There was a time in history when comorbidity between psychiatric disorders and autism spectrum disorders (ASD) were written about extensively, and autism was sometimes mistaken for a mental illness. Thankfully, these days there is much more understanding, awareness, and acceptance of autism. However, people still have many questions about what autism actually is and if conditions such as psychosis are connected.
In this article, we will take a look at this controversial topic and attempt to aid people in their understanding of the differences between autism and psychosis.
What are the psychological symptoms of autism?
It is well-known that autism spectrum disorder features symptoms such as social cognitive deficits, along with some restricted/repetitive behaviors. A research paper, Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis, published in Schizophrenia Bulletin Open, states these symptoms suggest overlap between ASD and psychotic disorders.
The researchers controversially state autism was thought to be a precursor to psychosis —something that many autistic advocates disagree with and that some other research papers contradict.
Are there similarities between psychiatric disorders and ASD?
Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis, shows there are undoubtedly some similarities between psychiatric disorders and ASD, as well as some differences, especially around brain structure.
The differences in brain structure include alternative genomic imprinting. Meanwhile, similarities include how the amygdala, hippocampus, and prefrontal cortex are connected and respond to experiences.
What does brain structure have to do with it?
Similarities in those with autism spectrum disorder and childhood onset schizophrenia include a larger brain size, with the increase of size in the amygdala and hippocampus in the individuals with ASD. Another similarity is that the brain size regulates to an average size by early adulthood.
When reading research, it is difficult to deny similarities between those diagnosed with childhood onset schizophrenia and those with ASD. The larger sized brain allows for more connections that are forming, in early childhood, between the amygdala and hippocampus and the pruning and average brain size that occurs in early adulthood.
Is autism related to schizophrenia?
In short, the answer is no. Autism and schizophrenia are two different conditions. Autism is not a mental illness. Autism is (in layman’s terms) a “differently wired brain” and a neurodiverse way of being.
However, autism spectrum disorder and psychiatric disorders are generally considered opposite extremes on a spectrum of human cognition. Human cognition includes the ability to form opinions and beliefs all the way to how individuals could interact with those around them and their environment.
One example includes those diagnosed with autism spectrum disorder typically have a hard time with social cognition. In contrast, those diagnosed with psychotic symptoms, like schizophrenia, focus more on a link between paranoid delusions and a decline in theory of mind.
Can schizophrenia be mistaken for autism?
Since schizophrenia and ASD are considered opposite extremes on the spectrum of mental disorders, it would be hard to mistake them for one another. However, people can be diagnosed with both disorders.
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There are also similarities between the two conditions, which can cause some misunderstandings in diagnoses. Mainly when an individual is diagnosed with both ASD and a psychotic illness, such as schizophrenia.
What do psychotic episodes have to do with autism?
Psychotic episodes are hallucinations and delusions that affect the general population. Psychotic episodes do not affect individuals that have been diagnosed with a psychotic disorder, such as schizophrenia.
There was a study in the article, The Prevalence of Psychotic Experiences in Autism Spectrum Disorder and Autistic Traits: A Systematic Review and Meta-analysis, that showed people with ASD have a higher likelihood of developing psychosis, such as delusions, than the general population.
Are autistic people more likely to be diagnosed with psychiatric disorders?
People with ASD may be as much as 24% more likely to have some form of psychotic episode as a neurotypical person, according to the above research article. It also showed that people with autism have a higher chance of developing schizophrenia than the neurotypical controls in the study.
The reasoning behind the risk factors to develop psychosis has not been thoroughly researched and could be due to bullying and other forms of peer victimization. Also, there could be false positives for psychotic symptoms or mislabeling of observations. More research needs to be done.
Which comorbid disorders can be assessed along with autism spectrum disorder?
When looking into comorbidities and autism, there are a number of medical disorders that can be associated with some autistic individuals. There are genetic disorders such as Fragile X and down syndrome, anxiety disorders, symptoms like migraines and sleep disorders, and mood disorders.
