Schizophrenia in Children and Teens

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KEY POINTS

• Schizophrenia is a serious lifelong condition that causes changes in thoughts, emotions, and behavior. Your child may not be able to tell what is real, may have trouble communicating with other people, and may have many other symptoms.
• Medicines are the most important part of the treatment. There are also several kinds of therapy that can help.
• Get emergency care if your child has thoughts of suicide or self-harm, violence, or harming others.

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What is schizophrenia?

Schizophrenia is a serious condition that causes changes in thoughts, emotions and behavior. Children with this condition may:

• Hear voices or see things that others do not
• Have behavior that is unusual
• Say things that others do not understand
• Have unusual or bizarre thoughts or not able to tell what is real from what is imagined
• Not show their emotions

This is almost always a lifelong disorder that can cause serious problems in day-to-day living. With medicine and good social support, however, most people with schizophrenia can lead productive lives. Often the symptoms decrease in middle age.

What is the cause?

The exact cause of this disorder is not known.

• Schizophrenia tends to run in families. If a child has one parent who has schizophrenia, then the risk of the child developing it are higher that of other children. This is true even if the child grows up away from the parent with schizophrenia.
• If a woman has a virus or nutrition problems while she is pregnant, it increases the risk that the child will develop schizophrenia later in life. Low oxygen levels from long labor or premature birth may also increase the risk.
• Stress also plays a part. Schizophrenia is not caused by poor parenting, child abuse, or neglect. However, a lot of stress or abuse may make the symptoms start sooner and be more severe.
• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way your child thinks, feels, or acts. Children with this disorder may have too little or too much of some of these chemicals.
• Children with this disorder may have physical changes in their brain. These changes may mean that some parts of the brain are more active or less active than in other children.
• Some drugs can cause schizophrenia symptoms. These include LSD, cocaine, and amphetamines.

Schizophrenia usually starts in the 20s or 30s, but early symptoms can start in the teen years. Girls and young women often develop symptoms later than boys and young men. Symptoms usually increase over 3 to 5 years but can start suddenly over a few weeks. It is rare for this disorder to start before age 12.

What are the symptoms?

No single symptom defines this illness. Some of the symptoms are behaviors that would not be seen in people without mental illness. These types of symptoms are called positive symptoms. They may come and go, and they may be mild to severe. Positive symptoms include:

• Hearing or seeing things that others do not
• Believing things that are not true such as thinking that others are trying to hurt them
• Not moving or responding to other people
• Having trouble keeping thoughts straight
• Stopping talking in the middle of a sentence
• Saying things that don’t make sense or making up words that have no meaning
• Repeating certain motions over and over

Some of the normal emotions and behaviors that people have are missing in children with schizophrenia. These are called negative symptoms. Negative symptoms are often harder to recognize and may be mistaken for depression or other mental illnesses. Negative symptoms include:

• Having no facial expression such as a smile or a frown
• Not making eye contact
• Neglecting personal appearance such as not bathing or combing hair
• Speaking in a flat voice or talking very little or not at all
• Having trouble enjoying anything
• Losing interest in normal activities

Other problems with the way children with schizophrenia think may make it hard to lead a normal life such as:

• Having trouble using information to make a decision
• Having trouble paying attention
• Having trouble using information that they have just learned

How is it diagnosed?

Your child's healthcare provider or therapist will ask about your child's symptoms, medical and family history, and any medicines your child is taking. Your provider will check for a medical illness or drug or alcohol problem that could cause the symptoms. Your child may have tests or scans to help make a diagnosis.

A mental health professional who specializes in working with children and teens should make the final diagnosis. The diagnosis is made based on a thorough psychiatric interview of your child and other family members.

How is it treated?

Medicines

Medicines are the most important part of the treatment. Several types of medicines can help. Your child may need to take more than one type of medicine. Your healthcare provider will work with you to select the best medicine for your child. These medicines may cause side effects, but you and your healthcare provider will be able to watch for them. Your child’s healthcare provider may change how much or how often your child takes the medicine or change the medicine your child has been taking.

It is important for your child to stay on the medicine to keep symptoms under control. If your child is thinking about stopping the medicine, talk to your child’s provider first. Medicines used to treat schizophrenia should not be stopped suddenly or without your child’s provider's advice.

Therapy

Schizophrenia changes the way your child relates to others and the way your child thinks about everyday activities. Other people may be uncomfortable with your child’s unusual or unexpected behavior and they may avoid your child. There are several kinds of therapy that can help.

Supportive therapy can help your child learn about schizophrenia and get advice about how to manage daily challenges.

Cognitive behavioral therapy (CBT) focuses on thinking and behavior. The therapist helps your child learn how to:

• Learn about the condition
• Test the reality of his or her own thoughts
• Ignore voices in his or her own head
• Cope with stress
• Identify early warning signs that symptoms are getting worse
• Set goals and motivate self

Family therapy is often helpful. Family therapy treats all members of the family rather than working with one person alone. It helps the whole family to make changes.

Group therapy can help your child deal with school, relationships, and drug therapy and side effects. It takes place in a group of 6 to 10 people, under the guidance of a therapist.

Day treatment is a special kind of school where your child goes to classes as well as therapy. It is helpful when your child's behavior is so out of control that he or she can no longer be safe or learn well in a regular school setting.

Your child may need to spend some time in a hospital if your child is thinking about hurting himself or herself or someone else.

How can I take care of my child?

• Help your child learn to manage stress. Teach your child to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax. For example, take up a hobby, listen to music, play, watch movies, or take walks.
• Take care of your child’s health. Make sure your child eats a variety of healthy foods and gets enough sleep and physical activity every day. Talk to your child about the risks of smoking, using e-cigarettes, drinking alcohol, and using drugs.
• Check your child’s medicines. To help prevent problems, tell your child's healthcare provider and pharmacist about all the prescription and nonprescription medicines, natural remedies, vitamins, and supplements your child takes. Make sure that your child takes all medicines as directed. It is very important that your child take the medicine even when feeling and thinking well. Without the medicine, your child’s symptoms may not improve or may get worse. Talk to your provider if your child has problems taking medicine or if the medicines don't seem to be working.
• Contact your child’s healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse. Help your child keep appointments with the therapist.
• Keep yourself informed about schizophrenia. This will help you know what behaviors to expect and what to do and say. Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.
• Consider attending a support group. Talking with other people who face the same challenges can help you cope with schizophrenia and its impact on your life. Talk honestly about your feelings and encourage others in the family to do the same.

Get emergency care if your child has thoughts of suicide or self-harm, violence, or harming others.

For more information, contact:

• National Alliance on Mental Illness (NAMI)
  800-950-6264
  https://www.nami.org
• Mental Health America
  800-969-6642
  https://www.mhanational.org