Schizophrenia in children, also known as childhood-onset schizophrenia (COS), affects one in 40,000 children before 13 years (1). It’s a severe form of schizophrenia that develops slowly and has a dismal prognosis.
Schizophrenia is a serious mental illness characterized by abnormal perceptions, emotions, thoughts, behavior, and language use. It’s a type of psychosis in which the child loses touch with reality and develops hallucinations, such as hearing voices (audio) or seeing things (visual) that aren’t there and experiencing delusions, such as false and fixed ideas that are warped from reality.
These psychotic symptoms are often associated with schizophrenia, but they can also be caused by other mental illnesses. Early therapy and training may benefit the child in coping with the severity of symptoms.
Read on to learn more about the causes, risk factors, symptoms, consequences, diagnosis, treatment, and prognosis of schizophrenia in kids.
Risk Factors And Causes Of Schizophrenia In Children
1. Genetic factors
A combination of genes passed down from both parents can result in schizophrenia.
Children with a family history of more than one affected person in the family may have a significant risk for developing the disorder than others. Genetic factors such as an inherited chemical imbalance in the brain are also strongly linked to the development of schizophrenia.
2. Environmental factors during pregnancy
The following environmental factors during pregnancy are believed to be associated with schizophrenia in children (1).
- Exposure to certain chemicals and hormones
- Illicit drug use
- Alcohol use
- Exposure to viral and other infections
- Increased stress during pregnancy
- Poor nutrition
- Age of the mother
Other factors that may increase the risk for schizophrenia in children may include
- Immune system activation due to inflammation.
- Increased paternal age.
Although the factors mentioned above are linked to schizophrenia in children, how they cause or trigger the disorder is unclear.
Symptoms Of Schizophrenia In Children
Children with schizophrenia can have slowly progressive or sudden onset of behavioral changes. For instance, they may gradually become shy and withdrawn.
- Bizarre and detailed thoughts and ideas
- Hallucinations, such as seeing, feeling, or hearing things that are not real
- Delusions such as having ideas that are not based on reality
- Confused thinking, such as confuse television with reality
- Paranoia or suspiciousness, such as fearing that something or someone is going to harm them
- Distorted perception of reality, such as being unable to differentiate dreams from reality
- Trouble sleeping
- Violent or aggressive behavior
- Severe anxiety and increased fear
- Inability to make friends and social withdrawal
- Difficulty in doing schoolwork
- Catatonic or disorganized behavior, such as suddenly becoming confused or agitated and sitting or staring as though they are immobilized
- Odd behaviors such as an older child acting like a young child
- Lack of emotional expressions in their speech
- Disoriented speech
- Ambivalent to people/ things
These schizophrenia symptoms are often classified into the following groups.
- Positive symptoms (hallucinations, delusions)
- Negative symptoms (social withdrawal, flat affect, emotional unresponsiveness)
- Disorganized speech (incomprehensible speech)
- Catatonic behaviors (mood swings, confusion, sudden aggression, and sudden staring and motionless)
Schizophrenia symptoms can be similar in children and adults. However, children are more likely to experience auditory hallucinations and lesser delusions or other forms of thought problems than adults.
Complications Of Schizophrenia
Untreated cases of childhood schizophrenia can lead to severe behavioral, emotional, and health problems in later life. The following are some complications of schizophrenia that may occur in childhood or later life (4).
- Self-harming (self-injury) behavior
- Family conflicts
- Anxiety disorders and panic disorders
- Obsessive-compulsive disorder (OCD)
- Alcohol and drug abuse
- Nicotine use
- Social isolation
- Inability to live independently
- Medical, legal, and financial problems
- Aggressive behavior (rare)
Complications may occur early or later in life depending on individual factors. Support and encouragement from family and friends with appropriate therapies may help alleviate or delay these complications.
Prevention Of Schizophrenia In Children
There is no known way to prevent schizophrenia in children. Proper pregnancy care, including good nutrition, may lower the risk of a child developing schizophrenia. Identifying the symptoms early on and providing timely care can help improve the child’s quality of life and prevent complications.
When To See A Doctor?
Seek pediatric consultation if your child has any symptoms of schizophrenia or other mental health disorders. You may also pay attention to their behavioral and academic problems and seek counseling if needed.
Diagnosis Of Schizophrenia
Schizophrenia is usually diagnosed after assessment by a psychiatrist. However, there are no known tests for schizophrenia (4) (5). Instead, mental health professionals may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association for diagnosis.
These criteria help rule out other mental health disorders and determine that the schizophrenic symptoms are not due to substance abuse, medications, or other medical problems.
Physical examination and tests are often done to rule out the other causes of symptoms. For example, blood or urine tests and screening to look for alcohol or substance use and imaging studies such as MRI or CT to visualize brain abnormalities are often ordered. These are done to exclude other conditions with similar symptoms before confirming the diagnosis.
