Childhood schizophrenia

Diagnosis

Diagnosis of childhood schizophrenia involves ruling out other mental health disorders and determining that symptoms aren't due to alcohol or drug use, medication or a medical condition. The process of diagnosis may involve:

• Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
• Tests and screenings. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. The doctor may also request imaging studies, such as an MRI or CT scan.
• Psychiatric evaluation. This includes observing appearance and demeanor, asking about thoughts, feelings and behavior patterns, including any thoughts of self-harm or harming others, evaluating ability to think and function at an age-appropriate level, and assessing mood, anxiety and possible psychotic symptoms. This also includes a discussion of family and personal history.
• Diagnostic criteria for schizophrenia. Your doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Challenging process

The path to diagnosing childhood schizophrenia can sometimes be long and challenging. In part, this is because other conditions, such as depression or bipolar disorder, can have similar symptoms.

A child psychiatrist may want to monitor your child's behaviors, perceptions and thinking patterns for several months or more. As thinking and behavior patterns and signs and symptoms become clearer over time, a diagnosis of schizophrenia may be made.

In some cases, a psychiatrist may recommend starting medications before making an official diagnosis. This is especially important for symptoms of aggression or self-injury. Some medications may help limit these types of behavior.

Treatment

Schizophrenia in children requires lifelong treatment, even during periods when symptoms seem to go away. Treatment is a particular challenge for children with schizophrenia.

Treatment team

Childhood schizophrenia treatment is usually guided by a child psychiatrist experienced in treating schizophrenia. The team approach may be available in clinics with expertise in schizophrenia treatment. The team may include, for example, your:

• Psychiatrist, psychologist or other therapist
• Psychiatric nurse
• Social worker
• Family members
• Pharmacist
• Case manager to coordinate care

Main treatment options

The main treatments for childhood schizophrenia are:

• Medications
• Psychotherapy
• Life skills training
• Hospitalization

Medications

Most of the antipsychotics used in children are the same as those used for adults with schizophrenia. Antipsychotic drugs are often effective at managing symptoms such as delusions and hallucinations.

In general, the goal of treatment with antipsychotics is to effectively manage symptoms at the lowest possible dose. Over time, your child's doctor may try combinations, different medications or different doses. Depending on the symptoms, other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks after starting a medication to notice an improvement in symptoms.

Second-generation antipsychotics

Newer, second-generation medications are generally preferred because they have fewer side effects than first-generation antipsychotics do. However, they may cause weight gain, high blood sugar, high cholesterol or heart disease.

Examples of second-generation antipsychotics approved by the U.S. Food and Drug Administration (FDA) to treat schizophrenia in teenagers age 13 and older include:

• Aripiprazole (Abilify)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)

Paliperidone (Invega) is FDA-approved for children 12 years of age and older.

First-generation antipsychotics

First-generation medications are usually as effective as second-generation antipsychotics in controlling delusions and hallucinations. In addition to having some side effects similar to those of second-generation antipsychotics, first-generation antipsychotics also may have frequent and potentially significant neurological side effects. These include the possibility of developing a movement disorder called tardive dyskinesia, which may or may not be reversible.

Because of the increased risk of serious side effects with first-generation antipsychotics, they often aren't recommended for use in children until other options have been tried without success.

Examples of first-generation antipsychotics approved by the FDA to treat schizophrenia in children and teens include:

• Perphenazine for children 12 years and older
• Thiothixene for children 12 years and older

Medication side effects and risks

All antipsychotic medications have side effects and possible health risks, some life-threatening. Side effects in children and teenagers may not be the same as those in adults, and sometimes they may be more serious. Children, especially very young children, may not have the capacity to understand or communicate about medication problems.

Talk to your child's doctor about possible side effects and how to manage them. Be alert for problems in your child, and report side effects to the doctor as soon as possible. The doctor may be able to adjust the dose or change medications and limit side effects.

Also, antipsychotic medications can have dangerous interactions with other substances. Tell your child's doctor about all medications and over-the-counter products your child takes, including vitamins, minerals and herbal supplements.

Psychotherapy

In addition to medication, psychotherapy, sometimes called talk therapy, can help manage symptoms and help you and your child cope with the disorder. Psychotherapy may include:

• Individual therapy. Psychotherapy, such as cognitive behavioral therapy, with a skilled mental health professional can help reduce symptoms and help your child learn ways to deal with the stress and daily life challenges of schizophrenia. Learning about schizophrenia can help your child understand the condition, cope with symptoms and stick to a treatment plan.
• Family therapy. Your child and your family may benefit from therapy that provides support and education to families. Involved, caring family members can be extremely helpful to children with schizophrenia. Family therapy can also help your family improve communication, work out conflicts and cope with stress related to your child's condition.

Life skills training

Treatment plans that include building life skills can help your child function at age-appropriate levels when possible. Skills training may include:

• Social and academic skills training. Training in social and academic skills is an important part of treatment for childhood schizophrenia. Children with schizophrenia often have troubled relationships and school problems. They may have difficulty carrying out typical daily tasks, such as bathing or dressing.
• Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs.

