Methods
Search Strategy and Selection Criteria
Eligibility Criteria
Inclusion Criteria
Exclusion Criteria
Outcome Measures and Data Extraction
Quality Assessment
Data Synthesis and Meta-analysis
Results
Database
Study Characteristics
Study | Study type and design | Country | Sample size | Diagnostic criteria | Mean age (SD) | Sex % males | NOS | Key findings |
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Eussen et al. (2014) | Longitudinal | The Netherlands | 142 ASD 32 CHR-P | ASD: DSM-IV/ADOS CHR-P: KFTDS/PQ/CAARMS | 16.03 (1.97) | 90,1 | 7 | Illogical thinking predicted severity of ASD symptoms but did not predict prodromal symptoms of psychosis. Illogical thinking significantly predicted a higher total score on the ADOS symptom severity score. Loose associations did not correlate significantly with ADOS total scores. Perceptual disturbances were present in 43%, unusual thought content in 40% and non-bizarre ideas in 37.5% |
Foss-Feig et al. (2018) | Longitudinal | US | 305 CHR-P 14 ASD | ASD: DSM-IV CHR-P: SIPS/SOPS | n/a | n/a | 3 | CHR-P/ASD+ and CHR-P/ASD− did not differ in the rate at which they converted to psychosis. Individuals with ASD and CHR-P had greater social deficits but showed similar psychotic symptoms and have similar risk for conversion to psychosis |
Foss-Feig et al. (2019) | Longitudinal | US | 764 CHR-P 26 ASD 279 HC | ASD: DSM-IV CHR-P: SIPS/SOPS | 18.53 (4.20) | 57,06 | 6 | Individuals with CHR with and without a comorbid ASD diagnosis did not differ in any of the summary scores of the SOPS domains. The CHR-P/ASD+ sample presented with higher levels of social anhedonia. CHR-P/ASD+ group had significantly lower social functioning scores compared to the CHR-P/ASD− group. Patients with CHR-P and ASD tended to exhibit greater social cognitive difficulties. Risk for conversion to co-occurring psychosis was equivalent between both groups |
Fraser et al. (2008) | Cross-Sectional | Australia | n/a | ASD: DSM-IV | n/a | n/a | 3 | The prevalence rates of ASD in CHR and FEP cohorts were greater than current community-based estimates. There was a greater percent of FEP with ASD (4.25%) as compared to the CHR-P cohort (1.12%) |
Guillory et al. (2018b) | Longitudinal | US | 305 CHR-P 14 ASD | ASD: DSM-IV CHR-P: SIPS/SOPS | n/a | n/a | 3 | P300 amplitude to visual distractor stimuli was larger in CHR-P/ASD+ converters than those at CHR-P without ASD |
Guillory et al. (2018a) | Longitudinal | US | 305 CHR-P 14 ASD | ASD: DSM-IV CHR-P: SIPS/SOPS | n/a | n/a | 3 | CHR-P/ASD+ converters showed a larger P300 wave amplitude in response to visual stimuli than those without ASD. For MMN, there were no significant amplitude differences between groups |
Jutla et al. (2020aa) | Cross-sectional | US | 151 ASD 425 CHR-P | ASD: pre-existing diagnosis CHR-P: PQ-BC | 9.91 (0.62) | 52,33 | 7 | ASD increased PQ-BC distress scores, suggesting ASD as a strong predictor of psychotic-like experiences. ASD also had a strong positive effect on PQ-BC distress score. The effect of ASD was also larger than the positive predictor trauma |
Jutla et al. (2020b) | Cross-sectional | US | 69 ASD 753 CHR-P | n/a | n/a | n/a | 3 | Retrosplenial-temporal, cinguloparietal, and cingulo-opercular connectivity most strongly predicted ASD without psychotic-like symptoms, ASD with psychotic-like symptoms, and psychotic-like symptoms without ASD respectively. Within the ABCD cohort, ASD with psychotic-like symptoms, ASD without psychotic-like symptoms, and psychotic-like symptoms without ASD were characterised by distinct connectivity patterns. These results suggest that ASD with psychotic-like symptoms may represent an ASD subtype with distinct neural correlates |
Maat et al. (2020) | Cross-sectional | The Netherlands | 53 CHR-P 21 ASD 81 HC | ASD: SCQ CHR-P: SIPS | 15.4 (2.05) | 71,7 | 7 | Traditional computerised assessment of facial affect processing is unlikely to detect early vulnerability markers for psychosis in adolescents with APS. A more autistic-like profile may be characterised by a generalised increase in response latencies, suggesting that the combined presence of autistic and psychotic traits may disproportionately affect cognitive performance. The CHR-P group with ASD generally showed slower responses for affective and non-affective face stimuli than CHR-P participants without ASD and healthy controls |
