Monday, June 25, 2012

What Is Childhood Schizophrenia? What Causes Childhood Schizophrenia?

Childhood schizophrenia, also known as childhood-onset schizophrenia or early-onset schizophrenia is basically the same as schizophrenia in adults, but its onset occurs earlier in life. In some cases the patient may be ten years old, or even younger. Childhood schizophrenia can have a serious impact on the child's ability to function properly.

Schizophrenia is a serious psychiatric illness. The patient experiences strange thoughts, strange feelings, and abnormal behavior. Schizophrenia is rare in children and difficult to recognize during its early phases.

Experts are not sure what the causes of schizophrenia are. Recent studies suggest a combination of factors, including brain changes, as well as biochemical, environmental and genetic factors may play a part.

Schizophrenia cannot be cured with modern medicine and therapies. However, it can be controlled.


A child with schizophrenia may have gradual changes in behavior - a child who was once clearly enjoying relationships with others may begin to become withdrawn and shy, and appear to be in a world of their own. They child may start talking about unusual ideas and fears. They may become clingy (with their parents) and say things that do not make any sense. Sometimes the schoolteacher may be the first person to notice the signs symptoms.

A child with schizophrenia may have hallucinations, delusions, irrational thinking, bizarre behavior, difficulties performing everyday tasks, such as washing.

Early age onset of schizophrenia poses special challenges for diagnosis, treatment and personal development.

Childhood schizophrenia is sometimes grouped together with similar conditions, known collectively as schizophrenia spectrum disorders.

Early-onset schizophrenia starts when the child is aged between 13 and 18 years. Very early-onset schizophrenia starts when the child is aged 12 years or less.

What are the Signs and Symptoms of Childhood Schizophrenia?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

The child may:
  • See things that are not there - visual hallucinations (much less common than hearing things)
  • Hear things that do not exist - auditory hallucinations
  • Appear to lack emotion
  • Have emotions which do not go with the situation
  • Be socially withdrawn
  • Not do well at school
  • Care for himself/herself poorly
  • Have bizarre eating rituals
  • Speak in an incoherent way
  • Have illogical thoughts
  • Be agitated
When symptoms start very early they tend to grow very gradually. Parents and family members may initially aware of something that is wrong, but cannot define it clearly and usually put them down to a developmental phase the child is going through. However, the signs do not go away, they gradually become more noticeable. The child may eventually develop symptoms of psychosis, which may include delusions, hallucinations and disordered thoughts. Eventually the disordered thoughts may lead to a break from reality, causing distress to the child and his/her family.

When to seek medical help - parents, guardians and family member may not be keen to seek medical help and stigmatize the child with a label. However, early treatment will help a patient with childhood schizophrenia.

If the child is not longer washing properly, socializing, and has become violent and aggressive, or has other signs that may indicate a mental disorder, it is important to seek medical help. The child may not have childhood schizophrenia - he/she may have depression, an anxiety disorder, some kind of developmental disorder, or a simple medical illness.

If your child has hallucinations, delusions or disorganized thinking, seek medical help immediately.

What are the Risk Factors for Childhood Schizophrenia?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
  • Genetics - children with a family history of schizophrenia have a higher risk of developing it themselves. If there is no history of schizophrenia in your family your chances of developing it (any type, child-onset or adult-onset schizophrenia) are less than 1%. However, that risk rises to 10% if one of your parents was/is a sufferer.

    A gene that is probably the most studied "schizophrenia gene" plays a surprising role in the brain: It controls the birth of new neurons in addition to their integration into existing brain circuitry, according to an article published by Cell.

    A Swedish study found that schizophrenia and bipolar disorder have the same genetic causes.
  • Viral infection - if the fetus (unborn baby in the womb) is exposed to a viral infection, there is a bigger risk of developing childhood schizophrenia. Fetal malnutrition - if the fetus suffers from malnutrition during the mother's pregnancy there is a higher risk of developing childhood schizophrenia.
  • Stress during early life - experts say that severe stress early on in life may be a contributory factory towards the development of childhood schizophrenia. Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocussed. This can trigger relationship problems. These factors are often blamed for the onset of the disease, when really it was the other way round - the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.
  • Childhood abuse or trauma
  • Age of parents when baby is born - older parents have a higher risk of having children with childhood schizophrenia, compared to younger parents.
  • Drugs - the use of drugs that affect the mind or mental processes during adolescence may sometimes raise the risk of developing schizophrenia.

What are the Causes of Childhood Schizophrenia?

Experts are not sure, but they believe childhood schizophrenia arises and develops in the same way as the adult type of schizophrenia. We really don't know why schizophrenia onset (start) occurs during childhood for some people, and later on for other individuals.

Research indicates that most forms of schizophrenia are caused by brain dysfunction; we just don't know why that brain dysfunction occurs. Most likely, it is caused by a combination of genetics and environmental triggers.

