Child Schizophrenia Test: What It Is, And When To Seek One

Schizophrenia usually emerges differently depending on a variety of factors, including age, environmental conditions, and family history. Typically, symptoms present in the late teens or early adult years. However, schizophrenia symptoms can appear in childhood or adolescence for some people. 

Early-onset schizophrenia can present unique challenges with recognition, diagnosis, and treatment, and it may contribute to significant difficulties in cognitive, emotional, and social development. One of the most reliable ways to detect schizophrenia in young people may be through testing and assessment administered by a mental health professional. 

Both children with schizophrenia and their parents may benefit from working closely with a licensed therapist for professional support.

What is childhood schizophrenia? 

Childhood schizophrenia, or pediatric schizophrenia, generally refers to a type of schizophrenia in which symptoms manifest during the formative years of childhood. Early-onset schizophrenia (when symptoms emerge before 18 years old) and childhood-onset schizophrenia (when symptoms appear before the age of 13) can both fall under the umbrella of pediatric schizophrenia.

While schizophrenia is a relatively rare disorder affecting an estimated 0.25% to 0.64% of the US population, very early-onset schizophrenia can be even less common.

Very early-onset schizophrenia affects roughly 0.04% of children in the US.

Signs and symptoms of childhood schizophrenia

Like their adult counterparts, children with schizophrenia may experience distorted thinking, perception, emotions, language, and behavior. However, symptoms may manifest differently in children than in adults. For example, children with schizophrenia may have developmental delays, social withdrawal, speech abnormalities, and impaired cognitive function. 

The core types of schizophrenia symptoms in childhood tend to be similar to those in adults. They are typically grouped into three categories: positive, negative, and cognitive.

Positive symptoms of schizophrenia

Positive schizophrenia symptoms typically refer to those that emerge outwardly as a break with reality. For example, a child may not be able to tell the difference between reality and dreams or stories. These types of symptoms typically emerge after negative symptoms during what's known as the prodromal phase. Specific types of positive symptoms can include the following:

• Hallucinations

Audio hallucinations, where the individual hears noises or voices that aren't real, tend to be the most common type. However, children with schizophrenia may also experience visual hallucinations and/or sensory hallucinations like feeling, smelling, or tasting things that don't exist. 

• Delusions

Like hallucinations, delusions can be frightening for children. For example, one may have a vivid belief that someone or something is "out to get them" or frighten them. Kids with schizophrenia may experience delusions of grandiosity where they believe they have magical powers or are receiving messages from unseen entities. 

• Disorganized thoughts and speech

Kids with schizophrenia may have considerable difficulty organizing their thoughts and expressing them verbally. Their words may emerge as "jumbled" or incoherent—a phenomenon sometimes referred to as "word salad."

• Disorganized behavior

Children with schizophrenia may intermittently (or consistently in some cases) behave as if they were much younger. They may appear confused and agitated or display catatonic behaviors where they cease movement and speech.  Some children alternate between agitated and catatonic behaviors. 

Negative symptoms 

These types of symptoms usually involve emotion and social interactions. They most often present during the prodromal phase of a schizophrenic disturbance before acute symptoms like delusions and hallucinations, or after the acute stage, during a period referred to as the recovery phase. 

• Flat affect: Lack of emotional expression in speech or facial expression
• Anhedonia: Inability to experience pleasure
• Avolition: A severe lack of motivation or inability to complete tasks or participate in daily life
• Asociality:  An aversion to being around others or reluctance to participate in activities involving social interaction
• Low mood, depression
• Anxiety

Cognitive symptoms

Cognitive symptoms usually reflect differences in a child with schizophrenia's thinking, memory, and understanding as compared to their non-schizophrenic peers. Often, children with schizophrenia are developmentally delayed and have trouble performing in school, difficulty following directions, and experience deficits in working memory. Cognitive symptoms are typically present during all stages of a schizophrenia disturbance. 

Diagnosis, testing, and treatment

Diagnosing childhood schizophrenia can be uniquely challenging for several reasons. For example, it can mimic other disorders, such as major depressive disorder (MDD) with psychosis, post-traumatic stress disorder (PTSD), and autism spectrum disorder (ASD). 

Additionally, children may experience marked difficulty in communicating and describing their symptoms or be confused by what they're experiencing, potentially making it challenging to relay their experiences to adults. 

It may be noteworthy that prevalence rates of pediatric schizophrenia tend to be low, and stigma surrounding mental illness in children may create more pronounced barriers to seeking diagnosis than in their adult counterparts. 

Diagnosing childhood schizophrenia usually requires a comprehensive approach with collaboration between various professionals, including psychiatrists, psychologists, pediatricians, and social workers.  Accurate, early diagnosis can be critical for long-term treatment outcomes. Often, the diagnostic process consists of several steps.

Initial evaluation

This typically involves gathering information from multiple sources, including parents, caregivers, teachers, school reports, and previous medical records, to assess the child's developmental history, family history of mental illness, and current symptoms.

Physical examination and screenings

A thorough physical examination may be necessary to rule out any medical conditions or substance use that could mimic symptoms of schizophrenia. Clinicians may order lab work and, in some cases, neuroimaging studies like computed tomography (CT) or magnetic resonance imaging (MRI) scans. 

Psychiatric evaluation 

A psychiatrist may interview the child, asking questions about their thoughts, feelings, cognitive function, and any behavioral incidents at school or home. During the evaluation, the psychiatrist may also observe the child's appearance, demeanor, and body language. 