Solomon et al. (2008) | Cross-sectional | US | 17 ASD 21 HC | ASD: DSM-IV/ADOS/SCQ CHR-P: KFTDS | 12.33 (2.31) | n/a | 7 | In participants with ASD, illogical thinking was related to aspects of cognitive functioning and to executive control. Loose associations were related to autism communication symptoms and to parent reports of stress and anxiety. When formal thought disorder is present in ASD, it is related to pragmatic language abnormalities |
Solomon et al. (2011) | Cross-sectional | US | 20 ASD 15 CHR-P 16 FEP 20 HC | ASD: DSM-IV/ADOS/SCQ CHR-P: SIPS | 15.24 (2.37) | 71,83 | 7 | ASD, CHR-P and FEP share common features of atypical neurodevelopment of language and social function. On the Social domain, ASD scored significantly worse. For Cognition, Motivation, and Mannerisms, each clinical group was significantly more impaired than HC. For Communication, ASD scored worse than all groups. On the structural and pragmatic language domains, individuals with ASD showed significantly greater impairment than all groups, including delayed echolalia and deficits in appreciating irony and sarcasm |
Sprong et al. (2008) | Longitudinal | The Netherlands | 32 ASD 80 CHR-P 82 HC | ASD: DSM-IV/ADI-R/SCQ CHR-P: SIPS/BSABS-P | 15.43 (1.82) | 55,15 | 6 | Subjects diagnosed with PDD are at high risk for developing psychosis. The CHR-P group reported higher levels of SIPS Positive and Negative symptoms than the ASD-group. ASD and CHR-P did not differ with regard to schizotypal traits and basic symptoms, as well as disorganised and general prodromal symptoms. ASD females at CHR-P scored higher levels on SIPS Positive, SIPS-General, BSABS-P Perceptual and SPQ-R Positive scales |
Wilson et al. (2020) | Cross-sectional | US | 21 ASD 0 CHR-P 22 HC | ASD: ADI-R/ADOS/SCQ CHR-P: SIPS | 14.83 (1.70) | 86 | 7 | A majority of verbal responses (93%) and behavioural responses (89%) to SIPS items were rated as adequate, suggesting that the positive domain items from the SIPS can be used with adolescents with ASD. Regardless of diagnosis, higher rates of response errors were significantly correlated with greater difficulty understanding ambiguous language. Results indicate that adolescents with ASD did not significantly differ from typically developing peers when answering questions about positive psychosis risk symptoms |
Systematic review findings | Metaanalysis ASD-CHR-P | |
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ASD & CHR-P | – Studies: 13 – N = 16,474 individuals ∙ Mean age range: 8.82–18.53 years ∙ Males: 53.5% – The APS group was the most frequent reported: 100%. 4% met criteria for GRD and 3.1% met criteria for BLIPS. 36.7% met criteria for basic symptoms – ADHD was present in 33.0–52.0%. Anxiety disorders in 14.0–44.0%. ODD in 22.0%. Mood disorders in 8.8%. Tourette’s disorder in 5.0% – ASD individuals at CHR-P showed significantly greater impairment in structural and pragmatic language and social functioning domains – CHR-P with ASD had higher impairment in facial affect recognition and showed slower responses for affective and non-affective face stimuli than those without ASD – ASD individuals at CHR-P had poorer social cognition – ASD at CHR-P showed a larger P300 wave amplitude in response to visual stimuli – Female ASD individuals at CHR-P had more general and positive symptoms on the SIPS – The presence of formal thought disorder in ASD ranged between 16.5 and 60.4% – ASD at CHR-P showed more social anhedonia – The frequency of ASD at CHR-P was reported as being 1.1–39.6% – the occurrence of CHR-P in ASD oscillated between 0 to 78.0% – Conversion rates of ASD at CHR-P range from 15.4 to 18.2% at 2 years of follow-up. ASD status was not associated with differential rates of conversion – The most used psychopharmacological treatment were antipsychotics | – 11.6% (95% CI 2.1–44.2) of CHR-P individuals have an ASD diagnosis – Heterogeneity was significant, (Q = 75.157, I2 = 96.008%) – Egger’s test result (0.425) did not reveal significant publication bias, (p = 0.712) |
