Berney TP. Indeed, despite similar deficits in facial emotion recognition in ASD and SZ, there are markedly different patterns of EEG- and fMRI-measured neurological dysfunction associated with these deficits (46, 47). JM consults with BlackThorn Therapeutics and has received research funding from Janssen Research and Development. Shortly thereafter, Sante De Sanctis extended the field of psychiatry to childhood, classifying ‘dementia praecocissima’ as a childhood condition that included psychotic and autistic symptoms by today’s definitions, such as “strangeness of character,” apathy, depressed mood, hallucinations and catatonia (13). Positive symptoms, especially hallucinations, delusions, grandiosity and suspiciousness may be most indicative of SZ. American Psychiatric Association. Psychiatr Clinics North Am (1993) 16(2):217–44. Van der Gaag RJ, Buitelaar J, Van den Ban E, et al. 1995;34:1096-1106. Asarnow RF, Brown W, Strandburg R. Children with a schizophrenic disorder: neurobehavioral studies. J Autism Dev Disord (2001) 31(1):19–28. ASD, Autism Spectrum Disorder; SZ, Schizophrenia; TD, Typical Development. By Metz’s (42) standards, negative items poorly discriminated ASD and SZ (Figure 1B), AUC = .64, p = .03. Schizophrenia and autism are two completely different neuro-psychological disorders. No use, distribution or reproduction is permitted which does not comply with these terms. • Children with autism are complex and at high risk for mental health conditions. Such measurement issues are not unique to the ADOS-2; in unpublished work from our group, we have found that both direct assessment and caregiver/self-report measures of ASD symptoms suffer from similar lack of specificity. Gotham K, Pickles A, Lord C. Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Further complicating diagnostic precision, both disorders often co-occur with other conditions—ASD frequently co-occurs with disorders such as ADHD, tic disorders, developmental coordination disorder, intellectual disability, depression, and anxiety (29), and SZ frequently co-occurs with panic disorder, posttraumatic stress disorder, obsessive compulsive disorder, depression, anxiety, and substance abuse disorders (30). Seventeen out of 39 participants (43.59%) with a SZ diagnosis met the ADOS-2 criteria for autism or autism-spectrum despite not meeting the DSM-5 criteria for ASD by consensus diagnosis (Table 2). USA: American Psychiatric Publishing (1968). Asperger disorder in adults. These symptoms, present since early childhood, predated his symptoms of psychosis and continue to require the support of autism-specific services. These respective descriptions suggest an overlap between ASD and SZ related to the absence of typical social and communicative behaviors (9). Meyer U, Feldon J, Dammann O. Schizophrenia and autism: both shared and disorder-specific pathogenesis via perinatal inflammation? Keywords: autism, schizophrenia, Autism Diagnostic Observation Schedule, Positive and Negative Syndrome Scale, positive symptoms, negative symptoms, symptom overlap, Citation: Trevisan DA, Foss-Feig JH, Naples AJ, Srihari V, Anticevic A and McPartland JC (2020) Autism Spectrum Disorder and Schizophrenia Are Better Differentiated by Positive Symptoms Than Negative Symptoms. Funding for this study was provided by NIMH R01 MH107426 (JM, VS) and NIMH R01 MH119172 (JF-F). Schizophr Res (2008) 99(1-3):164–75. Pinkham AE, Hopfinger JB, Pelphrey KA, Piven J, Penn DL. doi: 10.1203/PDR.0b013e318212c196, 27. Watkins JM, Asarnow RF, Tanguay PE. WB Saunders. doi: 10.1007/s10803-008-0674-3, 41. Am J Psychiatry. Autism spectrum disorders and childhood-onset schizophrenia: clinical and biological contributions to a relation revisited. Kolvin I. doi: 10.1093/schbul/13.2.261, 42. Table 3 shows intercorrelations between ADOS-Positive, ADOS-Negative, PANSS-Positive, and PANSS-Negative across the entire sample. J Child Psychol Psychiatry (2008) 49(11):1193–200. Meta-Analysis of Cognitive Performance in Neurodevelopmental Disorders during Adulthood: Comparisons between Autism Spectrum Disorder and Schizophrenia on the Wechsler Adult Intelligence Scales. In the early years of the autism diagnosis, autism was thought by some to be a mental illness caused by poor parenting in the form of “refrigerator mothers” rather than a developmental disability caused by a difference in neurological type. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Barch DM. 8. Shared shyness: Social difficulties in children with autism and schizophrenia dual diagnosis. American Psychiatric Association. AUCs can be roughly interpreted as excellent = .90–1; good = .80–.90; fair = .70–.80; poor = .60–.70; bad = .50–.60 (42). 