Childhood-Onset Schizophrenia: Children Can Be Schizophrenic, Too

Imagine someone pacing around making wild motor movements, talking — perhaps about rather frightening subjects — into thin air, aggressively yelling at things that aren't present. Imagine someone saying all kinds of things but making no sense whatsoever, someone warning you about wild conspiracies, or someone convinced that you're the devil.

This is the image people might conjure up when they hear the word "schizophrenia", and indeed, all of these things can be part of the symptomatic picture. Schizophrenia, in which the sufferer is yanked out of reality and transported to a completely different world in which auditory, visual and tactile hallucinations seem as real as the computer screen you're looking at now does to you, is a mental illness that really scares people.

It scares people enough when its symptoms are displayed by that middle-aged co-worker or discussed in a novel we're reading, when it's at a distance great enough to enable us to essentially ignore it. What if your child started displaying worrying symptoms, at first non-specific and then just as frightening as the stereotypical image of schizophrenia we have all built up, though? Schizophrenia, no matter how uncomfortable we are with that fact, can strike children too.

How Prevalent Is Childhood Schizophrenia?

Most people with schizophrenia develop symptoms in their twenties, and around a percent to a percent and a half of the general adult population is affected by the disorder. Childhood-onset schizophrenia, the symptoms of which must be identified before age 13 in order to qualify for that diagnosis, occurs in roughly one out of every 40,000 children. Most of these children will be over seven years of age when their schizophrenia is identified, however, there are also cases in which under-sevens received this diagnosis.

Rare though childhood schizophrenia may be, it has far-reaching consequences. The onset of symptoms may be gradual, but the condition tends to be severe in children who develop it.

Risk factors include having a first-degree relative with schizophrenia, exposure to certain toxins or viruses in utero or having been malnourished during that stage, and having an older father. Even being born in a city as opposed to a more rural area greatly increases the risk that someone will develop schizophrenia. Despite these known risk factors, it is not yet clear what circumstances must combine in order to cause schizophrenia, nor why this disease, which usually doesn't begin causing symptoms until much later in life, shows up in some younger children.

Childhood Schizophrenia: Symptoms

Children with schizophrenia will experience symptoms very similar to those of their adult counterparts, for which reason there are no separate diagnostic criteria for childhood-onset schizophrenia, besides the requirement that it be diagnosed before age 13.

Symptoms can all be said to fall into "positive", "negative", and cognitive categories. "Positive" refers to symptoms not typically present in healthy people, symptoms that indicate psychosis or loss of touch with reality, those things that the schizophrenia "adds". "Negative" symptoms are those things the disorder "takes away".

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Positive symptoms of schizophrenia may include:

• Hallucinations, which the sufferer experiences as completely real and that can be auditory, visual, and tactile.
• Delusions.
• Disorganized thinking patterns.
• Disorganized bodily movements.

Negative symptoms, on the other hand, are those that signify that the patient has lost the motivation to actively participate in the world. Flat emotions, social withdrawal or even an outright refusal to communicate, and no longer displaying an interest in activities they previously enjoyed, are examples.

Cognitive symptoms vary greatly from patient to patient, but can include indecisiveness, a lacking working memory, and difficulties in concentrating.

Diagnosing And Managing Childhood Schizophrenia

Childhood Schizophrenia Or Something Else?

Look at the list of symptom categories typical to schizophrenia, and you are bound to ask yourself this question. Plenty of children have imaginary friends (yes, even scary ones), or dreams so vivid that they're still frightened by them the next day. Plenty of children role play or engage in fantasizing. (How would you know whether the child is really seeing what they say they are seeing, or whether they are just playing?) Plenty of children hold slightly irrational beliefs, too, by virtue of them being children who have not yet developed reasoning skills nor a solid sense of reality.

The negative symptoms of schizophrenia could easily be explained by bullying, depression, or any number of factors, while the cognitive symptoms are much more likely to attract a mindlessly applied ADHD label than to lead a pediatrician to wonder if the child has schizophrenia — a rare diagnosis, after all, particularly in that age group.

The road to a childhood schizophrenia diagnosis can be long, and perhaps frustrating, for that exact reason. Before the diagnosis can be made, other conditions, ranging from central nervous system tumors, to chromosomal disorders, to other mental health disorders and psychotic disorders in particular, all have to be ruled out before childhood-onset schizophrenia can be diagnosed.

Blood tests, electroencephalograms, and MRI scans may all be part of the diagnostic exploration process, yet ultimately, the the diagnosis will be made clinically after ruling out differential diagnosis and ascertaining that the child's symptoms match that of schizophrenia. If you are a parent who suspects that your child may be suffering from schizophrenia, or you at least know that something is wrong, however, the most important step you can take is to approach your pediatrician, family doctor, or a child psychiatrist with your concerns.

What Happens After A Child Is Diagnosed With Schizophrenia?

Antipsychotic medications such as haloperidol, olanzepine, and risperidon form the cornerstone of effective management of schizophrenia. Newer-class antipsychotics offer the benefit of fewer side effects as well as the potential to reduce  "negative" schizophrenia symptoms.

During acute episodes, the focus will be on controlling the psychotic symptoms a patient experiences. Hospitalization will almost certainly be part of the approach to treatment during this time.

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Since schizophrenia can be managed but not cured, however, individuals diagnosed with the condition will need to take medication for the rest of their lives. Unfortunately, because childhood-onset schizophrenia is rare and the available body of research data based on studies conducted on adults, little is currently known about the exact effects of antipsychotic medications on schizophrenic children. Hence, a child's medication regime has to be monitored closely by their medical team, led by a pediatric psychiatrist.

Again, though too little is currently known about schizophrenia in children, there are indications that talk therapy for the child and their family is beneficial, along with therapy specifically focused on developing socials skills and functioning in the world with schizophrenia.

As research into schizophrenia continues and societal attitudes towards the disease shift, outcomes for children diagnosed with schizophrenia today are likely to be a whole lot better than they would have been a few generations ago. With the right support and medication, schizophrenia can be a chronic disease that requires constant monitoring, but which still enables the patient to live a full life.