Childhood schizophrenia is a serious and rare mental health condition that occurs in children younger than 13 years of age. It is a type of schizophrenia that makes sufferers perceive reality inaccurately.
- What Is Childhood Schizophrenia?
- Understanding Childhood Schizophrenia
- Symptoms Of Childhood Schizophrenia
- Childhood Schizophrenia & Brain Structure
- Causes Of Childhood Schizophrenia
- Who Is At Risk
- Diagnostic Criteria Of Childhood Schizophrenia
- Diagnosis Process Of Childhood Schizophrenia
- Complications Associated With Childhood Schizophrenia
- When To See A Doctor
- Treatment Of Childhood Schizophrenia
- 1. Medications
- 2. Psychotherapy
- 3. Life Skills Training
- 4. Hospitalization
- How Parents Can Help
- Coping & Supporting With Childhood Schizophrenia
- Prevention Of Childhood Schizophrenia
- Final Thoughts & Outlook
What Is Childhood Schizophrenia?
Also known as childhood-onset schizophrenia (COS), it is a psychiatric disorder that typically develops in children between the ages of 12 & 18 years. Another variant, known as very early-onset schizophrenia, affects an individual before they are 12 or 13 years of age. According to a study 1 , “Childhood-onset schizophrenia (defined by an onset of psychosis by age 12) is a rare and severe form of the disorder that is clinically and neurobiologically continuous with the adult-onset disorder.” Further research 2 reveals that psychosis associated with the condition generally occurs under 13 years of age and is considered as very early onset, however when onset is 13 and 17 years, then it is regarded as “adolescent onset.” Childhood schizophrenia shares the same symptomatology, effects and diagnostic criteria 3 as schizophrenia in adults, except for the age of onset. However, it can be harder to identify and diagnose COS than schizophrenia in adults. In some cases, the symptoms can worsen over time in children who experience them early. The disorder results in abnormal interpretation of reality in children and leads to different emotional, cognitive & behavioral challenges which adversely affects the sufferer’s ability to build healthy interpersonal relationships and function normally in daily life.
A child with this COS may experience certain positive symptoms, such as delusions, hallucinations, disorganized speech and abnormal behavior, before they reach the age of 13. They may also suffer from negative symptoms, such as emotional blunting, apathy or a lack of motivation along with other cognitive issues. Other symptoms may include auditory hallucinations such as hearing bangs or knocks, poor academic performance, irritability or looking for imaginary things. Moreover, additional research shows that nearly half of the children with this condition also tend to experience serious neuropsychiatric symptoms.
The disorder is also related to other neurodevelopmental conditions like attention deficit and hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). “Childhood onset schizophrenia (COS) patients have marked neuropsychological deficits in areas of attention, working memory and executive functions,” explains a 2006 study 4 .
However, it should be noted that childhood schizophrenia has not yet been recognized as an official diagnosis. It is extremely difficult to diagnose and treat childhood schizophrenia followed by educational, emotional, and social development. Although there is no specific cure, an individual with this psychiatric disorder can recover with effective treatment. Since it is a chronic condition, it must receive lifelong treatment. It is highly recommended to identify and start the treatment for COS at an early stage to significantly improve a child’s long-term outcome.
Understanding Childhood Schizophrenia
Schizophrenia is a significant psychiatric illness in the world of psychology and it is more prevalent in adults than in children and adolescents. However, when it occurs in children, the condition can cause:
- optical hallucinations of objects and people that are not really present
- auditory hallucinations of music, voices, or other sounds that are not real
- delusions of threats or dangers that are not connected to the reality
- trouble making friends and maintaining relationships
- damaged speech and other communication skills
- improper and abnormal behavior
Apart from these, when trying to understand the condition, certain aspects of the disorder must also be considered, such as:
- There is no known cause of the condition
- It’s likely a genetic condition, inherited from one of the family members
- The condition affects boys a tad more than girls during childhood, however, affects men and women equally during adolescence and adulthood
- The condition has no known cure but can be controlled effectively when identified early and treated with therapy, medications, and support
Symptoms Of Childhood Schizophrenia
COS revolves around a range of problems associated with thinking, behavior, or emotions, just like schizophrenia in adults. The signs and symptoms may differ from one child to another, however, it usually involves delusions, hallucinations, or disorganized speech, along with an impaired ability to function. While such symptoms in adults generally start in their mid to late 20s, it is uncommon in children which starts before the age of 13.
