Varieties of misdiagnosis in ASD: an illustrative case series.
Autism social quirks can mimic psychosis—double-check before starting antipsychotics.
01Research in Context
What this study did
Doctors looked at five teens who already had an autism diagnosis. Each teen had also been told they had a psychotic disorder.
The team re-checked every chart and watched the kids on the ward. They asked: do the "psychotic" signs fit better with autism?
What they found
All five teens lost the psychotic label. Odd speech, flat faces, and rigid routines looked "crazy" to staff, but they were just part of autism.
No one needed the antipsychotic drugs that had been started.
How this fits with other research
Joshi et al. (2010) extend this warning. They saw youth with autism rack up six extra psychiatric labels on average. More labels often mean more meds that do not help.
Nyrenius et al. (2025) pull together 17 papers and say the same overlap still confuses clinicians today. Their review shows the problem is bigger than these five cases.
Gillberg (1985) is an earlier single case that spotted the same pitfall. The new series confirms the old red flag still waves.
Why it matters
When an autistic teen talks to voices or stares flatly, pause before adding a psychotic diagnosis. Re-score social-communication quirks using autism lenses. Ask: did these signs start years ago, stay stable, and wax with stress? If yes, taper antipsychotics instead of raising them. Your reassessment can cut side effects and keep the right therapy target.
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02At a glance
03Original abstract
The relationship between autism spectrum disorders (ASD) and psychotic disorders (PD) is a focus of continued interest. There are substantial conceptual and clinical difficulties associated with diagnosing comorbid PD in individuals who have ASD. In this case series, we report on five cases where adolescents with previously diagnosed ASD were also diagnosed as psychotic. In each case, we found that these patients' 'psychotic' symptoms could be better understood as a part of their underlying ASD diagnosis, with significant implications for treatment, prognosis, and access to services. This misdiagnosis likely represents a combination of adult psychiatrists being relatively inexperienced with this population, and the system of care requiring providers to apply diagnostic labels to justify inpatient hospitalization.
Journal of autism and developmental disorders, 2015 · doi:10.1007/s10803-014-2239-y