Abstract
BackgroundAutism and schizophrenia spectrum disorders both represent severely disabling neurodevelopmental disorders with marked impairments in social functioning. Despite an increased incidence of psychosis in autism, and substantial overlap in symptoms and cognitive markers, it is unclear whether such phenotypes are specifically related to risk for psychosis or perhaps reflect more general, idiosyncratic autism traits. The attenuated psychosis syndrome (APS) is primarily defined by the presence of attenuated psychotic symptoms, which currently constitute the best and most-replicated clinical predictors of psychosis, and are common in clinical youth with and without autism. The aims of this study were to test the hypothesis that facial affect processing is impaired in adolescents with APS and to explore whether such deficits are more indicative of psychotic or autistic phenotypes on a categorical and dimensional level.Materials and MethodFifty-three adolescents with APS and 81 typically developing controls (aged 12–18) were included. The APS group consisted of adolescents with (n = 21) and without (n = 32) a diagnosis of autism spectrum disorder. Facial affect recognition was assessed with the Amsterdam Neuropsychological Tasks using a cascade model of cognitive processing, in which disturbances in “lower-level” cognitive abilities (pattern recognition), affect “higher-level” cognitive processes (face recognition and facial affect recognition). For associations with schizotypal and autistic-like traits the Schizotypal Personality Questionnaire and Social Communication Questionnaire were used in a confirmatory item factor analysis framework.ResultsContrary to expectation, APS in adolescents was not associated with impairments in pattern, face, or facial affect recognition. However, the APS group with autism spectrum disorder showed a general latency in response time to social and non-social stimuli. Dimensionally assessed schizotypal and autistic-like traits did not predict the accuracy or the speed of face or facial affect recognition.ConclusionFacial affect processing performance was not associated with APS in adolescence and represents an unlikely early vulnerability marker for psychosis. APS individuals with a more autistic-like profile were characterized by slower responses to social- and non-social stimuli, suggesting that the combined effect of APS and autism spectrum disorder on cognition is larger than for APS alone.
Highlights
Autism spectrum disorder (ASD) and schizophrenia spectrum disorders (SSD) both represent severely disabling neurodevelopmental disorders with marked impairments in social functioning
In a recent direct comparison of substantial clinical samples, adults with ASD seemed significantly more impaired than adults with SSD in emotion perception from faces [15]. This difference may become less pronounced with increasing age due to progressive cognitive deterioration in SSD [12], cross-sectional studies show that clear social cognitive impairments are already present at first onset of psychosis [17, 18]
The patient subsample consisted of adolescents with (n = 21; attenuated psychosis syndrome (APS)/ASD+ group) and without (n = 32; APS/ASD− group) a diagnosis of ASD
Summary
Autism spectrum disorder (ASD) and schizophrenia spectrum disorders (SSD) both represent severely disabling neurodevelopmental disorders with marked impairments in social functioning. Studies are increasingly focussing on dimensional rather than categorical approaches, with the aim of testing the hypothesis that both conditions represent extremes on an extended continuum of symptomatic severity These efforts provide evidence for elevated rates of autistic traits in individuals diagnosed with SSD, and report that these traits negatively affect clinical outcome such as quality of life and global functioning [3, 7,8,9,10]. In a recent direct comparison of substantial clinical samples, adults with ASD seemed significantly more impaired than adults with SSD in emotion perception from faces [15] This difference may become less pronounced with increasing age due to progressive cognitive deterioration in SSD [12], cross-sectional studies show that clear social cognitive impairments are already present at first onset of psychosis [17, 18]. The aims of this study were to test the hypothesis that facial affect processing is impaired in adolescents with APS and to explore whether such deficits are more indicative of psychotic or autistic phenotypes on a categorical and dimensional level
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