Neuroanatomical correlates of peripersonal space: bridging the gap between perception, action, emotion and social cognition.

Peripersonal space (PPS) is a construct referring to the portion of space immediately surrounding our bodies, where most of the interactions between the subject and the environment, including other individuals, take place. Decades of animal and human neuroscience research have revealed that the brain holds a separate representation of this region of space: this distinct spatial representation has evolved to ensure proper relevance to stimuli that are close to the body and prompt an appropriate behavioral response. The neural underpinnings of such construct have been thoroughly investigated by different generations of studies involving anatomical and electrophysiological investigations in animal models, and, recently, neuroimaging experiments in human subjects. Here, we provide a comprehensive anatomical overview of the anatomical circuitry underlying PPS representation in the human brain. Gathering evidence from multiple areas of research, we identified cortical and subcortical regions that are involved in specific aspects of PPS encoding.We show how these regions are part of segregated, yet integrated functional networks within the brain, which are in turn involved in higher-order integration of information. This wide-scale circuitry accounts for the relevance of PPS encoding in multiple brain functions, including not only motor planning and visuospatial attention but also emotional and social cognitive aspects. A complete characterization of these circuits may clarify the derangements of PPS representation observed in different neurological and neuropsychiatric diseases.

Eco-Anxiety: An Evolutionary Line from Psychology to Psychopathology.

According to the scientific literature, climate change, due to human activities, can damage the environment, with psycho-physical consequences for humans. The scientific literature has highlighted how severe weather events can cause fear, stress, concern for the future, and eco-anxiety. In light of this information, this study aims to explore the concept of eco-anxiety. However, climate change is still perceived as a secondary problem. It would also be worth investigating the real importance that people attach to environmental issues compared to other circumstances, such as wars or pandemics.

Gene Expression Analysis of nc-RNAs in Bipolar and Panic Disorders: A Pilot Study.

BACKGROUND: Bipolar Disorder (BD) is a chronic, highly disabling mood disorder. Among the major comorbidities, Panic Disorder (PD) is often associated with BD. This could suggest a common genetic and pathophysiological background between these two conditions, as suggested by previous studies. Despite the widespread diffusion of these conditions, little is still known about the exact pathophysiological dynamics that underlies them. Non-coding RNAs have recently started to gain attention in psychiatry research, with several papers indicating the dysregulation of lncRNAs as a possible key factor in etiopathogenesis of several mental disorders. In the light of the above, the aim of this study is to evaluate the gene expression levels of MALAT1, PANDA, GAS5, HOTAIR lncRNAs and miR-221-5p microRNA, which are highly expressed in the CNS, in drug-naïve/drug-free bipolar and panic patients. METHODS: the experimental plan envisaged the recruitment of sixteen patients with a first diagnosis of type one or type two BD and ten patients with PD. Patients with medical and/or psychiatric comorbidities were excluded. Peripheral venous blood was collected both from patients and healthy controls. Each of the patients recruited for the study was prescribed with therapy. Serum ncRNAs levels were remeasured after 5 months of therapy. RESULTS: MALAT-1, GAS-5 and miR-221-5p are significantly up-regulated in BD after therapy, while PD group showed a down-regulation of all the ncRNAs investigated after therapy. CONCLUSIONS: gene expression levels of the ncRNAs miR-221, MALAT1, GAS5, which are implicated in inhibitory modulation of the glucocorticoid receptor, are significantly over-expressed in bipolar patients following therapy, while all ncRNAs are significantly over-expressed in the PD T1 patients group compared with healthy controls. Data concerning PD represent, to our knowledge, a novelty.

Autistic and Catatonic Spectrum Symptoms in Patients with Borderline Personality Disorder.

