Childhood schizophrenia
Childhood schizophrenia (also known as childhood-onset schizophrenia, and very early-onset schizophrenia) is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.
| Childhood schizophrenia | |
|---|---|
| Other names | Childhood type schizophrenia; schizophrenia, childhood type; childhood-onset schizophrenia (COS); very early-onset schizophrenia (VEOS); schizophrenic syndrome of childhood |
| Specialty | Child psychiatry (EU), Child and adolescent psychiatry (USA), clinical psychology |
| Symptoms | Hallucinations, delusions, disorganized behavior or catatonia, negative symptoms (i.e., avolition or reduced affect display) |
| Usual onset | Before the age of 13 years |
| Types | Episodic-progredient/shiftlike childhood schizophrenia (malignant, paranoid and slow-progressive sub-types), continuous childhood schizophrenia, recurrent childhood schizophrenia (the rarest form – 5 % of all cases) |
| Differential diagnosis | Major depressive disorder or bipolar disorder with psychotic or catatonic features, brief psychotic disorder, delusional disorder, obsessive–compulsive disorder and body dysmorphic disorder, autism spectrum disorder or communication disorders, other mental disorders associated with a psychotic episode |
| Medication | Antipsychotics |
| Frequency | 1⁄5 of all forms of psychosis of the schizophrenia spectrum; 1.66:1000 among children (0–14 years) |
The disorder presents symptoms such as auditory and visual hallucinations, delusional thoughts or feelings, and abnormal behavior, profoundly impacting the child's ability to function and sustain normal interpersonal relationships. Delusions are often vague and less developed than those of adult schizophrenia, which features more systematized delusions. Among the psychotic symptoms seen in childhood schizophrenia, non-verbal auditory hallucinations are the most common, and include noises such as shots, knocks, and bangs. Other symptoms can include irritability, searching for imaginary objects, low performance, and a higher rate of tactile hallucinations compared to adult schizophrenia. It typically presents after the age of seven. About 50% of young children diagnosed with schizophrenia experience severe neuropsychiatric symptoms. Studies have demonstrated that diagnostic criteria are similar to those of adult schizophrenia. Neither DSM-5 nor ICD-11 list "childhood schizophrenia" as a separate diagnosis. The diagnosis is based on thorough history and exam by a child psychiatrist, exclusion of medical causes of psychosis (often by extensive testing), observations by caregivers and schools, and in some cases (depending on age) self reports from pediatric patients.