Hospitalization

During crisis periods or times of severe symptoms, hospitalization may be necessary. This can help ensure your child's safety and make sure that he or she is getting proper nutrition, sleep and hygiene. Sometimes the hospital setting is the safest and best way to get symptoms under control quickly.

Partial hospitalization and residential care may be options, but severe symptoms are usually stabilized in the hospital before moving to these levels of care.

Lifestyle and home remedies

Although childhood schizophrenia requires professional treatment, it's critical to be an active participant in your child's care. Here are ways to get the most out of the treatment plan.

• Follow directions for medications. Try to make sure that your child takes medications as prescribed, even if he or she is feeling well and has no current symptoms. If medications are stopped or taken infrequently, the symptoms are likely to come back and your doctor will have a hard time knowing what the best and safest dose is.
• Check first before taking other medications. Contact the doctor who's treating your child for schizophrenia before your child takes medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals, herbs or other supplements. These can interact with schizophrenia medications.
• Pay attention to warning signs. You and your child may have identified things that may trigger symptoms, cause a relapse or prevent your child from carrying out daily activities. Make a plan so that you know what to do if symptoms return. Contact your child's doctor or therapist if you notice any changes in symptoms, to prevent the situation from worsening.
• Make physical activity and healthy eating a priority. Some medications for schizophrenia are associated with an increased risk of weight gain and high cholesterol in children. Work with your child's doctor to make a nutrition and physical activity plan for your child that will help manage weight and benefit heart health.
• Avoid alcohol, recreational drugs and nicotine. Alcohol, recreational drugs and nicotine can worsen schizophrenia symptoms or interfere with antipsychotic medications. Talk to your child about avoiding drugs and alcohol and not smoking. If necessary, get appropriate treatment for a substance use problem.

Coping and support

Coping with childhood schizophrenia can be challenging. Medications can have unwanted side effects, and you, your child and your whole family may feel angry or resentful about having to manage a condition that requires lifelong treatment. To help cope with childhood schizophrenia:

• Learn about the condition. Education about schizophrenia can empower you and your child and motivate him or her to stick to the treatment plan. Education can help friends and family understand the condition and be more compassionate with your child.
• Join a support group. Support groups for people with schizophrenia can help you reach out to other families facing similar challenges. You may want to seek out separate groups for you and for your child so that you each have a safe outlet.
• Get professional help. If you as a parent or guardian feel overwhelmed and distressed by your child's condition, consider seeking help for yourself from a mental health professional.
• Stay focused on goals. Dealing with childhood schizophrenia is an ongoing process. Stay motivated as a family by keeping treatment goals in mind.
• Find healthy outlets. Explore healthy ways your whole family can channel energy or frustration, such as hobbies, exercise and recreational activities.
• Make healthy lifestyle choices. Maintaining a regular schedule that includes sufficient sleep, healthy eating and regular physical activity is important to mental health.
• Take time as individuals. Although managing childhood schizophrenia is a family affair, both children and parents need their own time to cope and unwind. Create opportunities for healthy alone time.
• Begin future planning. Ask about social service assistance. Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, affordable housing, transportation, self-help groups, other daily activities and crisis situations. A case manager or someone on the treatment team can help find resources.

Preparing for your appointment

You're likely to start by first having your child see his or her pediatrician or family doctor. In some cases, you may be referred immediately to a specialist, such as a pediatric psychiatrist or other mental health professional who's an expert in schizophrenia.

In rare cases where safety is an issue, your child may require an emergency evaluation in the emergency room and possibly admission for psychiatric care in a hospital.

What you can do

Before the appointment make a list of:

• Any symptoms you've noticed, including when these symptoms began and how they've changed over time — give specific examples
• Key personal information, including any major stresses or recent life changes that may be affecting your child
• Any other medical conditions, including mental health problems, that your child has
• All prescription and over-the-counter medications, vitamins, herbs or other supplements that your child takes, including the dosages
• Questions to ask the doctor

Basic questions to ask the doctor may include:

• What is likely causing my child's symptoms or condition?
• What are other possible causes?
• What kinds of tests does my child need?
• Is my child's condition likely temporary or long term?
• How will a diagnosis of childhood schizophrenia affect my child's life?
• What's the best treatment for my child?
• What specialists does my child need to see?
• Who else will be involved in the care of my child?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your child's doctor is likely to ask you and your child a number of questions. Anticipating some of these questions will help make the discussion productive. Your doctor may ask:

• When did symptoms first start?
• Have symptoms been continuous or occasional?
• How severe are the symptoms?
• What, if anything, seems to improve the symptoms?
• What, if anything, appears to worsen the symptoms?
• How do the symptoms affect your child's daily life?
• Have any relatives been diagnosed with schizophrenia or another mental illness?
• Has your child experienced any physical or emotional trauma?
• Do symptoms seem to be related to major changes or stressors within the family or social environment?
• Have any other medical symptoms, such as headaches, nausea, tremors or fevers, occurred around the same time that the symptoms started?

The doctor will ask additional questions based on responses, symptoms and needs.