Schizophrenia And Autism: Neurodivergence And Comorbidities

Schizophrenia has been extensively studied over the years, and researchers have found several mental health conditions that may be comorbid with the condition, including neurodevelopmental conditions like autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). 

Because there can be a higher rate of people with schizophrenia living with autism, some have wondered whether these conditions could be intrinsically connected and to what extent. Understanding the connection can be a step toward further understanding neurodiversity and the unique challenges certain individuals might face. Treatment for schizophrenia often includes doctor-prescribed medication, while difficulties associated with ASD may be addressed with various accommodations. Therapy can be helpful for both disorders.

Understanding schizophrenia

Schizophrenia is classified as a schizophrenia spectrum disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). This condition typically involves episodes of psychosis, which can be defined as periods of time in which a person seems to lose touch with reality.

DSM-V diagnostic criteria for schizophrenia

Diagnostic criteria for schizophrenia, as outlined in the DSM-V, include the following: 

• Hallucinations, or sensory perceptions that occur without stimuli (for example, hearing voices or seeing shadowy figures that aren’t there)
• Delusions, or false beliefs that cannot be changed, even with evidence against them
• Disorganized thinking and speech
• Disorganized or catatonic behavior (in cases of catatonia, a loss of movement, speech, and reaction to external stimuli) 
• Negative symptoms, such as a lack of emotional expression or withdrawal from social environments and connections 
• A significant lack of functioning in one or more major areas of life, such as relationships or self-care 

In general, to be diagnosed with schizophrenia spectrum disorder, an individual must experience positive, negative, and cognitive symptoms for at least six months, with at least one month of active-phase symptoms or a psychotic episode. In addition, a diagnostic provider must rule out schizoaffective disorder and bipolar disorder as causes of symptoms. 

*Paranoid schizophrenia is an outdated term for the condition schizophrenia, but paranoia is still a common part of the symptoms that people with schizophrenia experience.

Autism spectrum disorder symptoms 

Autism spectrum disorder can be seen as one of several neurodevelopmental disorders and forms of neurodivergence. Autism is normally present from birth, although signs may not appear until a child is a toddler or older. In some cases, autism is not diagnosed until adulthood, potentially due to diagnostic barriers or stigma. 

Neurodivergence and autistic people

In autism research and activism, neurodivergence generally refers to the idea that certain mental health conditions or disabilities are neurological differences and part of a person’s overall makeup instead of a condition that should be “cured” or “removed.” 

Neurodivergence might also showcase how certain “symptoms” of a condition may cease to exist or no longer cause harm if accommodation is made for a person to be able to exist as their whole self with comfort. Often, Autistic people identify as neurodivergent. However, not all do, so being mindful of language with each person you meet can be helpful.  

Autism spectrum symptoms

There are two primary symptom categories of autism outlined in the DSM-V diagnostic criteria:  

• Deficits in social interaction and communication 
• Restricted, repetitive patterns of behavior, interests, or activities 

Within these categories are several related symptoms. In general, a person must struggle in all three of the social deficit areas and at least two types of restricted or repetitive behaviors to be diagnosed. A person can be diagnosed as Autistic at any age. 

Are schizophrenia and autism spectrum connected? 

Because autism and schizophrenia can cause similar symptoms in some people, the key difference in diagnosing the two neuropsychiatric disorders may be the presence of psychosis. Psychotic symptoms like delusions and hallucinations are not diagnostic criteria for autism spectrum disorder, which can help a provider rule out the condition if other symptoms aren’t present. These specifications can also be considered when differentiating childhood-onset schizophrenia from infantile autism, as children with schizophrenia tend to have more psychotic symptoms.

Schizophrenia-autism? The link between schizophrenia and autism

However, studies suggest there may be a link between autism and schizophrenia, and some people might be diagnosed with both. A 2023 publication found that schizophrenia may be three to six times more likely to be diagnosed in Autistic individuals. In addition, psychotic symptoms can be more common in people with autism, regardless of whether they are living with schizophrenia, showing a potential link between autism and psychotic disorders. 

Comorbidity of autism and schizophrenia in women

In addition, a 2021 study found that Autistic adult women were usually more likely to be diagnosed with schizophrenia than men, suggesting a potential gender difference in this comorbidity. 

However, more research may be required to determine if this link is valid.

Is schizophrenia a form of neurodivergence? 

Some people might identify schizophrenia as a form of neurodivergence, given its unique differences from neurotypical behavior and other mental illnesses. Those who believe schizophrenia may be a form of neurodivergence similar to autism typically state that this condition may not be an anomaly but a “manifestation of neurodiversity stemming from unique cognitive biases.” Some may believe that certain mental health conditions are evolutionary adaptations that have benefits and are not necessarily negative or harmful, especially when accommodated. 

How to find mental health support for comorbid autism and schizophrenia

Autism and schizophrenia are often managed by looking at the individual’s unique symptoms and treatment goals and taking an integrative approach that centers on the client. Because both conditions are usually seen as spectrum disorders, each person may require different types of support. Below are a few standard symptom management options for comorbid schizophrenia and autism spectrum disorders.

Medication

Medication is often considered one of the first-line treatments for schizophrenia. There is no medication specifically for autism. However, medication may reduce the severity of co-occurring disorders like anxiety or depression, which tend to be common in both people with schizophrenia and Autistic individuals. 

Antipsychotic medications may be the first considered option for those living with psychotic episodes, as they may reduce symptoms like hallucinations and delusions and enable a person to live a more independent lifestyle. 

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. 

Accommodations 

Although not a professional treatment option, accommodations may be helpful for neurodivergent individuals facing challenges in daily life due to a lack of various interventions. Accommodations vary depending on each unique situation, but they can include the following: 

• Modifying chores to make them easier to complete
• Modifying a self-care routine 
• Using assistive technology, such as a text-to-speech device 
• Using sensory support items, such as headphones or sensory-friendly clothing 
• Getting a trained service dog to help you identify whether a hallucination is real 
• Creating a sensory-friendly retreat space in your home where you can go when overwhelmed or distressed

To come up with ways you might accommodate yourself in daily life, it may be helpful to brainstorm with a therapist. 

Therapy with mental health professionals

Alongside medication and accommodations, therapy can be a way for people with autism and schizophrenia spectrum disorders to build independence, coping strategies, and self-care abilities despite risk factors in their lives. In therapy, a mental health professional can guide schizophrenic patients through specific exercises, notify them when they show warning signs or an increased risk of an episode, assign homework, build a treatment plan, and help them track symptoms for more control over their daily experiences. This intervention may help clients respond to these symptoms with a safety plan if they occur. 

Online therapy

In-person therapy may be complex for individuals living with mental illness, as it can involve barriers related to cost, distance, and anxiety. In these cases, online therapy through a platform like BetterHelp may be helpful. Although online platforms are not a replacement for crisis services and may not be beneficial for psychotic episodes, they can be used from home to learn new coping skills and talk to a licensed provider. In addition, online platforms typically allow users to choose between phone, video, or live chat sessions, giving them control over the experience. 

Effectiveness of online therapy

Studies show online therapy may be helpful for psychotic disorders. More studies are likely needed to fully understand these treatments' benefits. However, in limited studies, online counseling has been shown to benefit people with schizophrenia and their family members.