Psychotic Symptoms in Attention-Deficit/Hyperactivity Disorder

21.04.2017 10:21:00






     Attention-deficit/hyperactivity disorder (ADHD) is a common disorder which inclines to continue into adolescence and adulthood. When examining psychotic disorders, It is communicable that the incidence of psychotic disorders is rare before puberty, then, it indicates an increase in adolescence and peaks in early adult life. Specifically, schizophrenia ,which includes 0.7 morbidity risk, has onset in the second or third decade of life. Early-onset schizophrenia ( onset before 18 years of age ) constitutes of one-fourth of cases. Considering these two disorders, ADHD symptoms are often involved in the prodrome of psychosis. Moreover, the visibility of  psychotic symptoms could be possible in the context of conditions other than schizophrenia such as major depression, mania, substance abuse, seizure disorders, and other neurologic disturbances.



     Especially, isolated psychotic experiences are comparatively common during development in spite of low prevalence of psychotic disorders. Isolated psychotic experiences are composed of subthreshold symptoms, such as unusual thoughts and auditory misperceptions ( illusions ) with rates as high as 12% in adolescence. Although the association between ADHD symptoms and psychosis has been mainly examined by retrospective assessments of adults diagnosed with a psychotic disorder, few data exists on the rate of psychosis in ADHD samples.


      So, this present study, which is published by Journal of the American Academy of Child and Adolescent Psychiatry, aims to assess the prevalence of psychotic symptoms among youths ( 14-25 years of age ) with a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) combined type and comparison with local normative comparison group.  Each assessment point was administered by trained research assistants as interview and evaluation for possible psychotic symptoms using the Psychosis Screener and Follow up Diagnostic Impression. In the evaluation part, participants were asked whether they have experienced perceptions suggestive of auditory, visual, or somatic/tactile hallucinations, and also they were evaluated for possible unusual thoughts or ideas suggestive of delusional thinking. In the interview part, participants were assessed for unusual or bizarre behaviour, disorganized speech and possible negatif symptoms of psychosis like flat affect, social withdrawal, and poverty of thoughts. Minimum 3 rating scores from any of positive symptoms or 4 rating scores from any of the negative symptoms corresponds to positive at the screening and be classified as spurious and not pathologic, pathologic but not psychotic, or possibly psychotic.


      According to results of the follow up assessments ( 6, 8, 10, 12, 14, 16 years ) of participants in the Multimodal Treatment Study of Children with ADHD, the prevalence of psychotic symptoms was found as 1.1% in the MTA group, whereas it was found as 0.7% in the local normative comparison group. Delusions and auditory hallucinations were reported as the most common type of psychotic symptoms and most psychotic symptoms were transient.    In conclusion, these findings indicate that a diagnosis of ADHD does not increase risk of psychotic experiences or of a psychotic disorder.









Algorta G. P., Arnold L. E., Howard A. L., Molina B. S. G., Stehli A. (2017). Psychotic Symptoms in Attention-Deficit/Hyperactivity Disorder: An Analysis of the MTA Database, J Am Acad Child Adolesc Psychiatry 2017;56(4):336-343.


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