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Schizophrenia in Children

What is schizophrenia in children?

Schizophrenia is a serious mental illness. It's a long-lasting and disabling problem of the brain. It can be treated, but right now there is no cure. A child with this disorder has unusual behavior and strange feelings. They may suddenly start to have psychotic symptoms. Experiencing psychosis means having strange ideas, thoughts, or feelings that are not based in reality.

Schizophrenia is not often found in children younger than age 12. It's also hard to spot in the early stages. Often, the psychotic symptoms start in the middle to late teen years. Slightly more boys develop it in childhood. But by the teen years, it affects both sexes equally.

What causes schizophrenia in a child?

Schizophrenia has no single cause. A combination of genes from both parents plays a role. So do unknown environmental factors. Experts believe that a child has to inherit a chemical imbalance in the brain to develop it.

Which children are at risk for schizophrenia?

Schizophrenia tends to run in families. A child who has a family member with the disorder has a greater chance of developing it.

What are the symptoms of schizophrenia in a child?

Behavior changes may occur slowly, over time. Or they may start suddenly. The child may slowly become more shy and withdrawn. They may start to talk about odd ideas or fears and start to cling more to parents.

Each child’s symptoms may vary. Early warning signs are:

  • Trouble telling dreams from reality (distorted view of reality)

  • Confused thinking, such as confusing TV with reality

  • Detailed and bizarre thoughts and ideas

  • Fear or belief that someone or something is going to harm them

  • Seeing, hearing, or feeling things that are not real, such as hearing voices (hallucinations)

  • Ideas that seem real but are not based in reality (delusions)

  • Extreme moodiness

  • Excessive anxiety or fear

  • Lack of emotional expression when speaking

  • Trouble doing schoolwork or a drop in levels of school success

  • Social withdrawal, such as having problems making and keeping friends

  • Sudden agitation and confusion

  • Disorganized behavior, such as doing private things in public. Or catatonic behavior, such as sitting and staring, as if the child can’t move.

  • Odd behaviors, such as an older child acting like they are much younger

Children with schizophrenia have the same symptoms as adults with the condition. But more children hear voices. Children also don’t tend to have delusions or formal thought problems until they are in their teens or older.

These symptoms may look like other health problems. Make sure your child sees their healthcare provider for a diagnosis.

How is schizophrenia diagnosed in a child?

A child with symptoms of schizophrenia needs a thorough medical and mental health evaluation. Talk with your child's healthcare provider if you are concerned about symptoms your child is having. A child psychiatrist or other qualified mental health expert can diagnose schizophrenia in children and teens. They do a mental health evaluation to figure out how best to treat the child.

When selecting an experienced child and adolescent psychiatrist, look for someone who considers and respects a family’s cultural background. Some behaviors may be related to a person or their family’s cultural belief systems as opposed to symptoms of a mental illness. For example, some cultures believe they can communicate with deceased loved ones. It’s very important that both the child and the family feel that their mental health providers will acknowledge and respect their cultural beliefs.

How is schizophrenia treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Schizophrenia is a serious, lifelong mental illness. Treatment is complex and needs direction from an expert in childhood schizophrenia, such as a board-certified child psychiatrist. A child often needs a combination of therapies and resources to meet their specific needs. Treatment is aimed at easing symptoms and improving your child's quality of life. It may include the following.

Medicines

The doses and types of medicines may need to be adjusted from time to time so they can keep working well. Your child may be given:

  • Medicines to help reduce delusions and hallucinations (antipsychotics). This special class of medicines can reduce symptoms or reduce how severe the symptoms are. But they don’t cure schizophrenia.

  • Mood stabilizing medicines. Examples are lithium and valproic acid, especially in the early stages of the illness.

Other treatment

  • Individual and family therapy. This may include supportive, thinking, and behavioral therapy.

  • Specialized educational or structured activity programs. These may include social skills training, vocational training, and speech and language therapy.

  • Self-help and support groups. These can help the child learn ways to cope with the disorder and also work on social skills.

How can I help prevent schizophrenia in my child?

