Childhood Schizophrenia

What is childhood schizophrenia?

Childhood schizophrenia is a very rare, severe psychiatric condition that begins before your child is 13. Psychiatric conditions affect people’s mental health and how they see the world around them. Symptoms of childhood schizophrenia include psychosis, and movement and thought (cognitive) disorders. Childhood schizophrenia interferes with things like your child’s:

• Thoughts.
• Memory.
• Senses.
• Behaviors.

As a result, your child may struggle in many parts of their day-to-day life. Untreated schizophrenia often disrupts your child’s relationships (with family, friends, classmates and teachers). It can also cause them to have trouble organizing their thoughts. Your child may behave in ways that can hurt themselves or others. They may have a higher risk of injuries or other illnesses.

At what age does childhood schizophrenia start?

To be diagnosed with childhood schizophrenia, children must be younger than 13. Especially in young children, childhood schizophrenia can look like other mental health or developmental conditions, including:

• Depression.
• Anxiety.
• Attention-deficit/hyperactivity disorder (ADHD).
• Autism spectrum disorder.

Symptoms of these conditions often appear before psychosis. This can make it difficult to say exactly when your child’s schizophrenia starts.

What is childhood schizophrenia also known as?

Childhood schizophrenia is also known as very early-onset schizophrenia, childhood-onset schizophrenia or pediatric schizophrenia. Very early-onset schizophrenia develops before a child turns 13. This is different from early-onset schizophrenia, which develops in adolescence.

How common is this condition?

Childhood schizophrenia is very rare. About 1 in 10,000 children has childhood schizophrenia.

What are the signs of schizophrenia in a child?

The first signs of childhood schizophrenia are often social and developmental delays, including:

• Delays in motor skills, including in learning to walk.
• Trouble paying attention.
• Poor eye contact.
• Poor performance in school.
• Difficulty with daily functioning, like brushing their teeth.
• Lack of impulse control. This means your child may take what they want as soon as they see it, blurt opinions or lash out.
• Big emotions that don’t seem to fit the situation.
• Speech delays or other problems, like repeating noises or words spoken by other people (echolalia).

What are the symptoms of childhood schizophrenia?

Childhood schizophrenia causes symptoms like schizophrenia in adults. Your child may have the following symptoms:

• Delusions. These are false beliefs that you hold even when there’s plenty of evidence that those beliefs are wrong. For example, your child might think that someone is controlling what they think, say or do.
• Hallucinations. Your child thinks they can see, hear, smell, touch or taste things that don’t exist, like hearing voices.
• Disorganized or incoherent speech. Your child may have trouble organizing their thoughts while speaking. This might look like trouble staying on topic, or their thoughts might be so jumbled that you can’t understand them.
• Disorganized or unusual movements. Your child might move differently than you expect. For example, they may move around a lot for no clear reason, or they might not move much at all.
• Negative symptoms. These refer to a reduction or loss of your child’s ability to do things as expected. For example, your child might stop making facial expressions, or speak with a flat, emotionless voice. Negative symptoms also include a lack of motivation, especially when they don’t want to socialize or do things they ordinarily enjoy.

What causes childhood schizophrenia?

Childhood schizophrenia doesn’t have just one cause. Instead, experts believe that multiple factors interact with each other to bring about this condition. Schizophrenia tends to be hereditary (runs in families). Researchers have also found some other factors that may play a role in developing schizophrenia, including:

• Brain development issues before birth.
• Pregnancy complications, like malnutrition or certain viral infections.
• Birth complications.
• Loss of connections between different areas of your child’s brain.
• Imbalances in chemical signals your child’s brain uses for cell-to-cell communication.

What are the complications of childhood schizophrenia?

Childhood schizophrenia may cause difficulties throughout your child’s life and can affect:

• Learning.
• Memory.
• Relationships.
• Productivity.

There isn’t a cure for schizophrenia. Even when they’re an adult, your child may experience symptoms of schizophrenia. They need continuous treatment to help them live a safe, productive life.

How is childhood schizophrenia diagnosed?

Your child must have symptoms for more than six months for a healthcare provider to diagnose childhood schizophrenia. Schizophrenia in children is difficult to diagnose. Many healthy children have hallucinations or delusions. For example, a young child may talk to an imaginary friend, which is normal and healthy. Additionally, a variety of conditions can lead to symptoms of psychosis, including medical and psychiatric illnesses. Your child’s healthcare providers will want to rule out these conditions.

Medical conditions

• Changes in blood flow to your child’s brain.
• Encephalopathy.
• Endocrine disorders.
• Infection.
• Metabolic disorders.
• Not getting enough of certain vitamins.
• Rheumatic and autoimmune diseases like lupus.
• Reye’s syndrome.
• Substance use.
• Temporal lobe epilepsy.
• Wilson’s disease.

Developmental and psychiatric conditions

• Autism spectrum disorder.
• Depression.
• Bipolar disorder.
• Eating disorders.
• Obsessive-compulsive disorder.
• Post-traumatic stress syndrome.
• Schizoaffective disorder.
• Schizophreniform disorder.

What tests will be done to diagnose this condition?

No single test can tell whether your child has schizophrenia. Psychiatrists diagnose childhood schizophrenia with a combination of mental and physical tests. To check for physical causes, your child’s psychiatrist may use:

• Imaging tests. Computed tomography (CT) or magnetic resonance imaging (MRI) can rule out issues like stroke, brain injuries, tumors and other changes to the structure of your child’s brain.
• Blood, urine and cerebrospinal fluid (spinal tap) tests. These tests look for chemical changes in bodily fluids that might explain changes in your child’s behavior.
• Brain activity testing. An electroencephalogram (EEG) detects and records the electrical activity in the brain. This test can help rule out conditions like epilepsy.

