Psychosis (Schizophrenia) in Children – Information for Parents

Popular Hollywood movies like “A Beautiful Mind” or “Donnie Darko” all deal with the medical illness called schizophrenia or psychosis. If you have seen any such movies, you might be familiar with what it entails. Any mother who is told that her child has schizophrenia will experience stages of shock, grief and a sense of helplessness. To help you understand what exactly the condition is, we will discuss schizophrenia in children along with its diagnosis, risk factors and treatment in this article.

What is Schizophrenia (Psychosis)?

Schizophrenia is an uncommon but chronic psychiatric illness where children interpret reality abnormally. It distorts their thinking and causes them to experience auditory and visual hallucinations, delusions and irrational behaviour. Since it is quite uncommon in children below 12, medical professionals may often miss the early signs of this disorder. Also, because kids are still growing and developing both mentally and physically, it is difficult to recognise the symptoms in early stages of this disorder.

Paediatric schizophrenia is essentially the same as adult schizophrenia, but it occurs early in life and may hugely impact the child’s behaviour and development. Therefore, there are special challenges for diagnosis, treatment, education, emotional and social development. Schizophrenia is a condition which requires lifelong treatment but identifying the disorder and starting treatment as early as possible may significantly improve your child’s long-term outcome.

Causes of Schizophrenia in Children

This is a question researchers have been grappling with for long. There is no single cause of schizophrenia. It is more due to the complex interaction between your kid’s genetics and the environment. Some of the causes may include –

1. Genetics

The hereditary factor seems to play a role in schizophrenia in children. A child has about 10 percent chance of getting schizophrenia if he or she has a schizophrenic parent or sibling. Alternatively, a child with no first degree schizophrenic relatives has a 1 percent chance of developing the condition. Genetics is not a cause of great worry as the illness is not determined by it, but merely influenced. Just because your family has a history need not mean your child will definitely get the illness, even if he or she has a predisposition to it. So you can rest easy.

2. Abnormal structure of the brain

Psychosis in children can also be because of the abnormal structure of the brain. Research has shown that schizophrenic patients have enlarged brain ventricles. This basically means that there is reduced volume of tissue in the brain and little activity in its frontal lobe, which is the area responsible for planning, making and reasoning. In few studies, researchers have also found abnormalities in the temporal lobes, hippocampus and amygdala. However, as schizophrenia is a result of complex interactions, assuming one single problem in your child’s brain is the cause will be illogical.

3. Environment

In the end, environmental factors will be responsible for triggering schizophrenia even if your child has a predisposition towards this disorder. Based on certain research, findings show that stress during pregnancy or at a later stage causes the stress hormone cortisol to sharply increase in the mother’s body. This increase in level is said to be the cause of schizophrenia in the child. Some other stressful situations that can trigger this illness are:

• Childhood physical or sexual abuse
• Exposure to viral infection in the womb
• Low oxygen levels during birth which may be caused due to premature pr prolonged labour
• Exposure to virus as an infant
• Losing or separation from a parent at an early age

Childhood Schizophrenia Signs and Symptoms

1. Early Signs

Usually the initial signs on schizophrenia in children are developmental problems which include –

Language delays

• Late walking
• Late or unusual crawling
• Abnormal behaviour like rocking or flapping of arms

Some of the above symptoms can also be observed in children who have developmental diseases like autism. So it is important that the specialist rule out these developmental diseases before diagnosing schizophrenia.

2. Signs In Teenagers

Schizophrenia symptoms in teenagers are similar to those observed in adults, only they may be slightly more difficult to recognise. Especially because many symptoms are similar to those experienced by teenagers in their typical development stages, such as

Withdrawal from friends and family

• A drop in school performance
• Trouble sleeping
• Irritation or depressed mood
• Substance abuse
• Strange behaviour
• No motivation

Compared with adults, teenagers are less likely to have delusions and more likely to experience visual hallucinations.

3. Later Symptoms

More signs of schizophrenia will develop with age, such as

• Hallucinations: Your child may experience seeing things and hearing things that are not actually there. Hallucinations are completely normal for a person with schizophrenia but hearing voices that don’t exist is the most common symptom.

• Negative symptoms: This means your child will display a lack of ability to function properly. For example, he or she may neglect personal hygiene, appear to lack emotion – avoiding eye contact, lacking facial expressions, speaking in a monotone or speaking without hand or head movements that normally accompany speech. This is also a phase when your child will lose interest in everyday activities, withdraw socially and feel unhappy.

• Delusions: Delusions are fake beliefs not grounded in reality. Your child may experience fake feelings of being harmed or harassed or may believe certain comments are directed at him or may even tell you that something in his body is not functioning as it should.

• Disorganized thinking: Schizophrenic children have a disorganized thought process which leads to disorganized speech. He or she may not answer questions, impairing communication. Answers to questions may be unrelated and your child may put together sentences of meaningless words, which is called word salad.

