What Is Childhood Schizophrenia?

Childhood schizophrenia (also called pediatric or early onset schizophrenia) is a complex mental health disorder that causes distorted thinking, altered perceptions, unusual behavior, and unusual use of language and words. It's very rare, affecting only about 0.04% of children.

If a child is diagnosed with childhood schizophrenia, extensive lifelong treatment is required, which includes medication and therapy. Treatment is usually carried out as a team by medical and psychiatric professionals, social workers, and the family.

What Is Childhood Schizophrenia?

Schizophrenia usually emerges in young adulthood, typically in the late teens into the mid-to-late 20s, but it can occur at any age, including in children.

Schizophrenia in children is very rare, occurring in approximately one in 40,000 people under the age of 18.

Childhood schizophrenia results in a disturbance in thinking, behavior, and emotions. It often causes:

• Hallucinations
• Delusions
• Extremely disordered thinking and behavior

Once schizophrenia develops (in childhood or adulthood), it requires lifelong treatment. While symptoms may get better and worse, there is no cure for schizophrenia and it will not go away on its own or with treatment. That said, certain symptoms of schizophrenia can be successfully managed with treatment, especially if diagnosed early and treatment is started promptly.

Types By Age

Some researchers sort schizophrenia into three age categories:

• Schizophrenia: Occurring in adults over age 18
• Early-onset schizophrenia: Occurring in children between the ages of 13 and 18
• Very early-onset schizophrenia: Occurring in children under age 13. Exceptionally rare.

Symptoms

Schizophrenia in children looks a lot like schizophrenia in adults, except that children are more likely to experience auditory hallucinations and generally don't develop delusions or formal thought disorders before they are in at least mid-adolescence.

Symptoms can occur as early as infancy but are very rare in children under age 13 and often overlap with other conditions or even typical development. If you see any of these symptoms in your child, discuss them with your healthcare provider to determine the cause and level of concern, whether or not it turns out to be caused by childhood schizophrenia.

With all of the below symptoms, a child or adolescent with schizophrenia is generally not aware that these behaviors pose a problem and does not have a sense of becoming ill or realize that something is wrong. The seriousness is only apparent to others.

Possible Early Warning Signs In Infants

• Extensive periods of inactivity or abnormal listlessness (little energy, sleeping a lot and/or is hard to rouse, not alert or attentive to visual cues)
• Overly relaxed or “floppy” arms or legs
• Unnaturally still
• Flat posture when lying down
• Unusually sensitive to bright lights or rapid movements

Possible Warning Signs In Toddlers

• Chronic high fevers
• Repeating behaviors, fixation on behaving according to a specific regimen, even in play
• Persistent state of distraction, anxiety, or distress
• Extreme degree of fear of certain events, situations, or objects that does not subside
• Weak and slumping posture

Possible Early Symptoms In School-Aged Children

• Auditory hallucinations (false perceptions of sounds. "Hearing" sounds that others don't hear), usually manifested as loud noises, whispers, or collective murmuring
• Claims that someone or something is “in my head” or “telling me to do things”
• Extreme sensitivity to sounds and lights
• Frequent self-talk, spending the majority of their time conversing and laughing with themselves while shutting out real people and surroundings. (Distinct from having an “imaginary friend” or the occasional talking to themselves common to all children.)
• Tendency to be very “closed off” from others
• Visual hallucinations (seeing things that are not actually there). This commonly includes streaks or swirls of light or flashing patches of darkness

Possible Early Symptoms In Adolescents and Teens

• “Blank affect” (a persistently vacant facial expression)
• Awkward, contorted, or unusual movements of the face, limbs, or body
• Suspicions of threats, plots, or conspiracies (for example, the complaint or belief that someone has been sent to spy on them)
• Dwelling excessively on failures, perceived slights, or past disappointments
• Unprovoked or disproportionate irritability or angry outbursts that are extreme
• Unwarranted resentment and accusations against others that is extreme (such as believing their parents are stealing from them)
• Difficulty following a single train of thought
• Inability to read and respond appropriately to other people's nonverbal “cues” (such as tone of voice, facial expressions, or body language)
• Inappropriate behavior and responses to social situations (for example, laughing out loud during a sad moment)
• Incoherent speech
• Poor personal hygiene practices, or lapses in personal hygiene practices
• Long periods of staring without blinking
• Difficulty focusing on objects
• Rapidly fluctuating moods
• Visual or auditory hallucinations (seeing or hearing things that others do not)
• Sudden, painful sensitivity to light and noise
• Sudden, significant changes in sleep patterns, such as the inability to fall or stay asleep (insomnia), or excessive sleepiness and listlessness (catatonia)
• Talking aloud to themselves, often repeating or rehearsing conversations with others (real or imaginary)
• Tendency to rapidly shift topics during a single conversation
• Using “nonsense” or made-up words
• Withdrawal from friendships, family, and activities

