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Examining the Link Between ADHD and Schizophrenia: Spot the Signs and Mitigate this Risk

By Dr. Eappen

In addition to the challenges children with Attention Deficit Hyperactivity Disorder (ADHD) face, studies have found that ADHD diagnosed prior to adulthood is associated with an increased risk for developing other psychotic disorders, including schizophrenia. 

While more research needs to be done to better understand the science linking ADHD to the development of other disorders, here’s what we know:

  • Early diagnosis of psychotic disorders leads to better outcomes
  • Psychotic disorders are extremely burdensome to patients, their loved ones, and society
  • The most burdensome of these disorders (i.e., schizophrenia, schizoaffective disorder) have no cure and cause progressive decline over time in mental and physical health.

So what does this mean for ADHD patients and families? If you or someone you love has been diagnosed with ADHD, you and your doctor should be on high alert looking for any biomarkers, signs, or symptoms of psychotic disorders. Let’s consider what to look for.

What is Schizophrenia?

Before we tackle some of the early signs that someone could develop schizophrenia, we need to discuss what characterizes this disorder. Schizophrenia is a serious mental disorder affecting brain function. People who develop schizophrenia interpret reality abnormally and the illness may cause symptoms such as hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning. Schizophrenia has no cure, can be disabling, and requires lifelong treatment.

In addition to schizophrenia’s direct burdens, there are more indirect burdens as well. Those with schizophrenia and related psychotic disorders often become outcasts because of their behavior. As a result, this population is at a higher risk of becoming homeless. While estimates are wide ranging, studies have found that schizophrenia affects anywhere from 9%-22% of the homeless population (compared with 1% of the overall population).

Further, there’s an elevated risk of substance abuse and suicide with these individuals, both of which (among other factors) contribute to a substantially reduced lifespan in those diagnosed with this illness. Clearly, psychotic disorders, such as schizophrenia and related illnesses, deserve our attention. 

head in the sunset signifying the thought of schizophrenia amongst ADHD patientsWhat are the Symptoms of Schizophrenia

As mentioned above, schizophrenia is characterized by a range of problems with thinking (cognition), behavior, and feelings. Symptoms may include:

  • Hallucinations: These involve seeing or hearing things that don’t exist. Although those without the disorder think of hallucinations as false beliefs, for the person with schizophrenia, they carry the full force and impact of normal existence. Hallucinations can involve any of the senses, but hearing voices is most common.
  • Delusions: These are false beliefs that are not based in reality. For example, you may think someone is out to get you or that certain gestures are directed at you. You may believe a major natural disaster is about to occur or is caused by an unrelated event. Most people with schizophrenia experience delusions.
  • Disordered thinking (speech): Disordered speech is evidence of disordered thinking. People with schizophrenia may have trouble communicating or the answers to questions may be unrelated. Rarely, speech may include meaningless words or putting together words that don’t make sense (AKA word salad).
  • Abnormal motor behavior: This can show up in a number of ways. People with schizophrenia can quickly shift from childlike silliness to extreme agitation. Because their behavior isn’t focused on a goal, it can be difficult to perform certain tasks. Behavior symptoms can include resistance to instructions, bizarre posture, a complete lack of responsiveness, or useless or excessive movement.
  • Inability to function normally: People with schizophrenia may experience a reduced or lack of ability to function normally. For example, they may neglect personal hygiene or appear to lack emotion (no eye contact, facial expressions stay the same, speak in a monotone). They may also lose interest in everyday activities, socially withdraw, or lack the ability to experience pleasure.

Symptoms often vary in type and seriousness over time, with periods of more severity and periods of remission of symptoms. Some symptoms may be constantly present.

Teenager with ADHD worried about whether she has schizophreniaSymptoms of Schizophrenia in Teenagers

While similar to those in adults, schizophrenia symptoms in teenagers may be more difficult to recognize. One challenge is that the early symptoms of schizophrenia are also common for typical development during teen years, such as:

  • Withdrawal from friends and family
  • A drop in performance at school
  • Trouble sleeping
  • Irritability or depressed mood
  • Lack of motivation

Also, recreational substance use, such as marijuana, methamphetamines, or LSD, can sometimes cause similar signs and symptoms.

Compared with schizophrenia symptoms in adults, teens may be:

  • Less likely to have delusions
  • More likely to have visual hallucinations

ADHD and Schizophrenia

While several studies have shown a correlation between a diagnosis of ADHD during childhood/adolescence and an increased risk of a psychotic disorder (including schizophrenia), we cannot (yet) pinpoint the causal relationship (if one indeed exists). We do not know, for example, if the increased risk is related to: 

  • ADHD symptoms such as impulsivity leading to an increased risk of substance abuse (which on its own can increase the risk of developing psychotic symptoms), or
  • Stimulants used to treat ADHD, or
  • Early-onset psychotic symptoms “disguising themselves” as ADHD symptoms, or
  • A genuine increased risk, meaning if someone has a genuine case of ADHD diagnosed prior to age 18, they are at genuine increased risk for developing a psychotic disorder regardless of whether they use stimulants or illicit drugs in their lifetime.

Even given these unknowns, it’s still important that we take the association seriously and do what we can, within reason, to minimize the risk of patients with ADHD developing psychotic symptoms. 

It’s important to know that aside from any genetic risk factors for developing psychotic symptoms, there are several environmental factors that we can control for. One major risk factor, as mentioned above, is substance abuse: especially the use of marijuana and hallucinogens. So I always advise patients with ADHD to avoid marijuana, hallucinogens, and all other illicit substances as a reasonable first step.

Second, there have been some promising studies demonstrating the effectiveness of including omega-3 fatty acid supplements as part of a treatment regimen for ADHD. These supplements have been found to not only reduce ADHD symptom severity but also reduce the likelihood of developing a psychotic disorder.

As researchers continue to do the work of better understanding the potential link between ADHD and schizophrenia, these types of suggested lifestyle modifications and treatments can minimize the development of psychotic disorders, especially if we identify symptoms early in life.

If we have the power to change the trajectory of one person’s life for the better, then that’s a win in my book!

Do you have questions about your or your child’s behavior? Contact our clinic today to make an appointment for a full evaluation.

About the Author

Seth Eappen, MD, is a board-certified adult, child and adolescent psychiatrist. Dr. Eappen completed medical school at the University of Illinois at Chicago and a residency at the University of Michigan, Ann Arbor. He completed his child psychiatry fellowship at MUSC in Charleston, SC, where he served as chief fellow. He is the founder of the Eappen Clinic, a private outpatient mental health practice with locations in Chicago and Oak Brook, IL.