Schizophrenia in Children

What is schizophrenia?

Schizophrenia is one of the most complex of all mental health disorders. It is a severe, chronic, and disabling disturbance of the brain that 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. Multifactorial inheritance means that "many factors" are involved. The factors are usually both genetic and environmental, where a combination of genes from both parents, in addition to unknown environmental factors, produce the trait or condition. Often, one gender (either males or females) is affected more frequently than the other in multifactorial traits. There appears to be a different threshold of expression, which means that one gender is more likely to show the problem, over the other gender. Slightly more males develop schizophrenia in childhood; however, by adolescence, schizophrenia affects males and females equally.

Who is affected by schizophrenia?

Schizophrenia is uncommon in children under the age of 12 and hard to identify in the early phases. A sudden onset of the psychotic symptoms of schizophrenia frequently occurs in middle to late adolescence. Statistics indicate that schizophrenia affects approximately 1% of Americans. A child born into a family with 1 or more family members affected by schizophrenia has a greater chance of developing schizophrenia than a child born into a family with no history of schizophrenia.

After a person has been diagnosed with schizophrenia in a family, the chance for a sibling to also be diagnosed with schizophrenia is 10%. If a parent has schizophrenia, the chance for a child to have the disorder is 10%. Risks increase with multiple affected family members.

What are the symptoms of schizophrenia?

In children with schizophrenia, behavior changes may occur slowly, over time, or have a sudden onset. The child may gradually become more shy and withdrawn.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 onset of its psychotic symptoms. "Psychotic" refers to ideas, perceptions, or feelings that are grossly distorted from reality. The following are the most common symptoms of schizophrenia. However, each child may experience symptoms differently.

Early warning signs of schizophrenia in children may include:

  • Distorted perception of reality (difficulty telling dreams from reality)

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

  • Detailed and bizarre thoughts and ideas

  • Suspiciousness and/or paranoia (fearfulness that someone, or something, is going to harm them)

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

  • Delusions (ideas that seem real but are not based in reality)

  • Extreme moodiness

  • Severe anxiety and/or fearfulness

  • Flat affect (lack of emotional expression when speaking)

  • Difficulty in performing schoolwork and/or a decline in previous levels of academic achievement 

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

  • Disorganized or catatonic behavior (suddenly becoming agitated and confused, or sitting and staring, as if immobilized)

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

The symptoms of schizophrenia are often classified as positive (symptoms including delusions, hallucinations, and bizarre behavior), negative (symptoms including flat affect, withdrawal, and emotional unresponsiveness), disorganized speech (including speech that is incomprehensible), and disorganized or catatonic behavior (including marked mood swings, sudden aggression, or confusion, followed by sudden motionlessness and staring). The symptoms of schizophrenia in children are similar to adults, however, children, more often (in 80% of diagnosed cases), experience auditory hallucinations and typically do not experience delusions or formal thought disorders until midadolescence or older. The symptoms of schizophrenia may resemble other problems or psychiatric conditions. Always consult your child's health care provider for a diagnosis.

How is schizophrenia diagnosed?

Schizophrenia in children and adolescents is usually diagnosed by a child and adolescent psychiatrist. Other mental health professionals usually participate in the completion of a comprehensive mental health evaluation to determine individualized treatment needs.

Treatment for schizophrenia

Specific treatment for schizophrenia will be determined by your child's health care provider based on:

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

  • Extent of the condition

  • Type of schizophrenia

  • Your child's tolerance for specific medications or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

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

  • Medications (also called psychopharmacological management; to reduce the symptoms of schizophrenia), including the following:

    • Antipsychotic medications (previously known as "neuroleptics") are medications that act against the symptoms of psychotic illness, but do not cure the illness. This specialized class of medications can reduce symptoms or reduce the severity of symptoms, and is used primarily 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 experiencing.

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

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

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

  • Self-help and support groups

Prevention of schizophrenia

Preventive measures to reduce the incidence of schizophrenia are not known at this time. However, identification and early intervention can improve the quality of life experienced by children and adolescents with schizophrenia. Further, treatment is most successful when symptoms of the first psychotic episode are addressed properly and promptly. It is crucial for a child or teen who is prescribed medications for the treatment of schizophrenia to remain adherent to the regimen. Dosages and types of medications may need to be adjusted periodically to maintain effectiveness. Always consult your child's health care provider for more information.