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... (Davidson, Greenwood, Stansfield, & Wright, 2013;Fraser et al., 2011;Upthegrove et al., 2018). A study that examined the impact of autistic traits on 99 individuals with early psychosis in the United Kingdom found that higher levels of autistic traits were associated with poorer quality of life, functioning and current psychotic symptoms (Chisholm et al., 2019). At present, there is still a dearth of research exploring autistic traits and early psychosis recovery, including a lack of studies in Asian populations. ...
... Interestingly, exploratory work by Chisholm et al. (2019) suggested that the optimal cut-off scores on the AQ-50 to detect T A B L E 3 AQ-10 scores at study enrolment and their association with clinical outcomes at 1-year (n = 160) Odds ratio obtained using multiple logistic regression where AQ-10 score was treated as the main predictor; adjusted for age, gender, duration of untreated psychosis, baseline employment, DSM-IV diagnosis and corresponding variable at baseline. b Beta coefficient was obtained using multiple linear regression where AQ-10 score was treated as main predictor; adjusted for age, gender, duration of untreated psychosis, baseline employment, DSM-IV diagnosis and corresponding variable at baseline. ...
... The authors have clarified that this does not mean that a lower AQ score is indicative of ASD in first-episode populations. Rather, the interpretation is that subthreshold but elevated autistic traits are highly clinically relevant in terms of their implications on clinical recovery in those with first-episode psychosis (Chisholm et al., 2019). ...
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Aim There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in Singaporean patients with first‐episode psychosis and their association with 1‐year psychosis recovery. Methods The relationship between baseline patient characteristics, autistic traits (measured with autism screening questionnaires) and psychosis recovery outcomes at 1‐year were examined in 180 adults in the Early Intervention Psychosis Programme in Singapore. Results Out of 180 participants, 50 (27.8%) had clinically elevated above screening‐cut off levels of autistic traits on the self‐reported 10‐item Autism Spectrum Quotient and 8 (4.4%) on the staff‐rated Autism Spectrum Disorder in Adults Screening Questionnaire. At baseline, those with more autistic traits were more likely to be unemployed, economically inactive (ie, students or homemakers); and to have diagnoses of mood disorder with psychotic features, brief psychotic disorder or psychotic disorder not otherwise specified as compared to schizophrenia spectrum and delusional disorder diagnoses. Although most participants showed improvements in their clinical outcomes at 1‐year, those with higher autistic traits improved less in the Positive and Negative Syndrome Scale general psychopathology scale and in Global Assessment of Functioning symptomatology. Conclusions Autistic traits are common in those with first‐episode psychosis and may be associated with poorer clinical outcomes. Validated screening tools should be developed in this population to support earlier reporting.
... The FEP group consisted of 99 individuals presenting in the early stages of psychotic illness, in keeping with the ICD-10 F20-23 and F25-29 criteria (for sample characteristics see Supplementary Table S2). These data were collected as part of a cross-sectional study that examined the clinical significance of autistic traits in people with FEP [35]. Functioning in the FEP group was assessed with the Social and Occupational Functioning Assessment Scale (SOFAS) [36], an interviewer-rated instrument that assesses psychosocial, social, and occupational functioning. ...
... In C, the negative association of positive symptoms with metacognition is significantly attenuated with increasing autistic traits (and vice versa as shown in D). These negative associations cease to be significant when the severity for autistic traits and positive symptoms is respectively ≥ 1. 35 Conversely, B shows that the positive association of the CNVs' impairing effect with their ORs of risk for autism is attenuated with increasing ORs of risk for schizophrenia, and abecomes significantly negative when the OR is ≥ 0.84 SD. provided for 26 independent CNV regions. However, we were only able to use 10 CNVs, since the impairing effects of the remaining CNVs on functioning were not computed as they have a low number of CNV carriers (N < 5), or because no odds ratios for autism and/or schizophrenia were provided. ...
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Functional impairment is a core feature of both autism and schizophrenia spectrum disorders. While diagnostically independent, they can co-occur in the same individual at both the trait and diagnostic levels. The effect of such co-occurrence is hypothesized to worsen functional impairment. The diametric model, however, suggests that the disorders are etiologically and phenotypically diametrical, representing the extreme of a unidimensional continuum of cognition and behavior. A central prediction of this model is that functional impairment would be attenuated in individuals with mixed symptom expressions or genetic liability to both disorders. We tested this hypothesis in two clinical populations and one healthy population. In individuals with chronic schizophrenia and in individuals with first episode psychosis we evaluated the combined effect of autistic traits and positive psychotic symptoms on psychosocial functioning. In healthy carriers of alleles of copy number variants (CNVs) that confer risk for both autism and schizophrenia, we also evaluated whether variation in psychosocial functioning depended on the combined risk conferred by each CNV. Relative to individuals with biased symptom/CNV risk profiles, results show that functional impairments are attenuated in individuals with relatively equal levels of positive symptoms and autistic traits—and specifically stereotypic behaviors—, and in carriers of CNVs with relatively equal risks for either disorder. However, the pattern of effects along the “balance axis” varied across the groups, with this attenuation being generally less pronounced in individuals with high-high symptom/risk profile in the schizophrenia and CNV groups, and relatively similar for low-low and high-high individuals in the first episode psychosis group. Lower levels of functional impairments in individuals with “balanced” symptom profile or genetic risks would suggest compensation across mechanisms associated with autism and schizophrenia. CNVs that confer equal risks for both disorders may provide an entry point for investigations into such compensatory mechanisms. The co-assessment of autism and schizophrenia may contribute to personalized prognosis and strati!cation strategies.
