Childhood Schizophrenia, also known as childhood psychosis is considered a rare form of mental illness affecting children; however, a child may be experiencing signs and symptoms of Schizophrenia or psychosis without an official diagnosis. Whether a child exhibits only a few symptoms or meets the full diagnostic criteria for Schizophrenia, it is essential to have the child evaluated and begin treatment.
High-Risk Childhood-Onset Schizophrenia
Although childhood-onset of Schizophrenia symptoms are uncommon (adolescent-onset, adult-onset and late-onset are more common), a diagnosis of Schizophrenia is given when the symptoms are present and are not better accounted for by a more common childhood disorder.
Childhood-onset Schizophrenia is also referred to as childhood Schizophrenia, developmental psychosis, symbiotic psychosis, atypical development or childhood psychosis. Regardless of the label given to the set of symptoms, childhood-onset is characterized by the set of typical symptoms appearing before the age of 18 years. The course of illness is more severe than those that develop later in life and continues on to adolescent and adult Schizophrenia.
Studies have shown that although there are no set criteria for assessing a child’s risk, some children are at a higher risk of developing childhood-onset Schizophrenia, based on biological and environmental factors. The majority of children diagnosed with Schizophrenia do not have biological parents with the disorder; however, those who have one schizophrenic parent have a 12 percent lifetime risk of developing the illness. The risk of developing a Schizophrenia spectrum disorder increases to 35 to 46 percent when both biological parents are affected.
Environmental and developmental factors also increase the child’s risk, particularly during prenatal and infancy stages. Prenatal stress of the mother, pregnancy and birth complications and early exposure to viral infections contribute to higher risk.
Young children with neurointegrative issues, social impairment, information processing problems or abnormal brain development and those with premature exposure to puberty hormones or an increased exposure (especially during fetal and infancy stages) to environmental hazards that affect the brain and nervous system are at a greater risk.
Delusions, Hallucinations and Paranoia
Hallucinations are sometimes common in children and are often confused with normal imaginary play (see Hallucinations in Children: Normal Imagination or Mental Disorder for more information). True hallucinations, delusions and paranoia are common among children with Schizophrenia. Often the object of the child’s delusions and hallucinations causes paranoia, which is most apparent by an increase in anxiety, panic and fear.
The child may experience delusions based on any number of themes, with persecutory delusions being the most common. For example, he may believe, unjustifiably, that he is followed, picked on, ridiculed or bullied – believing that classmates, teachers, parents or neighbors are “out to get him.” He may also have delusions related to his religious upbringing, immediate environment or an outside force controlling his mind or body. Bizarre delusions are referred to those that are not possible and often involve mind and body control, such as believing he has been abducted by an alien life form or a higher being is controlling his actions and thoughts.
Hallucinations can affect any of the sense; however, auditory hallucinations (hearing voices that are not there) are the most common, especially in children. The child may hear a voice, whether familiar or unfamiliar, talking to him, providing instructions or commanding him to act in a certain way. Likewise, he might hear two or more voices in a conversation or an outside voice commenting on his thoughts and actions.
Likewise, he might have visual hallucinations where he sees people or objects that are not there. This is often evident by observing the child and his behavior, particularly if he appears to be distant and distracted. As an example, I witnessed a 4-year-old male who would stare out the window for long periods on a regular basis, ranging from 20 minutes to an hour. He was intent on watching whatever was going on as if he were watching a favorite movie, yet there was nothing out the window to watch.
When asked what he was looking at, he could describe in great detail the people he saw and what they were doing. In this case, it went far beyond normal childhood imagination and the people and events he witnessed were very real to him. He did not understand others could not see what he saw. In other cases, children have seen objects, animals or people in their home, on the playground or elsewhere in the community.
Some cases of hallucinations involve tactile hallucinations and may be combined with auditory or visual hallucinations. Feeling and seeing bugs crawling on the child’s body are often related to certain medications; however, these types of hallucinations may also occur during the active phase of schizophrenia when they occur on a regular basis.
