Translation, Cross-cultural adaptation and Pretest of the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) for Brazilian Portuguese

Translation, Cross-cultural adaptation and Pretest of the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) for Brazilian Portuguese | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Translation, Cross-cultural adaptation and Pretest of the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) for Brazilian Portuguese Alex Vicente Spadini, Pedro Verçoza, Alessandro Chmiel dos Santos, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9034580/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Introduction: Autism Spectrum Disorder (ASD) in adult women presents diagnostic challenges due to phenotypic features that differ from the classic male presentation, particularly social camouflaging and internalized symptoms. The Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) was developed to address this gap. In Brazil, however, there is a lack of validated instruments designed for this population. Objective: To translate, culturally adapt, and conduct a pretest of the GQ-ASC for Brazilian Portuguese. Methods: The study followed international guidelines for cross-cultural adaptation, including independent forward translations, synthesis, back-translation, and expert committee review. The pre-final version was administered to 31 adult women with a formal ASD diagnosis recruited through expert referrals. The Social Responsiveness Scale, Second Edition (SRS-2), was used for exploratory convergent analysis. Cognitive debriefing interviews were conducted to assess item comprehension and cultural adequacy. Results: Expert evaluation indicated high semantic, idiomatic, experiential, and conceptual equivalence across items. In the pretest sample, the mean total GQ-ASC score was 63.3, with all participants scoring above the original screening cutoff of 56. The instrument showed high acceptability and alignment with expected autism-related profiles. Qualitative feedback indicated that while the translation was accurate, some items required additional contextual clarification to reduce ambiguity. This led to the development of two Brazilian versions: a concise standard version and a detailed version including explanatory examples. Conclusion: The Brazilian Portuguese adaptation of the GQ-ASC was successful and demonstrated cultural adequacy and comprehensibility. The scale shows promise as an auxiliary tool for identifying autistic traits in adult women in Brazil, warranting further psychometric validation in larger samples. Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Autism Spectrum Disorder (ASD) has historically been conceptualized and studied through a predominantly male-centric lens. Since the early descriptions by Kanner (1) and Asperger (2), the diagnostic criteria have been largely based on behavioral observations of boys, establishing a male-based model of autism as the clinical gold standard. This ascertainment bias has led to a systematic oversight of autistic females, resulting in a male-to-female diagnostic ratio that, while historically estimated at 4:1 (3,4), is increasingly being challenged by recent epidemiological data suggesting a much narrower gap when active case ascertainment is employed (5). Consequently, many women with ASD remain undiagnosed or receive misdiagnoses, such as borderline personality disorder, anxiety, or depression, before they are correctly identified (6). Emerging research highlights the existence of a distinct female phenotype of autism, which differs significantly from the classic male presentation (7). Women on the spectrum often display higher levels of social motivation and better capacity for social imitation than their male counterparts, which can mask their underlying difficulties. Unlike the mechanical or technical restricted interests frequently observed in males, autistic women often develop intense interests in culturally appropriate topics, such as literature, psychology, animals, or fashion, making their repetitive behaviors less conspicuous to clinicians (8). A core feature of this phenotype is social camouflaging: the conscious or unconscious use of cognitive strategies to mask autistic traits and socially adapt. While camouflaging facilitates social inclusion, it comes at a high psychological cost, frequently leading to "autistic burnout," sensory exhaustion, and severe mental health comorbidities (9). To address this limitation, the “Girls Questionnaire for Autism Spectrum Condition” (GQ-ASC) was developed by Attwood, Garnett, and colleagues (10). Unlike traditional scales, the GQ-ASC is designed to assess autism spectrum characteristics in adult women. The 21 self-reported items are organized according to a five-component structure identified through Principal Component Analysis. This structure reflects key domains of autism presentation in adulthood, particularly those more commonly reported by women. The five components include imagination and play, capturing interests in fantasy, fiction, and the nature of imaginative play in childhood; camouflaging, describing efforts to reduce the visibility of autistic traits in social contexts; sensory sensitivities, encompassing hypersensitivities and hyposensitivities across multiple sensory modalities; socialization, reflecting difficulties in social understanding and participation; and intense interests that are not stereotypically feminine. Items are rated on a four-point Likert scale, allowing a dimensional assessment of the presence and severity of autistic traits. Total scores range from 21 to 84, with scores above 56 showing approximately 80% sensitivity for autism cases. Six normative items are reverse scored to reduce acquiescence and confirmation biases. The scale has demonstrated excellent discriminative validity between autistic and non-autistic adult women, with an area under the ROC curve of 0.89 (11). The original english GQ-ASC version, publicly available and free for use, is included in the supplementary material (Supplementary Table 1) . Currently, there is no validated version of this instrument for the Portuguese-speaking population. The availability of a culturally adapted screening tool is crucial for improving diagnostic accuracy and clinical care in Brazil. Therefore, this study aims to translate and culturally adapt the GQ-ASC for Brazilian Portuguese and to assess its comprehensibility, equivalence and feasibility through a pilot study with adult women formally diagnosed with ASD. METHODS Study Design This study followed established international guidelines for the translation and cross-cultural adaptation of self-report instruments, aligning with previous validation efforts of the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) and related studies (11,12). The methodological framework was based on the protocol proposed by Beaton et al. (13), which comprises six sequential stages designed to ensure semantic, idiomatic, experiential, and conceptual equivalence between the original instrument and its adapted version. Formal authorization to translate and adapt the original GQ-ASC was obtained from the instrument’s author on August 27, 2023. Ethical Considerations The study protocol was reviewed and approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (HCPA) under the Certificate of Presentation to the Research Ethics Committee (CAAE): 84506224.4.0000.5327. All procedures complied with national and international ethical standards for research involving human participants, including respect for autonomy, beneficence, non-maleficence, and justice. All participants received detailed information regarding the study objectives, procedures, potential risks, and benefits. Written informed consent was obtained prior to participation. Participation was voluntary, and individuals could withdraw at any point without any consequences. Participant confidentiality and data privacy were strictly maintained in accordance with the Brazilian General Data Protection Law (LGPD, Law No. 13.709/2018). Data were anonymized, coded, and stored in a secure environment. Access was restricted to authorized research team members only. Results were reported in aggregate form to prevent individual identification. Artificial intelligence–based (AI) language assistance was used during the preparation of this manuscript to support linguistic revision, improve clarity, and enhance readability in English. The use of AI was limited to text editing and did not influence the study design, data collection, data analysis, interpretation of results, or the scientific conclusions presented in this article. Translation and Cross-Cultural Adaptation Procedure The cross-cultural adaptation of the GQ-ASC followed the six-step process outlined by Beaton et al. (13) and its summary is presented in Figure 1. Initially, two independent forward translations into the target language were produced by bilingual translators with distinct profiles, one with clinical expertise (T1C) and the other from a lay background (T2L), allowing for the identification of ambiguities and discrepancies between versions. These translations were then synthesized into a single consensual version (CON) through discussion among the translators and an observer, with all decisions and underlying rationales carefully documented. Subsequently, the synthesized version underwent back-translation (BT1 and BT2) into the source language by two native speakers from two professional translation companies (14,15) who were blinded to the original instrument, a step designed to identify potential semantic or conceptual inconsistencies. Seven independent experts reviewed the consensual version (CON) to support development of a prefinal version prior to pretesting. The panel included four child and adolescent psychiatrists with additional training in adult psychiatry, one psychologist with extensive experience in autism, and two linguists, one specializing in health terminology and one with experience translating health scales. Feedback was collected via a structured online form assessing clarity, translation adequacy, and four equivalence domains (semantic, idiomatic, experiential, conceptual) using 1 to 5 Likert ratings, plus two binary items (“translation adequate?” and “change?”). Thereafter, the coordinating committee reviewed the experts suggestions and produced the prefinal version (CPV), systematically evaluating and documenting semantic, idiomatic, experiential, and conceptual equivalence. The CPV was pretested in a sample of 31 individuals from the target population, using cognitive interviews to assess item comprehension and response patterns (e.g., the pretest phase). Participants rated each item on Likert scales assessing whether they understood what was asked, clarity of language, and adequacy of language. Finally, all reports and materials generated throughout the process were submitted to the coordinating committee for appraisal, ensuring adherence to recommended guidelines for cross-cultural adaptation. To enhance transparency, detailed documentation of each stage of the translation and adaptation process, including item-by-item comparisons and expert evaluations, is provided in the Supplementary Material. Pretest Procedures Sampling Recruitment used an online registration form disseminated through autism specialists and social media, as previously approved by the ethics committee. The pretest sample consisted of approximately 30 adult women with a formal diagnosis of ASD. Convenience sampling was used, aiming to include variability in age and educational background to optimize detection of potential comprehension issues. The inclusion criteria for the study required participants to identify as female, be 18 years of age or older, have a documented clinical formal diagnosis of Autism Spectrum Disorder based on DSM-5-TR (3) criteria, demonstrate cognitive functioning within the average range or above, be able to understand and respond in Brazilian Portuguese, provide informed consent, and have access to and familiarity with digital tools necessary for online participation. The exclusion criteria comprised participants who demonstrated cognitive functioning below the average range or who presented significant cognitive, attentional, or communicative impairments that could interfere with understanding the study procedures or completing the required tasks. Measures and Procedures Participants completed the adapted version of the GQ-ASC through videoconference-based interviews conducted by trained clinicians. During the interviews, the examiner shared the items on screen, read each question aloud, and recorded both the participants’ responses and any spontaneous comments or clarifications provided. The procedure included a cognitive debriefing, during which participants were asked about the clarity and comprehension of each item, as well as whether the content was considered appropriate and relevant to the Brazilian cultural context from their perspective. This process allowed the identification of potential ambiguities, comprehension difficulties, or cultural mismatches, contributing to the refinement and cultural adequacy of the adapted instrument. In the present study, the G-38 (16) was administered to exclude below-average intelligence as a potential confounding factor in the interpretation and evaluation of the questionnaire items, ensuring that participants had sufficient cognitive capacity to adequately understand and respond to the instruments and thereby strengthening the validity of the findings. The G-38 is a non-verbal intelligence test designed to assess general cognitive ability, specifically fluid intelligence, through 38 graphic items arranged in increasing order of difficulty. It evaluates logical, analytical, and abstract reasoning without reliance on language or prior knowledge and can be administered in person or online, individually or in groups within a 30-minute time limit. For convergent validity evaluation, the Brazilian Portuguese Adult version of the Social Responsiveness Scale, Second Edition (SRS-2) (17,18) was administered, given its robust psychometric properties and ease of administration. The SRS-2 Adult Form is a standardized, quantitative measure of autism-related social impairment that assesses the severity of difficulties in social awareness, social cognition, social communication, social motivation, and restricted and