... In a mediation analysis, they found that ASD traits specifically increased the likelihood of suicidal behavior via increased ratings of hopelessness. Chisholm et al. (2019) further found that more autistic traits cross-sectionally predicted greater severity of psychosis, poorer functioning, and lower quality of life in FEP. Zheng et al. (2020) found that, at baseline, more ASD traits among FEP patients were associated with a greater likelihood of having "psychosis, not otherwise specified," "mood disorder with psychotic features," or "brief psychotic disorder" diagnoses, rather than a schizophrenia diagnosis. ...
Article
Autism spectrum disorder (ASD) and schizophrenia (SCZ) are separate disorders, with distinct clinical profiles and natural histories. ASD, typically diagnosed in childhood, is characterized by restricted or repetitive interests or behaviors and impaired social communication, and it tends to have a stable course. SCZ, typically diagnosed in adolescence or adulthood, is characterized by hallucinations and delusions, and tends to be associated with declining function. However, youth with ASD are three to six times more likely to develop SCZ than their neurotypical counterparts, and increasingly, research has shown that ASD and SCZ converge at several levels. We conducted a systematic review of studies since 2013 relevant to understanding this convergence, and present here a narrative synthesis of key findings, which we have organized into four broad categories: symptoms and behavior, perception and cognition, biomarkers, and genetic and environmental risk. We then discuss opportunities for future research into the phenomenology and neurobiology of overlap between ASD and SCZ. Understanding this overlap will allow for researchers, and eventually clinicians, to understand the factors that may make a child with ASD vulnerable to developing SCZ. Lay Summary Autism spectrum disorder and schizophrenia are distinct diagnoses, but people with autism and people with schizophrena share several characteristics. We review recent studies that have examined these areas of overlap, and discuss the kinds of studies we will need to better understand how these disorders are related. Understanding this will be important to help us identify which autistic children are at risk of developing schizophrenia.
... Stereotype endorsement and difficulty in communication skills indirectly affected recovery via depressive symptoms. Several recent studies have shown autistic traits in patients with psychotic disorders, including first-episode psychosis, which has been associated with poor recovery outcomes and social functioning [19,20,34]. Considering these previous findings and the results of our study, selfstigma and depression may partially be related to the association between high levels of autistic traits in patients with psychosis and poor recovery-related outcomes and social functioning. ...
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Background Several studies have indicated that self-stigma is associated with depressive symptoms and could be a barrier to recovery in patients with schizophrenia-spectrum disorders. More recently, an association between autistic symptoms and self-stigma was found in schizophrenia-spectrum patients. This study aimed to investigate the association between self-stigma, autistic and depressive symptoms, and recovery in patients with schizophrenia. Methods In total, 105 participants were evaluated using the Autism Spectrum Quotient, the Internalized Stigma of Mental Illness Scale, the Quick Inventory of Depressive Symptomatology, and the Recovery Assessment Scale to investigate autistic symptoms, self-stigma, depressive symptoms, and recovery, respectively. The relationship between self-stigma, autistic symptoms, depressive symptoms, and recovery was assessed using structural equation modeling analysis. Results Impaired attention switching, one symptom of autism, was found to positively affect stereotype endorsement, which negatively influenced recovery through depressive symptoms. Moreover, problems with communication skills negatively affected recovery through depressive symptoms. Concerning self-stigma, stereotype endorsement and perceived discrimination had a negative effect on recovery through depressive symptoms, whereas stigma resistance had a direct negative effect on recovery. Conclusions This study may provide meaningful insight into the psychological structure of recovery and could inform effective interventions for patients with schizophrenia-spectrum disorders. This was a cross-sectionally designed study; therefore, further longitudinal studies are needed to identify the causal relationships between self-stigma, autistic and depressive symptoms, and recovery.
... The prevalence of psychosis was also higher in the ASD-diagnosed group (51.2% compared to 6.1% in the non-diagnosed group). Previous research has established a co-occurrence of ASD and psychosis (Chisholm et al., 2015(Chisholm et al., , 2019. There are many theories for why ASD and psychosis co-occur (Chisholm et al., 2015), and the elevated rates we have reported within this population of trans young people may be reflective of the co-occurrence within the general ASD-diagnosed *Significant difference between the ASD-diagnosed and non-ASD diagnosed groups (p < 0.05). ...
Article
Recent research highlights an overlap of gender diversity and autism spectrum disorders (ASD); however, data on individuals who are trans and also on the autism spectrum are largely from clinical samples and may not be representative of individuals who are trans with ASD in the general population. In addition, there is scant literature on the mental health of these individuals and their experiences in accessing gender-affirming care. We investigated the prevalence of ASD in trans young people, their mental health (psychiatric diagnoses and self-harm and suicidal behaviors) and experiences in accessing gender-affirming care. This is an analysis of data collected in an Australian cross-sectional mixed methods survey (N=859) of trans young people aged 14-25 years. Overall, 22.5% of participants had ever received a diagnosis of ASD from a health professional. This group was more likely to exhibit current psychopathology, have engaged in self-harming and suicidal behaviors, and was also more likely than the non-ASD diagnosed reference group to have received a psychiatric diagnosis. The ASD-diagnosed group were also more likely to experience barriers in accessing gender-affirming care. This is the first large population-based sample of trans individuals with ASD to report on mental health outcomes and experiences in accessing gender-affirming care. We highlight the necessity for clinicians working with either trans or ASD populations to have awareness of the co-occurrence, and to cultivate skills to work with individuals who are both trans and on the autism spectrum.
Article
Background In recent years, there has been an emerging interest in the overlap between schizophrenia and autism. The co-occurrence between these two disorders may be seen not only at a diagnostic level but also as the presence of autistic traits in schizophrenia. There has been a rapid rise in the number of studies focusing on autistic traits in schizophrenia and their clinical associations. Objective Here, we provide a review that summarizes the current findings and highlights gaps that may be addressed by future research. Results Higher levels of autistic traits have been associated with earlier age of onset, longer duration of illness, resistance to treatment, and more severe cognitive deficit. However, regarding social cognition and psychosocial functioning, the findings are mixed. Conclusion Patients with prominent autistic traits seem to be more affected. The effect of autistic traits on social cognition and psychosocial functioning remains unclear, as does their relationship with negative symptoms. Therefore, longitudinal studies are highly needed.
