What to Know about Schizophrenia in Kids

Schizophrenia is a mental health condition that alters people’s sense of what is real. In other words, what people with schizophrenia see, hear, feel, and think doesn’t match reality.

To understand schizophrenia in childhood, it’s helpful to know that schizophrenia occurs in phases:

• Prodrome: Subtle symptoms begin. Small personality changes, anxiety, depression, and increasing isolation may only be noticeable to those closest to the person with schizophrenia.

• Active: Symptoms become significant enough to interfere with daily functioning.

• Residual: Symptoms gradually recede or decrease.

About 75% of adults with schizophrenia have a prodrome phase that may last months or years before an active phase. For some people, prodrome begins in childhood or early teen years. For others, prodrome occurs in young adulthood or doesn’t happen at all.

When the symptoms of schizophrenia appear before young adulthood, healthcare experts often refer to the condition as early onset schizophrenia (EOS). At first, the symptoms of EOS can look much like the symptoms of other health conditions, which makes it harder to diagnose in children and teens.

Mental health experts generally divide symptoms into two categories: positive and negative symptoms. Positive symptoms are new experiences that weren’t present in a child’s life before schizophrenia started. Negative symptoms are experiences or abilities they once had but don’t have as much anymore.

Positive symptoms may include:

• Hallucinations: During hallucinations, a person sees, hears, feels, or tastes things that don’t line up with reality.
• Delusions: Delusions are beliefs about yourself or the world that don’t match reality.
• Disordered thinking: During disordered thinking, a person is confused, distracted, or has disjointed thoughts.
• Disorganized speech: A person chooses words based on sound instead of meaning, not completing thoughts or connecting unrelated ideas when speaking or writing.
• Issues with movement: A person exhibits unusual movements or lack of movement.

Negative symptoms may include:

• Blunted or flat affect: Blunted affect describes dulled or feeling “flat” or emotionless.
• Alogia: This presents as speaking less than you normally do, and it’s sometimes called dyslogia.
• Avolition: Avolition describes feeling less motivated or goal-oriented.
• Asociality: This is about preferring to be alone or wanting to interact less with other people.
• Anhedonia: Anhedonia is experiencing less pleasure or enjoyment.

Often, these symptoms can get in the way of a child’s social and emotional development. They may not sleep as well. They may not take care of themselves as well physically, and they may have trouble in school. Some people even experience extreme anxiety, fear, and aggression.

Schizophrenia is a neurodevelopmental condition. That means differences in brain structures and brain functions happen as a child develops. These differences later lead to schizophrenia.

Genes have a strong influence on whether someone develops schizophrenia. In large genome-wide association studies (GWAS), researchers have identified around 270 genetic differences in people with schizophrenia. Some of the gene differences are inherited, and others aren’t.

Genes don’t tell the whole story, though. Imaging studies show differences in brain chemicals and structures in people with schizophrenia.

Other factors that may contribute to schizophrenia include:

• the child’s environment
• inflammation
• viral infection
• malnutrition during pregnancy
• social and psychological factors, such as childhood trauma
• psychedelic drug use

Schizophrenia can be diagnosed by a pediatrician, a pediatric neurologist, or a pediatric psychiatrist or psychologist. There’s no one test that proves someone has schizophrenia. Your child’s healthcare professional may:

• look at images of your child’s brain using magnetic resonance imaging (MRI) or computed tomography (CT) scans to check for other possible causes
• take blood, urine, or other fluid samples
• use an electroencephalogram (EEG) test to look at your child’s brain activity

A healthcare professional will talk with your child and you to see which symptoms are present and how long they’ve been happening. For a diagnosis of schizophrenia, an individual must have at least two of the five positive symptoms listed above, and an individual must have been experiencing them for at least a month.

It may take some time to get a clear diagnosis because:

• Symptoms can come on gradually.
• The condition is rare in children, so health professionals may look for more common conditions at first.
• Symptoms can look like characteristics of other conditions, such as post-traumatic stress disorder (PTSD), personality disorders, or autism.

Treatments depend on your child’s specific symptoms and on any other health conditions your child is experiencing. Each person’s treatment plan will be determined by a treatment team that includes doctors, psychologists, physical and occupational therapists, educators, and other professionals involved in your child’s overall care.

Here are some common treatment options:

• medications that treat psychosis, depression, anxiety, and other symptoms
• therapy for the child and the family
• cognitive behavioral therapy (CBT) to help with thinking skills and emotional symptoms
• social skills training to help your child understand and communicate with other people
• electroconvulsive therapy (ECT) when other treatments aren’t effective

Schizophrenia has genetic, family, and environmental risk factors. The more risk factors someone has, the higher the chances that they’ll experience symptoms of schizophrenia.

When researchers looked at all the risk factors that predict a higher chance of developing schizophrenia, the only risk factor that made EOS more likely was having a family history of schizophrenia.

Researchers haven’t yet found a cure for schizophrenia. Once symptoms begin, they’re likely to increase over time. When schizophrenia symptoms appear during childhood, it can sometimes mean that symptoms in adulthood will be more severe.

It’s important to be aware that people with EOS have a higher risk of suicide than others. A good collaboration with healthcare professionals, social support, treatment for symptoms, and coping skills training can help lower that risk.

Here’s more information on resources for suicide prevention.

Where can families find help dealing with the stress schizophrenia can cause?

Parents, siblings, caregivers, family members, and friends can all experience stress when someone they love is living with schizophrenia. It’s very important to take good care of your own physical and mental health. These resources may help:

• National Alliance on Mental Health Family Support Group Locator
• Schizophrenia & Psychosis Action Alliance “I’m a Caregiver, Now What?” Toolkit
• Schizophrenia & Psychosis Action Alliance Families for Care Calls & Zoom Meetings

Can schizophrenia affect a child’s education?

Like many other health conditions, some children with schizophrenia also have learning difficulties. For example, studies have shown that schizophrenia and dyslexia both disrupt language, how you perceive what you see and hear, and executive function.

Researchers have also found that by age 16, many students with schizophrenia have lower math achievement. You have the right to work with your child’s school to create an education plan that meets all of your child’s needs.

What is electroconvulsive therapy (ECT)?

In ECT, doctors stimulate the brain with electricity to cause a very brief (20-60 seconds) seizure. During the seizure, the brain releases hormones and other chemicals that can help relieve schizophrenia symptoms.

When teens have the treatment, they’re usually admitted to the hospital so healthcare professionals can monitor their response.

Is electroconvulsive therapy safe for young people?

The American Academy of Child & Adolescent Psychiatry says ECT is safe for use with children and adolescents. Even so, it’s generally used to treat conditions that haven’t responded to first-line treatments.

Your child’s healthcare team will evaluate your child’s overall health before recommending ECT.

Schizophrenia in children is rare. When early onset schizophrenia (EOS) does happen, you may notice small personality changes at first. Over time, a young person with schizophrenia may begin experiencing hallucinations, delusions, and disorganized thinking and speech.

Because EOS can affect social relationships, education, and many other outcomes, it’s important to work with healthcare professionals to find the right diagnosis and start a treatment plan as early as you can.

Treatments can include medication, education for your family, and therapy to help young people build the skills they need to manage the condition. In rare cases, electroconvulsive therapy (ECT) may be an option.

Schizophrenia is a lifelong condition. For many people, there are times when symptoms are severe and times when they are in remission. With ongoing support from family, healthcare professionals, educators, and career specialists, a young person with schizophrenia has a better chance of managing symptoms and living a healthier life.