repetitive behaviors. It consists of 65 items rated on a Likert-type scale, reflecting the frequency of behaviors observed over recent months, and can be completed as a self-report or informant-based questionnaire. The SRS-2 provides total and subscale scores that allow dimensional characterization of autistic traits across the spectrum, facilitating comparison of constructs with the adapted instrument. To explore convergent validity, a preliminary association between total GQ-ASC scores and SRS-2 total T-scores was examined using Spearman’s rank correlation coefficient. Sociodemographic data were collected using the Brazilian Economic Classification Criterion (CCEB), as established by the Associação Brasileira de Empresas de Pesquisa (19). The CCEB is a standardized instrument widely used in Brazil to estimate socioeconomic status based on household characteristics, including ownership of durable goods, access to services, and the educational level of the head of the household. It classifies individuals into economic strata ranging from A to E, allowing a contextualized assessment of socioeconomic conditions. RESULTS The translation and cross-cultural adaptation process resulted in a linguistically and culturally appropriate Brazilian Portuguese version of the GQ-ASC, reflecting a progressive refinement of the instrument across successive stages. Across translations, back-translations, expert review, and lived-experience subjects’ suggestions, the items sustained a high degree of semantic, idiomatic, and conceptual equivalence, with adjustments primarily aimed at enhancing clarity, cultural relevance, and naturalness of language for adult Brazilian women. To ensure transparency and replicability, two comprehensive tables detailing all stages of item development are provided in the supplementary material. Supplementary Table 2 includes the original version (ORG), clinician (T1C) and lay translations (T2L) , the consensus version (CON), and the two independent back-translations (BT1 and BT2). Supplementary Table 3 compares the original version (ORG) with the finalized concise (CPV) and expanded (EPV) Brazilian Portuguese versions of each item. Forward Translation The two independently produced forward translations (T1C and T2L) demonstrated high semantic equivalence, although systematic differences emerged in linguistic register, style, and use of terminology. The clinician translation adopted a more formal and standardized tone, with complete syntactic structures and explicit subject pronouns, whereas the lay translation favored simpler, more natural phrasing consistent with everyday Brazilian Portuguese. In terms of clarity for the target population, the lay version emphasized fluency and intuitive comprehension through more concrete and accessible wording, while preserving the original constructs. Regarding terminology, the clinician version employed clinically neutral language, whereas the lay version used more colloquial and emotionally resonant expressions without altering meaning. Differences were also noted in sentence structure and punctuation, with the clinician translation closely mirroring the original syntax and length and the lay translation shortening sentences to enhance readability and naturalness. Consensus Meeting and Synthesis The consensus process resulted in a synthesized Brazilian Portuguese version (CON) that was linguistically natural, culturally appropriate, and conceptually faithful to the original instrument. Item-level decisions enhanced clarity, oral fluency, and comprehensibility for adult women, including selective omission of explicit subject pronouns and replacement of overly literal terms that could generate ambiguity in Brazilian Portuguese, while fully preserving the intended meaning to support accurate back-translation. Back-Translation The comparison between the original English version of the instrument and the two independent back-translations (BT1 and BT2) demonstrated a high level of semantic and conceptual equivalence. Both back-translations accurately reflected the content, intent, and scope of the original items, with no evidence of meaning distortion, omission of key elements, or introduction of new constructs. Minor differences between the back-translations and the original version were limited to lexical choices and syntactic variations that did not affect the underlying concepts being assessed. Overall, the back-translation process confirmed that the Brazilian Portuguese version adequately preserved the meaning and theoretical framework of the original instrument, supporting its suitability for subsequent expert review and pretesting. Expert Review The evaluation of the consensual version (CON) by the experts revealed that mean ratings across items were consistently high, with all items scoring above 4.0 across domains, indicating strong consensus regarding translation quality (Table 1). The highest-performing items showed means approaching or equal to 5.0 across domains, suggesting culturally appropriate and idiomatically natural formulations. The lowest idiomatic equivalence means were observed for Item 3 and Item 6, which also presented lower proportions of “adequate” endorsements and higher frequencies of “change” endorsements. These findings identified both items as focal areas for refinement, leading to targeted linguistic adjustments aimed at improving naturalness and idiomatic clarity in Brazilian Portuguese. Specifically, Item 3 was rephrased to enhance fluency and comparative clarity, and Item 6 was modified to replace a culturally marked metaphor with a more commonly used expression, resulting in versions that were more easily understood and culturally appropriate for the target population. Table 1. Analysis of the Cultural and Linguistic Equivalences of the Brazilian Version of the GQ-ASC by 7 Experts (Means and Agreement) Question Number Clarity (mean) Semantic Equivalence (mean) Idiomatic Equivalence (mean) Experiential Equivalence (mean) Conceptual Equivalence (mean) Adequate (agreement) Change (agreement) 1 4.71 4.71 4.86 4.86 4.71 100.0% 14.3% 2 5.00 5.00 5.00 4.86 4.86 100.0% 0.0% 3 4.29 4.14 3.71 4.00 4.00 57.1% 42.9% 4 5.00 5.00 4.86 4.86 4.57 100.0% 14.3% 5 4.43 4.57 4.29 4.57 4.43 100.0% 28.6% 6 4.14 4.29 3.86 4.00 3.86 71.4% 42.9% 7 4.86 4.71 4.71 4.57 4.57 85.7% 14.3% 8 4.71 4.86 4.86 4.71 4.86 100.0% 0.0% 9 4.57 4.29 4.57 4.57 4.57 85.7% 14.3% 10 4.71 4.71 4.71 4.71 4.71 85.7% 14.3% 11 4.29 4.29 4.43 4.57 4.29 85.7% 14.3% 12 4.71 4.57 4.71 4.71 4.71 100.0% 0.0% 13 4.29 4.43 4.14 4.14 4.43 85.7% 42.9% 14 5.00 4.86 5.00 5.00 5.00 100.0% 0.0% 15 4.57 4.57 4.57 4.57 4.57 85.7% 28.6% 16 5.00 5.00 5.00 5.00 5.00 100.0% 0.0% 17 4.86 4.71 4.71 4.86 4.86 85.7% 14.3% 18 5.00 5.00 5.00 4.71 5.00 100.0% 0.0% 19 5.00 5.00 5.00 4.71 5.00 100.0% 0.0% 20 5.00 5.00 4.86 4.57 4.57 100.0% 14.3% 21 5.00 5.00 5.00 5.00 5.00 100.0% 0.0% Analysis of the 21 questions from the preliminary version of the Girls Questionnaire for Autism Spectrum Condition conducted by 7 independent experts. For each item, the mean scores (Likert scale 1-5) are presented in the five dimensions of Clarity and Equivalence (Semantic, Idiomatic, Experiential, and Conceptual) and the percentages of "Yes" agreement in the binary questions "Is the translation adequate?" and "Should be changed?". Qualitatively, suggestions focused on fine-grained idiomatic and clarity improvements rather than conceptual concerns. Recommendations included minor adjustments to pronoun use, replacing terms perceived as overly rigid or culturally uncommon, improving fluency, and refining examples to avoid ambiguity. Several items received no suggested changes, reflecting broad acceptability of their phrasing. Pretest Sample Through the online form, a total of 230 individuals registered an interest to participate in the study. Based on order of registration and eligibility criteria, the first 40 registrants were invited via WhatsApp. Of these, 31 responded and provided medical documentation confirming ASD diagnosis according to DSM-5-TR (3) criteria, with corresponding ICD coding (ICD-10 F84.0, F84.1, F84.5, or ICD-11 6A02 and subdivisions) (20,21). The pretest included 31 cisgender women. Age ranged from 21 to 64 years (mean 35.3, SD 9.1). Most participants identified as heterosexual, and most self-identified as White. Educational attainment was high, with the majority reporting completed higher education, and socioeconomic classification concentrated in ABEP (19) classes B1 and B2 (Table 2). Table 2 – Characterization of the Sample (n = 31) Variable Category n % Age (years) Mean ± SD (21–64) 35,3 ± 9,1 Age Range (years) 20 to 29 9 29,0 30 to 39 13 41,9 40 to 49 7 22,6 ≥50 2 6,5 Gender Identity Cisgender Woman 31 100,0 Biological Sex at Birth Female 31 100,0 Sexual Orientation Heterosexual 20 64,5 Bisexual 5 16,1 Asexual 2 6,5 Homosexual 2 6,5 Other (pansexual, queer) 2 6,4 Ethnicity White 27 87,1 Brown 2 6,5 Black 1 3,2 Other 1 3,2 Relationship Status In a relationship and living together 16 51,6 Single (previously in a relationship) 9 29,0 In a relationship (not living together) 4 12,9 Single (never in a relationship) 2 6,5 Education Completed higher education 25 80,6 Completed secondary education / incomplete higher education 6 19,4 Occupation Employed 11 35,5 Self-Employed 8 25,8 Student 6 19,4 Unemployed 3 9,7 Other 3 9,7 Social Class (ABEP) Class A (Upper Class) 5 16,1 Class B1 (Upper-Middle Class) 12 38,7 Class B2 (Middle Class) 8 25,8 Class C1 (Lower-Middle Class) 6 19,4 G-38 Intellectual Classification Lower 2 6,7 Lower-Average 2 6,7 Average 15 50,0 Upper-Average 9 30,0 Superior 2 6,7 SRS-2 Classification (Total T-score) Within Normal Limits (≤ 59) 0 0 Mild Impairments (60 – 65) 3 9,7 Moderate Impairments (66 – 75) 27 87,1 Severe Impairments (≥ 76) 1 3,2 Participant ratings of comprehension, clarity, and language adequacy were generally high across items, with most items showing a large proportion of responses in the upper range (scores 4–5) and elevated mean values, supporting the overall comprehensibility and acceptability of the instrument (Table 3). A small number of items displayed comparatively lower ratings, highlighting specific targets for refinement. Table 3 - Evaluation of participants' comprehension, clarity, and linguistic appropriateness of the questions No. Question Did you understand what was asked? Language Clarity Language Appropriateness % (4-5) mean % (4-5) mean % (4-5) mean 1 Q01_FANTASY_WORLDS 80,80% 4,27 76,90% 4,19 96,20% 4,85 2 Q02_INTEREST_IN_FICTION 92,00% 4,76 96,00% 4,72 100,00% 4,92 3 Q03_PLAYED_IMAGINATION 91,70% 4,75 87,50% 4,67 100,00% 4,96 4 Q04_IMAGINARY_FRIENDS 95,70% 4,87 95,70% 4,87 100,00% 5,00 5 Q05_COMPLEX_SETUPS 90,90% 4,73 90,90% 4,77 95,50% 4,82 6 Q06_COPY_OR_IMITATE 95,20% 4,86 90,50% 4,76 100,00% 4,95 7 Q07_OBSERVE_OTHERS 100,00% 4,95 100,00% 4,95 100,00% 4,90 8 Q08_ATRACTED_STRONG 84,20% 4,53 84,20% 4,42 94,70% 4,79 9 Q09_DIFFERENT_PERSONA 94,40% 4,89 100,00% 4,89 100,00% 4,94 10 Q10_ATTACHED_OBJECTS 94,10% 4,82 94,10% 4,88 100,00% 4,82 11 Q11_DISCONFORT_GROOMING 93,80% 4,75 81,30% 4,44 87,50% 4,56 12 Q12_SOCIAL_MUTE 100,00% 4,93 100,00% 4,93 93,30% 4,67 13 Q13_SMELLS_FLAVOURS 100,00% 5,00 100,00% 5,00 100,00% 5,00 14 Q14_SOCIAL_EXAUSTED 100,00% 4,85 92,30% 4,69 100,00% 5,00 15 Q15_SOCIAL_MASK 91,70% 4,58 91,70% 4,58 91,70% 4,58 16 Q16_INTENSE_EMOTIONS 100,00% 5,00 100,00% 5,00 100,00% 5,00 17 Q17_APOLOGIZE_MISTAKE 100,00% 4,80 90,00% 4,50 100,00% 4,90 18 Q18_GIRLS_TOYS 100,00% 4,89 100,00% 4,89 100,00% 5,00 19 Q19_BOYS_TOYS 100,00% 4,88 100,00% 4,88 100,00% 5,00 20 Q20_ADVANCED_INTERESTS 100,00% 4,86 100,00% 4,71 100,00% 4,86 21 Q21_TALENT_MUSIC 100,00% 4,83 100,00% 4,83 100,00% 5,00 Results of the evaluation performed by the study participants regarding the comprehension of the questions, clarity of language, and linguistic appropriateness of the Brazilian version of the instrument. For each item, the percentage of responses with a score of 4 or 5 (on a Likert scale of 1 to 5) and the average of the scores assigned are presented, considering the domains: "Did you understand what was asked?", "Clarity of language," and "Appropriateness of language." The items are identified by alphanumeric codes corresponding to the respective questions of the instrument. Preliminary Score Distribution and Convergent Pattern Total GQ-ASC scores in the sample ranged from 56 to 71 (possible range 21 to 84), with a mean of 63.3 (SD = 4.4) and a median of 62.5 (IQR = 6.8). The histogram (Figure 2) suggested concentration in moderately elevated scores with limited dispersion, without visually prominent extreme outliers. All participants scored above the original English cut-off of 56, which is described as indicating high levels of autistic traits in the original scale, supporting expected performance in this ASD-confirmed sample. The SRS-2 was used both to corroborate the clinical diagnosis documented in the medical reports provided by the participants and to generate an initial estimate of potential convergent validity with the GQ-ASC. Total SRS-2 T-scores indicated clinically significant impairment in social responsiveness, with most participants falling within the moderate range and a small minority in the mild or severe ranges (Table 2). Subscale patterns suggested higher impairment in social motivation, social communication, and restricted and repetitive behaviors, consistent with core ASD features (Supplementary Table 4). A preliminary association between total GQ-ASC scores and SRS-2 total T-scores was positive and of moderate magnitude (Spearman's ρ = 0.41). The scatterplot (Figure 3) demonstrated that higher GQ-ASC totals correlated with higher SRS-2 T-scores, while still showing meaningful inter-individual variability, consistent with related but non-identical constructs and the dimensional nature of autistic traits. Cognitive Debriefing Findings Qualitative analysis of participant comments identified recurring barriers to comprehension and item interpretation, organized into five thematic categories: 1. Lexical and conceptual ambiguity Participants reported multiple interpretations for terms such as “fantasy,” “fiction,” “personality,” and “attraction,” with ambiguity between genre versus imagination, or romantic versus sexual versus admiring attraction. Examples: Item: “When I was 5-12 years old, I played as imaginatively as other girls.” “I keep wondering if it only concerns, for example, fictional things and not things, for example, getting stuck in my head thinking about things that don't exist.” Item: “I am interested in fiction.” “I don't know if it's a fantasy world that I create, or a fantasy world that already exists, like Harry Potter or others in that sense.” Item: “I adopt a different personality in different situations” “This part about personality felt a bit vague to me, because I wasn’t sure whether it meant personality in a psychological sense or just someone’s way of being.” Item: “I am attracted to females with strong personalities who tell me what to do.” “The word attraction confused me, because it can mean interest, admiration, something intellectual, not necessarily something romantic.” Item: “When I was 5-12 years old, I played as imaginatively as other girls.” “When it talks about imagination, I don’t know if it means being creative or escaping from reality, and that really changes how I answer.” 