Article
Background: Previous researches highlighted among patients with schizophrenia spectrum disorders (SSD) a significant presence of autistic traits, which seem to influence clinical and functional outcomes. The aim of this study was to further deepen the investigation, evaluating how patients with SSD with or without autistic traits may differ with respect to levels of functioning, self-esteem, resilience, and coping profiles. Methods: As part of the add-on autism spectrum study of the Italian Network for Research on Psychoses, 164 outpatients with schizophrenia (SCZ) were recruited at eight Italian University psychiatric clinics. Subjects were grouped depending on the presence of significant autistic traits according to the Adult Autism Subthreshold Spectrum (AdAS Spectrum) instrument ("AT group" vs "No AT group"). Other instruments employed were: Autism Spectrum Quotient (AQ), Specific Levels of Functioning (SLOF), Self-Esteem Rating scale (SERS), Resilience Scale for Adults (RSA), and brief-COPE. Results: The "AT group" reported significantly higher scores than the "No AT group" on SLOF activities of community living but significantly lower scores on work skills subscale. The same group scored significantly lower also on SERS total score and RSA perception of the self subscale. Higher scores were reported on COPE self-blame, use of emotional support and humor domains in the AT group. Several correlations were found between specific dimensions of the instruments. Conclusion: Our findings suggest the presence of specific patterns of functioning, resilience, and coping abilities among SSD patients with autistic traits.
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Lay abstract: In this study, we asked 164 undergraduate students to complete an online questionnaire. The questionnaire measured the students' levels of autistic traits, self-compassion, and experience of anxiety and depression. We were interested in knowing if self-compassion (defined as the extension of kindness to oneself when faced with challenges) had any influence on the relationship between autistic traits and experiences of anxiety and depression. The results of the study indicated that self-compassion may be an important factor influencing the relationship between autistic traits and mental health, with higher levels of self-compassion being related to more positive mental health outcomes. Although the findings should be considered preliminary in nature, they do suggest that self-compassion could potentially be a target for clinical intervention in people with elevated autistic traits and experience anxiety and/or depression.
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It has been shown that autistic traits may be observed both in individuals with autism spectrum disorders and to a lesser extent in the general population. Since these traits are closely associated with limitations in social functioning, they make development of interpersonal relations difficult, and therefore may have a negative impact on an individual’s quality of life (QoL). The purpose of this study was to explore these links, including the mediating effects of coping styles. A sample of 154 adults aged 19–38 years completed three questionnaires: Autism Spectrum Quotient (AQ), Coping Inventory for Stressful Situations and World Health Organization Quality of Life—BREF. Pearson’s r correlation coefficients were analysed, followed by path analysis. All domains of QoL (Physical health, Psychological, Relationships and Environmental) were negatively correlated with AQ. The correlations were low or moderate (from −0.36 to −. 42). AQ was also correlated with two coping styles: positively with Emotion-oriented coping and negatively with Social diversion. Path analysis models showed the mediating effect of coping styles with respect to the relationships between autistic traits and QoL domains. Autistic traits and coping styles explained the greatest level of variance for the Psychological domain (41 %). The results confirmed the relationship between autistic traits and QoL, mediated by two coping styles. Due to the small sample and narrow age range of participants, our findings should be treated as a preliminary report.
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Autism spectrum disorder often co-occurs with other psychiatric disorders. Although a high prevalence of autistic-like traits/symptoms has been identified in the pediatric psychiatric population of normal intelligence, there are no reports from adult psychiatric population. This study examined whether there is a greater prevalence of autistic-like traits/symptoms in patients with adult-onset psychiatric disorders such as major depressive disorder (MDD), bipo-lar disorder, or schizophrenia, and whether such an association is independent of symptom severity. The subjects were 290 adults of normal intelligence between 25 and 59 years of age (MDD, n=125; bipolar disorder, n=56; schizophrenia, n=44; healthy controls, n=65). Autistic-like traits/symptoms were measured using the Social Responsiveness Scale for Adults. Symptom severity was measured using the Positive and Negative Symptoms Scale, the Hamilton Depression Rating Scale, and/or the Young Mania Rating Scale. Almost half of the clinical subjects, except those with remitted MDD, exhibited autistic-like traits/symptoms at levels typical for sub-threshold or threshold autism spectrum disorder. Furthermore, the proportion of psychiatric patients that demonstrated high autistic-like traits/symptoms was significantly greater than that of healthy controls, and not different between that of remitted or unremitted subjects with bipolar disorder or schizophrenia. On the other hand, remitted subjects with MDD did not differ from healthy controls with regard to the prevalence or degree of high autistic-like traits/symptoms. A substantial proportion of adults with bipolar disorder and schizophrenia showed high autistic-like traits/symptoms independent of symptom severity, suggesting a shared pathophysiology among autism spectrum disorder and these psychiatric disorders. Conversely, autistic-like traits among subjects with MDD were associated with the depressive symptom severity. These findings suggest the importance of evaluating autistic like traits/symptoms underlying adult-onset psychiatric disorders for the best-suited treatment. Further studies with a prospective design and larger samples are needed.