Adolescents and teens with childhood schizophrenia may also experience irrational thinking, including:

• Assigning a “special meaning” to events and objects with no personal significance (for example, believing a famous person on television is conveying a secret message with their words or gestures)
• Assumption of extravagant religious, political or other authority (like believing they are God)
• Believing that another person or entity is controlling their body, thoughts, or movements
• Believing that an evil force, spirit or entity has “possessed” their body or mind

In childhood schizophrenia that has progressed, symptoms are grouped into four categories:

• Positive symptoms
• Negative symptoms
• Disorganized speech
• Disorganized or catatonic behaviors

Positive Symptoms

Positive symptoms of childhood schizophrenia involve the onset and acquisition of certain feelings, traits, and behaviors that were not there before. In this case, "positive" does not mean beneficial, but rather indicates that something has started rather than stopped.

Positive symptoms might include:

• Unfounded beliefs that someone, or something, poses a threat or is causing some type of harm
• Confused thinking (for example, difficulty distinguishing between fiction (like TV shows or dreams) and reality
• Hallucinations (seeing, hearing, or feeling things that are not real)
• Delusions (ideas, situations, or threats that seem real but are not actually based in reality. Not usually experienced until at least adolescence and more commonly early adulthood)
• Regressive behavior (for example, an older child suddenly acting like a much younger child)
• Severe anxiety
• Severe changes in behavior
• Suddenly having difficulty with schoolwork and/or being unable to comprehend material that was previously familiar
• Vivid, detailed, and bizarre thoughts and ideas

Negative Symptoms

Negative symptoms of childhood schizophrenia refer to the lack or loss of certain capabilities and traits. In this case, "negative" is not assigned because the trait or behavior is detrimental or harmful, but because it involves a previous trait or behavior ceasing, or the lack of a trait or behavior that should be there.

Negative symptoms might include:

• Lack of appropriate emotional responses (for example, laughing in a situation that is somber)
• Inability to sustain existing friendships and relationships and severe difficulty making friends
• Lack of emotional expression when interacting with others

Disorganized Speech

Disorganized speech describes spoken and written communication that is nonsensical, garbled, or impossible for others to follow.

This may include:

• Using words and sentences that do not fit together
• Inventing words or terms that make no sense to others
• inability to stay “on track” in a conversation

Disorganized or Catatonic Behaviors

This refers to impaired behaviors that drastically impact a person's daily functions and activities.

For example:

• Engaging in inappropriate activities or speech (like making an obscene gesture in an inappropriate setting)
• Extreme moodiness and irritability
• Wearing clothing that is inappropriate for the weather—such as a winter coat in summer heat
• Lack of or inappropriate habits personal hygiene habits, such as not bathing or not brushing their teeth
• Catatonic state (suddenly becoming confused or agitated, followed by sitting and staring in place as though “frozen”)

Diagnosis

Diagnosing childhood schizophrenia can be difficult, particularly in young children. This is partly because:

• Distinguishing between true hallucinations and normal childhood imaginative play can be difficult (for example, it is common for children to have an imaginary friend, which could be mistaken for psychosis)
• Children with poor or underdeveloped language skills may appear to be exhibiting the disorganized thought and speech patterns of childhood schizophrenia
• Children, with or without schizophrenia, cannot always describe their experiences accurately or reliably, making the collection of information needed to form a diagnosis difficult

With childhood schizophrenia, symptoms may build up gradually instead of having a sudden or noticeable onset. The early signs and symptoms may be vague and go unnoticed or may be attributed to a developmental phase.

Childhood schizophrenia can look like other conditions (including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder), particularly in the early stages. For this reason, determining a diagnosis of childhood schizophrenia involves ruling out other mental health disorders and determining that symptoms aren't due to substance abuse, medication, or a medical condition.

The process of diagnosing childhood schizophrenia may include:

• A physical exam: Your child's healthcare provider will speak with you and your child about their medical history and symptoms. The provider will perform an exam of your child, looking for anything that could explain the symptoms your child is experiencing.
• Tests and screenings: These may include blood tests or other lab tests, and/or imaging studies, such as an MRI or CT scan. These tests can rule out conditions with similar symptoms. The healthcare provider might also screen for alcohol and drugs.
• Diagnostic criteria for schizophrenia: Your child's healthcare provider or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. While there are some differences between childhood and adult schizophrenia, the criteria used for diagnosis are basically the same.