An exact diagnosis may not be possible in some cases if a child has symptoms of other psychiatric disorders along with schizophrenia. The common related mental illnesses may include
- Bipolar disorder, a psychiatric disorder characterized by extreme mood swings, mania (excited behaviors), and deep depression.
- Schizoaffective disorder, a mental disorder with symptoms of bipolar disorder and schizophrenia. This may occur once or often come and go and is usually triggered by stress.
- Substance misuse.
- Post-traumatic stress disorder (PTSD).
Treatment For Schizophrenia In Children
There is no specific cure for schizophrenia but early diagnosis will lead to early interventions. The existing treatment strategies aim to reduce symptoms and improve the child’s quality of life. A combination of therapies is often needed for the effective management of schizophrenia. Some children may require lifelong treatment. Parents need to be supportive and understand need of therapies and medications. The child with schizophrenia can lead a productive life if treatment is given with patience and love.
Hospitalization is often recommended for children with severe symptoms. This can ensure a child’s safety, nutrition, hygiene, and sleep. However, some children may receive partial hospitalization and residential care if the symptoms are not too severe (4).
The following treatment methods are often recommended by pediatric psychiatrists (6).
Medications are necessary to treat schizophrenia. Neuroleptics or antipsychotic medications are commonly prescribed to reduce schizophrenic symptoms in children. Taking medications as per the prescription can help reduce the severity of hallucinations, delusions, etc.
Follow-ups are required to adjust the dosage and type of medication over time to maintain their effectiveness. Haloperidol (Haldol), Loxapac (loxapine), Thorazine (chlorpromazine), etc., are examples of neuroleptics used to treat the symptoms of schizophrenia.
Psychotherapy or talk therapy is one of the main psychiatric treatments for mental health disorders in children. Sessions with pediatric psychologists or psychiatrists help improve the understanding of the disorder and various ways to manage the symptoms. Psychotherapy includes
- Individual therapy, which helps the child manage the symptoms and vocalize their feelings, such as anger, fear, anxiety, or sadness associated with chronic mental illnesses.
- Family therapy, which involves educating loved ones about the condition and what they can do to manage the child’s condition. This helps build a support system and enables the family members to be active participants in the child’s care.
Psychotherapies can also help the child deal with the stigma of mental illness and cope with daily challenges.
- Specialized educational and activity programs
Specialized programs offered in schools, communities, and medical centers can benefit children and teens with schizophrenia. The following trainings are offered to children with psychiatric illnesses.
- Smaller, customized classrooms with specially trained teachers
- Social skills training to improve personal interaction, such as maintaining eye contact when holding a conversation.
- Teaching personal hygiene skills and everyday tasks
- Teaching how to prepare a meal and other survival skills
- Vocational training to find volunteer and job opportunities
- Speech and language therapy and programs to improve verbal and written communication
Prognosis For Schizophrenia In Children
The prognosis may vary depending on the severity of symptoms. For example, early-onset of schizophrenia usually has poor outcomes. However, early ongoing treatment may offer better outcomes than leaving it untreated (7).
Coping And Support
The following tips may help parents cope and support a child with schizophrenia.
- Learn about the condition and the warning signs to seek medical care.
- Stick to the treatment plans, even though the results may be slow.
- Join a support group to learn about other parents’ experiences.
- Seek professional help if you feel distressed or overwhelmed about your child’s condition.
- Engage in healthy hobbies, exercises, and recreational activities to energize the family.
- Maintain a regular eating, sleeping, and activity schedule at home.
- Share responsibilities and find some time as individuals.
You may also seek support from online support groups and organizations. Sticking to a routine and not discontinuing a child’s training and therapy sessions may help improve their quality of life.
Schizophrenia in children is uncommon but possible. Though its precise cause is unknown, genetic and environmental factors may play a role. Currently, there’s no cure for Schizophrenia. However, timely treatment is essential to avoid complications, such as substance abuse and social isolation. Continued medical training and support can help children live relatively normal life. Seek support from friends and family to help you cope with the stress that raising a child with mental health condition could cause. Remember, the cause of Schizophrenia is unknown, so preventing Schizophrenia isn’t possible.
- Hallucinations, distorted perception of reality, moodiness, and trouble sleeping are some symptoms of schizophrenia in children.
- It may occur due to genetic and environmental factors during pregnancy, such as poor nutrition, illicit drug use, and high stress.
- Early diagnosis and a combination of therapies help treat the condition.
2. Jennifer Bartlett; Childhood-onset schizophrenia: what do we really know?; Health Psychology and Behavioral Medicine (2014).
3. Pediatric Schizophrenia; Children’s National Hospital
4. Childhood schizophrenia; St. Clair Health
5. Diagnosis; Schizophrenia; National Health Service
6. Treatments; Schizophrenia; Boston Children’s Hospital
7. Childhood Schizophrenia; Cleveland Clinic