Schizophrenia is a complex chronic disease, characterized by the presence of various symptoms, to varying degrees throughout the course of the disease and which can lead to deterioration if left untreated. In the childhood stages, schizophrenia is not very frequent, it is in an initial state that manifests itself fully in adulthood.
However, childhood schizophrenia is studied and treated as one of the branches of psychiatry in childhood and adolescence, along with other mental disorders. Let’s see what are the symptoms of childhood schizophrenia, which in any case requires a clinical diagnosis, as well as the risk factors of suffering from this disease.
Schizophrenia is a brain disorder that impairs the ability of people to develop their thoughts, dominate their emotions, make decisions and interact with others, although the disease does not affect those who suffer from it.
In general, it can be said that the disease involves delusions, hallucinations or disorganized speech, and reflects a deficient ability to live normally, so it can be disabling.
As children, sometimes the symptoms of schizophrenia are confused with other disorders, related to depression or behavior alterations (when showing withdrawal, aggressiveness…). Because of this and because a deterioration of the symptoms can occur, the clinical diagnosis by a specialist is important, as we will see.
In spite of everything, the signs of schizophrenia usually begin between 25 and 30 years of age. And although it is not common for a child to be diagnosed with schizophrenia, it can occur before the age of 18. In children under 13 years of age the diagnosis is exceptional. In the youngest children, all the psychopathological symptoms can not be given due to the cognitive immaturity they present.
Risk factors for childhood schizophrenia
According to the Spanish Association of Child and Adolescent Psychiatry (AEPNYA), the prevalence of schizophrenia in the child-adolescent population is 0.23%, with an incidence of 1.4-2 / 10,000, although there are no data in the population Spanish. In the adult population, the prevalence is 1%.
There are some risk situations of schizophrenia, among which the family antecedents stand out:
- Family history of schizophrenia. There are epidemiological studies that indicate that between 12-15% of the children of a schizophrenic parent have the disease, rising to around 45% when the two parents are schizophrenic.
- As for the siblings of the patients, the probability of presenting schizophrenia is 10%, reaching up to 46% in the case of monozygotic twins.
- Obstetric complications, especially hypoxia.
- Infections and malnutrition in pregnancy.
- Delay in psychomotor development.
- Motor coordination disorder and speech disorder.
- Difficulties in social adaptation.
- The consumption of cannabis could be a risk factor in the occurrence of schizophrenia, despite the controversy that exists about the possible effects that this soft drug can cause, according to the Association of Pediatrics of Primary Attention (AEPap) with reason of the Ninth Course of update in Pediatrics of Primary Attention.
Keep in mind that some signs related to schizophrenia at early ages such as delayed speech, delayed or atypical crawling, delayed walking and other abnormal motor behaviors, such as swinging or shaking the arm, coincide with developmental disorders or autism spectrum, so you have to be very careful in the diagnosis and rule out possibilities.
As we can see, the population of children and siblings of schizophrenic patients is considered to have a high genetic risk of suffering from the disease and will have a special follow-up. But how do you know if a child has symptoms of schizophrenia?
Symptoms of childhood schizophrenia
Schizophrenia is a disease that causes strange thoughts and feelings, as well as unusual behavior. As we have pointed out at the beginning, it is a psychiatric illness that is not very common in children and is very difficult to recognize in its early stages. In addition, the behavior of infants and adolescents with schizophrenia may be different from that of adults with schizophrenia.
According to the American Academy of child and adolescent psychiatry (American Academy of Child and Adolescent Psychiatry), psychiatrists look for the following early warning signs in youngsters with schizophrenia:
- See things and hear voices that are not real (hallucinations)
- Behavior and / or strange or eccentric language
- Unusual and rare ideas and thoughts
- Beliefs not based on reality (delusions)
- Confusion in the way of thinking
- Moody mood in the extreme
- Ideas that “are chasing him” or are talking about him
- Behave as a younger child
- Severe anxiety and fearfulness
- Confusion of television and dreams with reality
- Problems making and retaining friendships
- Retraction and increase in insulation
- Decrease in personal hygiene
The behavior of children with schizophrenia can change slowly with the passage of time and we must be attentive to these changes. For example, children who enjoy interacting with others may start to be shy and withdrawn. Many children begin to talk about fears and strange ideas and behave as if they lived in their own world.
Schizophrenia is a very serious chronic psychiatric disease and diagnosis and medical treatment is essential in time. It is a lifelong disease that can be controlled but not cured. If a child presents the problems and symptoms listed above, a comprehensive evaluation should be made by a specialist trained and accustomed to dealing with this disease.
Psychotic symptoms in children are not usually schizophrenic. For this reason, for the clinical diagnosis, complementary analytical explorations will be carried out (including thyroid, copper and ceruloplasmin…) to differentiate from other diseases (epilepsies, tumors, lupus, encephalitis…).
If the diagnosis is confirmed, usually these children with schizophrenia will need multidisciplinary treatment plans and a combination of medications and individual therapy, family therapy and specialized programs (schools, activities, etc.). There are antipsychotic drugs that can help treat many symptoms of schizophrenia, but they must be controlled under strict medical supervision.
Keep in mind that all antipsychotic medications have side effects and possible health risks, some very important. In addition, these side effects in children and adolescents may not be the same as in adults, so you must be very secure in the adscription and attentive to its effect.
In some cases psychotherapy may be useful with a mental health professional, both individual and family therapy, to help the child learn ways to cope with stress and the challenges of daily life caused by schizophrenia, learn to communicate better with the child and he with the others…
How schizophrenia is diagnosed in the child
According to the current ICD-10 (International Classification of Diseases, tenth version), these are the criteria to diagnose schizophrenia, always on the part of the medical professional:
- Echo, theft, insertion or dissemination of thought.
- Delirious ideas of control, influence or passivity, or strange delusions of another type and delusional perception.
- Auditory hallucinations that comment on the patient’s behavior, that they discuss among themselves or with a similar meaning.
- Persistent delusions of another type that are not appropriate to the culture of the individual or that are completely impossible, such as those of religious identity (…)
- Persistent hallucinations of any modality, when accompanied by unstructured and fleeting delusions without clear affective content, or persistent overvalued ideas, or when presented daily for weeks, months or permanently.
- Interpolations or blockages in the course of thought, which give rise to a divagatory language, disjointed, incoherent or full of neologisms.
- Catatonic manifestations, such as excitement, characteristic postures or waxy flexibility, negativism, silence, stupor.
- “Negative” symptoms such as marked apathy, language impoverishment, dullness or affective incongruence. It should be clear that these symptoms are not due to depression or neuroleptic medication. ￼9. A consistent and significant change in the general quality of some aspects of personal behavior, manifested as loss of interest, lack of objectives, idleness and social isolation.
In addition, it is pointed out that the diagnosis of schizophrenia will not have to be made in the presence of relevant depressive or manic symptoms, unless the schizophrenic symptoms clearly began before the affective disorder. Neither should one diagnose schizophrenia in the presence of a manifest brain disease or during intoxication with psychotropic substances or abstinence from them.
Schizoid disorder and schizophrenia
We conclude by establishing the distinction between schizoid disorder, which is included in the classification of pervasive developmental disorders and schizophrenia.
The schizoid disorder hinders the ability to relate to others, causing strange thoughts, excessive worry and fear, isolation … But there is no disconnection from reality, since there is no difficulty in distinguishing real experiences from fantasies. It can be treated by psychotherapy, while for schizophrenia the treatment is pharmacological.
As always, it will be the medical specialist who determines the extent of the child’s illness in line with the symptoms observed, making the necessary tests and follow-up, and confirming or not the diagnosis of schizophrenia.