Childhood Onset Schizohrenia - Diagnosis
The criteria used to diagnose schizophrenia in adults can be used to diagnose schizophrenia in children ( Mash & Wolfe, 1999).

The characteristic symptoms: Two or more of the following symptoms present for a significant portion of time during a 1 month period.

1. delusions

2. hallucinations

3. disorganized speech

4. gross disorganized or catonic behavior

5. negative symptoms

Social/occupational dysfunction: since the onset of disturbance there is a significant decrease in one or more of the following areas of functioning, such as interpersonal, academic, or occupational achievement.

Duration: continuous signs of disturbance must persist for at least 6 months.

The disorder is not attributed to Mood Disorder or Schizoaffective Disorder.

The disorder is not due to substance use or a general medical condition

There is no history of Pervasive Developmental Disorder, an additional diagnosis of Schizophrenia is given only if prominent delusions of hallucination are also present for at least a month (or less if successfully treated).

(American Psychiatric Association, 1994)

Early Warning Signs for Childhood-onset Schizophrenia

1. trouble telling dreams from reality,

2. seeing things and hearing voices which are not real,

3. confused thinking,

4. vivid and bizarre thoughts and ideas,

5. extreme moodiness,

6. odd behavior,

7. ideas that people are "out to get them,"

8. behaving like a younger child,

9. severe anxiety and fearfulness,

10. confusing television with reality,

11. severe problems in making and keeping friends.

Often children show their signs gradually, such a child may become shy or withdrawn. These signs are often first noticed by teachers. Children may begin talking about odd fears or ideas.

In children or adolescents there is a failure to achieve what is expected of the individual, rather than a deterioration in functioning. Comparing the child with unaffected siblings is helpful in making a decision. Their education is usually disrupted, and in adolescence many individuals can't hold onto a job for long (American Academy of Child & Adolescent Psychiatry, 1995).

Diagnosing children is challenging for a number of reasons, such as they are often unable to verbalize thoughts and feelings. So, a proper assessment is crutial to finding effective treatment strategies. The assessment should consist of gathering information from several sources: parents, child, teachers, pediatrician, etc. A full evaluation takes a number of hours, and the professional should have a good understanding of how the child is functioning in a number of settings. Signs and symptoms should also be gathered to see if the child meets DSM-IV criteria for the disorder ( Satcher, 2000).

The behavior of children with schizophrenia may change slowly over time. For example, children who used to enjoy relationships with others may start to become more shy or withdrawn and seem to be in their own world.

Sometimes youngsters will begin talking about strange fears and ideas. They may start to cling to parents or say things which do not make much sense. These early problems may first be noticed by the child's school teachers.

Schizophrenia is a serious psychiatric illness. The cause of schizophrenia is not known, however current research suggests that brain changes, bio-chemical, genetic and environmental factors may play a role. Early diagnosis and medical treatment are important. Schizophrenia is a life long disease that can be controlled but not cured. Children with the problems and symptoms listed above must have a complete evaluation. Usually these children need comprehensive treatment plans involving other professionals. A combination of medication and individual therapy, family therapy, and specialized programs (school, activities, etc.) is often necessary. Psychiatric medication can be helpful for many of the symptoms and problems identified. These medications require careful monitoring by a child and adolescent psychiatrist.

Parents should ask their family physician or pediatrician to refer them to a child and adolescent psychiatrist who is specifically trained and skilled at evaluating, diagnosing, and treating children with schizophrenia.




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