According to the National Alliance for the Mentally Ill (NAMI) one out of every five families is affected by a severe mental illness in their lifetimes. One of the more misunderstood mental disorders is schizophrenia. Schizophrenia is often misdiagnosis; especially in children. Schizophrenia in children occurs about one in 40,000 as compared to adults which occurs about one in 100.
Schizophrenia Symptoms and Diagnosis
When assessing a child for schizophrenia, the same criteria are used that is used for an adult; but the symptoms appear before the age of twelve. In children, the symptoms seem to appear gradually and are often preceded by some type of developmental disturbance such as delays in motor or speech development. Criteria used for diagnosis include:
- Seeing or hearing things that aren’t there (hallucinations)
- Paranoid, bizarre beliefs (delusions)
- Problems with attention
- Impaired reasoning and memory
- Speech impairment
- Inappropriate or flattened expression of emotion
- Poor social skills
- Depressed mood
In children, these criteria may manifest themselves in ways such as confusing television with reality; severe anxiety and fearfulness; extreme moodiness; vivid and bizarre thoughts and ideas; clumsiness; chronic insomnia; over or under sensitivity to external stimuli; or severe problems in making and keeping friends. With children it is more of a failure to achieve expectations rather than deterioration in functioning.
Some of these criteria mimic other childhood disorders and this is part of the reason why schizophrenia is so difficult to diagnose in children. Another challenge is the developmental stages of children must be considered in any diagnosis. Children can have imaginary friends, but this doesn’t mean they are schizophrenic.
Schizophrenia is often misdiagnosed as autism; however, the distinguishing features of schizophrenia are the persistence of hallucinations and delusions for at least six months; and the onset is usually at seven years of age rather than three years as is the criteria for autism. In teens; the schizophrenia symptoms can mimic bipolar disorder. Children of abuse can also mimic schizophrenia symptoms. Post-Traumatic Stress Disorder (PTSD) can illicit hallucinations with flashbacks of the trauma.
Schizophrenia Treatment and Prognosis
Schizophrenia in children is harder to treat than with adults; and the prognosis is worse. The most common course of treatment includes antipsychotic medication often in combination with an antidepressant. The traditional antipsychotics used for schizophrenia include Fluanxol, Loxapac, Thorazine, and Haloperidol. New medications include Aripiprazole (Abilify), Clozaril (Clozapine), Geodon, Resperdal, Seroquel, and Zyprexa.
All medications have side effects and antipsychotics are no exception. Side effects can include weight gain and tardive dyskinesia (neurological tics). The use of these drugs must be monitored closely by a professional.
Treatment for children with schizophrenia usually includes counseling or psychotherapy; often individual and family sessions. Social skills training is another beneficial component of comprehensive treatment plans. Children with schizophrenia usually require a special education program to accommodate their emotional needs within the educational system.
Causes of Schizophrenia
Schizophrenia is a disorder of the brain. There is a loss of gray matter in the brain that progresses from the back where attention and perception are centered; to the front of the brain where executive functioning is located. The brain can be affected by disturbances during development in utero. The disturbances can be stressful life events, viral infections or trauma during specifCredit: photo by Pete Sic stages of the brain development.
Genetics play a big role in the occurrence of schizophrenia. According to a study conducted at Penn state the risk of schizophrenia occurs in one percent when there is no family history of the disease; ten percent when there is a first degree relative with schizophrenia; and 50 percent when an identical twin has the disorder. There is also some link to older fathers and offsprings with schizophrenia.
Living with the Mental Illness
Schizophrenia as with other mental illnesses impacts the family. Issues can include trust, a loss of childhood for siblings who become parentified, and neglect when parents are required to spend more time and energy on the family member with the illness.
According to Doctors Peter Weiden and Leston Havens of St. Luke’s Roosevelt Hospital, there are five symptoms that are difficult to deal with for both professionals and family. These are:
- Denial of illness
- Terror being psychotic
In order to be supportive of the family member with schizophrenia the two doctors suggested specific ways of dealing with each symptom in their article in the 1995 May issue of Hospital and Community Psychiatry. The important thing to remember is that contrary to popular belief, violent and aggressive behavior occurs more frequently in other disorders than it does in schizophrenia.
The violence that does occur is usually caused by a misinterpretation; the schizophrenic feels threatened or cornered. The behavior usually occurs in conjunction with hallucinations and delusions and is more often against self than it is against others. An episode can be triggered by stress and schizophrenics can become preoccupied with jumbled thoughts. When preoccupied, they do not want to be disturbed.
Some schizophrenics don’t respond to medications and the disorder can sometimes take unexpected turns. There is a high incident of substance abuse in schizophrenics; most probably self-medicating. However, many people diagnosed with schizophrenia lead controlled and productive lives.
American Psychiatric Association: Diagnostic and Statistical manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C: American Psychiatric Association,2000.
The copyright of the article “Schizophrenia in Children not one of Typical Childhood Disorders” is owned by Cheryl Weldon and permission to republish in print or online must be granted by the author in writing.