Your child's healthcare provider may conduct or order a psychological evaluation.

A psychological evaluation can involve:

• Observing your child's appearance and demeanor
• Asking about your child's thoughts, feelings, and behavior patterns. (This includes discussing any thoughts of self-harm or harming others)
• Evaluating your child's ability to think and function at an age-appropriate level
• Assessing your child's mood, anxiety, and possible psychotic symptoms
• As with a physical exam, a psychological evaluation includes a discussion of family and personal history

Causes

The exact cause of childhood schizophrenia is unknown, but scientists have noticed some correlations that may contribute to its development.

Genetics

Schizophrenia is considered to have an inherited component. A combination of genes passed down from each parent can lead to schizophrenia. This includes:

• Being born into a family with one or more family members affected by schizophrenia means a person has a greater chance of developing schizophrenia than someone born into a family with no history of schizophrenia.
• After a person has been diagnosed with schizophrenia, the chance of a sibling also being diagnosed with schizophrenia is 7% to 8%.
• The child of a parent with schizophrenia has a 10% to 15% chance of developing the disorder.
• The likelihood of an individual being diagnosed with schizophrenia increases with multiple affected family members.
• Children whose fathers were older than 30 years old at the time of their conception also have a higher risk of developing schizophrenia.

Differences in the Brain

Scientists have discovered changes to the brain that indicate that schizophrenia is a brain disease. Problems with certain naturally occurring brain chemicals, like the neurotransmitters dopamine, serotonin, and glutamate, may contribute to schizophrenia. Differences in the brain structure and central nervous system of people with schizophrenia have been found with neuroimaging studies.

While research is still being conducted to learn how schizophrenia affects the brain, scientists believe the condition may be linked to:

• A below-normal amount of gray matter: Gray matter consists of nerve (neuron) cell bodies throughout the central nervous system. A below-normal amount of gray matter in the brain's temporal lobe (the part of the brain that is responsible for auditory processing and memory) and frontal lobe (the front portion of the brain's cerebral hemisphere, responsible for processing emotions, retaining memories, making decisions and measuring social responses) has been linked to schizophrenia.
• Related loss of gray matter in the parietal lobe: The parietal lobe is the part of the brain that processes information from the senses and coordinates spatial information.

Immune System

Increased immune system activation, such as from inflammation or autoimmune diseases, has been linked to childhood schizophrenia.

Complications, Exposures, or Stressors in the Womb

Though it hasn't been proven conclusively, stressors in the womb to parent or fetus have been linked to childhood schizophrenia. These can include:

• Maternal malnutrition
• Maternal drug or alcohol use
• Exposure to certain hormonal or chemical agents
• Exposure to certain viruses or infections
• Extreme stress

Environmental

Some other environmental factors that have been linked to the development of schizophrenia include:

• The use of psychoactive (mind-altering) drugs during teen years
• Regular use of cannabis before adulthood (this has been linked to schizophrenia, but has not as of yet been determined as a cause. More research is needed.)
• Childhood neglect or mistreatment (this has been linked to the development of schizophrenia symptoms, but more research is needed).

Treatment

Childhood schizophrenia is often treated as a team, lead by a child psychiatrist. Your child's team may include some or all of the following:

• A psychiatrist, psychologist, or other therapists
• A psychiatric nurse
• A social worker
• Family members
• A pharmacist
• A case manager (to coordinate care)

The course of treatment to take depends on the age of the child, how severe the symptoms are, and other mitigating factors—but treatment usually includes at least one of these options:

Medications

The medications used for childhood schizophrenia are generally the same ones used for adult schizophrenia, although some of these are not formally approved for use in children. Antipsychotics are frequently used to control some of the positive symptoms of childhood schizophrenia. Antipsychotics fall into two categories:

Second-Generation Antipsychotics

These drugs are newer and are generally the preferred choice because they tend to have fewer movement-related side effects than some of the older antipsychotics.

Some of the second-generation antipsychotics approved by the Food and Drug Administration (FDA) to treat schizophrenia in teenagers age 13 and older include:

• Aripiprazole (Abilify)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Paliperidone (Invega) (FDA-approved for children 12 years of age and older)

Side effects of second-generation antipsychotics include:

• Weight gain
• High blood sugar
• High cholesterol
• Sedation
• Activation/restlessness

First-Generation Antipsychotics

Though these first-generation antipsychotics are usually as effective as second-generation antipsychotics, they have a greater risk of certain potentially serious neurological side effects, including the movement disorder tardive dyskinesia, that may or may not be reversible. For this reason, they are generally only used for children when other options are not successful, tolerated, or available.

