The Relationship Between Autism and Schizophrenia

Autism, categorized in the Diagnostic and Statistical Manual of Mental Disorders as autism spectrum disorder, is a neurodevelopmental diagnosis that begins in early childhood and impacts an individual’s relationships and behaviors. Schizophrenia is a mental health condition characterized by abnormal perceptual experiences, delusional beliefs, and other atypical behaviors.

Researchers have long suspected a link between autism and schizophrenia, noting that autistic people are more likely to have schizophrenia compared to the general population. Studies have found that, although approximately 0.45% of the total population experiences schizophrenia in their lifetime, autistic people are 3.6 times as likely to develop schizophrenia compared to those who are not autistic. Additionally, some studies have shown that up to half of autistic people develop symptoms of schizophrenia at some point in their lives.

In this article, we discuss the connection between autism and schizophrenia and how autistic people are at higher risk for schizophrenia than non-autistic people.

The Connection Between Autism and Schizophrenia

The symptom overlap between autism and schizophrenia has been studied for decades. In fact, autism has previously been labeled as early childhood onset of schizophrenia due to the similarities in how these two diagnoses present.

Additionally, sometimes autistic people who do not experience psychotic symptoms get misdiagnosed with schizophrenia. Some measures used to test for hallucinations and delusions are worded in a way that can mislead autistic respondents. For example, when asked if they experience beliefs that other people find strange or unusual, autistic people might think of their special interests, and the measure may misinterpret this as delusions.

At the same time, as noted above, autistic people are at higher risk for developing schizophrenia compared to the non-autistic population. While research around the intersection of these two diagnoses is limited, the connection between autism and schizophrenia is clearly documented.

Researchers continue to explore this connection and increase our understanding of the connection between autism and schizophrenia.

Diagnosing Autism and Schizophrenia

Evaluating for autism and schizophrenia can be complicated. An individual may have one or both diagnoses, or they may have neither. Autistic individuals who are diagnosed in early childhood may develop schizophrenia later in life, as autism manifests in early childhood, and schizophrenia tends to develop in the late teens or early twenties.

Because autism and schizophrenia are two distinct diagnoses, there are different evaluations used to identify each condition, and they might not both be diagnosed at the same time. An individual might be identified as autistic in early childhood and then develop schizophrenia in adulthood. They might also go unidentified through childhood and not realize that they are autistic until after developing schizophrenia.

Diagnosing Schizophrenia

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the diagnostic criteria for schizophrenia are:

• Two or more of the following:
• Delusions
• Hallucinations
• Disorganized speech
• Disorganized behavior
• “Negative symptoms,” such as limited emotional or verbal expression
• The individual experiences decreased functioning in one or more areas
• The disturbance lasts at least six months
• Another psychotic disorder has been ruled out
• The disturbance is not due to a medical condition or substance use
• “If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least one month”

When evaluating for schizophrenia, a provider may use some of the following:

• Diagnostic Interview: A detailed, thorough history of symptoms and concerns.
• Mental Status Examination: Clinical observations of an individual’s functioning, memory, emotional expression, presentation, and connection to reality.
• Personality Measures: Some psychological assessments, known as personality measures, look at an individual’s overall psychological functioning and the symptoms they might be experiencing.
• Projective Measures: Measures may use ambiguous stimuli to gather information about how an individual perceives the world around them.

Diagnosing Autism

The diagnostic criteria for autism include:

• Social communication and interaction deficits, including:
• Difficulty with social-emotional reciprocity
• Difficulty with nonverbal communication
• Difficulty developing and maintaining relationships
• Restrictive, repetitive behaviors, interests, activities, et cetera
• Repetitive behavior or movements
• Inflexibility with routines
• Strong, intense interests
• Atypical responses to sensory input
• Symptoms begin early in development
• Symptoms cause significant impairment
• Symptoms are not better explained by another diagnosis

Psychologists and psychiatrists typically evaluate for autism. For children, a developmental pediatrician can also diagnose autism. Adults can also be tested for autism. Measures that test for autism include (but are not limited to):

• Autism Spectrum Rating Scale (ASRS). Parents or teachers can complete the ASRS to provide observations of a child’s behavior and symptoms. 
• Autism Diagnostic Observation Schedule-2 (ADOS-2). The ADOS-2 measures social and communication skills by presenting various tasks, and it can be administered to children or adults.
• Diagnostic Interview for Social and Communication Disorders (DISCO). The DISCO is an interview questionnaire developed for children and adults.
• The Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition (MIGDAS-2): The MIGDAS-2 is a structured interview form with a wide variety of questions to gather information about symptoms and history.
  

Treatment for Autism and Schizophrenia

Since autism is a neurodevelopmental difference and not a mental health disorder, it is not something that is cured or “fixed.” However, autistic people might require support, like psychotherapy to manage stress, speech or occupational therapy to help with communication and sensory issues, and services like vocational or financial assistance.

People with schizophrenia might require antipsychotic medication to manage hallucinations or delusions. They may also benefit from psychotherapy to help manage stress or improve insight into their symptoms. Family therapy can help caregivers understand their loved one’s symptoms and how to best support them.

Finally, group therapy can offer a supportive environment where the individual can connect with others with similar symptoms and experiences.

A Word From Verywell

Autism and schizophrenia have some symptom overlap, and autistic people are much more likely to develop schizophrenia than non-autistic people. There are added complications in identifying and treating these comorbid diagnoses, but individuals can seek support from qualified professionals to determine their diagnosis and access appropriate treatment.