Abstract
The relationship between autism spectrum disorders (ASD) and psychotic disorders (PD) is a focus of continued interest. There are substantial conceptual and clinical difficulties associated with diagnosing comorbid PD in individuals who have ASD. In this case series, we report on five cases where adolescents with previously diagnosed ASD were also diagnosed as psychotic. In each case, we found that these patients’ ‘psychotic’ symptoms could be better understood as a part of their underlying ASD diagnosis, with significant implications for treatment, prognosis, and access to services. This misdiagnosis likely represents a combination of adult psychiatrists being relatively inexperienced with this population, and the system of care requiring providers to apply diagnostic labels to justify inpatient hospitalization.
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References
American Psychiatric Association. (2013). DSM-5.
Barnard, L., Young, A. H., Pearson, J., Geddes, J., & O’Brien, G. (2002). A systematic review of the use of atypical antipsychotics in autism. Journal of Psychopharmacology, 16(1), 93–101. doi:10.1177/026988110201600113.
Baron-Cohen, S. (1989). Do autistic children have obsessions and compulsions? The British journal of clinical psychology/the British Psychological Society, 28(Pt 3), 193–200. http://www.ncbi.nlm.nih.gov/pubmed/2676040.
Crespi, B., & Badcock, C. (2008). Psychosis and autism as diametrical disorders of the social brain. The Behavioral and Brain Sciences, 31(3), 241–61; discussion 261–320. doi:10.1017/S0140525X08004214.
Dossetor, D. (2007). “All That Glitters Is Not Gold”: Misdiagnosis of psychosis in pervasive developmental disorders—a case series. Clinical Child Psychology and Psychiatry, 12(4), 537–548. doi:10.1177/1359104507078476.
Eminson, D. M., & Goodyer, I. M. (2004). Time for change to a developmental perspective in the education and training of psychiatrists. Psychiatric Bulletin, 28(10), 378–381. doi:10.1192/pb.28.10.378.
Fitzgerald, M. (2012). Schizophrenia and autism/Asperger’s syndrome overlap and difference. Clinical Neuropsychiatry, 171–176. http://www.clinicalneuropsychiatry.org/pdf/Fitzgerald.pdf.
Howlin, P. (2000). Outcome in adult life for more able individuals with autism or Asperger syndrome. Autism, 4(1), 63–83. doi:10.1177/1362361300004001005.
Kanner, L. (1971). Follow-up study of eleven autistic children originally reported in 1943. Journal of Autism and Childhood Schizophrenia, 1(2), 119–145. http://www.ncbi.nlm.nih.gov/pubmed/5172388.
Konstantareas, M. M., & Hewitt, T. (2001). Autistic disorder and schizophrenia: Diagnostic overlaps. Journal of Autism and Developmental Disorders, 31(1), 19–28. http://www.ncbi.nlm.nih.gov/pubmed/11439750.
Matson, J. L., & Dempsey, T. (2007). Autism spectrum disorders: Pharmacotherapy for challenging behaviors. Journal of Developmental and Physical Disabilities, 20(2), 175–191. doi:10.1007/s10882-007-9088-y.
McGorry, P. D., & Yung, A. R. (2003). Early intervention in psychosis: An overdue reform. The Australian and New Zealand Journal of Psychiatry, 37(4), 393–398. http://www.ncbi.nlm.nih.gov/pubmed/12873322.
Perlman, L. (2000). Adults with Asperger disorder misdiagnosed as schizophrenic. Professional Psychology: Research and Practice, 31(2), 221–225.
Rapoport, J., Chavez, A., Greenstein, D., Addington, A., & Gogtay, N. (2009). Autism spectrum disorders and childhood-onset schizophrenia: Clinical and biological contributions to a relation revisited. Journal of the American Academy of Child and Adolescent Psychiatry, 48(1), 10–18. doi:10.1097/CHI.0b013e31818b1c63.
Russell, A. (1994). The clinical presentation of childhood-onset schizophrenia. Schizophrenia Bulletin, 20(4), 631–646. http://www.ncbi.nlm.nih.gov/pubmed/7701273.
Rutter, M. (1972). Childhood schizophrenia reconsidered. Journal of Autism and Developmental Disorders, 315–337. http://psycnet.apa.org/psycinfo/1962-06944-000.
Sporn, A. L., Addington, A. M., Gogtay, N., Ordoñez, A. E., Gornick, M., Clasen, L., et al. (2004). Pervasive developmental disorder and childhood-onset schizophrenia: Comorbid disorder or a phenotypic variant of a very early onset illness? Biological Psychiatry, 55(10), 989–994. doi:10.1016/j.biopsych.2004.01.019.
Sullivan, S., Rai, D., Golding, J., Zammit, S., & Steer, C. (2013). The association between autism spectrum disorder and psychotic experiences in the Avon longitudinal study of parents and children (ALSPAC) birth cohort. Journal of the American Academy of Child and Adolescent Psychiatry, 52(8), 806–814.e2. doi:10.1016/j.jaac.2013.05.010.
Tsakanikos, E., Costello, H., Holt, G., Sturmey, P., & Bouras, N. (2007). Behaviour management problems as predictors of psychotropic medication and use of psychiatric services in adults with autism. Journal of Autism and Developmental Disorders, 37(6), 1080–1085. doi:10.1007/s10803-006-0248-1.
Vismara, L. A., & Rogers, S. J. (2010). Behavioral treatments in autism spectrum disorder: What do we know? Annual Review of Clinical Psychology, 6, 447–468. doi:10.1146/annurev.clinpsy.121208.131151.
Volkmar, F., & Cohen, D. (1991). Comorbid association of autism and schizophrenia. The American journal of psychiatry. December 1–3. http://psycnet.apa.org/psycinfo/1992-13243-001.
Volkmar, F., Reichow, B., & McPartland, J. (2014). Adolescents and adults with autism spectrum disorders. New York: Springer.
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The contributions of Dr James C McPartland were supported by Grant NIMH K23 MH086785.
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Van Schalkwyk, G.I., Peluso, F., Qayyum, Z. et al. Varieties of Misdiagnosis in ASD: An Illustrative Case Series. J Autism Dev Disord 45, 911–918 (2015). https://doi.org/10.1007/s10803-014-2239-y
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DOI: https://doi.org/10.1007/s10803-014-2239-y