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Schizophrenia and Other Psychotic Disorders in Autism Spectrum Disorder

There is substantial data pointing to evidence of heightened rates of psychotic experiences and schizophrenia spectrum disorders in individuals with autism spectrum disorder (ASD). Given overlapping genetics and neurobiology between the two disorders, the prevalence of this comorbidity is not surprising. And yet, psychosis in ASD has received relatively little attention in either the scientific or the clinical literatures. Following an introduction to the shared historical context of schizophrenia and ASD, this chapter reviews the diagnostic criteria for psychosis and the assessment tools available for evaluating symptoms. Difficulties in differentiating true psychotic symptoms from several hallmark ASD features, as well as in diagnosing psychosis in minimally verbal individuals with ASD, are highlighted, and recommendations for making this diagnostic distinction are offered. With regard to treatment, there is a striking absence of literature addressing how to treat psychosis when it presents in individuals with ASD. This chapter highlights best practice treatments for childhood-onset and adult schizophrenia and related disorders and discusses how these treatments might apply or need adaptation when treating an individual with ASD. Finally, this chapter offers recommendations for future research regarding the nature, prevalence, developmental course, assessment, and most effective treatments for schizophrenia and other psychotic disorders when they present in individuals with ASD.