Schizophrenia and other psychiatric disorders, such as depression, can also coincide with autism. They can all look different and affect the individual in different ways.
Are delusions a symptom of ASD?
Delusions among those with autism spectrum disorders could be as much as 45% more likely than the general population. Also, the prevalence of delusions could be higher than those of hallucinations, although a conclusion in this article was not conclusive.
If there is a strong link found in future studies, the article stated that since many people with ASD have weaker social skills and may not always understand people’s intentions, it could be that they form delusions about said intentions.
Can there be false positives?
There can be false positives when assessing any type of psychiatric disorder. If there was an action or something was said that was misunderstood it could be misconstrued as a symptom of psychotic illness. With the support of a good medical professional though, it should be rare that this is the case.
Another thought is that mislabeling a person’s behaviors can cause false positives when assessing psychosis. Assuming delusions of an autistic person with rigid behaviors could also occur. That’s why it is vital that parents consult with respected professionals with any concerns about their child.
What do early psychotic symptoms and signs look like in children?
Assessing psychosis in children starts with recognizing symptoms. The symptoms in children can look similar to those in adults, although when the symptoms show up earlier in life they tend to affect the child’s overall behavior and development.
Early psychotic symptoms can be as simple as language delays, delays in meeting developmental milestones, along with repetitive behaviors, like rocking back and forth. In teenagers, they can be as extreme as delusions, hallucinations, and disorganized and apparent depressed changes in mood and behavior. As mentioned above though, some of these symptoms can also be signs of ASD or another neurodivergence, so it’s important to never assume anything.
Don’t forget to ask the doctor
I must repeat it is always important to talk to the child’s doctor or medical professional if there are any concerns. These symptoms cover a range of different disorders, or could mean the child is developing at their own pace.
Getting a doctor’s opinion can help ease not knowing and concerns over what could be going on. In order to get assessments or other support started, it is necessary for a child to be seen by a doctor and then further assessments conducted.
So, what does it all mean?
Overall, a person who has been diagnosed with autism spectrum disorder might be more likely to develop and be diagnosed with a psychiatric comorbidity, such as schizophrenia.
Unfortunately though, there is not enough conclusive data to say that the similarities between the conditions are enough to cause the increased possibility of a diagnosis of both disorders.
To say someone with autism will most likely have some form of psychiatric disorder would be incorrect. There are many different factors that could cause this psychiatric comorbidity to occur.
What do the studies say?
Studies to date have been unable to come to a conclusion because the data wasn’t complete. Once there are more studies conducted and more consistency, there may be more information available to pinpoint how these disorders could both be diagnosed.
The world of autism and knowledge acquired has improved by leaps and bounds since the time when autism was considered a precursor to schizophrenia. As more studies are conducted and more data collected, more knowledge will be available to move autism awareness further forward.
What can you do?
As a parent or caregiver of someone who has been diagnosed with ASD, if you have questions and/or concerns, the first stop should be to talk to your child’s doctor.
Although it is not guaranteed that just because someone has autism they’ll also have schizophrenia, it could be a possibility. It is a good idea to watch for some of the signs and symptoms that have been discussed earlier in the article.
Another good resource is a local mental health facility and/or a health and human services location. They should have services and resources available and may be able to point someone in the right direction to get the appropriate services and/or therapies needed to live the best possible life!
Al-Beltagi, M. (2021). Autism medical comorbidities. US National Library of Medicine National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085719/
Ando, S., Fujikawa, S., Kasai, K., Kiyono, T., Morishima, R., Morita, M., Nishida, A., & Yamasaki, S. (2020). The Prevalence of Psychotic Experiences in Autism Spectrum Disorder and Autistic Traits: A Systematic Review and Meta-analysis. Schizophrenia Bulletin Open. https://academic.oup.com/schizbullopen/article/1/1/sgaa046/5899822
de Pablo, G., Santosh, P., Singh, J., & Vaquerizo-Serrano, J. (2021). Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis. Journal of Autism and Developmental Disorders. https://link.springer.com/article/10.1007/s10803-021-05046-0