What Is Childhood Schizophrenia?

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Childhood schizophrenia is an uncommon but severe mental disorder where children have unusual behavior and distorted perceptions of reality. It is characterized by onset prior to age 13, and affects one in 40,000 children. Schizophrenia is not often found in children younger than age 12. Symptoms often begin in the middle to late teen years. This condition is hard to spot in its early stages.

The concerns with schizophrenia range from behavioral to emotional effects, and may include hallucinations as well as impairment of everyday functionality.

Little girl covers her face with her hands

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Symptoms

Symptoms of childhood schizophrenia may vary, but usually include delusion, hallucinations, confused speech, and the inability to function. Behavioral changes can take place slowly over time, but they can also occur suddenly. A child with schizophrenia may slowly become more shy and withdrawn. They may also start to talk about odd ideas or fears and start to cling more to their parents.

Symptoms of schizophrenia in children are similar to those in adults, but children experience auditory hallucinations more often (80% of cases) and typically do not experience delusions or formal thought disorders until mid-adolescence or older. These symptoms of schizophrenia may resemble other problems or psychiatric conditions. It's important to consult with your pediatrician to rule out a diagnosis of childhood schizophrenia.

Early Signs

Early warning signs of childhood schizophrenia may differ from child to child, but can include:

  • Trouble telling dreams from reality (distorted view of reality)
  • Confused thinking, such as confusing TV with reality
  • Detailed and bizarre thoughts and ideas
  • Fear or belief that someone or something is going to harm him or her
  • Seeing, hearing, or feeling things that are not real, such as hearing voices (hallucinations)
  • Ideas that seem real but are not based in reality (delusions)
  • Extreme moodiness
  • Lots of anxiety or fear
  • Lack of emotional expression when speaking
  • Trouble doing schoolwork or a drop in levels of school success
  • Social withdrawal, such as having problems making and keeping friends
  • Sudden agitation and confusion
  • Disorganized behavior, such as doing private things in public. Or catatonic behavior, such as sitting and staring, as if the child can’t move
  • Odd behaviors, such as an older child acting like he or she is much younger

Later Signs

In older children, the following may be symptoms of schizophrenia:

  • A persistently vacant facial expression (known as blank affect)
  • Awkward, contorted, or unusual movements of the face, limbs, or body
  • Complaints and suspicions of threats, plots, or conspiracies
  • Dwelling excessively on perceived slights, failures, or past disappointments
  • Extreme irritability or angry outbursts that are unprovoked or disproportionate to the situation
  • Extreme or unwarranted resentment and accusations against others
  • Inability to follow a single train of thought
  • Inability to read nonverbal cues
  • Inappropriate behavior and responses to social situations like laughing in a sad situation
  • Incoherent speech
  • Irrational thinking, including assigning a special meaning to events and objects with no personal significance; assumption of extravagant religious, political, or other authority; belief that another person or entity is controlling their body, thoughts, or movements; or belief that an evil force, spirit, or entity has possessed their body or mind
  • Lapses in personal hygiene practices
  • Long periods of staring without blinking or difficulty focusing on objects
  • Rapidly fluctuating moods
  • Seeing or hearing things that others do not
  • Sudden, painful sensitivity to light and noise
  • Sudden significant changes in sleep patterns
  • Talking aloud to themselves, often repeating or rehearsing conversations with others (real or imaginary)
  • Tendency to rapidly shift topics during a single conversation
  • Use of nonsense or made-up words
  • Withdrawal from friendships and activities

Classifications of Symptoms

The symptoms of schizophrenia are classified as positive (delusions, hallucinations and bizarre behavior), negative (flat affect, withdrawal, and emotional unresponsiveness), disorganized speech (including speech that is incomprehensible), and disorganized or catatonic behavior (marked mood swings, sudden aggression, or confusion, followed by sudden motionlessness and staring).

Diagnosis

A child and adolescent psychiatrist may have to conduct a thorough physical and mental health evaluation to diagnose schizophrenia.

The tests a healthcare provider may perform to help diagnose childhood schizophrenia include:

  • Physical exam: This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
  • Tests and screenings: These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. The healthcare provider may also request imaging studies, such as an MRI or CT scan.
  • Psychiatric evaluation: This includes observing appearance and demeanor, asking about thoughts, feelings, and behavior patterns, including any thoughts of self-harm or harming others, evaluating ability to think and function at an age-appropriate level, and assessing mood, anxiety, and possible psychotic symptoms. This also includes a discussion of family and personal history.