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Background: In clinical practice, the differential diagnosis of Asperger syndrome (AS) versus schizophrenia can be a challenge. Some self-report instruments-such as the Autism-spectrum Quotient (AQ)-have been portrayed as proxies for the diagnosis of AS. However, it has not been demonstrated to what extent autistic traits-as measured by the AQ-separate AS from schizophrenia. Aim: To examine the AS-schizophrenia discriminating ability of the AQ. Method: The AQ is a 50-item self-administered questionnaire (with score range 0-50) for measuring "autistic traits" in adults. Here, it was completed by 136 individuals: 36 with schizophrenic psychosis, 51 with AS and 49 non-clinical comparison cases. A receiver operating characteristic (ROC) analysis for the total AQ score was performed to examine the discriminating power of the instrument. Result: Both individuals with schizophrenia and individuals with AS scored significantly higher on AQ than the non-clinical group. The mean total AQ score (± standard deviation) of the AS group (26.7 ± 8.9; range 9-44) was significantly higher than that of the schizophrenia group (22.7 ± 6.2; range 10-35) (P = 0.041). However, when using the full Likert scale for scoring, the difference did not reach significance. In the ROC analysis of total AQ scores for AS versus schizophrenia, the area under the curve (AUC) was 0.65 (P = 0.02). Conclusion: Although mean AQ scores separated AS and schizophrenia at a group comparison level, significant overlap of AQ scores across the two diagnostic groups clearly reduces the discriminating power of the AQ in the separation of schizophrenia from AS.
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Both schizophrenia (SCZ) and autism spectrum disorder (ASD) are characterized by mentalizing problems and associated neural dysfunction of the social brain. However, the deficits in mental state attribution are somehow opposed: Whereas patients with SCZ tend to over-attribute intentions to agents and physical events ("hyper-intentionality"), patients with autism treat people as devoid of intentions ("hypo-intentionality"). Here we aimed to investigate whether this hypo-hyper-intentionality hypothesis can be supported by neural evidence during a mentalizing task. Using functional magnetic resonance imaging (fMRI), we investigated the neural responses and functional connectivity during reading others intention. Scanning was performed in 23 individuals with ASD, 18 with paranoid SCZ and 23 gender and IQ matched control subjects. Both clinical groups showed reduced brain activation compared to controls for the contrast intentional vs physical information processing in left posterior superior temporal sulcus (pSTS) and ventral medial prefrontal cortex (vMPFC) for SCZ, and right pSTS in ASD. As predicted, these effects were caused in a group specific way: Relative increased activation for physical information processing in SCZ that was also correlated with positive PANNS score and relative decreased activation for intentional information processing in ASD. Additionally, we could demonstrate opposed connectivity patterns between the right pSTS and vMPFC in the clinical groups, ie, increased for SCZ, decreased for ASD. These findings represent opposed neural signatures in key regions of the social brain as predicted by the hyper-hypo-intentionality hypothesis.
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It is widely accepted that autism is associated with disordered emotion processing and, in particular, with deficits of emotional reciprocity such as impaired emotion recognition and reduced empathy. However, a close examination of the literature reveals wide heterogeneity within the autistic population with respect to emotional competence. Here we argue that, where observed, emotional impairments are due to alexithymia-a condition that frequently co-occurs with autism-rather than a feature of autism per se. Alexithymia is a condition characterized by a reduced ability to identify and describe one's own emotion, but which results in reduced empathy and an impaired ability to recognize the emotions of others. We briefly review studies of emotion processing in alexithymia, and in autism, before describing a recent series of studies directly testing this 'alexithymia hypothesis'. If found to be correct, the alexithymia hypothesis has wide-reaching implications for the study of autism, and how we might best support subgroups of autistic individuals with, and without, accompanying alexithymia. Finally, we note the presence of elevated rates of alexithymia, and inconsistent reports of emotional impairments, in eating disorders, schizophrenia, substance abuse, Parkinson's Disease, multiple sclerosis and anxiety disorders. We speculate that examining the contribution of alexithymia to the emotional symptoms of these disorders may bear fruit in the same way that it is starting to do in autism.
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The present study compared 21 high functioning individuals with autism, 21 individuals with schizophrenia and 21 healthy individuals in self-reported features of autism, as measured by the Autism-spectrum Quotient (AQ). The individuals with autism reported impairment on all AQ subscales, compared to the neurotypical group. The schizophrenia group reported deficits on all subscales except Attention to Detail, compared to the neurotypical group.The autism group reported more impairment than the individuals with schizophrenia in Social skill, Communication and Attention switching.
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We explored the relationships between 'autistic' traits as measured by the AQ (Autism-Spectrum Quotient; Baron-Cohen et al., J. Autism Develop. Disord. (2001b) 31 5) and various personality traits or cognitive ability, which usually coincide with autistic symptoms, for general populations. Results showed the AQ was associated with tendencies toward an obsessional personality as defined by the TCI (Temperament and Character Inventory), higher depression and anxiety, and higher frequency of experience of being bullied. These results parallel the patterns in autism and corroborate the validity of the AQ for general populations. Contrary to our prediction, however, there was no relationship between the AQ and cognitive ability, such as theory of mind, executive functioning, and central coherence, suggesting the AQ does not reflect autism-specific cognitive patterns in general populations.
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Including children with autism in regular classrooms has become prevalent; yet some evidence suggests such placements could increase the risk of isolation and rejection. In this study, we used social network methods to explore the involvement of children with autism in typical classrooms. Participants were 398 children (196 boys) in regular 2nd through 5th grade classes, including 17 children (14 boys) with high functioning autism or Asperger's syndrome. Children reported on friendship qualities, peer acceptance, loneliness, and classroom social networks. Despite involvement in networks, children with autism experienced lower centrality, acceptance, companionship, and reciprocity; yet they did not report greater loneliness. Future research is needed to help children with autism move from the periphery to more effective engagement with peers.
