Autism Spectrum Disorder (ASD) And Autism Psychosis Features

Approximately 34.8% of people diagnosed with autism spectrum disorder may experience symptoms of psychosis, such as social withdrawal, at some time in their lives. Both autism spectrum disorder and psychosis tend to occur on a continuum of severity (a spectrum ranging from mild to severe). In this article, we’ll explore the features of psychosis symptoms in people diagnosed with autism.

Autism spectrum disorders and psychosis

Autism spectrum disorders are a group of neurodevelopmental conditions that manifest with different levels of autism and are characterized by different severities of difficulty with communication, social interactions, and behavior.

Approximately 11.6% of individuals who are considered to be at high risk of developing psychosis are diagnosed with autism spectrum disorder. Psychosis is a mental state involving a disconnect from reality that is often accompanied by symptoms like delusions, hallucinations, and disordered thinking and speech. Psychosis may also be associated with negative symptoms, which represent a lack of typical behaviors. Negative symptoms can include social withdrawal (asociality), an inability to experience pleasure (anhedonia), and a lack of motivation (avolition), among others.

While the same study references numerous studies that report that many people with autism spectrum disorders also experience psychotic disorders, like schizophrenia, it also clarifies that in certain cases, people with autism spectrum disorders may experience symptoms of psychosis, such as hallucinations and delusions, even without being diagnosed with a psychotic disorder.

The overlap between autism spectrum disorders and schizophrenia spectrum disorders

Schizophrenia spectrum disorders generally include schizophrenia, schizoaffective disorder, and schizotypal personality disorder. Some theories suggest that autism spectrum disorders and schizophrenia spectrum disorders (SSDs) may be influenced by the same genes. A 2009 systematic review has pointed to potential shared risk factors and genetic overlap between the two conditions.

One study observed the symptoms of people with autism spectrum disorders and schizophrenia and found that people diagnosed with both conditions experienced autistic symptoms, as well as psychotic features such as negative symptoms and impaired social communication or relating to a lack of typical social behaviors and typical communicative behaviors. These findings highlight the significant differences and similarities in clinical presentation, which may contribute to diagnostic difficulties in clinical practice.

Distinctions between autism spectrum disorder and schizophrenia 

Autism spectrum disorders and schizophrenia spectrum disorders are two distinct conditions. People with autism spectrum disorder are more likely to experience difficulties with and a lack of social communication and interaction. People with schizophrenia spectrum disorders are more likely to experience psychotic symptoms, such as delusions, disordered thinking, and hallucinations. 

While autism spectrum disorders and schizophrenia spectrum disorders are two different conditions, they may frequently occur together. They may be caused by the same genetic abnormalities or shared clinical risk factors, according to findings in systematic review studies.

Childhood-onset schizophrenia and autism spectrum disorder

Childhood-onset schizophrenia (COS) is a rare and severe subtype of schizophrenia in which psychotic symptoms present before the age of 13. A diagnosis is usually made when other mental disorders or neuropsychiatric disorders have been ruled out. However, clinical and genetic commonalities between COS and ASD have been noted by various researchers, particularly among ASD patients.  

One recent case report on childhood-onset schizophrenia notes the possibility of "a single underlying pathology resulting in a unique mixed form of catatonia, autism, and psychosis." 

The case report seeks to examine the mechanisms affecting overlapping diagnostic features of COS, ASD, and catatonia, and how so-called hidden features of catatonia may go undiagnosed in COS and ASD. The report also highlights the need for further investigation into whether this pattern of catatonia within these distinct disorders may constitute a single diagnosis or reflect clinical dimensions shared by both autistic people and those who experience psychosis. 

Potential mental health risk of misdiagnosis

In certain cases, autism may be misdiagnosed as a schizophrenia spectrum disorder due to some similarities in symptom presentation. One study, for example, noted a case in which atypical symptoms of ASD or autistic disorder were misdiagnosed as schizoaffective disorder. The misdiagnosed individual in question was found to have undiagnosed ASD with brief psychosis due to stress.

While the study noted that SSDs and ASD patients can have some commonalities, like social and cognitive challenges, the correct diagnosis can inform appropriate treatment. 

Other studies suggest that the correlation between psychotic disorders and autism may be mainly due to the negative symptoms associated with psychosis.

Autistic traits may include the following:

• Social and communication challenges
• Restrictive behavior
• Repetitive behavior
• Challenges adapting to changes
• Anxiety around social situations
• Social withdrawal
• Finding it difficult to understand what others are feeling or thinking
• Challenges in expressing oneself
• Difficulty maintaining eye contact

It has also been noted that Autistic children who report auditory hallucinations, which can be a symptom of psychosis, may simply have difficulty differentiating their own voice from that of their imagination. These findings suggest that autistic children with what seem to be auditory hallucinations may actually be experiencing “pseudo-hallucinations” that do not indicate psychosis. Findings suggest that therapeutic interventions may reduce the stress and fear associated with imagined voices.

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Mental health options for individuals with autism psychosis features

If you’re experiencing signs of psychosis, consider calling your healthcare provider for help. Seeking help early on increases the possibility of a better recovery. Psychosis is typically treated with medication and talk therapy. Both of these treatment options may help reduce the risk of recurrence of psychotic symptoms, including positive symptoms like hallucinations or delusions.

Some individuals with autism, especially those with Asperger syndrome, may experience anxiety in social situations and, therefore, may feel overwhelmed by attending in-person therapy appointments. With online therapy, you can speak with a licensed therapist from the comfort of your home and customize sessions to your preferences. Users can schedule sessions at times that work for them and choose between video conferences, phone calls, and online chat for each appointment. 

One study evaluating individuals' experiences with a text-based online intervention suggested that internet-based treatment can be a convenient and "energy-saving treatment alternative for adults with autism." The same study noted that many individuals with ASD experienced stress when seeking in-person care and communicating their needs to strangers, and an online, text-based form of treatment could make care more convenient. In some cases, co-occurring conditions such as bipolar disorder may also need to be managed as part of a comprehensive treatment plan.