Schizophrenia in Children

Learning your child has schizophrenia—or suspecting your child may have it—can feel overwhelming and scary. But early identification and treatment are important in managing their symptoms and improving your child’s long-term prognosis.

Schizophrenia is a mental illness that causes people to interpret reality abnormally. It involves a range of cognitive, emotional, and behavioral problems that impair a child’s ability to function.

This article discusses the symptoms, causes, and prevalence of schizophrenia in children. It also covers how the disorder presents in kids, the available treatments, and things that parents can do to help kids cope.

Prevalence of Schizophrenia in Kids

Onset usually occurs between the late teens and the mid-thirties. The peak age of onset for males is the early twenties and for females the late twenties, but it may occur at any age. According to the National Institute of Mental Health, about 0.25% to 0.64% of Americans have schizophrenia.

Childhood schizophrenia, characterized by onset before age 13, is only found in 1 in 40,000 children. Childhood schizophrenia presents special challenges in terms of diagnosis and treatment.

Causes of Childhood Schizophrenia

Scientists haven’t found a single set of causes for schizophrenia. It’s suspected that there are multiple genetic and environmental factors that play a role:

• Genetic factors: Family, twin, and adoption studies support a strong genetic component in schizophrenia. Parents of children with schizophrenia are 10 times as likely to also develop schizophrenia. If an identical twin has the illness, the likelihood that the other twin will develop schizophrenia is over 40%.
• Environmental factors: There may be some environmental factors that contribute to schizophrenia in children, especially if there are already genetic components at play. Prenatal infections, obstetric complications, and maternal malnutrition may play a role.

Symptoms of Schizophrenia in Children

Hallucinations, thought disorder, and flattened affect have been consistently found in children with schizophrenia. Delusions and catatonic symptoms occur less frequently.

Childhood schizophrenia is also often associated with cognitive delays. Cognitive decline typically occurs at the time of onset of schizophrenia, but after the initial decline, intellectual deficits appear to be stable without getting progressively worse.

Early Signs

Schizophrenia can be more difficult to diagnose in younger children. Some of the early signs of the condition in kids can include:

• Aggressive behavior
• Bizarre speech
• Confusing imagination, dreams, or television with reality
• Difficulty sleeping
• Difficulty with hygiene or self-care
• Irritability
• Lack of emotion
• Poor motivation
• Problems with thinking
• Strange fears

Later Symptoms

As children with schizophrenia grow, they begin to display some of the more typical symptoms of the condition that are often also seen in adults with the condition. Some of these symptoms include:

• Hallucinations: Hallucinations involve seeing or hearing things that aren’t actually there. For example, a child may hear voices that don't actually exist. While the voices are not real, the child experiences them as if they are.
• Delusions: Delusions involve fixed false ideas that only the child believes and are often not based in reality. For example, a child may be convinced that another child or adult is harassing or trying to harm them when that is not the case.
• Disorganized thinking: Disorganized thinking is evidenced by derailed or incoherent speech. Kids may provide answers to questions that are incomplete or unrelated to the original questions. In some cases, speech may be unintelligible or meaningless.
• Flat affect: Children with schizophrenia may speak in a monotone voice, display diminished facial expressions, and appear apathetic. Known as negative symptoms, these behaviors may include not making eye contact, not making head or arm movements, and seeming unable to show emotions or feel pleasure.
• Paucity of speech or thought: Kids with schizophrenia may only speak when prompted and reply with short answers. When asked a question that might require a more detailed explanation, for example, a child might respond with a one-word answer that conveys little meaning or information.
• Bizarre behavior: Children with schizophrenia may also display inappropriate, disorganized, or odd behavior inappropriate for a child’s age. For example, they may engage in private behaviors in public settings, become easily agitated, act much younger than they are, or sit and stare as if they are unable to move.

Course

The course of schizophrenia varies from person to person. But, there are hallmark phases that people tend to experience.

• Prodrome phase: Most people with schizophrenia experience some functional deterioration before the onset of psychotic symptoms. Social withdrawal, bizarre preoccupations, unusual behavior, academic failure, or a decline in hygiene and self-care may begin before any signs of psychosis.
• Acute phase: This phase is marked by prominent symptoms, such as hallucinations, delusions, disorganized speech and behavior, and a serious deterioration in functioning. This phase may last several months depending on the response to treatment.
• Recuperative or recovery phase: After the acute psychosis subsides, there is generally a period when the person continues to experience a significant impairment. Flat affect and social withdrawal are often present.
• Residual phase: Children with schizophrenia may have extended stretches of time between acute phases. However, most people will continue to be at least somewhat impaired. Some never progress to residual symptoms and continue to have acute symptoms despite treatment.

