- What is childhood schizophrenia?
- What causes schizophrenia in children?
- Risk factors for COS
- Signs and symptoms of childhood schizophrenia
- Complications arising from COS
- When to see a doctor?
- Diagnosis of schizophrenia in children
- Treatment of schizophrenia in children
- How to take care of the child at home?
Does your child complain to you about hearing and seeing things that no one else does? Do they hold strange beliefs and behave awkwardly in gatherings and public?
Such behaviour is difficult to comprehend. But that could indicate illnesses such as schizophrenia.
What Is Childhood Schizophrenia?
When schizophrenia occurs in children aged below 13, it is known as very early-onset schizophrenia or childhood-onset schizophrenia (COS) (1). It is different from early-onset schizophrenia that occurs during the teenage (between 13 and 18 years).
Schizophrenia is a severe psychiatric disorder in which the difference between reality and fiction gets blurred for the person. It can lead to abnormal behaviour and impede the cognitive and emotional development of the child.
Childhood schizophrenia or COS is very rare and occurs in 1 out of 30,000 children.
What Causes Schizophrenia In Children?
According to research, a combination of factors leads to the development of this condition. It is not known why it starts earlier in some individuals than others.
Here are the reasons why COS occurs:
- Genetics: Studies have linked multiple genes to the onset of COS. However, the presence of these combinations of genes need not necessarily lead to schizophrenia.
Any history of mental illnesses in the family could be a reason for schizophrenia in children.
Also, the age of the father has an impact on the child. An advanced age of more than 30 years of the father could lead to COS in the child (2).
- Identical twins: In the case of identical twins, if one twin develops COS, the other child has a one in two chances of getting it. In the case of non-identical twins, the chances are one in seven (3).
- Anatomy of the brain: The structure of the brain and chemical changes can be a major factor. Certain neurotransmitters, like dopamine and glutamate, are naturally occurring in the brain. An imbalance in them can contribute to schizophrenia.
Neuroimaging has shown researchers that the brain structure of people with schizophrenia is different from that of normal people. They also have less grey matter, which is integral to processing, remembering and evaluating basic information (4).
- Childhood environment: Early parental loss, poor mothering, weak bonding with the mother, head injury, physical and mental abuse can have a direct impact on the child’s psychology and could lead to schizophrenia.
- Prenatal complications: Exposure of a pregnant woman to influenza virus, rubella virus, respiratory infection, analgesics and malnutrition can result in COS (5).
Abnormal fetal growth and development, such as low birth weight, congenital malformations, small head circumference; and obstetric complications such as asphyxia, uterine atony, emergency C-section can be the causes but usually in combination with other risk factors.
Let us see those risk factors.
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Risk factors for COS:
The risk factors are the same as the causes that lead to childhood schizophrenia. Some of them are:
- A family history of schizophrenia
- Chromosomal deletions on chromosomes 1, 8, 15 and 22
- Autoimmune diseases causing increased activation of the immune system
- Older age of the father
- Complications during pregnancy, such as poor nutrition or exposure to toxins that may affect the development of the brain
- Consumption of psychoactive drugs by parents during their teen years
If your child has a combination of these causes or risk factors, do look for the symptoms of schizophrenia.
Signs And Symptoms Of Childhood Schizophrenia
Schizophrenia symptoms in children are divided into negative and positive.
Positive: These symptoms are more visible than negative ones. There is a gradual change in the child’s behaviour or thoughts, for example, the child is hallucinating or is delusional.
- Distracted and unconnected beliefs having no relation to reality.
- Delusion of threats or other critical situations.
- Visual hallucinations, seeing people or objects, which do not exist.
- Auditory hallucinations, hearing sounds or voices that don’t exist.
- Inappropriate or strange behaviour in social situations or even in private.
- Apprehensive of incorrect reference; often patients think that they are being discussed somewhere, but in truth, it is not so.
- Having disorganized speech where the child may not be much expressive or has a poor hand or eye movements.
- Abnormal motor functions like sitting or doing things in an odd posture.
- Anxiety and fearfulness.
- Paranoia is also a positive symptom and is not a separate condition.
Negative: These symptoms don’t seem to be there but are there. The child is found withdrawn, both from basic work and emotionally. Let us take a look at them (8):
- Problems in connecting with people, making friendships or building trust.
- Suspicions or hostility toward others for no apparent reason.
- Extreme moodiness and irritable nature.
- Inability to show emotions.
- Lack of interest in any activities.
- Loss of enjoyment.
- Poor performance in school.
- Cognitive problems such as problems in remembering information or using them correctly.
Positive symptoms make treatment urgent because they are too visible to ignore, while negative symptoms could be misunderstood as the child’s obstinacy or mood swings.
Therefore, you need to be alert because undetected schizophrenia could lead to complications.
[ Read: ODD In Children ]
Complications Arising From COS
If schizophrenia is left untreated it can cause severe emotional and overall health damage. Complications that might arise are:
- Suicidal thoughts
- Panic disorders
- Anxiety attacks
- Acute depression
- Unable to lead an independent life
- Isolation from society and family
Taking medical help at the right time can avoid such serious issues.
