The Association between Autism and Psychosis and the Tools Used to Measure it: An Updated Systematic Review and Meta-Analysis
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Abstract
Objectives: Autistic individuals are more likely to be diagnosed with psychotic disorders and experience psychotic symptoms. This association may result from methodological issues, such as misinterpretation of psychosis questionnaires by autistic individuals and clinician difficulty differentiating between symptoms of autism and psychosis. This meta-analysis aimed to update the review of this association and examine whether it is moderated by the methods used to measure it. Methods: A systematic literature search was conducted in PsycINFO, MEDLINE, CINAHL, Embase, and Web of Science. Included studies required: autism and psychosis measurements, comorbidity data, adult participants, and quantitative data. Risk of bias was assessed using Hoy et al. (2012) criteria, and analyses examined correlational data, computed odds ratios, and computed Cohen's d. Results: Sixty-three papers were included. Significant correlations were found between autistic traits and overall (r = 0.435, p < .0001), positive (r = .274, p < .0001), negative (r = .506, p < .0001), and disorganized (r = .366, p < .0001) psychotic symptoms. Individuals with one condition had increased risk of being diagnosed with the other (OR = 7.03, p < .001), and scored higher on trait measures of the other (d = 1.187, p < .0001). No moderating effect of measurement was found. Discussion: This meta-analysis provides an updated overview of the association between autism and psychosis, with no evidence that methodological issues are specific to any measure. The weaker correlation between autistic traits and positive psychotic symptoms suggests symptom overlap may partly explain the association.
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This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/17753498.
This systematic review evaluates whether methodological and measurement issues are part of the link between autism and psychosis. Disentangling the two diagnostic constructs is complex, and authors clearly investigate different explanations for the common co-occurrence. The review shows the heterogeneity of the literature and explanations of the association between autism and psychosis, and emphasises that transparent reporting helps evidence synthesis. There is little justification for carrying out this meta-analysis aside from a gap of some years since the last on this topic. More detailed explanations of why this investigation was done would be beneficial.
Major strengths
This is …
This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/17753498.
This systematic review evaluates whether methodological and measurement issues are part of the link between autism and psychosis. Disentangling the two diagnostic constructs is complex, and authors clearly investigate different explanations for the common co-occurrence. The review shows the heterogeneity of the literature and explanations of the association between autism and psychosis, and emphasises that transparent reporting helps evidence synthesis. There is little justification for carrying out this meta-analysis aside from a gap of some years since the last on this topic. More detailed explanations of why this investigation was done would be beneficial.
Major strengths
This is measurement-focused investigation into transdiagnostic clinical traits which is an understudied area of real clinical significance.
Risk of bias criteria, study selection criteria, and review process are clearly presented.
Major issues
Justification for an updated meta-analysis in the context of any changes to the literature.
Minor issues
No clear delineation between planned and unplanned (sub-/sensitivity) analyses.
Reporting using the 'SWiM' – Synthesis Without Meta-Analysis – guidelines may bolster the claims made about the studies included in this systematic review.
The authors state in the discussion that the study "provides a thorough attempt of examining the moderating effect of measures used," but were unable to examine measurement as a moderator in analyses 2 and 3 due to limited data. While this limitation is appropriately acknowledged in the results and limitations sections, consider slightly softening the language in the abstract and discussion to reflect that moderation analyses were only possible for the correlational data (analysis 1), to more precisely represent the scope of the analyses conducted, given this was a main aim.
While the authors acknowledge considerable heterogeneity across all three analyses, the discussion of potential explanations remains somewhat limited. The authors note that age, sex, and measurement type do not fully explain this heterogeneity. The authors could expand their discussion of other potential moderators – authors may have more insight into potential explanations that would benefit the reader and future research.
Given that analyses 2 and 3 combined various psychotic conditions (schizophrenia, first episode psychosis, clinical high risk, schizotypal personality disorder), authors also could have explored whether diagnostic category moderates the association, particularly given that clinical high risk represents a different stage than established psychotic disorders.
Competing interests
The authors declare that they have no competing interests.
Use of Artificial Intelligence (AI)
The authors declare that they did not use generative AI to come up with new ideas for their review.
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