2008;69(suppl 4):15-20. Nat Neurosci (2006) 9(10):1218–20. The PANSS also has a General Psychopathology scale that measures somatic concerns, anxiety, and depression among other symptoms, but this scale was not analyzed for the purposes of the present study. Future research is needed to determine the biological systems that distinguish positive and negative symptom domains across ASD and SZ. Biol Psychiatry. In contrast, positive symptoms in ASD and SZ may be more disorder-specific. Br J Psychiatry. At the Yale Child Study Center, a subgroup of children with ASD was labeled as having multiplex developmental disorder.13,14 Researchers in the Netherlands used the term “multiple complex developmental disorders” (MCDD) to describe children who met criteria for ASD and also exhibited affect dysregulation and disordered thinking.15-18 Of significant interest are follow-up studies, which showed that psychosis developed by adulthood in 64% of children with MCDD.16. Therefore, we ran Brown––Forsythe tests to examine equality of means and Games–Howell post hoc comparisons, which are more robust to homogeneity of variance violations. Prior to the release of the DSM-III (16) when ASD was first presented as a distinct clinical diagnosis, children now considered to have ASD were commonly diagnosed with “childhood onset schizophrenia” (17)—a childhood disorder characterized by abnormal perceptions of reality in addition to deficits in social functioning (18). Although autism has long been recognized as a separate diagnostic entity from schizophrenia, both disorders share clinical features. Schizophr Bull (2009) 35(5):1022–9. For negative symptoms, the ASD group scored significantly higher than the TD group (p < .001), and group differences between the SZ and TD groups approached significance as the SZ group scored marginally higher (p = .061). How autism became autism: The radical transformation of a central concept of child development in Britain. 2005;15:465-476. Grinker RR. Konstantareas MM, Hewitt T. Autistic disorder and schizophrenia: Diagnostic overlaps. Semin Nucl Med (1978) 8(4):283–98. As an example, item B1 of the ADOS-2 relates to “unusual eye contact,” which is coded when the examiner observes poorly modulated eye contact used to initiate or regulate social interactions. Participants were matched on mean age but there were statistically significant group differences in IQ (see Table 1), F(2,129) = 13.661, p < .001, such that the SZ group had significantly lower IQ than the ASD group (p = .006) and the TD group (p < .001). Neuropsychological function and dysfunction in schizophrenia and psychotic affective disorders. Though ASD and SZ are now distinct disorders—today’s ASD remains a childhood-onset disorder whereas frank SZ predominantly emerges during young adulthood—the two disorders still share common genetic risk factors and symptom presentations (6, 14, 23–27). For both analyses, tests for homogeneity of variances were violated. Table 2 Sensitivity and Specificity of ADOS-2: Algorithm Scores. As such, though both instruments are intended to index “syndrome-specific” symptoms, due to overlapping negative symptomatology, individuals with ASD often obtain elevated scores on the PANSS and those with SZ on the ADOS-2 despite not also carrying the second diagnosis. 7. doi: 10.1002/aur.1977, 29. .Autism and schizophrenia may present as 2 separate disorders that need to be differentiated, or as comorbid conditions. First, observing elevated score patterns across both ASD and SZ diagnostic instruments should not automatically entice clinicians to suspect dual diagnosis; instead, clinicians ought to consider whether symptoms associated with the patient’s primary disorder are leading to score inflations on measures designed for the other. watman / Adobe Stock. SZ symptoms were quantified with the Positive and Negative Syndrome Scale (PANSS) (41) after administering the SCI-PANSS interview (35). We next examined ROC curves to see if ADOS-2 positive symptoms better discriminate ASD and SZ than ADOS-2 negative symptoms. J Autism Dev Disord (2014) 44(1):111–9. Autism Res (2018) 11(8):1110–9. © 2020 MJH Life Sciences and Psychiatric Times. – Considerable confusion surrounds the overlapping of autism and schizophrenia. Comorbid association of autism and schizophrenia. Eye contact could be rated “unusual” for two very different examinees: one who does not make any eye contact, and a second who stares unrelentingly. ASD symptoms were measured using the ADOS-2 (38). 2010;125:e727-e735. In clinical practice with people with IDD, the alternative or adjunctive diagnosis of ASD or SSD is particularly challenging. 2006;45:1104-1113. Revista de Psiquiatría y … 25. 14. Not surprisingly, these disorders frequently co-occur. His comorbid diagnosis was changed to schizoaffective disorder and, more recently, to schizophrenia. doi: 10.1038/sj.mp.4001563, 6. This decision was made to ensure ability to accurately self-report during diagnostic assessments. Table 3 Intercorrelations Among ADOS and PANSS Symptom Domains. Although George’s psychotic symptoms are well controlled by the medication, symptoms of ASD persist, including poor eye contact, ongoing failure to develop appropriate peer relationships, inability to sustain a conversation with others, encompassing preoccupation with restricted patterns of interest, stereotypies, and repetitive motor mannerisms. We ran two separate univariate ANOVAs with diagnosis (ASD, SZ or TD) as the independent variables in both models and ASD symptom type (positive or negative) as the respective dependent variables in either model. These analyses suggest that the key findings from our analyses were unlikely to be confounded by sex or IQ. The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00548/full#supplementary-material. 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