How is childhood schizophrenia treated?

Treatment for very early-onset schizophrenia depends on your child and the type and severity of their symptoms. Treatment usually includes therapy and education for both the child and their family. Depending on your child’s age, their provider may prescribe antipsychotic medications and sometimes, antidepressants to help control symptoms. At some point, many children with schizophrenia require hospitalization for their safety. They may also need to stay in the hospital from time to time if they’re unstable or as they start new medications.

In addition to medications, providers often recommend social skills training and counseling for the child and their family. Ongoing individual therapy helps children with schizophrenia learn coping skills. This support can help them maintain relationships and do better in school.

Side effects of psychotropics

Some of the antipsychotics used to treat childhood schizophrenia can cause significant weight gain and heart issues. Your child’s healthcare provider will weigh the benefits of the treatment with the potential side effects before prescribing antipsychotics. Then, they’ll regularly check measures of your child’s health, including:

• Measures of overweight/obesity like body mass index, waist circumference and glucose.
• Measures of heart health like blood pressure and lipids.

How soon after treatment will my child feel better?

Your child’s healthcare provider is the best person to tell you how long it will take for medication and therapy to work. Different medications take different amounts of time before they have noticeable effects. Their provider can also let you know about other treatment options that might help if the first treatments don’t work well.

Can I prevent childhood schizophrenia?

As there’s no single cause, childhood schizophrenia isn’t really preventable. But you can take steps to reduce your child’s risk.

How can I lower my child’s risk of developing schizophrenia?

To lower the risk that your child will have very early-onset schizophrenia, you can take the following steps:

• You might consider talking with a genetic counselor about preconception counseling, especially if you have a close biological family member with schizophrenia.
• Planning families when both partners are under 40 might help.
• Try to avoid malnutrition during pregnancy. If you’re experiencing morning sickness, try to eat small, nutritious snacks throughout the day and talk to your pregnancy care team for help.

It’s important to remember that even if you do everything right, there’s still a chance that your child will develop pediatric-onset schizophrenia. It’s not your fault.

What can I expect if my child has schizophrenia?

Every child with schizophrenia is unique, and their symptoms will vary. Childhood schizophrenia symptoms may come on rather quickly. Or they may develop gradually, with your child getting more symptoms that get worse over time.

You’ll spend time organizing their medications, especially if they take more than one medication to manage their symptoms. You can expect frequent check-ins with your child’s psychiatrist. It might help to keep a journal of your child’s symptoms — and their eating and sleeping patterns — and take this record to each appointment.

Your child may need extra support at school, and your child’s care team can advise you on that as well. There may also be a lot of absences from school for appointments, so early and regular communication is key.

What’s the outlook for childhood schizophrenia?

The outlook for children with schizophrenia depends on the severity of their symptoms. Many children with schizophrenia have a poor prognosis (outlook). But treatment improves long-term outcomes. You can help by ensuring that your child takes their medications as prescribed and follows up regularly with their care team.

Children with schizophrenia are at increased risk of suicide, especially among people assigned male at birth who also have substance use disorder.

How do I take care of my child?

Parenting a child with a mental health condition like childhood schizophrenia can be challenging. You want to do everything you can to set your child up for success, but it’s important to take care of yourself, too. Here are some ways to help take care of your child and get the support you need:

• Set and follow a medication schedule. Ask your child’s psychiatrist for help developing a medication schedule that’s as simple as possible. Let your child’s care team know when your child goes to school, as well as about any side effects — like sleepiness — that might impact your child’s performance. Be sure to follow the medication schedule closely.
• See your child’s psychiatrist as recommended. Your child’s psychiatrist will set up a schedule for you to see them. These visits are especially important to help with managing your child’s condition.
• Don’t ignore or avoid symptoms. Your child is more likely to respond to treatment and have a good outcome with early diagnosis and medical care.
• Actively engage your child’s teachers and guidance counselor. Ask that your child’s healthcare team be in regular contact with guidance counselors so they can work together to develop and monitor an accommodations plan.
• Communicate with adults in your child’s life. Talk with the leaders of any regular activities like sports and clubs to be sure they’re aware of your child’s condition and know what to do in case of an emergency.
• Seek support for yourself. Parenting can be hard. And parenting a child with a mental health condition can be even harder. But you don’t have to do it alone. There are many in-person and online support groups for parents of children with mental illness.

When should I see my healthcare provider?

You should see your child’s care team as recommended. You should also see them if you notice a change in your child’s symptoms, like if they get worse even if they’re taking their medication. You can also see them if medication side effects disrupt your child’s life. Your child’s psychiatrist can sometimes recommend alternative medications or treatments that might better treat their condition without causing those effects.

When should I go to the emergency room?

If your child expresses thoughts of harming themself or others, call the 988 Suicide and Crisis Lifeline (U.S.). If you feel like your child is in immediate danger of harming themselves or others, call 911 (or your local emergency services number) or go to the nearest emergency room.

A note from Cleveland Clinic

You’re bound to have a lot of feelings when your child starts showing signs of a severe mental health condition like childhood schizophrenia. Your child’s behaviors might scare you. You might feel a sense of loss, wondering where the child you’ve known has gone, and if you’ll ever get to see them again. You might blame yourself (but it’s not your fault!). It’s also demanding to care for a child with a psychiatric disorder. Be sure to ask your child’s psychiatrist for recommendations for parenting classes, support groups and books so you’re as prepared as possible for what’s coming. Most people won’t understand what life is like in your house, so it’s very important for you to find people who do.