The Autism-Schizophrenia Continuum? What is Big Pharma Up To Now?
In preparing for summer school, I review the Individualised Educational Plans (IEPs) of my new students. This year, I found something that I wasn’t expecting. This year, I have a student with an eligibility for an IEP of autism (not unique), but on the co-occurring section of the IEP I found that their IEP team had also listed ADHD (again, not unique), bi-polar (sort of rare at the student’s age, but not really unique), and schizophrenia (now that’s a unique finding given the student’s age).
This being the first time I’ve encountered such a profile, I did a bit of digging into the research. I found the usual silos of information about each of the “neurodevelopmental conditions.” But … I also found a bunch of research that suggests that autism and schizophrenia are on the same “spectrum.”
Trigger autistic deep dive … and little sleep.
For decades, autism and schizophrenia have been viewed as distinct ‘clinical entities,’ each with its own diagnostic criteria, ‘treatment’ approaches, and research paradigms. However, a growing body of evidence suggests that these ‘conditions’ may be more closely related than previously thought (never mind Dr. Sukhareva’s initial research that separated autism from schizophrenia), leading some researchers to propose a controversial yet intriguing concept: the autism-schizophrenia continuum.
This novel perspective challenges the traditional categorical approach to mental health diagnoses, suggesting instead that autism and schizophrenia might exist on a spectrum of neurodevelopmental variations. Rather than viewing these conditions as separate disorders with clear-cut boundaries, proponents of the ‘continuum model’ argue that there is a continuous distribution of traits and symptoms that span both ‘conditions.’
At first glance, autism and schizophrenia may seem vastly different. Autism is typically diagnosed in early childhood and is clinically characterised by difficulties in social communication, restricted interests, and repetitive behaviours. Schizophrenia, on the other hand, often emerges in late adolescence or early adulthood and is marked by hallucinations, delusions, and disorganised thinking. However, closer examination suggest several shared characteristics that blur the lines between these conditions, researchers say.
Both autism and schizophrenia can involve challenges in social cognition, communication difficulties, and sensory processing issues. According to the DSM, individuals with either diagnosis may struggle with executive functioning, ‘theory of mind,’ and emotional regulation. These overlapping features have led researchers to hypothesise that there might be common underlying neurobiological mechanisms at play.
Supporting this notion, genetic studies have uncovered shared risk factors for autism and schizophrenia, suggesting a potential common biological basis. Neuroimaging research has also identified similar structural and functional brain differences in both conditions, further bolstering the case for a continuum model.
The implications of this paradigm shift are far-reaching. From a diagnostic perspective, adopting a continuum approach could lead to more nuanced assessments that capture the full range of an individual’s strengths and challenges across multiple dimensions of functioning. This could help explain why some individuals show features of both conditions or don’t fit neatly into either category.
Researchers note that a ‘continuum model’ might pave the way for more personalised ‘treatment approaches’ based on an individual's specific profile rather than their diagnostic label. It could encourage clinicians to look beyond traditional diagnostic boundaries when planning ‘interventions,’ potentially leading to more effective and tailored support strategies.
However, the ‘continuum model’ is not without its critics. Some argue that whilst there are indeed similarities between autism and schizophrenia, there are also significant differences that should not be overlooked. Others express concern that a continuum approach might lead to over-diagnosis or under-recognition of distinct clinical needs.
Despite these challenges, the ‘autism-schizophrenia continuum model’ represents an curious development in neurodevelopmental research. It is part of a broader shift in psychiatry and neuroscience towards more dimensional, ‘spectrum-based’ understandings of mental health ‘conditions.’ As our understanding of the brain and its complexities continues to evolve, so too must our conceptual frameworks for understanding neurodevelopmental variations.
The Research
Again, the ‘continuum model for autism and schizophrenia’ suggests that these ‘disorders,’ traditionally seen as distinct entities, may actually represent opposite ends of a single spectrum. This model proposes that whilst autism and schizophrenia share some common traits, they differ in the direction and degree of certain neurodevelopmental features.
