Learning how to tell early schizophrenia symptoms in teens apart from typical adolescent strife can help your teen receive timely treatment.

Schizophrenia is a mental health disorder characterized by psychosis, a state of inaccurate reality perception that involves major symptoms like hallucinations, delusions, and disorganized thinking.

As a progressive, lifelong condition, however, schizophrenia often starts subtly with mild changes to mood, social function, and thinking. This early phase is known as the prodromal period.

In teens, symptoms of the prodromal period can look similar to depression or anxiety, making it challenging to know when your child may need mental health support.

In order to determine a schizophrenia diagnosis, mental health professionals use criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).

The DSM-5-TR focuses on the symptoms of fully developed schizophrenia, as not everyone experiences a prodromal phase.

Under the guidelines, schizophrenia can be diagnosed when the following symptoms have been present for the majority of time during a 1-month period and are persistent for at least 6 months:

  • delusions (rigid adherence to beliefs that can be proven untrue)
  • hallucinations (false sensory experiences)
  • disorganized thinking (disconnected, often incomprehensible thoughts and speech patterns)
  • disorganized motor function (agitation or catatonia)
  • negative symptoms

At least one of these symptoms must be delusions, hallucinations, or disorganized thinking.

Negative symptoms

Negative symptoms in mental health disorders are symptoms that imply a loss of natural function.

They include:

  • diminished emotional expression
  • decrease in purposeful, self-motivated activities (avolition)
  • diminished speech output (alogia)
  • inability to experience pleasure from positive stimuli (anhedonia)
  • social withdrawal or lack of interest in being social (asociality)

Other common experiences in schizophrenia that support diagnosis include:

  • inappropriate emotional responses (e.g., laughing for no reason)
  • anxiety and phobias
  • anger or irritability
  • sleep disturbance
  • refusing food
  • depersonalization
  • derealization
  • impaired cognitive function (poor memory, language impairment, difficulty learning)
  • inability to accurately interpret the intent in others’ words and actions
  • unawareness of the disorder (anosognosia)

Early symptoms

The early symptoms of schizophrenia in teens can be easily missed — or dismissed — because of how unassuming they often are.

In teens, early symptoms can appear as:

  • changed friend groups
  • difficulty making or keeping friends
  • mood changes
  • academic decline
  • disinterest in sports, hobbies, or other activities they used to enjoy
  • self-isolation from family and friends
  • a decline in personal hygiene
  • uncharacteristic beliefs or magical thinking
  • poor sleep
  • low energy
  • emotional coldness
  • fearfulness
  • uncharacteristic behaviors
  • unusual perceptual phenomena (e.g., feeling like they don’t recognize themselves or loved ones)

Research suggests that prodromal symptoms in adolescents occur over 1 year before classic symptoms of psychosis, and many are early manifestations of negative symptoms.

While anyone, at any age, can develop schizophrenia, women tend to see onset in their late 20s to early 30s, while men are more likely to experience onset during the late teens to early 20s.

Early-age-onset schizophrenia is rare and, therefore, understudied. Childhood-onset schizophrenia occurs in approximately 0.04% of the population.

You don’t have to wait until your child is experiencing symptoms of psychosis to seek a schizophrenia diagnosis.

A mental health professional starts the diagnostic process with a detailed history, both of prior medical concerns and of everyday changes that might contribute to symptoms.

Because many early schizophrenia symptoms in teens are nonspecific, part of making a diagnosis involves ruling out all other possible underlying causes.

Neurodegenerative disorders, developmental conditions, and other mental health disorders, such as severe depression, anxiety, and post-traumatic stress disorder (PTSD), can have similar presentations.

Your teen may need:

  • baseline psychometric testing
  • blood work
  • urine screenings
  • developmental testing
  • psychological or neuropsychological assessment (or both)

When everything else has been ruled out and schizophrenia is the most likely cause, this is when a diagnosis is made.

Schizophrenia without psychosis?

The DSM-5-TR states that hallucinations or delusions must be present for a schizophrenia diagnosis.

However, this manual is just a clinical standard that helps classify and identify disorders. In the prodromal phase, many hallmarks of schizophrenia aren’t evident, but that doesn’t mean you aren’t living with schizophrenia.

You can still receive a diagnosis when enough factors come together to suggest schizophrenia in its early stages.

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There’s no cure for schizophrenia, but treatment can significantly improve the severity of the symptoms throughout life.

Most people, including teens, benefit from the use of antipsychotic medications. These will be customized to your teen’s specific needs and closely monitored for any adverse side effects.

Medication can help control symptoms of psychosis, but schizophrenia is a lifelong condition that involves much more than reality perception.

Psychosocial treatments are just as important as medications in symptom management.

Family therapy can help everyone learn more about schizophrenia, how to recognize its symptoms, and which ways to best support a teenager with the diagnosis. Family therapy can also address group function and concerns.

For your teen, cognitive behavioral therapy (CBT) is the gold standard of psychotherapy in schizophrenia. A therapist works with your teen to develop coping strategies and to change unhelpful thoughts and behaviors into helpful ones. Other therapies, including acceptance and commitment therapy (ACT) and psychodynamic therapy, are treatment options as well.

Over time, your teen can learn how to self-manage many of the symptoms of schizophrenia, but they may need help in other ways.

As a parent, you can also:

  • advocate for academic accommodations, like tutors
  • connect your teen to support groups
  • help them find ways to stick to medication schedules
  • offer to participate with them in therapy sessions
  • check in with them regularly to ensure their needs are being met
  • encourage healthy lifestyle habits like exercise and a balanced diet

Schizophrenia symptoms in teens can be challenging to detect when they occur subtly in the prodromal phase.

If you notice your teen’s behavior has changed, they’re disinterested in their hobbies, and their grades have dropped, speaking with a mental health professional can help — regardless of the underlying cause.

Speaking with a therapist can help rule out conditions like schizophrenia, and even if a mental health disorder isn’t present, a therapist can help your teen cope with the stresses of adolescence.