2. Theory of mind and self-referential comparison demands Items requiring comparison to “other girls” or evaluation of “socializing well” were sometimes difficult due to uncertainty about normative standards, and items about apologizing for social mistakes were challenging when errors were not reliably perceived. Examples: Item: “When I was 5-12 years old, I played as imaginatively as other girls.” “I don't know what they imagined, so I wouldn't know how to compare.” Item: “I socialise quite well for a while, but subsequently feel exhausted.” “When it asks whether I socialize well, I’m not sure what ‘well’ means, because I don’t know what the normal is.” Item: “I apologise when I make a social error.” “I disagree perhaps totally because I never realize when something is inappropriate.” “The problem is knowing when we've made a mistake. Yes. Sometimes, we don't realize it.” 3. Logical structure of the item Items combining two premises within a single statement produced response conflicts, for example endorsing one clause but not the other. Examples: Item: “I am attracted to females with strong personalities who tell me what to do.” Example: “I get along with people with strong personalities in general, but that doesn’t necessarily mean I want to obey them.” Item: “I socialise quite well for a while, but subsequently feel exhausted.” Example: “And what if I disagree with part of the sentence? Because I don't know if... Yes, I feel exhausted, but I don't know if it's because I am socializing very well.” Item: “I am distressed by certain smells or I avoid certain tastes that are a typical part of a diet.” Example: “Smells. Flavors, no, although this is interconnected, I am very sensitive to smells... So maybe I partially agree... Smells yes, but I... okay.” 4. Adequacy of contextual examples Some examples were experienced as infantilizing or overly restrictive, particularly in adulthood. Participants recommended broader adult-relevant examples and inclusion of missing sensory modalities, notably texture. Examples: Item: “I am attached to certain objects or toys, for example, a favorite toy, pillow, piece of cloth...” “But I think there might be adult women my age who will answer this and might feel, 'oh, but I don't have a toy.' Maybe give it another name, just objects... ” Item: “I am distressed by certain smells or I avoid certain tastes that are a typical part of a diet.” “Regarding food and food items, it's very much a question of texture. Like, I like ketchup, but I can't eat tomatoes because of the seed. Pudding. I don't like the texture of pudding... ” “Oh, and there is the texture part too, which if it fits in this question, you can insert it, right? Which is texture, I have a lot of [issues with] food textures that I can't eat... the texture of a little ball like that, no, I can't. ” 5. Clarity of technical or community-specific terms Metaphors and terms such as “mask” or “social confusion,” as well as words with multiple clinical interpretations, were not uniformly understood, suggesting the need for clearer behavioral descriptions or brief clarifying language. Examples: Item: “I often have a facial mask that hides my ‘social confusion’.” “I don't understand the part in quotation marks... It was social confusion. For me, sometimes, it's the social environment with a lot going on.” “My question is what social confusion is... What does ‘social’ mean here?” Documentation, Final Review, and Proposed Revisions Technical reports were produced throughout all phases to document decisions, discrepancies, challenges, and resolutions, supporting transparency and methodological traceability. The coordinating team reviewed all documentation, integrating expert feedback, quantitative participant ratings, and cognitive debriefing themes. In response to improvement suggestions raised by participants during these last steps, two instrument formats were proposed for future validation. The concise version (CPV) corresponds to the version applied in the present study, whereas the expanded version (EPV) incorporates participant-informed clarifications and additional explanatory cues. Both versions preserve the original constructs and are presented in the supplementary material (Supplementary Table 3). Planned next steps include systematic comparison of the concise and expanded versions in a subsequent psychometric validation phase, assessing internal consistency, factor structure, stability, and acceptability, and evaluating whether the expanded version offers practical advantages in specific clinical or research contexts. DISCUSSION Autism in women remains under-recognized in both clinical and research contexts. This issue is further amplified in cross-cultural settings, where literal translation alone may fail to address culturally grounded meanings and experiential nuances (22). In this context, the present study aimed to translate, culturally adapt, and pretest a Brazilian Portuguese version of the GQ-ASC in a clinical sample of autistic adult women. The process resulted in two Brazilian Portuguese versions of the GQ-ASC: a concise version, prioritizing linguistic equivalence with the original instrument, and an expanded version, incorporating clarifications based on participant feedback addressing cultural and conceptual ambiguities. Cognitive debriefing indicated that most items were perceived as relevant and recognizable, with participants frequently relating item content to their own developmental histories and adaptive strategies. At the same time, difficulties were identified, including lexical ambiguity, dual-premise items, demands for social comparison, and examples insufficiently anchored in adult contexts. Consequently, this sheds light upon a broader methodological issue in scale adaptation for mental health assessment. Translated instruments often focus on linguistic equivalence while giving limited attention to systematic pretesting with members of the target population, leading to literal translations despite reported ambiguities or culturally specific misinterpretations (23). This practice might be behind difficulties in replicating factor structures and measurement properties across cultural contexts, with methodological shortcomings frequently addressed only at later psychometric stages (24,25). Recent studies further indicate that, in Brazil, even adaptations that claim adherence to cross-cultural guidelines often implement these procedures only partially (26). For example, the PHQ-9, one of the most widely used depression screening questionnaires in Brazil, underwent a process limited essentially to literal translation and back-translation (27,28), without formal cognitive debriefing with the target population, underscoring how cultural validation steps are frequently minimized. When compared with other instruments used to screen for autism in adults within the Brazilian context, the present study both aligns with some and surpasses others prior adaptation efforts. Earlier Brazilian work with the Autism-Spectrum Quotient (AQ) relied primarily on direct translation and back-translation followed by psychometric validation, without a formal pretest or systematic cultural refinement (29). In contrast, the Brazilian adaptation of the Broad Autism Phenotype Questionnaire (BAPQ) incorporated expert review, back-translation, and pilot testing with respondents, although limited by a very small sample size (30). Additionally, the Ritvo Autism Asperger Diagnostic Scale – Revised - Reduced Brazilian Version (RAADS-R-BR Screen) was developed through a more similar process of cross-cultural adaptation of the original instrument and included an adequate pretest phase to evaluate item comprehension and applicability (31). Building on these precedents, the present adaptation process places greater emphasis on iterative refinement through expert consensus and cognitive debriefing with the target population, explicitly integrating respondent experience into item evaluation. Although the preliminary results incipiently show consistency with the original version threshold and a moderate correlation between the CPV and the SRS-2, the present study does not ascertain internal validity, convergent validity or the relative psychometric performance of the two versions but documents the rationale for proposing both for subsequent study. Despite these promising findings, several limitations must be acknowledged. The small, non-probabilistic sample limits the generalizability of findings and does not permit robust psychometric analyses, such as confirmatory factor analysis or tests of measurement invariance. Reliance on self-report introduces potential biases related to memory, insight, and camouflaging behaviors, which may influence how participants interpret and endorse items (32). The absence of non-autistic and psychiatric comparison groups restricts conclusions about specificity and discriminative validity, and qualitative data were collected for cognitive debriefing purposes rather than through formal, systematically analyzed qualitative methods. The aforementioned constraints are consistent with the exploratory nature of a pretest study but highlight the need for further investigation. Future validation should explicitly compare the concise pretest version (CPV) and the expanded pretest version (EPV), examining internal consistency, factor structure, item functioning, and associations with external measures, and should investigate whether expanded cues improve precision without inflating scores or changing construct coverage. It must also include larger and more diverse samples, encompassing autistic and non-autistic comparison groups, as well as individuals with other psychiatric conditions, to allow a more comprehensive evaluation of diagnostic utility and construct specificity. CONCLUSION In conclusion, the Brazilian Portuguese version of the GQ-ASC demonstrates promising preliminary adequacy for use with autistic adult women, showing high acceptability, cultural relevance, and strong conceptual alignment with the original instrument. These findings are particularly relevant given that a substantial proportion of autistic women do not receive an accurate or timely diagnosis, often due to limitations in existing assessment tools and gender-related diagnostic biases (33). Most autism diagnostic instruments were originally standardized in pediatric populations (34), contributing to the frequent misdiagnosis of autistic adults, especially women, with other psychiatric conditions prior to receiving a formal autism diagnosis. This diagnostic trajectory underscores the urgent need for instruments and clinical approaches that are sensitive to the adult female autism phenotype (35). The present findings support progression to larger-scale validation studies to examine reliability, structural validity, criterion validity, and clinical utility across diverse Brazilian samples. With further psychometric refinement, the GQ-ASC has the potential to become a valuable complementary tool for both research and clinical assessment of autism in adult women in Brazil. Abbreviations ABEP: Brazilian Association of Research Companies ASD: Autism Spectrum Disorder CAAE: Certificate of Presentation to the Research Ethics Committee CAPES: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil CCEB: Brazilian Economic Classification Criterion CPV: Concise Brazilian Portuguese Version DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision EPV: Expanded Brazilian Portuguese Version G-38: G-38 - Nonverbal Intelligence Test GQ-ASC: Girls Questionnaire for Autism Spectrum Condition LGPD: Brazilian General Data Protection Law ROC: Receiver Operating Characteristic SRS-2: Social Responsiveness Scale, Second Edition Declarations Ethics approval and consent to participate This study was approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil Certificate of Presentation to the Research Ethics Committee (CAAE): 84506224.4.0000.5327. All participants provided written informed consent prior to participation. All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments. Consent for publication Not applicable. This manuscript does not contain any individual person's data in any form (including images, videos, or personal clinical details) that could lead to participant identification. Availability of data and materials All data supporting the findings of this study are available within the article and its Supplementary Information files. Additional information related to the dataset may be obtained from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001. Authors’ contributions A.V.S. wrote the main manuscript and conducted the study as part of his master’s research project. P.V. conducted the IQ assessments of the participants. A.C.S. coordinated the translation process and led the meetings with the translators. J.P. was responsible for organizing and conducting the expert committee review. A.S.G.M. served as co-supervisor of the project and contributed to the study design and manuscript review. T.A., the author of the original scale, provided expert consultation throughout the project. A.C. supervised the project as the principal investigator and main advisor. All authors reviewed and approved the final manuscript. Acknowledgements The authors thank the autistic women who generously participated in this study and shared their experiences during the cognitive debriefing interviews. Their contributions were essential for improving the cultural clarity and applicability of the Brazilian Portuguese version of the instrument. 