Here are the symptoms of childhood schizophrenia which may worsen over time:
1. Early Signs & Symptoms
The earliest signs of COS may be defined by developmental problems, such as:
- Late walking
- Late or unusual crawling
- Language delays
- Other strange motor behaviors, for example, rocking or arm flapping
Such symptoms are also common in children with pervasive developmental disorders, thus ruling out these developmental disorders is the first step in the diagnosis.
2. Symptoms in adolescents
Schizophrenia symptoms in teenagers are similar to those in adults, however, they are more difficult to recognize. The symptoms include:
- Irritability or depressed mood
- Poor performance at school
- Trouble sleeping
- Withdrawal from friends and family
- Strange behavior
- Lack of motivation
- Substance use
3. Symptoms in later age
As children with the disorder age, more common signs and symptoms of the disorder begin to appear which may include:
This is a symptom 5 where the person develops false beliefs that have nothing to do with reality. For example, the person may think someone is trying to harm him/her, trying to insult through comments or gestures, or another person in love with him/her, all of which are not even true in reality.
These usually involve seeing or hearing things 6 that don’t exist, thereby, leaving a serious impact impairing normal functioning and daily activities.
C. Disorganized Thinking
Disorganized thinking and disorganized speech go hand in hand. Productive communication can be impaired, and answers to questions may be partly or entirely unrelated.
D. Extremely Disorganized Motor Behavior
This may refer to childlike silliness to random anxiety. Since the behavior is not goal-oriented, which makes it hard to do tasks. Such behavior may include resistance to instructions, bizarre posture, excessive and useless movements, etc.
E. Negative Symptoms
This refers to decreased ability to function normally, for example, neglecting personal hygiene or lack of emotion. Also, the person is characterized by a reduced ability to engage in everyday activities.
When COS begins, symptoms take time to build to show up. The early signs and symptoms are vague enough not to get recognized, or parents may attribute them to a developmental phase. With time, however, the symptoms become extremely severe and more noticeable. Eventually, a child may develop the symptoms of psychosis, including hallucinations, delusions, and difficulty organizing thoughts.
Childhood Schizophrenia & Brain Structure
According to some researchers, COS may be associated with a deficit of gray matter 7 in the neuronal cell bodies of the brain. It includes brain areas which regulate sensory perception, emotions, memory, muscle control, decision making and speech. Research 8 shows that lower levels of gray matter in COS affected adolescents’ brains have been observed as compared to healthy individuals of the same age. “There is emerging evidence that gray matter (GM) is reduced in patients with schizophrenia,” add the researchers. It is observed in both male and female patients and this deficit is not related to severity of the symptoms. However, lower gray matter levels can affect cognitive performance. Another 2004 study 9 revealed that loss of cortical GM volume in patients with COS tend to be diagnostically specific. It adds “Recent anatomical brain magnetic resonance imaging (MRI) studies show a striking post-psychotic progressive loss of cortical gray matter (GM) in patients with childhood-onset schizophrenia (COS), which appears greater than that seen for adult patients.”
However, a 2016 study 10 found that prolonged and effective treatment can help to increase grey matter volume significantly. Particularly in the bilateral cerebellum, left superior occipital cortex, insula, the bilateral prefrontal cortex and the right thalamus. “Atypical antipsychotics could modulate brain morphology involving the thalamus, cortical grey matter and cerebellum,” adds the study.
