Youth at clinical high-risk for psychosis with an autism spectrum diagnosis: Symptomatology, premorbid adjustment, and current functioning Público
Novacek, Derek M. (2015)
Abstract
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
Participants
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
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