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There is increasing evidence to suggest both a symptomatic overlap and a clinically significant degree of co-occurrence between Autism Spectrum Disorders (ASD) and psychotic disorders such as schizophrenia but the nature of such relationships remain unclear. We reviewed the literature reporting prevalence rates of Autistic-like Traits (ALTs) and ASD in populations with a diagnosis of schizophrenia or other psychotic disorder. A search of three large databases was conducted and from this seven studies met the criteria for inclusion. The point prevalence rates for ALTs ranged from 9.6% to 61%, whilst the prevalence rates for diagnosed ASD ranged from <1% to 52% across outpatient and inpatient populations. This suggests that prevalence rates of ALTs and ASD in psychosis populations are much higher than in the general population. This has important implications regarding future research, and clinical implications in terms of ensuring that patients receive the most appropriate diagnosis and treatment.
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Atypical responses to salient information are a candidate endophenotype for both autism and psychosis spectrum disorders. The present study investigated the costs and benefits of such atypicalities for saliency-based selection in a large cohort of neurotypical adults in whom both autism and psychosis expressions were assessed. Two experiments found that autism tendencies and psychosis proneness interactively modulated the cost incurred in the presence of a task-irrelevant salient distractor. Specifically, expressions of autism and psychosis had opposing effects on responses to salient information such that the benefits associated with high expressions for autism offset costs associated with high expressions for psychosis. The opposing influences observed on saliency cost may be driven by distinct attentional mechanisms that are differentially affected by expressions for autism and psychosis.
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The mentalizing network is atypically activated in autism and schizophrenia spectrum disorders. While these disorders are considered diagnostically independent, expressions of both can co-occur in the same individual. We examined the concurrent effect of autism traits and psychosis proneness on the activity of the mentalizing network in 24 neurotypical adults while performing a social competitive game. Activations were observed in the paracingulate cortex and the right temporo-parietal junction (rTPJ). Autism traits and psychosis proneness did not modulate activity within the paracingulate or the dorsal component of the rTPJ. However, diametric modulations of autism traits and psychosis proneness were observed in the posterior (rvpTPJ) and anterior (rvaTPJ) subdivisions of the ventral rTPJ, which respectively constitute core regions within the mentalizing and attention-reorienting networks. Within the rvpTPJ, increasing autism tendencies decreased activity, and increasing psychosis proneness increased activity. This effect was reversed within the rvaTPJ. We suggest that this results from an interaction between regions responsible for higher level social cognitive processing (rvpTPJ) and regions responsible for domain-general attentional mechanism (rvaTPJ). The observed diametric modulation of autism tendencies and psychosis proneness of neuronal activity within the mentalizing network highlights the importance of assessing both autism and psychosis expressions within the individual.
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Introduction: Studies of executive function in autism spectrum disorder without intellectual disability (ASD-WID) patients are contradictory. We assessed a wide range of executive functioning cognitive domains in a sample of children and adolescents with ASD-WID and compared them with age-, sex-, and intelligence quotient (IQ)-matched healthy controls. Methods: Twenty-four ASD-WID patients (mean age 12.8±2.5 years; 23 males; mean IQ 99.20±18.81) and 32 healthy controls (mean age 12.9±2.7 years; 30 males; mean IQ 106.81±11.02) were recruited. Results: Statistically significant differences were found in all cognitive domains assessed, with better performance by the healthy control group: attention (U=185.0; P=.0005; D=0.90), working memory (T51.48=2.597; P=.006; D=0.72), mental flexibility (U=236.0; P=.007; D=0.67), inhibitory control (U=210.0; P=.002; D=0.71), and problem solving (U=261.0; P=0.021; D=0.62). These statistically significant differences were also found after controlling for IQ. Conclusion: Children and adolescents with ASD-WID have difficulties transforming and mentally manipulating verbal information, longer response latency, attention problems (difficulty set shifting), trouble with automatic response inhibition and problem solving, despite having normal IQ. Considering the low executive functioning profile found in those patients, we recommend a comprehensive intervention including work on non-social problems related to executive cognitive difficulties.
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The true extent of school bullying among youth with autism spectrum disorders (ASD) remains an underexplored area. The purpose of this meta-analysis is to: (a) assess the proportion of school-aged youth with ASD involved in school bullying as perpetrators, victims or both; (b) examine whether the observed prevalence estimates vary when different sources of heterogeneity related to the participants' characteristics and to the assessment methods are considered; and (c) compare the risk of school bullying between youth with ASD and their typically developing (TD) peers. A systematic literature search was performed and 17 studies met the inclusion criteria. The resulting pooled prevalence estimate for general school bullying perpetration, victimization and both was 10%, 44%, and 16%, respectively. Pooled prevalence was also estimated for physical, verbal, and relational school victimization and was 33%, 50%, and 31%, respectively. Moreover, subgroup analyses showed significant variations in the pooled prevalence by geographic location, school setting, information source, type of measures, assessment time frame, and bullying frequency criterion. Finally, school-aged youth with ASD were found to be at greater risk of school victimization in general, as well as verbal bullying, than their TD peers. Autism Res 2015. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
Conference Paper
The right temporo-parietal junction (rTPJ) is a shared region of networks subtending socio-cognitive functions such as mentalizing and domain-general computations such as attention-reorienting. Atypical activations in the rTPJ have been independently observed in autism and schizophrenia spectrum disorders in tasks activating either network. While considered diagnostically independent, traits of both disorders can co-occur. To date, no studies have examined the effect of such co-occurrence on rTPJ activity. In this ROI study, we investigated the neural activity of the rTPJ as a function of co-occurring autism and psychosis traits in 24 neurotypical adults while performing a competitive game. Whether the TPJ is a unified brain region has been controversial. Therefore, we also examined the effect of co-occurring autism and psychosis traits within subdivisions of the rTPJ. Co-occurring autism and psychosis traits diametrically modulated both the ventral posterior rTPJ and the ventral anterior rTPJ, which respectively constitute core regions within the mentalizing and attention-reorienting networks. The diametric effect of autism and psychosis traits within the ventral anterior rTPJ was in the opposite direction to that within the posterior rTPJ. The interactive effect of autism and psychosis traits implies that inter-individual differences in individuals with autism or psychosis spectrum disorders are likely to be better explained in terms of the relative expression of one disorder vis-à-vis the other. The opposite diametric effects in the anterior versus the posterior ventral rTPJ possibly reflect the nature of the complementary interaction between regions responsible for higher level social cognitive processing with regions subtending domain-general computational mechanism.