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Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, et al. “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. J Autism Dev Disord. 2017 Aug;47(8):2519–34. Buescher AVS, Cidav Z, Knapp M, Mandell DS. Costs of Autism Spectrum Disorders in the United Kingdom and the United States. JAMA Pediatr. 2014 Aug 1;168(8):721. Tony Attwood, Michelle S Garnett, Agnieszka Rynkiewicz. GIRLS’ QUESTIONNAIRE FOR AUTISM SPECTRUM CONDITIONS [Internet]. 2011. Available from: https://img1.wsimg.com/blobby/go/248a1726-f511-4023-953b-9b7298cd65bd/downloads/GQ-ASC_13-19_Years.pdf?ver=1601456687816 Brown CM, Attwood T, Garnett M, Stokes MA. Am I Autistic? Utility of the Girls Questionnaire for Autism Spectrum Condition as an Autism Assessment in Adult Women. Autism Adulthood. 2020 Sep 1;2(3):216–26. Validation of the Girls Questionnaire for Autism Spectrum Condition in French Language (fGQ-ASC) [Internet]. University Hospital, Grenoble; 2024. Available from: https://clinicaltrials.gov/study/NCT06280521 Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures: Spine. 2000 Dec;25(24):3186–91. Serviço de Tradução Profissional Online - Protranslate [Internet]. [cited 2025 Dec 21]. Available from: https://www.protranslate.net/pt/ Soluções linguísticas profissionais para o seu negócio – Translated [Internet]. [cited 2025 Dec 21]. Available from: https://translated.com/bem-vindo ColeçãoG-38. Vetor Editora; 2021. Bölte S, Poustka F, Constantino JN. Assessing autistic traits: cross-cultural validation of the social responsiveness scale (SRS). Autism Res. 2008 Dec;1(6):354–63. Bruni TP. Test Review: Social Responsiveness Scale–Second Edition (SRS-2). J Psychoeduc Assess. 2014 Jul;32(4):365–9. Critério de Classificação Econômica Brasil – CCEB [Internet]. ASSOCIAÇÃO BRASILEIRA DE EMPRESAS DE PESQUISA – ABEP; [cited 2024 Sep 24]. Available from: https://www.abep.org/criterio-brasil CID-11 [Internet]. [cited 2025 Dec 21]. Available from: https://icd.who.int/pt/ World Health Organization, editor. International statistical classification of diseases and related health problems. 10th revision, 2nd edition. Geneva: World Health Organization; 2004. 3 p. Berkanovic E. The effect of inadequate language translation on Hispanics’ responses to health surveys. Am J Public Health. 1980 Dec;70(12):1273–6. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005 Mar;8(2):94–104. Borsa JC, Damásio BF, Bandeira DR. Adaptação e validação de instrumentos psicológicos entre culturas: algumas considerações. Paid Ribeirão Preto. 2012 Dec;22(53):423–32. Cruchinho P, López-Franco MD, Capelas ML, Almeida S, Bennett PM, Miranda Da Silva M, et al. Translation, Cross-Cultural Adaptation, and Validation of Measurement Instruments: A Practical Guideline for Novice Researchers. J Multidiscip Healthc. 2024 May;Volume 17:2701–28. Bento MMDS, Elias CS, Barba PCDSD. Beaton’s guidelines in cross-cultural adaptation studies in Brazil: a systematic review. O Mundo Saúde [Internet]. 2025 Jun 6 [cited 2026 Jan 24];49. Available from: https://revistamundodasaude.emnuvens.com.br/mundodasaude/article/view/1889 Fraguasjr R, Gonsalveshenriquesjr S, Delucia M, Iosifescu D, Schwartz F, Rossimenezes P, et al. The detection of depression in medical setting: A study with PRIME-MD. J Affect Disord. 2006 Mar;91(1):11–7. Santos IS, Tavares BF, Munhoz TN, Almeida LSPD, Silva NTBD, Tams BD, et al. Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da população geral. Cad Saúde Pública. 2013 Aug;29(8):1533–43. Do Egito JHT, Ferreira GMR, Gonçalves MI, Osório AAC. Brief Report: Factor Analysis of the Brazilian Version of the Adult Autism Spectrum Quotient. J Autism Dev Disord. 2018 May;48(5):1847–53. Prata LDL, Camargos Junior W, Teodoro MLM, Rocha FL. Qualidades psicométricas da versão brasileira da Escala Broad Autism Phenotype Questionnaire (BAPQ-Br). Context Clínicos. 2019 Apr 8;12(1):186–203. Hartwig, M. D. Tradução e adaptação transcultural do Ritvo Autism Asperger Scale Revised (RAADS‑R) para o português do Brasil [Internet]. Universidade Federal Rural do Rio de Janeiro – UFRRJ; 2023. Available from: https://rima.ufrrj.br/jspui/handle/20.500.14407/20797 Stacey R, Cage E. “Simultaneously Vague and Oddly Specific”: Understanding Autistic People’s Experiences of Decision Making and Research Questionnaires. Autism Adulthood. 2023 Sep;5(3):263–74. Huang Y, Arnold SR, Foley KR, Trollor JN. Diagnosis of autism in adulthood: A scoping review. Autism. 2020 Aug;24(6):1311–27. Hirota T, So R, Kim YS, Leventhal B, Epstein RA. A systematic review of screening tools in non-young children and adults for autism spectrum disorder. Res Dev Disabil. 2018 Sep;80:1–12. Kentrou V, Livingston LA, Grove R, Hoekstra RA, Begeer S. Perceived misdiagnosis of psychiatric conditions in autistic adults. eClinicalMedicine. 2024 May;71:102586. Additional Declarations No competing interests reported. Supplementary Files Supplementary.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 May, 2026 Reviews received at journal 05 May, 2026 Reviewers agreed at journal 19 Apr, 2026 Reviews received at journal 19 Apr, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviewers agreed at journal 26 Mar, 2026 Reviewers invited by journal 26 Mar, 2026 Editor assigned by journal 26 Mar, 2026 Editor invited by journal 12 Mar, 2026 Submission checks completed at journal 11 Mar, 2026 First submitted to journal 11 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9034580","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":635059968,"identity":"0a98dc27-f374-4ec1-9f55-2c5e1f8ecafb","order_by":0,"name":"Alex Vicente Spadini","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYDACdhjjeAOQMLAgQgszjHHmAEiLBClabiSASCK08DczH5P82WaTz3fz+dUNPwokGPjbuxPwapE4zJZszNuWZjnzdk7ZzR6gwyTOnN2A35rDPIaPGbcdNjC4nZN2gweoxUAiF78W+cP8Hw7+BGm5eSbt5h9itBgc5mF8wAvScoP92G2ibDE8zGZszPsvzUDyTA7bbRkDCR6CfpE73vxM8scZGwO+48ef3Xzzx0aOv72XgPcRgMcATBKrHATYH5CiehSMglEwCkYQAAC440gVQcydVwAAAABJRU5ErkJggg==","orcid":"","institution":"Federal University of Rio Grande do Sul","correspondingAuthor":true,"prefix":"","firstName":"Alex","middleName":"Vicente","lastName":"Spadini","suffix":""},{"id":635059969,"identity":"cb3e04eb-ea07-4362-9861-4f0aaf2f85f4","order_by":1,"name":"Pedro Verçoza","email":"","orcid":"","institution":"Federal University of Rio Grande do Sul","correspondingAuthor":false,"prefix":"","firstName":"Pedro","middleName":"","lastName":"Verçoza","suffix":""},{"id":635059973,"identity":"ad481fb7-fa64-4e12-b30e-1b3899bd4d20","order_by":2,"name":"Alessandro Chmiel dos Santos","email":"","orcid":"","institution":"Faculdade das Américas","correspondingAuthor":false,"prefix":"","firstName":"Alessandro","middleName":"Chmiel dos","lastName":"Santos","suffix":""},{"id":635059975,"identity":"3b7ab06d-c0cf-4d43-9980-75d63f2e88b2","order_by":3,"name":"Joana Portolese","email":"","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Joana","middleName":"","lastName":"Portolese","suffix":""},{"id":635059978,"identity":"a02f9d71-70ac-4261-962d-47f7fea87419","order_by":4,"name":"Ana Soledade Graeff-Martins","email":"","orcid":"","institution":"Federal University of Rio Grande do Sul","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Soledade","lastName":"Graeff-Martins","suffix":""},{"id":635059980,"identity":"8f896f61-1b74-42be-8801-a816c218ac05","order_by":5,"name":"Tony Attwood","email":"","orcid":"","institution":"Griffith University","correspondingAuthor":false,"prefix":"","firstName":"Tony","middleName":"","lastName":"Attwood","suffix":""},{"id":635059989,"identity":"fc98fa22-f227-48b3-b9e4-8e39130fcf18","order_by":6,"name":"Arthur Caye","email":"","orcid":"","institution":"Federal University of Rio Grande do Sul","correspondingAuthor":false,"prefix":"","firstName":"Arthur","middleName":"","lastName":"Caye","suffix":""}],"badges":[],"createdAt":"2026-03-05 01:23:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9034580/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9034580/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108955242,"identity":"a06aa752-c164-435d-8c1a-64b5109e2524","added_by":"auto","created_at":"2026-05-11 08:06:30","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48428,"visible":true,"origin":"","legend":"\u003cp\u003eSummary of the phases and the versions produced. Adapted from Beaton et al. (2000)(13).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9034580/v1/9ab3a7f61d2faa4efd801456.jpg"},{"id":108977537,"identity":"02ebd947-5fe6-46bb-950a-67ef97a59620","added_by":"auto","created_at":"2026-05-11 11:32:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23576,"visible":true,"origin":"","legend":"\u003cp\u003eHistogram of total scores obtained by study participants on the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC), an instrument composed of 21 items, with a total score ranging from 21 to 84. The horizontal axis represents the total score values ​​and the vertical axis indicates the number of participants at each score, allowing visualization of the dispersion and concentration of scores in the studied sample.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9034580/v1/892ee2f0cac7f53d1de6b389.png"},{"id":108978206,"identity":"a17ba7bc-27e8-4122-a770-8306cba3670c","added_by":"auto","created_at":"2026-05-11 11:34:56","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":35528,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between Total Scores on the GQ-ASC and SRS-2 Scales. The scatter plot illustrates the relationship between the total raw score on the Autism Spectrum Quotient Questionnaire (GQ-ASC) (horizontal axis) and the total T-score on the Social Responsiveness Scale (SRS-2) (vertical axis) for the sample participants. Blue Dots: Each dot represents an individual participant. Red Line: The linear regression line indicates the overall trend of the data, demonstrating a moderate positive correlation (ρ = 0.41). As the GQ-ASC score increases, the SRS-2 score tends to increase. Green Dashed Line: Marks the clinical cutoff point of 56 points on the GQ-ASC scale. Points located to the right of this line indicate participants who scored above the screening threshold for autism spectrum characteristics.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9034580/v1/20e6bc692b6466a543c0c64a.png"},{"id":108979928,"identity":"30d19057-4b8b-4bd5-bc39-07aacdcb3f2b","added_by":"auto","created_at":"2026-05-11 12:02:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":629565,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9034580/v1/7ee55b53-dd83-42ef-8630-d5f5ee6af625.pdf"},{"id":108977606,"identity":"2a2bec62-6dd9-489d-8f32-7fa0bcbb858b","added_by":"auto","created_at":"2026-05-11 11:32:18","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":4076620,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-9034580/v1/6811dbb11d0378cd147af5e7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Translation, Cross-cultural adaptation and Pretest of the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) for Brazilian Portuguese","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAutism Spectrum Disorder (ASD) has historically been conceptualized and studied through a predominantly male-centric lens. Since the early descriptions by Kanner (1) and Asperger (2), the diagnostic criteria have been largely based on behavioral observations of boys, establishing a male-based model of autism as the clinical gold standard. This ascertainment bias has led to a systematic oversight of autistic females, resulting in a male-to-female diagnostic ratio that, while historically estimated at 4:1 (3,4), is increasingly being challenged by recent epidemiological data suggesting a much narrower gap when active case ascertainment is employed (5). Consequently, many women with ASD remain undiagnosed or receive misdiagnoses, such as borderline personality disorder, anxiety, or depression, before they are correctly identified (6).\u003c/p\u003e\n\u003cp\u003eEmerging research highlights the existence of a distinct female phenotype of autism, which differs significantly from the classic male presentation (7). Women on the spectrum often display higher levels of social motivation and better capacity for social imitation than their male counterparts, which can mask their underlying difficulties. Unlike the mechanical or technical restricted interests frequently observed in males, autistic women often develop intense interests in culturally appropriate topics, such as literature, psychology, animals, or fashion, making their repetitive behaviors less conspicuous to clinicians (8). A core feature of this phenotype is social camouflaging: the conscious or unconscious use of cognitive strategies to mask autistic traits and socially adapt. While camouflaging facilitates social inclusion, it comes at a high psychological cost, frequently leading to \"autistic burnout,\" sensory exhaustion, and severe mental health comorbidities (9).\u003c/p\u003e\n\u003cp\u003eTo address this limitation, the \u003cem\u003e“Girls Questionnaire for Autism Spectrum Condition”\u0026nbsp;\u003c/em\u003e(GQ-ASC) was developed by Attwood, Garnett, and colleagues (10). Unlike traditional scales, the GQ-ASC is designed to assess autism spectrum characteristics in adult women. The 21 self-reported items are organized according to a five-component structure identified through Principal Component Analysis. This structure reflects key domains of autism presentation in adulthood, particularly those more commonly reported by women. The five components include imagination and play, capturing interests in fantasy, fiction, and the nature of imaginative play in childhood; camouflaging, describing efforts to reduce the visibility of autistic traits in social contexts; sensory sensitivities, encompassing hypersensitivities and hyposensitivities across multiple sensory modalities; socialization, reflecting difficulties in social understanding and participation; and intense interests that are not stereotypically feminine. Items are rated on a four-point Likert scale, allowing a dimensional assessment of the presence and severity of autistic traits. Total scores range from 21 to 84, with scores above 56 showing approximately 80% sensitivity for autism cases. Six normative items are reverse scored to reduce acquiescence and confirmation biases. The scale has demonstrated excellent discriminative validity between autistic and non-autistic adult women, with an area under the ROC curve of 0.89 (11). The original english GQ-ASC version, publicly available and free for use, is included in the supplementary material \u003cstrong\u003e(Supplementary Table 1)\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCurrently, there is no validated version of this instrument for the Portuguese-speaking population. The availability of a culturally adapted screening tool is crucial for improving diagnostic accuracy and clinical care in Brazil. Therefore, this study aims to translate and culturally adapt the GQ-ASC for Brazilian Portuguese and to assess its comprehensibility, equivalence and feasibility through a pilot study with adult women formally diagnosed with ASD.