The Onset of Schizophrenia in Children

"Schizophrenia is rare in children, affecting only about 1 in 40,000" (National Institute of Mental Health, 2001, p.1). It is a rare disorder due to the fact that many children are mistakenly misdiagnosed with other disorders such as, autism, bipolar disorder, major depressive disorder, or compulsive disorders. These children are therefore misunderstood and suffer alone in a state of confusion and fear. Despite the low number of children affected by Schizophrenia, it still remains an extremely critical disorder that is currently highly misunderstood. Childhood schizophrenia generates unusual thoughts and emotions, as well as abnormal behavior (American Academy of Child & Adolescent Psychiatry, 2003, p.1). It is more difficult to diagnose than adult schizophrenia, and for that reason is first characterized by many specific warning signs. These warning signs eventually develop into full-fledged effects, which enable childhood schizophrenia to be defined. Childhood schizophrenia is difficult to understand mainly because there are so many different warning signs that can point towards it. Consequently, in order for a child to be diagnosed as schizophrenic several of the warning signs must first be in effect. More importantly, however is that these warning signs must first be understood and connected to the child in order to properly understand the diagnosis of a schizophrenic child.

Childhood schizophrenia emerges slowly but steadily. It only worsens as time passes, which causes the child's behavior to degenerate slowly but surely. Specifically though, as described in the National Institute of Mental Health, schizophrenia is "often preceded by developmental disturbances, such as lags in motor and speech/language development" (2001, p.1). Symptoms of schizophrenia in children usually become apparent before the age of twelve. The American Academy of Child & Adolescent Psychiatry (2003, p.1) states that schizophrenia is often characterized by warning signs such as the following:

� Hallucinations

� Odd and eccentric behavior, and speech

� Unusual or bizarre thoughts and ideas

� Confusing television and dreams from reality

� Confused thinking

� Extreme moodiness

� Ideas that people are "out to get them," or talking about them

� Behaving like a younger child

� Severe anxiety and fearfulness

� Confusing television and dreams with reality

� Difficulty relating to peers, and keeping friends

� Withdrawn and increased isolation

� Decline in personal hygiene

These warning signs aid in diagnosing a child with schizophrenia. However, these warning signs are not necessary for diagnosing schizophrenia, but are only symptoms that can be used to acknowledge that schizophrenia may be present. It is therefore the warning signs, which indicate that something is not right with a particular child, and which will help in providing a diagnosis. In addition, symptoms of a schizophrenic child are described as either positive or negative:

Hallucinations, delusions, disorganized speech and behavior are considered positive symptoms. These symptoms are considered positive because of their more active and engaging symptoms, whereas the negative symptoms are seen as inactive symptoms. Negative symptoms include flat affects, alogia, and avolitions. Individuals with Alogia do not speak often, while avolition is marked by not being able to start a job or complete a job. (cited in American Psychiatric Association, 1994, p.1)

Symptoms of schizophrenia vary from child-to-child, so that not every child will have all of the symptoms described or the same symptoms present in another child who has been diagnosed as schizophrenic. It is for this reason that childhood schizophrenia is such a difficult disorder to diagnose as well as understand.

Schizophrenia occurs in varying degrees, and so each child must be dealt with differently depending on which effects the child is experiencing. It is a disorder that can cause devastating effects in children, although there are some effects that are more common than others. Self-awareness is one problem that is often present. Children who have problems with schizophrenia often cannot identify proper images of themselves. They don't understand who they are or what their bodies represent. As Goldfarb, Mintz, and Stroock state, "The schizophrenic child's image of his body is frequently amorphous in form, unstable in size, and lacking in clear-cut boundaries" (1969, p.21). In other words, the child doesn't understand who he is, what his body is, or what his body can do. It is a problem that basically means that to the child he has no identity. Identity and self-acceptance mean nothing to the schizophrenic child. It therefore causes an inability for the child to understand, accept, and love himself because he doesn't know who he actually is or what his identity is.

Many schizophrenic children also have difficulties regarding time and space. These particular children become confused about time and location. They often can't decipher what time actually means or represents, and thus are unable to know what part of the day or night it is because they can't tell time. In addition, space and location is another problem that schizophrenic children experience. Schizophrenic children are

unable to recognize a person or object that is familiar to them if they see it in an unfamiliar or unknown place. Schizophrenic children rely heavily on the familiar and consequently dread the unfamiliar. Therefore, time and location causes schizophrenic children to become disoriented concerning their surroundings, which in turns causes confusion and fear.