Causes Of Childhood Schizophrenia
Research shows that it is “a neurodevelopmental disorder with a multifactorial etiology.” Although, there may not be any specific known causes of COS, it is believed that the disease is influenced by the following factors:
While there is no single cause for childhood schizophrenia, experts believe that the disease is caused due to an inherited 11 chemical imbalance in the brain. If a combination of genes 12 passed down by both parents, it can lead to this disorder. If one of the parents has the disorder, chances are high that the child will also develop it. The presence of a schizophrenic sibling also leaves a chance for the child to develop the disease. In other words, the risk of developing this condition in a child increases if more than one family member has the disease. “Evidence suggests there is a significant heritable component to COS. There are multiple genes and genetic mutations that have been hypothesized as being integral to COS and its hereditary nature,” says a study 13 .
The study also says that the age of the paternal parent is a risk factor that determines the development of childhood schizophrenia. Precisely, if the age of the paternal parent is 30 or above at the time of conception, the chances are high that the child may develop the condition. This concept is assumed as cell mutation occurs as paternal age increases, although the entire mutation process is not yet understood. Evidence 14 also suggests that a family history of mental illness may increase the chances of developing COS. According to a 2009 study 15 , “Examination of familial transmission of known candidate risk genes was carried out, and a 10% rate of cytogenetic abnormalities was found.”
2. Complications During Pregnancy
According to a 2013 study 16 , “At least in part, events occurring within the intrauterine (within the uterus) or perinatal (during pregnancy) environment at critical times of brain development underlies emergence of the psychosis observed during adulthood, and brain pathologies that are hypothesized to be from birth.” Though it’s not certain, doctors are of the opinion that a child’s schizophrenia may be linked to certain complications and environmental factors that affect the mother during pregnancy. Such factors can be:
- lack of proper nutrition for the mother during pregnancy
- exposure to viruses during pregnancy
- extreme stress
- prenatal infections
- exposure to particular hormonal or chemical agents
- drug or alcohol use while pregnant
- exposure to certain viruses or infections
Who Is At Risk
Although the exact cause of schizophrenia is not known, there are a few particular factors that seem to increase the risk of developing COS such as:
- Having schizophrenia in family history
- Increased immune system activation, such as from inflammation or autoimmune diseases
- Older age of the father, 30 or above
- Complications during pregnancy and birth, such as malnutrition and exposure to toxins or viruses that may affect brain development
- Taking mind-altering drugs during the teen years
Diagnostic Criteria Of Childhood Schizophrenia
“The gold standard for diagnosis remains the use of unmodified DSM criteria, based on extensive collateral information,” explains a 2013 study. The diagnostic criteria for childhood schizophrenia are the same as adult schizophrenia as per DSM IV-TR, which includes the following.
1. Characteristic Symptoms
Two or more of the following symptoms should be present in the patient for a period of 1 month.
- disorganized speech
- grossly disorganized or catatonic behavior
- negative symptoms
2. Social or Occupational Dysfunction
For a notable amount of time since the onset of the condition, one or more major areas of functioning such as work, interpersonal relations, or self-care are considerably below the level accomplished prior to the onset.
Continuous signs of the disturbance should remain for at least 6 months. This 6-month period must include at least 1 month of symptoms that meet Criterion A and may consist of periods of prodromal or residual symptoms.
4. Schizoaffective and Mood Disorder Exclusion
Schizoaffective Disorder and Mood Disorder With Psychotic Features must be ruled out as-
- No major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms
- If mood episodes have transpired during active-phase symptoms, the total span was shorter relative to the duration of the active and residual periods.
5. Substance/General Medical Condition Exclusion
The disorder is not due to any direct physiological effects of a substance or a general medical condition.
7. Relationship to a Pervasive Developmental Disorder
If there is a record of autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia will be made only if prominent delusions or hallucinations are also present for at least a month.
Diagnosis Process Of Childhood Schizophrenia
Symptoms such as disorganized speech and behavior are also associated with other disorders of childhood-onset such as autism spectrum disorder, obsessive-compulsive disorder, and attention-deficit hyperactivity disorder. Thus, it is essential to consider other common disorders of childhood before connecting symptoms to schizophrenia. Hence, in the process of diagnosing childhood schizophrenia, the doctor must rule out other mental health disorders first along with determining that the symptoms are not a result of substance abuse, medication, or a medical condition. The process of diagnosis 17 may involve:
1. Physical Exam
This is done to rule out other problems resulting in the symptoms and to check for any related complications.