BACKGROUND: Recent literature has shown that a considerable percentage of patients with severe mental disorders can develop, over time, full-blown or subthreshold catatonia. Some studies corroborate the model of an illness trajectory in which different mental disorders would be arranged along a continuum of severity until the development of catatonia. In such an illness pathway, autistic traits (AT) and borderline personality disorder (BPD) may represent important steps. In order to further explore the association between AT, BPD, and catatonia, the aim of this study was to compare catatonic spectrum symptoms and AT among patients with major depressive disorder (MDD), BPD, and healthy controls (CTL), also evaluating possible predictive dimensions of the different diagnoses. METHODS: A total of 90 adults affected by BPD, 90 adults with a diagnosis of MDD, and 90 CTL, homogeneous in terms of gender and age, were recruited from six Italian university departments of psychiatry and assessed with the SCID-5-RV, the Catatonia Spectrum (CS), and the Adult Autism Subthreshold Autism Spectrum (AdAS Spectrum). RESULTS: The total CS score was significantly higher in the BPD and MDD groups than in the CTL group, while the majority of CS domain scores were significantly higher in the BPD group than in the MDD group, which scored significantly higher than the CTL group. The total AdAS Spectrum score and the AdAS Spectrum domain scores were significantly higher in the BPD group than in the MDD group, which in turn scored significantly higher than the CTL group. The CS domains "psychomotor activity" and "impulsivity", and AdAS Spectrum domains "verbal communication", "empathy", and "hyper-/hyporeactivity to sensory input" were associated with the risk of presenting a diagnosis of BPD.

The mediating effect of mood spectrum on the relationship between autistic traits and catatonia spectrum.

Background: In the recent years, several studies have shown a correlation between autism spectrum disorder (ASD) and catatonia. It is also known that both conditions are found to be associated with mood disorders. This study aimed to investigate the relationship between autistic traits and catatonic symptoms, as well as the potential mediating role of mood disorder spectrum in the relationship between them. Methods: The total sample of 514 subjects was composed by four diagnostic groups, composed by patients affected by catatonia (CTN), borderline personality disorder (BPD), major depressive disorder (MDD) and healthy controls (HC). Subjects were assessed with the SCID-5-RV, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Catatonia Spectrum (CS) and the Mood Spectrum Self-Report (MOODS-SR). Statistical analyses included Pearson's coefficient calculation, multiple linear regression, and mediation analysis. Results: all the correlations appear to be strongly positive and significant with the strongest coefficient emerging between AdAS Spectrum total score and CS total score (r = 0.762, p < 0.001). The Mediation Analysis showed that AdAS Spectrum total score showed a significant indirect effect on CS total score through MOODS-SR total score (b = 0.168, 95% bootstrapped CI [0.127:0.207]). Conclusion: The present study highlights the presence of a mediating role of the mood disorder spectrum in the relationship between autistic traits and the catatonia spectrum.

The Role of Hyperarousal and Aberrant Salience in the Acceptance of Anti-COVID-19 Vaccination.

Background and Objectives: This present study was aimed at exploring hyperarousal and aberrant salience in a sample of the Italian general population to understand their possible role in the acceptance of anti-COVID-19 vaccination. Materials and Methods: Sociodemographic data questions, the "Acceptance of Vaccination" measure, the Hyperarousal Scale (H-Scale), and the Aberrant Salience Inventory (ASI) were sent as an unpaid online survey to the general population (age range 18-80 years) within the Italian territory. Results: The enrolled subjects were divided into two subgroups: "Pro-vax" (n = 806; 87.4%) and "No-vax" (n = 116; 12.6%). Statistical analysis showed significant differences between groups in the "Education Level" (p = 0.001) category, higher in the "Pro-vax" group, and in the ASI "Senses Sharpening" (p = 0.007), "Heightened Emotionality" (p = 0.008), and "Heightened Cognition" (p = 0.002) subscales with the "Total Score" (p = 0.015), all higher in "No-vax" subjects. Furthermore, a linear regression model evidenced that only "Education Level" (ß = 0.143; p < 0.0001) and "Senses Sharpening" (ß = -0.150; p = 0.006) were, respectively, direct and inverse predictors of "Acceptance of Vaccination". Conclusions: Our results show that several subthreshold conditions, such as somatosensory amplification, anxiety traits, and panic experiences, should be taken into account by authoritative sources involved in health education, communication, and policy to alleviate public concerns about vaccine safety, for the present and also future pandemics, and to provide more inclusive, informed, and accurate public health preventive and treatment programs.

Investigating suicidality across the autistic-catatonic continuum in a clinical sample of subjects with major depressive disorder and borderline personality disorder.

