These studies would benefit from the inclusion of genetics and characterization of family members to get a clearer sense of the genotype-phenotype associations and predictors of outcome. Volkmar FR, Cohen DJ. Genome Med. 2008;17:628-638. Areas under the curve (AUC) of 1 represent perfect sensitivity and specificity of a measure, whereas.5 represents a test that is completely ineffective at discriminating diagnostic status. Although George’s psychotic symptoms are well controlled by the medication, symptoms of ASD persist, including poor eye contact, ongoing failure to develop appropriate peer relationships, inability to sustain a conversation with others, encompassing preoccupation with restricted patterns of interest, stereotypies, and repetitive motor mannerisms. J Am Acad Child Adolesc Psychiatry. Cogn Neurosci Schizophrenia Annu Rev Clin Psychol (2005) 1:321–53. Autism spectrum disorder (ASD) and schizophrenia (SZ) are neurodevelopmental disorders with heterogeneous and sometimes, overlapping symptom presentation (1–5). In addition, sex ratios between groups were unequal, χ2 (2, N = 132) = 10.04, p = .007. What new information does this article add? doi: 10.1016/j.schres.2007.10.024, 37. To test our prediction that the ADOS would be more effective at discriminating the ASD and TD groups versus the ASD and SZ groups, we constrained the samples to just the ASD and TD groups in one analysis and just the ASD and SZ groups in a second analysis. doi: 10.1176/ajp.148.12.1705, 12. Schizophrenia; TD, Typical Development. Psychiatr Clinics North Am (1993) 16(2):217–44. doi: 10.1176/appi.ajp.2010.09091379. 2005;15:465-476. Participants were excluded if they met the DSM-5 criteria for both ASD and SZ diagnosis (n = 2) as this would preclude inclusion in either group for sensitivity/specificity analyses. Table 1 Sex Distributions and Means and Standard Deviations of Age and Intelligence (IQ). There are two key clinical implications of this study, both related to situations where clinicians are considering a differential diagnosis between SZ and ASD. 2008;320:539-543. This fits with the neurodevelopmental insult and imbalance in excitatory and inhibitory transmission hypothesis for both autism and schizophrenia.20, Specific deletions associated with schizophrenia include 22q11.2, 1q21.1, and 15q13.3, which have been found to be associated with autism, attention-deficit disorder, and mental retardation.20 In individuals with velocardiofacial syndrome (chromosome 22q11), rates of ASD and psychosis are higher.21 Similarly, 16p11.2 microdeletions or microduplications have been reported in 1% of cases of autism and in 2% of the NIMH COS cohort.22-24 These copy number variants confer a risk for a range of neurodevelopmental phenotypes that include autism and schizophrenia.20 Although there have not been systemic comparisons of genome-wide association studies for autism and schizophrenia, some functional links have been reported at voltage-gated calcium channel genes, which are integral to presynaptic function and plasticity, across phenotypes.20, Both autism and schizophrenia have accelerated trajectories of brain development around the age of symptom onset: those with autism have an acceleration or brain overgrowth during the first 3 years of life, and those with COS have an acceleration of brain development (pruning) during adolescence.7, Cheung and colleagues25 attempted to quantify brain structural similarities and differences in ASD and schizophrenia using a quantified anatomical likelihood estimation approach to synthesize existing brain imaging datasets. Although autism has long been recognized as a separate diagnostic entity from schizophrenia, both disorders share clinical features. ‘Dementia praecocissima’: the Sante De Sanctis model of mental disorder in child psychiatry in the 20th century. Am J Psychiatry (1991) 148(12):1705–7. doi: 10.1016/S0001-2998(78)80014-2, 43. The studies involving human participants were reviewed and approved by Yale University School of Medicine Human Subject Investigation Committee. An anatomical likelihood estimation. Data used in the preparation of this manuscript are publicly available to approved researchers as part of the NIMH Data Archive ( in collection C2312. Res Dev Disabilities (2010) 31(6):1543–51. Happé F, Ronald A, Plomin R. Time to give up on a single explanation for autism. New research at Swinburne has revealed a significant overlap in the traits associated with autism and schizophrenia. Rare structural variants disrupt multiple genes in neurodevelopmental pathways in schizophrenia. Copyright © 2020 Trevisan, Foss-Feig, Naples, Srihari, Anticevic and McPartland. doi: 10.1093/schbul/13.2.261, 42. Among the 22 cases who manifested psychotic symptoms (84.6%), 16 had a concurrent diagnosis of schizophrenia (72.73%) and 6 of mood disorders (27.27%). Positive symptoms, especially hallucinations, delusions, grandiosity and suspiciousness may be most indicative of SZ. (C) ROC curves predicting DSM-5 ASD or SZ diagnostic status based on continuous PANSS Negative and Positive symptoms. • To ensure that clinical staff are … Unstrange minds: Remapping the world of autism. Arch Gen Psychiatry (1982) 39(7):789–94. Carroll LS, Owen MJ. J Child Adolesc Psychopharmacol. Findings from this study also call for increased research into the shared underlying biological systems that may give rise to ASD and SZ. The ADOS-2 was administered by trained, research-reliable clinicians and consists of semistructured activities and conversations meant to sample a participant’s real-world social behavior and core autistic characteristics related to language and communication, reciprocal social interaction, imagination and creativity, stereotyped behaviors and restricted interests, and other atypical behaviors. 