Shared Social Deficits in Autism Spectrum Disorders, First Episode Schizophrenia and Ultra High Risk for Psychosis Patients

Background:

Individuals with autism and schizophrenia spectrum disorders exhibit similar social, language, and repetitive behavior symptoms. However, there have been few studies comparing specific differences in these domains in individuals with autism spectrum disorder (ASD), versus those at ultra high risk for developing psychotic disorders (UHR) or for those with first episode schizophrenia (FE). This work has implications for understanding the comparative neurobiology of these disorders, for identification of precursors to psychosis and risk prediction, and for intervention.

Objectives:

The first goal of the study is to distinguish behavioral profiles of ASD, FE, and UHR across domains of reciprocal social interaction, structural and pragmatic language, and sensory/motor symptoms. The second goal is to begin to develop hypotheses about shared genetic and neurobiological mechanisms in ASD, schizophrenia spectrum, and other neurodevelopmental disorders. Finally we seek to consider dimensional rather than categorical approaches to characterizing symptomatology.  

Methods: Four groups of 15 patients aged 12-18 diagnosed using gold standard measures as being ASD, UHR, FE, or typically developing (TYP) were ascertained from a clinically referred sample. Parents completed common autism research measures including the Social Communication Questionnaire, the Social Responsiveness Scale, the Children’s Communication Checklist-2, and the Short Sensory Profile.

Results:

Based on SCQ, 6% and 7 % of each UHR and EPP cohorts respectively exhibited symptoms consistent with an ASD diagnosis. On the CCC-2, ASD demonstrate the highest level of global language impairment, however UHR and FE evidenced intermediate levels of impairment between ASD and TYP. UHR and FE exhibited more scripted language, less coherent speech, and increased language context violations relative to TYP.  UHR resembled ASD in their tendency to talk repetitively about topics without regard for listener interest, while FE resembled ASD in relational aspects of communication as well structural language production. On the SRS, FE and UHR demonstrated similar impairments in reciprocal social behavior to ASD with a reduction in social motivation. ASD and FE were similarly impaired in lack of social awareness conversational skills, and autistic mannerisms. On the Short Sensory Profile, ASD, FE, and UHR shared comparable levels of sensitivity to Movement, Taste/smell, and increased Sensory Seeking behaviors while ASD and FE demonstrated similar low levels of energy.

Conclusions:

In this pilot sample, UHR and FE had about a 7% prevalence of ASD as determined by SCQ, however UHR and FE show symptoms that are generally of intermediate severity to TYP and ASD. Notable exceptions are that EPP and ASD share deficits in social awareness, conversational skills, autistic mannerisms, and low energy. UHR, unlike FE, show inappropriate social initiations comparable to ASD. While ASD tend to display worse language, social, and sensory/motor symptoms than other groups, specific impairments in social relational aspects of communication and some elements of sensory/motor atypicalities are similarly impaired in UHR and FE. Given the similarity of social and pragmatic language impairments across the ASD, UHR, and EP cohorts, social intervention and occupational therapy strategies for ASD may also be appropriate and useful for UHR and FE.