How do you know if your child has schizophrenia

Childhood schizophrenia - Symptoms and causes

Overview

Childhood schizophrenia is an uncommon but severe mental disorder in which children and teenagers interpret reality abnormally. Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. It may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs your child's ability to function.

Childhood schizophrenia is essentially the same as schizophrenia in adults, but it starts early in life — generally in the teenage years — and has a profound impact on a child's behavior and development. With childhood schizophrenia, the early age of onset presents special challenges for diagnosis, treatment, education, and emotional and social development.

Schizophrenia is a chronic condition that requires lifelong treatment. Identifying and starting treatment for childhood schizophrenia as early as possible may significantly improve your child's long-term outcome.

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Symptoms

Schizophrenia involves a range of problems with thinking, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. The effect can be disabling.

In most people with schizophrenia, symptoms generally start in the mid- to late 20s, though it can start later, up to the mid-30s. Schizophrenia is considered early onset when it starts before the age of 18. Onset of schizophrenia in children younger than age 13 is extremely rare.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present. Schizophrenia can be difficult to recognize in the early phases.

Early signs and symptoms

Schizophrenia signs and symptoms in children and teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group.

Early signs and symptoms may include problems with thinking, behavior and emotions.

Thinking:

Problems with thinking and reasoning
Bizarre ideas or speech
Confusing dreams or television for reality

Behavior:

Withdrawal from friends and family
Trouble sleeping
Lack of motivation — for example, showing up as a drop in performance at school
Not meeting daily expectations, such as bathing or dressing
Bizarre behavior
Violent or aggressive behavior or agitation
Recreational drug or nicotine use

Emotions:

Irritability or depressed mood
Lack of emotion, or emotions inappropriate for the situation
Strange anxieties and fears
Excessive suspicion of others

Later signs and symptoms

As children with schizophrenia age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:

Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; that certain gestures or comments are directed at you; that you have exceptional ability or fame; that another person is in love with you; or that a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, hallucinations have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
Disorganized thinking. Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
Extremely disorganized or abnormal motor behavior. This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion — doesn't make eye contact, doesn't change facial expressions, speaks in a monotone, or doesn't add hand or head movements that normally occur when speaking. Also, the person may avoid people and activities or lack the ability to experience pleasure.

Compared with schizophrenia symptoms in adults, children and teens may be:

Less likely to have delusions
More likely to have visual hallucinations

Symptoms may be difficult to interpret

When childhood schizophrenia begins early in life, symptoms may build up gradually. Early signs and symptoms may be so vague that you can't recognize what's wrong. Some early signs can be mistaken for typical development during early teen years, or they could be symptoms of other mental or physical conditions.

As time goes on, signs may become more severe and more noticeable. Eventually, your child may develop the symptoms of psychosis, including hallucinations, delusions and difficulty organizing thoughts. As thoughts become more disorganized, there's often a "break from reality" (psychosis) frequently requiring hospitalization and treatment with medication.

When to see a doctor

It can be difficult to know how to handle vague behavioral changes in your child. You may be afraid of rushing to conclusions that label your child with a mental illness. Your child's teacher or other school staff may alert you to changes in your child's behavior.

Seek medical care as soon as possible if you have concerns about your child's behavior or development.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a child or teen who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your child to the nearest hospital emergency room.

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Causes

It's not known what causes childhood schizophrenia, but it's thought that it develops in the same way as adult schizophrenia does. Researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder. It's not clear why schizophrenia starts so early in life for some and not for others.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Risk factors

Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

Having a family history of schizophrenia
Increased immune system activation, such as from inflammation
Older age of the father
Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
Taking mind-altering (psychoactive) drugs during teen years

Complications

Left untreated, childhood schizophrenia can result in severe emotional, behavioral and health problems. Complications associated with schizophrenia may occur in childhood or later, such as:

Suicide, suicide attempts and thoughts of suicide
Self-injury
Anxiety disorders, panic disorders and obsessive-compulsive disorder (OCD)
Depression
Abuse of alcohol or other drugs, including nicotine
Family conflicts
Inability to live independently, attend school or work
Social isolation
Health and medical problems
Being victimized
Legal and financial problems, and homelessness
Aggressive behavior, although uncommon

Prevention

Early identification and treatment may help get symptoms of childhood schizophrenia under control before serious complications develop. Early treatment is also crucial in helping limit psychotic episodes, which can be extremely frightening to a child and his or her parents. Ongoing treatment can help improve your child's long-term outlook.

By Mayo Clinic Staff

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Schizophrenia in Children | Cedars-Sinai

ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS

What is schizophrenia in children?

Schizophrenia is a serious mental illness. It is a long-lasting and disabling problem of the brain. A child with this disorder has unusual behavior and strange feelings. He or she may suddenly start to have psychotic symptoms. Psychotic means having strange ideas, thoughts, or feelings that are not based in reality.

