A Meta-Analysis of Autism and Clinical High-Risk for Psychosis is Too Premature. Comment on: Vaquerizo-Serrano, Salazar de Pablo, Singh & Santosh (2021).

Ziermans et al. (2022) asked if the Structured Interview for Psychosis-Risk Syndromes works with verbal autistic teens. They ran the same interview with autistic adolescents who have solid language skills and with neurotypical peers. When a teen used odd words or jokes, the interviewer paused and checked what the teen really meant.

Design was quasi-experimental: two groups, same protocol, no random assignment.

Both groups answered the interview in the same way. Autistic teens only needed extra help when questions used sarcasm, metaphors, or other non-literal language. Once the interviewer clarified, answers lined up with typical peers.

Language skill, not autism label, predicted who needed the extra check-ins.

Ring et al. (2018) saw the same pattern in lab tasks. Autistic teens with good structural language used context just like controls; problems showed up only when language skill was low. Tim’s real-world interview replicates that finding in a clinical setting.

Morsanyi et al. (2012) looked darker: their high-functioning autistic teens struggled with fantasy reasoning. That sounds like a clash, but the tasks differ. Kinga used made-up stories; Tim used a psychosis screen where interviewers could ask follow-ups. Live clarification erases the gap.

Ruiz Callejo et al. (2023) split autistic teens by early language delay and still found speech-in-noise deficits. Tim adds a new slice: if language is currently intact, psychosis-risk interviews are fair game.

You no longer need to skip psychosis-risk screening for verbal autistic clients. Run the Structured Interview, flag any non-literal items, and simply probe: “What did you mean by that?” Document the clarification. This keeps your assessment both inclusive and accurate without creating extra tools.