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

Marinos Kyriakopoulos,Avi Reichenberg,Daniel Stahl,Sophia Frangou,Brian Jacobs,Emily Simonoff,Sofia Manolesou,Maja Drobnič Radobuljac,Argyris Stringaris

doi:10.1007/s00787-014-0576-1

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.

Highlights

Autistic and psychotic disorders have historically been considered as related diagnostic entities
Our goals were (a) to specify the number and types of autism spectrum disorders (ASD) classes according to multiple complex developmental disorder (MCDD) criteria (b) to validate the derived classes on the basis of the presence of hallucinations, a psychotic symptom outside the MCDD criteria, and (c) to determine whether the identified classes differ in terms of their overall function and response during inpatient treatment
Depressive and anxiety symptoms often cooccur in ASD children [14, 35] and we compared the two classes in terms of the prevalence of depressive disorder (Table 2)

Summary

Introduction

Autistic and psychotic disorders have historically been considered as related diagnostic entities. In the late 1970s, autism spectrum disorders (ASD) and schizophrenia (SZ) were split into two different diagnostic categories (DSMIII). The boundaries between the two disorders, continue to be debated. ASD and SZ share common neurobiological processes [1, 2] and genetic risk factors [3,4,5]. The presence of autistic traits in early childhood increases the risk of psychotic experiences in adolecence [6] and of SZ and SZ spectrum disorders in adulthood [7]. A significant proportion of adults with SZ fulfils criteria of childhood ASD [8].

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Conclusion