Schizophrenia in Children and Teenagers

Schizophrenia is a chronic and severe mental disorder that affects the domains of the brain controlling behaviour, thinking and perception. It requires lifelong treatment and management. Unfortunately, schizophrenia gets a really bad rap in the press and on social media and the mere mention of the word conjures up images of a violent, uncontrollable person completely out of touch with reality. Admittedly, someone with schizophrenia will experience delusions and hallucinations, however, if the disorder is diagnosed early and an appropriate treatment plan implemented, many will recover and remain stable throughout the life span.

Whilst the exact cause of schizophrenia is still unknown, it is thought to be a combination of genetics, brain chemistry and the environment (internal/external).

Risk factors include:

  • Family history
  • Older age of father
  • Pregnancy/birth complications: malnutrition, toxins, viruses that may affect in utero brain development
  • Taking mind altering drugs during teenage years
  • Increased immune system activation: autoimmune disorders

Signs and symptoms of schizophrenia usually occur between the age of 16 to 30; however, there is a rare form of early onset schizophrenia, also called childhood schizophrenia which usually presents around 7 years old. In over half of children who develop childhood schizophrenia, early signs and symptoms usually present in first months of life:

  • Language problems
  • Late or unusual crawling
  • Late walking
  • Abnormal motor behaviour

It is important to note that these developmental problems are also common in children with pervasive development disorders such as autism spectrum disorder. Therefore, physician assessment is necessary.

The challenge with childhood schizophrenia is that other mental disorders also present with similar symptoms e.g. depression, bipolar disorder, PTSD, OCD, severe personality disorders.

According to the American Academy of Child and Adolescent Psychiatry the symptoms typical of childhood schizophrenia are:

  • Odd and eccentric behaviours
  • Catatonic behaviour
  • Extreme moodiness
  • Severe anxiety related to delusions and hallucinations
  • Self isolation and difficulty making friends
  • Poor hygiene
  • Believes television and dreams are real
  • Communication impairment
  • Poor eye contact
  • Blunted affect
  • Avolition

Signs and symptoms of schizophrenia in teenagers

Whilst the symptoms are similar to adults, the disorder may be difficult to recognise at first, because some of the early signs/symptoms are common for typical development during adolescence e.g. substance use, trouble sleeping, lack of motivation, strange behaviour, social withdrawal, problems at school. As the teenager ages, the more common symptoms appear which are categorized into three groups: positive, negative, cognitive.

1. Positive Symptoms:
Thought disorders – disorganized thinking, word salad
Movement disorders- unpredictable mood swings, easily agitated, childlike silliness
Hallucinations – seeing/hearing things that don’t exist
Delusions – false beliefs not based in reality

2. Negative Symptoms:
Flat affect
Reduced speaking
Decreased feelings of pleasure in everyday life
Difficulty starting and continuing activities

3. Cognitive symptoms:
Trouble focusing, paying attention
Poor executive functioning
Problem with working memory (using information immediately after learning it)

If left untreated, eventually the child/teenager becomes so unwell that he/she may become psychotic and experience a ‘break from reality.’ Untreated and/or inappropriate treatment of early childhood schizophrenia can result in severe emotional, behavioural and health problems in adolescence and adulthood. Therefore, prompt assessment comprising a physical exam, diagnostic tests and drug screening, psychological evaluation and review of all signs and symptoms is encouraged.

Problems include:

  • Depression
  • Anxiety
  • Non suicidal self injury
  • Family conflicts
  • Social isolation
  • Victimization
  • Alcohol/substance abuse, smoking
  • Homelessness
  • Inability to live independently, attend school, work
  • Suicide

When to Seek Help

  • Child has significant developmental delays
  • Reduced socialization with friends/family
  • Failing grades in school
  • Strange eating rituals
  • Excessive paranoia and suspicion of others
  • Stops bathing, dressing
  • Lack of emotion or inappropriate emotions
  • Strange, bizarre ideas and fears
  • Unpredictable behaviour – aggressive, agitated, violent outbursts
  • Suicidal thoughts and behaviors
  • Bizarre ideas, behaviours, speech
  • Confuses dreams, TV shows for reality

Treatment Plan
Medications – antipsychotic drugs
Psychotherapy – talk therapy, family counselling, cognitive behavioural therapy
Community supports
Life skills training – vocational rehabilitation, social and academic skills training, supported employment
In patient treatment

How to help a child/teenager with schizophrenia
Education is key; this is a lifetime mental disorder that requires medication management, periods of therapy, etc. Parents and other family members should utilize all supports and resources that are offered. Schizophrenia is a very challenging illness and it can be very stressful and scary watching the child/teenager experiencing the different symptoms. Feelings of helplessness, sadness, embarrassment and blame are not uncommon in parents/siblings. Therefore, the more informed parents are about the disorder, the better able they are to support the child/teenager and help educate other family, siblings, friends.

Adherence to the treatment plan is key to healing and better long-term outcomes for the child/teenager e.g. ensure medications are taken as prescribed, monitor and report side effects and/or changes in behaviours, etc.

Follow though with planned psychotherapy, life skills classes
Work with teachers, counsellor re: appropriate school plan
Adopt healthy diet, exercise, follow daily routine to promote sense of normalcy
Monitor for signs of self harm, substance use, being bullied, suicidal thoughts
Consider joining a support group
Be patient, offer support and guidance, monitor for changes and most importantly, show love

In my next Blog #25
I will discuss eating disorders in children and teenagers

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