Childhood schizophrenia: Symptoms, diagnosis, and treatment

Childhood schizophrenia, also known as very early-onset schizophrenia, is a rare and severe form of the mental disorder.

The condition is defined as schizophrenia that starts in children younger than 13 years of age (and usually older than 7). Apart from age of onset and severity, it is much the same as adult schizophrenia.

This article will focus on the symptoms, diagnosis, and treatment of childhood schizophrenia. To learn more about schizophrenia in general, including the possible causes of schizophrenia, please visit the Medical News Today page on schizophrenia.

Childhood schizophrenia versus autism

Sad child in the shadows
Childhood schizophrenia is a rare condition.

It was not until 1980 that childhood schizophrenia became understood as a separate diagnosis – before that time, children who today would be diagnosed with autism, which is a type of ‘pervasive developmental disorder,’ were grouped under the diagnosis of schizophrenia.

The confusion persists today. Because of its rarity, and because the paranoid symptoms often present as hostile and oppositional behaviors, children with schizophrenia may falsely be diagnosed with conduct disorder.

The confusion is understandable given that family, genetic, and imaging findings show similarities between autism and childhood schizophrenia.

Early descriptions that were used to classify autism included “atypical and withdrawn behavior,” “failure to develop identity separate from the mother’s,” and “general unevenness, gross immaturity, and inadequacy in development.” See below how symptoms of childhood schizophrenia compare with these descriptions of autism.

Molecular genetic findings also indicate an overlap between developmental disorders and schizophrenia. Genetic vulnerability to schizophrenia is shared with bipolar disorder, too.

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Symptoms

The video below, produced by the Child Mind Institute, a non-profit organization, shows a leading expert on childhood schizophrenia talking about how the symptoms appear and the distressing effects they can produce.

Prof. Rochelle Caplan describes how it is a slow-onset disorder in most cases. She explains how the experience can be “very scary” for the child at onset, and how the parents may notice this as anxiety.

It is frightening for the child, Prof. Caplan explains, because the hallucinations or delusions can be threatening; also, children understand from the age of about 5 that it is not normal to hear, for example, external voices that are not there, and that are not experienced by other people.

Childhood versus adult schizophrenia

The hallmark of schizophrenia in any person is psychosis – schizophrenia is a psychotic illness. This means a loss of contact with reality because of hallucinations and delusions – the so-called positive symptoms of schizophrenia.

Two other Medical News Today pages give detailed information on psychosis symptoms and schizophrenia, so here we will concentrate on the main differences between adult onset and childhood schizophrenia.

Before psychosis appears in people with schizophrenia, there is often a phase leading up to it called premorbid or prodromal. This phase is more pronounced in children than in adults.

In childhood schizophrenia, the premorbid developmental impairments include:

language impairments

motor (movement) effects

social deficits

In over half of children who go on to develop childhood schizophrenia, this phase is found to have started from the first months of life.

Compared with the usual onset of schizophrenia in adolescence or adulthood, this suggests there is a more severe and earlier disruption of brain development when schizophrenia appears in 7-13-year-olds.

Hallucinations, as with adult cases, are usually auditory in childhood schizophrenia (hearing external voices that do not exist); visual and tactile (touch) hallucinations are rarer. The type of delusion is slightly different in childhood schizophrenia – the bizarre false beliefs are usually related to childhood themes and are less complex than those experienced by adolescents and adults.

The cognitive and motivational impairments observed in schizophrenia (also called negative symptoms) are more obvious in the very early-onset disorder. These include impairments in emotional expression, social interaction, and volition (the will to make decisions).

“Flat or inappropriate affect” is the main impairment – a loss of ability to express or recognize emotions.

In studies, flat affect in schizophrenia can be measured as reduced facial expressions during social interactions, emotional films, and cartoons, and an inability to recognize faces. The patients themselves lack insight into these deficits, reporting normal emotional experiences.

All children with very early-onset schizophrenia show an obvious decline in functioning. Their social and functional problems and their symptoms are similar to those in adults but more severe.

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