What are environmental triggers? Imagine your body is full of buttons, and some of those buttons result in schizophrenia if somebody comes and presses them enough times and in the right sequences. The buttons would be your genetic susceptibility, while the person pressing them would be the environmental factors.

Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. They also believe that this imbalance is most likely caused by your genes making you susceptible to the illness. Some researchers say other the levels of other neurotransmitters, such as serotonin, may also be involved.

Changes in key brain functions, such as perception, emotion and behavior lead experts to conclude that the brain is the biological site of schizophrenia.

Schizophrenia could be caused by faulty signaling in the brain, according to research published in the journal Molecular Psychiatry.

Diagnosing Childhood Schizophrenia

The American Academy of Child Adolescent Psychiatry writes on its web site:

Children with schizophrenia must have a complete evaluation. Parents should ask their family physician or pediatrician to refer them to a psychiatrist, preferably a child and adolescent psychiatrist, who is specifically trained and skilled at evaluating, diagnosing, and treating children with schizophrenia. Children with schizophrenia need a comprehensive treatment plan. A combination of medication, individual therapy, family therapy, and specialized programs (school, activities, etc.) is often necessary. Psychiatric medication can be helpful for many of the symptoms and problems identified. These medications require careful monitoring by a psychiatrist (preferably a child and adolescent psychiatrist.)


To help with diagnosis, the following tests may be done:

Physical exam - the child's height, weight, heart rate, blood pressure, temperature are checked. The doctor will listen to the patient's heart and lungs, and check the abdomen.

CBC (complete blood count) - to check for alcohol and drugs, as well as thyroid function.

MRI (magnetic resonance imaging) or CT (computed tomography) scan - the aim here is to look for brain lesions or any abnormalities in the brain structure.

EEG (electroencephalogram) - to check for brain function.

Psychological evaluation - the psychiatrist, preferably a child and adolescent psychiatrist, who is specifically trained and skilled at evaluating, diagnosing, and treating children with schizophrenia will ask the patient about their thoughts, feelings and behavior patterns. They will discuss symptoms, when they started, how severe they are, and how they affect the patient's life. The doctor will also try to find out how often and when episodes had occurred.

The doctor will most probably try to find out whether the child had any thoughts about self-harm or harming other people.

The patient's ability to think and function in a way appropriate for his/her age will be evaluated. Among other things, this may involve looking through the child's school reports, and completing some psychological questionnaires to evaluate their moods, anxieties and possible psychosis.

A proper diagnosis may take time

Sometimes a long time may pass before a diagnosis of schizophrenia is confirmed. Other conditions/illnesses, such as bipolar disorder (manic depression), depression or substance abuse have to be considered - these conditions have many overlapping signs and symptoms. Most doctors will chose to monitor the child for a few months before confirming a diagnosis. During this time the doctor will try to determine whether symptoms occur at home, school or everywhere. Sometimes medications may be prescribed before an official diagnosis is reached, as may be the cases with aggression or self-harm.

Diagnostic criteria for Childhood Schizophrenia

For diagnosis of childhood schizophrenia to be officially confirmed, the patient must meet specific DSM symptom criteria. DSM stands for the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. This manual is used by health care professionals to diagnose mental conditions - insurance companies also use this manual when deciding on reimbursing the patient's medical expenses.

Initially, the child may be diagnosed with a non-specific psychotic disorder, instead of schizophrenia. As the patient's behavior and thinking patterns and signs and symptoms become more evident and easier to define and describe over time, a diagnosis of schizophrenia may be reached - as long as the criteria are met.

The diagnostic criteria for childhood and adult schizophrenia are fundamentally the same, and include:
  • Two of the following are present:
    - Delusions
    - Hallucinations
    - Disorganized speech
    - Disorganized or catatonic behavior
    - Lack of emotion
    - Social withdrawal
    - Inability to carry out routine daily tasks, such as bathing or dressing
  • Failure to achieve the expected level of academic, social or work performance
  • Signs persevere for six months or more
  • Other mental health disorders have been excluded

What are the Treatment Options for Childhood Schizophrenia?

Childhood schizophrenia is a condition that lasts throughout life - it is a chronic condition. Children with schizophrenia require treatment on a permanent basis; even when symptoms seem to have disappeared. Treatment is basically the same for all forms of schizophrenia. However, because childhood is such a strategic period in the formation of the person, treatment can be a challenge.

A whole team of health care professionals will be involved in treating a child with schizophrenia; usually led by a psychiatrist specialized in childhood schizophrenia. Schizophrenia can affect many areas of the patient's life - therefore the team will have a wide range of experts, including:
  • A case worker
  • A GP (general practitioner, primary care physician, family doctor)
  • A pediatrician
  • A pharmacist
  • A psychiatric nurse
  • A psychiatrist
  • A psychotherapist
  • A social worker
  • Members of the child's family
Medications - most medications used for childhood schizophrenia are the same as the ones used for adult schizophrenia, with antipsychotics being at the heart of treatment. The medications are mostly used off-label in children - this means they have not been specifically approved for pediatric use, but can be legally if the doctor believes it will help the child.

