Psychometric Validation of the Camouflaging Autistic Traits Questionnaire

Study Overview
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Brief Summary
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For many affected individuals, despite impairment and distress, autism spectrum disorder (ASD) is recognized and diagnosed late, in school age, adolescence, or even in adulthood, which could be due, among other things, to the use of compensatory strategies such as so-called camouflaging by the respective individual. In order to better investigate and quantify these adaptive and compensatory strategies of individuals with autism, the Camouflaging Autistic Traits Questionnaire (CAT-Q) has recently been developed and validated in the English-speaking world. The CAT-Q is designed to assess the extent of camouflaging behavior, in which autistic individuals consciously or unconsciously attempt to conceal or attenuate their autistic traits in order to better adapt to social situations. So far, however, there is no German-language questionnaire that can be used to validly assess camouflaging. The aim of the planned research project is to psychometrically validate the CAT-Q in German-speaking adolescents aged 14-21 years. The validation of the CAT-Q represents an important basis for further research on the construct camouflaging and can subsequently contribute to an improvement of diagnostics as well as support the development of individual treatment approaches.

Official Title
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Psychometric Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q/DE) in a German Population of Autistic and Non-autistic Adolescents.

Conditions
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Autism Spectrum Disorder

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria study group: - patients who meet the principal diagnosis of ASD, which includes atypical autism (ICD-10: F84.1) and Asperger syndrome (ICD-10: F84.5), and are between the ages of 14 and 21 years old. Exclusion Criteria study group: Dementia / below average cognitive abilities (IQ < 85) lack of German language skills severe visual or hearing impairment (uncorrected) Inclusion Criteria control group: - Adolescents who do not have a lifetime principal diagnosis of a psychiatric disorder (ICD-10-GM-2016: F10 - F69) and are between 14 and 21 years old. Exclusion Criteria Control Group: dementia / below average general cognitive ability (IQ < 85) lack of German language skills severe impairment of vision or hearing (not corrected).

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 21 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Study group<br>Adolescents between the ages of 14-21 who meet diagnostic criteria for an autism spectrum disorder. | |
| Control group<br>Adolescents aged 14-21 years without a lifetime psychiatric diagnosis. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Camouflaging | Camouflaging Autistic Traits Questionnaire (CAT-Q; Hull et al., 2019) is a quantitative measure of camouflaging. The CAT-Q can be used as a self-report and parent report version. The CAT-Q was constructed to be appropriate for both autistic and non-autistic populations (Hull et al., 2019). The instrument includes 25 items that are answered on a seven-point Likert scale. | 3-4 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Autistic Traits | The Social Responsiveness Scale (SRS-16; Constantino et al., 2003) is a quantitative measure of autistic traits in children, adolescents, and adults. The SRS-16 (Sturm et al., 2017) is a 16-item parent questionnaire assessing social, communicative, and rigid behaviors in children and adolescents in terms of a dimensional diagnosis of autism. | 3 minutes | 
| Mental health | The Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) is one of the most frequently used methods for assessing mental health in children and adolescents from a self- and parent perspective. In addition to the version for children and adolescents, there is also a version for adults, the SDQ 18+. The SDQ assesses mental health problems and resources of children and adolescents with 5 items each on five subscales: behavioral problems, emotional problems, hyperactivity, peer problems, and prosocial behavior. It has good psychometric properties, is economical, and has been widely used in research (Goodman, 2001). | 4 minutes | 
| Symptoms of depression | The Beck Depression Inventory for Youth - Second Edition (BDI-Y-2; Beck et al., 2001), is a self-report questionnaire designed to assess the severity of depressive disorder in children and adolescents 7 to 18 years of age. For adults 18 years and older, there is the Beck Depression Inventory-II (BDI- II). The 20 items assess a child's or adolescent's negative thoughts about themselves, their life, and the future, as well as feelings of sadness and physiological symptoms of depression, using the DSM-5 diagnostic criteria. | 3 minutes | 
| Symptoms of anxiety | The Beck Anxiety Inventory for Youth - Second Edition (BAI-Y-2; Beck et al., 2001), is a self-report questionnaire designed to assess the severity of anxiety in children and adolescents 7 - 18 years of age. For adults 18 years and older, there is the Beck Anxiety Inventory (BAI). The 20 items assess specific and generalized anxiety. These include anxiety at school, fear of being hurt, and health-related anxiety. In addition, various symptoms of anxiety, e.g., rumination and worry-related thoughts, as well as physiological symptoms are recorded, taking into account the diagnostic criteria of the DSM-5. | 3 minutes | 
| Stress | The Perceived Stress Scale (PSS-10; Schneider et al., 2020) is a 10-item questionnaire commonly used to assess stress levels in adolescents and adults 12 years and older. It assesses the extent to which a person has perceived life as unpredictable, uncontrollable, and overwhelming in the past month. | 1-2 minutes | 
| Loneliness | 3-item Loneliness Scale (Klein et al., 2021): Loneliness is also measured by the 3-item Loneliness Scale. The scale is an economic measure derived from the R-UCLA Loneliness Scale (Russell et al., 1980) that captures basic aspects of loneliness: A sense of isolation, disconnectedness, and not belonging. Items are rated on 5-point Likert scales. Responses are summed for a total score ranging from 0 to 12, with higher scores indicating higher levels of loneliness. | 1 minute | 
| Mentalizing | The Reflective Function Questionnaire for Youth-5 (RFQ-Y; Sharp et al., 2022) measures mentalizing ability in adolescents. The English version showed satisfactory psychometric properties (Sharp et al., 2022). | 1 minute | 
| Theory of Mind | The Frith-Happé Animations Test (Livingston et al., 2021), which represents interactions between triangles in animations, is an online instrument for measuring Theory of Mind (ToM). The web-based version of this test provides a quick and objective measurement of the construct ToM using multiple-choice questions. The instrument demonstrated good psychometric properties in a clinical as well as a non-clinical sample (Livingston et al., 2021). | 3-4 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Camouflaging, Late diagnosis, Adolescents