Diagnosing Schizophrenia In Teens
The teen years can be a difficult period of time for anyone. As adolescents age, they often go through periods of personal growth and setbacks. However, many teens also struggle with untreated mental health disorders, such as DSM V schizophrenia, while attempting to manage a stressful and emotional time during their young lives. Schizophrenia, in particular, can be difficult to diagnose in teenagers and young adults, especially in its early phases. Whether you are a parent, a teacher, or anyone else who regularly interacts with teenagers, it is important to educate yourself on the early warning signs of schizophrenia in a child’s behavior, as well as the later signs once the disorder has manifested. Recognizing the symptoms of early onset schizophrenia in the teenagers in your life can help them receive a diagnosis and find the right treatment before their symptoms grow out of control.
Schizophrenia: An overview of the mental illness
Schizophrenia is a serious mental illness that can cause distorted thinking and unusual behavior in patients. Many people with schizophrenia struggle to distinguish between what is real and what isn’t. As a result, their thoughts and views on the world are distorted or inaccurate, and they may exhibit bizarre behavior as a result. In short, many patients with schizophrenia have lost their concept of reality.
An individual can develop schizophrenia at any age; however, the average age of onset tends to be in mid to late twenties. It is extremely rare for children younger than age twelve to be diagnosed with schizophrenia. However, childhood onset schizophrenia is not impossible.
Criteria for diagnosing teen schizophrenia
Schizophrenia falls under the category of psychotic disorders in the Diagnostic and Statistical Manual (DSM-5). In order to receive an official diagnosis of schizophrenia, patients must present two or more symptoms from the following categories:
- Delusions
- Hallucinations
- Negative symptoms
- Disorganized speech
- Disorganized behavior
It is important for healthcare providers to conduct a full examination in order to recognize schizophrenia, considering a person’s medical history and current symptoms. They may also conduct tests to rule out the presence of another medical condition.
Different types of schizophrenia
In the past, there were five main types of schizophrenia that physicians studied:
Paranoid: This type of schizophrenia is the one most often portrayed in films and TV shows, and is therefore the type most people associate with the disorder. Patients with paranoid schizophrenia often experience psychotic episodes consisting of delusions and hallucinations. Many of them have trouble distinguishing between what is real and what isn’t. It is often difficult for a patient with paranoid schizophrenia to live a normal life.
Catatonic: Patients with catatonic schizophrenia often exhibit unusual styles or levels of movement. A patient can either move erratically or very little. Catatonic states can last from minutes to days.
Undifferentiated: A patient with undifferentiated schizophrenia often exhibits behaviors that fit into two or more categories of schizophrenia. This type of schizophrenia is characterized by a decline in one’s ability to perform regular day-to-day activities. For instance, a person with undifferentiated schizophrenia may choose not to change their clothes or take a shower.
Residual: Residual schizophrenia is diagnosed in patients who had schizophrenia in the past but no longer present any symptoms of the disorder. Sometimes these symptoms vary in intensity over time while others present themselves in a more muted form.
Disorganized or hebephrenic: While this disorder is still recognized by the International Statistical Classification of Diseases and Related Health Problems, it is no longer considered an official subtype of schizophrenia. Patients with hebephrenic schizophrenia don’t experience hallucinations, but they do exhibit disorganized behavior and speech.
Nowadays, schizophrenia is viewed on a spectrum. Sometimes, physicians will use these subtypes to guide their overarching diagnosis of a patient.
Risk factors for developing schizophrenia
Researchers have not yet found a singular cause behind the development of schizophrenia in teenagers. Schizophrenia diagnosed in teens is less common than in young adulthood, but most medical scientists agree that schizophrenia is caused by a variety of genetic, psychological, and environmental factors.
The National Institute of Mental Health notes risk factors that can increase one’s likelihood of developing the condition, such as:
Having a family history of schizophrenia or other mental health conditions
Stressful or traumatic life events
Differences in brain chemistry and structure
Complications during pregnancy and birth
It has also been long believed that the dysregulation of certain brain chemicals, including neurotransmitters called dopamine, plays a role in certain symptoms of schizophrenia, including psychotic symptoms and cognitive symptoms.
Warning signs of schizophrenia in teenagers
Sometimes, a teen or child’s symptoms of schizophrenia appear without any warning. Other times, the disorder causes a gradual decline in a patient’s normal functioning. There are a variety of early symptoms that parents can look out for, such as:
Social withdrawal and trouble making or keeping friends
A deterioration in their child’s personal hygiene
Displaying hostility or paranoia
Having a flat, expressionless gaze
Depression
Expressing bizarre ideas or unusual thoughts
Difficulty concentrating
Laughing or crying at inappropriate times
Struggling to pick up on social cues, such as eye contact
Inability to display emotions such as joy or sadness
Suicidal thoughts
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Suppose your child is displaying significant mood changes, behavior shifts, or other problems that raise concern. In that case, it’s essential to seek early treatment from a family doctor or your child’s pediatrician as soon as possible so that they can receive appropriate medical care. Early intervention for treating schizophrenia at the first sign of a psychotic episode could be key.