Schizophrenia is not often found in children younger than age 12. It's also hard to spot in the early stages. Often, the psychotic symptoms start in the middle to late teen years. Slightly more boys develop it in childhood. But by the teen years it affects both boys and girls equally.

What causes schizophrenia in a child?

Schizophrenia has no single cause. A combination of genes from both parents plays a role. So do unknown environmental factors. Experts believe that a child has to inherit a chemical imbalance in the brain to develop it.

Which children are at risk for schizophrenia?

Schizophrenia tends to run in families. A child who has a family member with the disorder has a greater chance of developing it.

What are the symptoms of schizophrenia in a child?

Behavior changes may occur slowly, over time. Or they may start suddenly. The child may slowly become more shy and withdrawn. He or she may start to talk about odd ideas or fears and start to cling more to parents.

Each child’s symptoms may vary. Early warning signs are:

Trouble telling dreams from reality (distorted view of reality)
Confused thinking, such as confusing TV with reality
Detailed and bizarre thoughts and ideas
Fear or belief that someone or something is going to harm him or her
Seeing, hearing, or feeling things that are not real, such as hearing voices (hallucinations)
Ideas that seem real but are not based in reality (delusions)
Extreme moodiness
Lots of anxiety or fear
Lack of emotional expression when speaking
Trouble doing schoolwork or a drop in levels of school success
Social withdrawal, such as having problems making and keeping friends
Sudden agitation and confusion
Disorganized behavior, such as doing private things in public. Or catatonic behavior, such as sitting and staring, as if the child can’t move.
Odd behaviors, such as an older child acting like he or she is much younger

Children with schizophrenia have the same symptoms as adults with the condition. But more children hear voices. Children also don’t tend to have delusions or formal thought problems until they are in their teens or older.

These symptoms may look like other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is schizophrenia diagnosed in a child?

A child with symptoms of schizophrenia needs a thorough medical and mental health evaluation. Talk with your child's healthcare provider if you are concerned about symptoms your child is having. A child psychiatrist or other qualified mental health expert can diagnose schizophrenia in children and teens. He or she does a mental health evaluation to figure out how best to treat the child.

How is schizophrenia treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Schizophrenia is a major mental illness. Treatment is complex. A child often needs a combination of therapies to meet the specific needs. Treatment is aimed at easing symptoms. It may include the following.

Medicines

The doses and types of medicines may need to be adjusted from time to time so they can keep working well. Your child may be given:

Medicines to help reduce delusions and hallucinations (antipsychotics). This special class of medicines can reduce symptoms or reduce how severe the symptoms are. But they don’t cure schizophrenia.
Mood stabilizing medicines. Examples are lithium and valproic acid, especially in the early stages of the illness.

Other treatment

Individual and family therapy. This may include supportive, thinking, and behavioral therapy.
Specialized educational or structured activity programs. These may include social skills training, vocational training, and speech and language therapy.
Self-help and support groups. These can help the child learn ways to cope with the disorder and also work on social skills.

How can I help prevent schizophrenia in my child?

Experts don’t know how to prevent schizophrenia. But early diagnosis and treatment can improve a child’s quality of life. Treatment works best when early symptoms are dealt with quickly.

How can I help my child live with schizophrenia?

Schizophrenia is a serious mental illness that will require your support, patience, and attention. You are your child’s best advocate. Here are things you can do to help:

When should I call my child’s healthcare provider?

Call your healthcare provider right away if your child:

Feels extreme depression, fear, anxiety, or anger toward him or herself or others
Feels out of control
Hears voices that others don’t hear
Sees things that others don’t see
Can’t sleep or eat for 3 days in a row
Has new symptoms or if current symptoms get worse
Shows side effects of medicines
Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Schizophrenia may increase a child’s risk for suicidal thinking.

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.

Key points about schizophrenia in children

Schizophrenia is a serious mental illness.
A child with this disorder has unusual behavior and strange feelings. He or she may have delusions or hallucinations.
Symptoms can develop slowly over time or start quickly.
A mental health expert can diagnose schizophrenia. Ask for a referral to a psychiatrist with experience evaluating and treating children with schizophrenia.
Treatment can include a combination of medicine, therapy, and special programs.
The American with Disabilities Act (ADA) and Section 504 of the Civil Rights Act provide legal protections for your child in a public school setting.
Schizophrenia is a difficult disease. Talk with your child’s healthcare provider about a support group for caregivers of children with schizophrenia or seek counseling.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Schizophrenia in children and adolescents

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Early diagnosis of schizophrenia in children, symptoms of childhood schizophrenia – Allianz Central Medical Center

Particular difficulties in diagnosis and treatment are caused by an early form of the schizophrenic process - schizophrenia in children. Symptoms and signs of the disease in different periods of childhood are different and difficult to describe and systematize. Confirmation of the diagnosis and selection of therapy should be done by a competent psychiatrist who has many years of experience working with schizophrenic children.

