Youth at clinical high-risk for psychosis with an autism spectrum diagnosis: Symptomatology, premorbid adjustment, and current functioning Open Access

Novacek, Derek M. (2015)

Permanent URL:


Psychotic and autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by social, communicative, and cognitive impairments. Previously conceptualized as unrelated, more recent evidence suggests the two share genetic, prenatal, and environmental risk factors. Psychosis research has focused on identifying predictors and mechanisms that contribute to the disorder's onset. Despite this, few studies have examined how ASD might influence the development of psychosis during the clinical high-risk (CHR) period. A prodromal period of functional decline and attenuated psychotic symptoms often precedes the onset of psychosis. Given the multitude of factors that influence risk for psychosis, it is assumed that there are multiple developmental pathways to psychosis. With retrospective studies findings that 7-50% of individuals with ASD also had a comorbid psychotic disorder, it is possible that ASD is associated with one or more of these pathways, manifesting in the trajectory of functional decline and prodromal symptomatology. The present study examined whether CHR youth with (n = 25) and without (n = 739) an ASD diagnosis exhibited differences in prodromal symptoms, premorbid adjustment, and current functioning. The Structured Interview for Prodromal Syndromes assessed prodromal symptoms and determined CHR status. The Premorbid Adjustment Scale and the Global Functioning Social and Role Scales assessed premorbid adjustment and current functioning respectively. Results revealed that ASD group endorsed greater severity of social anhedonia and decreased ideational richness. The ASD group also endorsed more impairment in sociability, peer relationships, and adaptation to school in both childhood and early adolescence. In current functioning, the ASD group endorsed more deficits in social functioning, but no differences were found in role functioning. These findings provide evidence of a differing developmental trajectory to the psychosis prodrome for youth with ASD.

Table of Contents

Introduction. 1

Overlapping Symptomatology and Clinical Features

Disorders of Social Dysfunction

Shared Neurobiology

Etiological Commonalities

Developmental Links

ASD in the Psychosis Prodrome: Present Study & Hypotheses

Methods. 16


Measures and Procedures

Results. 20

Prodromal Symptomatology

Premorbid Adjustment

Current Social and Role Functioning

Discussion. 24

Developmental Pathways to Psychosis: Evidence of Equifinality?

Anhedonia and the Autism Spectrum

Negative Symptoms and their Treatment Implications

Strengths, Limitations, & Conclusions

References. 32

Appendix. 51

Tables 1-4, Figures 1-5

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Last modified

Primary PDF

Supplemental Files