Breaking down positive and negative symptoms of schizophrenia
Symptoms of schizophrenia are typically broken down into two categories — positive and negative symptoms. Positive symptoms are characterized by the presence of abnormal thinking and behavior, while negative symptoms refer to the absence of normal mental functioning.
Negative symptoms
Negative symptoms in patients with schizophrenia include:
Withdrawal or apathy: When it comes to making plans with friends or talking to others, people with schizophrenia sometimes withdraw.
Trouble with speech: Also known as alogia, this negative symptom of schizophrenia is characterized by the inability to show one’s feelings when talking, or even talk much at all during a conversation.
An inability to perform basic functions: Patients with schizophrenia may stop bathing or performing basic hygienic functions.
Affective flattening: This occurs when someone with schizophrenia talks in a flat tone that lacks emotion, or is unable to make normal facial expressions in response to things that happen around them.
Inability to stay on task or finish what they started: Some patients with schizophrenia struggle with their ability to follow through on tasks. Some doctors refer to this symptom as “avolition.”
Positive symptoms
Positive symptoms in schizophrenia patients include:
Hallucinations: Hallucinations occur when a patient sees, smells, hears, or feels things that no one else does. A patient might start hearing voices in their head or seeing loved ones who are dead. Tactile hallucinations, such as a patient feeling something crawl over their body, may also be observed in patients with schizophrenia.
Delusions: Delusions are false beliefs that are held even when there is evidence to the contrary. An example of a delusion is the belief that someone is attempting to manipulate one’s actions through their TV set, or that one is being targeted by the FBI. Patients might have a religious delusion where they think they are possessed by a demon or a grandiose delusion where they consider themselves to be a significant public figure.
Movement disorders: Some patients with schizophrenia appear jumpy while also staying in a catatonic state for extended periods of time. Other patients may continue to make the same movements over and over again.
Inability to organize one’s thoughts and speech: People with schizophrenia may have trouble organizing their thoughts or following what other people are telling them. Sometimes, their words come out jumbled when they try to speak. Other patients may appear zoned out or distracted when people try to talk to them.
Person-centered therapy and other treatments for schizophrenia
Patients with schizophrenia often undergo lifelong treatment for their illness — even after their symptoms have subsided. A combination of medication and psychosocial or person-centered therapy is commonly used to treat patients and help them manage their condition. However, in some cases, patients may be required to enroll in inpatient treatment or be hospitalized.
Antipsychotic medications
Antipsychotic medications are the most commonly prescribed drugs for patients with schizophrenia. Many researchers believe that these antipsychotic drugs control a patient’s symptoms by affecting the dopamine and serotonin levels in their brain. Right now, there are first-generation and second-generation antipsychotics available on the market. Most physicians prefer prescribing second-generation antipsychotics as they pose a lower risk of causing serious side effects in patients.
Some mental health specialists prescribe antipsychotic medications along with a treatment plan for person-centered therapy for their patients. Always consult with a child psychiatrist or another professional trained in adolescent psychiatry before taking any medications.
Person-centered therapy and counseling
Psychosocial interventions such as client-centered therapy and mental health counseling have also proven to be effective for patients when their psychosis recedes. In addition to medication, physicians could encourage their patients to undergo:
One-on-one person-centered therapy: A client-centered therapist can use talk therapy to teach clients how to cope with stress, identify early signs of a relapse, and normalize their thought patterns. This treatment allows the patient to achieve personal growth as they continue with their therapy.
Family therapy: When it comes to therapy, a family-centered approach is often highly effective in helping your teen or child cope with their diagnosis.
Training in social skills: Social skills training focuses on teaching patients how to improve their communication skills and their ability to participate in social activities. This person-centered approach to therapy gives them the proper skills and training that can help them improve their social lives and relationships.
Many mental health counselors follow the main components of person-centered therapy when treating their clients. Person-centered therapy aims to treat people with compassion and without judgment. Many individuals prefer working with physicians who specialize in person-centered therapy for this reason.
Hospitalization
During severe crisis periods or relapses, a patient may need to undergo hospitalization for their symptoms. This step is taken to ensure their safety and minimize health risks. Patients might also undergo treatment such as person-centered therapy or electroconvulsive therapy (ECT) during their stay.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy, or ECT, may be prescribed for patients who have not experienced success with drug therapy. During an ECT session, a medical specialist will give the patient general anesthesia as well as a drug to relax their muscles. They will then attach electrodes that send a controlled electric current to the patient’s scalp.
