Towards autism-informed early intervention in psychosis: acceptability of the CAARMS tool among autistic adults

Abstract

Background: Autistic people are over-represented among individuals who experience psychosis. However, psychosis screening tools such as the Comprehensive Assessment of At-Risk Mental States (CAARMS, introduced in 2005) have not been evaluated in this population, despite rising rates of adult autism diagnosis, particularly among women. Aims: This study sought to explore the acceptability of the CAARMS among autistic adults. Methods: 17 recently diagnosed autistic adults (aged 25-64 years) completed CAARMS assessments followed by semi-structured interviews. Transcripts were analysed using a combination of inductive and deductive coding, informed by the Theoretical Framework of Acceptability [1]. Independent analyses were conducted by two researchers and a lived experience representative, and findings were discussed collaboratively to ensure reflexivity and rigour. Results: Six overarching themes were identified: (1) the CAARMS was broadly acceptable for some autistic individuals; (2) ambiguity and vagueness made questions difficult to interpret; (3) cognitive and emotional burden required careful handling; (4) overlap between autistic and psychotic experiences risks misdiagnosis and harm; (5) simple adjustments could improve accessibility and acceptability; and (6) some sections of the CAARMS need adapting for autistic people. Participants proposed practical adjustments, including clearer phrasing, flexible pacing, sensory accommodations and autism-informed interviewer training. Conclusion: While the CAARMS can be acceptable for some autistic adults, its current format may increase risks of misunderstanding and iatrogenic harm. Incorporating reasonable adjustments and autism-specific clinician training could improve the validity and acceptability of the CAARMS. These findings highlight the importance of adapting psychosis screening tools to ensure equitable and accurate care for autistic people.