Though diagnostic criteria for early-onset schizophrenia are the same for adults and children, the treatment approach may differ. For instance, discussing the symptoms of psychosis with children can be challenging. Often parental report is utilized when discussing symptoms; however, as noted by Caplan (2011), parents may be unaware of the experience of hallucinations by their child.
Children may not spontaneously talk about hallucinations due to others negating the experience (e.g., It’s nothing; It’s only your imagination), being scared to talk about it, feeling they will burden their parents with it, or believing that talking about the hallucination will make it happen (Caplan, 2011). Clinicians should use careful wording to ask about hallucinations. Delusions, like hallucinations, should be differentiated from normal developmental phenomena (e.g., fantasies, magical thinking; Caplan, 2011). Though morbid fantasies may be upsetting, they too are common (Caplan, 2011); however, if they are pervasive and acted upon they might be “precursors of delusions” (Caplan, 2011, p. 60). Disorganized speech and thought disorders are reflected in illogical thinking, loose associations, and impaired discourse skills (Caplan, 2011; Shatkin, 2015). This communication difficulty must be distinguished from language problems related to language disorders or intellectual disability (Caplan, 2011; Stentebjerg-Olesen et al., 2016); thus it may be beneficial to refer to speech or language therapist to help clarify diagnoses.
Compared to adults, negative symptoms are more prominent in children and adolescents (Harvey, James, & Shields, 2016). Additionally, negative symptoms are noted to be predictors of poorer clinical and functional outcomes (Harvey et al., 2016). Other symptoms related to early-onset schizophrenia are abnormalities of gait, posture, and muscle tone (Shatkin, 2015).
Given the trajectory and progressive course of schizophrenia, early identification and intervention should be emphasized, especially in light of the findings that longer duration of untreated psychosis and poorer premorbid adjustment are associated with poorer outcomes (Stentebjerg-Olesen, Pagsberg, Fink-Jensen, Correll, & Jeppesen, 2016). Furthermore, early-onset schizophrenia is often refractory to treatment. Recent research has indicated that clozapine demonstrated greater efficacy compared to other antipsychotics (Kasoff, Ahn, Gochman, Broadnax, & Rapoport, 2016), where as other research (Harvey et al., 2016) demonstrated that antipsychotics showed a trend of reduction of symptoms compared to placebos, but only olanzapine and risperidone demonstrated statistically significant improvements for positive symptoms, as well as general psychopathology as measured by the Positive and Negative Syndrome Scale (PANSS).
References
Caplan, R. (2011). Childhood schizophrenia: Diagnostic and treatment challenges. Cutting Edge Psychiatry in Practice, 3(1), 55-67.
Harvey, R. C., James, A. C., & Shields, G. E. (2016). Assess the relative efficacy of antipsychotics for the treatment of positive and negative symptoms in early-onset schizophrenia. CNS Drugs, 30(1), 27-39.
Kasoff, L. I., Ahn, K., Gochman, P., Broadnax, D. D., & Rapoport, J. L. (2016). Strong treatment response and high maintenance rates of clozapine in childhood-onset schizophrenia. Journal of Child and Adolescent Psychopharmacology, 26(5), 428-435.
Shatkin, J. P. (2015). Child & adolescent mental health: A practical, all-in-one guide. New York: W. W. Norton & Company.
Stentebjerg-Olesen, M., Pagsberg, A. K., Fink-Jensen, A., Correll, C. U., & Jeppesen, P. (2016). Clinical characteristics and predictors of outcome of schizophrenia-spectrum psychosis in children and adolescents: A systematic review. Journal of Child and Adolescent Psychopharmacology, 26(5), 410-427.
Dannie S. Harris
WKPIC Doctoral Intern