Translation and validation of the camouflaging autistic traits questionnaire (CAT-Q) into arabic: a cross-sectional study among Egyptian medical students

Abstract Background Autism Spectrum Disorder (ASD) is a neurodevelopmental condition diagnosed based on early onset social communication and social interaction difficulties, as well as restricted and repetitive interests, activities, and behaviors. Camouflaging represents a complex adaptive mechanism used by individuals with ASD to compensate for social deficits, but it may entail several negative implications including risks of misdiagnosis, late diagnosis, or underdiagnosis. Despite growing research on camouflaging behaviors, there remains a significant gap in diagnostic and assessment tools for autism among adults in Arabic-speaking regions. Methods This cross-sectional validation study employed the dual-language split-half (DLSH) methodology to validate the Arabic translation of the Camouflaging Autistic Traits Questionnaire (CAT-Q) among 105 bilingual medical students from Egyptian universities. The translation process followed enhanced back-translation procedures including forward translation by two independent translators, back-translation by two different translators, comparison with the original version, and cognitive interviews. Participants completed counterbalanced dual-language forms (Form A: 13 Arabic + 12 English items; Form B: 12 Arabic + 13 English items). Psychometric properties were assessed using Cronbach’s alpha for internal consistency, item-total correlations, and paired samples t-tests for translation equivalence. Results The Arabic CAT-Q demonstrated acceptable internal consistency (Cronbach’s α = 0.721) compared to the English version (α = 0.687). Paired samples t-tests revealed good translation equivalence, with only one item showing significant differences between versions ( p = 0.035). Item-total correlations ranged from − 0.335 to 0.625, with most items showing positive correlations with the total scale score. Effect sizes were generally small (Cohen’s d = -0.298 to 0.307), indicating minimal practical differences between language versions. Conclusions The Arabic translation of the CAT-Q demonstrates acceptable reliability and validity for use in Arabic-speaking populations. This validated instrument fills an important gap in autism research tools for Arabic-speaking regions and can facilitate better understanding and assessment of camouflaging behaviors in individuals with ASD. Future research with larger clinical samples is needed to establish diagnostic cut-off points and confirm the factor structure.