CHILDHOOD SCHIZOPHRENIA
By: Amie Peters
In this day and age, the information on Schizophrenia is much more evolved than even 60 years ago. We still have a long way to go in fully understanding this disease. Past history has shown us that those who had this illness had one of two fates: either be passed by and dismissed as crazy, or the other extreme, to be accused of being “possessed”. Luckily, much advancement in the field of psychology has been made. We have come to realize that the individuals who live with this illness can be helped. Those who are in need of the most help are the children. Innocent and confused, they must face this world with a huge obstacle blocking their way. However, with the intervention and care of others, their life no longer has to be one that conforms to our standards, but rather we have to be and should be the ones to conform to them.
The growing interest in childhood schizophrenia is primarily due to the fact that there has been mounting evidence that like autism, schizophrenia has neurodevelopmental roots. While the manifestation of schizophrenia in children before the age of 7 is rare, it is still very important for us to study its effect and determine if there are any possible cures or causes that may be unknown to us. The Harvard Mental Health Letter (1997) stated, “Neurodevelopmental damage seems to be greater in childhood schizophrenia than in the adult-onset type. Most schizophrenic children show delays in language and other functions long before their psychotic symptoms
( hallucinations, delusions, and disordered thinking ) appear, usually at age 7 or later. In the first years of life, about 30% of these children have transient symptoms of pervasive developmental disorder, such as rocking, posturing, and arm flapping. Childhood home movies indicate uneven motor development, such as unusual crawling, in adult-onset schizophrenic patients. Children with schizophrenia may be even more seriously impaired in this respect; they are also more anxious and disruptive than adult-onset schizophrenic patients were as children.” ( p. 1-8 )
Typically in adults and adolescents the onset of schizophrenia starts with a sudden psychotic break, but in looking at children this does not seem to be the case. Children seem to gradually develop their symptoms. Otherwise the symptoms are similar to those of adult-onset schizophrenia. Both types are also associated with similar irregularities in autonomic nervous system arousal, similar difficulties in visual tracking of moving objects, and similar abnormalities of brain structure. Researchers are currently conducting family studies to learn more about the distinctive features of childhood schizophrenia and its relationship to the adult-onset form of the disorder. They also will look for subgroups of schizophrenic children with distinct genetic markers.
Another interesting fact is that currently they are trying to determine whether a child with more than one problem such as ADD, and ADHD with social withdraw, and language issues, may be neurobiologically related to childhood schizophrenia. This issue is vital because research depends on the assumption that childhood and adult-onset types of schizophrenia are closely related. It is important to note that 90% of children who have multiple disorders at one time are boys. Mash and Wolfe (2002) findings revealed, “Childhood-onset occurs earlier in boys ( 2-4 years ) and is approximately twice as common in boys as in girls. This gender difference is not apparent in adolescence through adulthood.” ( p. 285-290 )
It is imperative that when a child is being diagnosed with schizophrenia, their age, developmental stage, and all other possibilities are ruled out. An example of this would be a three- year old child who may have an imaginary friend and may engage in conversations and play with them. This of course would be normal; however, it is abnormal on the other hand for a child who is at the age of seven to experience social withdrawal, delusions, hallucinations and other symptoms of psychosis. Since the normal developing stages of a child are commonly the signs of schizophrenia in adults and adolescents, the DSM-IV-TR set the criteria for childhood-onset schizophrenia. The DSM-IV-TR (2002) states, “The child must display the symptoms of withdrawal, delusions, hallucinations and other symptoms for at least one month. At this point the child would be diagnosed with childhood-onset schizophrenia.” Misdiagnosis is common in young children, because psychosis occurs after other impairments are apparent. Autism is the most frequent diagnosis in young children, who are actually suffering from the beginning stage of schizophrenia. Additionally only 1 in 10,000 children are affected by this illness. One unfortunate finding is that onset before age ten is correlated with a worse prognosis
It is important to look at warning signs in children that may alert us to the onset of schizophrenia. It was hard to find anything regarding to research that was done in this area, but I did find one that was interesting. Journal of Child Psychology and Psychiatry (2005), researched Delayed Oculomotor Response (DOR) and discovered the following:
“Delayed oculomotor response ( DOR ) task requires response inhibition followed by movement of gaze towards a known spatial location without a current stimulus. Abnormalities in response inhibition and in the spatial accuracy of the eye movement are found in individuals with schizophrenia and in many of their relatives, supporting the use of these saccadic abnormalities as endophenotypes in genetic studies.” ( p. 1354-1362 )
They performed a study on 187 children, ages 5-16 years of age, 45 children with childhood-onset schizophrenia, 64 children with a first-degree relative with schizophrenia, and 84 typically developing children.