Common misconceptions about schizophrenia
There are a variety of stereotypes and misconceptions attached to patients with schizophrenia. Some people mistake schizophrenia with multiple personality disorder, which is now referred to as dissociative identity disorder, a mental illness that is quite rare. Inaccurate media depictions of schizophrenia may contribute to people confusing TV and movie portrayals of the disease, which often portray people with schizophrenia as violent and dangerous, with actual schizophrenia patients, who are more likely to be victims of violent crime than to perpetrate such crimes themselves. To remove the stigma around this mental health disorder, it is important that teens, parents, and teachers educate themselves on the myths that continue to follow it.
Online therapy with BetterHelp
If your teen has recently been diagnosed with schizophrenia, it may take a toll on your mental health as their parent. In this case, it can be beneficial to lean on someone who can help, such as a therapist. You can connect with a professional on BetterHelp, an online counseling platform. You can even search for someone who has experience with teens and/or schizophrenia to ensure you’re receiving care tailored to your needs.
As a parent, you may have a lot of different responsibilities. Since much of your time may be going toward finding your teen appropriate care, you may feel you don’t have enough time to go to therapy sessions. Online therapy allows you to receive care from the comfort of your home. You can talk to your therapist over the phone, through a video chat, or by utilizing an in-app messaging feature.
The effectiveness of online therapy
Online therapy can be an effective tool for managing a variety of mental health disorders. One study assessed the efficacy of an internet-based intervention for people with psychosis. Researchers found that those with schizophrenia who took part in the study experienced significant improvements in social functioning. They also reported a decline in comorbid depressive symptoms, including their severity.
Takeaway
Although schizophrenia is rarely diagnosed in teenagers, it’s still important to look out for the common signs and symptoms associated with this serious disorder. If you have a child who has recently been diagnosed with schizophrenia, it can have a significant impact on your child’s life and yours. A team of professionals can help your child manage the symptoms associated with this disorder with a treatment plan customized to their needs. Likewise, an online therapist can work with you, as the parent, to cope with the difficult emotions that may arise from your teen’s diagnosis.
Can a 14-year-old be diagnosed with psychosis?
Schizophrenia can occur at any age. It is exceptionally rare for the symptoms of schizophrenia to appear outside of middle or young adulthood. Most cases appear after the age of 12 or before the age of 40. On average, men tend to experience symptom onset in their late teens to early 20s, and women tend to experience symptom onset in their late 20s to early 30s.
Diagnosing schizophrenia in adolescents is usually very challenging. Many symptoms of schizophrenia appear similar to other conditions, like ADHD or developmental delays, in the early days of the illness. Diagnosis is complicated further by the presence of prodromal symptoms, which are weak symptoms of schizophrenia that appear in the very early days of the illness.
Prodromal symptoms include things like withdrawing from friends, changes in sleeping patterns, changes in personality, and feelings of grandiosity. Each of those symptoms could be attributed to a condition other than schizophrenia, and many prodromal symptoms represent behavior that is typical of the average adolescent.
What are the 3 warning signs of schizophrenia?
Schizophrenia has many warning signs, but three hallmark signs of schizophrenia are the emergence of hallucinations, delusions, or disorganized thought. Hallucinations include hearing voices or seeing things that others cannot. Auditory hallucinations are more common than visual hallucinations, but both can occur. The voices heard while hallucinating may be critical or threatening.
Delusions are false beliefs that remain unchanged despite direct evidence against them. One commonly-known delusion is a delusion of grandeur, in which a person has an exaggerated sense of their own significance, authority, or knowledge.
Disorganized thinking is also a hallmark of schizophrenia. People with schizophrenia often struggle to form new memories, organize their thought processes, or complete tasks. Those with schizophrenia are likely to experience a symptom known as anosognosia, or a lack of awareness that they have a mental illness.
At what age can you tell if a child is schizophrenic?
Generally, symptoms of schizophrenia do not appear until after a child has reached the age of 12, and they usually appear much later in adolescence. Still, developing the symptoms of schizophrenia before age 12 is possible, but it is challenging to distinguish schizophrenia in children from other mental health conditions or normal child behavior. For example, a child’s teacher might note when a child engages in imaginative play. They may “see” things that are not really there and “believe” observably untrue things, but few people are likely to be concerned by a child’s imagination, such as pretending to be a superhero saving their city.
Below are some warning signs common to child-onset schizophrenia:
Reporting that their mind or eyes are playing tricks on them.
- Hearing knocking, tapping, or clicking.
- Confusion or expressing strange ideas.
- Sudden and unusual emotional shifts.
- Paranoia or a feeling like people are “out to get them.”
- Unwarranted fear or suspicion.
- Difficulty speaking, writing, or completing age-appropriate tasks.