Disorganized Thought, Speech and Behavior
Young children often jump from one thought to another, answer questions inappropriately, act silly and behave unpredictably, making it difficult to distinguish normal child behavior from that which is cause for concern. Occasional or mild instances are generally not a cause for concern. Severe occurrences that prevent effective communication and functioning appropriate for the child’s age and ability are worth noting.
- Consistently shifting from one topic to another, rapidly – unrelated to a normal short attention span.
- Answers questions with unrelated answers – Question: What do you want to eat for dinner? Answer: I went to the library at school today and the teacher read a book about a dog. More severe – Q: Where is your homework? A: Pizza and ice cream.
- Completely incoherent word babbling – not attributed to the child’s age and appropriate developmental level.
- Immature silliness and inappropriate dress – for example, wearing four pairs of pants and three coats on a hot, summer day. Be aware that much of this is typical child behavior and must be severe enough to interfere with normal daily activities.
- Inappropriate sexual behavior – beyond normal childhood exploration
- Unprovoked anger outbursts and agitation – consistently without motivation
Catatonic Behavior, Repetition and Unresponsiveness
Catatonic behaviors in children range from a mild decrease in responsiveness to the environment and surroundings to severe unresponsiveness or resistance to all outside stimuli.
- Decrease in reaction to or complete unawareness of surroundings – the child does not react to outside of events or does not notice.
- Rigidity, tense or stiffness, irregular posture – the child resists moving, being moved or asked to move, whether minor movement of extremities or whole body movement. He may assume strange or inappropriate positions and refuse attempts to move.
- Excessive movement without a purpose – The child moves part or all of his body excessively without any reason or stimulation. Normal childhood play is not considered excessive.
- Emotional or mental unresponsiveness – The child appears unresponsive, emotionally or mentally, as evident by a lack of eye contact, appropriate body language or by observing facial expressions. He often appears “blank” or “empty.”
- Inability to express thoughts through speech – The child expresses short and brief, empty replies, appearing to have a decrease in thoughts, making speech unproductive. This must be differentiated from a child refusing to talk out of stubbornness or fear of getting in trouble when he has been caught doing something wrong.
- Lacks initiative and persistence – The child may sit for long periods and show little or no interest in participating in activities or playing. He lacks the initiative or motivation to do things he normally enjoys.
- Repetitive speech or gestures – The child says certain words or phrases repeatedly, most often out of context and in a flat tone of voice. He may also perform repetitive body movements or gestures, such as arm flapping, kicking, rocking or tapping.
It is important to realize that many of the speech and behavior symptoms, when taken individually, are often normal during child development. One or two signs present only occasionally are not sufficient for immediate concern. The child should be observed and monitored in different situations to determine if there is really an issue for concern beyond normal child development.
Disclaimer: Childhood Schizophrenia is a serious mental health condition requiring professional diagnosis and treatment by a qualified mental health specialist. If your child, or a child in your care, is experiencing true hallucinations, delusions, paranoia, dangerous behavior or other signs of childhood Schizophrenia, seek help from the child’s pediatrician, child psychiatrist or emergency medical services immediately. Do not hesitate to have the child evaluated.
*While the designation ‘he’ may be used to represent all children, the use of ‘he’ does not imply this is relevant only to males. The behaviors and strategies are equally relevant to females. The designation of ‘he’ or ‘she’ should be considered interchangeable.
Photos ©Malysa Stratton Louk. All rights reserved. Photos may not be copied, borrowed, altered or reproduced in any way, either electronically or in print, without prior written permission from the copyright holder.
Sources:
- “DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders”; The American Psychiatric Association; 2000.
- “The Encyclopedia of Schizophrenia and Other Psychotic Disorders”; Third Edition; Richard Noll, PhD; 2007.
Malysa Stratton Louk - Malysa Stratton Louk is a freelance writer, journalist & photographer in the Pacific Northwest. View her full profile for more ...
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