 42.2, AS: 39.7), the subscale scores (ideas of reference [SPD: 6.7, AS: 3.8], odd beliefs or magical thinking
[SPD: 3.3, AS: 1.7], unusual perceptual experienced [SPD: 4.8, AS: 2.5], and no close friends [SPD: 7.0, AS: 4.7]) of the SPQ were
lower in the AS group than in the SPD group. The total score and subscale scores of the SPQ were also higher in the AS and SPD
groups than in the control group. The SPQ scores were similar between the values in the present study and those in the study of
Raine (1991). In addition, the SPQ scores of the control group were similar to those in an early study examining the structure of
schizotypy by administering the SPQ (Rossi & Daneluzzo, 2002) (the present study: 9.0, Rossis study: 10.5), which validates the
adequacy of our study. The high scores of the SPQ in the AS group might reect the clinical overlap between the diagnostic
criteria for AS and SPD. Although AS and SPD would have overlapping clinical traits on the basis of our ndings, further studies
by administering the AQ and SPQ to adults with SPD are needed. Moreover, whether these two disorders have a common
pathophysiology requires further examination.
A signicant positive correlation was found between the AQ scores and the SPQ subscale scores (unusual perceptual
experiences, odd or eccentric behavior, and suspiciousness) in the AS group. This nding is consistent with clinical
symptoms of AS, abnormal sensory responses (corresponding to unusual perceptual experiences), and restricted repetitive
behaviors (corresponding to odd or eccentric behavior) (Boyd, McBee, Holtzclaw, Baranek, & Bodsh, 2009). Individuals
with AS might also have suspicious and untrusting attitudes toward people, which emerged in response to lifelong histories
of being bullied, ridiculed, and rejected by others (Gaus, 2007). Previous research indicates that individuals with AS are at
greater risk of being victims of bullying in childhood and adolescence (Little, 2002; Shtayermman, 2007). AS patients might
feel a sense of mistrust toward other people due to traumatic experiences throughout life. The results also suggest a clinically
signicant notion that the AQ and SPQ could be used to elucidate the clinical characteristics of AS in patients with AS. In other
words, higher scores on the AQ and in the subscales of unusual perceptual experiences, odd or eccentric behavior, and
suspiciousness of the SPQ might imply the clinical characteristics of AS. The present ndings indicate that assessment using
the AQ and SPQ together could assist in making a diagnosis of AS by evaluating the clinical traits of AS. Further studies based
190 C. Kanai et al. / Research in Autism Spectrum Disorders 5 (2011) 185190

on a larger number of subjects using other instruments are necessary to conrm the clinical overlap between AS and SPD to
elucidate the clinical traits of AS.
One limitation of this study is the use of the Japanese version of the EPQ, which has an internal consistency reliability that
is only moderate to high (Tsuji et al., 1990). Many studies of personality traits, however, have used the EPQ (Lewis, Scott, &
Frangou, 2009; Martinotti et al., 2009), which is standardized for use worldwide. Therefore, we assumed that the Japanese
version of the EPQ was also a useful instrument for studying whether patients with AS show a bias in personality traits.
Indeed, we obtained satisfactory internal consistency reliability (Cronbachs a > 0.70 in the two groups) using the Japanese
version of the EPQ in the present study. Further studies are necessary using the Japanese version of the EPQ with a larger
sample size. Nevertheless, the present ndings support a clinically signicant notion that the AQ and other personality scales
could be used to elucidate the clinical characteristics of AS in AS patients.

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