Can schizophrenia be mistaken for ADHD in my 15-year-old son?

Question

Hello doctor,

My 15-year-old son has been struggling socially and academically for years. He was first diagnosed with ADHD at age nine, and then with autism spectrum disorder at age 12. He is now being seen by a new psychiatrist who is questioning both diagnoses and has mentioned the possibility of early-onset schizophrenia.

He occasionally talks about hearing faint voices and sometimes believes his classmates are secretly recording him. Risperidone was recently started, but I am feeling confused and frightened.

Can schizophrenia be mistaken for autism or ADHD in a 15-year-old, and how do doctors actually tell the difference? His previous evaluations never mentioned psychosis, and I do not understand how three specialists reached three different conclusions. His EEG was normal, and the MRI showed no structural abnormalities.

Are there specific tests or criteria that can confirm schizophrenia at this age, or should we seek a second opinion from a child psychiatrist?

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

First of all, schizophrenia can begin before the age of 13 years, and this is known as early-onset schizophrenia.

The diagnosis can be understood as follows:

The prodromal phase of schizophrenia is characterized by subtle symptoms such as poor academic performance, lack of attention and concentration, multiple somatic complaints, inability to complete tasks, impaired social interaction, and seeming not to hear others. These symptoms can easily be misunderstood as the inattention seen in ADHD (attention-deficit hyperactivity disorder).
Autism spectrum disorder also shares a similar symptom profile, and in the past, it was sometimes considered a form of childhood schizophrenia.
Before the onset of full-blown psychosis (schizophrenia), many individuals experience a prodromal phase, which can last for several years.
The current symptoms are consistent with schizophrenia, which is why the consulting psychiatrist has diagnosed it as schizophrenia at present.

The diagnosis of schizophrenia is based on a specific set of symptoms and the duration of those symptoms, and these diagnostic criteria are universally accepted. It is primarily a clinical diagnosis. Structural brain changes are usually subtle, and MRI (magnetic resonance imaging) and EEG (electroencephalogram) findings are often unremarkable in psychiatric disorders.

I hope this helps you.

Thank you.