Understanding The ADHD And Schizophrenia Comorbidity
Attention-deficit/hyperactivity disorder (ADHD) is commonly defined as a neurodevelopmental condition causing symptoms of hyperactivity, impulsivity, and inattention. Affecting millions of children and adults worldwide, this condition frequently co-occurs with other mental illnesses. Schizophrenia may occur in some individuals with ADHD. Understanding the connection between the two conditions can be a step toward finding effective treatment or symptom management options for both, including therapy with a licensed mental health professional.
Symptoms of attention-deficit/hyperactivity disorder (ADHD)
There are three subtypes of ADHD listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), including primarily inattentive (ADHD-PI), hyperactive-impulsive type (ADHD-HI), and combined type. Although used in previous editions of the DSM, attention deficit disorder (ADD) is no longer a clinical diagnosis and has been replaced with ADHD-PI.
Symptoms of inattention that may be present in individuals with ADHD-PI or the combined subtype for an ADHD diagnosis typically include the following:
- Forgetfulness
- Difficulty focusing on tasks for extended periods
- Difficulty following instructions
- Lacking organization
- Losing items, such as keys or one’s wallet
- Becoming distracted during conversations or activities
- Difficulty finishing tasks at work or school
- Forgetting appointments
Symptoms of hyperactivity and impulsivity that may be present in individuals with ADHD-HI or the combined subtype include the following:
- Difficulty remaining still
- Interrupting others during a conversation
- Speaking too loudly or quickly
- Frequently jumping from one activity to the next
- Fidgeting
- Stimulus-seeking behavior
- Seeming to be “driven by a motor” or “on autopilot”
- Impulsivity
Attention-deficit/hyperactivity disorder and neurodiversity
ADHD can be considered a form of neurodiversity, which generally means there is no “cure” for this condition, and it tends to be present for one’s entire life. Individuals who identify with the neurodiversity model may believe that some of the most difficult challenges of ADHD stem from living in a society that focuses on neurotypical needs. Positive aspects of ADHD can include creativity, passion for one’s interests, and increased sensory perception.
Symptoms of schizophrenia
Schizophrenia is listed under the schizophrenia spectrum and related psychotic disorders category in the DSM-5 and may be associated with a subsequent psychotic disorder.
In general, for a diagnosis to be made and to investigate schizophrenia risk, an individual must have two or more of the following symptoms for at least one month:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized behavior or catatonia
- Negative symptoms
- A lack of emotional expression
- Social dysfunction impacting at least one central area of functioning
The symptoms must not be caused by substance use or another schizophrenic disorder like schizoaffective disorder. The DSM-5 notes that schizophrenia can only be diagnosed alongside a neurodevelopmental disorder like ADHD or autism spectrum disorder (ASD) if prominent hallucinations or delusions are also present for at least a month.
Are ADHD and schizophrenia connected?
What might explain why ADHD is commonly associated with schizophrenia?
According to a 2015 study, ADHD can increase one’s chances of substance use, which may further increase their risk of developing psychosis as a symptom of schizophrenia. Treating substance use challenges and working with individuals with ADHD to reduce risk-taking behavior can be one way to prevent the risk of severe symptoms.
If you notice symptoms of both ADHD and schizophrenia in yourself or a dependent, you may benefit from seeking professional support. Symptoms of schizophrenia can become severe and potentially escalate to a crisis. ADHD symptoms, on top of schizophrenia symptoms, may cause higher levels of paranoia and more hyperactivity during psychosis.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
If you are experiencing suicidal thoughts or urges during a crisis, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.
Treatment for comorbid ADHD and schizophrenia
Several treatments and symptom management options may be beneficial for those living with both ADHD and schizophrenia spectrum disorders. Carefully monitoring psychiatric comorbidities and risk factors can reduce symptoms. Below are a few evidence-based options for symptom management.
Medication
Medication tends to be more often recommended for treating schizophrenia than ADHD. However, psychiatric comorbidity often requires different types of medication to manage multiple symptoms. Stimulants are frequently prescribed for ADHD, which may worsen paranoia or hyperactivity in individuals with schizophrenia. Antipsychotic medications are usually prescribed for schizophrenia.
Maintain an open dialogue with your prescribing doctor when finding medications that work for both ADHD and schizophrenia. Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.
