Schizophrenia in Children and Adolescents

ICD-10 code: F20.9

Schizophrenia is part of a cluster of diagnoses called the schizophrenia spectrum and other psychotic disorders.  Schizophrenia spectrum and other psychotic disorders are a group of psychiatric conditions that include:

  • Schizotypal (personality) disorders
  • Brief Psychotic Disorder
  • Schizophreniform Disorder
  • Schizophrenia
  • Schizoaffective Disorder
  • Substance/Medication-Induced Psychotic Disorder
  • Psychotic Disorder Due to Another Medical Condition
  • Catatonia

Onset of Schizophrenia before age 18 is commonly characterized as early-onset schizophrenia (EOS). Onset before age 13 is considered childhood-onset schizophrenia (COS).

These disorders are characterized by symptoms that can be divided into two groups: positive and negative.

Positive symptoms are those which are in addition to normal experiences and which youth without schizophrenia will rarely experience. Positive symptoms include delusions, hallucinations, disorganized thinking (speech), and grossly disorganized or abnormal motor behavior (including catatonia). Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Hallucinations are perception-like experiences that occur without external stimulus. Disorganized thinking/speech is characterized by a derailment or loose associations in an individual’s speech pattern. Grossly disorganized or abnormal motor behavior is a difficulty in sustaining goal-oriented behavior. This may manifest itself in a variety of ways, ranging from childlike “silliness” to unpredictable agitation.

Negative symptoms include diminished emotional expression, avolition, alogia and anhedonia. Negative symptoms are those that involve a loss of normal function or experience. Diminished emotional expression is the reductions in the expression of emotions in the face, eye contact, intonation of speech, and movement of hand, head, and face that normally give an emotional emphasis to speech. Avolition is a decrease in motivated self-initiated purposeful movement. Alogia is manifested by diminished speech output. Anhedoia is the decreased ability to experience pleasure from positive stimuli.

What is Schizophrenia?

Schizophrenia is a neuropsychiatric disorder that affects approximately 0.3-0.7% of adults. Onset of schizophrenia typically occurs between ages 16 and 30. Schizophrenia in youth is extremely rare. Schizophrenia with onset in youth accounts for approximately 1% of all individuals with schizophrenia.

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Understanding Schizophrenia

Although the essential features of adult schizophrenia are the same in childhood, it is harder to diagnose in children and adolescents. Common premorbid difficulties include social withdrawal and isolation, disruptive behavior disorders, academic difficulties, speech and language problems, although these problems are also often present in children who do not go on to develop schizophrenia.

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How is Early-Onset Schizophrenia treated?

EOS is treated using generalized results from adult schizophrenia population studies. Published treatment guidelines for EOS include those from the Journal of the American Academy of Child and Adolescent Psychiatry.

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