The PAUSS showed acceptable internal consistency, but some items were critical.

Our EFA results identified a 3-factor model but dissimilar to the original autism model.

At entry, PAUSS+ patients showed greater severity in psychopathology and social impairment.

Across the 2-year follow-up, PAUSS + patients had lower incidence rate of symptomatic remission.

The PANSS Autism Severity Score (PAUSS) is a recent popular measure of autistic characteristics in Schizophrenia Spectrum Disorders (SSD). Evidence on its factor structure, longitudinal course, and treatment response is poor. The main aims of this investigation were: to examine its internal consistency and factor configuration in young patients with first-episode SSD treated in an Early Intervention (EI) service, and to compare clinical outcomes between SSD individuals with or without “autistic features” across 2 years of follow-up, as well as their treatment response.

SSD participants completed the Positive And Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), and the Health of the Nation Outcome Scale (HoNOS) across the follow-up. Statistical tests included the α statistic, Exploratory Factor Analysis, Kaplan-Meyer survival analysis, mixed-design ANOVA, and multiple linear regression analysis.

170 SSD individuals were enrolled (58 [34.1 %] scoring above the PAUSS cut-off [PAUSS+]). Internal consistency of the PAUSS was acceptable (α = .792). EFA identified a 3-factor model. At baseline, PAUSS + individuals showed greater severity in psychopathology and social decline. Across the follow-up, PAUSS + individuals had lower incidence rates of symptomatic remission. No PAUSS long-term stability was found, but a significant reduction that was predicted by lower antipsychotic dosage and higher number of case management sessions offered along the follow-up.

The PAUSS seems to capture a SSD subgroup characterized by higher baseline severity levels in psychopathology and poorer outcomes.

PAUSS

Autism

Schizophrenia

First episode psychosis

Psychopathology

Early intervention

Follow-up

© 2025 The Author(s). Published by Elsevier Ltd.