Reported autism diagnosis strongly predicts psychotic-like experiences in the Adolescent Brain Cognitive Development cohort

Although the schizophrenia rate is increased in autism spectrum disorder (ASD), it is difficult to identify which youth with ASD will go on to develop psychosis. We explored the relationship between ASD and emerging psychotic-like experiences in the Adolescent Brain Cognitive Development (ABCD) cohort of school-aged children. We predicted that ASD would robustly predict psychotic-like experience severity, even relative to other established predictors, and that ASD youth with psychotic-like experiences would have a characteristic neurocognitive profile. In a sample of 9,130 youth aged 9-11, we fit regression models that included parent-reported ASD, family history of psychosis, lifetime trauma, executive function, processing speed, working memory, age, sex, race, ethnicity, and income-to-needs ratio as predictors of Prodromal Questionnaire - Brief Child (PQ-BC) score. We assessed cognitive profiles using analysis of variance on NIH Toolbox measures. ASD increased PQ-BC distress scores by 2.46 points (95% CI 1.32 - 3.60), an effect at least as large as those of family history of psychosis (1.05 points, 95% CI 0.56 - 1.53), Latinx ethnicity (0.99 points, 95% CI 0.52 - 1.45) and black race (0.89 points, 95% CI 0.30 - 1.48). We did not identify a unique cognitive profile for ASD youth with psychotic-like experiences. Our finding that ASD predicts psychotic-like symptoms in youth is consistent with previous literature, and adds new information in suggesting that ASD is a strong predictor of psychotic-like experiences even when compared to other established SCZ risk factors.