2. Tests & Screenings
This step involves tests that enable the elimination of other similar symptoms followed by screening for alcohol and drugs. The doctor may also suggest imaging studies, such as an MRI or CT scan.
3. Psychological Evaluation
This step is defined by observing the appearance and behavior, inquiring about thoughts, feelings, and behavior patterns, including any feelings of causing self-harm or hurting others. It also evaluates the capacity to think and function at an age-appropriate level along with assessing mood, anxiety, and possible psychotic symptoms. The doctor also discusses family and personal history.
Complications Associated With Childhood Schizophrenia
If left untreated, childhood schizophrenia can lead to severe emotional, behavioral, and health complications such as:
- Anxiety disorders & panic disorders
- Obsessive-compulsive disorder (OCD)
- Inflicting self-injury
- Substance abuse such as alcohol, other drugs, or tobacco
- Family conflicts
- Social isolation
- Lack of ability to live independently, attend school or work
- Health and medical problems
- Being victimized
- Legal and financial problems, and homelessness
- Aggressive behavior
- Suicidal behavioral pattern or tendency for self-harm & commit suicide
When To See A Doctor
It can be a challenge for the parents to handle vague behavioral changes in their child. Additionally, parents may receive some sort of an alert from the child’s teacher or other school staff about the changes in the child’s behavior. Thus, one must seek medical help if the child:
- has developmental delays compared with other siblings or peers
- has stopped doing daily hygiene activities such as bathing or dressing
- no longer wants to socialize
- is performing poorly in academics
- has strange eating rituals
- shows excessive mistrust towards others
- shows a lack of emotion or shows emotions inappropriate for a particular situation
- has strange thoughts and fears
- confuses dreams or television for reality
- has eccentric ideas, behavior, or speech
- has violent or aggressive behavior or agitation
However, these signs or symptoms do not mean that a child has childhood schizophrenia. These could also mean that there is another mental health disorder such as depression or an anxiety disorder, or a medical condition. Suicidal thoughts and behavior may also be common among children or teens with this disorder. Thus, parents must seek medical care as soon as possible if they have concerns about their child’s behavior or development.
Treatment Of Childhood Schizophrenia
After a child is diagnosed with COS, the doctor will explain to the parents its possible causes, effects, and long-term consequences. Precisely, the doctor will give a thorough overview of the condition. Following this, the doctor along with the parents agree upon a treatment plan consisting of psychotherapy and medication along with school and community support that will work towards the betterment of the child and the family. The parents along with the child will have the opportunity to ask questions along with bringing up any or all concerns, worries, and fears. This way, the clinical team will be able to provide the information and support the child and the family needs.
The treatment 18 is generally conducted by a child psychiatrist experienced in treating schizophrenia. The team of people who will be treating the condition may be available in clinics with experience in schizophrenia treatment. The team may include:
- Psychiatrist, psychologist, or another therapist
- Social worker
- Psychiatric nurse
- Family members
- Case manager to coordinate care
Schizophrenia in children is a lifelong treatment, even during periods when the symptoms seem to go away. The treatment in itself is challenging for a child with schizophrenia. Some common effective treatment options for COS typically include the following:
- Life Skills Training
The antipsychotics that are prescribed for children are also used for adults with schizophrenia. Research 19 shows that “antipsychotic medications are considered as the first-line treatment” for patients with COS. Antipsychotic drugs are usually effective at controlling or treating delusions, hallucinations, loss of motivation, and lack of emotion. When it comes to treatment with antipsychotics, the doctor aims to manage the symptoms effectively at the lowest possible dose. Over time, the doctor may introduce different medications, combinations, or different doses. Depending on the symptoms, other medications such as antidepressants or anti-anxiety drugs may also help.
