Cognitive Profiles in Adolescents and Young Adults With Co‐Occurring Autism and First‐Episode Psychosis: A Preliminary Neuropsychological Investigation

Autism spectrum disorder (ASD) and psychosis are traditionally considered distinct psychiatric conditions with divergent developmental trajectories, yet emerging evidence suggests they may share overlapping neurodevelopmental characteristics. This study examined whether the cognitive profile associated with co-occurring autism and first-episode psychosis (FEP) reflects additive or interactive influences of the two conditions. Neuropsychological profiles were compared across four age-, sex-, intelligence quotient-, and education level-matched groups of adolescents and young adults (n = 45; aged 13-21): individuals with co-occurring ASD and FEP (FEP-ASD), FEP without ASD (FEP-O), ASD without FEP, and non-autistic controls. The FEP-ASD group exhibited an uneven cognitive profile characterised by relative strengths in visuospatial processing and recognition memory, alongside marked impairments in information processing speed, attentional control, and working memory. This pattern resembled the ASD profile but at a lower overall performance level, consistent with the additive impact of psychosis on ASD-related cognitive characteristics. FEP-ASD participants outperformed FEP-O in recognition memory, a domain usually preserved in ASD but impaired in psychosis. These preliminary findings suggest that co-occurring ASD and psychosis may produce a cognitive profile shaped by influences from both conditions. Larger longitudinal and multimodal studies are needed to clarify the underlying mechanisms.