Evidence
Morphometric Differences:
A study comparing brain volumes found that individuals with schizophrenia tend to have lower gray matter and higher white matter volumes, whilst those ‘with autism’ showed the opposite pattern. This suggests that autism and schizophrenia may lie at opposite extremes of a cognitive continuum (Mitelman et al., 2017).
Neural Network Models:
Neural network models indicate that autism is characterised by increased sensory precision and inhibitory connections, whilst schizophrenia is associated with neural dysconnections and inhibitory imbalance. These distinctions in neural processing further support the continuum model (Lanillos et al., 2019).
Phenotypic Continuum:
Research using the ‘Movie for the Assessment of Social Cognition’ (MASC) demonstrated that social cognition deficits could discriminate between autism and schizophrenia, supporting the idea of a ‘phenotypic continuum’ between the two disorders (Martinez et al., 2017).
Genomic Evidence:
Genomic studies show that both autism and schizophrenia share genetic risk factors and pathogenic mechanisms, suggesting they are part of a ‘neurodevelopmental continuum.’ These findings imply a ‘gradient of severity’ and ‘overlap in the etiology’ of these ‘disorders’ (Owen & O'Donovan, 2017).
Neurobehavioural Markers:
A study found that individuals’ positions along ‘the autism-schizophrenia continuum’ influenced their predictive strategies in decision-making, further illustrating ‘the continuum’s’ impact on cognitive processing (Tarasi et al., 2023).
Given the research in this area, the ‘continuum model of autism and schizophrenia’ suggests that these ‘disorders’ may not be distinct but rather represent varying manifestations along a single ‘neurodevelopmental spectrum.’ This perspective has significant implications for diagnosis, ‘treatment,’ and understanding the underlying mechanisms of these disorders.
The Takeaway
The emerging research into ‘the autism-schizophrenia continuum model,’ whilst potentially groundbreaking in scientific circles, could raise significant concerns within the autistic community. As a non-verbal autistic person (aka, gestalt processor), and a trans woman, I’ve highlighted my initial unease about this new direction in research. It’s likely that others in the neurodivergent community might share similar reservations when they become aware of this model.
This ‘spectrum view’ could be particularly unsettling for those who have embraced their autism as a fundamental aspect of their identity. There’s a possibility that such a model might be perceived as diluting or undermining the sense of self that many autistic individuals have carefully cultivated. The neurodiversity movement, which champions autism as a natural variation of human neurology rather than a ‘disorder,’ might view this research as potentially regressive, especially considering the stigma often associated with schizophrenia.
Linking autism with a condition traditionally viewed as a mental illness could potentially complicate years of progress in promoting autism acceptance and understanding. Practical concerns might arise regarding how this model could affect diagnosis, access to appropriate supports, and the allocation of research funding. Many autistic individuals could feel that their lived experiences are fundamentally different from those with schizophrenia, and that a ‘continuum model’ may not accurately reflect their reality.
From an intersectional perspective, there might be heightened awareness of how medical models can sometimes oversimplify complex aspects of identity and neurology. Given the history of autism being misunderstood and misdiagnosed, there could be wariness about new models that appear to blur diagnostic boundaries.
As this research develops, it will be crucial to ensure that the voices and experiences of autistic individuals are centred in the discourse. The perspective of autistic people will be invaluable in shaping how this research is conducted and interpreted. It’s important of course to remember that ‘scientific models’ don't negate personal experiences or identities, and fostering ongoing dialogue between researchers and the autistic community will be vital to ensure that any new understanding of autism respects and reflects the lived experiences of autistic individuals.
Big Pharma’s Agenda?
Me being me, I’m deeply concerned about this new direction in autism research. The proposed ‘autism-schizophrenia continuum model’ isn’t just a scientific theory – it’s a potential threat to our identity and well-being.
From my perspective, this research feels like yet another attempt to pathologise our neurodiversity. Again, we’ve fought hard for recognition and acceptance of autism as a natural variation of human neurology, not a disorder. Linking autism with schizophrenia on a continuum risks undoing years of progress in autism acceptance and understanding.
What’s particularly alarming is how this research could play right into the hands of Big Pharma. I can already see them lining up a new sales vertical for ‘therapies.’ Given the track record of pharmaceutical companies in mental health, it’s not hard to imagine them developing new drugs or rebranding existing ones to target this supposed continuum. This feels like a step backwards, medicalising our experiences and potentially subjecting more of us to unnecessary medication.