Antipsychotic medication may have serious side effects. It is important for parents and guardians, and also the patient to be aware of them, and to be able to weigh them up against the benefits they offer.

Atypical antipsychotics (2nd generation antipsychotics) - are a group of antipsychotic drugs used to treat psychiatric conditions. Atypicals differ from typical antipsychotics in that they are less likely to cause extrapyramidal symptoms (EPS). EPS include parkinsonian-type movements, rigidity and tremor. The Food and Drug Administration (FDA) in the USA has approved two atypical antipsychotics for children aged between 13 and 17 years:
  • Risperidone (Risperdal)
  • Aripiprazole (Abilify)
They are effective in treating hallucinations, lack of emotion, motivation problems and delusions.

Side effects may include:
  • Weight gain
  • Diabetes
  • High cholesterol
Typical antipsychotics (1st generation antipsychotics) - although they are as effective in treating the same symptoms atypical antipsychotics are, patients are more likely to have extrapyramidal symptoms (EPS), including involuntary movements of the face, tremor and parkinsonian-type movements. The generic versions of these drugs are much cheaper than atypical antipsychotics. Because of the risk of serious side effects, they are not usually recommended for pediatric use, unless other treatments have not worked.

Side effects in children - children may have different, and sometimes worse side effects than adults. Sometimes the side effects may even be life-threatening. When the child is very young, he/she may not be able to talk about medical problems clearly, and might not really know what is going on. Parents/guardians need to make sure they have discussed all aspects of the child's medication with the doctor - any health problems experienced during treatment need to be reported immediately.

If any problems with medications are identified early, the doctor can then adjust the dosage, or change the treatment (use another drug). A parent/guardian can also be taught to manage side effects.

Drug interactions (drug clashes with other substances) - it is important that the parents/guardians, and eventually the patient know what other medications, vitamins, minerals and herbal supplements may clash with their medications.

Psychotherapy - psychotherapy consists of a series of techniques for treating mental health, emotional and some psychiatric disorders. Psychotherapy helps the patient understand what helps them feel positive or anxious, as well as accepting their strong and weak points. If people can identify their feelings and ways of thinking they become better at coping with difficult situations. It only works if a trusting relationship can be built up between the client and the psychotherapist (in psychology "client" can mean "patient"). Treatment can continue for several months, and even years. Psychotherapy may be practiced on a one-to-one basis, or in pairs, and even in groups.

With individual therapy the child has the opportunity to learn about childhood schizophrenia; understand it better and cope with persistent symptoms. The importance of complying to a treatment plan becomes more compelling and relevant. Psychotherapy may also help the child overcome the stigma associated with schizophrenia.

The child's family may also benefit from family psychotherapy, which may become a vital source of support and education.

Social and academic skills training - this is a vital part of childhood schizophrenia treatment. The child will benefit from help in overcoming problem relationships and difficulties at school. Treatment plans can be set in place to deal with problems with washing and dressing, and functioning in an "appropriate" way for his/her age.

Hospitalization - this may be necessary when symptoms are severe, both for the child's personal safety, the safety of others, and to make sure he/she gets enough sleep, proper nutrition, and hygiene. It is vital that symptoms are brought under control rapidly - which a hospital setting is often better equipped to do.

What are the Possible Complications of Childhood Schizophrenia?

If the child with schizophrenia is not treated, there is a risk of serious complications, which may be behavioral, emotional, and cognitive. There is also a risk of eventual problems with the law. The following complications are possible:
  • Depression - more common later in life, but may also emerge beforehand. Although depression may be the result of the negative social impact caused by schizophrenia, some experts believe that depression may be a part of the disease itself.
  • Suicidal thoughts
  • Suicidal behavior
  • Inability to dress properly
  • Lack of personal hygiene
  • Decline in school performance
  • The child becomes unable to attend school
  • The child becomes an adult who cannot live independently
  • Social withdrawal
  • Withdrawal from family
  • Confrontations - arguments or physical confrontations
  • Substance abuse
  • Physical health - studies have shown that people with serious mental problems have a higher risk of developing (physical) health problems; not only because of side effects caused by medications.
  • The effect on loved ones - family members may suffer from grief, guilt, and several other emotional issues when faced with a loved one with childhood schizophrenia. The family members themselves are also at risk of depression, exhaustion, and other physical and mental problems.
With proper treatment, adherence to treatment (compliance, following the treatment plan), and support the child has a significantly better chance of eventually becoming a productive, independent and creative adult.

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