Autism and Schizophrenia

Did you know when autism was first described it was thought of as a version of childhood-onset schizophrenia? Today, we know that autism and schizophrenia are unrelated diagnoses with very different features. Understanding the overlap between autism and schizophrenia, however, remains important, as schizophrenia may be more common among autistic people than in the general population. One study suggests that autistic youth may be three to six times more likely to develop schizophrenia than allistic (AKA non-autistic) peers. 

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Read on to learn about these two diagnoses’ co-occurrence and how to get support.

Autism spectrum disorder (ASD) and schizophrenia are very different diagnoses, but they share some attributes. Autistic people and schizophrenic individuals both experience internal worlds that can look and feel different from others’. They may have different styles of thinking and ways of communicating. However, for people with schizophrenia, their inner world is disconnected from reality, while autistic individuals maintain contact with reality but might interact with and understand it differently from allistic people.

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Autism is a neurodevelopmental disorder, meaning it affects the development of the brain and nervous system. Autistic traits often first present during a person's early childhood. Schizophrenia is a severe mental illness, and it is also considered a neurodevelopmental disorder; however, it usually appears in the late teens or early adulthood. 

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Autistic traits look quite different from symptoms of schizophrenia. Autism is not associated with psychotic symptoms like hallucinations and delusions, although autistic people can also experience psychosis. Allistic schizophrenic individuals may not exhibit traits common among autistic people, such as special interests or a strong preference for routine.

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Despite their differences, autism and schizophrenia can co-occur. Because research on schizophrenia in autistic individuals is limited, people with both diagnoses can struggle to find adequate support.

Some symptoms of schizophrenia, like executive dysfunction and disorganized thinking and communication, can appear similar to some autistic traits, such as differences in information processing and social styles. Individuals with both diagnoses could experience an amplification of these traits.

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More broadly speaking, autistic individuals and schizophrenic people both face stigma, mistreatment and a societal failure to accommodate their needs. Having both diagnoses can make this an even greater challenge, putting a person at greater risk of marginalization.

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Autistic individuals with schizophrenia can have a harder time accessing treatment, as well. Sometimes, clinicians may incorrectly attribute symptoms of a patient’s schizophrenia to their autism, which can delay or prevent an accurate schizophrenia diagnosis.

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Early intervention makes a huge difference in treating schizophrenia. Without a diagnosis, these individuals can find their psychotic symptoms progress much further before they finally get the support they need.

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Further research is needed to gain a deeper understanding of the relationship between autism and schizophrenia. This knowledge could enable better support and treatment options for individuals with both diagnoses, as well as increase broader awareness of their overlap.

Autism spectrum disorder (ASD) encompasses a diverse array of experiences, traits and behaviors. Autism is dimensional, meaning each autistic person experiences a unique combination and intensity of autistic traits and support needs. Often,  autistic traits are grouped into three categories:

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Communication and social styles

Autistic individuals tend to find neurotypical social norms non-intuitive. They may interpret social cues differently from others, exhibit different habits in conversations and communicate in more literal ways.

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Information processing styles

Autistic people also typically process sensory information differently. It’s common for autistics to be hypersensitive to sensory inputs like loud noises, bright lights and certain textures. Autistic individuals often have distinct cognitive processing styles, characterized by strong pattern recognition skills and a detail-driven, bottom-up approach to thinking.

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Repeated behavior and specific interests

Autistic individuals also tend to exhibit repetitive behaviors, strongly preferring predictability and routine. Many autistic people also have intense and specific interests, often called special interests. They may spend a great deal of time on and develop deep expertise in these interests.

Schizophrenia is a mental health condition characterized by psychosis, a group of symptoms associated with a loss of contact with reality. It is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) as one of several schizophrenia spectrum disorder diagnoses, along with schizoaffective disorder and schizophreniform disorder.

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Schizophrenia makes it difficult for people to discern between reality and delusions, which can be extremely distressing and cause challenges in many aspects of a person’s life. Symptoms of schizophrenia typically first emerge between a person’s late teens and early 30s. It’s a relatively uncommon mental illness, affecting less than 1% of the U.S. population. Schizophrenia is a chronic condition, but with treatment, many schizophrenic individuals can reduce the severity and frequency of their symptoms and enjoy a good quality of life.

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Schizophrenic symptoms fall into three categories: positive symptoms, disorganized symptoms, and negative symptoms. 

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Positive symptoms are associated with psychosis and are often episodic, meaning a person may experience periods without these symptoms in between episodes. These symptoms include:

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• Hallucinations
• Paranoia
• Distorted perceptions
• Delusions (false beliefs)

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Disorganized symptoms include:

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• Disorganized thinking
• Speech that may appear random or nonsensical to others
• Behaviors that may seem odd or don’t make sense to others
• Unpredictable emotions

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Negative symptoms of schizophrenia can persist even outside of psychotic episodes. They include:

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• A flat affect, or limited outward emotional expression
• Speaking less
• Withdrawing socially
• Reduced motivation
• Decreased interest in and enjoyment of activities

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Treatment and support can help an autistic person with schizophrenia thrive. Working with a clinician you trust who is knowledgeable about autism can be the first step to identifying what interventions are right for you. Most often, both psychotherapy and medication are recommended to help reduce psychotic symptoms and address any other mental health concerns.

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Psychotherapy

Psychotherapy, or talk therapy, is a hugely impactful intervention for autistic individuals, schizophrenic individuals and those with both diagnoses. In addition to helping a person manage and accept symptoms associated with schizophrenia, therapy can help them manage co-occurring conditions like anxiety and depression, which may accompany both schizophrenia and autism. Therapy can also address common challenges among autistic adults, like burnout, meltdowns, disclosing their diagnosis and coping with social stigma.

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Various therapeutic approaches can help manage both diagnoses, including cognitive behavioral therapy (CBT). CBT works by helping people identify their negative beliefs and unhelpful thought patterns, and then teaching them to replace these with more balanced ones.

Other therapeutic modalities may help schizophrenic and autistic individuals manage symptoms, like group therapy or acceptance and commitment therapy (ACT), which helps people accept and manage their symptoms through a mindfulness-driven approach. 

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Medication

Antipsychotic medications can help reduce the intensity of psychotic symptoms and the frequency of psychotic episodes. Typical or conventional antipsychotics, like haloperidol (Haldol), have been prescribed for years to treat schizophrenia, and atypical antipsychotics, like risperidone (Risperdal) or aripiprazole (Abilify), are medications that are more commonly prescribed today to treat psychotic symptoms.

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Antipsychotics can be prescribed as daily pills or as long-acting injectable antipsychotics (LAIs). LAIs are administered less frequently, with doses typically spaced between two and four weeks apart. Some individuals take both oral medications and LAIs. Your doctor can help determine which options are best for you.

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While antipsychotics are typically the first line medication treatment for schizophrenia, clinicians will often prescribe other psychotropic medications to treat non-psychotic symptoms of schizophrenia. These medications will vary based on an individual’s medical history, but may include antidepressants, mood stabilizers and anti-anxiety medications.

If you are looking for support with autism, Prosper Health can help. Prosper Health’s therapists specialize in adult autism and can work with you to understand your goals for your mental health. Our clinicians accept most major insurance providers, and therapy sessions are conducted 100% remotely. However, if schizophrenia is interfering significantly with your life, we may suggest a referral to a provider who specializes in severe mental health conditions to get you the support you need. 

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If you think you might be autistic but haven’t been formally diagnosed, Prosper Health also provides autism assessments via telehealth. Prosper Health’s assessments are specifically designed for adults and are also covered by insurance.

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To get started, click the link below and connect with a provider within days.