Cognitive-behavioral therapy (CBT)
Alongside medication, cognitive-behavioral therapy (CBT) can be a beneficial tool for symptom management. Although schizophrenia and ADHD cannot be “cured,” therapy can help individuals manage daily life and make healthy lifestyle changes that may reduce the severity or frequency of challenging symptoms.
Cognitive-behavioral therapy is often considered the “gold standard” treatment for psychiatric disorders like anxiety disorders, bipolar disorder, and depressive disorders, which may also be comorbid with ADHD. A CBT therapist can guide you through coping techniques like mindfulness, radical acceptance, and fact-checking, which may be beneficial for those who experience hallucinations or difficulty connecting with reality.
Social recovery therapy
Social recovery therapy can be defined as a modality specifically geared toward supporting individuals with an increased risk of early psychosis, which can be a symptom of schizophrenia. This modality can be considered a form of cognitive-behavioral therapy that tends to be more geared toward severe symptoms than traditional CBT.
In a 2019 study on social recovery therapy, researchers found that this modality could be a “promising psychological intervention to improve social recovery in individuals with early psychosis.” Although not explicitly adapted to manage ADHD symptoms, this modality could be used in conjunction with another treatment for a more comprehensive approach.
Group therapy
Group therapy can be effective in managing symptoms of ADHD and schizophrenia. In one study, group cognitive-behavioral therapy for adults with ADHD was found to improve knowledge about ADHD, self-efficacy, and self-esteem in participants, although updated evidence may be needed.
Another study found that group therapy could reduce some symptoms of schizophrenia. Participants experienced cognitive and social improvement in symptom severity. However, the study authors recommend further research to understand this connection more fully.
Group therapy may also be effective because it usually allows individuals to connect with others who are experiencing similar challenges. Social support can be beneficial to mental and physical health, so being able to connect in this way can be healing for those who do not have a support system at home.
Alternative support options for ADHD and schizophrenia
ADHD and schizophrenia can cause symptoms that make it difficult to seek support. For example, individuals with ADHD may struggle to set in-person appointments, and people with schizophrenia may have trouble functioning in public settings during more severe episodes. In these cases, online therapy through a platform like BetterHelp may be more convenient. Please note that individuals experiencing acute psychosis may require in-person care.
With an online platform, individuals can find unique tools like worksheets, journaling prompts, and more. In addition, they can attend sessions from home via phone, video, or live chat with a licensed therapist.
Studies tend to support the effectiveness of online therapy. A 2022 study found that social function and attention were improved in approximately 95% of participants in an online therapy intervention targeted at managing ADHD symptoms in clients. While not much research exists on the efficacy of online therapy for schizophrenia treatment, online therapy generally produces the same results as in-person therapy.
Takeaway
Frequently asked questions
If ADHD is commonly associated with schizophrenia, how does this affect treatment and diagnosis?
The relationship between ADHD and schizophrenia might complicate diagnosis and treatment for some individuals. Medical professionals may have to assess symptoms closely to avoid misdiagnosing patients. In some cases, treating both conditions at once may involve a combination of medications, which calls for close supervision.
ADHD and schizophrenia are two different disorders that can coexist
Knowing that these two conditions can coexist allows patients and doctors to create a treatment plan that covers the whole spectrum of symptoms. This also underlines how crucial early intervention is to effectively manage specific disorders and improve overall quality of life.
Are people with ADHD always active and talkative?
Though hyperactivity and ADHD are often connected, not everyone with ADHD is constantly chatty or active. Some people, especially those of the inattentive subtype, may have a more subdued and calm attitude and struggle internally with organization and focus instead of outward hyperactivity.
Although ADHD and schizophrenia are two different disorders, what symptoms overlap?
ADHD and schizophrenia may have several symptoms that overlap, including difficulty focusing, impulsivity, or disordered thinking.
What challenges arise when managing ADHD and schizophrenia together?
Managing both disorders can be challenging since the symptoms of ADHD and schizophrenia can interact and affect daily life. Working with a healthcare professional can help an individual find the right balance of treatments, which can be especially important when navigating medication.
Do people with ADHD hate noise?
Not always, but many people with ADHD report problems with hearing sensitivity. This sensitivity could make it more difficult for them to concentrate in noisy environments, causing either discomfort or aggravation. Everybody is unique, though, and while some people find background noise helpful, others might prefer quiet locations to focus.
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