Background: Recent literature has highlighted that catatonia may be more prevalent among psychiatric patients than previously thought, beginning from autism spectrum disorders (ASD), for which it has been suggested to represent a severe late consequence, but also among individuals with mood disorders and borderline personality disorder (BPD). Interestingly, one critical point shared by these conditions is the increased risk of suicidality. The aim of this study was to evaluate how the presence and the prevalence of catatonic symptoms may shape and correlate with suicidal risk in a sample of individuals with major depressive disorder (MDD) or BPD. Methods: We recruited two clinical samples of subjects (BPD and MDD) and a control group without a diagnosis according to DSM-5 (CTL). Subjects were assessed with the catatonia spectrum (CS) and the MOODS-SR for evaluating suicidality. Results: In the total sample, suicidality score was significantly and positively correlated with all CS domains and CS total score. Correlation and regression analyses highlighted specific patterns of association among Catatonia spectrum domains and suicidality in the MDD and BPD group and in the total sample. Conclusion: In both disorders, higher catatonic traits are linked to higher suicidal tendencies, confirming the high risk of suicide for this population. However, different patterns of association between catatonic symptoms and suicidality were highlighted in the two disorders.

Eating behaviors and body self-esteem in couple's satisfaction during COVID-19 quarantine.

Background: Many experts agree that the Covid-19 pandemic and lockdown restriction have had an impact on relationships and eating habits in couples, but this hypothesis lacks evidence and empirical studies. Aim: The aim of the study was to investigate the relationship between satisfaction with the couple's relationship, body self-esteem, and eating behaviors during the Covid-19 lockdown. Method: Three hundred and eighty-one subjects, aged between 18 and 60 years (M = 26.88; SD = 9.22), of whom 89.8% women, participated in the survey. The online assessment included: the Relationship Assessment Scale; the Multidimensional Self Concept Scale and the Eating Disorder Examination Questionnaire. Results: The results showed that the relationship and the levels of couple's satisfaction are independent of respect to body experience and eating behavior. On the contrary, bodily experience is negatively correlated with diet, weight, body shape, and restriction attempts. However, the eating style of couple showed a change during the quarantine period, both in healthy and at-risk of ED subjects. Conclusion: The psychological impact of Covid-19 and its lockdown has had profound repercussions on the subjective relationship with body and food but have apparently preserved stable and satisfying bonds. The importance of the study confirmed the primary relation between self and body's satisfaction in subjective dimensions of life.

Cognitive and Mood Effect of Alpha-Lipoic Acid Supplementation in a Nonclinical Elder Sample: An Open-Label Pilot Study.

BACKGROUND: Memory disorders are common among elder people, and nonclinical cognitive decline is commonly experienced with age. Preclinical investigations have explored the possible role of alpha-lipoic acid (ALA), a known antioxidant compound abundant in vegetables and animal tissues, in reducing oxidative stress in the aging brain and preventing cognitive decline. However, clinical evidence is limited, and the few existing results are contrasting. In addition, while most of the existing trials have been focused on the effects of ALA administration in Alzheimer's disease (AD) or other types of dementia, studies evaluating its effects on nonclinical elder population are still missing. METHODS: In the present open-label, pilot study, fifteen elder patients (mean age: 84.5 ± 5.77) received ALA at a daily dose of 600 mg/day for 12 weeks. General cognitive function, executive function, and mood symptom assessment were carried out at baseline and at the endpoint. RESULTS: Overall, ALA administration was generally well-tolerated (only one dropout due to gastrointestinal side effects). However, no statistically significant effects either on cognitive function, executive function, or mood were found. CONCLUSIONS: Despite several limitations, our study found no evidence of positive effects on cognition and mood after ALA administration in elder people without the diagnosis of AD or cognitive impairment. Further clinical trials are needed to better investigate ALA effectiveness on cognition and mood in elder subjects.

Job satisfaction in the health professions: The role of affective temperaments.

BACKGROUND: Job satisfaction, as a multidimensional psychological response to work experience, includes both cognitive and affective components which influence individuals' appraisals and state of minds. In recent years, researchers have begun to explore the psychological processes that might underlie the dispositional causes of job satisfaction. Affective temperaments can influence the experience of emotionally significant events at work and this, in turn, may influence job satisfaction. OBJECTIVE: To investigate possible associations between affective temperamental features and job satisfaction in the health professions. METHODS: The sample consisted of 294 subjects selected among health professionals. Data were collected by an online survey including the Professional Quality of Life (ProQOL) questionnaire and the short form of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A) questionnaire. RESULTS: Hyperthymic, depressive, irritable and anxious temperaments predicted the risk of experiencing job dissatisfaction in healthcare professionals. No associations between cyclothymic temperament and job satisfaction were found. CONCLUSION: The identification of affective temperamental assets and liabilities is potentially useful in the development of supportive and psycho-educational strategies, aimed at preventing work-related stress and promoting mental health in workplaces, also reducing the risk of job dissatisfaction.

