Differentiating Prodromal Psychosis from ASD Comorbidities Using Eye Movement Analysis

Adolescents with Autism Spectrum Disorder (ASD) frequently experience comorbidities such as attention-deficit hyperactivity disorder (ADHD), anxiety disorders, and mood disturbances, which can present symptoms similar to prodromal psychosis, leading to diagnostic challenges. This narrative review synthesizes the potential of eye movement analysis as a non-invasive, objective tool to differentiate prodromal psychosis from these overlapping ASD comorbidities. We explore the prevalence and nature of ASD psychosis overlaps, shared and distinct clinical features, and various eye tracking paradigms, including free viewing, smooth pursuit, antisaccade tasks, and gaze perception exercises, that may reveal unique abnormalities in psychotic conditions compared to ASD alone or with comorbidities. Key findings indicate that metrics like reduced scanpath length, fewer fixations, impaired smooth pursuit gain, and atypical saccade latencies are often more pronounced in emerging psychosis, potentially aiding in early identification. The review also addresses methodological considerations, ethical implications, clinical integration challenges, and future research directions, emphasizing the role of eye tracking in improving diagnostic precision and facilitating timely interventions to enhance long-term outcomes for vulnerable youth.