Psychiatry Research 235 (2016) 169–176

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Automatic and controlled processing and the Broad Autism Phenotype

Amy Camodeca n, Sylvia Voelker
University of Windsor, 401 Sunset Avenue, Windsor, ON, Canada N9B 3P4

art ic l e i nf o a b s t r a c t

Article history: Research related to verbal fluency in the Broad Autism Phenotype (BAP) is limited and dated, but gen-
Received 26 February 2015 erally suggests intact abilities in the context of weaknesses in other areas of executive function (Hughes
Received in revised form et al., 1999; Wong et al., 2006; Delorme et al., 2007). Controlled processing, the generation of search
23 October 2015
strategies after initial, automated responses are exhausted (Spat, 2013), has yet to be investigated in the
Accepted 9 November 2015
Available online 12 November 2015
BAP, and may be evidenced in verbal fluency tasks. One hundred twenty-nine participants completed the
Delis–Kaplan Executive Function System Verbal Fluency test (D-KEFS; Delis et al., 2001) and the Broad
Keywords: Autism Phenotype Questionnaire (BAPQ; Hurley et al., 2007). The BAP group (n ¼53) produced sig-
Verbal fluency nificantly fewer total words during the 2nd 15ʺ interval compared to the Non-BAP (n ¼76) group. Partial
Executive function
correlations indicated similar relations between verbal fluency variables for each group. Regression
Cognition
analyses predicting 2nd 15ʺ interval scores suggested differentiation between controlled and automatic
Strategies
processing skills in both groups. Results suggest adequate automatic processing, but slowed development
of controlled processing strategies in the BAP, and provide evidence for similar underlying cognitive
constructs for both groups. Controlled processing was predictive of Block Design score for Non-BAP
participants, and was predictive of Pragmatic Language score on the BAPQ for BAP participants. These
results are similar to past research related to strengths and weaknesses in the BAP, respectively, and
suggest that controlled processing strategy use may be required in instances of weak lower-level skills.
& 2015 Elsevier Ireland Ltd. All rights reserved.

1. Introduction helping understand the cognitive weaknesses observed in those

The Broad Autism Phenotype (BAP) refers to characteristics of
the core symptoms of autism (disordered communication, poor
social interest, and stereotyped behaviors) that are of insufficient
severity for a diagnosis of autism spectrum disorder (Davidson
et al., 2014; McCray et al., 2014). Executive function weaknesses
are observed in the Broad Autism Phenotype (Hughes and Ensor,
2010; McLean et al., 2014). Verbal fluency is a frequently re-
searched component of executive function (Andreou and Trott,
2013; Metternich et al., 2014; Herbert et al., 2014; Czermainski
et al., 2014). Verbal fluency tasks require generation of words
within a time limit according to either a letter cue (phonemic/
letter fluency) or a category cue (semantic/category fluency) (Delis
et al., 2001; Malek-Ahmadi et al., 2011). Verbal fluency tasks
overall are thought to be indicative of cognitive flexibility and the
ability to generate a search strategy (Kenworthy et al., 2013). Re-
search in this area is important because it has implications re-
garding adaptive behavior, academic achievement, and occupa-
tional outcomes for those with autism characteristics, as well as in
n
Corresponding author. Present address: The Pennsylvania State University, 100
University Drive, Monaca, PA 15061 USA.
E-mail address: asc19@psu.edu (A. Camodeca).
with an autism spectrum diagnosis (Kenworthy et al., 2009, 2013;
Barkley and Fischer, 2011; Culbertson et al., 2013; Panerai et al.,
2014; Pugliese et al., 2015).
The relatively limited research related to verbal fluency in the
BAP is dated, but does provide some evidence for weaknesses in
this area compared to controls. In one study, siblings of individuals
with autism obtained lower scores on tasks of letter and semantic
verbal fluency compared to control siblings (Hughes et al., 1999).
However, other findings indicate that although parents of children
with autism demonstrated weaker performance in ideational flu-
ency compared to control parents, no differences in semantic
verbal fluency scores were observed (Hughes et al., 1999; Wong
et al., 2006). Other research has further supported the idea that no
significant differences between parents of children with autism
and controls exist for either letter or semantic fluency (Delorme
et al., 2007). It is possible that verbal fluency is a relatively pre-
served area of executive functioning in the BAP population.
1.1. Limitations of previous research
However, the above studies may not have adequately assessed
verbal fluency weaknesses. One limitation concerns adequate
measurement of processing strategies. Automatic processing refers
to the production of information relatively easily due to extensive

