Schizophrenia is one of the most complex of all mental health disorders. It is a severe, chronic and disabling disturbance of the brain that causes distorted thinking, strange feelings and unusual behavior, and use of language and words.

Who Is Affected?

Schizophrenia is uncommon in children under the age of 12 and hard to identify in the early phases. A sudden onset of the psychotic symptoms of schizophrenia frequently occurs in middle to late adolescence. Statistics indicate that schizophrenia affects 1% of the population in the United States. A child born into a family with one or more family members affected by schizophrenia has a greater chance of developing schizophrenia than a child born into a family with no history of schizophrenia.

After a person has been diagnosed with schizophrenia in a family, the chance for a sibling to also be diagnosed with schizophrenia is 7-8%. If a parent has schizophrenia, the chance for a child to have the disorder is 10-15% Risks increase with multiple affected family members.

There is no known single cause responsible for schizophrenia. It is believed that a chemical imbalance in the brain is an inherited factor which is necessary for schizophrenia to develop. However, it is likely that many factors — genetic, behavioral and environmental — play a role in the development of this condition.

Schizophrenia is considered to be multi-factorially inherited. Multi-factorial inheritance means that "many factors" are involved. The factors are usually both genetic and environmental, where a combination of genes from both parents, in addition to unknown environmental factors, produce the trait or condition. Often, one gender (either males or females) is affected more frequently than the other in multi-factorial traits. There appears to be a different threshold of expression, which means that one gender is more likely to show the problem, over the other gender. Slightly more males develop schizophrenia in childhood. However, by adolescence, schizophrenia affects males and females equally.

In children with schizophrenia, behavior changes may occur slowly, over time or have a sudden onset. The child may gradually become more shy and withdrawn. They may begin to talk about bizarre ideas or fears and begin to cling more to parents. One of the most disturbing and puzzling characteristics of schizophrenia is the sudden onset of its psychotic symptoms. "Psychotic" refers to ideas, perceptions or feelings that are grossly distorted from reality. However, each child may experience symptoms differently. The following are the most common symptoms:

Early warning signs of schizophrenia in children may include:

• Distorted perception of reality (difficulty telling dreams from reality)
• Confused thinking (i.e., confusing television with reality)
• Detailed and bizarre thoughts and ideas
• Suspiciousness and paranoia (fearfulness that someone, or something, is going to harm them)
• Hallucinations (seeing, hearing or feeling things that are not real such as hearing voices telling them to do something)
• Delusions (ideas that seem real but are not based in reality)
• Extreme moodiness
• Severe anxiety and fearfulness
• Flat affect (lack of emotional expression when speaking)
• Difficulty in performing schoolwork
• Social withdrawal (severe problems in making and keeping friends)
• Disorganized or catatonic behavior (suddenly becoming agitated and confused, or sitting and staring, as if immobilized)
• Odd behaviors (i.e., an older child may regress significantly and begin acting like a younger child)

The symptoms of schizophrenia are grouped into different types:

• Positive symptoms: Things that are "added," like seeing or hearing things that aren't there (hallucinations) or believing things that aren't true (delusions).
• Negative symptoms: Things that are "taken away," like showing little emotion or not being interested in things.
• Disorganized speech: Speech that is jumbled and hard to understand.
• Disorganized or catatonic behavior: Sudden mood swings, aggression or becoming frozen and staring.

Kids with schizophrenia often have hallucinations, but usually don't have delusions until they're older teens. Since these symptoms can be confused with other problems, it's always best to see a doctor for a proper diagnosis.

Specific treatment for schizophrenia will be determined by your child's physician based on:

• Your child's age, overall health and medical history
• Extent of the condition
• Type of schizophrenia
• Your child's tolerance for specific medications or therapies
• Expectations for the course of the condition
• Your opinion or preference

Schizophrenia is a major psychiatric illness. Treatment for schizophrenia is complex. A combination of therapies is often necessary to meet the individualized needs of the child or adolescent with schizophrenia. Treatment is aimed at reducing the symptoms associated with the disorder. Types of treatment that may be helpful to a child or adolescent with schizophrenia may include:

• Medications (also called psycho-pharmacological management to reduce the symptoms of schizophrenia), including the following:
  • Antipsychotic medications (previously known as "neuroleptics") — medications that act against the symptoms of psychotic illness, but do not cure the illness. This specialized class of medications can reduce symptoms or reduce the severity of symptoms, and is used primarily to treat the pervasive, intrusive and disturbing thoughts of a person with schizophrenia. They are designed to help minimize the severity of delusions and hallucinations the child is experiencing.
  • Mood stabilizing agents, such as lithium or valproic acid, especially in the initial phase of an illness episode
• Individual and family psychotherapy (including supportive, cognitive and behavioral therapy)
• Specialized educational and structured activity programs (i.e., social skills training, vocational training, speech and language therapy)
• Self-help and support groups

Prevention of Schizophrenia

Treatment works best when a child gets help quickly for their first psychotic episode. It's also very important that a child or teen takes their medicine exactly as their doctor tells them to. Sometimes, the type of medicine or the dose needs to be changed over time to keep it working well. If you have any questions, you should always talk to your child's doctor.