Editorial

Autism spectrum disorder (ASD) is characterized by persistent alterations in social communication, interactions, and behavior, with limited interests and activities and repetitive patterns of actions ¹. ASD emerges during development from the first years of life to adolescence, determining clinical pictures of different severity. With a prevalence estimated at just under 1 percent, approximately 78 million people worldwide are affected by ASD, with a high burden on those affected and their families ^2,3. From childhood to adolescence and adulthood, alongside the different degrees of severity of the classic clinical picture with or without intellectual disability and language disorder, heterogeneous psychopathological conditions appear, which reach full manifestations of comorbid psychiatric syndromes up to 70% in people with ASD ^1,4,5. The high comorbidity in ASD causes a psychopathological richness that is often challenging for clinicians due to the need to identify the hierarchy of different syndromic manifestations in the general clinical picture and, therefore, to set the correct treatment. The current Special Issue of the Journal of Psychopathology, entitled Psychopathologies in autism spectrum disorder, aims to provide an update on the emerging psychopathologies of ASD. It comprises original contributions from different Italian research groups actively involved in the clinical characterization of ASD from diagnosis to treatment, from childhood to adulthood. Barlattani and colleagues ⁶ conducted a narrative review focusing on eight psychiatric comorbidities (attention deficit hyperactivity disorders, ADHD; anxiety disorders; personality disorder; repetitive behaviors and obsessive-compulsive disorders, OCD; sleep disorders; mood disorders; Tourette syndrome and tic disorder studies; feeding and eating disorder) in ASD. In addition to confirming worse ASD outcomes in the presence of psychiatric comorbidity, the Authors provide evidence of an overlap between the core psychopathology of ASD and comorbid disorders. With some exceptions, the current psychopathological evaluations generally do not allow to discriminate well the different comorbid conditions. An active research area is the study of the comorbidity between autism and psychosis ^7-9. Ribolsi and colleagues ¹⁰ provided an overview of the onset of delusion in ASD, focusing on the Attributional style and Theory of Mind (ToM). Riccioni and colleagues ¹¹ reviewed gender dysphoria in ASD. The Authors highlighted the psychopathological overlap of these two conditions. They supported the need to characterize these disorders better in four clinical domains, i.e., social behavior and theory of mind impairment, repetitive thoughts/obsessions, cognitive inflexibility, and sensory processing aspects. Psychopharmacological treatment is always a critical issue in ASD. Davico and colleagues ¹² conducted a narrative review focusing on the pharmacological treatments of comorbid disorders in ASD. The Authors summarized the evidence from the existing literature, underling the lack of robust evidence and, therefore, the limitation in providing useful indications to the clinicians to treat these psychiatric comorbidities in people with ASD. Mazza and colleagues’ original research ¹³ investigated the relations between ToM, executive functioning, and repetitive behavior in ASD. The authors demonstrated that repetitive behavior mediated the relationship between ToM and executive functioning, providing new directions for improving rehabilitation interventions in ASD. The Special Issue also contains three interesting clinical cases, focusing on the relation between autism and psychosis ¹⁴, suicide ¹⁵, and bipolar disorder ¹⁶. The Authors demonstrated once again the difficulties in the psychopathological characterization, clinical presentation and course, and treatment. Awareness of autism has grown tremendously over the past 20 years, due to its prevalence and the burden it affects individuals and families. We believe the Special Issue Psychopathologies in autism spectrum disorder provides a contribution to improve the sensibleness of clinicians towards the psychopathological characterization of those people affect by autism and also in those with other psychiatric disorders in which autism was unrecognized in childhood and adolescence ^17,18.