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Autism spectrum disorder (ASD) is often associated with poor emotional control and psychopathology, such as anxiety and depression; however, little is known about the underlying mechanisms. Emotion regulation (ER) is a potential contributing factor, but there has been limited research on ER and its role in comorbid psychopathology in ASD. In this study, we compared self-reported ER with self- and parent reports of psychopathology in 25 high-functioning adolescents with ASD and 23 age- and Intelligence Quotient (IQ)-matched typically developing controls. Contrary to expectations, both groups reported similar levels of adaptive, voluntary forms of ER (problem solving, acceptance, etc.). However, the ASD group reported significantly greater use of involuntary forms of ER that are typically maladaptive, including remaining focused on the stressor (e.g. rumination and emotional arousal) and shutting down (e.g. emotional numbing and being unable to think or act). Associations between ER and psychopathology were generally more robust using self-report rather than parent report. For both groups, greater endorsement of involuntary ER strategies was associated with higher ratings of psychopathology, whereas voluntary ER strategies focused on changing or adapting to the situation were significantly associated with lower levels of psychopathology. The magnitude and direction of association between ER types and psychopathology were similar for measures of depression and anxiety. These findings can help guide the development of psychosocial treatments targeting dysfunctional ER in adolescents with ASD. Interventions focused on ER as a transdiagnostic process may be a more robust method to improve emotional control and decrease emotional distress in ASD than disorder-specific interventions. Autism Res 2014, ●●: ●●–●●. © 2014 International Society for Autism Research, Wiley Periodicals, Inc.
Article
Background There is a lack of systematic studies into comorbidity of Asperger syndrome and psychosis. AimTo determine the prevalence of Asperger syndrome among patients of an early intervention in psychosis service. Methods This study was a cross-sectional survey consisting of three phases: screening, case note review and diagnostic interviews. All patients on caseload (n=197) were screened using the Autism Spectrum Disorder in Adults Screening Questionnaire. The case notes of patients screened positive were then reviewed for information relevant to Asperger syndrome. Those suspected of having Asperger syndrome were invited for a diagnostic interview. ResultsThirty patients were screened positive. Three of them already had a diagnosis of Asperger syndrome made by child and adolescent mental health services. After case note review, 13 patients were invited to interview. Four did not take part, so nine were interviewed. At interview, four were diagnosed with Asperger syndrome. In total, seven patients had Asperger syndrome. Thus, the prevalence rate in this population is at least 3.6%. Conclusions The results suggest that the prevalence of Asperger syndrome in first-episode psychosis is considerably higher than that in the general population. Clinicians working in early intervention teams need to be alert to the possibility of Asperger syndrome when assessing patients.
Article
I define three separate and distinct types of non-random comorbidity: epidemiologic, clinical and familial. These might exist singly or in any combination for a pair of disorders. The focus is on their definition and the measurement and interpretation of the types of comorbidity of most common concern: epidemiologic comorbidity. I discuss certain sources of epidemiologic comorbidity such as shared risk factors, or diagnostic ‘fuzziness’, and I indicate the directions of research design and analyses to disclose such sources.
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Morosini P-L, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social funtioning. Acta Psychiatr Scand 2000: 101:323–329. © Munksgaard 2000. Objective: Development of a scale to assess patients' social functioning, the Personal and Social Performance scale (PSP). Method: PSP has been developed through focus groups and reliability studies on the basis of the social functioning component of the DSM-TV Social and Occupational Functioning Assessment Scale (SOFAS). The last reliability study was carried out by 39 workers with different professional roles on a sample of 61 psychiatric patients admitted to the rehabilitation unit. Each patient was rated independently on the scale by the two workers who knew them best. Results: The PSP is a 100–point single-item rating scale, subdivided into 10 equal intervals. The ratings are based mainly on the assessment of patient's functioning in four main areas: 1) socially useful activities; 2) personal and social relationships; 3) self-care; and 4) disturbing and aggressive behaviours. Operational criteria to rate the levels of disabilities have been defined for the above-mentioned areas. Excellent inter-rater reliability was also obtained in less educated workers. Conclusion: Compared to SOFAS, PSP has better face validity and psychometric properties. It was found to be an acceptable, quick and valid measure of patients' personal and social functioning.
Article
Impaired social functioning is a hallmark of autism spectrum conditions. The purpose of this study was to investigate possible relationship between social functioning and a broader autism phenotype. With a sample of non-clinical undergraduate students from a large, urban university (N = 97; mean age = 19.4 ± 2 years), characteristics associated with autism were measured as well as self-reported dating and friendship history, feelings of loneliness, and social motivation. Results indicate that those individuals with a stronger autism phenotype (e.g., rigidity, preference for sameness, high attention to detail) report significantly more loneliness (r = .52, p < 0.01) and fewer and shorter duration friendships. Also, for participants in romantic relationships, a stronger phenotype was moderately and positively correlated with length of relationship (r = .34, p < 0.05). Findings support the view that individuals with characteristics of autism and related conditions do not necessarily prefer aloneness, as once assumed, but rather experience increased levels of loneliness related to lack of social skill and understanding. Significance and limitations of these findings are discussed and future directions for research and possibilities for social skills training in this population are explored.
