Standardization of the Japanese version of the Glasgow Sensory Questionnaire (GSQ)
Introduction
Autism spectrum disorders (ASD) also known as pervasive developmental disorders (PDD) are characterized by markedly abnormal or impaired development of social interaction and a restricted and stereotyped repertoire of activities and interests (American Psychiatric Association, 1994, American Psychiatric Association, 2013, World Health Organization, 1993). According to previous studies, individuals with ASD often have sensory processing problems. Crane, Goddard, and Pring (2009) showed that 94.4% of adults with ASD have extreme levels of sensory processing problems in at least one sensory domain. In each sensory domain, such as visual (Simmons et al., 2009), auditory (Haesen, Boets, & Wagemans, 2011), and tactile (Cascio et al., 2008), various studies reported differences between the ASD and control groups.
Most problems of sensory modulation in ASD are expressed as either hyper- and/or hyposensitivity (Rogers, Hepburn, & Wehner, 2003). An individual with hypersensitivity is uncomfortable with or avoids a particular sensory stimulus that most people do not perceive or regard important because of weakness of the stimuli. In contrast, an individual with hyposensitivity either reacts too weakly to a particular sensory stimulus or actively pursues the stimulus (Ben-Sasson et al., 2007). Previous studies reported that the sensory modulation problem in ASD is associated with symptoms of anxiety (Green, Ben-Sasson, Soto, & Cater, 2012) and social isolation (Cosbey, Johnston, & Dunn, 2010).
The sensory modulation problems in ASD have not been included in the 3 concepts of ASD proposed by Wing (1996) and in the universal standard diagnostic criteria: the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) and the International Classification of Diseases (ICD-10; World Health Organization, 1993). However, in 2013, those problems were finally acknowledged in a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), and thereafter, the sensory modulation problems have gained recognition as one of the core symptoms of ASD. DSM-5 describes “hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment” as a symptomatic criteria of ASD. Understanding of sensory features of ASD is important and necessary for diagnosis, assessment of comorbid conditions, and clinical interventions for sensory symptoms and social adjustment.
On the other hand, there are some problems in assessment of the sensory features of ASD because existing standard clinical tests do not necessarily detect these sensory processing problems (Simmons et al., 2009). The need for tests that can detect sensory processing problems in the daily life of individuals with ASD has resulted in the development of several rating scales using the English language in the past; however, such scales are not available in Japanese. Brown and Dunn (2002) published a self-report sensory questionnaire (the Adult/Adolescent Sensory Profile; AASP), and it is currently being standardized in Japanese (Ito et al., 2013). Although this rating scale is valid and effective, it was designed to quantify sensory problems in various mental and physical disorders, not specifically in individuals with ASD.
Recently, Robertson and Simmons (2012) developed a self-rating sensory scale, the Glasgow Sensory Questionnaire (GSQ). Because individuals with ASD are located at the extreme end of a continuum of autistic traits that are also present in the general population (Constantino & Todd, 2003), the researchers tested GSQ on the general population and compared the results with the autism spectrum quotient (AQ; Baron-Cohen, Wheelwright, Skinner, Martin, & Clubley, 2001). Their data suggest a strong link between sensory processing and autistic traits in the general population.
We decided that developing a Japanese version of GSQ was a worthwhile task for evaluating sensory abnormalities in individuals with ASD in Japan; therefore, we developed and validated this GSQ and investigated sensory problems in Japanese individuals with ASD.
Section snippets
Participants and procedures
Participating patients and healthy individuals provided written consent prior to administration of the questionnaires and subsequent testing. The study protocol was approved by the Ethics Committee of the Faculty of Medicine of Showa University.
The clinical group of the study comprised 64 outpatients from the Showa University Hospital (mean age, 30.4 years; range, 20–48 years; standard deviation (SD) = 6.6; 56 men and 8 women). All patients were referred to our institution by physicians from
Test scores
The scores on AQ, the Japanese version of GSQ, and their respective subscales are listed in Table 1. The mean total score of AQ was significantly higher in the ASD group than that in the control group (t = 13.957, df = 131, p < 0.001) and, the score of each subscale of AQ was significantly higher in the ASD group than that in the control group. The mean total score on the Japanese version of GSQ was also significantly higher in the ASD group than that in the control group (t = 4.872, df = 132, p < 0.001)
Discussion
In the present study, we developed and validated a Japanese version of GSQ, which is a self-rating test for measuring sensory sensitivity. We investigated characteristic features of sensory processing in adult with ASD in comparison with a control group. The results were highly comparable to those of the original GSQ study. The present study also assessed scientific validity of the new test by analyzing the adequate number of mean value of Cronbach's α high reliability and internal consistency
Acknowledgements
We would like to thank Dr. D. Simmons, A. Robertson for kindly giving us a permission to translate the questionnaire and for helping with the back-translation process. We would also like to thank Drs. M. Kawato and F. Pollick for introducing the original version of the questionnaire and Mr. S. Beasom and Mrs.Y. Noda for back-translation of the questionnaire. This work was supported by CREST of Japanese Science and Technology (JST) to KN.
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