Autistic people are more likely to experience symptoms linked to psychosis. Our new research, published in the British Journal of Clinical Psychology, brings together findings from over 60 studies to explore why this happens, and whether the tools we use to measure these conditions are fit for purpose.
What We Did
We reviewed 63 studies involving nearly 7 million people (N = 6,903,960). We examined whether the link between autism and psychosis holds up, and whether the way these conditions are measured affects the results.
What We Found
- An autistic person is about 7 times more likely to be diagnosed with a psychotic disorder than someone without autism (and vice versa).
- Autistic people were more likely to score higher on psychosis-related traits, and people with psychosis scored higher on autism-related traits compared to the general population with neither diagnosis.
- Traits like social withdrawal and reduced emotional expression (known as “negative symptoms” in psychosis) were most strongly linked to autistic traits. Traits like hallucinations or delusions (“positive symptoms”) were linked too, but less strongly.
Why It Matters
Understanding this overlap is crucial, especially in clinical settings. Misdiagnosis can lead to the wrong treatment and lack of support. We suggest that some tools used to measure psychosis may not work well for autistic people. This could be because certain traits overlap between autism and psychosis, or because some questionnaire items don’t clearly separate autistic from psychosis-like traits. For autistic individuals, who often interpret language very literally, this can be a problem when similar wording is used to describe very different traits.
For example, a common screening questionnaire for psychosis asks people to agree or disagree with statements like “Some people think that I am a very bizarre person” or “I am an odd, unusual person.” Autistic behaviours such as stimming or other unique traits might be misinterpreted as “odd” or “bizarre,” even though they are typical for autistic people. Other common items assessing negative symptoms of psychosis may assess more shared interpersonal experiences, such as “I am not good at expressing my true feelings by the way I talk and look” and “My ‘nonverbal’ communication (smiling and nodding during a conversation) is not very good” and so exaggerate the association.
What’s Next?
We wanted to see if the type of measurement tool changed the strength of the relationship between autistic and psychosis-traits, but the data available wasn’t able to answer this. While the evidence for a strong association between autistic and psychotic-like traits is clear, more research is needed to improve assessment tools and ensure autistic people get accurate diagnoses and the right support.
Reference: Miles, M. R., Golm, D., & Palmer‐Cooper, E. (2025). The association between autism and psychosis and the tools used to measure it: An updated systematic review and meta‐analysis. British Journal of Clinical Psychology.
Emma Palmer-Cooper 