The onset of delusion in autism spectrum disorder: a psychopathological investigation

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects social communication and behavioral routines. Diagnosis is complicated due to the age of symptom onset and the diverse symptomatology. ASD frequently occurs with comorbid psychiatric disorders, including psychotic disorders, that affect the individual's quality of life, health, and prognosis. The presence of psychosis in ASD is still a debatable topic. We conducted a narrative review to investigate the psychopathological factors that may contribute to the onset of delusion in individuals with ASD, focusing on Attributional style and Theory of Mind (ToM). Although an external Attributional style for negative events is a risk factor for the pathogenesis of delusion in individuals with psychotic spectrum disorders, it seems not to play a pivotal role in the onset of delusions in ASD patients. On the other hand, there is stronger evidence for the lack of ToM in delusional genesis in both psychotic and ASD subjects. To date, the available literature on ToM is still contradictory, and more research is needed, including consideration of social-cognitive deficits and a deeper understanding of the timing of ToM deficit onset in these conditions. Future studies should also investigate the prevalence and type of delusions in ASD patients and their correlation with the severity of autistic symptoms. It is important for modern psychopathology to address these aspects systematically due to the increasing number of ASD diagnoses.