Here are commonly prescribed medications for childhood-onset schizophrenia:
A. Second-Generation Antipsychotics
Newer, second-generation medications, also known as atypical antipsychotics, are popular among the doctors for the treatment of childhood schizophrenia as they have fewer side effects than first-generation antipsychotics. According to a 2015 study 20 , “Atypical antipsychotics (AAPs) have been successfully used in early-onset schizophrenia (EOS).” However, these medicines can result in weight gain, high cholesterol, high blood sugar, and heart disease. Some examples of second-generation antipsychotics as approved by the Food and Drug Administration (FDA) are:
- Aripiprazole (Abilify)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
B. First-Generation Antipsychotics
These first-generation medications are, in most cases, as effective as second-generation medicines when it comes to controlling delusions and hallucinations. However, apart from the similar side-effects as mentioned in second-generation medication, they may also cause frequent and potentially significant neurological side effects. First-generation antipsychotics are cheaper than second-generation antipsychotics and this is a significant factor, especially when considering long-term treatment. Some examples of first-generation antipsychotics as approved by the FDA are:
- Haloperidol for children 3 years and older
- Chlorpromazine for children 13 and older
- Perphenazine for children 12 years and older
C. Side Effects & Risks of Medications
According to a research 21 conducted in 2014, “In spite of rapidly growing antipsychotic prescription rates for young patients in many countries, most antipsychotic medications have not been specifically approved to treat EOS (early-onset schizophrenia), mainly because such medications have not been thoroughly tested in the young.” All antipsychotic medicines have side-effects and potential health risks, some of which are life-threatening as well. These side-effects in children and teenagers may differ from those in adults, and sometimes they may be more serious. However, studies 22 show that weight gain is one of the most common side effects of antipsychotics in children, adolescents and young adults
Since children do not have much capacity to understand or communicate medication problems, parents must consult the doctor to discuss possible side-effects and risks. Parents must be aware of all the possible side-effects and report it to the doctor as soon as they see it. 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.
Apart from medication, psychotherapy or talk therapy, can also manage the symptoms and help a child cope with the disorder. Some of the most recommended and effective psychotherapies for this disorder may include:
A. Cognitive Therapies
According to a 2012 study 23 , cognitive therapies (CTs) can prove to be effective for high-risk individuals. However, CT can be even more effective when combined with other therapies that focus on different aspects of functioning such as family interventions, cognitive rehabilitation, social problem solving, along with school interventions & occupational therapy for vocational development. The researcher found that cognitive behavioral therapy (CBT) can yield more benefits when focused on social functioning. The study adds “CBT and supportive counseling both improved social adjustment at 12 months, and patients in the CBT group were less likely to convert to psychosis.”
Cognitive behavioral therapy, with a skilled therapist, can help a child to learn coping tips to manage stress and daily life challenges with the onset of schizophrenia. The therapy helps in lowering the symptoms, thereby enabling a child to make friends and succeed at school. The therapist must help the child to understand his/her condition that will further help him/her cope with symptoms, and stick to the treatment plan.
B. Family Therapy
Family therapy 24 is designed to benefit the child and the parents while supporting and educating both parties. Family therapy can also help improve communication, work out conflicts, and cope with stress related to a child’s condition.
According to a 2012 study 25 , some other psychotherapeutic interventions that childhood schizophrenia are:
- Cognitive enhancement therapy
- Cognitive remediation therapy
- Multifamily psycho-education
- Supportive counseling
- Social skills training
- Individualized psychological treatments
The study adds “psychotherapeutic interventions may thus be an important platform to alleviate psychotic relapse, re-admission, and medication compliance; systematic validation of such measures however is warranted.”
3. Life Skills Training
For children with schizophrenia, treatment plans are built to help them learn life skills that will enable a child to function at age-appropriate levels when possible. Skills training may include:
A. Social & Academic Skills Training
Helping a child to learn social and academic skills is an imperative part of treatment for this condition. Children with schizophrenia usually have troubled relationships and school problems. They may also have trouble carrying out normal daily tasks such as bathing or dressing.
B. Vocational Rehabilitation & Supported Employment
This aims at helping people with schizophrenia to prepare for a job, find one, and helps to keep the job.
