Paternal Broader Autism Phenotype and Adolescent Avoidant Attachment as Independent Predictors of Negative Symptoms...

Familial neurodevelopmental traits and early relational experiences are increasingly recognized as contributors to heterogeneity in psychosis outcomes. However, little is known about how parental broader autism phenotype (BAP) and adolescent attachment jointly relate to symptom severity and treatment adherence in early-onset psychosis.

This cross-sectional study enrolled 42 adolescents (aged 12-17 years; 88.1% schizophrenia, 11.9% schizoaffective disorder) and their biological parents. Parental BAP was assessed using the Autism Spectrum Quotient-Revised (AQ-R), adolescent attachment with the Psychosis Attachment Measure (PAM), symptom severity with the Scale for the Assessment of Positive/Negative Symptoms (SAPS/SANS), and parent-reported medication adherence with the MARS-5. Hierarchical multiple regression analyses were conducted to test the hypotheses.

Parental BAP did not predict adolescent attachment. However, the model predicting negative symptoms was significant (R² = 0.439, p = 0.022). Higher paternal AQ-R scores (β = 0.45, p = 0.016) and avoidant attachment (β = 0.46, p = 0.005) independently predicted more severe negative symptoms. Medication adherence was not associated with parental BAP; instead, longer DUP was the only robust correlate of poorer adherence (β = -0.56, p = 0.005). Sensitivity analyses using AQ-50 scores yielded consistent findings.

Paternal autistic traits and adolescent avoidant attachment may represent independent developmental and relational factors associated with negative symptoms in early psychosis. These findings underscore the need for family-informed assessment and intervention strategies, particularly targeting paternal characteristics and attachment dynamics. Given the modest sample size and cross-sectional design, replication in larger longitudinal cohorts is warranted.