Experts don’t know how to prevent schizophrenia. But early diagnosis and treatment can improve a child’s quality of life. Treatment works best when early symptoms are dealt with quickly.

How can I help my child live with schizophrenia?

Schizophrenia is a serious mental illness that will require your support, patience, and attention. You are your child’s best advocate. Here are things you can do to help:

  • In an age-appropriate manner, explain schizophrenia to your child and the reasons they need to take medicines and talk to so many different adults treating them. Since this is a lifelong illness, the more you can empower your child to understand schizophrenia, be aware of their unique symptoms, and learn how the illness is managed, the better prepared your child will be to care for themselves as they age. If you are uncomfortable doing this, ask your child's mental health professional for help.

  • Keep all appointments with your child’s healthcare provider and educational team. Talk with your child’s provider about referring your child to a psychiatrist with experience evaluating and treating children with schizophrenia.

  • Be sure you understand your child's medicines, including what side effects to look for, what do to when a dose is missed, and when to call the provider.

  • Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include experts like psychiatrists, counselors, therapists, school psychologists, teachers, and social workers. Your child’s care team will depend on their needs and how serious the schizophrenia is.

  • Tell others who need to know about your child’s schizophrenia. Work with your child’s healthcare provider and school to develop a treatment plan.

  • Take care of yourself. Schizophrenia is a difficult disease. You may feel overwhelmed or stressed out. Being in touch with other parents who have a child with schizophrenia may be helpful. Talk with your child’s healthcare provider about a support group for caregivers of children with schizophrenia or seek counseling.

  • Remember your other children. Siblings also suffer when a brother or sister is ill. Again, in an age-appropriate manner, explain schizophrenia. Consider support groups for your other children to help them deal with the stress they are experiencing. Ask your mental health providers for help if you are not sure how to explain the situation.

  • The Americans with Disabilities Act (ADA) and Section 504 of the Civil Rights Act help ensure that public school meets your child's educational needs. Talk with your child’s teacher and school principal about reasonable accommodations so your child can be successful in school.

  • If your child is older, make sure they have emergency numbers in their phone. Emergency numbers include parents, other trusted adults, the healthcare provider, and the National Suicide Prevention Lifeline at 800-273-8255. Help your child understand that reaching out for help is the most courageous thing to do if self-harm is being considered.

Call or text 988 in a crisis

  • Take all symptoms of depression and suicide very seriously. Get help now. Suicide is a health emergency. Call or text 988 if your child has thoughts or plans to harm themselves or others. You will be connected to trained crisis counselors at the 988 Suicide & Crisis Lifeline. An online chat option is also available. Lifeline is free, confidential, and available 24/7.

When should I call my child’s healthcare provider?

Call your healthcare provider right away if your child:

  • Refuses to take their medicine for more than one dose

  • Feels extreme depression, fear, anxiety, or anger toward themselves or others

  • Feels out of control

  • Hears voices that others don’t hear

  • Sees things that others don’t see

  • Can’t sleep or eat for 3 days in a row

  • Has new symptoms or current symptoms get worse

  • Shows side effects of medicines

  • Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Schizophrenia may increase a child’s risk for suicidal thinking. 

Key points about schizophrenia in children

  • Schizophrenia is a serious, lifelong mental illness. It can be treated but not cured.

  • A child with this disorder has unusual behavior and strange feelings. They may have delusions or hallucinations.

  • Symptoms can develop slowly over time or start quickly.

  • A mental health expert can diagnose schizophrenia. Ask for a referral to a psychiatrist with experience evaluating and treating children with schizophrenia.

  • Treatment can include a combination of medicine, therapy, and special programs.

  • The American with Disabilities Act (ADA) and Section 504 of the Civil Rights Act provide legal protections for your child in a public school setting.

  • Schizophrenia is a difficult disease. Talk with your child’s healthcare provider about a support group for caregivers and siblings of children with schizophrenia or seek individual and family counseling.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.

  • Ask if your child’s condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if your child does not take the medicine or have the test or procedure.

  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your child’s provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.

Medical Reviewers:

  • L Renee Watson MSN RN
  • Paul Ballas MD
  • Rita Sather RN
    •