http://dx.doi.org/10.1016/j.psychres.2015.11.012
0165-1781/& 2015 Elsevier Ireland Ltd. All rights reserved.
170 A. Camodeca, S. Voelker / Psychiatry Research 235 (2016) 169–176
familiarity and practice (Hurks et al., 2006). Controlled processing
refers to the generation of search strategies in production of in-
formation after initial, automatic responses are exhausted (Van-
norsdall et al., 2014; Spat, 2013). A study utilizing the Delis–Kaplan
Executive Function System’s Verbal Fluency task, which allows for
computation of time-based normative scores, demonstrated the
potential usefulness of the evaluation of the number of words
generated in the four 15ʺ intervals of verbal fluency tasks (Hurks
et al., 2006). In this study, it was suggested that Total Words
Generated in each of the 2nd through 4th 15ʺ intervals were re-
flective of controlled processing strategies, whereas words gener-
ated during the 1st 15ʺ interval were reflective of automatic pro-
cessing (Hurks et al., 2006). Automatic versus controlled proces-
sing, especially regarding time intervals in verbal fluency tasks,
has yet to be studied in the BAP population. It is possible that
intact or better than average automatic processing skills, coupled
with weak or slow to develop controlled processing skills, are
related to the overall intact performance in the BAP group com-
pared to controls. The current study will investigate this idea.
Additionally, the limited available research on automatic and
controlled processing does not include evidence for construct va-
lidity; the current study will address this lack of evidence.
Another limitation of the above studies is related to sampling.
Many studies, including the available studies regarding verbal
fluency, utilize the presence/absence of a child or sibling with an
autism spectrum disorder (ASD) to classify individuals into BAP
and Non-BAP groups, respectively (e.g., Hughes et al., 1999; Kadak
et al., 2014; Martinez-Sanchis et al., 2014). This classification is
based on the extant research indicating a strong heritability of
autism spectrum disorders (Colvert et al., 2015). Twin and sin-
gleton autism sibling studies indicate greater similarity in symp-
toms and diagnosis with higher proportion of shared genes (Zhao
et al., 2007; Taylor et al., 2013; Frazier et al., 2014), and more
pronounced autism traits have been observed in non-autism sib-
lings in multiplex than simplex families (Pisula and Zeigart-Sa-
dowks, 2015; Tayor et al., 2015). The 200 þ specific genes identi-
fied in autism diagnoses have been implicated in sub-clinical
autism characteristics as well (Nishiyama et al., 2014; Robinson
et al., 2014). However, using child diagnosis as a classification
method may misclassify many parents. Studies suggest an in-
creasing number of children are born to families considered “low
risk” for having a child with autism (Losh et al., 2008; Nishiyama
et al., 2014; Iossifov et al., 2014; Davidson et al., 2014). De novo
mutations, epigenetically modified genes, and perinatal compli-
cations have been implicated in autism diagnosis (Chaste and Le-
boyer, 2012; Flashner et al., 2013; Taylor et al., 2013; Tordjman
et al., 2014). Much of the research investigating cognitive profiles
in the BAP, and particularly regarding verbal fluency in the BAP,
does not consistently differentiate between single and multiple
incidence families or utilize both parents in their sample (e.g.,
Hughes et al., 1999; Wong et al., 2006; Delorme et al., 2007; Levy
and Bar-Yuda, 2011; Kadak et al., 2014; Martinez-Sanchis et al.,
2014). Additionally, group classification on the basis of child di-
agnosis systematically excludes those with the BAP who do not
have children, or whose child does not yet have a diagnosis of ASD.
1.2. Purpose of the current study
The current study purported to determine if weaknesses in
verbal fluency in the BAP could be attributed to automatic and
controlled processing abilities, and provide evidence of validity of
these constructs. Planned analyses, including t-tests, correlations,
and regressions were conducted with verbal fluency variables to
examine group differences, and to provide evidence for the va-
lidity of automatic and controlled processing strategies in each
group. Additional exploratory analyses were conducted to
determine how automatic and controlled processing skills related
to BAP characteristics.
2. Method
2.1. Participants
The 129 participants included 107 females (82.90%) and 22
males with a mean age of 33.10 (SD ¼11.07) years. The sample was
predominantly (86.00%) right handed, and all had English as their
first language. Participants were predominantly Canadian
(66.70%). The “other” ethnicity category consisted of several ethnic
groupings with fewer than 8 people per group, including Italian,
Chinese, French, and African-Canadian. Average socio-economic
status as assessed by Hollingshead Four Factor Index was 45.45
(SD ¼14.46), corresponding to middle-class (Hollingshead, 1975).
The majority (61.6%) of participants had children.
As the current study was attempting to address the limitations
of classification methods of previous studies while obtaining a
sample of persons likely to demonstrate the BAP, the sample in-
cluded parents of children with autism (n ¼31, 24.00%), parents of
children with other developmental disabilities (n ¼34, 26.40%),
and undergraduate students who had either had no children or
whose children did not have any disabilities (n ¼64, 49.60%).
Parents of children with autism or another developmental dis-
ability were automatically eligible for participation. Under-
graduates without children, or whose children did not have dis-
abilities, were screened for participation based on scores 71.5
standard deviations above or below the overall mean in the
standardization sample for the BAPQ (Hurley et al., 2007) in order
to ensure adequate variability in the sample.
Participants were classified into Broad Autism Phenotype (BAP)
(n ¼53, 41.10%) and Non-Broad Autism Phenotype groups (Non-
BAP) (n¼ 76, 58.90%) based on gender-normed cutoff scores on the
Broad Autism Phenotype Questionnaire (Hurley et al., 2007). Chi
Square and t-tests indicated no significant differences between
groups regarding demographic variables or Vocabulary or Block
Design scores (all X2s r4.939, all ps Z0.09; all ts o1.53, all
ps Z 0.13). Of the 64 screened undergraduate participants who
completed the study, 50.2% met criteria for the BAP based on the
gender normed means and 49.8% did not. No significant differ-
ences in instance of the BAP were observed between parents of
children with autism or parents of children with other develop-
mental disabilities (X2(1,65)¼9.685, p ¼0.408). When these two
groups were compared with the pre-screen undergraduate sample
(n ¼763), no significant differences in the BAP incidence were
observed (X2(2,828) ¼1.013, p ¼0.603). Refer to Table 1 for demo-
graphic characteristics of the resulting BAP and Non-BAP sub-
groups. As there were no systematic differences between groups
on any demographic variables, cognitive abilities, or incidence of
the BAP, and because BAP classification was the primary grouping
variable of interest in this study, the three groups (autism parents,
other developmental disability parents, and undergraduates) were
collapsed in future analyses.
2.2. Measures
2.2.1. General cognitive ability
General cognitive ability was estimated using the Block Design
and Vocabulary Subtests from the Wechsler Adult Intelligence
Scale-IV (WAIS-IV; Wechsler, 2008), which together provide a re-
liable and valid estimate of an individual’s overall IQ (Sattler, 2001;
Wechsler, 2008). The Block Design subtest requires the examinee
to reconstruct a block pattern within a time limit. This test cor-
relates at 0.69 with the Full Scale IQ (FSIQ) score. The Vocabulary
 A. Camodeca, S. Voelker / Psychiatry Research 235 (2016) 169–176 171