• Abnormal movements: Your child will find it difficult to perform simple tasks and may adopt bizarre or inappropriate posture, be catatonic, display excessive movements, show resistance to instructions and may not respond to your or anyone else. Basically, his or her behaviour will not be focused on a goal.

What is Child-Onset Schizophrenia?

Child-onset schizophrenia is a severe form of the disorder that usually occurs in children aged 12 or younger. This form of psychosis is chronic and debilitating. Researchers have studied childhood-onset schizophrenia and have concluded that it is a virulent childhood version of the same schizophrenia exhibited by teenagers and adults. The condition is extremely tough to diagnose in children even though the symptoms are similar to the latter.

If your child has childhood-onset schizophrenia, he or she may not experience elaborate delusions and hallucinations like those experienced by adults but more of visual hallucinations. You should take care to distinguish these from the normal fantasy play.

1. Diagnostic Criteria For Child-Onset Schizophrenia

The specialist should take care to rule out other disorders like autism spectrum disorder and ADHD before diagnosing child-onset schizophrenia, as these disorders also exhibit the same symptoms in children. The diagnostic criteria for schizophrenia require at least two of the following five symptoms to be present for a month. Out of which at least one should be either of the first three –

• Delusions
• Hallucinations
• Disorganized speech
• Negative symptoms
• Hugely disorganized or catatonic behaviour

Other criteria include a lower level of functioning in one or more major areas like inter-personal relationships or self-care, continuous signs of disturbance for at least half a year, ruling out of schizoaffective disorder and exclusion of substance abuse or any other medical condition causing the disturbance. If the child is a patient of autism spectrum disorder or a communication disorder, the diagnosis of schizophrenia is made only if prominent delusions and hallucinations along with the other symptoms of schizophrenia are present for a month or more.

2. Prognosis Of Child-Onset Schizophrenia

The prognosis of child-onset schizophrenia differs from child to child. Some may display normal functions with medication while some may need a combination of psychotherapy and drugs.

3. On-Set Schizophrenia Risk Factors

The main risk factor is that the earlier your child develops schizophrenia, the poorer the outcome as it will prevent him or her from attending school and completing education. However, since you will always be around your children, it makes it easier to identify the symptoms of child-onset schizophrenia and get treatment sooner. Early diagnosis and treatment can reduce long-term impairment that schizophrenics experience.

Paranoid Schizophrenia In Kids

Paranoid schizophrenia causes children to experience intense feelings of fear and anxiety, because they think and feel something which is actually not there. They might feel some kind of bodily threat which will affect their thoughts and thinking process, causing them to withdraw from social settings. They will try to stay in isolation because of the fear that someone or something may be trying to hurt them.

1. Sign And Symptoms Of Paranoid Schizophrenia

Some symptoms of paranoid schizophrenia include –

• Delusions: This is the most common symptom is that the child will feel harmed, or harassed without any reason.
• Fear of being taken advantage of: The child will become argumentative, distrustful and lose the ability to relax as he will believe that everyone around is always trying to take advantage of him.
• Sense of fear, mistrust and suspicion: The child will become extremely tense, defensive and vigilant due to the delusions and beliefs he carries.

Paranoid schizophrenia can develop gradually. Watch out if your child, who is normally outgoing and friendly, suddenly reverts into himself, starts talking about strange fears and beliefs, and saying things that don’t make sense.

Diagnosis of Schizophrenia in Children

The diagnosis of childhood schizophrenia always starts with ruling out other mental health diseases associated with similar symptoms, like autism spectrum disorder and determining that the symptoms aren’t due to substance abuse or medication. The diagnosis process may involve –

• Physical exam: This may be done to rule out other problems causing the symptoms and to check for any related complications.
• Tests and screenings: These include tests to rule out other medical disorders and tests to screen for drugs and alcohol. The doctor may also ask to get an MRI or CT scan done.
• Psychological evaluation: This involves doing a complete psyche analysis – observing the child’s appearance, asking about thoughts feelings and behaviour patterns (including thoughts of self-harm or harming others), evaluating the ability to think and function at the age-specific level, noting anxiety and psychotic symptoms, and discussing family history.
• Diagnostic criteria for schizophrenia: The doctor may use the criteria in the Diagnostic and Statistic Manual of Mental Health Disorders (DSM-5), published by the American Psychiatric Association to diagnose the schizophrenia in the child.

