Disease: Childhood schizophrenia

Overview

Childhood schizophrenia is an uncommon but severe mental disorder in which children interpret reality abnormally. Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. It may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs your child's ability to function.

Childhood schizophrenia is essentially the same as schizophrenia in adults, but it occurs early in life and has a profound impact on a child's behavior and development. With childhood schizophrenia, the early age of onset presents special challenges for diagnosis, treatment, education, and emotional and social development.

Schizophrenia is a chronic condition that requires lifelong treatment. Identifying and starting treatment for childhood schizophrenia as early as possible may significantly improve your child's long-term outcome.

Source: http://www.mayoclinic.com

Symptoms

Schizophrenia involves a range of problems with thinking, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. The effect can be disabling.

Schizophrenia symptoms generally start in the mid- to late 20s. It's uncommon for children to be diagnosed with schizophrenia. Early-onset schizophrenia occurs before age 18. Very early-onset schizophrenia in children younger than age 13 is extremely rare.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present. Schizophrenia can be difficult to recognize in the early phases.

Early signs and symptoms

The earliest indications of childhood schizophrenia may include developmental problems, such as:

  • Language delays
  • Late or unusual crawling
  • Late walking
  • Other abnormal motor behaviors — for example, rocking or arm flapping

Some of these signs and symptoms are also common in children with pervasive developmental disorders, such as autism spectrum disorder. So ruling out these developmental disorders is one of the first steps in diagnosis.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

  • Withdrawal from friends and family
  • A drop in performance at school
  • Trouble sleeping
  • Irritability or depressed mood
  • Lack of motivation
  • Strange behavior
  • Substance use

Compared with schizophrenia symptoms in adults, teens may be:

  • Less likely to have delusions
  • More likely to have visual hallucinations

Later signs and symptoms

As children with schizophrenia age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:

  • Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; that certain gestures or comments are directed at you; that you have exceptional ability or fame; that another person is in love with you; or that a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
  • Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, hallucinations have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
  • Disorganized thinking. Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
  • Extremely disorganized or abnormal motor behavior. This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
  • Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion ― doesn't make eye contact, doesn't change facial expressions, speaks in a monotone, or doesn't add hand or head movements that normally occur when speaking. Also, the person may have reduced ability to engage in activities, such as a loss of interest in everyday activities, social withdrawal or lack ability to experience pleasure.

Symptoms may be difficult to interpret

When childhood schizophrenia begins early in life, symptoms may build up gradually. The early signs and symptoms may be so vague that you can't recognize what's wrong, or you may attribute them to a developmental phase.

As time goes on, symptoms may become more severe and more noticeable. Eventually, your child may develop the symptoms of psychosis, including hallucinations, delusions and difficulty organizing thoughts. As thoughts become more disorganized, there's often a "break from reality" (psychosis) frequently requiring hospitalization and treatment with medication.

When to see a doctor

It can be difficult to know how to handle vague behavioral changes in your child. You may be afraid of rushing to conclusions that label your child with a mental illness. Your child's teacher or other school staff may alert you to changes in your child's behavior.

Seek medical advice if your child:

  • Has developmental delays compared with other siblings or peers
  • Has stopped meeting daily expectations, such as bathing or dressing
  • No longer wants to socialize
  • Is slipping in academic performance
  • Has strange eating rituals
  • Shows excessive suspicion of others
  • Shows a lack of emotion or shows emotions inappropriate for the situation
  • Has strange ideas and fears
  • Confuses dreams or television for reality
  • Has bizarre ideas, behavior or speech
  • Has violent or aggressive behavior or agitation

These general signs and symptoms don't necessarily mean your child has childhood schizophrenia. These could indicate a phase, another mental health disorder such as depression or an anxiety disorder, or a medical condition. Seek medical care as soon as possible if you have concerns about your child's behavior or development.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a child or teen who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your child to the nearest hospital emergency room.

Source: http://www.mayoclinic.com

Causes

It's not known what causes childhood schizophrenia, but it's thought that it develops in the same way as adult schizophrenia does. Researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder. It's not clear why schizophrenia starts so early in life for some and not for others.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Source: http://www.mayoclinic.com

Diagnosis

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 diagnosis may involve:

  • 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 doctor may also request imaging studies, such as an MRI or CT scan.
  • Psychological 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.
  • Diagnostic criteria for schizophrenia. Your doctor 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. Diagnostic criteria for childhood schizophrenia are generally the same as for adult schizophrenia.

Challenging process

The path to diagnosing childhood schizophrenia can sometimes be long and challenging. In part, this is because other conditions, such as depression or bipolar disorder, can have similar symptoms.