As a gestalt processor, I find this reductionist approach particularly jarring. Our experiences as autistic individuals are complex and holistic – they can’t be neatly placed on a linear spectrum with another ‘condition.’ This model fails to capture the richness and diversity of autistic experiences.
Moreover, as a trans woman, I’m acutely aware of how medical models can oversimplify and misrepresent complex aspects of identity and neurology. This research seems to follow that same problematic pattern.
The global implications are equally concerning. With Western neoliberal and neocolonial capitalism driving the spread of these ideas, there’s a risk of exporting this model worldwide, potentially overriding local and indigenous understandings of neurodiversity.
We need to be vigilant and vocal about these developments. It’s crucial that autistic voices are centred in any research about us. We must push back against attempts to further pathologise our neurology and resist the commercialisation of our identities. Our focus should be on understanding and supporting autistic individuals, not on creating new markets for pharmaceutical interventions.
The Receipts
It’s important to remember that the pharmaceutical industry, often referred to as “Big Pharma,” plays a significant role in shaping Western healthcare practices, policies, and therapies. This influence extends beyond the development and marketing of drugs to encompass broader socio-economic and political dimensions. The industry’s practices are interwoven with the structures of Western neoliberal and neocolonial capitalism, which can impact healthcare accessibility, pricing, and the prioritisation of certain types of ‘therapies.’
Evidence
Influence on Medical Practices and Prescribing Habits:
Pharmaceutical companies invest heavily in marketing, which influences healthcare practitioners' prescribing habits. This includes direct-to-consumer advertising and various forms of engagement with healthcare professionals (Rhee, 2008).
The promotional strategies often lead to an increased prescription of newer, more expensive medications, sometimes at the expense of older, potentially equally effective alternatives (Kyle et al., 2008).
Economic and Societal Impact:
The pharmaceutical industry significantly contributes to the economy, creating jobs and generating revenue. However, the industry’s focus on profit maximisation can lead to practices that prioritise financial returns over public health needs (Nojszewska, 2019).
This focus on profitability is often reflected in the pricing of drugs, which can limit access to essential medications, particularly in developing countries (Dukes, 2002).
Influence on Research and Medical Knowledge:
Pharmaceutical companies fund a significant portion of medical research, which can lead to biased outcomes that favor their products. Studies have shown that industry-funded research is more likely to report positive outcomes for the drugs being tested (Tungaraza & Poole, 2007).
The influence extends to educational initiatives and the development of clinical guidelines, often leading to conflicts of interest among medical professionals (Jelinek & Neate, 2009).
Marketing and Disease Definition:
Pharmaceutical companies play a role in defining illnesses and expanding the market for their products. This can involve marketing strategies that medicalize normal life processes and push for broader diagnostic criteria to increase the patient pool for certain medications (Kitsis, 2011).
Regulatory Influence:
The industry exerts considerable influence over regulatory bodies and government policies, which can lead to weaker regulations that prioritize industry profits over public health. This includes lobbying efforts and the funding of political campaigns (Abraham, 2002).
Final thoughts …
The emerging research on ‘the autism-schizophrenia continuum model’ presents a complex and potentially concerning development for the autistic community. Whilst scientific inquiry is valuable, we must remain vigilant about how such research could be co-opted by pharmaceutical interests and capitalist structures to create new markets for ‘therapies’ at the expense of neurodivergent individuals’ well-being and identity.
As an autistic person and a member of multiple marginalised communities, I urge for caution and critical examination of this research direction. We must prioritise the voices and lived experiences of autistic individuals in shaping any new understanding of autism. The focus should be on supporting and accommodating neurodiversity, not on further pathologising natural variations in human cognition.
Moving forward, it’s crucial that we resist attempts to oversimplify or commercialise our identities. We must advocate for research that genuinely aims to understand and support autistic individuals, rather than creating new avenues for pharmaceutical interventions. Our neurodiversity is not a condition to be ‘treated.’ but a valuable aspect of human variation to be respected and embraced.
Now back to planning for my instructional day …