An experienced psychiatrist should diagnose and prescribe treatment for a child diagnosed with schizophrenia. nine0003

Childhood schizophrenia begins at an early age, when the psyche is just beginning to develop. This gives rise to three features:

blurring of the clinical picture - the symptoms of the disease do not reach the level of adult schizophrenia. For example, signs of schizophrenia in children under one year old are an inadequate reaction to discomfort, indifference to the mother and loved ones. By themselves, they seem insignificant, but a skilled psychiatrist can identify a child at risk at such a young age; nine0034
children's specificity - a sick child fantasizes a lot and strangely, talks on philosophical topics; may strive for asociality, vagrancy, the use of alcohol and narcotic substances;
uneven development - periods of advancing the norm alternate with delays. For example, a child got up late and learned to walk, but spoke in whole phrases early.

These features allow us to better understand how schizophrenia manifests itself in children depending on the age of onset of the disease. nine0003

How schizophrenia manifests itself in children

At the age of two, the child develops his own speech. Up to this point, the main signs are violations of the emotional connection with the mother and behavior caused by hallucinations. The child sees or hears the real only for him and behaves accordingly. The most common manifestation: irrational fears - for example, fear of white.

Admission to kindergarten is the beginning of an active social life. And here, detachment or obsession, helplessness or aggressiveness, advancing or lagging development are manifested. If your baby has unusual symptoms, see a child psychiatrist who knows how to identify schizophrenia in a child. nine0003

Important

The diagnosis cannot be made by one or even several symptoms. Schizophrenia is an insidious disease that can be similar to neurosis, depression, and dementia. Objective diagnostics is possible - for example, with the help of Neurotest.

Before the onset of puberty in girls and boys, the disease proceeds in the same way. Psychotic symptoms develop from a child's picture of the world. The acting characters of delusions and hallucinations are toys, folklore characters, fictional characters. nine0003

Puberty adds appearance and sexuality to possible painful experiences. The development of the psyche and the baggage of knowledge of adolescents is approaching the level of young adults. Therefore, the signs in schizophrenic children aged 12 years and older (depending on the speed of maturation) are approaching the classic ones - inadequate ideas that the child gets hung up on, “voices”, incomprehensible sensations or “visions”. There is excessive attention to appearance (weight loss up to anorexia, the desire to correct non-existent physical defects), delusions of other people's parents, obsessive thoughts and actions, inappropriate behavior with aggression, disinhibition of drives, leaving home. nine0003

In the absence of treatment and rehabilitation, the onset of the disease distorts the further development of personality and intelligence. In some cases, it not only stops, but also regresses. This can happen at 17 or 5 years old.

How to recognize schizophrenia in a child

Even in adult practice, there is no symptom that will unambiguously tell whether a person has schizophrenia or not. The specialist always focuses on the totality of symptoms, their development over time and the order of appearance. Against the backdrop of an undeveloped child's psyche, this is especially important. nine0003

Childhood schizophrenia symptoms and signs are divided into:

simple - there are no delusions and hallucinations, the leading symptoms are depression of will, motivation and flattening, impoverishment of emotions. Children with this form are highly susceptible to treatment;
hebephrenic - pretentious antics, protest, impulsiveness, aggression towards oneself and others come to the fore. Without treatment, such children are practically unlearnable, dangerous to themselves and others. nine0034
catatonic - children maintain the pretentious poses that they are given, waving their arms or swaying, shouting or chattering monotonously, flatly refuse to talk, repeat words, facial expressions, movements after those around them.

Early diagnosis of schizophrenia in children is carried out by a child psychiatrist. A conversation with a doctor is an important step in the process that determines further tactics. It is difficult to make a diagnosis based on symptoms alone, but modern diagnostic methods come to the rescue - Neurotest. nine0003

Neurotest is a study of a small blood sample taken from a finger. If the level of the test substances is elevated, then the diagnosis of schizophrenia is confirmed.

It has been proven that even if the clinical picture (manifestations of the disease) is vague and cannot be clearly described, by increasing the level of pro-inflammatory biological substances in the blood, it can be confirmed whether the child has a schizophrenic disease and how acute it is. The neurotest can be carried out both at 4 years old and at 15 years old. nine0003

The first signs of schizophrenia in children can be identified by a clinical psychologist. He performs a pathopsychological study - tests the child's cognitive processes. Certain deviations from the norm show violations of thinking already in the early stages.

In complex cases, a good clinic can quickly arrange an appointment with a scientific consultant, a narrow specialist, or a consultation.

Signs of schizophrenia in children: behavior and signals at different ages

Behavior and play are extremely important for clarifying mental health. After all, even having mastered speech, children learn to express their inner world in words for a long time. And in the game, they unconsciously project their ideas and experiences.

An attentive parent may be disturbed by playing with reincarnations. The child strives to be only a negative character, imitates socially disapproved actions.

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