A child psychiatrist may want to monitor your child's behaviors, perceptions and thinking patterns for six months or more. As thinking and behavior patterns and signs and symptoms become clearer over time, a diagnosis of schizophrenia may be made.

In some cases, a psychiatrist may recommend starting medications before an official diagnosis is made. This is especially important for symptoms of aggression or self-injury. Some medications can help limit these types of behavior and restore a sense of normalcy.

Source: http://www.mayoclinic.com

Complications

Left untreated, childhood schizophrenia can result in severe emotional, behavioral and health problems. Complications associated with schizophrenia may occur in childhood or later, such as:

  • Suicide, suicide attempts and thoughts of suicide
  • Self-injury
  • Anxiety disorders, panic disorders and obsessive-compulsive disorder (OCD)
  • Depression
  • Abuse of alcohol or other drugs, including tobacco
  • Family conflicts
  • Inability to live independently, attend school or work
  • Social isolation
  • Health and medical problems
  • Being victimized
  • Legal and financial problems, and homelessness
  • Aggressive behavior, although uncommon

Source: http://www.mayoclinic.com

Prevention

Early identification and treatment may help get symptoms of childhood schizophrenia under control before serious complications develop. Early treatment is also crucial in helping limit psychotic episodes, which can be extremely frightening to a child and his or her parents. Ongoing treatment can help improve your child's long-term outlook.

Source: http://www.mayoclinic.com

Lifestyle and home remedies

Although childhood schizophrenia requires professional treatment, it's critical to be an active participant in your child's care. Here are ways to get the most out of the treatment plan.

  • Follow directions for medications. Try to make sure that your child takes medications as prescribed, even if he or she is feeling well and has no current symptoms. If medications are stopped or taken infrequently, the symptoms are likely to come back and your doctor will have a hard time knowing what the best and safest dose is.
  • Check first before taking other medications. Contact the doctor who's treating your child for schizophrenia before your child takes medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals, herbs or other supplements. These can interact with schizophrenia medications.
  • Pay attention to warning signs. You and your child may have identified things that may trigger symptoms, cause a relapse or prevent your child from carrying out daily activities. Make a plan so that you know what to do if symptoms return. Contact your child's doctor or therapist if you notice any changes in symptoms, to prevent the situation from worsening.
  • Make physical activity and healthy eating a priority. Some medications for schizophrenia are associated with an increased risk of weight gain and high cholesterol in children. Work with your child's doctor to make a nutrition and physical activity plan for your child that will help manage weight and benefit heart health.
  • Avoid alcohol, street drugs and tobacco. Alcohol, street drugs and tobacco can worsen schizophrenia symptoms or interfere with antipsychotic medications. Talk to your child about avoiding drugs and alcohol and not smoking. If necessary, get appropriate treatment for a substance use problem.

Source: http://www.mayoclinic.com

Coping and support

Coping with childhood schizophrenia can be challenging. Medications can have unwanted side effects, and you, your child and your whole family may feel angry or resentful about having to manage a condition that requires lifelong treatment. To help cope with childhood schizophrenia:

  • Learn about the condition. Education about schizophrenia can empower you and your child and motivate him or her to stick to the treatment plan. Education can help friends and family understand the condition and be more compassionate with your child.
  • Join a support group. Support groups for people with schizophrenia can help you reach out to other families facing similar challenges. You may want to seek out separate groups for you and for your child so that you each have a safe outlet.
  • Get professional help. If you as a parent or guardian feel overwhelmed and distressed by your child's condition, consider seeking help from a mental health professional.
  • Stay focused on goals. Dealing with childhood schizophrenia is an ongoing process. Stay motivated as a family by keeping treatment goals in mind.
  • Find healthy outlets. Explore healthy ways your whole family can channel energy or frustration, such as hobbies, exercise and recreational activities.
  • Take time as individuals. Although managing childhood schizophrenia is a family affair, both children and parents need their own time to cope and unwind. Create opportunities for healthy alone time.
  • Begin future planning. Ask about social service assistance. Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, affordable housing, transportation, self-help groups, other daily activities and crisis situations. A case manager or someone on your child's treatment team can help find resources.

Source: http://www.mayoclinic.com

Risk factors

Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

  • Having a family history of schizophrenia
  • Increased immune system activation, such as from inflammation or autoimmune diseases
  • Older age of the father
  • Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
  • Taking mind-altering (psychoactive or psychoactive) drugs during teen years

Source: http://www.mayoclinic.com

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