Association between schizophrenia and autism spectrum disorder: A systematic review and meta-analysis.
Autism and schizophrenia travel together far more than we thought—so screen every client for psychotic symptoms.
01Research in Context
What this study did
Zhen and the team looked at every paper that measured both autism and schizophrenia. They pulled 46 studies that covered 1.9 million people. Then they ran the numbers to see how often the two conditions show up in the same person.
What they found
People with autism are 3.5 times more likely to have schizophrenia than the general crowd. That means for every 1,000 autistic clients you serve, about 35 will also have psychotic symptoms. The link stayed strong whether the person had intellectual disability or not.
How this fits with other research
Pathak et al. (2019) showed that bright, older kids with autism often look fine on IQ tests but still struggle with daily living skills. Zhen’s numbers say some of those daily struggles may come from hidden psychosis, not just autism.
Deserno et al. (2017) found that young adults with autism have big gaps between IQ and adaptive skills when they also carry anxiety or depression. Zhen’s meta adds schizophrenia to that watch list—another reason the gap can widen.
Schaaf et al. (2015) warned that 25–50 % of high-functioning clients lost their autism label under DSM-5. Zhen’s study says to keep screening these clients anyway; losing the label does not drop their schizophrenia risk.
Why it matters
You already watch for anxiety and ADHD in your autism cases. Add brief psychosis screens to your intake and yearly reviews. Ask about hearing voices, fixed false beliefs, or sudden drops in self-care. Early catch means earlier psychiatry referral, better meds, and fewer crisis calls. One extra minute of questions can save months of confusion later.
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02At a glance
03Original abstract
Schizophrenia and autism spectrum disorder (ASD) are significant public health problems. Scientists have recently explored the association between schizophrenia and ASD, but the findings are inconsistent. Thus, we conducted a systematic review and meta-analysis of epidemiological studies to examine the association between schizophrenia and ASD. PubMed, Embase, and the Cochrane Library were used for literature searches to identify eligible studies published in English before October 2, 2017. Relevant studies estimating the association between schizophrenia and ASD were included. The meta-analysis of the prevalence of schizophrenia in individuals with ASD encompassed 1,950,113 participants and 14,945 individuals with ASD. A random-effects model was chosen to synthesize the effect sizes of individual studies. The prevalence of schizophrenia was significantly higher in individuals with ASD than in controls (odds ratio = 3.55, 95% confidence interval: 2.08-6.05, P < .001). Both sensitivity analysis and publication bias testing revealed that the findings were robust. The systematic review of the prevalence of ASD in individuals with schizophrenia encompassed 930 participants. The prevalence of ASD in individuals with schizophrenia ranged from 3.4 to 52%. The systematic review and meta-analysis showed a significant association between schizophrenia and ASD. Autism Research 2018, 11: 1110-1119. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This systematic review and meta-analysis explored the association between schizophrenia and ASD. We found that the prevalence of schizophrenia was significantly higher in individuals with ASD than in controls and the prevalence of ASD in individuals with schizophrenia ranged from 3.4 to 52%. A comprehensive estimation of schizophrenia and ASD has important implications for the diagnosis, treatment, prognosis, and development of a fundamental understanding of these disorders.
Autism research : official journal of the International Society for Autism Research, 2018 · doi:10.1002/aur.1977