Sex Differences in Emotions and Eating Behaviors among People Affected by Obesity.

Relatively little research has examined sex differences among people affected by obesity. The aim of this study is to assess the relationship between negative emotions and eating behaviors, taking into account the role of biological sex. The final sample consists of 200 candidates for bariatric surgery, 62 males (31%) and 138 females (69%), aged from 18 to 60 years (M = 40.71; SD = 11.30). Participants were screened with the Binge Scale Questionnaire (BSQ) and individually evaluated with the Eating Disorder Inventory (EDI) and the Profile of Mood States (POMS). Correlations were calculated by splitting the sample by sex. Analyses of the relationship between negative emotions and eating behavior showed a large number of correlations in the sample of women and few correlations in men. The differences between women and men with obesity suggest the need for a different theoretical construct that explains the differentiated mechanisms of functioning and lays the foundations for specific therapeutic paths.

Emotional Temperament and Character Dimensions and State Anger as Predictors of Preference for Rap Music in Italian Population.

The objective of the current work was to examine the relationships between affective temperaments dimensions, trait anger, and the preference for rap music in a sample of Italian adults. An online survey was administered to 662 subjects. We assessed preference for rap music using a Likert scale. Ina addition, we investigated the sample' affective temperament traits using the Memphis, Pisa, Paris, and San Diego (TEMPS-A) short scale and the trait anger by using the Trait Anger component of the State Trait Anger Expression Inventory 2 (STAXI-2). Multiple linear regression indicated that cyclothymic temperament score, hyperthymic temperament score, and trait anger scores were positive predictors while older age, and depressive temperament and higher education score were negative predictors of preference for rap music. The results expand previous literature on personality and music preference indicating the association of high energy/high activity temperaments and trait anger to preference for rap music.

Factors Affecting Perceived Work Environment, Wellbeing, and Coping Styles: A Comparison between Physicians and Nurses during the COVID-19 Pandemic.

The COVID-19 pandemic is a current emergency worldwide. All the consequent changes in sanitary systems have negatively affected the work-life balance. In particular, healthcare workers suffered from anxiety, stress, and depression, mostly nurses compared to physicians. To handle this situation, the adoption of different coping strategies has played a strategic role in psychophysical wellbeing. Our main goal is to the assess the perception of work environment and wellbeing (EQ-5D questionnaire), as well as to analyze possible differences in coping styles between physicians and nurses (brief COPE questionnaire). The arising differences were compared between the two groups, and associations with variables were assessed through a bivariate correlation analysis. This cross-sectional study was conducted from November to December 2020 through an online survey. A total of 172 respondents (117 physicians and 55 nurses), of which 102 were women and 70 were men, accepted to join the study. Our results showed that physicians referred a higher perception of wellbeing, and nurses reported an increased perception of work activity and efficiency, along with an unchanged economic status. The most frequently adopted coping strategies were Active and Planning (self-sufficient coping). Physicians showed a greater tendency to use avoidant coping strategies. More-experienced nurses and physicians were less prone to adopt socially supported coping strategies, emphasizing the need for novel organizational measures at the social dimension that favored sharing and interaction between peers. Future research should aim to further investigate the relationship between the perception of work environment and coping strategies in order to identify risk factors to be prevented by promoting adequate measures at an organizational level.

Motor Cortex Response to Pleasant Odor Perception and Imagery: The Differential Role of Personality Dimensions and Imagery Ability.