Article
One of the difficulties facing schizophrenia patients is a failure to construct appropriate relationships with others in social situations. This impairment of social cognition is also found in autism-spectrum disorder (ASD). Considering such commonality between the two disorders, in this study we adopted the Autism-Spectrum Quotient (AQ) score to assess autistic traits, and explored the association between such traits and gray matter (GM) alterations of the brain in schizophrenia. Twenty schizophrenia patients and 25 healthy controls underwent structural magnetic resonance imaging (MRI), and AQ was assessed, comprising five subscales measuring different facets of autistic traits. Voxel-based morphometry (VBM) was applied to investigate the correlation between these AQ scores and regional GM alterations. Schizophrenia patients showed significantly higher scores in total AQ, and in four of the five subscales, compared to healthy controls. The total AQ score in schizophrenia showed significant negative correlation with GM volume reduction in the cortical area surrounding the left superior temporal sulcus (STS), which is considered to be important in social perception. Our findings suggest a possible neuroanatomical basis of autistic tendencies in schizophrenia.
Article
Pervasive developmental disorders (PDDs) were originally conceptualised as a form of ("infantile") psychosis. Recently, the disorders have been viewed as separate constructs. However, there is evidence of overlapping psychopathology, pathophysiology, and occurrence of the two syndromes. A historical overview is provided. A systematic search strategy was then used to identify literature relating to the co-occurrence of PDD and nonaffective psychosis. The methodology and estimated rates of psychosis occurring in PDD varied dramatically, and few conclusions could be drawn due to the level of heterogeneity and selection bias in the populations studied. However, there were indications from the literature that rates of comorbid PDD were elevated in adolescents affected by juvenile-onset psychosis but the methodology was insufficiently robust to estimate a pooled prevalence. There is some evidence for elevated rates of comorbid PDD in individuals with childhood-onset psychosis. Further work is needed in order to understand the potential mechanisms underlying such co-occurrence and how such affected individuals can be best supported.
Article
There is substantial evidence for Theory of Mind (ToM) deficits in patients with schizophrenia. Many psychotic symptoms may best be understood in light of an impaired capacity to infer one's own and other persons' mental states and to relate those to executing behavior. The aim of our study was to investigate ToM abilities in first-episode schizophrenia patients and to analyze them in relation to neuropsychological and psychopathological functioning. A modified Moving Shapes paradigm was used to assess ToM abilities in 23 first-episode patients with schizophrenia and 23 matched healthy controls. Participants had to describe animated triangles which moved (1) randomly, (2) goal-directed, or (3) in complex, socially interactive ways (ToM video sequences). Neuropsychological functioning, psychopathology, autistic and alexithymic features as well as empathetic abilities were correlated with ToM performance. Compared to healthy controls, first-episode schizophrenia patients gave more incorrect descriptions and used less ToM-related vocabulary when responding to socially complex ToM video sequences. No group differences were revealed for videos with random movements. ToM abilities correlated significantly with positive symptoms, reasoning, verbal memory performance and verbal IQ, but not with empathetic abilities or autistic and alexithymic features. When controlling for reasoning, verbal memory performance and verbal IQ, the correctness of video descriptions was still significantly worse in schizophrenia patients. The results of our study in first-episode schizophrenia patients underline recent findings on ToM deficits in the early course of schizophrenia. Only a moderate influence of neurocognitive deficits on ToM performance was observed. Impairment in ToM abilities seems to be predominantly independent of clinical state, alexithymia and empathy.
Article
Axis V, which uses the Global Assessment of Functioning Scale in the multiaxial system of DSM-III-R, is under review for DSM-IV. This article examines what is known about axis V and selectively reviews the literature on measures of social functioning to identify potential alternatives to the Global Assessment of Functioning Scale. About 25 studies on the use, reliability, and validity of axis V in DSM-III and DSM-III-R are reviewed. In addition, nearly 30 measures of social functioning are reviewed and analyzed as potential substitutes for the Global Assessment of Functioning Scale. The analysis focuses on the strengths and weaknesses of each measure for assessing functioning on axis V. Axis V measures are modestly reliable and valid but not widely used. The authors identify and discuss two particular limitations of the Global Assessment of Functioning Scale: 1) the combination of measures of symptoms and measures of social functioning on a single axis and 2) the exclusion of physical impairments from the rating of functioning. None of the measures of social functioning reviewed is clearly superior to the Global Assessment of Functioning Scale for use on axis V. A modified version of the Global Assessment of Functioning Scale, separating the measures of social and occupational functioning from the measures of symptoms and psychological functioning, is proposed for field testing, along with a new set of instructions permitting the rating of limitations due to both physical and mental impairments.
Article
There is growing interest in deficit symptoms in studies of the course and treatment response of schizophrenia. However, existing clinical assessment instruments focus primarily on productive symptoms. The authors describe the Quality of Life Scale (QLS), a 21-item scale based on a semistructured interview designed to assess deficit symptoms and thereby fill an important gap in the range of instruments now available. Data regarding reliability and training in the use of the QLS are presented. A factor analysis of the items yields results compatible with the conceptual model on which the scale is based. The factor analysis was also performed separately by sex and was fundamentally similar for men and women.
Article
The Premorbid Adjustment Scale (PAS) is a rating scale which was developed to be applicable in a research setting. It is designed to evaluate the degree of achievement of developmental goals at each of several periods of a subject's life before the onset of schizophrenia. A description of the scale and its use is presented, along with a discussion of psychometric properties. The PAS has been found to be useful in identifying patients likely to become chronically hospitalized or at high risk for readmission. It may also serve as a possible predictor of patients with brain abnormalities on a computerized tomography (CT) scan.
