Chapter 95

Schizophrenia in children is defined in the same way as for adolescents and adults, based on characteristic psychotic symptoms (ie, hallucinations, delusions, and symptoms of thought disorder) accompanied by deficits in adaptive functioning for at least 6 months.1 Historically, the term was used broadly and included children who had what we now know to be autism; schizophrenia and autism are now seen as being quite different.2 The concept of childhood psychosis is problematic, considering the marked developmental changes in children’s understanding of reality (see Table 95-1).

Table 95-1. Developmental Aspects of Psychotic Phenomena

Although adolescent- and adult-onset schizophrenia is relatively common, childhood onset of the disorder is rare (2 in 10,000). As with adults, there may be a preponderance of lower socioeconomic status in affected children. Also as with adults, there are frequent associations with anxiety and mood disorders.3

Various lines of evidence suggest the importance of neurobiological factors in the pathogenesis of this syndrome. Neuropsychological studies reveal deficits in attention, short-term memory, and information processing. Abnormalities in smooth-pursuit eye movements (saccades) are frequent. Family studies (eg, of adopted children) suggest that rates of schizophrenia are substantially higher among children whose parents have the disorder.1 It had been proposed that psychological factors are important in the pathogenesis, but data supporting this notion are limited. However, stressful life experiences may be important in precipitating psychotic episodes in children. Exposure to pharmacological agents (eg, stimulants) may produce a schizophrenic-like psychosis. Changes in MRI studies include increased volume of the lateral ventricle and basal ganglia and decreased gray matter; it is possible that some of these changes may reflect long-term medication effects.4 Recent genetic studies have identified several microdeletions and copy number variations that appear to increase the risk for schizophrenia in adults.

Children who develop schizophrenia often demonstrate premorbid features such as problems with language development, attention, inhibition, withdrawal, and social oddity.3 Although studies of adults who develop schizophrenia suggest some childhood precursors of the condition, their applicability to childhood schizophrenia is limited.

This condition rarely manifests before 5 years of age. Three patterns of onset are noted: acute, insidious with gradual deterioration, and insidious onset with an acute exacerbation of disturbance. Males are ...

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