\u003c/p\u003e"},{"header":"METHODS","content":"\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThis study followed established international guidelines for the translation and cross-cultural adaptation of self-report instruments, aligning with previous validation efforts of the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) and related studies (11,12). The methodological framework was based on the protocol proposed by Beaton et al. (13), which comprises six sequential stages designed to ensure semantic, idiomatic, experiential, and conceptual equivalence between the original instrument and its adapted version. Formal authorization to translate and adapt the original GQ-ASC was obtained from the instrument’s author on August 27, 2023.\u003c/p\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (HCPA) under the Certificate of Presentation to the Research Ethics Committee (CAAE): 84506224.4.0000.5327. All procedures complied with national and international ethical standards for research involving human participants, including respect for autonomy, beneficence, non-maleficence, and justice. All participants received detailed information regarding the study objectives, procedures, potential risks, and benefits. Written informed consent was obtained prior to participation. Participation was voluntary, and individuals could withdraw at any point without any consequences. Participant confidentiality and data privacy were strictly maintained in accordance with the Brazilian General Data Protection Law (LGPD, Law No. 13.709/2018). Data were anonymized, coded, and stored in a secure environment. Access was restricted to authorized research team members only. Results were reported in aggregate form to prevent individual identification.\u003c/p\u003e\n\u003cp\u003eArtificial intelligence–based (AI) language assistance was used during the preparation of this manuscript to support linguistic revision, improve clarity, and enhance readability in English. The use of AI was limited to text editing and did not influence the study design, data collection, data analysis, interpretation of results, or the scientific conclusions presented in this article.\u003c/p\u003e\n\u003ch3\u003eTranslation and Cross-Cultural Adaptation Procedure\u003c/h3\u003e\n\u003cp\u003eThe cross-cultural adaptation of the GQ-ASC followed the six-step process outlined by Beaton et al. (13) and its summary is presented in Figure 1. Initially, two independent forward translations into the target language were produced by bilingual translators with distinct profiles, one with clinical expertise (T1C) and the other from a lay background (T2L), allowing for the identification of ambiguities and discrepancies between versions. These translations were then synthesized into a single consensual version (CON) through discussion among the translators and an observer, with all decisions and underlying rationales carefully documented. Subsequently, the synthesized version underwent back-translation (BT1 and BT2) into the source language by two native speakers from two professional translation companies (14,15) who were blinded to the original instrument, a step designed to identify potential semantic or conceptual inconsistencies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeven independent experts reviewed the consensual version (CON) to support development of a prefinal version prior to pretesting. The panel included four child and adolescent psychiatrists with additional training in adult psychiatry, one psychologist with extensive experience in autism, and two linguists, one specializing in health terminology and one with experience translating health scales. Feedback was collected via a structured online form assessing clarity, translation adequacy, and four equivalence domains (semantic, idiomatic, experiential, conceptual) using 1 to 5 Likert ratings, plus two binary items (“translation adequate?” and “change?”).\u003c/p\u003e\n\u003cp\u003eThereafter, the coordinating committee reviewed the experts suggestions and produced the prefinal version (CPV), systematically evaluating and documenting semantic, idiomatic, experiential, and conceptual equivalence. The CPV was pretested in a sample of 31 individuals from the target population, using cognitive interviews to assess item comprehension and response patterns (e.g., the pretest phase). Participants rated each item on Likert scales assessing whether they understood what was asked, clarity of language, and adequacy of language. Finally, all reports and materials generated throughout the process were submitted to the coordinating committee for appraisal, ensuring adherence to recommended guidelines for cross-cultural adaptation. To enhance transparency, detailed documentation of each stage of the translation and adaptation process, including item-by-item comparisons and expert evaluations, is provided in the Supplementary Material.\u003c/p\u003e\n\n\u003ch3\u003ePretest Procedures\u003c/h3\u003e\n\u003ch4\u003eSampling\u003c/h4\u003e\n\u003cp\u003eRecruitment used an online registration form disseminated through autism specialists and social media, as previously approved by the ethics committee. The pretest sample consisted of approximately 30 adult women with a formal diagnosis of ASD. Convenience sampling was used, aiming to include variability in age and educational background to optimize detection of potential comprehension issues.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for the study required participants to identify as female, be 18 years of age or older, have a\u0026nbsp;documented clinical formal diagnosis of Autism Spectrum Disorder based on DSM-5-TR (3) criteria, demonstrate cognitive functioning within the average range or above, be able to understand and respond in Brazilian Portuguese, provide informed consent, and have access to and familiarity with digital tools necessary for online participation.\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria comprised participants who demonstrated cognitive functioning below the average range or who presented significant cognitive, attentional, or communicative impairments that could interfere with understanding the study procedures or completing the required tasks.\u003c/p\u003e\n\u003ch4\u003eMeasures and Procedures\u003c/h4\u003e\n\u003cp\u003eParticipants completed the adapted version of the GQ-ASC through videoconference-based interviews conducted by trained clinicians. During the interviews, the examiner shared the items on screen, read each question aloud, and recorded both the participants’ responses and any spontaneous comments or clarifications provided. The procedure included a cognitive debriefing, during which participants were asked about the clarity and comprehension of each item, as well as whether the content was considered appropriate and relevant to the Brazilian cultural context from their perspective. This process allowed the identification of potential ambiguities, comprehension difficulties, or cultural mismatches, contributing to the refinement and cultural adequacy of the adapted instrument.\u003c/p\u003e\n\u003cp\u003eIn the present study, the G-38 (16) was administered to exclude below-average intelligence as a potential confounding factor in the interpretation and evaluation of the questionnaire items, ensuring that participants had sufficient cognitive capacity to adequately understand and respond to the instruments and thereby strengthening the validity of the findings. The G-38 is a non-verbal intelligence test designed to assess general cognitive ability, specifically fluid intelligence, through 38 graphic items arranged in increasing order of difficulty. It evaluates logical, analytical, and abstract reasoning without reliance on language or prior knowledge and can be administered in person or online, individually or in groups within a 30-minute time limit.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor convergent validity evaluation, the Brazilian Portuguese Adult version of the Social Responsiveness Scale, Second Edition (SRS-2) (17,18) was administered, given its robust psychometric properties and ease of administration. The SRS-2 Adult Form is a standardized, quantitative measure of autism-related social impairment that assesses the severity of difficulties in social awareness, social cognition, social communication, social motivation, and restricted and repetitive behaviors. It consists of 65 items rated on a Likert-type scale, reflecting the frequency of behaviors observed over recent months, and can be completed as a self-report or informant-based questionnaire. The SRS-2 provides total and subscale scores that allow dimensional characterization of autistic traits across the spectrum, facilitating comparison of constructs with the adapted instrument. To explore convergent validity, a preliminary association between total GQ-ASC scores and SRS-2 total T-scores was examined using Spearman’s rank correlation coefficient.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSociodemographic data were collected using the Brazilian Economic Classification Criterion (CCEB), as established by the Associação Brasileira de Empresas de Pesquisa (19). The CCEB is a standardized instrument widely used in Brazil to estimate socioeconomic status based on household characteristics, including ownership of durable goods, access to services, and the educational level of the head of the household. It classifies individuals into economic strata ranging from A to E, allowing a contextualized assessment of socioeconomic conditions.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u0026nbsp;The translation and cross-cultural adaptation process resulted in a linguistically and culturally appropriate Brazilian Portuguese version of the GQ-ASC, reflecting a progressive refinement of the instrument across successive stages. Across translations, back-translations, expert review, and lived-experience subjects\u0026rsquo; suggestions, the items sustained a high degree of semantic, idiomatic, and conceptual equivalence, with adjustments primarily aimed at enhancing clarity, cultural relevance, and naturalness of language for adult Brazilian women.\u003c/p\u003e\n\u003cp\u003eTo ensure transparency and replicability, two comprehensive tables detailing all stages of item development are provided in the supplementary material. \u003cstrong\u003eSupplementary Table 2\u0026nbsp;\u003c/strong\u003eincludes the original version (ORG), clinician (T1C) and lay translations (T2L) , the consensus version (CON), and the two independent back-translations (BT1 and BT2). \u003cstrong\u003eSupplementary Table 3\u0026nbsp;\u003c/strong\u003ecompares the original version (ORG) with the finalized concise (CPV) and expanded (EPV) Brazilian Portuguese versions of each item.\u003c/p\u003e\n\u003ch3\u003eForward Translation\u003c/h3\u003e\n\u003cp\u003eThe two independently produced forward translations (T1C and T2L) demonstrated high semantic equivalence, although systematic differences emerged in linguistic register, style, and use of terminology. The clinician translation adopted a more formal and standardized tone, with complete syntactic structures and explicit subject pronouns, whereas the lay translation favored simpler, more natural phrasing consistent with everyday Brazilian Portuguese. In terms of clarity for the target population, the lay version emphasized fluency and intuitive comprehension through more concrete and accessible wording, while preserving the original constructs. Regarding terminology, the clinician version employed clinically neutral language, whereas the lay version used more colloquial and emotionally resonant expressions without altering meaning. Differences were also noted in sentence structure and punctuation, with the clinician translation closely mirroring the original syntax and length and the lay translation shortening sentences to enhance readability and naturalness.\u003c/p\u003e\n\u003ch3\u003eConsensus Meeting and Synthesis\u003c/h3\u003e\n\u003cp\u003eThe consensus process resulted in a synthesized Brazilian Portuguese version (CON) that was linguistically natural, culturally appropriate, and conceptually faithful to the original instrument. Item-level decisions enhanced clarity, oral fluency, and comprehensibility for adult women, including selective omission of explicit subject pronouns and replacement of overly literal terms that could generate ambiguity in Brazilian Portuguese, while fully preserving the intended meaning to support accurate back-translation.\u003c/p\u003e\n\u003ch3\u003eBack-Translation\u003c/h3\u003e\n\u003cp\u003eThe comparison between the original English version of the instrument and the two independent back-translations (BT1 and BT2) demonstrated a high level of semantic and conceptual equivalence. Both back-translations accurately reflected the content, intent, and scope of the original items, with no evidence of meaning distortion, omission of key elements, or introduction of new constructs.\u003c/p\u003e\n\u003cp\u003eMinor differences between the back-translations and the original version were limited to lexical choices and syntactic variations that did not affect the underlying concepts being assessed. Overall, the back-translation process confirmed that the Brazilian Portuguese version adequately preserved the meaning and theoretical framework of the original instrument, supporting its suitability for subsequent expert review and pretesting.