During this diagnostic phase, the mental health professional may assess the presence and severity of core positive symptoms like hallucinations, delusions, disorganized thinking, and abnormal motor behavior. The clinician may also note any adverse symptoms that are present, such as reduced emotional expression or avolition. 

Clinical testing 

In the past, clinicians sometimes used adult measurement tools modified to diagnose childhood schizophrenia. However, contemporary testing methods such as the Melbourne Assessment of Schizotypy in Kids (MASK) and the Early Psychotic Symptoms Screening Scale (EPSy) have since been developed to assess children. In some cases, neuropsychological testing may also be conducted to assess cognitive function, which can differentiate schizophrenia from other conditions.

DSM-V

After testing, evaluations, and physical screenings, the doctor or mental health professional may compare the information gathered with the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) to arrive at a definitive diagnosis. 

Treatment approaches

Once a diagnosis is established, the child and their family can work with healthcare professionals to develop a comprehensive treatment plan tailored to their needs. There is currently no cure for schizophrenia. However, given its developmental nature, longitudinal assessment may be necessary to monitor the progression of symptoms over time and adjust treatment as needed.

Common treatments for childhood schizophrenia may include the following:  

• Medication

Depending on the child's age and physical condition, a psychiatrist may prescribe antipsychotic medications to manage symptoms like hallucinations and delusions. In some cases, they may supplement antipsychotics with antidepressants to address negative symptoms like flat affect, anhedonia, and avolition. 

• Individual therapy

Cognitive behavioral therapy (CBT) and other psychotherapeutic interventions can assist in managing symptoms, building coping skills, improving mental function, and teaching social skills. Cognitive remediation therapy (CRT) may also improve executive function, verbal memory, and daily living/adaptive functioning. 

• Family therapy

Family therapy often focuses on teaching the family how to best support a child with early-onset schizophrenia. This may include psychoeducation, building emotional regulation skills, learning stress reduction methods, and cultivating solid crisis intervention and problem-solving skills. 

• Support services

Social skills training and a structured, individualized, early education program can be integral to successful outcomes and prognosis in children with schizophrenia. Families and children may also benefit from support groups and resources that offer guidance and assistance in navigating the challenges associated with the disorder.

When to seek help 

There are several signs of schizophrenia in children, although they may not be so easy to identify at first. For example, during the prodromal phase: 

• You might notice a drop in your child's ability to perform in school or a decline in their ability to engage in activities they once enjoyed. 
• Your child may begin to isolate themselves from friends and family or have difficulty forming and maintaining relationships. 
• They may experience sudden changes in mood, such as going from being happy to angry or sad with no apparent cause. 
• They may have trouble focusing on tasks or following instructions, leading to problems in school or other activities. 

Beyond this stage, your child might display additional core symptoms of psychosis that are usually easier to recognize:

• Your child might have difficulty organizing their thoughts or expressing themselves clearly. 
• They may speak in a way that's hard to follow or understand. 
• They might hear, see, smell, or feel things that aren't real.
• They may believe things that aren't grounded in reality, even with evidence to the contrary.
• Your child might exhibit odd behaviors or movements that seem inappropriate for the situation or their age. 

It isn't uncommon for parents, caregivers, and physicians to mistake some schizophrenia symptoms for other mental health disorders like anxiety, depression, or ADHD, particularly in the prodromal phase. Alternatively, they might assume the child is struggling in school due to bullying or experiencing changes due to physiological milestones like puberty.  Some may believe their child is experimenting with substances or alcohol or is associating with peers who are a negative influence.

While these can be common challenges associated with adolescence and childhood, they may also be signs of a mental health condition. It can be critical to reach out to a mental health professional if your child is struggling with symptoms like those described above. 

Early detection can be critical in treating schizophrenia

Review your child’s symptoms with a therapist

How to support your child 

If you suspect your child has schizophrenia or another mental health disorder, it may help to be prepared when you visit your child's mental healthcare provider. Here are some tips:

• Write down a list of your child's symptoms and any questions you have.
• Come prepared with your child's school transcripts or any other relevant information the doctor may request. 
• Communicate why you sought professional help and what you specifically want for your child.
• Learn about potential causes and risk factors. 
• Write down the details of the diagnostic plan. For example, why do they recommend certain tests or procedures during the process? What could the results mean? 
• Ask for psychoeducational materials and resources, including group support options.
• Ask for your child's treatment plan in writing, including details about medications and psychotherapeutic interventions. 
• Know how to handle a psychiatric emergency and get contact information to reach your child's doctor outside of office hours. 

Seeking support as a parent

Studies suggest that parents and caregivers who receive physical, psychological, and financial support tend to be better able to support their loved ones experiencing schizophrenia. As such, it may be essential to utilize any available resources you may have access to. 

Despite its importance, some parents of children with mental health issues encounter barriers to accessing mental health care for themselves. For example, individual therapy can be costly without insurance. Because of scheduling demands, making time to attend appointments may be challenging. For some people, finding a compatible therapist may be difficult due to geographical limits or challenges commuting to and from appointments. 

For many, virtual therapy can offer solutions to such barriers. For example, online therapy platforms usually provide individuals with access to a greater pool of mental health professionals with varying experiences and backgrounds. They can also offer the flexibility to schedule appointments at your convenience or switch counselors as needed. 

Online therapy is often less expensive than in-person treatment without insurance, and a growing body of research indicates it can be just as effective. 

Takeaway

While childhood schizophrenia can present significant challenges, advancements in research and treatment may offer hope for improved outcomes. A close partnership with your child's pediatric psychologist, teachers, and counselors can be critical for the best possible outcomes. Consider seeking support as a parent by reaching out to a licensed therapist in your local area or through an online therapy platform.