Psychosis-Autism CAARMS Study (PACS)
Research type
Research Study
Full title
A pilot study to explore the acceptability of the Comprehensive Assessment of At-Risk Mental States (CAARMS) for people with Autism Spectrum Disorder (ASD)
IRAS ID
291758
Contact name
Conor Davidson
Contact email
Sponsor organisation
Leeds and York Partnership NHS Foundation Trust
Clinicaltrials.gov Identifier
CF15, Approval number
Duration of Study in the UK
0 years, 9 months, 6 days
Research summary
Research Summary
There is a high degree of overlap between autism and psychosis, and these conditions share some clinical features. Healthcare professionals therefore often struggle to distinguish one from the other, and rates of misdiagnosis are high.Early Intervention in Psychosis (EIP) services across the UK widely use the Comprehensive Assessment of At-Risk Mental States (CAARMS) as a screening tool for psychosis. Previous research has shown that the CAARMS works well to identify patients who might benefit from EIP services. It has potential to identify psychotic features in people with autism, but its use in this population has not been tested.
The aim of this study is to explore how acceptable the CAARMS is for patients with autism. This will be achieved by recruiting participants with a recent diagnosis of autism, administering the CAARMS, then exploring their views and experiences through semi-structured interviews. This will identify opportunities to improve the acceptability of the CAARMS for people with autism, with a focus on reasonable adjustments.
It is hoped that this study will inform the development of a larger future study to assess the validity of the CAARMS for people with autism.
Summary of Results
Autistic people may experience psychosis more often than the general population. However, some autistic experiences, such as sensory differences, unusual perceptions or differences in communication, can resemble symptoms of psychosis. This can make assessment difficult and may increase the risk of misunderstanding or misdiagnosis.Early Intervention in Psychosis services commonly use an interview called the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify people who may be developing psychosis. The CAARMS was not specifically designed or tested for autistic people. This study explored how acceptable and understandable autistic adults found the assessment.
Seventeen autistic adults aged 25–64, all recently diagnosed with autism and with no previous history of psychosis, completed a CAARMS assessment and were then interviewed about their experience. Their interviews were analysed to identify common themes.
Some participants found the CAARMS straightforward and acceptable, particularly when it was delivered in a supportive and flexible way. Others found some questions vague, abstract or difficult to interpret, and described the assessment as mentally demanding. Participants were also concerned that longstanding autistic experiences could be mistaken for symptoms of psychosis.
Suggested improvements included using clearer language, allowing more time, providing written questions, making sensory adjustments, clarifying whether experiences were new or longstanding, and ensuring clinicians have a good understanding of autism.
The study suggests that relatively simple autism-informed adjustments could make the CAARMS more acceptable and reduce the risk of misunderstanding. Further research is needed to test adapted approaches and their accuracy in autistic people.
REC name
Wales REC 4
REC reference
24/WA/0026
Date of REC Opinion
15 Mar 2024
REC opinion
Further Information Favourable Opinion