Varieties of Misdiagnosis in ASD: An Illustrative Case Series

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.

Experience of mental health diagnosis and perceived misdiagnosis in autistic, possibly autistic and non-autistic adults

“…However, when the clients' impairments in social communication and reciprocity were taken into consideration, it was concluded that clients' presentation could be better explained by ASC, with the preoccupations accounted for under 'restricted, repetitive patterns of behaviour, interest, and activities' (APA, 2013). Other case reports (Luciano et al, 2014;Van Schalkwyk et al, 2015) also indicated that mental health professionals' failure to collect information about developmental history, and lack of understanding about ASC presentation, contributed to mental health misdiagnoses in both individuals with an existing autism diagnosis and those who obtained a diagnosis during the studies. Misdiagnosis of ASC as a mental health condition could lead to unnecessary treatment (e.g.…”

Autism Spectrum Disorder and Psychosis: A Case Study

“…Brief reactive psychosis should be part of the therapeutic index of suspicion, which needs to be explored in people with ASD in the context of increased stress and anxiety. It has been observed that psychosis may be a misdiagnosis in people with ASD if the experience occurs at the time of disrupted routine and resolves without the need for medication and with the introduction of structure (Van Schalkwyk, Peluso, Qayyum, McPartland, & Volkmar, 2015). In this case study, presented resolution did not occur until the prescription of antipsychotic medication.…”

“…Diagnostic constructs are developed as useful instruments to guide treatment and not statements of definitive truth (Hallerback, Lugnegard, & Gillberg, 2012). It has been observed that psychosis may be a misdiagnosis in people with ASD if the experience occurs at the time of disrupted routine and resolves without the need for medication and with the introduction of structure (Van Schalkwyk, Peluso, Qayyum, McPartland, & Volkmar, 2015). Until we have biological markers to increase diagnostic certainty, it remains a case of needing to exercise diagnostic common sense (Nylander et al, 2008).…”

An Exploratory Trial of Transdermal Nicotine for Aggression and Irritability in Adults with Autism Spectrum Disorder

“…Poorly controlled aggression may contribute to an increased need for psychiatric services, including hospital admission and the prescription of psychotropic medication (Tsakanikos et al 2007). Individuals with ASD who display prominent aggressive symptoms may be misdiagnosed as having comorbid psychotic illnesses, potentially misdirecting their subsequent treatment (Van Schalkwyk et al 2015b). Behavioral treatments are typically considered to be the first-line intervention for this clinical problem (Matson 2009), although a large number of trials support the utility of atypical antipsychotic medications (McCracken et al 2002; McDougle et al 2005; Potenza et al 1999; van Schalkwyk et al 2017).…”