Comparison of Developmental History, Co-Occurring Difficulties, Presenting Behaviors, and Cognition between ASD and ASPD
| History, Co-Occurring Difficulties, Behavior, and Cognition | Typical Presentation in | |
|---|---|---|
| Autism Spectrum Disorders | ASPD | |
| Developmental history where known | Pattern of developmental disturbance such as with speech and language development (sometimes delayed), play (often a lack of make-believe play with others), preoccupations, motor coordination difficulties, and atypical sensory function | No evidence of delayed early motor, language, or social development. Conduct disorder is common. This is a currently a requirement for the diagnosis of ASPD in the DSM-5 (but not the ICD-10). |
| Adverse early life experiences | Children with development disabilities had 1.5- to 3-fold higher risk of maltreatment compared to neurotypical controls.32,33 | ASPD is associated with adverse early life experiences. One study found that the severity of childhood maltreatment was linked to severity of psychopathy and ASPD in adulthood.34 |
| Psychiatric comorbidity | Affective, anxiety and psychotic disorders are more common in those with ASDs compared to the general population. | Anxiety disorders are common. The combination of anxiety disorders and ASPD may predispose to depressive and substance use disorders.35 |
| Presence of other neurodevelopmental disorders | Estimates in children with ASDs suggest comorbidity is more common than not, including ADHD, tic disorder, intellectual disabilities, and obsessive-compulsive disorder.36 | ADHD is common in children with conduct disorder and increases the risk of developing ASPD in adulthood.37 |
| Sensory functioning | Altered sensory sensitivity is common across a range of stimuli (light, sounds, textures, etc.). This usually manifests as sensory hypersensitivities and sensory avoidance. | No evidence that altered sensory sensitivities are characteristic. |
| Social communication difficulties during interviews | Common features include a lack of intonation, literal interpretation of comments, unusual eye contact, repetitive behaviors, and difficulties with reciprocal discussions. | Often one-sided interactions, but no difference in speech, use of language and nonverbal communication compared with the general population. |
| Personal need for routine and predictability in the immediate environment | Often very important for an individual, with any deviation resulting in heightened anxiety levels | Not usually present or associated with impaired function. If deviation of personal routines occurs, however, this may be viewed as a personal insult or injustice. |
| Preoccupations and restricted range of interests | Tendency to develop preoccupations and have a restricted range of interests | Preoccupations typically related to perceived critical comments and actions to self rather than to nonpersonal interests. |
| Emotion regulation | Difficulties in emotional regulation are common, including alexithymia | Difficulties in emotional regulation are common, including being quick to anger and hostility in response to personal stresses or perceived criticisms. |
| Neuropsychological characteristics and thinking style | Difficulties with central cohesion (failing to appreciate the bigger picture) and a tendency for literal thinking and problems generalizing (learning from one situation to another) are common | No overt profile of any neuropsychological difficulties; however some features of executive dysfunction may be present, including difficulties with attention, working memory and planning, inhibitory control and response reversal, which manifest in impulsivity and short-term thinking.38 |
| Empathy (the ability to understand and share the emotions and feelings of others) | Deficits in cognitive empathy (Theory of Mind and perspective taking) relative to affective empathy are noted. | Deficits in affective empathy are more notable. |
| Mentalization | Theory of Mind deficits that can lead to difficulties in perspective taking and understanding the thoughts and feelings of others and how this influences behavior | Tendency for negative interpretations of others' motives and behavior that may be used as justification for one's own behavior in response. |
| Attitudes towards others and society in general | Often expressed as a need for others to follow consistent rules and fairness | Tends to hold a critical view of the intentions of others, or that if other people step out of line, criticisms and negative consequences are justified. |
ADHD = attention-deficit hyperactivity disorder; ASD = autism spectrum disorder; ASPD = antisocial personality disorder.