What is childhood schizophrenia?
Schizophrenia is a serious mental illness that requires lifelong treatment. It is a chronic and disabling brain condition that may become a mixture of hallucinations, delusions and extremely disordered thinking and behaviors that impair a person's ability to function.
Childhood schizophrenia is much the same as schizophrenia in adults; it just starts earlier. Childhood schizophrenia is an uncommon but severe mental disorder in which children and teenagers interpret reality abnormally.
Childhood schizophrenia is classified as either “very early-onset schizophrenia” or “early-onset schizophrenia.”
Very early-onset schizophrenia develops before the teens
Early-onset schizophrenia develops in the teens
Childhood schizophrenia is very rare and is seldom found in children under age 12. Because the “psychotic symptoms” usually start in the middle to late teens, it is difficult to diagnose in the early stages. Psychotic means having strange ideas, thoughts or feelings that are not based in reality.
The prevalence of very early-onset schizophrenia is uncertain. What is certain, however, is that the frequency of cases rises dramatically in the teens. Slightly more boys develop very early-onset schizophrenia. By the teens, both genders are affected equally.
What causes schizophrenia in children & teens?
Scientists do not know exactly what causes schizophrenia. They also can’t explain why it starts in childhood or the teens for some people and in adulthood for others. Neither do they know how to prevent schizophrenia.
Scientists suspect that there is no one cause; that a combination of brain chemistry, genetics and environment contribute to development of the disorder. For example, a blend of genes from both parents plays a part, as does unknown environmental factors. They also believe that a child must inherit a chemical imbalance in the brain to develop the disorder.
Studies show a strong genetic component in schizophrenia, because it tends to run in families. Children who have a family member with the disorder have a greater chance of developing it.
When a parent has the disorder, a child has about a 10%-15% chance of developing it
When a sibling is schizophrenic, a child has an estimated 7%-8% chance of developing the disease
When an identical twin has the illness, the chance that the other twin will develop schizophrenia is over 40%
When more than one family member has the disease, the risk increases considerably
Scientists are still studying how schizophrenia impacts the brain. They believe that problems with naturally-occurring brain chemicals, such as dopamine and glutamate, may contribute. Brain scans show differences in the brain structure and central nervous system of schizophrenics. Some scientists also attribute it to a loss or below-normal amount of “gray matter” (tissue in the central nervous system that plays a vital role in functioning normally).
Environmental factors may also contribute to schizophrenia in children, especially if there are already genetic components involved. Some scientists believe the child’s schizophrenia may be linked to certain environmental factors that affect the mother during pregnancy.
Contact with viruses, bacteria or chemicals
Drug or alcohol use
Exposure to certain hormonal or chemical agents
High stress
Maternal malnutrition
Obstetric complications
Prenatal infections
What are the signs & symptoms of schizophrenia in children & teens?
Behavior changes can start suddenly or occur over time. A child may slowly become withdrawn or clingy or suddenly start talking about strange ideas or fears. Some children may also hear voices in their head. Symptoms can vary in type and severity over time, with periods of worsening followed by remission of symptoms. Some symptoms may always remain present.
Children who develop schizophrenia may retreat from daily life, with more anxiety and less interest in school or social contact. Childhood schizophrenia is also associated with cognitive delays. Mental decline tends to occur at the time of onset of the disorder.
Early signs and symptoms may be so vague that you can't tell what's wrong. Indeed, some early signs can be mistaken for typical childhood developmental issues. They also may be symptoms of other mental or physical ailments.
In other words, childhood schizophrenia can be difficult to recognize in the early stages. Symptoms may emerge slowly, develop over time or occur suddenly.
What follows is a list of warning signs for schizophrenia. Many of these symptoms may be caused by a condition other than schizophrenia and some will occur in children who do not have any disorder. Watch for changes in thinking, emotions and behavior.
Possible warning sign & symptoms in infants & toddlers
Chronic high fevers
Developmental delays in crawling, walking or talking
Fixation on repeating behaviors
Floppy arms or legs
Long periods of sluggishness or inactivity
Obvious and chronic fear of certain events, situations or objects
Odd movements, such as rocking or flapping the arms
Overly relaxed or floppy arms or legs
Persistent state of distraction, anxiety or distress
Unnaturally still, flat posture when lying down
Unusual sensitivity to bright lights or rapid movements
Weak and slumping posture
Possible warning signs & symptoms in school-age children & teens
Angry, violent or aggressive behavior
Auditory or visual hallucinations
Awkward or unusual movements of the face or body
Bizarre behavior, thoughts, speech or ideas
Confused thinking
Delusions
Depression
Distorted view of reality
Disorganized behavior and thinking
Disorganized or incoherent speech
Disorganized or unusual movements
Extreme moodiness
Extreme, persistent fear of certain situations or objects
Extreme sensitivity to sounds and lights
Flattened affect
Frequent self-talk
Incoherent speech
Irritability
Lack of concentration
Lack of emotions
Lack of impulse control
Lack of motivation
Limited conversation
Odd behaviors
Paranoia
Poor eye contact
Poor personal grooming and self-care
Poor posture
Poor school performance
Problems making and keeping friends
Problems thinking and reasoning
Reverting to infantile behaviors or speech
Severe anxiety or strange fears
Sleep disturbances
Slow walking
Social isolation and withdrawal
Strange fears
Substance abuse
Sudden agitation and confusion
Suicidal thoughts, gestures or attempts
Threatening behaviors
Trouble with schoolwork
Unblinking, vacant facial expression or emotionless voice
Unusual behavior or strange feelings
Withdrawal from friends and family
Parents should take note of any of these thoughts, emotions or behaviors that persist and contact a mental health professional. Depression, suicidal thoughts and behaviors are common among people with schizophrenia, including teenagers. If you think your child is depressed or suicidal, please read our short book.
