Determination of psychosis-related clinical profiles in children with autism spectrum disorders using latent class analysis

Abstract

In children with autism spectrum disorders (ASD), high rates of idiosyncratic fears and anxiety reactions and thought disorder are thought to increase the risk of psychosis. The critical next step is to identify whether combinations of these symptoms can be used to categorise individual patients into ASD subclasses, and to test their relevance to psychosis. All patients with ASD (n = 84) admitted to a specialist national inpatient unit from 2003 to 2012 were rated for the presence or absence of impairment in affective regulation and anxiety (peculiar phobias, panic episodes, explosive reactions to anxiety), social deficits (social disinterest, avoidance or withdrawal and abnormal attachment) and thought disorder (disorganised or illogical thinking, bizarre fantasies, overvalued or delusional ideas). Latent class analysis of individual symptoms was conducted to identify ASD classes. External validation of these classes was performed using as a criterion the presence of hallucinations. Latent class analysis identified two distinct classes. Bizarre fears and anxiety reactions and thought disorder symptoms differentiated ASD patients into those with psychotic features (ASD-P: 51 %) and those without (ASD-NonP: 49 %). Hallucinations were present in 26 % of the ASD-P class but only 2.4 % of the ASD-NonP. Both the ASD-P and the ASD-NonP class benefited from inpatient treatment although inpatient stay was prolonged in the ASD-P class. This study provides the first empirically derived classification of ASD in relation to psychosis based on three underlying symptom dimensions, anxiety, social deficits and thought disorder. These results can be further developed by testing the reproducibility and prognostic value of the identified classes.

ASD Validity

“…Multiple complex developmental disorder (MCDD) is a psychosis prodrome disorder leading to overt psychosis or SCZ that is often found with ASD or PDD symptoms, as well as with panic, explosive emotional behaviors, magical thinking, easy confusability, and paranoid preoccupations (AdDab'bagh and Greenfield 2001;de Bruin et al 2007;Kyriakopoulos et al 2015;Sprong et al 2008;Oranje et al 2013;Ziermans et al 2009). MCDD is not a DSM-5 diagnosis, and the brain basis of MCDD remains unknown.…”

Autism Spectrum Disorder and Psychosis: A Case Study

“…ASD and SSD overlap boundaries in the areas of behavior, cognitions, neurobiological, and genetic etiology (Bejerot & Wetterberg, 2008;Kyriakopoulos et al, 2015). The premorbid behavior anomalies observed in SSD and behavioral characteristics of ASD share many features in the domains of behavior and cognition, including social cognition and the use of language (Solomon et al, 2011).…”

“…They also share what is described as at times bizarre or illogical thinking when viewed through a neurotypical lens (Raja & Azzoni, 2010). Moreover, ASD and SSD are often characterized by phobias (Kyriakopoulos et al, 2015). See Table 1 for a comparison of linguistic, cognitive, and behavioral features of ASD and SSD.…”

“…Kyriakopoulos et al (2015) conducted a case review of all clients with ASD admitted to a specialist in-patient unit from 2003 to 2012 (n = 84). In the sample, 80% experienced delusions and 73% reported hallucinations.…”

How and Why is Autism Spectrum Disorder Misdiagnosed in Adult Patients? - From Diagnostic Problem to Management for Adjustment -

“…Neurocognitive impairments such as executive dysfunction [51] and deficits in theory of mind [52] in subjects with ASD are considered a vulnerability for future psychosis according to studies on prodromal psychosis [53][54][55]. Moreover, one study found that three underlying symptoms (i.e., unusual fears, thought disorder, and bizarre anxiety reactions) are related to psychosis in ASD [56]. As ASD has been mostly regarded as a risk factor for psychotic experiences [57] or non-affective psychotic disorder in several cohort studies [58], clinicians may need to make a differential diagnosis between onset of endogenous psychosis as comorbidity and transient psychotic reaction to a stressful situation in ASD individuals.…”