Are you the parent of a child or adolescent who has been diagnosed with schizophrenia or some type of psychotic disorder? If so, you are not alone. You can probably relate to the devastation may parents experience when they finally receive a diagnosis that entails psychotic symptoms. It’s as if the world completely stops and all of the goals and dreams of the future, put on hold. As rare as childhood onset schizophrenia (COS) is, there are many parents who are flabbergasted by the diagnosis so soon in their child’s life. No parent ever wants to consider that their child will have to grapple with the complex symptoms of schizophrenia for the rest of their lives. Sadly, schizophrenia is a pervasive illness that requires lifelong treatment. There are no easy routes.
About 1% of the adult population suffers from schizophrenia. Children, however, only suffer about 1 in 40,000. Childhood onset schizophrenia is a rare occurrence. It is referred to as “early onset” because it occurs before the age of 13. Schizophrenia has long been considered an “adult disease” because of the complexities involved in identifying delusions and hallucinations as well as thought disorder in young children. Schizophrenia can also be hard to detect in childhood because a range of childhood disorders overlap with schizophrenia such as symptoms found in mood disorders (bipolar disorder or depression) or behavioral disorders (oppositional defiant disorder and ADHD). Other youngsters can exhibit symptoms that appear similar to COS if they have been severely abuse and neglected or traumatized. Children and adolescents who have been abandoned by their families and placed in foster care or adoption agencies tend to exhibit symptoms such as poor attachment, decreased emotionality, flat affect, rigidity, aggression or emotional outbursts, suicidal thoughts or attempts, and depression. All of these symptoms tend to occur in COS.
Interestingly, another reason it can be difficult to identify COS is because some of the symptoms of COS mimic those of Asperger’s disorder. Current research has suggested genetic similarities between some of the symptoms of schizophrenia and autism spectrum disorders. For example, language delays, flat affect, decreased emotional expression, lack of interest in interpersonal relationships or social situations, delayed reaction to pain or decreased sensitivity to pain, abnormal motor movements such as rocking back and forth (known as echolalia in autism), and delayed developmental milestones can all be found in COS. Many kids who have autism may walk or talk late in life, but so do some kids who will eventually be diagnosed with schizophrenia. To make matters worse, children diagnosed with reactive attachment disorder and who have been severely neglected or abused also exhibit delayed development, aggression, flat affect, and abnormal motor movements. Obtaining a correct diagnosis means a great deal to a family who relies heavily on medication and therapy for stabilization of symptoms.
Diagnosing schizophrenia in adolescence can also be a challenge because many teens exhibit many of the behaviors seen in youngsters who are diagnosed with schizophrenia such as:
- Withdrawing from friends and family
- Struggling with grades or experiencing a drop in GPA
- Irritability, aggression, and mood instability
- Lack of motivation or sluggishness
- Overall strange behavior
In many cases, delusions are more prevalent among adults who have psychotic disorders, while visual hallucinations are more likely to be experienced as adolescents. The most important thing about COS to remember is that as most kids age, more of the typical symptoms of schizophrenia such as hallucinations, delusions, disorganized thinking, and abnormal behavior are likely to be exhibited. The negative symptoms (symptoms that do not include hallucinations of delusions) of schizophrenia such as lack of eye contact, flat affect, and speaking without inflection are easier to identify as children age as well. The positive symptoms of schizophrenia (hallucinations and delusions) are also more likely to be noticeable.
In mid-September I featured three mothers (Kathy Brandt, Sharon Page, Melanie Jimenez) who have had to live with the reality of their adult children living with schizophrenia, schizo-affective disorder, bipolar disorder, and other psychotic disorders. Personal Stories Week, featured on Caregivers, Family, & Friends blog, allows these moms to share their deepest concerns, fears, and challenges. They have expressed the confusion often inherent in a schizophrenia diagnosis. One mother once said to me “the moment you are told that your child has schizophrenia, the world stops. Nothing matters at that point because your life has drastically changed.” Kathy, Sharon, and Melanie can certainly agree. But one of the things all three of these women insinuated in their articles was the fact that it can be difficult to identify when your child is sick, retreating into poor heath, or needing intense psychiatric treatment. As a therapist, I often educate families on the red-flags and warning signs that appear when psychiatric treatment is needed.
As stated in a previous article, individuals who are retreating into their illness often exhibit certain signs and symptoms. A few red flags or warning signs that you should look for include but are not limited to:
1. Restless behavior: the fact that an individual is restless alone doesn’t necessarily say that that person needs psychiatric attention. There are a lot of days that many of us are restless. Life alone, your job alone, or your relationships can make you restless. But if that restlessness takes over an individual’s behavior so much that they appear anxious, disheveled, or simply out of control, mental health intervention may be needed.
2. Agitation and frustration: again everybody can get agitated and everybody can get frustrated. But it’s when that agitation and frustration is unfounded, unnecessary, and disruptive to people around the individual, that psychiatric intervention may be needed.
3. Increased substance abuse: an individual who is a substance abuser can demonstrate restless behavior, agitation, and frustration. It can be difficult to distinguish between a natural emotional reaction to life or behavior as a result of substance abuse. But if you are looking at an individual who has picked up greater amounts of alcohol, marijuana, over-the-counter prescription medication, or other drugs, intervention may be needed. Substance abusers typically lack coping skills, so their way of coping is usually to increase the amount of drugs that they take in. If you observe increased drug abuse, intervention is typically needed.
4. Depressed mood: sometimes it’s very difficult for us to determine how tired we are, how much intervention we may need, or even how much sleep and relaxation we have neglected in our lives. Individuals who are hard-pressed, may lack the ability to know when it’s time to pull over. Therefore, it is important that people on the outside who care for this individual keep their eyes peeled for strange behavior. Someone who is repeatedly depressed, crying often, unable to sleep or sleeping too much, eating too much or not eating enough, exhibit a in irritability for no apparent reason, picking fights, or simply hopeless, is usually in need of intervention.
5. Isolation: some individuals are natural loners. Some individuals are natural introverts. Some people, including myself, appreciate alone time and time to reflect upon our own emotions, our own thoughts, our own goals, and maybe even our future direction. However, there are some individuals who isolate more often than normal when they are in need of help. If an individual is depressed, increasing their substance use, feeling agitated at the drop of a hat, or even filling hopeless about life, it is easy for them to isolate. You want to be careful not to put pressure on the person who is isolating to become extroverted. Sometimes this makes matters worse. But I encourage you to ask your loved one if they are going through a tough time.
As you can see, childhood onset schizophrenia can be a very difficult diagnosis to not only live with, but also identify correctly. As a result, it is important that you receive second opinions and multiple treatment options for your loved one. The other thing to keep in mind is being aware of the warning signs of relapse.
As always, I wish you well.