Background: Neuroimaging studies have shown a complex pattern of brain activation during perception of a pleasant odor and during its olfactory imagery. To date, little is known regarding changes in motor cortex excitability during these tasks. Bergamot essential oil (BEO) is extensively used in perfumes and cosmetics for its pleasantness. Therefore, to further our understanding of the human sense of smell, this study aimed to investigate the effect of perception and imagery of a pleasant odor (BEO) on motor cortex using Transcranial magnetic stimulation (TMS). Materials and Methods: We examined the primary motor cortex (M1) excitability during perception of a pleasant odor (BEO) or perception of odorless saline (experiment 1). Furthermore, we tested the effect of olfactory imagery (OI) of BEO on corticospinal excitability (experiment 2). The increase in motor evoked potential (MEP) amplitude was correlated with personality dimensions scores, pleasantness, vividness, and general imagery ability. Results: The results indicate that the corticospinal excitability changed after both perception and imagery of a pleasant odor (BEO). The correlation analysis shows an association with neuroticism personality trait (experiment 1) and with general olfactory imagery ability (experiment 2). Conclusion: Both perception of a pleasant odor and its olfactory imagery modulate motor cortex excitability. The enhanced brain activation is affected by specific individual characteristics. Overall, our findings provide physiological evidence for a complex interaction between the olfactory and motor systems.

Impulsivity and Metacognition in a Psychiatric Population.

Objective: The main purpose of this study was to examine a possible relationship among the three constructs of impulsivity, according to Barratt's theory and metacognition subdimensions, as described in Wells and Cartwright-Hatton's theory, in various psychiatric disorders, in order to explore the potential predictive role of impulsivity on metacognition. Method: The Barratt Impulsiveness Scale-11 (BIS-11) and the Metacognitions Questionnaire (MCQ-30) were administered to a sample of 100 patients affected by psychiatric disorders. Linear regression was used first to study the relationship between impulsivity as an independent variable and metacognition as a dependent variable and then to evaluate the relationship between the three construct of impulsivity and the five subdimensions of metacognition. Results: BIS-11 total score was a valid predictor of Total MCQ-30 (p <.0001), whereas Attentive Impulsiveness was a good predictor of the factors "Negative Beliefs" (p <.0001), "Cognitive Confidence" (p =.004) and "Need to control thoughts" (p =.002). Conclusions: since "Attentive Impulsiveness", "Negative believes", "Cognitive Confidence" and "Need to Control Thought" are psychological constructs, psychotherapy is the more effective tool to intervene on their imbalance. In particular, literature demonstrates the effectiveness of Cognitive-Behavioural Therapy and Mindfulness therapies in rebalancing impulsivity and enhancing metacognitive skills.

Catatonia Spectrum: Validation of a Questionnaire Investigating Catatonia Spectrum.

Aim: A growing body of literature has demonstrated the utility of a dimensional perspective on mental disorders. The current study aims to determine the psychometric properties of the Catatonia Spectrum (CS), a new questionnaire specifically tailored to assess the spectrum of catatonia, from full blown forms to subthreshold ones. Methods: 86 adults with at least three symptom criteria for catatonia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 81 adults affected by borderline personality disorder (BPD), 104 adults with a diagnosis of major depressive disorder (MDD), and 105 subjects without mental disorders (CTL), were recruited from six Italian University Departments of Psychiatry and administered the: Bush-Francis Catatonia Rating Scale (BFCRS), Bush-Francis Catatonia Screening Instrument (BFCSI), and CS. Results: CS scale demonstrated a high level of internal consistency and excellent test-retest reliability for total and domain scores. CS domain scores were positively and significantly correlated with each other (p < 0.001) with Pearson's coefficients ranging from 0.337 to 0.663. All the CS domain scores were highly correlated with the CS total score. The correlation coefficients between CS and alternative measures of catatonia appeared all significant and positive. Significant differences among diagnostic groups on both CS domains and total scores were found. CS total scores increased significantly and progressively from the CTL, to the MDD and the BDP group, up to the catatonia group, which reported the highest value. Conclusion: The CS showed excellent internal consistency and test-retest reliability and strong convergent validity with alternative dimensional measures of catatonia. The questionnaire performed differently across the four diagnostic groups, with an increasing score gradient from healthy controls to patients with MDD, BPD and up to the catatonia group.

Sexual Desire and Body Image. Gender Differences and Correlations before and during COVID-19 Lockdown.