Article
Schizophrenia is a severe mental illness that affects 1% of the population. The diagnosis is made according to current diagnostic systems of DSM-IV (American Psychiatric Association, 1994) and ICD-10 (World Health Association, 1992) on the basis of characteristic 'positive' and 'negative' symptoms. The traditional medical model assumes a categorical view of the schizophrenia syndrome and its core symptoms, in which differences between psychotic symptoms and their normal counterparts are considered to be qualitative. An alternative, dimensional approach assumes that schizophrenia is not a discrete illness entity, but that psychotic symptoms differ in quantitative ways from normal experiences and behaviours. This paper reviews evidence for the continuity of psychotic symptoms with normal experiences, focusing on the symptoms of hallucinations and delusions. It concludes by discussing the theoretical and treatment implications of such a continuum.
Article
Recent research has indicated that autism is not a discrete disorder and that family members of autistic probands have an increased likelihood of exhibiting autistic symptoms with a wide range of severity, often below the threshold for a diagnosis of an autism spectrum disorder. To examine the distribution and genetic structure of autistic traits in the general population using a newly established quantitative measure of autistic traits, the Social Responsiveness Scale (formerly known as the Social Reciprocity Scale). The sample consisted of 788 pairs of twins aged 7 to 15 years, randomly selected from the pool of participants in a large epidemiologic study (the Missouri Twin Study). One parent of each pair of twins completed the Social Responsiveness Scale on each child. The data were subjected to structural equation modeling. Autistic traits as measured by the Social Responsiveness Scale were continuously distributed and moderately to highly heritable. Levels of severity of autistic traits at or above the previously published mean for patients with pervasive developmental disorder not otherwise specified were found in 1.4% of boys and 0.3% of girls. Structural equation modeling revealed no evidence for the existence of sex-specific genetic influences, and suggested specific mechanisms by which females may be relatively protected from vulnerability to autistic traits. These data indicate that the social deficits characteristic of autism spectrum disorders are common. Given the continuous distribution of these traits, it may be arbitrary where cutoffs are made between research designations of being "affected" vs "unaffected" with a pervasive developmental disorder. The genes influencing autistic traits appear to be the same for boys and girls. Lower prevalence (and severity) of autistic traits in girls may be the result of increased sensitivity to early environmental influences that operate to promote social competency.
Article
Sex differences in the risk of a particular disorder can yield important clues regarding its pathogenesis. The evidence for a sex difference in the risk of schizophrenia is inconclusive. The purpose of this study was to integrate results from the published literature and to provide a quantitative index of the male-female ratio for the incidence of schizophrenia. The MEDLINE and PsychLIT databases were searched for English-language publications on "incidence and schizophrenia" that appeared during the period between January 1980 and September 2001. Population-based incidence studies using standard clinical diagnostic criteria were included if they reported sex-specific incidence rates. Sex-specific incidence figures were extracted directly from each study. Categorical analyses were conducted on a subset of studies that met specific methodological criteria (to minimize criterion bias, hospital bias, and age bias). Study categorization and data extraction were performed independently by 2 of us (A. A. and J.-P.S.). Log risk ratio meta-analysis was conducted using a random-effects model. The incidence risk ratios for men to develop schizophrenia relative to women were 1.42 (95% confidence interval [CI], 1.30-1.56) when all studies were included in the analysis (49 effect sizes), 1.31 (95% CI, 1.13-1.51) when studies that minimized selection biases were analyzed separately (23 effect sizes), and 1.39 (95% CI, 1.15-1.68) when only high-quality studies were included (11 effect sizes). The sex difference was significantly smaller in studies with sample years before 1980 than those with sample years after 1980. No significant sex differences were reported in studies from developing countries. A final analysis, limited to studies with an age cutoff of 64 years or older (16 effect sizes), yielded a mean risk ratio of 1.32 (95% CI, 1.13-1.55). This meta-analysis provides evidence for a sex difference in the risk of developing schizophrenia, as reported in the published literature from the last 2 decades.
Article
Comorbidity has presented a persistent puzzle for psychopathology research. We review recent literature indicating that the puzzle of comorbidity is being solved by research fitting explicit quantitative models to data on comorbidity. We present a meta-analysis of a liability spectrum model of comorbidity, in which specific mental disorders are understood as manifestations of latent liability factors that explain comorbidity by virtue of their impact on multiple disorders. Nosological, structural, etiological, and psychological aspects of this liability spectrum approach to understanding comorbidity are discussed.
Article
The comparison of high-risk populations with different developmental pathways to psychosis may lend more insight into the heterogeneity of the manifestation of the psychotic syndrome, and possible differing etiological pathways. To compare high-risk traits and symptoms in two populations at risk for psychosis, i.e. (1) help-seeking adolescents presenting with prodromal symptoms meeting the criteria for At Risk Mental State (ARMS), and (2) adolescents with Multiple Complex Developmental Disorder (MCDD), a PDD-NOS subtype characterized by severe, early childhood-onset deficits in affect regulation, anxieties, disturbed social relationships, and thought disorder. 80 ARMS- and 32 MCDD-adolescents (12-18 years) were compared on prodromal symptoms (Structured Interview of Prodromal Symptoms, and Bonn Scale for the Assessment of Basic Symptoms-Prediction list), and autism traits (Social Communication Questionnaire). In addition, both high-risk groups were compared with 82 healthy controls on schizotypal traits (Schizotypal Personality Questionnaire-Revised). Although the high-risk groups clearly differed in early developmental and treatment histories as well as autism traits, they did not differ with regard to schizotypal traits and basic symptoms, as well as disorganized and general prodromal symptoms. There were, however, group differences in positive and negative prodromal symptoms. Interestingly, 78% of the adolescents with MCDD met criteria for ARMS. These findings suggest that children diagnosed with MCDD are at high risk for developing psychosis later in life, and support the notion that there are different developmental pathways to psychosis. Follow-up research is needed to compare the rates of transition to psychosis in both high-risk groups.
The positive and negative syndrome scale (PANSS) for schizophrenia
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Index for rating diagnostic tests
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Revising axis v for DSM-IV: a review of measures of social functioning
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