Autism spectrum disorders among adolescents and adults and comparison with schizophrenia

Abstract

Objectives: Autism Spectrum Disorders (ASD) may be commonly misdiagnosed as schizophrenia due to common symptoms and accompanying psychotic manifestations in both adolescence and adulthood. The purpose of this study is to examine and compare the autistic symptoms and positive and negative symptoms of schizophrenia in cases diagnosed as Autism Spectrum Disorder.

Methods: Twenty-one patients between ages of 16-36 who have admitted to outpatient clinic have previously been diagnosed as autism spectrum disorders (autistic disorder, Asperger Syndrome, pervasive development disorder not otherwise specified) according to DSM-IV diagnosis criteria, have an IQ of 50 or above, have been included in the study. Control group have been composed of 21 patients between ages of 21-39 who have been diagnosed as schizophrenia according to DSM-IV diagnosis criteria and have an IQ of 50 or above. Psychiatric assessment has been made with Childhood Autism Rating Scale (CARS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), SCID-I and WAIS.

Results: The negative symptoms of ASD are found to be higher than schizophrenia cases where as the positive symptoms of schizophrenia cases are found to be higher than ASD cases. Twenty percent (n = 4) of OSB cases do not meet autism symptoms while none of the schizophrenia cases meet autism symptoms. In one case of the ASD group, additional schizophrenia diagnosis was present.

Conclusions: In this study, it has been found that negative symptoms of schizophrenia are widely observed in adolescent and adult patients followed with ASD diagnosis. Consequently, autism spectrum disorders are manifested common symptoms with schizophrenia in adolescence and adulthood. 

Keywords

• Autism spectrum disorders,shizophrenia,symptom

References

1. [1] Fombonne E. Epidemiology of pervasive developmental disorders. Pediatric Res 2009;65:591-8.
2. [2] Seltzer MM, Krauss MW, Shattuck PT, Orsmond G, Swe A, Lord C. The symptoms of autism spectrum disorders in adolescence and adulthood. J Autism Dev Disord 2003;33:565-81.
3. [3] Ketelaars C, Horwitz E, Sytema S, Bos J, Wiersma D, Minderaa R, et al. Brief report: adults with mild autism spectrum disorders: scores on the autism spectrum quotient (AQ) and comorbid psychopathology. J Autism Dev Disord 2008;38:176-80.
4. [4] Hollis C. Child and adolescent schizophrenia. A case control study of premorbid developmental impairments. Br J Psychiatry 1995;166:489-95.
5. [5] Alaghband-Rad J, McKenna K, Gordon CT, Albus KE, Hamburger SD, Rumsey JM, et al. Childhood-onset schizophrenia: the severity of premorbid course. J Am Acad Child Adolesc Psychiatry 1995;34:1273-83.
6. [6] Sporn A, Addington AM, Gogtay N, Ordoñez AE, Gornick M, Clasen L, et al. Pervasive development disorder and childhood-onset schizophrenia: comorbid disorder or a phenotypic variant of a very early onset illness? Biol Psychiatry 2004;55:989-94.
7. [7] Clarke DJ, Littlejohns CS, Corbett JA. Pervasive development disorders and psychoses in adult life. Br J Psychiatry 1989;155:692-9.
8. [8] Volkmar FR, Cohen DJ. Comorbid association of autism and schizophrenia. Am J Psychiatry 1991;148:1705-7.