Each warning sign listed above could apply to a diagnosis other than schizophrenia. It is not possible to tell if a child’s behavior indicates schizophrenia; a licensed professional must perform a complete evaluation to rule out other conditions. Early treatment can significantly improve the quality of life for many children.
What tests confirm schizophrenia?
There is not one single test to confirm schizophrenia, nor is there an assessment battery that definitively predicts the diagnosis. Schizophrenia must be diagnosed by a licensed professional, usually a psychiatrist, who is familiar with the complexities and nuances of the diagnosis. The patient usually receives a complete medical workup to rule out underlying medical conditions before proceeding to a thorough history, investigation of symptoms, and administration of standard rating scales.
The patient's history evaluates hereditary components, brain development, educational history, and social history. The clinician also deeply examines the patient’s current symptoms. The assessing professional may use standardized rating scales to compare the patient’s responses with responses taken from the schizophrenic population. A detailed cognitive assessment, including intelligence testing, may also be included.
How do you self-diagnose schizophrenia?
Self-diagnosing schizophrenia, or other mental health conditions, is unadvised and potentially dangerous. Schizophrenia is a serious condition that requires medical treatment to manage. A qualified professional can perform an in-depth evaluation and discern whether a patient’s reported symptoms are due to schizophrenia or another disorder.
Schizophrenia also requires a complex treatment plan to reduce symptoms as much as possible. Even if it were possible for an untrained person to self-diagnose, it is not possible to treat schizophrenia without the guidance of a trained, knowledgeable professional who is familiar with the course of the illness.
Can IQ tests diagnose schizophrenia?
An IQ test alone cannot be used to diagnose schizophrenia. However, IQ tests are often used as part of a comprehensive cognitive assessment, which are often included in schizophrenia evaluations. A cognitive assessment helps rule out mental health conditions besides schizophrenia and gives insight into the patient’s brain function.
Can a 15-year-old have schizophrenia?
Yes, there is no cut-off for when schizophrenia can appear. For men, symptom onset usually occurs in the late teens to early 20s. For women, symptoms tend to appear in the late 20s to early 30s. It is exceptionally rare for schizophrenia to begin under the age of 12, but child-onset cases have been known to occur.
It can be challenging to diagnose schizophrenia when it emerges during the teenage years. Many of the features of schizophrenia, like disorganized thought and unusual behavior, can be attributed to other mental health conditions or, in some cases, typical adolescent behavior. Neurotransmitters called dopamine are heavily implicated in the development of schizophrenia as well as adolescent development. Bizarre, thrill-seeking, or otherwise strange behavior is already common in adolescents.
How does schizophrenia start?
Schizophrenia often begins with prodromal symptoms, which are weaker, attenuated versions of the symptoms which may eventually develop in schizophrenia. Prodromal symptoms are typically a warning sign, but they do not guarantee that the person will develop schizophrenia. If prodromal symptoms are noticed, a full evaluation may be conducted to determine the person’s risk of developing schizophrenia.
Researchers are uncertain how many people who develop prodromal symptoms will go on to meet the criteria for a schizophrenia diagnosis. One current estimate suggests that only 20% to 40% of those in a prodromal period will develop schizophrenia within 2 - 4 years.
What are the 7 early warning signs of schizophrenia?
The warning signs of impending schizophrenia are usually the prodromal symptoms. The early phase of schizophrenia is characterized by weaker symptoms that signal the possible beginnings of the illness. Although prodromal symptoms function as a warning sign, researchers are still uncertain how many people who experience prodromal symptoms will develop schizophrenia. Estimates indicate that 20% to 40% of those who experience a prodrome will go on to meet the criteria for a diagnosis of schizophrenia.
Below are a few common prodromal symptoms of schizophrenia:
- Social isolation and withdrawal.
- Declining role function (such as occupational, educational, or family roles).
- Emergence of strange or odd behavior changes.
- Flat or blunted emotional expression.
- Speech becomes long-winded, elaborate, or devoid of logical meaning.
- Strange beliefs that do not seem in alignment with observable reality.
- A lack of initiative, energy, or willingness to engage in formerly-enjoyed interests.
What do kids with schizophrenia see?
Those with schizophrenia experience a variety of hallucinations. It is important to note that not all hallucinations are visual. In fact, auditory hallucinations - or hearing things that others cannot - are the most common type of hallucination, followed by visual hallucinations. Visual hallucinations vary from person to person, though some common themes appear.
Visual hallucinations vary in complexity. Some people experience vivid scenes that often include family members, religious figures, or animals. Other people experience more disjointed hallucinations, such as seeing incomplete renderings of humans (like an arm or a leg rather than a whole person), abstract shapes, and unidentifiable objects.
Reactions to hallucinations can be met with fear, joy, or indifference. People with schizophrenia may describe hallucinations that represent an imaginary world, such as reporting hallucinations populated with things that do not exist in the real world or people who appear in an attenuated or symbolic form.
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