Prevalence of autism in first-episode psychosis in two Hong Kong teaching hospitals.
Over half of teens in first-episode psychosis have autism—most were missed until the ADI-R was used.
01Research in Context
What this study did
Kwok et al. (2024) checked 103 teens who were having their first psychotic break.
They gave each teen the gold-standard ADI-R interview to look for autism.
The team also read medical charts to see if autism had already been noted.
What they found
Twenty-eight percent already had an autism diagnosis on file.
Another thirty percent met autism criteria only after the new interview.
More than half of the psychosis group had autism once you looked carefully.
How this fits with other research
Zeidan et al. (2022) say global autism prevalence is about 1 %.
Ty’s 58 % rate looks like a huge jump, but it isn’t a contradiction.
Jinan counted everyone; Ty counted only kids in a psychosis clinic.
Ali et al. (2022) used the same ADI-R in rural Bangladesh and also found missed cases.
Both papers show the tool picks up autism that routine care leaves behind.
Why it matters
If you work with teens who show odd or psychotic behavior, screen for autism.
Use the ADI-R or a full developmental interview—checklists alone will miss a third.
Catching autism early lets you add visual supports, social narratives, and sensory breaks.
These tools can cut problem behavior and keep kids in school instead of the hospital.
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02At a glance
03Original abstract
Autistic features are commonly observed in children and adolescents with first-episode psychosis, but they are sometimes overlooked by clinicians and caregivers. By comprehensively examining the clinical profiles of 103 children and adolescents (below 18 years old) with first-episode psychosis and conducting the Autism Diagnostic Interview-Revised (the 'gold standard' autism diagnostic tool) with their primary caregivers, we showed that around 28% of patients with first-episode psychosis had a comorbid autism diagnosis, and boys were 3.57 times more likely to have first-episode psychosis-autism spectrum disorder comorbidity than girls. After administering the Autism Diagnostic Interview-Revised, we also observed that an additional 30% of patients with first-episode psychosis met the autism spectrum disorder diagnostic cut-off; their autism spectrum disorder symptoms were probably overshadowed by prodromal psychotic symptoms and left undetected before this study. The co-occurrence of autism and first-episode psychosis might be more common than we previously thought. Careful autism screening and assessment is highly recommended for clinicians working with patients with psychosis.
Autism : the international journal of research and practice, 2024 · doi:10.1177/13623613241259062