Table 1 0.49 for Category Switching (Delis et al., 2001).

Demographic characteristics, IQ, and BAP scores of BAP and Non-BAP groups.

Characteristic BAP (n¼ 53) Non-BAP (n¼ 76) 2.3. Procedure

Age 31.32 (SD ¼11.35) 34.34 (SD ¼ 10.77)
Hollingshead SES Score 43.76 (SD ¼ 13.72) 46.59 (SD ¼ 14.89)
Participants completed the WAIS-IV Block Design and Voca-
Block Design Scaled Score 9.28 (SD ¼ 3.07) 8.95 (SD ¼ 3.08) bulary subtests,D-KEFS Verbal Fluency Test, and the BAPQ as part
Vocabulary Scaled Score 9.68 (SD ¼ 1.97) 9.62 (SD ¼ 2.36) of a larger study investigating cognitive skills and social cognition
in the Broad Autism Phenotype (Camodeca, 2011). Findings related
BAPQ Scoresa
Total 3.48 (SD ¼ 0.49) 2.47 (SD ¼ 0.36) to executive function and social cognition are reported elsewhere
Aloof 3.51 (SD ¼0.83) 2.26 (SD ¼ 0.56) (Camodeca et al., 2011), whereas the current study focuses speci-
Pragmatic Language 3.14 (SD ¼ 0.59) 2.33 (SD ¼ 0.44) fically on automatic and controlled processing. Participants were
Rigid 3.81 (SD ¼ 0.71) 2.80 (SD ¼ 0.56)
recruited from the participant pool at a large University in
Gender Southwestern Ontario as well as from community events and
Females 79.20% 85.50% agencies for children with developmental disabilities in the sur-
Males 20.80% 14.50%
rounding community. Participants received course credit or a $20
Education Level gift card to a local business for participation.
High School Equivalent or Less 32.10% 15.10%
Some College or Bachelor’s Degree 54.70% 68.50%
Graduate Degree 13.20% 15.80%
3. Results
Handedness
Right 81.10% 89.50%
3.1. Preliminary analyses
Left 18.90% 10.50%

Ethnicity Prior to analysis, all variables were examined for accuracy of

Canadian 66.00% 67.10% data entry, missing values, and assumptions of analysis as well as
Other 34.00% 32.90%
systematic differences based on demographic or cognitive char-
a
Ranges BAP Group: total 2.75–5.25; Aloof 1.50–5.42; Pragmatic Language acteristics. t-Tests indicated significant differences on Category
2.08–4.92; Rigid 2.17–5.67. Ranges Non-BAP Group: total 1.56–3.19; Aloof 1.25– Switching scores based on gender (t¼2.92 p ¼0.004). When ana-
3.42; Pragmatic Language 1.00–3.75; Rigid 1.58–4.25.
lyzing Category Switching, gender was used as a control variable.

