How Childhood Schizophrenia Is Treated

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Childhood schizophrenia, also called childhood-onset schizophrenia (COS) or very early–onset schizophrenia, is a severe mental health disorder diagnosed in children under the age of 13. It is characterized by distorted thinking, altered perceptions, unusual behavior, and unusual use of language and words.

While each child's treatment plan will differ depending on age, the nature and severity of symptoms, response to treatment, and comorbid disorders (other conditions they have), the most common treatment options are medication in combination with psychotherapies. Psychosocial interventions are also a common treatment option.

Treatment for Childhood Schizophrenia

Verywell / Jessica Olah

As the condition is not curable, current treatments focus on managing symptoms and helping with day-to-day life. Childhood schizophrenia can severely affect how a child develops and their ability to function on a daily basis.

Early treatment of the disorder is seen as vital to improving symptoms and minimizing social, cognitive, and functional deficits. This article will discuss the prescription medications, therapies, alternative and complementary therapies, and lifestyle modifications used to treat childhood schizophrenia.

How Common Is Childhood Schizophrenia?

Childhood schizophrenia is very rare, affecting less than 0.04% of children. When the condition is diagnosed before the age of 18 but after age 13, it is referred to as early-onset schizophrenia (EOS). EOS is rare, though not as rare as childhood schizophrenia, with an estimated prevalence of 0.23%.

Prescription Medications

Antipsychotics are commonly used to treat schizophrenia. They work by helping to reduce the intensity and frequency of the positive symptoms of psychosis (such as hallucinations and delusions). Positive symptoms are symptoms that add experiences or behaviors.

Antipsychotics can potentially have severe side effects. The balance between the risks and benefits of these medications appears less favorable in children than in adults. However, given the severity and debilitating nature of childhood schizophrenia, they are also prescribed for treating children and adolescents.

Multiple randomized control trials have shown that both first- and second-generation antipsychotics are superior to a placebo (an inactive medication) in treating psychotic symptoms.

The specific medications prescribed are generally the same for both adults and children, although some of these are not formally approved for the treatment of children and adolescents.

Second-Generation Antipsychotics

Also referred to as atypical antipsychotics, second-generation antipsychotics are generally the preferred choice for the treatment of schizophrenia. In addition to blocking dopamine (a chemical messenger in the brain), these antipsychotics also affect another brain chemical called serotonin.

No second-generation antipsychotics are approved by the Food and Drug Administration (FDA) for treating schizophrenia in children younger than 12, so they would be prescribed off-label.

Some of the second-generation antipsychotics approved by the FDA to treat schizophrenia in those ages 13 and older include:

  • Abilify (aripiprazole)
  • Zyprexa (olanzapine)
  • Seroquel (quetiapine)
  • Risperdal (risperidone)
  • Invega (paliperidone) *approved for children ages 12 and over

Side effects of second-generation antipsychotics include:

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

There is evidence that children and adolescents taking antipsychotics for schizophrenia may be at greater risk of side effects, such as weight gain, than adults. As such, their widespread use in children and adolescents, who are in a vulnerable phase of their physical growth and brain development, has been questioned.

It is important to have a frank discussion with your child's doctor about both the benefits and drawbacks of antipsychotic medication for your child.

Treatment-Resistant Childhood Schizophrenia

Childhood schizophrenia is associated with poor treatment response, meaning that children may be less likely to respond well to traditional treatments than adults.

Studies suggest that a second-generation antipsychotic, Clozaril (clozapine), is more effective for those with childhood schizophrenia than all other antipsychotics. It is approved for the treatment of severely ill adults who fail to respond to standard drug treatment for schizophrenia.

However, clozapine has the potential for very serious side effects, and so it is not usually given to children unless they are severely ill and other medications have failed to improve their symptoms.

Clozapine carries serious warnings, called black box warnings, about possible severe side effects including the potential to lower white blood cell counts. Because of this, it can only be prescribed through a special program that restricts distribution called the Clozapine Risk Evaluation and Mitigation Strategies (REMS) Program.

In terms of common side effects to second-generation antipsychotics, a 2018 meta-analysis found that out of all antipsychotics used to treat schizophrenia in children, clozapine had one of the highest levels of weight gain.

First-Generation Antipsychotics

Also called typical antipsychotics, first-generation antipsychotics are older medications that impede dopamine.

Though these antipsychotics are usually as effective as second-generation antipsychotics, they have a greater risk of certain potentially serious neurological side effects. These include the movement disorder tardive dyskinesia, which may or may not be reversible.