Depression & Suicide in Childhood & Adolescence: How Parents Can Reduce Depression & Suicide Risk
What are the types of schizophrenia in children & teens?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), the handbook used by healthcare professionals as the authoritative guide to the diagnosis of mental disorders, schizophrenia is considered a “spectrum disorder.” A spectrum disorder is one disorder of a group of disorders that share signs and symptoms on a continuum, but that manifest in noticeably different forms and degrees.
Positive symptoms are psychotic, meaning there is a break with reality, including unusual movements, hyperactivity, unusual thoughts, delusions and hallucinations
Negative symptoms involve behavior and emotion, including social isolation, not speaking much or at all and showing little or no emotion
Cognitive symptoms show differences in how a child thinks or remembers, such as trouble focusing or understanding something. Cognitive dysfunction is a core feature of schizophrenia
How is schizophrenia diagnosed in children & teens?
Diagnosing schizophrenia in children is challenging because early symptoms can be mistaken for normal childhood behaviors. For example, psychologically healthy children may have imaginary friends.
As children grow into the teens, their symptoms tend to resemble those of the disorder, including hallucinations, delusions and disorganized thinking.
A child or teen must display signs or symptoms for more than six months for an accurate psychiatric evaluation to diagnose childhood schizophrenia.
No single test can tell if a child has schizophrenia. Psychiatrists diagnose childhood schizophrenia with a combination of physical and mental tests.
To check for physical causes of schizophrenia, a psychiatrist may use:
Brain imaging tests to rule out issues like stroke, brain injuries, tumors and other changes to the structure of the brain
Blood, urine and cerebral fluid tests to look for chemical changes in bodily fluids that may explain changes in behaviors
Brain activity tests to detect and record electrical activity in the brain
To check for psychological causes of schizophrenia, a psychiatrist may use:
SANS test (Scale for the Assessment of Negative Symptoms) to measure 25 negative symptoms, including lack of facial expressions, social inattentiveness and lack of interest and relationships
SAPS test (Scale for the Assessment of Positive Symptoms) to measure 34 positive symptoms, including hallucinations, delusions, bizarre behaviors and formal thought disorders
BPRS test (Brief Psychiatric Rating Scale) to check severity by looking at 18 symptoms of behaviors, such as hostility, disorientation and hallucination
CDSS test (Calgary Depression Scale for Schizophrenia) to check for symptoms of depression that can affect daily life or lead to suicidal thoughts, gestures or attempts
Because different mental health conditions sometimes share similar signs and symptoms, making an accurate diagnosis can be difficult and take time and patience. Making an accurate diagnosis is how mental health professionals create the correct treatment plan.
What are the treatments for schizophrenia in children & teens?
Treatment plans for schizophrenia in children and teens depends on their age, general health, symptoms and the severity of their condition. Because schizophrenia is a serious, life-long mental illness, treatment is complex and requires direction from an expert in childhood or adolescent schizophrenia, such as a board-certified psychiatrist.
Treatment is aimed at easing symptoms and improving quality of life. Treatment usually involves therapy and education for both the child and the family. Children and teens with schizophrenia often need a combination of therapies and resources to meet the specific needs, including medications and other therapeutic treatments.
Medications
Antipsychotics reduce delusions and hallucinations. They can reduce symptoms and their severity. They do not cure schizophrenia
Mood stabilizing medicines, such as lithium and valproic acid, are especially helpful in the early stages of the disorder
Other therapeutic treatments
Individual and family therapy may include supportive, thinking and behavioral therapy
Specialized educational or structured activity programs may include social skills training, vocational training, speech and language therapy
Self-help and support groups can help the child learn ways to cope with the disorder and also work on social skills
Talk therapy may also help children and teens with schizophrenia. They and their parents may benefit from psychoeducation and problem-solving sessions. Involving siblings in therapy can help them understand their brother’s or sister’s disorder.
Children and teens are at significant risk of relapse, if they stop taking their antipsychotic medications. Furthermore, antibiotics can cause significant weight gain and heart issues. Parents need to stay in touch with mental health professionals in order to monitor symptoms, side-effects and adherence to the treatment plan.
At times, children and teens with schizophrenia will require hospitalization for their safety. They may also need to stay in the hospital, if they are unstable or as they start new medications.
Identifying and starting treatment for childhood schizophrenia as early as possible may significantly improve the child's or teen’s long-term outcome. Although the symptoms can be treated, there is no cure for the disorder.
About the author
I was 15-years-old when two white cops in black suits grabbed me under the armpits and dragged me from the busted-up padded cell at the county hospital to the crappy brown four-door Ford idling outside. Seventy-some hours earlier I had threatened suicide, run away from home, been picked up by the cops and taken to the hospital for a check-up, gotten angry because the doctor wouldn’t let me go home, threw a fit and chucked a water pitcher at a nurse, got shot in the ass with god-knowns-what that zonked me into la-la land, awakened in a padded cell, tore it – and myself – up and held everybody at bay who tried entering through the dented metal door with a small screened window until I finally crashed two days later. I was now on my way to another lock-up, the Harrisburg State Hospital, aka the Pennsylvania State Lunatic Hospital.
If you are interested in reading more about my childhood and adolescent mental health issues, how I mastered most of them and what I’ve learned in the process, please read my memoir: Saving the Schizo Kid: Reflection on Divorce, Mental Health and Recovery