subtest requires an individual to orally define words, and corre-

3.2. Verbal Fluency Scores between BAP and Non-BAP groups
lates at 0.75 with the FSIQ (Wechsler, 2008). Both tests demon-
strate strong (Z0.80) internal consistency and test–retest reli-
t-Tests were conducted with BAP status as the independent
abilities (Wechsler, 2008).
variable and Letter Fluency Total Correct, Category Fluency Total
2.2.2. Broad Autism Phenotype Correct, and all 15ʺ interval scores as dependent variables. Sig-
Sub-clinical autism characteristics were assessed using The nificant differences between BAP statuses were found on the 2nd
Broad Autism Phenotype Questionnaire (BAPQ; Hurley et al., 15ʺ Interval score (t(126) ¼7.228, p ¼0.02) (see Table 2). No sig-
2007). The BAPQ is a 36-item, self-report questionnaire with a nificant differences between groups were observed for Letter
Likert scale response format (1 ¼very rarely–6 ¼very often). Fluency Total Correct, Category Fluency Total Correct or 1st, 3rd,
Higher scores correspond to greater BAP characteristics. The BAPQ and 4th 15ʺ interval scores (all ts Z1.779, all ps Z0.079).
provides an overall score and three subscale scores: Aloof Per- An ANCOVA controlling for gender was conducted with BAP
sonality, Pragmatic Language, and Rigid Personality. The authors status as the independent variable and Category Switching as the
suggest using the criteria of at least two subscale scores above dependent variable. No significant differences between BAP sta-
gender-normed cutoffs for each subscale as BAP “present”. Cron- tuses were observed (F(2, 127) ¼2.776 p¼ 0.980) (see Table 2).
bach’s alphas are 0.94 for Aloof Personality, 0.91 for Rigid Per-
sonality, and 0.85 for Pragmatic Language. The subscales showed Table 2
moderate intercorrelations in controls (r ¼0.51–0.54) and moder- t-Tests and ANCOVA between Broad Autism Phenotype Statuses with Verbal Flu-
ency Scoresa.
ate to high correlations in parents of children with autism
(r ¼ 0.61–0.72). Sensitivity of the BAPQ is 70% or higher for the t Value BAP Group Mean Non-BAP Group
subscale scores and 81.8% for the total score. Specificity is 73% or (SD) Mean (SE)
higher for the subscale scores and 73% for the total score (Hurley
et al., 2007). Letter Fluency Total Score 1.32 10.49 (3.05) 11.22 (3.12)
Category Fluency Total 1.14 11.50 (3.38) 12.18 (3.32)
Score
2.2.3. Verbal Fluency 1st 15ʺ Interval Total 0.23 11.94 (2.95) 12.07 (2.91)
Verbal Fluency (VF) was assessed by the Verbal Fluency Test of 2nd 15ʺ Interval Total 2.35* 9.67 (2.53) 10.86 (3.03)
the Delis–Kaplan Executive Function System (D-KEFS; Delis et al., 3rd 15ʺ Interval Total 1.77 10.12 (0.39) 11.07 (3.06)
4th 15ʺ Interval Total 1.67 9.83 (0.39) 11.04 (3.07)
2001). This task consists of three letter, two category, and one
category-switching trial of 60 s each. Scores for all trails and F value BAP Present BAP Absent Mean
number of correct responses for each 15ʺ interval are provided. The Mean (SE) (SE)
internal consistency reliability of total correct response scores for
the 20–49 year age groups ranged from 0.77–0.85 for Letter Flu- Category Switching Total 1.80 10.71 (2.65) 11.68 (3.22)
Correcta
ency and 0.63–0.76 for Category Fluency, and 0.43–0.68 for Cate-
gory Switching. Test–retest reliabilities of total correct response a
Control variable: gender.
scores were 0.76 for Letter Fluency, 0.81 for Category Fluency, and *
p o0.020.
172 A. Camodeca, S. Voelker / Psychiatry Research 235 (2016) 169–176

Table 3
Correlations and partial correlationsa among Verbal Fluency Scores and Cognitive Variables for BAP and Non-BAP groups.