\u003c/p\u003e\n\u003ch3\u003eExpert Review\u003c/h3\u003e\n\u003cp\u003eThe evaluation of the consensual version (CON) by the experts revealed that mean ratings across items were consistently high, with all items scoring above 4.0 across domains, indicating strong consensus regarding translation quality (Table 1). The highest-performing items showed means approaching or equal to 5.0 across domains, suggesting culturally appropriate and idiomatically natural formulations. The lowest idiomatic equivalence means were observed for Item 3 and Item 6, which also presented lower proportions of \u0026ldquo;adequate\u0026rdquo; endorsements and higher frequencies of \u0026ldquo;change\u0026rdquo; endorsements. These findings identified both items as focal areas for refinement, leading to targeted linguistic adjustments aimed at improving naturalness and idiomatic clarity in Brazilian Portuguese. Specifically, Item 3 was rephrased to enhance fluency and comparative clarity, and Item 6 was modified to replace a culturally marked metaphor with a more commonly used expression, resulting in versions that were more easily understood and culturally appropriate for the target population.\u003c/p\u003e\n\u003cp\u003eTable 1. Analysis of the Cultural and Linguistic Equivalences of the Brazilian Version of the GQ-ASC by 7 Experts (Means and Agreement)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eQuestion Number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eClarity (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSemantic Equivalence (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIdiomatic Equivalence (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eExperiential Equivalence (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eConceptual Equivalence (mean)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAdequate (agreement)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eChange (agreement)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e71.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAnalysis of the 21 questions from the preliminary version of the Girls Questionnaire for Autism Spectrum Condition conducted by 7 independent experts. For each item, the mean scores (Likert scale 1-5) are presented in the five dimensions of Clarity and Equivalence (Semantic, Idiomatic, Experiential, and Conceptual) and the percentages of \u0026quot;Yes\u0026quot; agreement in the binary questions \u0026quot;Is the translation adequate?\u0026quot; and \u0026quot;Should be changed?\u0026quot;.\u003c/p\u003e\n\u003cp\u003eQualitatively, suggestions focused on fine-grained idiomatic and clarity improvements rather than conceptual concerns. Recommendations included minor adjustments to pronoun use, replacing terms perceived as overly rigid or culturally uncommon, improving fluency, and refining examples to avoid ambiguity. Several items received no suggested changes, reflecting broad acceptability of their phrasing.\u003c/p\u003e\n\u003ch3\u003ePretest Sample\u003c/h3\u003e\n\u003cp\u003eThrough the online form, a total of 230 individuals registered an interest to participate in the study. Based on order of registration and eligibility criteria, the first 40 registrants were invited via WhatsApp. Of these, 31 responded and provided medical documentation confirming ASD diagnosis according to DSM-5-TR (3) criteria, with corresponding ICD coding (ICD-10 F84.0, F84.1, F84.5, or ICD-11 6A02 and subdivisions) (20,21).\u003c/p\u003e\n\u003cp\u003eThe pretest included 31 cisgender women. Age ranged from 21 to 64 years (mean 35.3, SD 9.1). Most participants identified as heterosexual, and most self-identified as White. Educational attainment was high, with the majority reporting completed higher education, and socioeconomic classification concentrated in ABEP (19) classes B1 and B2 (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2 \u0026ndash; Characterization of the Sample (n = 31)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD (21\u0026ndash;64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35,3 \u0026plusmn; 9,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge Range (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 to 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30 to 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40 to 49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender Identity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCisgender Woman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBiological Sex at Birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSexual Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHeterosexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBisexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAsexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHomosexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther (pansexual, queer)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBrown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRelationship Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIn a relationship and living together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle (previously in a relationship)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIn a relationship (not living together)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle (never in a relationship)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCompleted higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCompleted secondary education / incomplete higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSelf-Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSocial Class (ABEP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eClass A (Upper Class)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eClass B1 (Upper-Middle Class)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eClass B2 (Middle Class)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eClass C1 (Lower-Middle Class)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eG-38 Intellectual Classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLower-Average\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUpper-Average\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSuperior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSRS-2 Classification (Total T-score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWithin Normal Limits (\u0026le; 59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMild Impairments (60 \u0026ndash; 65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eModerate Impairments (66 \u0026ndash; 75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSevere Impairments (\u0026ge; 76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eParticipant ratings of comprehension, clarity, and language adequacy were generally high across items, with most items showing a large proportion of responses in the upper range (scores 4\u0026ndash;5) and elevated mean values, supporting the overall comprehensibility and acceptability of the instrument (Table 3). A small number of items displayed comparatively lower ratings, highlighting specific targets for refinement.\u003c/p\u003e\n\u003cp\u003eTable 3 - Evaluation of participants\u0026apos; comprehension, clarity, and linguistic appropriateness of the questions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQuestion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDid you understand what was asked?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLanguage Clarity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLanguage Appropriateness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e% (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e% (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e% (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ01_FANTASY_WORLDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e80,80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e76,90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e96,20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ02_INTEREST_IN_FICTION\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e92,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e96,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ03_PLAYED_IMAGINATION\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e91,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e87,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ04_IMAGINARY_FRIENDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e95,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e95,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ05_COMPLEX_SETUPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e90,90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e90,90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e95,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ06_COPY_OR_IMITATE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e95,20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e90,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ07_OBSERVE_OTHERS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ08_ATRACTED_STRONG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e84,20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e84,20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e94,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ09_DIFFERENT_PERSONA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e94,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ10_ATTACHED_OBJECTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e94,10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e94,10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ11_DISCONFORT_GROOMING\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e93,80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e81,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e87,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ12_SOCIAL_MUTE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e93,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ13_SMELLS_FLAVOURS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ14_SOCIAL_EXAUSTED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e92,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ15_SOCIAL_MASK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e91,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e91,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e91,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ16_INTENSE_EMOTIONS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ17_APOLOGIZE_MISTAKE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e90,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ18_GIRLS_TOYS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ19_BOYS_TOYS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ20_ADVANCED_INTERESTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eQ21_TALENT_MUSIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100,00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults of the evaluation performed by the study participants regarding the comprehension of the questions, clarity of language, and linguistic appropriateness of the Brazilian version of the instrument. For each item, the percentage of responses with a score of 4 or 5 (on a Likert scale of 1 to 5) and the average of the scores assigned are presented, considering the domains: \u0026quot;Did you understand what was asked?\u0026quot;, \u0026quot;Clarity of language,\u0026quot; and \u0026quot;Appropriateness of language.\u0026quot; The items are identified by alphanumeric codes corresponding to the respective questions of the instrument.\u003c/p\u003e\n\u003ch4\u003ePreliminary Score Distribution and Convergent Pattern\u003c/h4\u003e\n\u003cp\u003eTotal GQ-ASC scores in the sample ranged from 56 to 71 (possible range 21 to 84), with a mean of 63.3 (SD = 4.4) and a median of 62.5 (IQR = 6.8). The histogram (Figure 2) suggested concentration in moderately elevated scores with limited dispersion, without visually prominent extreme outliers. All participants scored above the original English cut-off of 56, which is described as indicating high levels of autistic traits in the original scale, supporting expected performance in this ASD-confirmed sample.\u003c/p\u003e\n\u003cp\u003eThe SRS-2 was used both to corroborate the clinical diagnosis documented in the medical reports provided by the participants and to generate an initial estimate of potential convergent validity with the GQ-ASC. Total SRS-2 T-scores indicated clinically significant impairment in social responsiveness, with most participants falling within the moderate range and a small minority in the mild or severe ranges (Table 2). Subscale patterns suggested higher impairment in social motivation, social communication, and restricted and repetitive behaviors, consistent with core ASD features (Supplementary Table 4).\u003c/p\u003e\n\u003cp\u003eA preliminary association between total GQ-ASC scores and SRS-2 total T-scores was positive and of moderate magnitude (Spearman\u0026apos;s \u0026rho; = 0.41). \u0026nbsp;The scatterplot \u0026nbsp;(Figure 3) demonstrated that higher GQ-ASC totals correlated with higher SRS-2 T-scores, while still showing meaningful inter-individual variability, consistent with related but non-identical constructs and the dimensional nature of autistic traits.\u003c/p\u003e\n\u003ch4\u003eCognitive Debriefing Findings\u003c/h4\u003e\n\u003cp\u003eQualitative analysis of participant comments identified recurring barriers to comprehension and item interpretation, organized into five thematic categories:\u003c/p\u003e\n\u003cp\u003e1. Lexical and conceptual ambiguity\u003c/p\u003e\n\u003cp\u003eParticipants reported multiple interpretations for terms such as \u0026ldquo;fantasy,\u0026rdquo; \u0026ldquo;fiction,\u0026rdquo; \u0026ldquo;personality,\u0026rdquo; and \u0026ldquo;attraction,\u0026rdquo; with ambiguity between genre versus imagination, or romantic versus sexual versus admiring attraction.\u003c/p\u003e\n\u003cp\u003eExamples:\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;When I was 5-12 years old, I played as imaginatively \u0026nbsp;as other girls.\u0026rdquo;\u003cbr\u003e\u003cem\u003e\u0026ldquo;I keep wondering if it only concerns, for example, fictional things and not things, for example, getting stuck in my head thinking about things that don\u0026apos;t exist.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I am interested in fiction.\u0026rdquo;\u003cbr\u003e\u003cem\u003e\u0026ldquo;I don\u0026apos;t know if it\u0026apos;s a fantasy world that I create, or a fantasy world that already exists, like Harry Potter or others in that sense.