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Are you worried that your child may have child schizophrenia? Here’s what you should know about this rare, yet serious mental illness.

Schizophrenia is a chronic, debilitating mental illness that causes people to experience the world differently than most other people do. Consequently, the way they communicate and behave often appears to be disorganised, illogical, detached, imaginary or paranoid. While childhood schizophrenia is essentially the same brain disorder as schizophrenia in adults, the early age of onset presents special considerations for diagnosis, treatment, educational needs, emotional and social development, family relationships, and other factors.

Did you know? It is estimated that only 1 child in 10 000 will develop child schizophrenia before age 13.

The Odds
Childhood-onset schizophrenia is very rare in children under the age of 13. After childhood the number of childhood cases of schizophrenia rises dramatically, with an approximate 10-fold increase in children between 12 and 15 years of age. Childhood-onset schizophrenia is known to occur less frequently than with Autism and in fact one of the conditions that it can seem similar to at first is Autism.

There is also an interesting gender shift with age. Males predominate in early-onset cases, with a male- to- female ratio between 2:1 and 5:1, while the rates for males and females are more even in adolescence.

Causes
There are a number of different theories as to what can cause schizophrenia in children. It can run in families and there is a definite genetic component. It is also known to occur much more commonly in first-line relatives where one parent has the condition, than in the general population.

Some of the areas of current research as to what causes childhood-onset schizophrenia include risk-associated genes, exposure to certain viruses or malnutrition in the womb and stressful childhood environments in genetically susceptible children.

One of the psychology theories is that “high expressed emotion in the home” puts a child at a higher predisposition for developing schizophrenia. Often when there is a lot of discordance in the home and emotionality and disagreement, there is a risk of instability within the child, so harmony in the home is important – yet this as a cause on its own has not been scientifically validated.

Behavioural Symptoms
The way that childhood-onset schizophrenia presents itself is very similar to adult schizophrenia. What often happens is that at first one may have an acute episode where there are positive symptoms, e.g. hallucinations or delusions.

A hallucination is a disturbance of perception – one perceives something that is not actually there. There are different perceptual modalities. One of the most common is auditory hallucination, where often someone will tell you that they hear voices. Sometimes the person will report that the voices they are hearing are telling them to do something, where these are referred to as “command-hallucinations”. Delusions are disturbances of thought – strange, crazy, bazaar thoughts that have no basis in reality.

Other symptoms of the disease, which are known collectively as psychosis, include:

  • Disorganised thinking
  • Irrational behavior
  • Physical immobility
  • Excessive mobility with no purpose
  • Absent or inappropriate emotional expression
  • Little verbal communication with other people
  • Inability to initiate plans

According to a Johannesburg based psychiatrist in private practice, symptoms such as hallucinations and delusions are often seen to occur in an acute episode, but often before such an episode one would see a build up known as the prodrome, where the child just seems to be failing to progress or develop appropriately. “The behaviour can seem inappropriate, for example the child can cry for no reason or start giggling out of the blue.

During the initial prodromal phase it can sometimes seem to manifest into something like Autism, but when the acute symptoms of psychosis, being the hallucinations and delusions, are present, that’s when one makes a diagnosis. Also in children who have Autism, there can frequently be limited intellectual functioning however with schizophrenia their intellect is usually normal.” he says.

Children with schizophrenia are often socially rejected, they are clingy and they have limited social skills. There may be histories of delayed motor and verbal milestones and they often do badly at school despite having normal intelligence.

Diagnostic Challenges
Since the onset of schizophrenia in children is usually very slow, beginning with a poor level of functioning, it can sometimes take months or years to recognise that the condition is actually schizophrenia.

As with adults there are also different types of schizophrenia, like the paranoid type, where mainly the type of thinking is paranoid. Other types include what are referred to as undifferentiated, catatonic and disorganised.

There is the possibility that many cases of childhood-onset schizophrenia go misdiagnosed or are left undiagnosed until much later in life. “It is very uncommon to make the diagnosis before adolescence or young adulthood,” says the psychiatrist. “It may be that certain cases are misdiagnosed or that schizophrenia in children is under-diagnosed, but often it is a very difficult diagnosis to make because often the way it presents, which often doesn’t seem as though it is schizophrenia at first,” he adds.

When childhood-onset schizophrenia begins very early, the disease often manifests itself gradually and builds up to the first psychotic episode. Early signs of the disease may include social withdrawal, disruptive behaviors, academic problems, speech or language problems, or other developmental delays.
These early signs aren’t specific to childhood-onset schizophrenia and may indicate a variety of other conditions, including:

  1. Bipolar disorder
  2. Shizoaffective disorder, a condition with some manifestations of both schizophrenia and a mood disorder
  3. Severe anxiety disorders
  4. Depression with psychotic features
  5. Post-traumatic stress disorder
  6. Delusional disorders
  7. Medical disorders that affect the brain
  8. Personality disorders
  9. Autism spectrum disorders

Treatment
In treating schizophrenia in adults, the use of anti-psychotic medication is very important. It will often be used in treating childhood-onset schizophrenia as well, except that children often seem to show a less-favourable response. These drugs help suppress psychotic behaviours through regulation of dopamine-associated nerve pathways. They may also prevent the recurrence or lessen the intensity of psychotic episodes.
It’s important to report any observable medication side effects to your doctor immediately. By spotting medication problems early, your doctor can adjust dosing or choice of medication. Such careful monitoring may improve the overall course of treatment and may help you and your child adhere to treatment guidelines.

Other Interventions
Since there is no actual cure for childhood-onset schizophrenia, family support and family education about the condition is of the utmost importance.

Other intervention for childhood-onset schizophrenia designed to complement drug treatment may include:

  • Ongoing, age-appropriate education about the disease and treatment options for both the child and family members, including siblings.
  • Social skills and basic life skills training at home, school and in the community.
  • Psychotherapy for child and parents or guardians that focuses on coping strategies, problem-solving skills, and awareness of symptoms and the circumstances that may prompt or exacerbate them.
  • Special educational programs that address learning and developmental needs.
  • Day programs or at-home services for children who can’t attend school for an entire day.
  • Hospitalisation when psychotic behaviors aren’t well-managed by drug treatment or when behaviors, particularly paranoid delusions or hallucinations, present a danger to the child or others.

Finding the Right Support
Certain organisations such as the National Schizophrenia Foundation and the National Alliance on Mental Illness facilitate support groups for families dealing with childhood schizophrenia. Children and parents who attend these groups can learn about schizophrenia, develop and improve coping skills, find encouragement to stay on treatment plans, and experience a sense of community.

Hearing Voices vs. the Voice of Reason
While there is definitely an increase in awareness around the condition of childhood-onset schizophrenia, it must still be remembered that this is a very rare disorder. Most children have impressive and wild imaginations – and your child may often tell you stories about made up friends – where there is no cause for concern, unless it affects their mood and leads to disturbing actions.

If all other possible factors for observing symptoms of schizophrenia have been ruled out and your child is still displaying strange behaviour, you will need to seek professional help from a child psychiatrist who will be able to make the correct diagnosis and proceed with various treatment options. With the correct medical care and family support, you can help your child to better manage and control their behaviour so that they can enjoy their youth and lead a more hopeful life, despite the many challenges associated with the disorder.

Reference Sources
Developmental Psychopathology from Infancy through Adolescence; Fifth Edition by Charles Wenar & Patricia Kerig; McGraw Hill 2006.

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