1 2 3 4 5 6 7 8

1 Letter Fluency Total

2 Category Fluency Total 0.37b**
0.47c***
3 1st 15ʺ Interval Total 0.68*** 0.65***
0.70*** 0.62***
4 2nd 15ʺ Interval Total 0.64*** 0.59*** 0.39**
0.67*** 0.70*** 0.49***
5 3rd 15ʺ Interval Total 0.65*** 0.62*** 0.58*** 0.45***
0.58*** 0.65*** 0.40*** 0.54***
6 4th 15ʺ Interval Total 0.66*** 0.62** 0.51*** 0.56*** 0.54***
0.74*** 0.67*** 0.47*** 0.58*** 0.52***
7 Category Switching Total Correcta 0.32* 0.39** 0.40** 0.40** 0.42** 0.47**
0.31*** 0.50*** 0.51*** 0.52*** 0.29** 0.41***
8 Vocabulary 0.00 0.07 0.07  0.02  0.05  0.01  0.10
0.29* 0.19 0.21 0.29* 0.17 0.32** 0.24*
9 Block Design 0.32* 0.39** 0.40** 0.40** 0.42** 0.47** 0.06 0.25
0.31*** 0.50*** 0.51*** 0.52*** 0.29** 0.41*** 0.20 0.51***

a
Control variable: gender.
b
BAP group.
c
Non-BAP group.
*
p o 0.05.
**
po 0.01.
***
p o 0.001.

3.3. Correlations between verbal fluency variables
To determine if similar relations between verbal fluency vari-
ables existed between BAP and Non-BAP groups, correlations were
conducted for Letter Fluency, Category Fluency, and 15ʺ interval
scores, and a partial correlation with gender as a covariate was
conducted for Category Switching (see Table 3). Fisher’s r to z
transformations indicated no significant differences in correlations
between groups (all zs r|1.03|, all ps Z0.30). Overall, the correla-
tions suggested significant but low correlations between Letter
Fluency and Category Fluency scores in both groups (rs r0.47).
Category Switching demonstrated a low correlation with Letter
Fluency (rs r0.32) in both groups. Category Switching and Cate-
gory Fluency demonstrated a low correlation in the BAP group
(r ¼0.37), and a moderate correlation in the Non-BAP Group
(r ¼0.47). Both Letter and Category fluency demonstrated moder-
ate to strong relations (rs range¼0.59–0.74) with 15ʺ interval
any findings could be attributed to executive function and not
cognitive abilities. Letter Fluency and 1st 15ʺ interval were entered
in the second block as measures of controlled and automatic
processing, respectively. The results of the regression analyses are
presented in Table 4. For the BAP group, only Letter Fluency was a
significant predictor in the overall model (B ¼0.683, pr 0.001).
However, for the Non-BAP group, Block Design was a significant
predictor of controlled processing (B ¼0.240, p ¼0.013) along with
Letter Fluency (B ¼0.491, p o0.001), but no other variables were
significant (B values o0.117 ps 40.348).
Table 4
Regression analyses predicting 2nd 15ʺ interval scores.

scores. Category Switching demonstrated low to moderate corre- Group Block Variables F value R2 B value Std. β p Value
lations with 15ʺ interval scores (rs range¼ 0.29–0.52). The 1st–4th entered
15ʺ interval scores demonstrated low to moderate intercorrela-
tions (rs range¼0.39–0.58). BAP 1 (Overall 0.113 0.005 0.893
Model)
In anticipation of stepwise regression analyses, cognitive vari-
Vocabulary 0.005 0.004 0.980
ables (Block Design and Vocabulary) were included in correlations/ Block Design 0.066 0.069 0.640
partial correlations with Verbal Fluency variables as well. No sig- 2 (Overall 8.371 0.653 o 0.001
nificant correlations were observed for the BAP group (all rs o| Model)
Vocabulary  0.009  0.006 0.959
0.121|, all ps 40.391). In the Non-BAP group, weak but significant
Block Design  0.061  0.064 0.583
correlations were observed for 2nd and 4th 15ʺ interval for both 1st 15ʺ  0.138  0.150  0.366
Vocabulary and Block Design (rs range¼0.252–0.322, ps r0.028). Interval
However, no significant differences in correlations were observed 2nd 15ʺ 0.683 0.762 o 0.001
between groups (all Zs r|1.87|, all ps Z0.062). Interval

Non-BAP 1 (Overall 6.273 0.126 .003

3.4. Predicting controlled processing Model)
Vocabulary 0.257 0.195 0.124
Compared to Category Fluency, Letter Fluency tasks pre- Block Design 0.244 0.254 0.046
2 (Overall 17.019 0.346 o 0.001
sumably have higher demands for lexical search strategies, similar
Model)
to controlled processing, although there may be some auto- Vocabulary  0.001  0.001 0.994
maticity involved in the 1st 15ʺ interval portion of this trial Block Design 0.240 0.250 0.013
(Kleinhaus et al., 2005; Hurks et al., 2006; Andreou and Trott, 1st 15ʺ 0.117 0.118 0.348
2014). A stepwise regression analysis was conducted, with cogni- Interval
2nd 15ʺ 0.491 0.530 o 0.001
tive ability measures (Vocabulary and Block Design) in the first Interval
block. Vocabulary and Block Design were included to ensure that
 A. Camodeca, S. Voelker / Psychiatry Research 235 (2016) 169–176 173

