Childhood schizophrenia is an uncommon but severe mental disorder in which children and teenagers interpret reality abnormally. Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. It may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs your child's ability to function.
Childhood schizophrenia is essentially the same as schizophrenia in adults, but it starts early in life — generally in the teenage years — and has a profound impact on a child's behavior and development. With childhood schizophrenia, the early age of onset presents special challenges for diagnosis, treatment, education, and emotional and social development.
Schizophrenia is a chronic condition that requires lifelong treatment. Identifying and starting treatment for childhood schizophrenia as early as possible may significantly improve your child's long-term outcome.
Schizophrenia involves a range of problems with thinking, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. The effect can be disabling.
In most people with schizophrenia, symptoms generally start in the mid- to late 20s, though it can start later, up to the mid-30s. Schizophrenia is considered early onset when it starts before the age of 18. Onset of schizophrenia in children younger than age 13 is extremely rare.
Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present. Schizophrenia can be difficult to recognize in the early phases.
Schizophrenia signs and symptoms in children and teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group.
Early signs and symptoms may include problems with thinking, behavior and emotions.
Thinking:
Behavior:
Emotions:
As children with schizophrenia age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:
Compared with schizophrenia symptoms in adults, children and teens may be:
When childhood schizophrenia begins early in life, symptoms may build up gradually. Early signs and symptoms may be so vague that you can't recognize what's wrong. Some early signs can be mistaken for typical development during early teen years, or they could be symptoms of other mental or physical conditions.
As time goes on, signs may become more severe and more noticeable. Eventually, your child may develop the symptoms of psychosis, including hallucinations, delusions and difficulty organizing thoughts. As thoughts become more disorganized, there's often a "break from reality" (psychosis) frequently requiring hospitalization and treatment with medication.
It can be difficult to know how to handle vague behavioral changes in your child. You may be afraid of rushing to conclusions that label your child with a mental illness. Your child's teacher or other school staff may alert you to changes in your child's behavior.
Seek medical care as soon as possible if you have concerns about your child's behavior or development.
Suicidal thoughts and behavior are common among people with schizophrenia. If you have a child or teen who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your child to the nearest hospital emergency room.
It's not known what causes childhood schizophrenia, but it's thought that it develops in the same way as adult schizophrenia does. Researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder. It's not clear why schizophrenia starts so early in life for some and not for others.
Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that schizophrenia is a brain disease.
Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:
Left untreated, childhood schizophrenia can result in severe emotional, behavioral and health problems. Complications associated with schizophrenia may occur in childhood or later, such as:
Early identification and treatment may help get symptoms of childhood schizophrenia under control before serious complications develop. Early treatment is also crucial in helping limit psychotic episodes, which can be extremely frightening to a child and his or her parents. Ongoing treatment can help improve your child's long-term outlook.
Diagnosis of childhood schizophrenia involves ruling out other mental health disorders and determining that symptoms aren't due to alcohol or drug use, medication or a medical condition. The process of diagnosis may involve:
The path to diagnosing childhood schizophrenia can sometimes be long and challenging. In part, this is because other conditions, such as depression or bipolar disorder, can have similar symptoms.
A child psychiatrist may want to monitor your child's behaviors, perceptions and thinking patterns for several months or more. As thinking and behavior patterns and signs and symptoms become clearer over time, a diagnosis of schizophrenia may be made.
In some cases, a psychiatrist may recommend starting medications before making an official diagnosis. This is especially important for symptoms of aggression or self-injury. Some medications may help limit these types of behavior.
Schizophrenia in children requires lifelong treatment, even during periods when symptoms seem to go away. Treatment is a particular challenge for children with schizophrenia.
Childhood schizophrenia treatment is usually guided by a child psychiatrist experienced in treating schizophrenia. The team approach may be available in clinics with expertise in schizophrenia treatment. The team may include, for example, your:
The main treatments for childhood schizophrenia are:
Most of the antipsychotics used in children are the same as those used for adults with schizophrenia. Antipsychotic drugs are often effective at managing symptoms such as delusions and hallucinations.
In general, the goal of treatment with antipsychotics is to effectively manage symptoms at the lowest possible dose. Over time, your child's doctor may try combinations, different medications or different doses. Depending on the symptoms, other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks after starting a medication to notice an improvement in symptoms.
Newer, second-generation medications are generally preferred because they have fewer side effects than first-generation antipsychotics do. However, they may cause weight gain, high blood sugar, high cholesterol or heart disease.
Examples of second-generation antipsychotics approved by the U.S. Food and Drug Administration (FDA) to treat schizophrenia in teenagers age 13 and older include:
Paliperidone (Invega) is FDA-approved for children 12 years of age and older.
First-generation medications are usually as effective as second-generation antipsychotics in controlling delusions and hallucinations. In addition to having some side effects similar to those of second-generation antipsychotics, first-generation antipsychotics also may have frequent and potentially significant neurological side effects. These include the possibility of developing a movement disorder called tardive dyskinesia, which may or may not be reversible.
Because of the increased risk of serious side effects with first-generation antipsychotics, they often aren't recommended for use in children until other options have been tried without success.
Examples of first-generation antipsychotics approved by the FDA to treat schizophrenia in children and teens include:
All antipsychotic medications have side effects and possible health risks, some life-threatening. Side effects in children and teenagers may not be the same as those in adults, and sometimes they may be more serious. Children, especially very young children, may not have the capacity to understand or communicate about medication problems.
Talk to your child's doctor about possible side effects and how to manage them. Be alert for problems in your child, and report side effects to the doctor as soon as possible. The doctor may be able to adjust the dose or change medications and limit side effects.
Also, antipsychotic medications can have dangerous interactions with other substances. Tell your child's doctor about all medications and over-the-counter products your child takes, including vitamins, minerals and herbal supplements.
In addition to medication, psychotherapy, sometimes called talk therapy, can help manage symptoms and help you and your child cope with the disorder. Psychotherapy may include:
Treatment plans that include building life skills can help your child function at age-appropriate levels when possible. Skills training may include:
During crisis periods or times of severe symptoms, hospitalization may be necessary. This can help ensure your child's safety and make sure that he or she is getting proper nutrition, sleep and hygiene. Sometimes the hospital setting is the safest and best way to get symptoms under control quickly.
Partial hospitalization and residential care may be options, but severe symptoms are usually stabilized in the hospital before moving to these levels of care.
Although childhood schizophrenia requires professional treatment, it's critical to be an active participant in your child's care. Here are ways to get the most out of the treatment plan.
Coping with childhood schizophrenia can be challenging. Medications can have unwanted side effects, and you, your child and your whole family may feel angry or resentful about having to manage a condition that requires lifelong treatment. To help cope with childhood schizophrenia:
You're likely to start by first having your child see his or her pediatrician or family doctor. In some cases, you may be referred immediately to a specialist, such as a pediatric psychiatrist or other mental health professional who's an expert in schizophrenia.
In rare cases where safety is an issue, your child may require an emergency evaluation in the emergency room and possibly admission for psychiatric care in a hospital.
Before the appointment make a list of:
Basic questions to ask the doctor may include:
Don't hesitate to ask any other questions during your appointment.
Your child's doctor is likely to ask you and your child a number of questions. Anticipating some of these questions will help make the discussion productive. Your doctor may ask:
The doctor will ask additional questions based on responses, symptoms and needs.
