Behavior-Related Autistic Traits and Symptoms (BRATS): Advancing Knowledge About Autistic Characteristics in a General Population of Adults

Diagnosing adult autism remains challenging due to limitations in the current classification system (DSM-5-TR), and emerging HiTOP framework. There are also difficulties distinguishing autism from some other conditions such as ADHD, various types of empathy, personality traits, and other forms of psychopathology. This study was designed to address important questions raised by the scant literature on adult ASD that currently exists. The study yielded results about the distribution of autistic characteristics as measured by the Autism Quotient (AQ) and Empathy Quotient (EQ), in a general population of 446 adults by employing multiple different quantitative research methods such as questionnaires to collect data, and descriptive, correlational, and factor analysis methods to analyze the data. First, factor analytic methods were utilized to examine the underlying structure of self-report measures of autism (AQ) empathy (EQ), and adult ADHD (ASRS v1.1). Next, correlations among newly derived factors (AQ-Unsociability [AQ-US], AQ Imperceptiveness [AQ-IP], AQ Diffused Focus [AQ-DF], EQ Low Cognitive Empathy [EQ-LCe], EQ Social Sensitivity [EQ-SS], EQ Emotional Insensitivity [EQ-EI], ASRS-Combined [ASRS-C], and ASRS-Hyperactive-Motor [ASRS-HM]), and the Five Factor Model (FFM) of personality were investigated. Further analyses examined relations between the eight factor scales and measures of anxiety, depression, personality traits (in both the adaptive and maladaptive ranges), psychopathy, and aggression. Finally, a hierarchical unfolding analysis was conducted to identify potential latent domains underlying all assessed constructs. The AQ factors did not effectively distinguish autistic characteristic from other psychological conditions. Similar results were found for the EQ factors. The ASRS v1.1 produced a unique two-factor solution (ASRS-C and ASRS-HM), suggesting a distinct presentation of combined ADHD symptoms. Overall, the factor structures of the AQ, EQ, and ASRS factor scales displayed limitations in specifically measuring their target constructs. The study also investigated relations between the factor scales and personality traits. Different personality traits were associated with all eight factor scales, suggesting potential common underlying mechanisms. A hierarchical structural factor analysis revealed a complex behavior-related autistic traits and symptoms (BRATS) structure encompassing all the measures. Findings suggest the AQ and EQ are not ideal for diagnosing autism or autistic empathy overall, but may be better suited for measuring specific aspects of social communication and empathy. The ASRSv1.1 identified a unique factor of combined ADHD, warranting further investigation. This study’s discussion highlights the complex interplay between autistic traits (AQ/EQ), ADHD, personality, and other forms of psychopathology. It underscores the need for more refined diagnostic tools and research into the underlying mechanisms of these associations