Table 5 4. Discussion
Regression analyses Predicting Pragmatic Language scores.
The purpose of the current study was to determine if weak-
Group Block Variables F value R2 B value Std. β p Value
entered nesses in verbal fluency in the BAP could be attributed to con-
trolled processing abilities, and provide evidence of validity for
BAP 1 (Overall 1.079 0.042 0.348 automatic and controlled processing constructs. These results
Model) provide evidence of intact automatic processing skills (no differ-
Vocabulary 0.017 0.058 0.690
Block Design 0.036 0.183 0.211
ences between 1st 15ʺ interval scores) in the BAP compared to
2 (Overall 2.908 0.198 0.031 controls. The weaknesses observed in the 2nd 15ʺ interval only,
Model) and not the 3rd and 4th 15ʺ intervals, which also require con-
Vocabulary 0.024 0.081 0.552 trolled processing strategies (Hurks et al., 2006) suggest that
Block Design 0.033 0.168 0.219
weaknesses relate to initial generation of controlled processing
1st 15ʺ Interval  0.038  0.198 0.171
2nd 15ʺ 0.097 0.429 0.004 strategies; over time those with the BAP were able to improve
Interval performance. These weaknesses regarding initial strategy genera-
tion use could not be attributed to systematic differences between
Non-BAP 1 (Overall 1.349 0.036 0.266 groups in terms of cognitive ability as measured by Vocabulary or
Model)
Vocabulary 0.010 0.054 0.687
Block Design scores, or demographic variables.
Block Design  0.030  0.210 0.119 The results of correlation analyses between Verbal Fluency
2 (Overall 0.872 0.047 0.485 variables indicated no differences when comparing BAP and Non-
Model) BAP groups, suggesting that the Verbal Fluency task itself taps
Vocabulary 0.015 0.082 0.556
similar skills in each group – that is, the verbal fluency task is not a
Block Design  0.030  0.206 0.134
1st 15ʺ Interval  0.012  0.079 0.556 qualitatively different task for those with the BAP compared to
2nd 15ʺ  0.007  0.046 0.738 those without. These results also provide evidence for the integrity
Interval of the 1st 15ʺ interval as a measure of automatic processing, and
the 2nd 15ʺ interval score as a measure of controlled processing
(strategy generation) in each group.
It was of interest that Block Design was an additional predictor
3.5. Controlled processing predicting BAP characteristics
of controlled processing in the Non-BAP group, but not the BAP
Group. The Block Design subtest is thought to require some ex-
Correlational analyses, and partial correlations in the case of
ecutive function skills, specifically strategy generation and orga-
Category Switching, were conducted with all Verbal Fluency scores
nization (Kenworthy et al., 2014; Muth et al., 2014; Jepson, 2013;
and BAPQ scores to determine if controlled processing was related
Kana et al., 2013). It may be that for those with the BAP, Block
to these personality characteristics. No significant correlations
Design requires less strategy generation. That is, while not an
were observed for the Non-BAP group (all rs r0.17, all ps Z0.141).
entirely automatic task, the Block Design task may draw upon a
In the BAP group, a significant low correlation was observed be-
lower level visual-spatial skill advantage in those with the BAP.
tween BAPQ Rigid and Category Switching scores (r ¼0.32, This conclusion becomes stronger when considering the con-
p ¼0.023), but this was not significantly different between BAP and sistent evidence for better performance of those with high levels
Non-BAP groups (Z¼ 1.32, p ¼0.190). A significant low correlation of autism symptoms on the Embedded Figures Test (De Jonge
was also observed between BAPQ Pragmatic Language score and et al., 2006; Keehn et al., 2009; Russell-Smith et al., 2012; Dillen
2nd 15ʺ Interval Score (r ¼ 0.36, p ¼0.009), which was significantly et al., 2015).
different between groups (Z¼2.65, p¼ 0.008). To date, no study has investigated correlations between verbal
In anticipation of stepwise regression analyses, cognitive vari- fluency variables and the BAPQ scores. Given the evidence estab-
ables (Block Design and Vocabulary) were included in correlations/ lished for the construct validity of the Verbal Fluency task for both
partial correlations with BAPQ variables as well. No significant the BAP and Non-BAP groups, the differences in the correlation
correlations were observed for either the BAP or Non-BAP group and regression for Pragmatic Language and the 2nd 15ʺ interval
(all rs o |0.198|, all ps Z0.160). No significant differences in corre- scores between groups was somewhat unexpected. The positive
lations were observed between groups (all Zs r |1.87|, all relation, indicating that better controlled processing was corre-
ps Z0.062). lated with/predictive of more problems in Pragmatic Language for
These findings suggested controlled processing was differen- the BAP group was unexpected as well, given the research in-
tially related to Pragmatic Language across BAP groups. As such, dicating a negative relation between global executive functioning
further regression analyses were conducted to determine if Prag- abilities and pragmatic language difficulties (Oerlemans et al.,
matic Language could be predicted by controlled processing. To 2013; McDonald et al., 2014). This finding does not necessarily
provide consistency, and because Block Design had predicted detract from this study’s prior conclusions, however. It may be that