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I adopt a different personality in different situations\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;This part about personality felt a bit vague to me, because I wasn\u0026rsquo;t sure whether it meant personality in a psychological sense or just someone\u0026rsquo;s way of being.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I am attracted to females with strong personalities who tell me what to do.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The word attraction confused me, because it can mean interest, admiration, something intellectual, not necessarily something romantic.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;When I was 5-12 years old, I played as imaginatively \u0026nbsp;as other girls.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When it talks about imagination, I don\u0026rsquo;t know if it means being creative or escaping from reality, and that really changes how I answer.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e2. Theory of mind and self-referential comparison demands\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Items requiring comparison to \u0026ldquo;other girls\u0026rdquo; or evaluation of \u0026ldquo;socializing well\u0026rdquo; were sometimes difficult due to uncertainty about normative standards, and items about apologizing for social mistakes were challenging when errors were not reliably perceived.\u003c/p\u003e\n\u003cp\u003eExamples:\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;When I was 5-12 years old, I played as imaginatively \u0026nbsp;as other girls.\u0026rdquo;\u003cbr\u003e\u003cem\u003e\u0026ldquo;I don\u0026apos;t know what they imagined, so I wouldn\u0026apos;t know how to compare.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I socialise quite well for a while, but subsequently feel exhausted.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When it asks whether I socialize well, I\u0026rsquo;m not sure what \u0026lsquo;well\u0026rsquo; means, because I don\u0026rsquo;t know what the normal is.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I apologise when I make a social error.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I disagree perhaps totally because I never realize when something is inappropriate.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The problem is knowing when we\u0026apos;ve made a mistake. Yes. Sometimes, we don\u0026apos;t realize it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e3. Logical structure of the item\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Items combining two premises within a single statement produced response conflicts, for example endorsing one clause but not the other.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExamples:\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I am attracted to females with strong personalities who tell me what to do.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExample: \u0026ldquo;I get along with people with strong personalities in general, but that doesn\u0026rsquo;t necessarily mean I want to obey them.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I socialise quite well for a while, but subsequently feel exhausted.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExample: \u0026ldquo;And what if I disagree with part of the sentence? Because I don\u0026apos;t know if... Yes, I feel exhausted, but I don\u0026apos;t know if it\u0026apos;s because I am socializing very well.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I am distressed by certain smells or I avoid certain tastes that are a typical part of a diet.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExample: \u0026ldquo;Smells. Flavors, no, although this is interconnected, I am very sensitive to smells... So maybe I partially agree... Smells yes, but I... okay.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e4. Adequacy of contextual examples\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Some examples were experienced as infantilizing or overly restrictive, particularly in adulthood. Participants recommended broader adult-relevant examples and inclusion of missing sensory modalities, notably texture.\u003c/p\u003e\n\u003cp\u003eExamples:\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I am attached to certain objects or toys, for example, a favorite toy, pillow, piece of cloth...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;But I think there might be adult women my age who will answer this and might feel, \u0026apos;oh, but I don\u0026apos;t have a toy.\u0026apos; Maybe give it another name, just objects...\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I am distressed by certain smells or I avoid certain tastes that are a typical part of a diet.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Regarding food and food items, it\u0026apos;s very much a question of texture. Like, I like ketchup, but I can\u0026apos;t eat tomatoes because of the seed. Pudding. I don\u0026apos;t like the texture of pudding...\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Oh, and there is the texture part too, which if it fits in this question, you can insert it, right? Which is texture, I have a lot of [issues with] food textures that I can\u0026apos;t eat... the texture of a little ball like that, no, I can\u0026apos;t.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e5. Clarity of technical or community-specific terms\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; Metaphors and terms such as \u0026ldquo;mask\u0026rdquo; or \u0026ldquo;social confusion,\u0026rdquo; as well as words with multiple clinical interpretations, were not uniformly understood, suggesting the need for clearer behavioral descriptions or brief clarifying language.\u003c/p\u003e\n\u003cp\u003eExamples:\u003c/p\u003e\n\u003cp\u003eItem: \u0026ldquo;I often have a facial mask that hides my \u0026lsquo;social confusion\u0026rsquo;.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I don\u0026apos;t understand the part in quotation marks... It was social confusion. For me, sometimes, it\u0026apos;s the social environment with a lot going on.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My question is what social confusion is... What does \u0026lsquo;social\u0026rsquo; mean here?\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e\u0026nbsp;Documentation, Final Review, and Proposed Revisions\u003c/h3\u003e\n\u003cp\u003eTechnical reports were produced throughout all phases to document decisions, discrepancies, challenges, and resolutions, supporting transparency and methodological traceability. The coordinating team reviewed all documentation, integrating expert feedback, quantitative participant ratings, and cognitive debriefing themes. In response to improvement suggestions raised by participants during these last steps, two instrument formats were proposed for future validation. The concise version (CPV) corresponds to the version applied in the present study, whereas the expanded version (EPV) incorporates participant-informed clarifications and additional explanatory cues. Both versions preserve the original constructs and are presented in the supplementary material (Supplementary Table 3).\u003c/p\u003e\n\u003cp\u003ePlanned next steps include systematic comparison of the concise and expanded versions in a subsequent psychometric validation phase, assessing internal consistency, factor structure, stability, and acceptability, and evaluating whether the expanded version offers practical advantages in specific clinical or research contexts.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAutism in women remains under-recognized in both clinical and research contexts. This issue is further amplified in cross-cultural settings, where literal translation alone may fail to address culturally grounded meanings and experiential nuances (22). In this context, the present study aimed to translate, culturally adapt, and pretest a Brazilian Portuguese version of the GQ-ASC in a clinical sample of autistic adult women.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe process resulted in two Brazilian Portuguese versions of the GQ-ASC: a concise version, prioritizing linguistic equivalence with the original instrument, and an expanded version, incorporating clarifications based on participant feedback addressing cultural and conceptual ambiguities. Cognitive debriefing indicated that most items were perceived as relevant and recognizable, with participants frequently relating item content to their own developmental histories and adaptive strategies. At the same time, difficulties were identified, including lexical ambiguity, dual-premise items, demands for social comparison, and examples insufficiently anchored in adult contexts.\u003c/p\u003e\n\u003cp\u003eConsequently, this sheds light upon a broader methodological issue in scale adaptation for mental health assessment. Translated instruments often focus on linguistic equivalence while giving limited attention to systematic pretesting with members of the target population, leading to literal translations despite reported ambiguities or culturally specific misinterpretations (23). This practice might be behind difficulties in replicating factor structures and measurement properties across cultural contexts, with methodological shortcomings frequently addressed only at later psychometric stages (24,25). Recent studies further indicate that, in Brazil, even adaptations that claim adherence to cross-cultural guidelines often implement these procedures only partially (26). For example, the PHQ-9, one of the most widely used depression screening questionnaires in Brazil, underwent a process limited essentially to literal translation and back-translation (27,28), without formal cognitive debriefing with the target population, underscoring how cultural validation steps are frequently minimized.\u003c/p\u003e\n\u003cp\u003eWhen compared with other instruments used to screen for autism in adults within the Brazilian context, the present study both aligns with some and surpasses others prior adaptation efforts. Earlier Brazilian work with the Autism-Spectrum Quotient (AQ) relied primarily on direct translation and back-translation followed by psychometric validation, without a formal pretest or systematic cultural refinement (29). In contrast, the Brazilian adaptation of the Broad Autism Phenotype Questionnaire (BAPQ) incorporated expert review, back-translation, and pilot testing with respondents, although limited by a very small sample size (30). Additionally, the Ritvo Autism Asperger Diagnostic Scale – Revised - Reduced Brazilian Version (RAADS-R-BR Screen) was developed through a more similar process of cross-cultural adaptation of the original instrument and included an adequate pretest phase to evaluate item comprehension and applicability (31).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBuilding on these precedents, the present adaptation process places greater emphasis on iterative refinement through expert consensus and cognitive debriefing with the target population, explicitly integrating respondent experience into item evaluation. Although the preliminary results incipiently show consistency with the original version threshold and a moderate correlation between the CPV and the SRS-2, the present study does not ascertain internal validity, convergent validity or the relative psychometric performance of the two versions but documents the rationale for proposing both for subsequent study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Despite these promising findings, several limitations must be acknowledged. The small, non-probabilistic sample limits the generalizability of findings and does not permit robust psychometric analyses, such as confirmatory factor analysis or tests of measurement invariance. Reliance on self-report introduces potential biases related to memory, insight, and camouflaging behaviors, which may influence how participants interpret and endorse items (32). The absence of non-autistic and psychiatric comparison groups restricts conclusions about specificity and discriminative validity, and qualitative data were collected for cognitive debriefing purposes rather than through formal, systematically analyzed qualitative methods.\u003c/p\u003e\n\u003cp\u003eThe aforementioned constraints are consistent with the exploratory nature of a pretest study but highlight the need for further investigation. Future validation should explicitly compare the concise pretest version (CPV) and the expanded pretest version (EPV), examining internal consistency, factor structure, item functioning, and associations with external measures, and should investigate whether expanded cues improve precision without inflating scores or changing construct coverage. It must also include larger and more diverse samples, encompassing autistic and non-autistic comparison groups, as well as individuals with other psychiatric conditions, to allow a more comprehensive evaluation of diagnostic utility and construct specificity.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, the Brazilian Portuguese version of the GQ-ASC demonstrates promising preliminary adequacy for use with autistic adult women, showing high acceptability, cultural relevance, and strong conceptual alignment with the original instrument. These findings are particularly relevant given that a substantial proportion of autistic women do not receive an accurate or timely diagnosis, often due to limitations in existing assessment tools and gender-related diagnostic biases (33). Most autism diagnostic instruments were originally standardized in pediatric populations (34), contributing to the frequent misdiagnosis of autistic adults, especially women, with other psychiatric conditions prior to receiving a formal autism diagnosis. This diagnostic trajectory underscores the urgent need for instruments and clinical approaches that are sensitive to the adult female autism phenotype (35). The present findings support progression to larger-scale validation studies to examine reliability, structural validity, criterion validity, and clinical utility across diverse Brazilian samples. With further psychometric refinement, the GQ-ASC has the potential to become a valuable complementary tool for both research and clinical assessment of autism in adult women in Brazil.