Childhood schizophrenia, also known as very early-onset schizophrenia, is a rare and severe form of the mental disorder.1,2
The condition is defined as schizophrenia that starts in children younger than 13 years of age (and usually over seven years of age), and apart from age of onset and severity, it is much the same as adult schizophrenia.2,3
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 and autism
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.3
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.4
When schizophrenia appears between the ages of seven and 13 years, it shares some of the features of autism, such as social difficulties and withdrawal.
The diagnostic overlap is understandable given that family, genetic and imaging findings show similarities between autism and childhood schizophrenia.3
Early descriptions that were used to classify autism included "atypical and withdrawn behavior," "failure to develop identity separate from the mother's," and "general unevenness, gross immaturity and inadequacy in development."3 See below how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.5
Symptoms of childhood schizophrenia
The video below, produced by the Child Mind Institute, a nonprofit organization, shows a leading expert on childhood schizophrenia talking about how the symptoms appear and the distressing effects they can produce.
Professor Rochelle Caplan describes how it is a slow-onset disorder in most cases. She describes a "very scary" experience for the child at the onset, and that parents may notice this as anxiety.
It is frightening for the child, Prof. Caplan explains, because hallucinations or delusions are threatening and also because children understand from the age of about five years that it is not normal to hear, for example, external voices or smells that are not there, and that are not experienced by other people.
How schizophrenia symptoms differ versus schizophrenia in adults
The hallmark of schizophrenia in any person is psychosis - schizophrenia is a psychotic illness.6 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 in general, so the key points about childhood schizophrenia are offered here with the main differences from the same illness as it appears in adolescents and adults.
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.7
In childhood schizophrenia, the premorbid developmental impairments include:7
- Language impairments
- Motor (movement) effects, and
- 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.7
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 seven- to 13-year-olds.7
Hallucinations, as with adult cases, are usually auditory in childhood schizophrenia (hearing external voices that do not exist); visual and tactile 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.7
The cognitive and motivational impairments observed in schizophrenia - the so-called negative symptoms, the impairments in emotional expression, social interaction and volition (the will to make decisions)8 - are predominant in the very early-onset disorder.7
"Flat or inappropriate affect" is the main impairment - a loss of ability to express or recognize emotions.7
In research studies, flat affect in schizophrenia has been observed as reduced facial expression during social interactions, emotional films and cartoons, and worse ability to recognize faces. The patients themselves lack insight into the deficits, reporting normal emotional experiences, but these are not accompanied by normal facial expression.9
All children with the very early-onset disorder display an obvious worsening from a previous level of functioning.7 Their social and functional impairments and their symptom profiles are similar to those in adults, but more severe.10
The American Academy of Child and Adolescent Psychiatry has provided a list of example symptoms typical of childhood schizophrenia in its factsheet for families about the disorder.
The group of psychiatrists lists the following examples alongside hallucinations and delusions:11
Psychosis in children may mean they are unable to distinguish reality from the television, or from dreams.
- Odd and eccentric behavior and/or speech (so-called disorganized and disordered symptoms)
- Confusing television and dreams from reality (an example of psychosis)
- Extreme moodiness
- Severe anxiety (due to fear of threatening hallucinations or delusions)
- Difficulty relating to and keeping friends
- Withdrawing and becoming increasingly isolated
- Worsening personal grooming (problems with bathing).
On the next page we look at how childhood schizophrenia is diagnosed and the treatment options that are available.