Bottom-up cognition in autism is not psychosis
Conflating bottom-up bias with psychosis does concrete harm
Autistic perception has long been described as “bottom-up,” meaning that raw sights, sounds, and touches receive more weight than top-down expectations drawn from prior experience. Evidence indicate that autistic adults detect high-spatial-frequency patterns at lower contrast thresholds, respond more quickly to brief auditory tones, and resist classic visual illusions that rely on context.¹,² Computational models reproduce these findings by reducing the influence of priors without inserting hallucinations.³ [When the world becomes 'too real': a Bayesian explanation of autistic perception is a must read]
Psychosis presents a different picture. Hallucinations and delusions emerge when the brain tags random or internally generated signals as salient and then builds explanatory stories around them. Neuroimaging, pharmacology, and computational studies converge on dopamine-linked circuits that assign excessive precision to noise.⁴ ⁵ Reality testing is compromised; patients often hold firm to beliefs that clash with external evidence.
The two constructs do share vocabulary of prediction errors, precision weighting. But, they diverge in measurable ways.
Autistic perception is stable across development, appears in early childhood, and rarely includes hallucinations.⁶
Psychosis typically surfaces in late adolescence or early adulthood, fluctuates over time, and is marked by sensory intrusions.⁴
Even when autistic and psychotic traits co-occur, detailed phenotyping shows that sensory strengths and dopaminergic dysregulation follow separate tracks.⁷
Conflating bottom-up bias with psychosis does concrete harm.
First, it amplifies stigma. When a neutral sensory style is framed as a severe mental illness, public perception shifts from curiosity to fear.
Second, it fuels diagnostic overshadowing, the tendency to attribute all difficulties to a single label leading clinicians to overlook co-occurring conditions such as anxiety, depression, or epilepsy.⁸
Third, it burdens autistic people with self-doubt. Social camouflaging already predicts elevated exhaustion and suicidal ideation.⁹
Minority-stress research confirms that chronic invalidation of one’s perceptual experience worsens mental-health outcomes.¹⁰ False correlations add another layer of invalidation.
The impact on false correlation is not restricted to individuals.
Policymakers and educators who misunderstand the difference may allocate resources to treat a non-existent psychotic risk while neglecting sensory accommodations that actually improve daily functioning.
Researchers may chase spurious links, diverting funding from fruitful avenues such as sensory processing interventions or assistive technology. P
ublic discourse may discourage autistic self-advocacy by casting perceptual differences as delusional rather than informative.
Clear terminology is therefore essential. Bottom-up bias is a documented cognitive style measured in milliseconds and decibels. Psychosis is a clinical syndrome defined by hallucinations, delusions, and impaired reality testing. The scientific literature places them in distinct categories with distinct mechanisms. Preserving that distinction protects vulnerable minds from stigma, guides clinicians toward accurate assessment, and keeps research agendas aligned with empirical reality.
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References
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Robertson CE, Baron-Cohen S. Sensory perception in autism. Nat Rev Neurosci. 2017 Nov;18(11):671-684. doi: 10.1038/nrn.2017.112. Epub 2017 Sep 29. PMID: 28951611. https://pubmed.ncbi.nlm.nih.gov/28951611/
Pellicano E, Burr D. When the world becomes 'too real': a Bayesian explanation of autistic perception. Trends Cogn Sci. 2012 Oct;16(10):504-10. doi: 10.1016/j.tics.2012.08.009. Epub 2012 Sep 7. PMID: 22959875. doi:10. https://pubmed.ncbi.nlm.nih.gov/22959875/
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Mason D, McConachie H, Garland D, Petrou A, Rodgers J, Parr JR. Predictors of quality of life for autistic adults. Autism Res. 2018 Aug;11(8):1138-1147. doi: 10.1002/aur.1965. Epub 2018 May 7. PMID: 29734506; PMCID: PMC6220831. https://pmc.ncbi.nlm.nih.gov/articles/PMC6220831/
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Botha M, Frost DM. Extending the minority stress model to understand mental health problems experienced by the autistic population. Soc Ment Health. 2020;10(1):20-34. doi:10.1177/2156869318804297. https://journals.sagepub.com/doi/10.1177/2156869318804297