Controlled Processing in the Non-BAP group in previous analyses, those with the BAP use controlled processing strategies ex-
Block Design and Vocabulary were entered into the first block; 1st tensively in verbal exchanges, possibly in an attempt to compen-
15ʺ interval and 2nd 15ʺ interval were entered into the second sate for weaknesses in lower level skills such as emotion re-
block. Letter Fluency was not entered due to high multicollinearity cognition (Poljac et al., 2012; Miu et al., 2012). Their difficulties in
when 1st and 2nd 15ʺ interval scores were entered together; fur- Pragmatic Language may be due to this lower level weakness for
ther, the 15ʺ interval scores are more specific measures of auto- which they cannot compensate, despite their efforts. Additionally,
matic and controlled processing, respectively (Delis et al., 2001; the task of controlled processing used in this study was non-social
Hurks et al., 2006; Tabachnick and Fidell, 2012). In the Non-BAP (Mason et al., 2011). Perhaps those with the BAP are over-applying
Group, none of the independent variables predicted Pragmatic controlled processing strategies, perhaps attempting to use non-
Language (all Bs o|0.030|, all ps 4 0.134). However, in the BAP social task based strategies in social situations, and experience
group, Pragmatic Language was predicted by 2nd 15ʺ interval pragmatic language problems. This follows the findings of a recent
scores (B ¼0.097, p ¼0.004), implicating controlled processing in study utilizing a measure of systemizing (data-related, non-social
this characteristic (see Table 5). thinking) and empathizing (social thinking) indicating that, in
174 A. Camodeca, S. Voelker / Psychiatry Research 235 (2016) 169–176
non-autism and non-BAP individuals, systemizing and empathiz-
ing were independent constructs, but were related in the autism
and BAP population (Baron-Cohen et al., 2009; Grove et al., 2013).
It may be that Non-BAP individuals are able to avoid the mistake of
using non-social skills in social interactions and thus experience
lesser pragmatic language difficulties (Grove et al., 2014).
That BAP incidence rate was not higher in parents of a child
with autism than non-autism families is inconsistent with past
research. The low rates of male participation in this sample may be
a factor (Maxwell et al., 2013; De Jonge et al., 2015); as only one
parent per family participated in this study, it is also possible that
the parent with the BAP was less likely to volunteer. However,
both of these explanations would likely decrease the incidence of
the BAP for both groups, not just parents of those with autism. A
more likely explanation is related to the samples used for control
groups in BAP incidence rate studies (parents of children with
Down Syndrome or typically developing children) (Cruz et al.,
2013). It is possible that incidence of the BAP in autism families
and (non-autism) developmental disability families not as dis-
crepant as when comparing autism families to those with typically
developing children. Another final explanation lies with differ-
ences in measurement of the BAP in this study. In most research
with families of children with autism, groups are formed based on
child diagnosis and mean group differences on a single construct
or skill are considered as evidence of the BAP (for comprehensive
reviews, see Sauzeon et al. (2011), Cruz et al. (2013)). While valid,
those studies are not equal comparisons to the current study in
terms of BAP incidence.
4.1. Implications
These subtle differences in controlled processing strategy
generation have the potential to explain the equivocal findings
regarding executive function weaknesses in the BAP (Losh et al.,
2009; Cruz, Carmargo-Junior, and Rocha, 2013; McLean et al.,
2014). Although these weaknesses appear related to initial strat-
egy generation only, delays of up to 15ʺ to “catch up” regarding
strategy use may not only have significant negative impact on
timed tasks of cognitive skills (e.g., planning) (Culbertson and
Zillmer, 2005; Wechsler, 2008; Weschler, 2014), but also have
implications for social situations, in which delays of less than 1 s
are sufficient to cue social errors (Zein et al., 2015). This finding
has implications for training to compensate for this slowed de-
velopment to help those with the BAP in social situations.
These findings provide further evidence that task-related
thinking and social-related thinking may be connected in those
with the BAP. It is possible that this relation underlies weaknesses
in social reasoning skills, and as such has implications for identi-
fying a specific social process that could also be the target of
training and intervention for those with the BAP.
These results also have implications regarding characteristics
that may differentiate those with the BAP from those without.
Some studies have suggested planning weaknesses as a marker for
the BAP, given the relative robustness of planning weaknesses
observed in this population (Piven and Palmer, 1997; Hughes, Le-
boyer, and Bouvard, 1997; Hughes et al., 1999; Delorme et al.,
2007; Goussé and Rastan, 2010). Given the multiple executive
functions required for planning tasks (Goussé and Rastan, 2010), it
is possible that deficits in controlled processing may be related to
planning weaknesses, and thus are a more specific deficit in the
BAP. As weaknesses in automatic processing are observed in ADHD
