What is Childhood-Onset Schizophrenia?by Natasha Tracy - April 9th, 2015
Childhood-onset schizophrenia is rare. The onset of schizophrenia is usually between the late teens and mid-30s with men experiencing a first psychotic episode, on average, in their early to middle 20s while women experience their first episode a little later, typically in their late 20s. Total numbers of people with schizophrenia reaches about 1% of the population.
That being said, a small percentage of people with schizophrenia have childhood-onset schizophrenia. In preadolescents, the estimated prevalence of childhood-onset schizophrenia is less than one case in 100,000 people.
What Signs Appear Before Childhood-Onset Schizophrenia?
Childhood-onset schizophrenia correlates with a number of experiences in childhood. Before the onset of psychosis, many children who develop schizophrenia:
• Have disturbances in behavior and cognition
• Experience delays in speech, language, and acquisition of motor milestones (about 50% of children in this group)
• Have impaired coordination
• Show impaired social skills and school achievement
• Develop symptoms of inattention, hyperactivity, aggression, or rage (about 1/3 of children in in this group)
• Show more illogical thinking and poverty of content in their speech when studied
It is because of these initial issues that help may have been sought and other diagnoses may have been levied. These initial diagnosis may be things like attention-deficit/hyperactivity disorder (ADHD), pervasive developmental disorder (PDD), or affective disorders such as depression or bipolar disorder. In one study, the first symptoms of psychosis didn’t appear until 2.5 years after the initial clinical presentation.
Diagnosis of Childhood-Onset Schizophrenia
Once a child experiences psychosis, it is then that childhood-onset schizophrenia may be considered as a diagnosis. Because of the earlier symptoms though, and in an attempt to rule out other diagnoses, this can take some time. In one study, it took, on average, two years to get a diagnosis of childhood-onset schizophrenia after the initial psychotic episode.
There are no differences in diagnostic criteria between childhood-onset and adult-onset schizophrenia and all adult symptoms of schizophrenia have also been documented in children.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, at least two of the following five symptoms must be present for at least one month for a diagnosis of schizophrenia. At least one of these symptoms must be items 1, 2, or 3.
1. Delusions – intensely-held false beliefs
2. Hallucinations – perception that aren’t real in any of the five senses
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms – such as flattened affect, poverty of speech, and loss of interest and drive
Other criteria for the diagnosis is the severe impairment in one or more major life areas (such as personal care, school, etc.) and a persistence of continuous signs for at least six months. Additionally, schizoaffective disorder must be ruled out as must substance use disorders or another medical condition.
Differences in Childhood-Onset Schizophrenia
While not enough study has been completed, some studies have shown that bizarre behavior and negative symptoms may be more common in the earlier-occurring forms of schizophrenia. Additionally, when compared to adult-onset schizophrenia children:
• Have catatonia less often
• Commonly experience changes in affect (mood)
• Experience blunting or inappropriate affect (in about 2/3 of children with schizophrenia)
• Experience significant sleep disturbances that highly relate to symptom severity
Cognitive functioning is often impaired at the onset of childhood schizophrenia. Full-scale intelligence quotients (IQs) have been in the 80s with particular deficits in verbal comprehension, language, and short-term memory. Attention and executive function may also be impaired.
Expressions of Psychosis in Children with Schizophrenia
Hallucinations, often auditory, are the most commonly reported symptom of psychosis. A recent study showed that of children with schizophrenia:
• 94.9% had auditory hallucinations
• 80.3% had visual hallucinations
• 60.7% had tactile/somatic hallucinations
• 29.9% had olfactory hallucinations
Those with visual hallucinations tended to have lower IQ scores, earlier age of onset, and more severe symptoms compared to children who didn’t experience visual hallucinations. Delusions were present in approximately 60% of patients.
Treatment of Childhood-Onset Schizophrenia – Medication
While schizophrenia is a serious, lifelong disorder, treatment is available. Treatment of childhood-onset schizophrenia should include psychosocial management as well as medication.
No medications are Food and Drug Administration (FDA) approved for use in children with schizophrenia. However, atypical (second generation) antipsychotics are the general frontline treatments. Occasionally, a benzodiazepine may be added for a severely agitated child.
Unfortunately, atypical antipsychotics have been shown to have serious side effects in adults and children. A recent study examined the cardiometabolic effects of olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and aripiprazole (Abilify) in a 12-week trial in children and adolescents with mood and psychotic disorders. Findings include:
• Significant weight gain was seen with all medications.
• Weight gain was greatest with quetiapine and olanzapine.
• Olanzapine and quetiapine significantly increased total cholesterol and triglycerides.
For these reasons, it’s critical to monitor children on antipsychotics closely, particularly initially, and perform cardiometabolic monitoring biannually after the first three months.
In one study in adolescents and young adults, omega-3s were shown to reduce the risk of progression to full-threshold psychosis and may also be useful in treatment.
Treatment of Childhood-Onset Schizophrenia – Psychosocial Management
In addition to medication, children with schizophrenia should be receive additional forms of care such as:
• Social skills training
• A structured, individualized special education program
• A supportive environment
• Supportive psychotherapy (cognitive behavioral therapy has also been shown to be useful in adults)
• Substance abuse treatment, if necessary
• Weight monitoring and a calorie-conscious diet to combat the side effects of antipsychotic medication
Finally, it’s important to remember that long-term monitoring is critical to successful treatment of childhood-onset schizophrenia.
Medscape, Childhood-Onset Schizophrenia, Accessed Feb. 28, 2015.
Medscape, Schizophrenia, Accessed Feb. 28, 2015
Natasha Tracy is a bipolar freelance writer for Canadian pharmaceuticals