Child and Adolescent Psychiatry

196 Chapter 24

remember that the classical emphasis on there being a clear distinction
between schizophrenia and bipolar disorder has turned out to be an
over-simplification – they are now seen not as stark alternatives, but
as opposite poles of a continuum (with schizoaffective disorders in the
middle). Detecting drug-induced psychoses depends on history and drug
testing.
In younger and more delayed children, it can be difficult to distinguish
delusions and hallucinations from exaggerated age-appropriate fears and
fantasies, especially if there is a coexisting language disorder. Rarely,
childhood-onset schizophrenia does seem to develop on top of pre-existent
autism spectrum disorders. In general, however, the distinction between
autism and schizophrenia is straightforward – and since this is a favourite
examination topic, we have summarized the key distinguishing features,
as well as a couple of points of similarity in Box 24.2.

Box 24.2Comparing autism and schizophrenia

Autism Schizophrenia

Characteristic features Severe social impairment

(aloof or unempathic).

Severe communication

problems. Rituals and

repetitive behaviours.

Hallucinations, delusions,

thought disorder,

negative symptoms

Onset Under three years, often from

birth

Over seven years, mostly

postpubertal±

premorbid

developmental

abnormalities (milder

and less specific than in

autism)

Family history 2% of siblings have autism

and over 10% have lesser

features of autism

Often positive family

history of schizophrenia

Intellectual disability Commonly Rarely

Course Non-episodic, chronic, mostly

improving somewhat with

maturation

Episodic, often with

gradually deteriorating

social adaptation

Neuroleptics

(‘Antipsychotics’)

useful

Rarely Usually

Severe long-term

social impairment

Usually Usually

Need community care

and specialist

services

Usually Usually