Five Facts About Childhood-Onset Schizophrenia

Schizophrenia typically begins in late adolescence and young adulthood. Research estimates that the average age of onset for psychotic disorders like schizophrenia lies between ages 20 and 29, with women often receiving the diagnosis later than men (Miettunen et al., 2019).

Still, childhood schizophrenia is not entirely unheard of. Here are five things we know about early-onset schizophrenia.

1. It's Rare

Receiving a diagnosis of schizophrenia before the age of 13 is extremely rare. The estimated prevalence of pre-adolescent onset is one in 10,000 (Leslie, 2023). When children experience difficulties that look like psychosis, it is critical to rule out physical, psychological, and social problems.

Children are usually less able to vocalize what is going on in their minds, and might, for example, use words such as "voices" to describe unwanted or intrusive thoughts. Paranoia and hypervigilance are tragically common indicators of child abuse. A list of neurological conditions can create experiences that mimic psychosis. When a child develops signs of schizophrenia, specialty care involving a psychiatrist and potentially a neurologist is usually indicated.

2. The Illness Tends to Be More Severe

Research has shown that individuals with early-onset schizophrenia tend to struggle more over their lifetime in terms of work, relationships, and symptoms than those with a later onset (Driver et al., 2020). While the reason for this is unknown, one hypothesis is that those who develop psychosis later in life have had more time for healthy social and emotional development. Many who experience a first episode of psychosis in their twenties have had an increased chance of having hit the typical milestones before a focus turns to the condition

3. There is a High Overlap with Autism

Research has suggested that autism may also be present in 30-50% of individuals diagnosed with schizophrenia in childhood (Rapoport et al., 2019). While there is some overlap with autism in adult-onset schizophrenia as well, the prevalence of autism in children who develop schizophrenia is at least three times that of adults with both disorders. A study utilizing health data from 638 youth living with a psychotic disorder also found that those who were also autistic were significantly less likely to have a positive response to antipsychotic medication, a common psychiatric intervention for schizophrenia (Downs et al., 2017). This difference in treatment response may also suggest a different phenotype of schizophrenia in those with an especially early onset.

4. It May Represent a Separate Phenomena

While child-onset schizophrenia may share many of the clinical qualities of the adult-onset version of the conditions, there do seem to be some core differences in this phenotype. Features of schizophrenia include catatonia, a state where a person may become frozen as if a wax figure of themselves. This particular manifestation is rare among adults with the diagnosis but seems to be more common in childhood schizophrenia (Leslie, 2023). Some researchers have described an "iron triangle" involving childhood-onset schizophrenia, catatonia, and autism. Further, one hypothesis of why generally schizophrenia occurs is that the rapid brain development that takes place in late adolescence goes astray in individuals with late adolescent or adult onset of the disorder. A child-onset version of schizophrenia challenges this notion and may represent a different phenotype or even a separate phenomenon altogether

5. There is Hope

Interventions, which may include intensive psychotherapy, specialized psychiatric services, family psychoeducation, and extra accommodations at school, can be beneficial to youth living with schizophrenia. These services are often available through early psychosis coordinated specialty care (CSC). In such programs, families receive wraparound support from a team of specialized providers. There is hope. With support, many with schizophrenia chase their dreams and live good lives.