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eABEP: Brazilian Association of Research Companies\u003c/p\u003e\n\u003cp\u003eASD: Autism Spectrum Disorder\u003c/p\u003e\n\u003cp\u003eCAAE: Certificate of Presentation to the Research Ethics Committee\u003c/p\u003e\n\u003cp\u003eCAPES: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil\u003c/p\u003e\n\u003cp\u003eCCEB: Brazilian Economic Classification Criterion\u003c/p\u003e\n\u003cp\u003eCPV: Concise Brazilian Portuguese Version\u003c/p\u003e\n\u003cp\u003eDSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision\u003c/p\u003e\n\u003cp\u003eEPV: Expanded Brazilian Portuguese Version\u003c/p\u003e\n\u003cp\u003eG-38: G-38 - Nonverbal Intelligence Test\u003c/p\u003e\n\u003cp\u003eGQ-ASC: Girls Questionnaire for Autism Spectrum Condition\u003c/p\u003e\n\u003cp\u003eLGPD: Brazilian General Data Protection Law\u003c/p\u003e\n\u003cp\u003eROC: Receiver Operating Characteristic\u003c/p\u003e\n\u003cp\u003eSRS-2: Social Responsiveness Scale, Second Edition\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil Certificate of Presentation to the Research Ethics Committee (CAAE): 84506224.4.0000.5327. All participants provided written informed consent prior to participation. All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person's data in any form (including images, videos, or personal clinical details) that could lead to participant identification.\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eAll data supporting the findings of this study are available within the article and its Supplementary Information files. Additional information related to the dataset may be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThis study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.\u003c/p\u003e\n\u003ch3\u003eAuthors’ contributions\u003c/h3\u003e\n\u003cp\u003eA.V.S. wrote the main manuscript and conducted the study as part of his master’s research project. P.V. conducted the IQ assessments of the participants. A.C.S. coordinated the translation process and led the meetings with the translators. J.P. was responsible for organizing and conducting the expert committee review. A.S.G.M. served as co-supervisor of the project and contributed to the study design and manuscript review. T.A., the author of the original scale, provided expert consultation throughout the project. A.C. supervised the project as the principal investigator and main advisor. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003ch3\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eThe authors thank the autistic women who generously participated in this study and shared their experiences during the cognitive debriefing interviews. Their contributions were essential for improving the cultural clarity and applicability of the Brazilian Portuguese version of the instrument.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKanner, L. \u0026ldquo;Autistic Disturbances of Affective Contact\u0026rdquo;. 2nd ed. 1943;217\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003eAsperger, H. Die \u0026lsquo;Autistischen Psychopathen\u0026rsquo; im Kindesalter. Arch F\u0026uuml;r Psychiatr Nervenkrankh. 1944;(117):76\u0026ndash;136.\u003c/li\u003e\n\u003cli\u003eAmerican Psychiatric Association, editor. Diagnostic and statistical manual of mental disorders: DSM-5-TR. Fifth edition, text revision. Washington, DC: American Psychiatric Association Publishing; 2022. 1 p.\u003c/li\u003e\n\u003cli\u003eLai MC, Lombardo MV, Baron-Cohen S. Autism. The Lancet. 2014 Mar;383(9920):896\u0026ndash;910.\u003c/li\u003e\n\u003cli\u003eLoomes R, Hull L, Mandy WPL. What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2017 Jun;56(6):466\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eOchoa-Lubinoff C, Makol BA, Dillon EF. Autism in Women. Neurol Clin. 2023 May;41(2):381\u0026ndash;97.\u003c/li\u003e\n\u003cli\u003eBargiela S, Steward R, Mandy W. The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. J Autism Dev Disord. 2016 Oct;46(10):3281\u0026ndash;94.\u003c/li\u003e\n\u003cli\u003eHull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, et al. \u0026ldquo;Putting on My Best Normal\u0026rdquo;: Social Camouflaging in Adults with Autism Spectrum Conditions. J Autism Dev Disord. 2017 Aug;47(8):2519\u0026ndash;34.\u003c/li\u003e\n\u003cli\u003eBuescher AVS, Cidav Z, Knapp M, Mandell DS. Costs of Autism Spectrum Disorders in the United Kingdom and the United States. JAMA Pediatr. 2014 Aug 1;168(8):721.\u003c/li\u003e\n\u003cli\u003eTony Attwood, Michelle S Garnett, Agnieszka Rynkiewicz. GIRLS\u0026rsquo; QUESTIONNAIRE FOR AUTISM SPECTRUM CONDITIONS [Internet]. 2011. Available from: https://img1.wsimg.com/blobby/go/248a1726-f511-4023-953b-9b7298cd65bd/downloads/GQ-ASC_13-19_Years.pdf?ver=1601456687816\u003c/li\u003e\n\u003cli\u003eBrown CM, Attwood T, Garnett M, Stokes MA. Am I Autistic? Utility of the Girls Questionnaire for Autism Spectrum Condition as an Autism Assessment in Adult Women. Autism Adulthood. 2020 Sep 1;2(3):216\u0026ndash;26.\u003c/li\u003e\n\u003cli\u003eValidation of the Girls Questionnaire for Autism Spectrum Condition in French Language (fGQ-ASC) [Internet]. University Hospital, Grenoble; 2024. Available from: https://clinicaltrials.gov/study/NCT06280521\u003c/li\u003e\n\u003cli\u003eBeaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures: Spine. 2000 Dec;25(24):3186\u0026ndash;91.\u003c/li\u003e\n\u003cli\u003eServi\u0026ccedil;o de Tradu\u0026ccedil;\u0026atilde;o Profissional Online - Protranslate [Internet]. [cited 2025 Dec 21]. Available from: https://www.protranslate.net/pt/\u003c/li\u003e\n\u003cli\u003eSolu\u0026ccedil;\u0026otilde;es lingu\u0026iacute;sticas profissionais para o seu neg\u0026oacute;cio \u0026ndash; Translated [Internet]. [cited 2025 Dec 21]. Available from: https://translated.com/bem-vindo\u003c/li\u003e\n\u003cli\u003eCole\u0026ccedil;\u0026atilde;oG-38. Vetor Editora; 2021.\u003c/li\u003e\n\u003cli\u003eB\u0026ouml;lte S, Poustka F, Constantino JN. Assessing autistic traits: cross-cultural validation of the social responsiveness scale (SRS). Autism Res. 2008 Dec;1(6):354\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003eBruni TP. Test Review: Social Responsiveness Scale\u0026ndash;Second Edition (SRS-2). J Psychoeduc Assess. 2014 Jul;32(4):365\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eCrit\u0026eacute;rio de Classifica\u0026ccedil;\u0026atilde;o Econ\u0026ocirc;mica Brasil \u0026ndash; CCEB [Internet]. ASSOCIA\u0026Ccedil;\u0026Atilde;O BRASILEIRA DE EMPRESAS DE PESQUISA \u0026ndash; ABEP; [cited 2024 Sep 24]. Available from: https://www.abep.org/criterio-brasil\u003c/li\u003e\n\u003cli\u003eCID-11 [Internet]. [cited 2025 Dec 21]. Available from: https://icd.who.int/pt/\u003c/li\u003e\n\u003cli\u003eWorld Health Organization, editor. International statistical classification of diseases and related health problems. 10th revision, 2nd edition. Geneva: World Health Organization; 2004. 3 p.\u003c/li\u003e\n\u003cli\u003eBerkanovic E. The effect of inadequate language translation on Hispanics\u0026rsquo; responses to health surveys. Am J Public Health. 1980 Dec;70(12):1273\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eWild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005 Mar;8(2):94\u0026ndash;104.\u003c/li\u003e\n\u003cli\u003eBorsa JC, Dam\u0026aacute;sio BF, Bandeira DR. Adapta\u0026ccedil;\u0026atilde;o e valida\u0026ccedil;\u0026atilde;o de instrumentos psicol\u0026oacute;gicos entre culturas: algumas considera\u0026ccedil;\u0026otilde;es. Paid Ribeir\u0026atilde;o Preto. 2012 Dec;22(53):423\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eCruchinho P, L\u0026oacute;pez-Franco MD, Capelas ML, Almeida S, Bennett PM, Miranda Da Silva M, et al. Translation, Cross-Cultural Adaptation, and Validation of Measurement Instruments: A Practical Guideline for Novice Researchers. J Multidiscip Healthc. 2024 May;Volume 17:2701\u0026ndash;28.\u003c/li\u003e\n\u003cli\u003eBento MMDS, Elias CS, Barba PCDSD. Beaton\u0026rsquo;s guidelines in cross-cultural adaptation studies in Brazil: a systematic review. O Mundo Sa\u0026uacute;de [Internet]. 2025 Jun 6 [cited 2026 Jan 24];49. Available from: https://revistamundodasaude.emnuvens.com.br/mundodasaude/article/view/1889\u003c/li\u003e\n\u003cli\u003eFraguasjr R, Gonsalveshenriquesjr S, Delucia M, Iosifescu D, Schwartz F, Rossimenezes P, et al. The detection of depression in medical setting: A study with PRIME-MD. J Affect Disord. 2006 Mar;91(1):11\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eSantos IS, Tavares BF, Munhoz TN, Almeida LSPD, Silva NTBD, Tams BD, et al. Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da popula\u0026ccedil;\u0026atilde;o geral. Cad Sa\u0026uacute;de P\u0026uacute;blica. 2013 Aug;29(8):1533\u0026ndash;43.\u003c/li\u003e\n\u003cli\u003eDo Egito JHT, Ferreira GMR, Gon\u0026ccedil;alves MI, Os\u0026oacute;rio AAC. Brief Report: Factor Analysis of the Brazilian Version of the Adult Autism Spectrum Quotient. J Autism Dev Disord. 2018 May;48(5):1847\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003ePrata LDL, Camargos Junior W, Teodoro MLM, Rocha FL. Qualidades psicom\u0026eacute;tricas da vers\u0026atilde;o brasileira da Escala Broad Autism Phenotype Questionnaire (BAPQ-Br). Context Cl\u0026iacute;nicos. 2019 Apr 8;12(1):186\u0026ndash;203.\u003c/li\u003e\n\u003cli\u003eHartwig, M. D. Tradu\u0026ccedil;\u0026atilde;o e adapta\u0026ccedil;\u0026atilde;o transcultural do Ritvo Autism Asperger Scale Revised (RAADS‑R) para o portugu\u0026ecirc;s do Brasil [Internet]. Universidade Federal Rural do Rio de Janeiro \u0026ndash; UFRRJ; 2023. Available from: https://rima.ufrrj.br/jspui/handle/20.500.14407/20797\u003c/li\u003e\n\u003cli\u003eStacey R, Cage E. \u0026ldquo;Simultaneously Vague and Oddly Specific\u0026rdquo;: Understanding Autistic People\u0026rsquo;s Experiences of Decision Making and Research Questionnaires. Autism Adulthood. 2023 Sep;5(3):263\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eHuang Y, Arnold SR, Foley KR, Trollor JN. Diagnosis of autism in adulthood: A scoping review. Autism. 2020 Aug;24(6):1311\u0026ndash;27.\u003c/li\u003e\n\u003cli\u003eHirota T, So R, Kim YS, Leventhal B, Epstein RA. A systematic review of screening tools in non-young children and adults for autism spectrum disorder. Res Dev Disabil. 2018 Sep;80:1\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eKentrou V, Livingston LA, Grove R, Hoekstra RA, Begeer S. Perceived misdiagnosis of psychiatric conditions in autistic adults. eClinicalMedicine. 2024 May;71:102586.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9034580/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9034580/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Introduction: Autism Spectrum Disorder (ASD) in adult women presents diagnostic challenges due to phenotypic features that differ from the classic male presentation, particularly social camouflaging and internalized symptoms. The Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) was developed to address this gap. In Brazil, however, there is a lack of validated instruments designed for this population.\nObjective: To translate, culturally adapt, and conduct a pretest of the GQ-ASC for Brazilian Portuguese.\nMethods: The study followed international guidelines for cross-cultural adaptation, including independent forward translations, synthesis, back-translation, and expert committee review. The pre-final version was administered to 31 adult women with a formal ASD diagnosis recruited through expert referrals. The Social Responsiveness Scale, Second Edition (SRS-2), was used for exploratory convergent analysis. Cognitive debriefing interviews were conducted to assess item comprehension and cultural adequacy.\nResults: Expert evaluation indicated high semantic, idiomatic, experiential, and conceptual equivalence across items. In the pretest sample, the mean total GQ-ASC score was 63.3, with all participants scoring above the original screening cutoff of 56. The instrument showed high acceptability and alignment with expected autism-related profiles. Qualitative feedback indicated that while the translation was accurate, some items required additional contextual clarification to reduce ambiguity. This led to the development of two Brazilian versions: a concise standard version and a detailed version including explanatory examples.\nConclusion: The Brazilian Portuguese adaptation of the GQ-ASC was successful and demonstrated cultural adequacy and comprehensibility. The scale shows promise as an auxiliary tool for identifying autistic traits in adult women in Brazil, warranting further psychometric validation in larger samples.","manuscriptTitle":"Translation, Cross-cultural adaptation and Pretest of the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC) for Brazilian Portuguese","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 08:06:26","doi":"10.21203/rs.3.rs-9034580/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-17T06:14:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T22:08:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"93835056880080208705556439545019895205","date":"2026-04-19T14:19:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T10:42:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184344772202794937521254214236236734333","date":"2026-04-18T21:10:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332232977724103903419068765394298941517","date":"2026-03-26T10:43:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-26T08:33:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-26T08:27:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-12T05:17:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-11T23:11:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2026-03-11T15:21:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1ad67345-3b64-4211-ba30-8b0c4ddbd1ed","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-17T06:14:56+00:00","index":68,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T22:08:16+00:00","index":67,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T08:06:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 08:06:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9034580","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9034580","identity":"rs-9034580","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}