1995;34:1096-1106. The boundaries of schizophrenia. 2009;48:10-18. A recurring issue is the overlap and boundaries between Intellectual Developmental Disorder (IDD), ASD and Schizophrenia Spectrum Disorders (SSD). J Autism Dev Disord (2009) 39(5):693–705. Table 3 shows intercorrelations between ADOS-Positive, ADOS-Negative, PANSS-Positive, and PANSS-Negative across the entire sample. Br J Psychiatry. doi: 10.1093/schbul/sbn135, 31. Evidence of positive symptoms from both ASD and SZ diagnostic assessments may warrant a dual diagnosis, which recent research converges in suggesting occurs with more frequency than once thought (27, 46). Washington DC: American Psychiatric Pub (2013). doi: 10.1017/S003329170999078X. J Am Acad Child Adolesc Psychiatry (2009) 48(1):10–8. For both analyses, tests for homogeneity of variances were violated. 1971;118:381-384. Lord C, Risi S, Lambrecht L, Cook EH, Leventhal BL, DiLavore PC, et al. These symptoms, present since early childhood, predated his symptoms of psychosis and continue to require the support of autism-specific services. 8. 15. 1995;34:1273-1283. South Med J (2011) 104(4):264–8. London, England: SAGE Publications Sage UK (2018). Mol Psychiatry (2006) 11(9):815–36. Next, we examined several Receiver Operating Characteristic (ROC) curves using ADOS scores. In these children, the hallucinations or delusional preoccupations may initially be attributed to the developmental disorder. 2010;5:e12233. Recently, a large-scale meta-analysis aggregating close to 2,000,000 million participants found that individuals with ASD are 3.55 times more likely to have a concurrent diagnosis of SZ than controls (28). A pattern emerged such that individuals with ASD and SZ have overlap in the overt presentation of negative symptoms, such as reduced social–emotional reciprocity, blunted affect, reduced nonverbal communication, apathy, reduced affect sharing, and reduced social overture and response, resulting in elevated scores in both groups on the negative scales of both the ADOS-2 and PANSS. Basic principles of ROC analysis. doi: 10.1371/journal.pone.0010887, PubMed Abstract | CrossRef Full Text | Google Scholar, 3. For negative symptoms, the ASD group scored significantly higher than the TD group (p < .001), and group differences between the SZ and TD groups approached significance as the SZ group scored marginally higher (p = .061). Prior to the release of the DSM-III (16) when ASD was first presented as a distinct clinical diagnosis, children now considered to have ASD were commonly diagnosed with “childhood onset schizophrenia” (17)—a childhood disorder characterized by abnormal perceptions of reality in addition to deficits in social functioning (18). Author. Childhood-onset schizophrenia (COS), considered a rare and severe form of schizophrenia, frequently presents with premorbid developmental abnormalities. After grouping ADOS-2 items into positive and negative categories, codes indicating presence of a symptom were converted to ‘1’ and codes indicating absence of a symptom were coded as ‘0’ before being summed (see Supplemental Material). Likewise, better understanding the neural mechanisms of more distinct positive features of SZ and ASD may provide clues to disorder-specific pathology that could be helpful for understanding etiology, distinguishing between disorders, and developing targeted treatment. For the present study, we recruited community samples of adults with ASD, SZ, and typical development (TD) and administered gold-standard diagnostic interviews for both ASD and SZ. Resolving the matter of whether negative symptoms have similar or distinct biological mechanisms is critical for determining whether ASD and SZ populations are likely to benefit from similar treatments. J Child Psychol Psychiatry. 9. Therefore, we ran Brown–Forsythe tests to examine quality of means and Games–Howell post hoc comparisons, which are more robust to homogeneity of variances violations. Within this framework, positive symptoms refer to the presence of atypical symptoms that are not observed in typical development, such as hallucinations or delusions. Keywords: autism, schizophrenia, Autism Diagnostic Observation Schedule, Positive and Negative Syndrome Scale, positive symptoms, negative symptoms, symptom overlap, Citation: Trevisan DA, Foss-Feig JH, Naples AJ, Srihari V, Anticevic A and McPartland JC (2020) Autism Spectrum Disorder and Schizophrenia Are Better Differentiated by Positive Symptoms Than Negative Symptoms. Lord C, Rutter M, DiLavore P, Risi S, Gotham K, Bishop S. Autism diagnostic observation schedule–2nd edition (ADOS-2). Kolvin I, Ounsted C, Humphrey M, McNay A. His thoughts are more linear, he rarely talks about “she,” and he is much more able to engage in his schoolwork. 18. de Bruin EI, de Nijs PF, Verheij F, et al. 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