9. [9] Larson FV, Wagner AP, Jones PB. Pychosis in autısm:comprasion of the features of both conditions in a dually affected cohort. Br J Psychiatry 2017;210:269-75.
10. [10] Aggarwal S, Angus B. Misdiagnosis versus missed diagnosis: diagnosing autism spectrum disorder in adolescents. Australas Psychiatry 2015;23:120-3.
11. [11] Matson JL, Kozlowski AM, Hattier MA, Horovitz M, Sipes M. DSM-IV vs DSM-5 diagnostic criteria for toddlers with autism. Dev Neurorehabil 2012;15:185-190.
12. [12] Sung M, Goh TJ, Tan BLJ, Chan JS, Liew HSA. Comparison of DSM-IV-TR and DSM-5 Criteria I diagnosing Autism Spectrum Disorders in Singapore. J Autism Dev Disord 2018;48:3273-81.
13. [13] First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Clinical Version (SCID-I/CV). Washington DC and London: American Psychiatric Press; 1997:p.23.
14. [14] Özkürkçügil A, Aydemir Ö, Yıldız M, Danacı AE, Köroğlu E. [Adaptation into Turkish and reliability study of the structured clinical interview for DSM-IV axis I disorders]. İlaç ve Tedavi Dergisi 1999;12:233-36. [Article in Turkish]
15. [15] Andreasen NC. Scale for the assesment of positive symptoms: SAPS Iowa: Dept. of Psychiatry, College of Medicine, the University of Iowa; 1984.
16. [16] Erkoç S, Arkonaç O, Ataklı C, Ozmen E. [The validity and reliability of the scale for the assessment of positive symptoms]. Düşünen Adam 1991;4:20-4. [Article in Turkish]
17. [17] Andreasen NC. Negative symptoms in schizophrenia definition and reliability. Arch Gen Psychiatry 1982;39:784-8.
18. [18]. Erkoç Ş, Arkonaç O, Ataklı C, Ozmen E. [The validity and reliability of the scale for the assessment of negative symptoms]. Düşünen Adam 1991;4:16-9. [Article in Turkish]
19. [19]. Epir S, İskit Ü. Wechsler Yetişkinler Zekâ Ölçeği Türkçe Çevirisinin Ön Analizi ve Üniversite Danışmanlık Merkezlerindeki Uygulama Potansiyeli. Hacettepe Sosyal ve Beşeri Bilimler Dergisi 1972;4:198-205.
20. [20] Konstantareas MM, Hewitt T. Autistic disorder and schizophrenia: diagnostic overlaps. J Autism Dev Disord 2001;31:19-28.
21. [21] Spek AA, Wounters SGM. Autism and schizophrenia in high functioning adults. Behavioral differences and overlap. Res Autism Spect Disord 2010;4:709-17.
22. [22] Esterberg ML, Trotman HD, Brasfield JL, Compton MT, Walker EF. Childhood and current autistic features in adolescents with schizotypal personality disorders. Schizophr Res 2008;104:265-73.
23. [23] Hurst RM, Nelson-Gray RO, Mitchell JT, Kwapil TR. The relationship of Asperger‘s characteristics and schizotypal personality traits in a non-clinical adult sample. J Autsim Dev Disord 2007;37:1711-20.
24. [24] Barlati S, Deste G, Gregorelli M, Vita A. Autistic traits in a sample of adult patients with schizophrenia: prevalence and correlates. Psychol Med 2019;49;140-8.
25. [25] Stahlberg O, Soderstrorm H, Rastam M, Gillberg C. Bipolar disorder, schizophrenia and other pyschotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders. J Neural Transm (Vienna) 2004;111:891-902.
26. [26] Mouridsen SV, Rich B, Isager T, Nedergaard NJ. Psychiatric disorders in individuals diagnosed with infantile autism as children: a case control study. J Psychiatr Pract 2008;14:5-12.
27. [27] Hofvander B, Delorme R, Chaste P, Nydén A, Wentz E, Ståhlberg O, et al. Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry 2009;9:35.
28. [28] Hutton J, Goode S, Murphy M, Le Couteur A, Rutter M. New-onset psychiatric disorders in individuals with autism. Autism 2008;12:373-90.
29. [29] Mançe Çalışır Ö, Atbaşoğlu EC, Devrimci Özgüven H, Ölmez Ş.. Cognitive features of high-functioning adults with Autism and Schizophrenia Spectrum Disorders. Turk Psikiyatri Derg 2018;29:1-10.
30. [30] Guilmatre A, Dubourg C, Mosca AL, Legallic S, Goldenberg A, Drouin-Garraud V, et al. Recurrent rearrangements in synaptic and neurudevelopmental genes and shared biologic pathways in schizophrenia, autism, and mental retardation. Arch Gen Pychiatry 2009;66:947-56.