Childhood schizophrenia is a schizophrenia spectrum disorder that is characterized by hallucinations, disorganized speech, delusions, catatonic behavior and “negative symptoms”, such as neglecting personal hygiene or appearing to lack emotion. Childhood schizophrenia is very rare, so when parents see what they believe are the signs of schizophrenia in their child and possibly ask their pediatrician about a child schizophrenia test, it’s likely that their fears are unfounded.

“Schizophrenia in children is quite uncommon, although it can be present,” says Victor Fornari, MD, director of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, New York and Cohen Children’s Medical Center in New Hyde Park, New York.

In fact, childhood-onset schizophrenia (COS) is rare.1 With an estimated prevalence rate of around 1 in 10,000 children, it tends to be diagnosed more often in males than females. With schizophrenia, the prodrome phase, or early signs of concern, generally begin in adolescence, he says, and the age of full onset is late adolescence to early adulthood—basically from ages 18 to 25, Dr. Fornari says.

Called COS when it’s diagnosed in kids under age 13, childhood schizophrenia remains a controversial diagnosis among clinicians. If you are seeing unusual behavior in your child that makes you worry it could be schizophrenia, or your child is hearing voices, you’ll definitely want to have her evaluated, says Michael Houston, a member of the American Academy of Child & Adolescent Psychiatry. “But this behavior does not mean they necessarily have schizophrenia,” he says.

“The chances are high that they may have a developmental issue or something else going on. Children with autism can have hallucinations and delusions.” And, he adds, psychosis can also occur with depression and anxiety. A good place to start is with your pediatrician, who may refer you to a child and adolescent psychiatrist.

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“Naturally, there is typically a high level of parental distress and confusion when a young child demonstrates what appear to be the symptoms of schizophrenia,” says Peter L. Klinger, MD, assistant professor in the Departments of Psychiatry and Pediatrics at the University of Arizona in Tucson and psychiatrist for the Early Psychosis Intervention Center (EPICENTER) at Banner University Medical Group.

Schizophrenia or Autism?

It is very important to clarify questions about schizophrenia and autism, he says. “Whereas autism is present and can be diagnosed in the first years of life, the first signs of psychosis in childhood-onset schizophrenia do not come on until years later,” he says. While these disorders are very different, they can share certain features that contribute to confusion.

“For example, kids with autism can be quite preoccupied with their internal experiences, and may not pick up on social cues, nor engage in help-seeking and reality testing in typical ways,” Dr. Klinger says. They can be overwhelmed with sensory stimuli and immersed in their own fantasies, and this may manifest as distorted perceptions, beliefs, and hallucinations, he adds. “In a very different way, children with features of schizophrenia may become increasingly withdrawn and internally preoccupied, showing less interest in others, but again, this pattern starts much later in their development and is associated with a deterioration in their level of functioning,” Dr. Klinger says.

If symptoms that worry you last for more than a week in a young child, say, under the age of four, it is important to see a doctor, Dr. Houston says. “It could mean there is something going on, but it is still important to consider that the likelihood of it being schizophrenia is much higher in an adolescent. Autism is more likely in a younger child.”

Symptoms of Schizophrenia in Children

The symptoms of childhood schizophrenia are much like the symptoms that are present in adults with the disease. “There is social withdrawal, a decline in functioning with role impairment, the presence of abnormal perceptual experiences, such as hearing voices, or auditory hallucinations,” Dr. Fornari explains. “They may also experience delusions or false fixed beliefs.”

Some children with autism can have problems with psychosis, Dr. Houston says. “These children may have hallucinations and delusions, but it’s usually a developmental issue,” he says. “It’s important to differentiate between psychosis, a symptom that involves being out of touch with reality, and schizophrenia, which is a degenerative disease.”

Risk Factors for the Disease

A family history of schizophrenia does increase the chances of getting the disorder, and first-degree relatives are at an increased risk for being diagnosed, Dr. Fornari says. A lower IQ, delays in social development, and not reaching developmental milestones on time, such as language and motor skills, are risk factors as well, Dr. Houston says. While the disorder is present in only about 1 percent of the population, it occurs in up to 5 percent of first degree relatives (siblings and children) of individuals who have schizophrenia.

How Is Schizophrenia Treated in a Child?

“Antipsychotic medications are the treatment of choice, Dr. Fornari says. ”If a child were to be diagnosed with COS, second-generation antipsychotic medications would be used,” he says. But early identification of the disorder is important, as are psychosocial treatment such as social support groups. For a child with schizophrenia, both academic and social support is key.”

Finding ways to keep the person motivated and engaged is important, too, Dr. Houston says. “Now people are really recognizing the value of these psychosocial interventions,” he says.

Can Children Outgrow Schizophrenia?

COS is not likely to go away without treatment and is generally a chronic condition. But the right combination of medication and mental health services, particularly early identification and intervention, can help, Dr. Klinger says. “The goal is to get the person diagnosed early and involved in an out-patient program that offers individual therapy, medical management, and group therapy with peers as well as with multiple families facing the challenges together,” he says.

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Last Updated: Jul 17, 2019