Risk Factors for Childhood Schizophrenia

As mentioned before, there is no single cause for the development of schizophrenia. However, some factors may increase the risk of triggering childhood schizophrenia. These include–

• Having a family history of schizophrenia
• Advanced age of the father (over 40)
• Pregnancy and birth complications such as malnutrition or exposure to toxins or viruses which may have impacted brain development
• Increased immune system activation, such as from inflammation or auto-immune diseases

Complications

If childhood schizophrenia is left untreated, it can cause severe emotional, health and behavioural problems. Complications associated with the mental illness can arise in childhood or later, such as –

• Suicide, suicide attempts and thoughts of suicide
• Depression
• Self-injury
• Anxiety disorders such as OCD and panic disorders
• Family conflicts
• Inability to live independently, attend school or work
• Social isolation
• Health and medical problems
• Being victimized
• Legal and financial problems
• Homelessness
• Aggressive behaviour
• Alcohol abuse and abuse of other drugs including tobacco

Treatment of Schizophrenia in Kids

Treatment of childhood schizophrenia is a particular challenge as it is a lifelong process and must be continued even when the symptoms seem to go away. The main treatments for schizophrenia are –

1. Psychotherapy

Also called talk therapy, psychotherapy can help you and your child cope with schizophrenia. This may be –

• Individual therapy: Cognitive behavioural therapy with a skilled mental health professional can help your child learn ways to deal with the stress of managing everyday schizophrenia. Therapy can help the child attend school normally and make friends while learning about the disorder can help your child understand the symptoms and stick to a treatment plan.
• Family therapy: This involves support and education to families so that they may understand and help children who are living with this condition amongst them. Family therapy can also help in reducing conflicts, improve communication and cope collectively with the stress of the child’s schizophrenia.

2. Medications

This involves using anti-psychotic drugs which are effective for managing delusions, hallucinations, lack of motivation and emotion. Over time, the child’s doctor may try different combinations of drugs or different doses depending on the severity of the illness. Depending on the symptoms, other medication like anti-depressants or anti-anxiety drugs can also help. It can take several weeks after starting with medication to notice the results. It is important to remember that all anti-psychotic medications have health risks and side effects. Talk to your child’s doctor about the possible side effects and how to manage them. Make sure to report to the doctor anything different in your child after he or she starts taking the medication.

3. Life Skills Training

Building life skills as part of a treatment plan can ensure that your child can function at age-appropriate levels. It may include –

• Social and academic skills training – This is an important part to treat childhood schizophrenia. Schizophrenic children may have trouble at school and with friends. They may not be able to do daily tasks such as dressing and bathing.
• Vocational rehabilitation and supported employment – This helps people with schizophrenia prepare to find and keep jobs.

4. Hospitalisation

When your child displays severe symptoms, or in times of crisis, hospitalisation may be necessary. This will ensure the child’s safety and make sure that he is getting proper sleep, hygiene and nutrition. Partial hospitalisation and residential care may be options but usually, the child is first stabilized in the hospital before moving to other levels of care.

Home Remedies and Lifestyle

Here are ways to get the most out of a childhood schizophrenia treatment plan –

• Follow directions for medications
• Check first before taking other medications
• Pay attention to warning signs
• Make physical activity and healthy eating a priority
• Avoid alcohol, street drugs and tobacco

Prevention

• Early identification and treatment will help control symptoms of childhood schizophrenia before serious complications develop.
• Early treatment is also imperative to avoid and limit psychotic episodes which can be very scary for a child and his parents.
• On-going treatment with proper treatment plans can help improve a child’s long-term outlook on the illness.

Coping and Support

Coping with childhood schizophrenia is always challenging. You and your child may feel angry and resentful at managing a condition which requires life-long treatment or medications may have unwanted side effects. Some ways which can help cope with childhood schizophrenia are –

• Learn about the condition
• Join a support group
• Get professional help
• Stay focused on goals
• Find healthy outlets
• Begin planning for the future
• Take time as individuals

When should you Consult a Doctor?

Seek medical help if you notice a change in your child’s behaviour and the appearance of symptoms of childhood schizophrenia, such as

• Has stopped doing daily tasks such as bathing or dressing
• No longer wants to socialize
• Is slipping in academic performance
• Has strange eating rituals
• Shows excessive suspicion towards others
• Has strange ideas and fears
• Confuses dreams or television for reality
• Has violent or aggressive behaviour
• Has developmental delays compared with other siblings or peers
• Shows a lack of emotion
• Has bizarre ideas, behaviour or speech

FAQs

Here are some frequently asked questions related to paediatric schizophrenia –

1. Is Schizophrenia Hereditary in Kids?

Schizophrenia does not result from a single gene or specific cause, and so does not pass from one generation to another genetically. If you have schizophrenia in your family, your child may have a predisposition to it but may not develop it altogether. Schizophrenia is the result of a complex interaction of genes, environment and psychological factors.

2. Can People Diagnosed with Schizophrenia have Children?

There is no right or wrong answer for this but yes, people with schizophrenia can have children. However, it is best if the woman discusses with her psychiatrist her plan to have a baby and seek specialist advice before taking the decision. In many cases, the mother may need to be on medication during pregnancy or may need additional support for the baby as she may not be able to be the sole care provider.

3. Does Child Abuse Lead to Schizophrenia?

The amount of research on whether child abuse results in the development of schizophrenia in the child is not conclusive. However, it cannot be ruled out that child abuse may be one of the causes, as serious trauma during childhood can lead to schizophrenia.

Although discovering that your child has schizophrenia is devastating, an early diagnosis and treatment will improve prognosis and the child’s outlook towards life. You can also join a support group to empower yourself to be better prepared to cope with the situation and help your child to lead a normal life.