Recent literature has extensively examined sexual behavior during lockdown due to COVID-19. However, there are no recent studies that have considered the relationship between body image quality, sexual arousability, and sexual anxiety. The present study has two main objectives: (1) to examine gender differences in bodily and sexual experience; and (2) the comparison of bodily and sexual experience, before and during the COVID-19 lockdown. A total of 301 adult subjects (161 women and 140 men) aged between 16 and 73 years (Mean = 37.4; S.D. = 10.3) participated in the study. Data on biographical information were collected via an online panel. The Body Uneasiness Test (BUT) and the Sexual Arousability Inventory (SAI) were used for the assessment. Univariate ANOVA showed worse scores for women, compared with men, in terms of body image avoidance, depersonalization, overall severity of body image quality, sexual arousability, and sexual anxiety dimensions. When compared against time, only women showed significant correlations between the function of sexual arousal and all parameters concerning body image alteration. Interestingly, these correlations were weak and sporadic before lockdown, but strong and numerous during lockdown. This finding suggests that the impact of COVID-19 restrictions affected the female population more, with a profound repercussion on self-image and sexual and mental well-being.

The relationship between subthreshold psychiatric symptoms and Internet Addiction in an Italian population.

BACKGROUND: Internet addiction (IA) is an emerging psychopathological entity, often comorbid with a variety of psychiatric disorders. Subthreshold psychopathology has recently emerged as a new field of research, with solid evidence highlighting its role in causing psychological distress. AIMS: The study aimed to evaluate the presence of subthreshold psychopathological symptoms and IA in Italian adults recruited from the general population, searching for possible correlations between specific subclinical psychiatric disorders and internet abuse. METHODS: The study was conducted by an online survey released through social networks, web advertising, institutional and professional mailing lists, and messaging services. The General 5-Spectrum Measure (GSM-V) and the Internet Addiction Test (IAT) were chosen to assess subthreshold symptoms, and IA, respectively. RESULTS: Significant positive correlations between the total score of the IAT total scores and the multiple domains of GSM-5 (p <0.0001), except for the "Mania" dimension (p = 0.717). CONCLUSIONS: IA is very common in subjects unaffected by major psychiatric disorders and it is associated with subthreshold psychopathological dimensions. Further studies on larger samples and the inclusion of a dimensional framework in research settings and clinical practice are needed to better understand the nature and the reciprocal relationships between IA and subthreshold psychopathology.

Autistic Traits, Arousal, and Gender Features in a Nonclinical Sample of Italian Adolescents.

(1) Background: Subthreshold autism is a sub-clinical pattern of autism spectrum disorder-like (ASD-like) traits, including poor social skills, cognitive rigidity, anxiety, and aloofness. These ASD-like traits are significantly more prevalent among parents and relatives of participants with autism; however, evidence suggests that subclinical autistic traits are not restricted to the family members of individuals with autism but rather are continuously distributed in the general population. Though the autistic subclinical form is perhaps prevalent among adults, little attention has been paid to the association between autistic traits and global functioning in adolescence. The aim of the present study is to investigate the subthreshold autism phenotype in adolescence and its relationship with arousal correlates, exploring gender differences emerging in the sample. (2) Methods: A sample of 725 students (293 males and 432 females; mean age 17.19) were recruited from three high schools in Southern Italy. They were assessed by the following instruments: Autism Spectrum Quotient, Adult Autism Subthreshold Spectrum, Ritvo Autism and Asperger Diagnostic Scale 14, and Hyperarousal Scale. (3) Results: In males, significant direct correlations between all dimensions of arousal and all variables related to autistic traits emerged except for the correlations between the H-Scale "Introspection score", the AQ questionnaire "Total score" (p = 0.094), and the AdAS-Spectrum questionnaire "Empathy factor" (p = 0.210); in females, significant positive correlations between all dimensions of arousal and all variables related to autistic traits emerged. (4) Conclusions: In the sample of adolescents with subclinical profiles of autistic traits, the Empathy factor of the AdAS Spectrum questionnaire was significantly higher in the male group than in the female group, underscoring lower empathic abilities in the former group. In the male group, the empathy factor did not have a statistically significant correlation with the H-scale introspection factor or with the autistic traits measured by AQ. We suppose that in male adolescents, another hypothetical factor seems to intervene in the relationship between autistic traits and arousal. Otherwise, empathy is a preponderant factor closely related to hyper-arousal responses in female adolescents with autistic traits.