(Hurkes et al., 2006; Andreou and Trott, 2013) the weaknesses in
initial controlled processing strategy use may differentiate these
two groups, and may differentiate the BAP from other groups as
well. Further, while there is extensive research related to visual
skills in the BAP, few studies have focused on a process approach
to performance analysis in the BAP population (De Jonge et al.,
2006; Keehn et al., 2009); non-use of controlled processing stra-
tegies in visually based tasks may be a marker for the BAP, as could
the relatedness of social and non-social thinking.
4.2. Strengths and limitations
This study examined characteristics of the BAP regardless of the
type of disability in the child, and included individuals without
children, correcting the sampling bias often demonstrated in other
studies. It utilized a 3-factor measure of the BAP expressly de-
signed for assessment of BAP characteristics, with established va-
lidity from follow up studies aside from the original questionnaire
creation (Sasson et al., 2013, 2014; Davidson et al., 2014). It in-
cluded an ethnically diverse sample. A potential confounding
variable (gender) was identified and controlled. Most importantly,
this study contributed to the currently very limited research re-
garding automatic and controlled processing strategies in general,
and is the first study to assess these strategies in the BAP
population.
Regarding limitations, it is possible some of the participants in
this study would meet criteria for autism, and thus should not be
considered part of the BAP per se. It was not possible to exclude
participants based on their BAPQ scores as, at present, there are no
established cut offs for autism diagnosis using the BAPQ. In addi-
tion, despite the evidence for the quantitative nature of the autism
spectrum, the authors have stated the BAPQ should not be utilized
to diagnose autism (Piven and Sasson, 2014). However, no parti-
cipants in this sample self-reported diagnoses on the autism
spectrum. Another possible limitation relates to benefit from
practice. As Letter Fluency was the first task presented, it may be
that no differences in Category and Category Switching scores
were observed due to the BAP group obtaining more benefit from
these initial letter trials then the Non-BAP Group. However, it
would seem that a strategy that depended on letters would not
generalize well to one that relies on categories, particularly in light
of the evidence suggesting letter and category tasks rely on dif-
ferent parts of the brain and are sensitive to different types of
damage (Ellfolk et al., 2014; Herbert et al., 2014; Metternich et al.,
2014; Vannorsdall et al., 2014). Additionally, greater benefit from
practice does not adequately explain the weaknesses observed on
the 2nd 15ʺ interval, or the fact that letter fluency, but not 1st 15ʺ
interval, was a significant predictor of 2nd 15ʺ interval scores.
Regarding external validity, the majority of participants were
female, and the majority of both male and females in the study
had levels of education of college level or higher. More pro-
nounced difficulties with verbal fluency may have been observed
in a sample comprised of more males (Donfrancesco et al., 2010) or
those with lower levels of education (Johnson et al., 2011). How-
ever, there currently exists limited research related to autism
characteristics in high functioning individuals in general, and in
females in particular (Lai et al., 2013), with many studies reporting
findings for males only (e.g., Scheeren and Stauder, 2008; Brunyéa
et al., 2011; Dickerson et al., 2014). As such, while generalizability
may be more limited than in other studies with a more equal
gender distribution, this study is a contribution to the literature for
a currently under-investigated population.
4.3. Future research
Future research could investigate controlled processing strat-
egy requirements in other tasks of executive function. Research
could also examine how the need for automatic and controlled
processing strategies might be present in structured social tasks as
well as real-world social interactions. Additional populations could
be examined to determine the specificity of weaknesses in
 A. Camodeca, S. Voelker / Psychiatry Research 235 (2016) 169–176
controlled processing to the BAP, both in verbal fluency and other
tasks of executive function. Given the heritability of autism char-
acteristics, at least for a proportion of individuals, (Taylor et al.,
2013; Klusek et al., 2014), controlled and automatic processing in
verbal fluency tasks could be investigated in children of those
identified with the BAP. Further research could investigate social
and non-social tasks and the use of controlled processing strate-
gies in the BAP and Non-BAP population. Finally, given the quan-
titative nature of autism symptoms, all of the findings in the study
are targets for replication in those diagnosed with autism. In
particular, given the evidence for phonemic fluency and controlled
processing strategies, it is possible that the weak phonemic flu-
ency observed in autism (Kleinhaus et al., 2005; Robinson et al.,
2009) is related to more pronounced weaknesses in controlled
processing in the autism population compared to the BAP
population.
Acknowledgments
This research was partially funded by a grant from Autism
Ontario.
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