When To See A Doctor?
You should take your child to a doctor when (9):
- They are not maintaining personal hygiene like cleaning and bathing.
- Not able to perform normal tasks.
- Have developmental delays compared to children of the same age.
- Poor performance in studies.
- Very suspicious of others.
- Have a strange thinking pattern.
- Flat emotional expression or not expressiveness at all.
- Confused between reality and fiction.
- Often aggressive.
- See and hear things that others don’t.
- Feel that their thoughts are being controlled.
- Speak in a flat or monotonous way without making facial expressions.
- Confusing responses.
The first step to treatment and cure for your child would be to get a proper diagnosis done.
[ Read: Rumination Disorder In Kids ]
Diagnosis Of Schizophrenia In Children
A mental health professional, usually a child psychiatrist, will make a complete evaluation of your child (10).
- Your child’s doctor may ask you questions about:
- your child’s general health
- family medical history
- social behaviour
- daily life performance
- They will do psychological scrutiny of the child by examining the kid’s physical appearance, thoughts, and emotions
- Behavioural evaluation to see how the child feels, if they are insecure, have self-harming thoughts, aggressive mood, and anxiety
- Your child’s doctor may perform a physical examination to check other possibilities for the symptoms to rule out any other conditions such as depression or bipolar disorder
- Computational image analysis such as MRI
Schizophrenia is suspected if the child has at least two of the positive and negative symptoms for a minimum of six months.
Once it is established that the child has schizophrenia, the doctor will chalk out a treatment plan and discuss it with you. This plan will include medication and psychotherapy.
Treatment Of Schizophrenia In Children
The treatment aims to eliminate the symptoms of COS as there is no total cure. It could be complex and lifelong.
The treatment includes a combination of therapies and may vary from one child to another, depending on their particular symptoms.
It is usually a combination of:
1. Antipsychotic drugs
Doctors commonly prescribe antipsychotic drugs also known as neuroleptics such as (11):
- Fluphenazine (brand name Prolixin)
- Trifluoperazine (Stelazine)
- Loxitane (Loxapine)
- Chlorpromazine (Thorazine)
These medicines are prescribed to reduce the severity of hallucinations and delusions.
However, most antipsychotic medicines have side-effects. Hence be alert and inform the doctor if the child is facing any problem.
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Psychotherapy is integral to psychiatric treatment (12) for children; it is basically a talk therapy.
Through these sessions, your child’s psychiatrist will help them:
- Understand the symptoms of the disease better
- Manage themselves
- Be vocal about their fears and emotions
- Perform everyday tasks with ease
- Deal with society and question people in life
Besides medication and talk therapy, a lot can be done at home to help your child be less anxious and get through it with greater ease.
How To Take Care Of The Child At Home?
Schizophrenia can be devastating for the entire family but you may take some crucial measures and make lifestyle changes to care for your child (13):
- Give medications on time: Make sure your child is taking medicines regularly even if their symptoms subside or the child seems better than before. Symptoms are likely to come back if proper care is not taken. Always contact the doctor before giving your child any other medicines as they may interrupt in the treatment process.
- Always talk positive: Getting diagnosed with childhood-onset schizophrenia may frighten your child. Therefore, be their pillar of support, and keep talking about positive things in life. Tell them about success stories where people with schizophrenia have completed their education, did jobs and even had families. Also, always address any concerns your child might have during the treatment process.
- Learn more about the illness: Conditions like schizophrenia need more than just medicines. You must educate yourself, your child and the family about the condition and how to manage it better. This will help the entire family make your child feel better hopeful.
- Self-help strategies: This is an excellent way to manage symptoms effectively and have a sense of control over one’s well being. For example, regular exercising involves a work out of the body and the mind, making the kid feel more energetic and motivated. Have your child do exercises like cycling, swimming or dancing. Meditation helps keep emotions under control and lead a peaceful life.
- Avoid difficult situations: Stress can trigger psychotic symptoms, which may affect your kid’s health negatively. Have frequent discussions with your child without judging, scolding or criticizing them. A supportive family makes recovery smoother for the child.
- Help them socialize: Your child may not be a social person. Don’t force them into making new connections but occasionally have them be in touch with trusted family members and close friends.
- Let them sleep well: Make sure your child is getting enough sleep, especially when they are on medication. They would require more than the regular eight hours and that is okay.
- Take care of the diet: Give the child nutritious meals every day, minimize the sugar content in the food, and avoid sleep-disturbing ingredients like caffeine.
- Increase omega 3 fatty acids, such as fish, fish oil, and walnuts, in their diet.
- Add more fruits and vegetables, starchy food like pasta, rice, and potatoes.
- Include high-fiber foods.
- Give brown bread and cereals such as muesli.
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It is difficult for a parent to accept the fact that their child has a mental illness. You might want to deny the situation, scrap the reports and want to prove everybody wrong. It takes time to accept the truth but meanwhile do not delay in providing treatment and proper care to the child.
This is a sensitive time for the child and they desperately need your love and support. Come to terms yourself and help them recover. Make them lead a life as normal as possible.
Do you have any experiences or suggestions to share? Let us know in the comment section below.
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