Childhood Trauma As a Mediator of the Association Between Autistic Traits and Psychotic Experiences: Evidence From the Avon Longitudinal Study of Parents and Children Cohort.

This large UK study followed children from birth to age 24 and found that children with more autistic traits were more likely to experience distressing psychotic symptoms as young adults. However, childhood trauma appeared to explain about one-third of this connection. This suggests that preventing or addressing childhood trauma might help reduce the risk of psychotic experiences in autistic individuals later in life.

This large population-based cohort study from the UK examined associations between childhood autistic traits and psychotic experiences in young adulthood using the ALSPAC birth cohort (n=3,707-13,105). The study found that broad autistic traits and social communication difficulties in childhood were associated with distressing/frequent psychotic experiences at ages 18-24. Importantly, childhood trauma (ages 5-11) mediated approximately 28-36% of these associations, suggesting it may be a key pathway linking autistic traits to later psychotic experiences. Schizophrenia polygenic risk did not confound the associations.

The findings highlight childhood trauma as a potentially modifiable risk factor in the relationship between autistic traits and psychotic psychopathology.

Clinicians should be aware of increased risk of psychotic experiences in autistic individuals, particularly those with childhood trauma history. Early identification and trauma-informed interventions may help prevent development of psychotic symptoms. Routine screening for trauma history in autistic children and young people may be beneficial.

Single cohort study from one geographic region. Psychotic experiences measured by self-report rather than clinical diagnosis. Childhood trauma assessment relied on questionnaires and interviews which may underestimate prevalence. Causal relationships cannot be definitively established from observational data.

Little is known on whether associations between childhood autistic traits and psychotic experiences persist into adulthood and whether genetic confounding and childhood trauma influence them. Here we investigate the associations between childhood autistic traits and psychotic experiences until young adulthood and assess the influence of schizophrenia polygenic risk and childhood traumatic experiences, using the Avon Longitudinal Study of Parents and Children (ALSPAC) population-based birth cohort. We used a measure of broad autistic traits (autism factor mean score), and four dichotomised measures of autistic traits capturing social communication difficulties (age 7), repetitive behaviours (age 5), sociability (age 3), and pragmatic language (age 9). Psychotic experiences were assessed at ages 18 and 24 using the semi-structured Psychosis-Like Symptoms interview (PLIKSi).

Traumatic experiences between ages 5 and 11 were assessed with questionnaires and interviews administered to children and parents at multiple ages. Broad autistic traits, as well as social communication difficulties, were associated with psychotic experiences that were distressing and/or frequent until age 24 (autism factor mean score, n = 3707: OR 1.19, 95%CI 1.01-1.39; social communication difficulties, n = 3384: OR 1.54, 95%CI 0.97-2.45). Childhood trauma mediated a substantial proportion of the identified associations (~28% and 36% respectively, maximum n = 3577). Schizophrenia polygenic risk did not appear to confound the associations.

Multiple imputation analyses (maximum n = 13 105) yielded comparable results. Childhood trauma may be an important, potentially modifiable pathway between autistic features and later onset of psychotic psychopathology.