Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul;51(10):1704-1713.
doi: 10.1017/S0033291720000458. Epub 2020 Mar 10.

Autistic traits in psychotic disorders: prevalence, familial risk, and impact on social functioning

Tim B Ziermans  1   2 , Frederike Schirmbeck  1   3 , Floor Oosterwijk  4 , Hilde M Geurts  2   5 , Lieuwe de Haan  1   3 ; Genetic Risk and Outcome of Psychosis (GROUP) Investigators
Affiliations

Autistic traits in psychotic disorders: prevalence, familial risk, and impact on social functioning

Tim B Ziermans et al. Psychol Med. 2021 Jul.

Abstract

Background: Prevalence estimates of autistic traits in individuals with psychotic disorders (PD) vary greatly and it is unclear whether individuals with a familial risk (FR) for psychosis have an increased propensity to display autistic traits. Furthermore, it is unknown whether the presence of comorbid autism traits disproportionally affects the cognitive and behavioral aspects of social functioning in PD.

Methods: In total, 504 individuals with PD, 587 unaffected siblings with FR, and 337 typical comparison (TC) individuals (16-50 years) were included. Autistic and psychotic traits were measured with the Autism Spectrum Quotient (AQ) and the Community Assessment of Psychic Experiences (CAPE). Social cognition was assessed with the Picture Sequencing Task (PST) and social behavior with the Social Functioning Scale (SFS).

Results: For PD 6.5% scored above AQ clinical cut-off (⩾32), 1.0% for FR, and 1.2% for TC. After accounting for age, sex, and IQ, the PD group showed significantly more autistic traits and alterations in social behavior and cognition, while FR and TC only displayed marginal differences. Within the PD group autistic traits were a robust predictor of social behavior and there were no interactions with positive psychotic symptoms.

Conclusions: Levels of autistic traits are substantially elevated in PD and have a profoundly negative association with social functioning. In contrast, autistic traits above the clinical cut-off are not elevated in those with FR, and only marginally on a dimensional level. These findings warrant specific clinical guidelines for psychotic patients who present themselves with autistic comorbidity to help address their social needs.

Keywords: autism; functional outcome; mentalizing; psychosis; schizophrenia; social cognition.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
Left: Histogram plot with the normal curve of Total AQ scores stacked across groups. Right: Normal curves per group: PD (top), FR (middle), and TC (bottom).
Fig. 2.
Fig. 2.
Z-transformed group means for Picture Sequencing Test – False Belief (PST-FB; left) and the Social Functioning Scale (SFS; right). Error bars represent ±1 standard error.
See this image and copyright information in PMC

References

    1. Abu-Akel, A., Allison, C., Baron-Cohen, S., & Heinke, D. (2019). The distribution of autistic traits across the autism spectrum: Evidence for discontinuous dimensional subpopulations underlying the autism continuum. Molecular Autism, 10, 1752–1764. - PMC - PubMed
    1. Abu-Akel, A., Apperly, I., Spaniol, M. M., Geng, J. J., & Mevorach, C. (2018a). Diametric effects of autism tendencies and psychosis proneness on attention control irrespective of task demands. Scientific Reports, 8, 8478. - PMC - PubMed
    1. Abu-Akel, A. M., Apperly, I. A., Wood, S. J., & Hansen, P. C. (2017b). Autism and psychosis expressions diametrically modulate the right temporoparietal junction. Social Neuroscience, 12, 506–518. - PubMed
    1. Abu-Akel, A., Apperly, I. A., Wood, S. J., Hansen, P. C., & Mevorach, C. (2017a). Autism tendencies and psychosis proneness interactively modulate saliency cost. Schizophrenia Bulletin, 43, 142–151. - PMC - PubMed
    1. Abu-Akel, A., Testa, R. R., Jones, H. P., Ross, N., Skafidas, E., Tonge, B., & Pantelis, C. (2018b). Attentional set-shifting and social abilities in children with schizotypal and comorbid autism spectrum disorders. Australian and New Zealand Journal of Psychiatry, 52, 68–77. - PubMed

Publication types