The association between autism and psychosis: measurement, disambiguation, and the impact of adversity and camouflaging

Abstract

Autistic individuals are at increased risk of being diagnosed with a psychotic disorder and having psychotic experiences. Research has largely sought to quantify the association between these two conditions, with little attempting to understand why it exists. Risk factors of psychosis, such as adverse childhood experiences (ACEs), are largely unexplored within autistic individuals. Research has also relied on using standard psychosis measures, the suitability of which have been questioned for use within autistic populations, for reasons of symptom overlap and misinterpretation. Our research, therefore, aimed to: i) create an amended psychosis screening tool for use within autistic populations, and ii) examine whether trauma moderates the association between autism and psychosis. Study 1 meta-analysed the literature on the autism-psychosis association, finding a consistent relationship between conditions at both a trait and diagnostic level. Notably, associations between autistic and psychosis-spectrum traits were largely driven by non-psychotic overlap (e.g., social difficulties, “odd” behaviours), questioning the accuracy of standard screening tools for use within autistic populations. As such, Study 2 examined how autistic individuals interpreted the Schizotypal Personality Questionnaire–Brief Revised (SPQ-BR), a common psychosis-spectrum screening tool, finding that over half of the items were frequently misinterpreted by both autistic and non-autistic individuals. As such, through co-creation with autistic individuals, an amended SPQ-BR was devised and validated. Using this amended questionnaire, Study 3 examined the role of ACEs on the autism-psychosis association. Compared to the general population, both the autistic and psychosis samples reported higher ACE exposure. There was no clear evidence, however, of ACEs moderating the autism-psychosis trait association. Collectively, these studies highlight factors that help explain and contextualise the autism-psychosis association. Future research should further examine the appropriateness of common psychometric measures within autistic populations, and more investigation is required into the early-life adversity autistic individuals may face.

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Identifiers

ORCID for Michael Reuben Miles: orcid.org/0000-0003-2985-1311

ORCID for Dennis Golm: orcid.org/0000-0002-2950-7935

ORCID for Emma Palmer-Cooper: orcid.org/0000-0002-5416-1518

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