Hospitalization becomes mandatory during crisis periods or when the symptoms become severe. This is helpful for the child’s safety and makes sure that the child is getting enough nutrition, sleep, and hygiene. At times, the hospital setting is the safest and best way to get symptoms under control quickly.
How Parents Can Help
While it is essential to treat the condition with the help of a professional, parents should also participate actively to reduce the symptoms via home and lifestyle remedies. Here are ways to get the most out of the treatment plan.
1. Follow Doctor’s Instructions
Parents should make sure to provide their children with medicines as prescribed by the doctor, in terms of time and dosage. Even if they feel there are no current symptoms, they must continue the medicine to avoid the symptoms from coming back. Stopping the medicines suddenly may lead to further development of the symptoms and this may make it extremely difficult for the doctor to understand the best and safest dose for the child.
2. Consult the Doctor for Other Medications:
Parents must frequently consult the doctor who is treating their child for the disorder. They should inform the doctor about any progress or side effects. Moreover, before the child takes any over-the-counter medications, vitamins, minerals, herbs, or other supplements, it is essential to consult the doctor to avoid further complications.
3. Look for Warning Signs
Parents and children should stay alert for any warning signs displaying the factors that trigger the symptoms, cause relapse, or prevent a child from carrying out daily activities. In such situations, parents must chalk a plan to handle such situations where the symptoms might come back. Additionally, they must contact the child’s doctor or therapist in case of any noticeable changes in symptoms, to check the situation from worsening.
4. Foster Physical Activity & Healthy Eating Habits
Some medications for schizophrenia may result in weight gain and high cholesterol in children. Parents must discuss with the doctor to come up with a nutrition and physical activity plan for the child that will help manage weight gain while taking care of heart health.
5. Avoid substances
Alcohol, street drugs, and tobacco should be avoided at any cost as such substances only worsen schizophrenia symptoms or interfere with antipsychotic medications.
Coping & Supporting With Childhood Schizophrenia
Coping and supporting a condition that requires lifelong treatment can be extremely daunting, not only for the child but also for the parents and the rest of the family. Medications tend to leave unwanted side-effects that can further give rise to resentful feelings. Thus, to cope with childhood schizophrenia, there are certain things that one must do, such as:
1. Gather Knowledge
Having adequate knowledge about the condition can help parents and the child to feel hopeful while staying committed to the treatment plan. Education can also help friends and other family members to understand the condition and act more compassionately with the child.
2. Support Groups
Parents should join support groups where they can meet other families with the same condition. This way, they can discuss the condition within the group and learn various ways to cope with the condition. This way, the child’s parents will also feel that they are not alone in this journey and fight against the condition.
3. Professional Help
Parents should always consider seeking professional help, especially when they feel confused and distressed by their child’s condition.
4. Stay Goal-Oriented
Dealing with childhood schizophrenia is a lifelong process. However, a family can overcome all the obstacles if they stand together, stay motivated, and focus on the treatment goals.
5. Seek Healthy Outlets
A family must explore the various ways to channel energy or frustration, such as participating in hobbies, exercise, and recreational activities. They should also seek support from friends and family as well and socialize adequately.
6. Spend Some Alone Time
Although managing childhood schizophrenia is a family activity, it is necessary for both children and parents to spend some healthy alone time to cope and unwind.
Prevention Of Childhood Schizophrenia
Early identification and treatment may help parents to control the symptoms of childhood schizophrenia before it leads to any serious complications. Early treatment is essential to limit psychotic episodes, which can be extremely terrifying to a child and his/her parents. While an ongoing treatment can help improve a child’s long-term outlook, it will not prevent or cure the condition completely.
Final Thoughts & Outlook
Childhood schizophrenia is a lifelong condition. It is not possible to cure or prevent it, however, early treatment can manage it. If a child has a diagnosis of this condition, his/her family and caregivers can help the child by gathering knowledge about the condition, trying to learn how the child feels, and ensuring that they receive continuous treatment. Depending on the type and severity of the symptoms, treatment can help many people with this condition, thereby enabling them to go to work 26 while enjoying fulfilling relationships.References:
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