For this reason, they are generally used for children only when other options are not successful, tolerated, or available.

Some of the first-generation antipsychotics used to treat schizophrenia in children include:

  • Thorazine (chlorpromazine)
  • Haldol (haloperidol)
  • Perphenazine

Adjusting Medications

Sometimes people need to try out a few different medications before they find the best one for them. However, it is important to talk to your child's healthcare professional before your child stops taking medication. The healthcare professional can adjust your child's treatment plan safely and effectively.

Therapies

Psychotherapy and psychosocial interventions are used alongside medication in the treatment of childhood schizophrenia.

Although there is strong evidence that these treatments are effective in adults when used alongside medication, there have been a limited number of randomized control trials of these interventions specifically in children.

Common psychotherapeutic and psychosocial treatments are:

  • Individual therapy: Cognitive behavioral therapy (CBT) is a common form of psychotherapy used with children who have schizophrenia. It may help your child with struggles at school and making friends and in coping with their symptoms. Those who have regular psychosocial treatment are less likely to relapse or be hospitalized.
  • Family therapy: Improving how key supports in a child's life understand psychotic symptoms, treatment options, and the course of recovery can ensure that your child is supported in the best way possible.

Life Skills Training

The goal of life skills training is to help your child function at an age-appropriate level. 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, school, and 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.

Multidisciplinary Approach

There is evidence that the most effective treatment of childhood schizophrenia involves a combination of both medications and different types of psychotherapies, along with psychosocial intervention.

A 2016 study evaluated the benefit of a comprehensive, multidisciplinary, team-based treatment approach as compared with community care for first-episode psychosis across 34 clinics in the United States for patients ages 15 to 40 years old.

This multidisciplinary approach includes four main interventions:

  • Medication management
  • Family psychoeducation to help the patient and family cope and support the patient’s treatment and recovery
  • Resilience-focused individual therapy to maximize strengths and increase illness management skills
  • Supported employment and education addressing illness-related challenges to both work and school

The study found that participants receiving this type of intervention, when compared with those receiving community care, had significantly improved psychopathological symptoms as well as quality of life.

There is also evidence that early intervention can help to improve symptoms.

A 2012 randomized control trial looked at young people with early initial signs of psychosis and investigated the effectiveness of integrated psychological intervention, including CBT, group skills training, and multifamily psychoeducation as well as supportive counseling.

The study found that the integrated intervention was more effective in delaying the onset of psychosis over a 24-month follow-up period.

Alternative Treatments

The use of alternative treatments for psychotic disorders is of growing interest, but clinical trials are limited and have shown inconsistent results. Speak to your child's healthcare professional before considering any alternative or complementary treatments.

Nutritional and Dietary Supplements

Specific nutrients are believed by some to be useful as complementary options in the treatment of schizophrenia due to their essential role in proper brain functioning. Omega-3s, for example, have been studied for schizophrenia. However, the evidence regarding their effects on this condition is inconclusive.

The extract from ginkgo leaves is also promoted as a dietary supplement for many conditions, including schizophrenia. According to the National Center for Complementary and Integrative Health, a small amount of evidence suggests a benefit from taking ginkgo for schizophrenia, but the overall evidence is not conclusive.

Be Aware of Drug Interactions

The prescription medications used to treat childhood schizophrenia can interact negatively with other drugs. Make sure to tell your child's healthcare provider about any prescription or over-the-counter medication, vitamins, supplements, and/or herbal or natural products that they are taking or are going to take.

Lifestyle

Getting treatment for childhood schizophrenia requires a qualified mental health practitioner. However, several self-care strategies can help with symptoms and are also helpful for those supporting a child with schizophrenia.

These strategies can support the treatment plan and help reduce anxiety and stress.

Examples of self-care strategies are:

  • Eating a healthy diet
  • Exercising regularly
  • Getting enough sleep
  • Effectively dealing with minor illnesses and conditions

Summary

Childhood schizophrenia is most commonly treated with medication alongside psychotherapy. Second-generation antipsychotic medications are preferred. Cognitive behavioral therapy and family therapy may be used. Psychosocial interventions to support education and employment are also treatment options.

A Word From Verywell

Childhood schizophrenia is a serious and lifelong mental health disorder. If diagnosed, your child will need ongoing support, so make sure you speak to a medical professional about all possible treatment options.

While the disorder cannot be cured, if your child's symptoms are addressed early on, treatment can be successful and help improve symptoms. 

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