Communication is also troublesome for children suffering from schizophrenia. Goldfarb, Mintz, and Stroock explain this notion by saying that "Without speech and language skills he remains isolated from others and cannot achieve an adequate conceptualization of the world around him." (1969, p.106). It is a problem that is caused by the inability to communicate. Schizophrenic children do not understand when something is being communicated to them and thus are often misunderstood because they do not understand how to communicate. In addition to communication difficulties, separation anxiety prevents schizophrenic children from forming bonds with other human beings. It is a problem that is caused because these children are unable to perceive people as real and stable. Schizophrenic children need constant familiarity and if not then they become anxious and afraid. Goldfarb, Mintz, and Stroock emphasis this point:

The schizophrenic child perceives other people so poorly that he may not even recognize the persons most familiar to him if he sees them in strange surroundings. Since he does not incorporate a clear image of people, they frequently cease to exist for him when they are out of sight. He is then subject to feelings of having been abandoned and of worthlessness. (1969, p.66)

It is therefore the presence of separation anxiety that often causes these children to become so high-strung and needy. They are seeking stability and constant attention, in order to ward off feelings of fear and apprehension.

Withdrawal is also another common feature of schizophrenic children. Schizophrenic children who experience withdrawal suffer from extreme isolation and alienation. Jeffrey expands on this point by explaining that:

Such a person is not able to experience himself 'together with others,' or 'at home in the world,' but, on the contrary, he experiences himself in despairing aloneness and isolation; moreover, he does not experience himself as a complete person, but rather as a 'something' split in various ways, sometimes as a mind more or less tenuously linked to a body, or as two or more 'selves' and so on. (1969, p.10)

Schizophrenic children are fearful of forming bonds with other people and so they allow themselves to pull-away. Withdrawal can therefore be described as the child looking on from the outside, but being unable to become a part of the inside.

It is easy to see why there is so much confusion surrounding childhood schizophrenia. Schizophrenia in children is more often than not misdiagnosed, which causes the child to suffer alone not knowing or understanding why he is experiencing such confusing feelings, or why he is acting so differently from other children. The onset of childhood schizophrenia is characterized by numerous warning signs, which must be carefully observed before landing on a diagnosis of schizophrenia. These warning signs exist interchangeably from child-to-child, and it is only after a certain period of time with several of the warning signs present that will allow schizophrenia to be considered as the answer. It is therefore the warning signs, which indicate the onset of childhood schizophrenia, and which enables the effects that the child is experiencing to be examined closely and thoroughly. Childhood schizophrenia is a difficult disorder to understand, and even more so because it is happening to such young and innocent human beings who

haven't even been given a real chance at life yet. However, with the research and progress that is continually being made in childhood schizophrenia each and every day, hopefully these innocent children will soon be able to rid themselves of "the stigma of being 'schizophrenic'" (DeCesare, Pellegrino, & Yuhasz, p.2).

References:

Childhood-Onset schizophrenia: An update from the National Institute of Mental Health.

National Institute of Mental Health. (2001) Retrieved July. 27, 2003. Available:

http://www.nimh.nih.gov.publicat/schizkids.cfm

DeCesare, S., Pellegrino, P., & Yuhasz, J. Childhood-onset schizophrenia. Retrieved

July. 27, 2003. Available: http://ac.marywood.edu/pellegrino/www/COS.htm

Easson, W. (1996). The management of the severely disturbed adolescent. Connecticut:

International Universities Press, INC.

Goldfarb, W. (1961). Childhood schizophrenia. Massachusetts: Harvard University

Press.

Goldfarb, W., Mintz, I., & Stroock, K. (1969). A time to heal: Corrective socialization.

New York: International Universities Press, INC.

Hoffer, A., & Foster, H. (2000). Why schizophrenics smoke but have a lower incidence

Of lung cancer: Implications for the treatment of both disorders. Journal of

Orthomolecular Medicine, 15, 141-144.

Jeffrey, C. (1969, April). As it happeneth to the fool. Guild lecture No.151.

Schizophrenia in children. American Academy of Child & Adolescent Psychiatry.

(2003) Retrieved July. 27, 2003. Available:

http://www.aacap.org/publications/factsfam/schizo.htm