Your healthcare provider or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Diagnostic criteria for childhood schizophrenia are generally the same as for adult schizophrenia.

The DSM-5 diagnostic criteria for schizophrenia in children are:

  • Delusions
  • Hallucinations
  • Disorganized speech (i.e., frequent derailment or incoherence)
  • Grossly disorganized or catatonic behavior
  • Negative symptoms
  • Failure to achieve expected level of interpersonal, academic, or occupational functioning
  • Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less if successfully treated)
  • The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition
  • If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least one month, or less if successfully treated

When to See a Healthcare Provider

If your child has several of the following experiences, consider visiting a medical professional with your child to rule out the possibility of schizophrenia:

  • Is your child developmentally delayed?
  • Has your child stopped bathing or dressing themself?
  • Has your child become increasingly antisocial?
  • Are their academic goals slipping?
  • Have their eating habits changed?
  • Are they becoming paranoid and suspicious of other people?
  • Do they lack emotion?
  • Do they confuse dreams with reality?
  • Are they becoming aggressive?

Causes

The cause of childhood schizophrenia is unknown. However, researchers do believe that like adult schizophrenia, genetics, brain chemistry, and environmental factors play a part. In identical twins, if one twin has the disorder, the other twin has a 40% to 50% chance of also developing schizophrenia. However, not everyone who has a family history of this condition will have it.

Some studies have found that abnormalities in the naturally occurring brain chemicals, dopamine and glutamate, may contribute to schizophrenia as well. Other studies have looked at the differences between the brain of a person with the disorder and that of those who don’t. Another theory is that there is abnormal brain development during both early fetal stages and adolescence.

Some experts believe a child’s schizophrenia may also be linked to certain environmental factors that affect the mother during pregnancy, such as:

  • Drug or alcohol use
  • Exposure to particular hormonal or chemical agents
  • Exposure to certain viruses or infections
  • Extreme stress
  • Poor nutritional health

Treatment

Schizophrenia in children is generally treated with a combination of medications and therapy. Lifelong monitoring by a qualified mental health professional is a must for anyone diagnosed with schizophrenia.

Medications

Antipsychotics are typically prescribed for children with schizophrenia. These types of medications help manage delusions, hallucinations, and disorganized thinking. A healthcare provider may try a variety of medications or a combination of several drugs if necessary. If mood symptoms are present, mood-stabilizing medicines like lithium and valproic acid or antidepressants may also be prescribed.

Antipsychotic drugs may have side effects, including drowsiness, restlessness, muscle spasms, dry mouth, and blurred vision. If your child experiences these side effects, a healthcare provider can lower the dosage or make changes in medications to help the body better adjust.

Therapy

Psychotherapy will help your child deal with the life changes that schizophrenia brings. Family therapy will provide education to the entire family and show the child that everyone is involved in their health and well-being. Specialized educational or structured activity programs, which include social skills training, vocational training, and speech and language therapy, may also be helpful.

Children with schizophrenia are also encouraged to participate in a support group, which can help them cope with the condition and work on their social skills.

Coping

If your child has schizophrenia, here are some things you can do to help:

  • Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include experts like psychiatrists, counselors, therapists, psychologists, and social workers. Your child’s care team will depend on the nature of their schizophrenia.
  • Take care of yourself. You may feel overwhelmed or stressed out. Being in touch with other parents who have a child with schizophrenia may be helpful. Talk with your child’s healthcare provider about a support group for caregivers of children with schizophrenia or seek counseling.
  • The Americans with Disabilities Act and Section 504 of the Civil Rights Act help ensure that public school meets your child's educational needs. Talk with your child’s teacher and school principal about reasonable accommodations so your child can be successful in school.
  • Take all symptoms of depression and suicide very seriously. Suicide is a health emergency.

Prognosis

There are no preventive measures or cure for schizophrenia at the moment, but if parents address their child's symptoms early on, treatment can be very successful and helpful. Children and adolescents with the disease can still achieve milestones at school, at work, and in their personal lives. With proper treatment, many children with schizophrenia can go to college, hold jobs, and have families as adults.

A Word From Verywell

Schizophrenia is a serious, lifelong mental illness. Children with the disorder need ongoing support, patience, nurturing, and attention. As a parent, make sure to discuss all possible treatment options with a medical professional—don't give up.

It’s normal to feel scared, stressed, and overwhelmed when your child has schizophrenia. Build a network of other parents whose children struggle with schizophrenia as well. Talk about the disorder. Reach out to others for help. And most importantly, take care of yourself so you can take care of your child. 

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9 Sources
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