ASD vs CHR-P | – The mean age was 11.09 years for ASD – The mean age was 18.23 years for CHR-P – Among those CHR-P individuals without ASD, 91.3–100% met the APS criteria; 0.8–11.3% met BLIPS criteria and 4.6–11.3% met GRD criteria – ASD individuals without CHR-P had less impairment on social cognition – ASD with psychotic-like symptoms and ASD without psychotic-like symptoms are characterized by distinct connectivity patterns. Retrosplenial-temporal, cinguloparietal, and cingulo-opercular connectivity most strongly predicted ASD without psychotic-like symptoms, ASD with psychotic-like symptoms, and psychotic-like symptoms without ASD respectively – Conversion rate in CHR-P without ASD ranged 11.1–14% at 2 years – Antipsychotics (19.0–50.0% versus 25.0%) and psychostimulants (15.6–48.0% versus 2.5%) were prescribed more frequently in ASD than in CHR-P – Anxiolytics (11.3% vs 5.0%) were prescribed more frequently in CHR-P than in ASD |
Clinical Comorbidity
Functioning, Cognition and Quality of Life
Neuroimaging & Neurophysiology
Clinical Characteristics, Prediction of Outcomes and Conversion
Interventions
Quality Assessment
Discussion
Symptoms | ASD | CHR-P | Comments |
---|---|---|---|
Symptoms present before 3 years (early developmental period) | +++ | – | In ASD, symptoms typically appear during pre-school years |
Emergence of symptoms in adolescence or young adulthood | – | +++ | Not seen in ASD. CHR-P usually appears in 12–35-year-olds individuals |
Deficits in social-emotional reciprocity | +++ | + | Core ASD symptom. May appear in CHR-P |
Deficits in nonverbal communicative behaviours | +++ | + | Core ASD symptom. May appear in CHR-P |
Deficits in developing, maintaining, and understanding relationships | +++ | + | Core ASD symptom. May appear in CHR-P |
Stereotyped or repetitive motor movements, use of objects, or speech | +++ | ++ | Core symptom in ASD. May appear in CHR-P |
Insistence on sameness, inflexible adherence to routines, or ritualised patterns of behaviour | +++ | + | Core symptom in ASD. Rituals may occasionally appear in CHR-P |
Highly restricted, fixated interests | +++ | + | Core symptom in ASD. Uncommon in CHR-P |
Hyper or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment | +++ | – | Core symptom in ASD. Does not typically appear in CHR-P |
Unusual thought content | + | +++ | Core symptom in CHR-P. May appear in ASD associated with a circumscribed intense interest |
Thought interference | – | +++ | Core symptom in CHR-P. Not typical in ASD |
Thought perseveration | ++ | +++ | Core symptom in CHR-P. May appear in ASD |
Thought pressure | – | ++ | Frequent in CHR-P. Not typical in ASD |
Thought blockages | – | ++ | Frequent in CHR-P. Not typical in ASD |
Suspiciousness | + | +++ | Core symptom in CHR-P. May appear in ASD, particularly in those who misconstrue social cues |
Unstable ideas of reference | – | +++ | Frequent in CHR-P. Not typical in ASD |
Perceptual abnormalities | + | +++ | Core symptom in CHR-P. May appear in ASD as part of ‘imaginary friends’ since early life and not a new phenomenon |
Visual perception disturbances | + | ++ | Core symptom in CHR-P. May appear in ASD due to sensory issues |
Acoustic perception disturbances | + | +++ | Core symptom in CHR-P. May appear in ASD due to sensory hyperresponsivity but is not a new-onset phenomenon |
Decreased ability to discriminate between ideas, perception, fantasy and true memories | + | ++ | Frequent in CHR-P. May appear in ASD |
Derealisation | – | ++ | Frequent in CHR-P. Not typical in ASD |
Disorganised communication | + | +++ | Core symptom in CHR-P. May appear in ASD |
Disturbance of expressive speech | ++ | ++ | Core symptom in CHR-P. May appear in ASD |
Disturbance of receptive speech | +++ | +++ | Core symptom in CHR-P and ASD |
Grandiose ideas | – | +++ | Core symptom in CHR-P. Not typically present in ASD |
Disturbances of abstract thinking | +++ | ++ | Core symptom in ASD. May appear in CHR-P |
Inability to divide attention | ++ | ++ | May appear in ASD and CHR-P |
Captivation of attention by details of the visual field | +++ | ++ | Core symptom in ASD. May appear in CHR-P |
Mannerism | +++ | + | Core symptom in ASD. May appear in CHR-P |
Stereotypy | +++ | + | Core symptom in ASD. May appear in CHR-P |
Agitation not influenced by external stimuli | ++ | ++ | Frequently reported in ASD and CHR-P |