Childhood-Onset Schizophrenia: Symptoms & Treatment

Schizophrenia is a severe, recurring, and debilitating neurodevelopmental illness that disrupts brain functioning, resulting in deficits in thinking, reasoning, perception, social and personal care abilities, and unpleasant symptoms (e.g., social disengagement and emotional flatness).

Meaning of Childhood-onset Schizophrenia (COS)

Childhood-onset schizophrenia (COS), referred as the start of the condition at 12 or less, appears to be a more severe type of disorder. Schizophrenia usually appears in late adolescence or early adulthood. COS is quite unusual. Its prevalence estimates vary from 0.002 to 0.04 in 100, compared to 1 in 100 for adult-onset schizophrenia. It is relatively uncommon in children under the age of seven.

Premorbid Characteristics

Following are the major characteristics of Schizophrenic children −

• A language impairment characterized by disorder of speech rhythm, articulation, and elective mutism, or language comprehension;

• Motor function impairment characterized by abnormal repetitive movements (stereotypies), neuro integrative problems, poor coordination, and they may also display attention deficits, hyperactivity, aggressiveness, disruptive behaviors, anxiety, emotional instability, or academic failure; and

• A social impairment referred as social withdrawal, aloofness, and atypical peer relationships.

Symptoms of COS

The criteria for schizophrenia in the American Psychiatric Association's Fourth Edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) are the same for onset in childhood or adulthood. To meet the criteria for schizophrenia, the individual must have had at least six months of continuous signs of schizophrenia, including at least one month with two or more of the core symptoms. Such as "delusions, hallucination, grossly disorganized or catatonic, disorganized speech, and negative symptoms (affective flattening, alogia, or avolition)."

However, the child's speech and behavior must be assessed in the context of developmental, psychosocial, cognitive, and cultural aspects. Hallucinations (false perceptions) and delusions (false fixed beliefs), which are "positive" symptoms of schizophrenia, are also defined as psychotic symptoms. Auditory hallucinations, delusions, cognitive disorder, and dull, flat, or inappropriate effects characterize most children with schizophrenia. Some people experience wrath, anxiety, and hypersensitivity. The typical IQ is between 80 and 90; nevertheless, the condition is likely to have a negative impact on the IQ.

Furthermore, thought disorder is classified as:−

• Illogical Thinking;

• Loose Connections (A Change in the Subject without Preparing the Listener for the Change in Topic);

• Incoherence; and

• Lack of Speech Substance (Overuse of Nonsubstantive Terms)

According to Caplan and colleagues (2000), loose connections appear to be particular to COS and are not observed in normal children above 7. Illogical thinking is common in children beyond seven but is not exclusive to COS. Younger schizophrenia children exhibit more irrational thinking and erratic connections than older youngsters. In youngsters with schizophrenia, incoherence and a lack of substance are uncommon.

Neurodevelopmental Theory

The neurodevelopmental theory of schizophrenia assumes that early central nervous system injuries interfere with normal maturational processes. This view is partly supported by premorbid abnormalities noted in infancy and adolescence in people who subsequently develop schizophrenia, which may represent neuropathologic signs. In the 1970s, Kolvin discovered that 87% of 33 children with the equivalent of EOS were morbidly strange and had developmental deficits, mainly in speech. Several recent studies have also confirmed delayed motor milestones, speech difficulties, worse educational exam scores, and poor social integration prior to the start of the disease.

According to a recent study, these deficiencies may be significant to people who develop the disease as adolescents. Perinatal problems, changes in brain shape and size, minor physical defects, and interruption of fetal neural development, particularly during the second trimester of pregnancy, have been linked to the disease in the adult literature.

Assessment of COS

An accurate assessment of EOS in children is critical for early diagnosis, management, and therapy. Although there is little evidence of early intervention in the EOS literature, studies have demonstrated that the length of untreated psychosis predicts poorer outcomes in adults with schizophrenia. Unfortunately, EOS is frequently misdiagnosed due to its rarity and symptoms similar to other mood disorders.

A comprehensive, multi-informant, multi-method evaluation is essential in adolescents to avoid misdiagnosis and improve prognosis. According to the AACAP practice criteria, the evaluation should also include an awareness of the youth's developmental, social, educational, and psychological requirements.

A thorough diagnostic diagnosis should involve interviews with the adolescent and his family, a study of prior records and other relevant information, and a complete evaluation of the psychotic symptoms. The evaluation should address essential aspects such as symptom presentation, illness course, confounding variables, family psychiatric history, and a mental state test.

During the first assessment period, the physician should select broadband (generic screening tools) and narrowband (disorder-specific) tests to rule in/rule out other probable diagnoses or concomitant disorders.

Childhood Antecedents

In general, the antecedents of schizophrenia are subtle, and people who will acquire schizophrenia do not constitute an easily recognizable subgroup, which would allow a precise cause to be identified. Average group deviations from the norm might be in either direction: higher or poorer performance. Birth cohort studies have revealed mild nonspecific behavioral characteristics, some evidence of psychotic-like experiences (especially hallucinations), and various cognitive precursors.

Some variations in the precise areas of functioning have been discovered, whether they persist throughout infancy or are unique to schizophrenia. A prospective study discovered average differences across various developmental domains, including reaching motor development milestones later, having more speech problems, lower educational test results, solitary play preferences between the ages of four and six, and being more socially anxious at the age of thirteen.

Treatment of Childhood-Onset Schizophrenia

Antipsychotic drugs, as well as individual and family therapy, are commonly used in treatment. The child's personalized treatment plan frequently includes exceptional education, group therapy, therapeutic leisure, and occupational therapy. If careful surveillance is required or there is a fear that the child may be hazardous to himself or others, the kid's symptoms may need to be stabilized in an inpatient environment.

Case management services and parent support groups can also be beneficial. Interventions attempt to reduce the child's psychotic symptoms, treat co-morbid conditions, promote age-appropriate skill development, and create a supportive social and emotional environment at home and school.

Carers can typically better handle a disruptive kid if they are aware when the youngster is confused, paranoid, or overwhelmed or is acting on hallucinations or delusions. In such situations, adults can provide reality testing (helping the youngster discern between reality and fantasy) and make the child feel comfortable in a peaceful environment.

Behavioral and cognitive-behavioral therapy should be tailored to the child's interests and cognitive and emotional capacities. These interventions are also more likely to be effective if the child's psychotic symptoms have been stabilized. Social skills, anger management, communication, problem-solving, leisure skills, and safe and proper behavior can all benefit from psychoeducation and organized group experiential activities.

Conclusion

Schizophrenia is a severe neurodevelopmental illness that disrupts brain functioning, resulting in deficits in thinking, reasoning, perception, social and personal care abilities, and unpleasant symptoms. It is caused by an interplay of hereditary sensitivity and early environmental conditions, which alter the development of the nervous system.

The criteria for schizophrenia are the same for onset in childhood or adulthood and include delusions, hallucinations, cognitive disorder, dulled effect, wrath, anxiety, and hypersensitivity. MDID children are more likely to have language/learning impairments, attention deficiencies, mood swings, recurrent violence, and transitory hallucinations/delusions than schizophrenic children. Carers should provide reality testing and help the child feel comfortable in a peaceful environment.