From the Guidelines
There is no conclusive evidence to suggest a significantly increased risk of developing first episode psychosis in individuals with a history of Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) based on the most recent and highest quality study available. According to the study published in 2023 1, ASD is not associated with an increased risk for psychotic illness. However, some sites report an association with childhood attention deficit hyperactivity disorder inattentive type and/or anxiety. Key points to consider include:
- The study highlights that verbal IQ, and/or IQ decline, is correlated with a somewhat increased risk of a psychotic disorder 1.
- Optimal assessment of psychopathology in children with neurodevelopmental disorders occurs in the context of language/cognitive/psycho-educational assessment, overall physical conditions 1.
- Decreasing stress and avoidance of alcohol and drugs, especially early and chronic use of marijuana, is recommended to lower the risk of mood- and psychotic illness 1. It is essential to note that the relationship between ASD, ADHD, and the risk of developing first episode psychosis is complex and may be influenced by various factors, including genetic vulnerabilities, neurobiological mechanisms, and environmental factors. Regular mental health monitoring and early intervention strategies are crucial for individuals with ASD and ADHD, and clinicians should be aware of the potential risks and take a multidisciplinary approach to manage these conditions effectively.
From the Research
Risk of Developing First Episode Psychosis
- Individuals with a history of Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) may be at an increased risk of developing first episode psychosis, as studies have shown a significant comorbidity between psychotic disorders and ADHD or ASD 2.
- Research has found that psychosis-proneness displays comorbidity with traits of autistic-spectrum disorders and ADHD, suggesting a common pathway in the underlying information processing of these states 2.
- A systematic review of 34 studies found that individuals with co-occurring ASD and ADHD (ASD+) are associated with more severe impairments in cognitive functioning, adaptive behavior, and increased likelihood to present more emotional/behavioral problems, which may contribute to an increased risk of developing first episode psychosis 3.
Cognitive, Social, and Behavioral Manifestations
- The co-occurrence of ASD and ADHD is associated with complex presentations that may complicate diagnosis and treatment, and individuals with ASD+ may have unique cognitive, social, and behavioral manifestations that require specialized care 4.
- Studies have found that individuals with ASD and ADHD symptoms are more severely impaired, with significant deficits seen in social processing, adaptive functioning, and executive control, which may increase the risk of developing first episode psychosis 5.
Diagnostic and Treatment Challenges
- The diagnosis and treatment of individuals with co-occurring ASD and ADHD can be challenging, and healthcare practitioners may need to consider the complexities of these conditions when working with this population 4, 6.
- Further research is needed to enhance our understanding of the diagnosis, treatment, and management of individuals presenting with comorbid ASD and ADHD, and to develop effective strategies for preventing and treating first episode psychosis in this population 4.