When to See a Doctor

It’s hard to identify schizophrenia in children. Young children have excellent imaginations so it’s common for them to have imaginary friends with whom they carry on conversations. That type of pretend play doesn’t mean your child is having hallucinations.

Kids also aren’t good at telling adults about their symptoms. When young children are asked questions about hallucinations or delusions, many of them say yes. But, that doesn’t mean they have psychosis.

Instead, in a paper published in 2013, researchers believe kids may report having those symptoms because they have overactive imaginations, cognitive limitations, or they simply misunderstand the question. So asking your child questions like, “Do you ever see things that no one else sees?” isn’t likely to give you much insight into whether your child should see a doctor.

Symptoms also tend to begin gradually. Over time, however, a child may develop psychosis and the symptoms become much more obvious. If you notice developmental delays, strange eating rituals, bizarre behavior or ideas, change in academic performance, or social isolation, consult your child's doctor.

Diagnosing Schizophrenia in Children

There isn’t a lab test that identifies schizophrenia. Mental health professionals make the diagnosis based on several factors after gathering a full history, observing the child, and interviews with the parent and child. Other conditions must also be ruled out.

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Many of the symptoms of schizophrenia in children are also found in other disorders, such as autism spectrum disorders (ASD), mood disorders with psychotic features, or obsessive-compulsive disorder.

Medical conditions may also result in overlapping symptoms. For example, central nervous system infections, endocrine disorders, genetic syndromes, autoimmune disorders, and toxic exposures may cause children to exhibit symptoms like psychosis.

Drug use may also cause psychosis. Hallucinogenic mushrooms, stimulants, inhalants, and cannabis are just a few of the drugs that may lead to psychotic symptoms. Prescription drug misuse may also lead to acute psychosis. Symptoms generally resolve within a few days to weeks after the drug is discontinued.

Treatments for Schizophrenia in Kids

Antipsychotic medication is the primary treatment for schizophrenia in children and adults. People with schizophrenia are at significant risk of relapse if they stop taking their antipsychotic medication. It’s essential for parents of children diagnosed with schizophrenia to maintain contact with physicians to monitor symptoms, side effects, and adherence.

Talk therapy may also be helpful to children with schizophrenia. Children and their parents may benefit from psychoeducation and problem-solving sessions. It may be important for siblings to get involved in therapy so they can understand their sibling’s behavior.

Social skills training, relapse prevention, and basic life skills training may also be helpful. Some children with schizophrenia may need specialized education programs or vocational training programs.

Prognosis

Childhood-onset schizophrenia is associated with low intellectual functioning and higher rates of negative symptoms across the lifespan.

According to a 2011 study published in Pediatric Clinics of North America, childhood-onset schizophrenia is associated with greater social deficits in adulthood compared to those with other mental illnesses. It’s also been linked to lower levels of employment and a lesser likelihood of living independently, compared to other psychiatric disorders.

Adolescents are at a higher risk of suicidal behavior during their first episode of psychosis. At least 5% of people who exhibited symptoms of schizophrenia before age 18 die by suicide or accidental death directly related to behaviors caused by their psychotic thinking.

People with schizophrenia also are at a higher risk of physical health conditions such as heart disease, obesity, hepatitis, diabetes, and HIV. There isn’t a cure for schizophrenia, but symptoms can be managed with treatment. Early intervention is key to improving the outcome for children with schizophrenia.

Coping and Support

Learning your child has schizophrenia—or suspecting that they may have it—can feel scary and overwhelming. It’s important to learn as much as you can about schizophrenia in children, however, so you can best support and advocate for your child.

Ask your child’s doctor for resources on schizophrenia. Attending support groups for people who have a family member diagnosed with schizophrenia can serve as a wealth of information.

The National Alliance on Mental Illness (NAMI), may also be a valuable resource. NAMI is a mental health organization that has local affiliates who provide support, education, and services in communities throughout the United States. NAMI may be able to help you locate the resources, tools, and information you need to help your child.

It’s important to take care of yourself as well. Attend a support group or seek therapy for yourself. Managing your stress level will be key to helping you be best equipped to support your child.

A Word From Verywell

While there is no way to prevent schizophrenia in children, being aware of the risk factors and keeping an eye out for potential symptoms can help with the early identification of the condition. Early treatment can help improve outcomes. It can also help limit some of more serious symptoms such as psychosis. If you suspect that your child has symptoms of childhood schizophrenia, talk to your child's doctor for further evaluation and treatment options.