Distinct profiles of social skill in adults with autism spectrum disorder and schizophrenia

Abstract

Scientific Abstract Overlapping social impairments in Autism Spectrum Disorder (ASD) and Schizophrenia (SCZ) contributed to decades of diagnostic confusion that continues to this day in some clinical settings. The current study provides the first direct and detailed comparison of social behavior in the two disorders by identifying profiles of social skill in adults with ASD (n=54), SCZ (n=54), and typically-developing (TD) controls (n=56) during a real-world social interaction. ASD and SCZ groups exhibited poorer social skill, both overall and on most discrete abilities, relative to the TD group. Direct comparison of ASD to SCZ revealed distinct behavioral profiles, with ASD uniquely characterized by fewer interactive behaviors, and SCZ characterized by greater impaired gaze and flat/inappropriate affective responses. Additionally, IQ was associated with both overall social skill and many discrete social skills in SCZ, but was largely unrelated to social skill in ASD. These results indicate that overlapping social deficits in ASD and SCZ are comprised of both shared and distinct social skill impairments. The largest distinctions — reduced social reciprocity but better expressivity in ASD relative to SCZ, and a greater role of IQ in social skill for SCZ than ASD — highlight disorder-specific features that can improve etiological understanding, diagnostic differentiation, and treatment strategies.

Psychometric Evaluation of Social Cognitive Measures for Adults with Autism

“…All but two participants with ASD ( n = 101) had completed the Wechsler abbreviated scale for intelligence [WASI; Wechsler, ] in a prior study session, and a subset of TD participants ( n = 47) completed the WASI as the first task before being administered the social cognitive measures. All participants completed a proxy for verbal IQ [i.e., the wide range achievement test; WRAT‐3; Wilkinson, ], followed by a battery of tasks assessing the domains of social cognition and social skills [findings concerning social skills can be found in Morrison et al, ]. The order administering domains (e.g., social cognition, social skills) and tasks within each domain were both counterbalanced.…”

“…In studies directly comparing adults with ASD and those with schizophrenia, not only do both groups demonstrate poorer performance in social skills [Morrison et al, ], social functioning [APA, ], and social cognitive performance [Sasson et al, ] relative to TD controls, but they also show similar underactivation in brain regions associated with social cognition [Couture et al, ; Crespi, Stead, & Elliot, ; Pinkham, Hopfinger, Pelphrey, Piven, & Penn, ; Sullivan et al, ]. Other studies, however, show distinctions in aspects of social cognition, such as greater impairments in social perception in ASD [e.g., face processing; Pilowsky, Yirmiya, Arbelle, & Mozes, ; Sasson et al, ; Sasson, Pinkham, Weittenhiller, Faso, & Simpson, ] but fewer impairments in higher‐order social appraisal [e.g., theory of mind and attributional biases Pinkham et al, ; Sasson et al, ].…”

Autism, early psychosis, and social anxiety disorder: understanding the role of social cognition and its relationship to disability in young adults with disorders characterized by social impairments

“…Similarly, for those with ASD there is a large body of research in children that shows persistent social cognitive impairments 22 , 23 and these impairments represent one of the first identifiable markers of the disorder 24 . Research evaluating social-cognitive impairments in adults with ASD is more scant 25 , 26 , however, although social-cognition impairments have been shown to predict poorer objective social skill 27 .…”

The benefit of directly comparing autism and schizophrenia, revisited

“…While we fully agree that basic performance-based social cognitive comparisons between ASD and SCZ cannot address mechanism, we disagree that behavioral similarities necessarily imply mechanistic ones. Indeed, we explicitly caution against such an interpretation in the paper's discussion and have previously written extensively, both in empirical (Morrison et al, 2017;Sasson et al, 2007;Sasson, Pinkham, Weittenhiller, Faso, & Simpson, 2016) and review (Sasson, Pinkham, Carpenter, & Belger, 2011) papers, about the possibility of different mechanisms within ASD and SCZ producing similar behavioral outcomes. Additionally, although Crespi cites several studies suggesting divergent neurobiological mechanisms of social cognitive ability within ASD and SCZ, we are aware of several other studies, uncited in his letter, that suggest shared mechanisms (e.g.…”