Some of the first-generation antipsychotics approved by the FDA to treat schizophrenia in children and teens include:

• Chlorpromazine for children 13 and older
• Haloperidol for children 3 years and older
• Perphenazine for children 12 years and older

Psychotherapy

Sometimes called talk therapy, psychotherapy can be used alongside medication to help treat childhood schizophrenia. Psychotherapy can involve your child, your child's family, or both.

• Individual therapy: Psychotherapy may help your child with struggles at school and making friends, and coping with their symptoms. Cognitive behavioral therapy is a common form of psychotherapy used with children who have schizophrenia.
• Family therapy: Psychotherapy that involves the whole family is a great way to support your child who has schizophrenia and for your family members to get the support and information they need.

Life Skills Training

The goal of life skills training is to help your child function at age-appropriate levels. While this is not possible with all children, life skills training helps them reach their best potential. Skills training may include:

• Social and academic skills training: Children with schizophrenia often have difficulties with relationships, with school, and with everyday activities such as self-care. With appropriate training, they can improve the skills they need to succeed in these areas.
• Vocational rehabilitation and supported employment: Gaining and maintaining employment is difficult for teens with schizophrenia. This training helps teens with schizophrenia build their job skills.

Hospitalization

Childhood schizophrenia cannot always be managed safely at home. During a period of crisis or when symptoms are severe, treatment in a hospital setting may be necessary to ensure your child's safety and to help make sure they are getting proper sleep, hygiene, and nutrition.

Once severe symptoms have been stabilized in the hospital, partial hospitalization (a structured outpatient program for psychiatric services) may be possible, or residential care may be an option if your child is not ready or able to return home.

Coping

Living with childhood schizophrenia is difficult for your child and the whole family. In addition to formal treatment, there are things you can do to support your child, your family, and yourself.

How to Support Your Child

• Keep your child's appointments with their healthcare provider, and ask for referrals to specialists such as a child psychiatrist if necessary.
• Work with your child's school to implement and follow a treatment plan. The Americans with Disabilities Act (ADA) and Section 504 of the Civil Rights Act help ensure that public schools meet the educational needs of all children. You are your child's advocate.
• Educate yourself about childhood schizophrenia, and keep up-to-date on new studies and information.
• Look into social service assistance, both for now and for the future. Most children with schizophrenia continue to need support and some level of care into adulthood.
• Help your family stay focused on goals. Living with childhood schizophrenia is an ongoing process that can cause stress for everyone. Focusing on goals can help.

How To Take Care Of Yourself

• Join a support group.
• Protect your own mental health by seeking professional help if you are feeling overwhelmed.
• Explore healthy outlets that help you and your family channel energy or frustration, such as hobbies, exercise, and recreational activities.
• Regularly take some time for yourself to decompress and relax, even if you need to schedule it. Create opportunities for each member of your family to have their own much-needed alone time too.

Outlook

Left untreated (and sometimes with treatment), childhood schizophrenia can lead to short-term and long-term complications, such as:

• Health, medical, and additional mental health disorders
• Substance abuse
• Legal and financial problems
• Social isolation
• Family conflict
• Inability to work, attend school, or live independently
• Self-harm
• Suicide, suicide attempts, and thoughts of suicide

Prognosis

While there is no cure, treatment for childhood schizophrenia can be quite successful. With proper treatment, children and teens are often able to meet milestones at school, at work, and in their personal lives—many grow up to go to college, hold jobs, and have families.

Treatment for childhood schizophrenia is most effective if the condition is caught early and a treatment plan is started. Other factors in the successful treatment of schizophrenia include:

• A foundation of family and school support and awareness.
• Remaining under the care of a healthcare provider for therapeutic treatment and regular monitoring
• Seeking professional treatment as soon as symptoms emerge
• Taking prescribed medications exactly as directed and for as long as directed (medication is often needed long-term or even life-long)

A Word From Verywell

While childhood schizophrenia is difficult for your child and your whole family, effective treatment is available. If your child is showing signs of childhood schizophrenia, take them to see their healthcare provider. If your child receives a diagnosis of childhood schizophrenia, work with your child's mental health team to make a treatment plan, and find ways for your family to get the support they need. A diagnosis of childhood schizophrenia can be scary—but with proper help, it is manageable.