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Childhood schizophrenia

Childhood schizophrenia is a severe brain disorder in which children interpret reality abnormally. Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behavior. Signs and symptoms may vary, but they reflect an impaired ability to function.

Childhood schizophrenia is essentially the same as schizophrenia in adults, but it occurs early in life 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, educational needs, and emotional and social development.

Schizophrenia requires lifelong treatment. Identifying and starting treatment for childhood schizophrenia as early as possible may significantly improve your child's long-term outcome.

Symptoms Causes Risk factors Complications Prevention

Early signs and symptoms

The earliest indications of childhood schizophrenia may include developmental problems, such as:

  • Language delays
  • Late or unusual crawling
  • Late walking
  • Other abnormal motor behaviors — for example, rocking or arm flapping

Some of these signs and symptoms are also common in children with pervasive developmental disorders, such as autism spectrum disorders. So ruling out these developmental disorders is one of the first steps in diagnosis.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be harder to recognize. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

  • Withdrawal from friends and family
  • A drop in performance at school
  • Trouble sleeping
  • Irritability or depressed mood
  • Lack of motivation
  • Strange behavior

Compared with adults, teens may be:

  • Less likely to have delusions
  • More likely to have visual hallucinations

Later signs and symptoms

As children with schizophrenia age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:

  • Hallucinations. Hallucinations can involve any of the senses, but these usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience.
  • Delusions. These are false beliefs that are not based in reality. For example, you believe that you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; a major catastrophe is about to occur; or your body is not functioning properly.
  • Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
  • Disorganized or abnormal motor behavior. This may show in a number of ways. Behavior is not focused on a goal, which makes it hard to perform tasks. Abnormal motor behavior can include resistance to instructions, inappropriate and bizarre posture, a complete lack of response, or useless and excessive movement (catatonia).
  • Negative symptoms. This refers to lack of or reduced ability to function normally. For example, the person appears to lack emotion, such as not making eye contact, not changing facial expressions, or speaking without inflection. Also, the person may talk less, neglect personal hygiene, lose interest in everyday activities or socially withdraw.

Symptoms may be difficult to interpret

When childhood schizophrenia begins early in life, symptoms may build up gradually. The early signs and symptoms may be so vague that you can't recognize what's wrong, or you may attribute them to a developmental phase.

As time goes on, symptoms 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," frequently resulting in hospitalization and treatment with medication.

When to see a doctor

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. But early treatment will likely help in the long run. Your child's teacher or other school staff may alert you to changes in your child's behavior.

Seek medical advice if your child:

  • Has developmental delays compared with other siblings or peers
  • Has stopped meeting daily expectations, such as bathing or dressing
  • No longer wants to socialize
  • Is slipping in academic performance
  • Has strange eating rituals
  • Shows excessive suspicion of others
  • Shows a lack of emotion or shows emotions inappropriate for the situation
  • Has strange ideas and fears
  • Has violent or aggressive behavior or agitation

These general signs and symptoms don't necessarily mean your child has childhood schizophrenia. They could indicate simply a phase or another condition, such as depression, an anxiety disorder or a medical illness that requires other types of evaluation.

Seek medical care as soon as possible if your child has a change in thinking, as these symptoms should be addressed right away. Signs and symptoms can include:

  • Having beliefs not based on reality (delusions)
  • Seeing or hearing things that don't exist (hallucinations), especially voices
  • Disorganized or illogical thinking
  • Speech that doesn't make sense

It's not known what causes childhood schizophrenia, but it's thought that it develops in the same way as adult schizophrenia does. It's not clear why schizophrenia starts so early in life for some and not others.

Childhood schizophrenia and other forms of schizophrenia are brain disorders. Genetics and environment likely both play a role in causing schizophrenia.

Problems with certain naturally occurring brain chemicals called neurotransmitters may contribute to childhood schizophrenia. Imaging studies show differences in the brain structure of people with schizophrenia, but the significance of these changes isn't clear.

Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

  • Having a family history of schizophrenia
  • Exposure to viruses, toxins or malnutrition while in the womb
  • Abnormal activation of the immune system, such as from inflammation or autoimmune diseases
  • Older age of the father
  • Taking psychoactive drugs during teen years

Schizophrenia symptoms generally start in the late teens to the mid-30s. It's uncommon for children to be diagnosed with schizophrenia. Early-onset schizophrenia occurs in children younger than age 17. Very early-onset schizophrenia in children younger than age 13 is rare.

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:

  • Poor performance or inability to attend school or work
  • Inability to perform daily activities, such as bathing or dressing
  • Withdrawal from friends and family
  • Suicide
  • Self-injury
  • Anxiety and phobias
  • Depression
  • Abuse of alcohol, drugs or prescription medications
  • Poverty
  • Homelessness
  • Family conflicts
  • Inability to live independently
  • Health problems, including those associated with antipsychotic medications, smoking and poor lifestyle choices
  • Being a victim of aggressive behavior
  • Aggressive behavior

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. Avoid treatment delays to help improve your child's long-term outlook.

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