Schizophrenia is a disabling, chronic and very complex disorder. Rarely does this disorder appear during childhood.

Infantile schizophrenia , although it is part of the spectrum of schizophrenia, receives a specific name because children who suffer from it show a very homogeneous picture with an unfavourable prognosis that must be diagnosed when first to stop the clinical worsening of the patient.

These children, who like adults suffer from hallucinations and delusions, also show brain abnormalities and genetic risk factors that explain the early development of the disease.

Childhood Schizophrenia Clinic

Most cases of childhood schizophrenia are diagnosed through the presence of hallucinations , a very striking symptom.

However, is not the only symptom these children exhibit . As with schizophrenia in adulthood, the psychotic picture of schizophrenics is very diverse and includes different symptoms, both psychotic and disorganizing.

Psychotic symptoms

The main cause of alert for parents is the presence of hallucinations. The most common ones are auditory hallucinations such as unpleasant and negative voices speaking to the patient or calling him/her. The voices may be male or female, familiar or unfamiliar, critical or flattering. Sounds, noises or music are considered less frequent and severe.

It is also possible to find visual hallucinations, see shapes, colors or people that are not present and may even have religious characteristics, for example, seeing the devil or Christ.

Another psychotic manifestation is the presence of delusions. A delusion is an unfounded and rigid belief to which the patient clings like a burning nail, whose content is implausible or very difficult to believe. For example, delusions of persecution where the patient believes he is the victim of a conspiracy, that someone is spying on him, etc.

Children are very imaginative individuals, that is why it is very easy to confuse delusions with fantasies which can be more or less extravagant depending on the child’s creativity. Likewise, ideas like “my parents can read my thoughts” can either be delusions or the product of an innocent and credulous mind. The clinician’s good judgment is crucial here.

2. Symptoms of disorganization

In childhood schizophrenia we find extravagant behaviour, for example unusual food preferences , strange social behaviour, strange or illogical speech. Again, we have to separate the incoherence of the child’s speech from the illogicality that does not correspond to the child’s developmental level.

Of all the disorganizing manifestations in childhood schizophrenia, the most visible are the motor and social ones. Prior to diagnosis, it is common for parents to talk about strange gestures, grimaces or postures that anticipate the development of the disorder. In addition, these children are socially awkward. They may find it difficult to hold a conversation with other children, express ideas, talk about extravagant subjects and lose the thread of the dialogue. They are often described as “strange” by their peers.

Causes of childhood schizophrenia

Although the direct cause of the development of childhood schizophrenia is unknown, we do know several risk factors that are associated with the disorder.

Having first-degree relatives with schizophrenia increases the likelihood of having this disorder, so there is a genetic burden in its development. The presence of other comorbid disorders, such as anxiety disorders, ADHD, or conduct disorder, often accompanies childhood schizophrenia. It is also found that in families of children with this disorder, emotions are expressed with greater intensity.

There are several studies that describe how complications during childbirth can lead to abnormalities in neurological development and subsequently to schizophrenia. In particular, complications involving cutting off the flow of oxygen to the brain and causing hypoxia have been linked to the further development of the disorder, although the exact mechanism is not at all clear.

In these children, the lateral ventricles of the brain are enlarged. In addition, they progressively lose grey substance in the frontal and temporal regions of the brain, similar to adults. Thus, patients with childhood schizophrenia have a lower brain volume than the normal population.

Prognosis and treatment

The age at which schizophrenia debuts is a very strong predictor of its severity and prognosis. Those who develop schizophrenia earlier will be more affected and therefore have a worse prognosis. They are expected to be more impaired in thinking, language, motor and social behaviour than those who have debuted later.

Because of this, childhood schizophrenia predicts a poor prognosis for those who suffer it unless it is diagnosed in time. This makes the evaluation of possible schizophrenia during childhood a race against time where the professional must be thorough, but not go too fast and mark a child for life.

Once it is determined that the child is indeed suffering from childhood-onset schizophrenia, drug therapy with antipsychotics will be started immediately to cushion as much as possible the deterioration caused by the disorder . Parents will also need to be trained in what kinds of symptoms to expect, how to handle them, and what special needs the child might have later on.

At the same time, delusions and hallucinations are dealt with psychologically by teaching the child to recognize them as such. Psychotic symptoms are often preceded by negative moods and it is possible to realize when one is in a vulnerable period. Moreover, it is imperative to teach these patients to make alternative interpretations of the facts in order to get out of the rigidity which characterises delusions.

Finally, it is possible to address the social behavior of the child with schizophrenia through social skills training to teach him how to relate to others in a normal way and to be able to form meaningful bonds with his classmates.