Harvard Mental Health Letter ( 1997 ) discovered that, “Children with childhood-onset schizophrenia demonstrated impaired response inhibition and impaired spatial accuracy compared to both relatives and typicals. However, relatives and typicals did not differ from each other. Children with childhood-onset schizophrenia have saccadic abnormalities similar to those found in adults with schizophrenia, supporting the continuity of executive function deficits in childhood-onset with adolescent and adult-onset schizophrenia. However, saccadic tasks are not sensitive to genetic risk in non-psychotic children.” ( p. 44-69 )
After reading this study, I began to question if it would be possible for a previous traumatic brain injury, for example being dropped as a baby, car accident, or even falling off of a bicycle as a child, could be a leading cause of the onset of schizophrenia. There was once again little information available, but I did uncover one write up on this idea. Research was done on psychosis following traumatic brain injury in which a patient may or may not have displayed symptoms of schizophrenia. Both of these studies were limited by unclear findings regarding traumatic brain injury. Schizophrenia relating to traumatic brain injury has not been thoroughly reviewed. According to Current Opinion in Psychiatry ( 2008 ), “The evidence supports a risk-modifying effect of traumatic brain injury in individuals who are genetically at risk for schizophrenia, but is less supportive of traumatic brain injury as an independent risk factor for schizophrenia in individuals without such risk. Research in psychotic disorders following traumatic brain injury must distinguish schizophrenia from other psychotic syndromes, and take familial risk factors into consideration.”
In looking at possible medication to help manage the psychological effects of this disorder, I found that typical standard antipsychotic drugs appeared to be regarded as effective for schizophrenic children and adolescents. Also, the atypical drug clozapine is helpful for at least half of those who do not respond to typical drugs. It was noted in a few cases their psychotic symptoms seem to disappear entirely. Unfortunately, it was found that children may be more susceptible than adults to the toxic effects of clozapine and about a third of them had to stop taking it because of the side effects. Doctors are now testing newer antipsychotic drugs that may be safer and just as effective.
Studies have shown that in young patients with schizophrenia, schizoaffective, or schizophreniform disorders, olanzapine treatment was associated with marked symptom improvement. Journal of Childhood & Adolescence Psychopharmacology ( 2005 ) was quoted saying, “As changes in weight and prolactin levels may be greater in adolescent than in adult patients, potential risks and benefits of olanzapine treatment in adolescents should be considered carefully.” ( p. 44-69 )
According to Kumra (2000), “Other possible treatment programs are psycho educational training programs, social skills training and individual and family counseling.” ( p. 923-930 ) The objective of the psychoeducational training program is to improve attitudes toward treatment, reduce fear of side effects, and increase confidence in the treating physician and the prescribed medication. The goal of social skills training is to teach acceptance, coping, and adjustment in social situations. Individual and family counseling offers another pillar of support for those affected by the child’s early-onset schizophrenia.
Despite what little information is available to us in regards to this disorder, it was found that development of schizophrenia during adolescence, and is more common in children that have parents with schizophrenia.
Asarnow (1998) study found the following:
“Some attributes of the family environment that have been associated with increased risk are family communication, lack of communication, negative communication, yelling, fighting, poor parenting styles, and disturbances or trouble in the family environment.” (p.180-194)
In conclusion, the history of medical mysteries has unveiled much to us about childhood disorders. Children with disorders are no longer envisioned as possessed, but rather diagnosed with known medical disorders. In past centuries, children were seen as miniature adults who were responsible for their own well-being. Much has changed since then and society now embraces the fact that children have a need to be nurtured and guided, and parenthood is now a joy with many responsibilities. Whether or not you saw yourself as a parent of a child with this disorder, you must remember one thing. Children are blessings and they are also like flowers. Without the warmth of your love, and the rain from your tears, they will fail to bloom. Sometimes the most healing thing to a child is just that, the love of another. In short, while you are dealing with the doctors and medications and all the other difficult things, take the time to look at this child and put things into perspective. When you think your life is hard just remember, they are the ones who live it, we’re the ones who share it.
References
Dittmann, R . , Meyer, E . , Freisleder, F . , Remschmidt, H . , Wex, C . , Junghanss, J . , Hagenah, U . , Markwort, M . , Poustka, F . , Schmidt, M . ,
Schulz, E . , Mstele, A . , Wehmeier, P . (2008). Effectiveness and Tolerability of Olanzapine in the Treatment of Adolescents with Schizophrenia and Related Psychotic Disorders. Journal of Child and Adolescent Psychopharmacology, 18(1), 54-69.
Ross, R . , Heinlein, S . , Zerbe, G . , & Radant, A . (2005). Saccadic eye movement task identifies cognitive deficits in children with schizophrenia, but not in unaffected child relatives. Journal of Child Psychology and Psychiatry, 46(12), 1354-1362.
Edward Kim (2008). Does traumatic brain injury predispose individuals to develop schizophrenia?. Current Opinion in Psychiatry, 21(3), 286.
Mash, E . , & Wolfe, D. (2002). Abnormal Child Psychology (2nd ed). 285-290.
DSM-IV-TR. (2000). Diagnostic and statistical manual of mental disorders, para. (2-5)
Harvard Mental Health Letter. (1997). What is known about childhood schizophrenia?, 14 (6), 1-8.
Kumra, S . , Shaw, M . , Merka, P . , Nakayama, E . , Augustinm, R . (2001). Childhood-onset schizophrenia: research update. Canadian Journal of Psychiatry, 46(10), 923-930.
Asarnow, J . , Tompson, M . , McGrath, E . (2004). Annotation: Childhood-onset schizophrenia; Clinical and treatment issues. Journal of Child Psychology and Psychiatry, 45(2), 180-194.