Schizophrenia in Children

What is schizophrenia?

Schizophrenia is one of the most complex of all mental health disorders. It is a severe, long-lasting (chronic), and disabling disturbance of the brain. It causes distorted thinking, strange feelings, and unusual behavior and use of language and words.

What causes schizophrenia?

There is no known single cause responsible for schizophrenia. It is believed that a chemical imbalance in the brain is an inherited factor that is necessary for schizophrenia to develop. However, it is likely that many factors (genetic, behavioral, and environmental) play a role in the development of this condition.

Schizophrenia is considered to be multifactorially inherited. This means that many factors are involved. The factors are usually both genetic and environmental. This means a combination of genes from both parents, as well as unknown environmental factors, produce the trait or condition. Often, one gender (either males or females) is affected more often than the other in multifactorial traits. Slightly more males develop schizophrenia in childhood. But by the teen years, schizophrenia affects both males and females equally.

Who is affected by schizophrenia?

Schizophrenia is not often found in children younger than age 12. It is also hard to identify in the early stages. Often, the psychotic symptoms of schizophrenia will suddenly occur in the middle to late teen years. Statistics show that schizophrenia affects about 1% of Americans. A child born into a family with 1 or more family members affected by schizophrenia has a greater chance of developing the disorder than a child born into a family with no history of schizophrenia.

What are the symptoms of schizophrenia?

In children with schizophrenia, behavior changes may occur slowly, over time. Or these behavior changes may start suddenly. The child may slowly become more shy and withdrawn. He or she may begin to talk about bizarre ideas or fears and begin to cling more to parents. One of the most disturbing and puzzling characteristics of schizophrenia is the sudden start of its psychotic symptoms. Psychotic refers to ideas, views, or feelings that are not based in reality. Each child’s symptoms may vary. The following are the most common symptoms of schizophrenia.

Early warning signs of schizophrenia in children may include:

  • Trouble telling dreams from reality (distorted view of reality)

  • Confused thinking (such as, confusing TV with reality)

  • Detailed and bizarre thoughts and ideas

  • Being suspicious or paranoid (fearfulness that someone, or something, is going to harm him or her)

  • Hallucinations (seeing, hearing, or feeling things that are not real such as hearing voices telling the child to do something)

  • Ideas that seem real but are not based in reality (delusions)

  • Extreme moodiness

  • Severe anxiety or fearfulness

  • Lack of emotional expression when speaking (flat affect)

  • Trouble performing schoolwork or a decline in previous levels of academic achievement 

  • Social withdrawal (severe problems in making and keeping friends)

  • Suddenly becoming agitated and confused, or sitting and staring, as if the child can’t move (disorganized or catatonic behavior)

  • Odd behaviors (for example, an older child may severely regress and begin acting like a younger child)

The symptoms of schizophrenia are often classified as the following:

  • Positive. Symptoms include delusions, hallucinations, and bizarre behavior.

  • Negative. Symptoms include flat affect, withdrawal, and emotional unresponsiveness.

  • Disorganized speech. This includes speech that others can’t understand.

  • Disorganized or catatonic behavior. This includes marked mood swings, sudden aggression, or confusion, followed by sudden motionlessness and staring.

The symptoms of schizophrenia in children are similar to adults. But more children diagnosed with the disorder (about 80%) hear voices. Also children typically don’t have delusions or formal thought disorders until they are in their middle teen years or older. The symptoms of schizophrenia may look like other problems or psychiatric conditions. Always see your child's healthcare provider for a diagnosis.

How is schizophrenia diagnosed?

Schizophrenia in children and teens is usually diagnosed by a child and adolescent psychiatrist. Other mental health professionals usually take part in a full mental health evaluation to figure out the child’s treatment needs.

Treatment for schizophrenia

Your child's healthcare provider will figure out the best treatment plan for your child based on:

  • Your child's age, overall health, and medical history

  • How severe your child’s condition is

  • The type of schizophrenia

  • How well your child handles certain medicines, treatments, or therapies

  • If your child’s condition is expected to get worse

  • The opinion of the healthcare providers involved in your child's care

  • Your opinion and preference

Schizophrenia is a major psychiatric illness. Treatment for schizophrenia is complex. A combination of therapies is often necessary to meet the specific needs of the child or teen. Treatment is aimed at reducing symptoms. Types of treatment that may be helpful for a child or teen with this disorder may include:

  • Medicines (also called psychopharmacological management), including the following:

    • Antipsychotic medicines act against the symptoms of psychotic illness, but they don’t cure the illness. This special class of medicines can reduce symptoms or reduce the severity of symptoms. These medicines are used mainly to treat the pervasive, intrusive, and disturbing thoughts of a person with schizophrenia. They are designed to help minimize the severity of delusions and hallucinations the child is having.

    • Mood stabilizing agents, such as lithium or valproic acid, especially in the first stage of an illness episode

  • Individual and family psychotherapy (including supportive, cognitive, and behavioral therapy)

  • Specialized educational or structured activity programs (for example, social skills training, vocational training, and speech and language therapy)

  • Self-help and support groups

Can schizophrenia be prevented?

It is not known how to prevent schizophrenia. But identification and early intervention can improve the quality of life for children and teens with this disorder. Treatment is most successful when symptoms of the first psychotic episode are addressed properly and quickly. It is crucial for a child or teen who is prescribed medicines for schizophrenia to stick to the regimen. The dosages and types of medicines may need to be adjusted from time to time so they can keep being effective. Always see your child's healthcare provider for more information.

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