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In the early detection of psychosis, the differential diagnosis between autism spectrum disorder (ASD) and schizophrenia spectrum disorders (SSD) is clinically challenging due to substantial symptom overlap and potential comorbidity. Camouflaging and masking may further contribute to an underlying ASD remaining unrecognized in individuals at clinical high risk for psychosis. The present case report illustrates the long-term clinical course of a patient whose core autistic features were interpreted as treatment-resistant negative symptoms of schizophrenia for years. Only through ongoing clinical observation in an inpatient setting ASD was confirmed according to current gold standards diagnostic. This case highlights the critical need to consider ASD as a primary differential diagnosis in individuals presenting psychotic and psychotic-like experiences during early detection of psychosis. By raising clinical awareness of autistic phenomenology earlier identification may be facilitated, enable timely and appropriate support, and help affected individuals develop a coherent illness model for further therapeutic progress.