Created on August 5, 2017. Last updated on February 17th, 2020 at 05:00 pm
Schizophrenia is the most common psychotic disorder and is characterized by unusual thoughts, unstable and intense emotions, and strange behavior. People with schizophrenia may be unable to consistently distinguish what is real from what is imaginary and may perceive images, sounds or other sensory experiences in the absence of a stimulus. People with schizophrenia may also struggle to care for themselves and may withdraw from activities or people they normally enjoy, and/or express fear and anxiety that interferes with their functioning.
Childhood-onset schizophrenia is rare and represents a severe form of the disorder, with more pronounced early neurodevelopment abnormalities and often a chronic, treatment-refractory course. It also poses unique challenges for diagnosis and treatment. Symptoms of schizophrenia more typically begin in middle- or late-adolescence.
Schizophrenia is one of several disorders characterized by psychotic symptoms; a full evaluation at the onset of symptoms can help to clarify diagnosis and ensure the administration of appropriate treatment.
Psychotic symptoms, including hallucinations (the experience of hearing, seeing, tasting, smelling, or feeling something that is not actually there) and delusions (thought disturbances in which the person maintains a false belief despite the absence of proof) can develop gradually or suddenly. Symptoms of childhood-onset schizophrenia may include delays in language, poor motor development, unusual crawling, rocking, posturing, and arm flapping. Symptoms of adolescent-onset schizophrenia are more likely to include increased anxiety, depression, irritability and disruptiveness, in addition to withdrawal from family and peers, diminished academic and cognitive performance, and trouble sleeping.
The diagnostic criteria for schizophrenia include both negative and positive symptoms. Positive symptoms of schizophrenia include hallucinations and delusions. Negative symptoms of schizophrenia typically include a lack of interest in initiating and pursuing activities (avolition), minimal speech (alogia), lack of pleasure from typically-enjoyable activities (anhedonia), and low emotional expression. Negative symptoms may become apparent when youth fail to complete daily activities, such as bathing, and withdraw from other people.
Although schizophrenia is a chronic illness, symptoms tend to follow an episodic course, especially early on. With treatment, symptoms may remit (positive symptoms are often more responsive to treatment than negative symptoms) resulting in periods of relative wellness.
Initiating treatment as early as possible may significantly improve a child’s long-term outcome. There are few studies of treatment for child-onset schizophrenia. Because child-onset schizophrenia is often associated with significant developmental abnormalities, these youth are likely to require intensive services to assist with both mental health and daily functioning.
Treatment guidelines for adolescents with psychotic symptoms recommend both medication and psychosocial interventions. There are early-treatment programs for psychotic disorders nationwide (http://www.raiseetp.org/forfamilies/participate.cfm) that provide both medication and psychosocial interventions. These multimodal programs have the strongest evidence base and include components of the other interventions that have been tested through randomized clinical trials, including family therapy, individual cognitive therapy, academic and job support, and social skills training. Schizophrenia affects multiple domains of functioning and a more comprehensive approach to treatment offers the best chance at reducing the consequences of this illness.
Other interventions with strong empirical support include family-focused therapy, cognitive behavior therapy for psychosis, special services at school to maintain academic functioning, and social services, such as vocational skills training.
The use of antipsychotic medications is also recommended for most children and adolescents with schizophrenia or other psychotic disorders. You can read more about this here: https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf
Multimodal therapy (includes components of many of the other therapies for psychotic disorders)
CBT for psychosis
Omega-3 fatty acids supplementation
Social skills training
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