Early and Differential Detection of Autism Spectrum and Prodromal Symptoms of Schizophrenia in the Ecuadorian Child and Adolescent

Abstract

Autism Spectrum Disorder (ASD) and Early-Onset Schizophrenia (EOS/VEOS) pose a significant diagnostic challenge in the child and adolescent population due to their notable symptomatic overlap, especially during adolescence, prompting this research to determine differential symptomatic profiles and establish a high-specificity early detection model, which is critical in the Ecuadorian context due to structural barriers and limited specialized training. The observational, descriptive, and retrospective methodology involved reviewing anonymized clinical records from child and adolescent patients in specialized centers in Guayaquil, Ecuador, to quantify the prevalence and co-occurrence of dual diagnoses. The theoretical analysis confirmed a critical symptomatic overlap in social withdrawal and restricted affect; however, the distinction rests on the fact that ASD deficits are evolutionary and persistent, while Schizophrenia involves a recent functional regression or qualitative change. This overlap is explained by a neurodevelopmental continuum and shared genetic risk, leading to high co-occurrence rates and poorer outcomes in dual pathology. The low rate of ASD detection in Ecuador and the urgency to intervene in the Clinical High-Risk (CHR) state for psychosis substantiate the study's central proposal. Consequently, the implementation of a specific clinical referral algorithm in Primary Care, based on validated screening tools and the awareness of the psychopathological continuum, is considered essential to optimize health resource allocation, shorten intervention times, and significantly improve the long-term prognosis for affected children and adolescents in the country.