Signs of schizophrenia in children
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Signs of Schizophrenia in Children
Early Developmental Impairments in Childhood Schizophrenia
Childhood-onset schizophrenia (COS) often presents with significant developmental impairments long before the onset of psychotic symptoms. These impairments can include language, motor, and social deficits, which are more pronounced in children with earlier onset compared to those with later onset 1. These early signs, often referred to as "pandysmaturation," can be observed from the first months of life in more than half of the children who will develop COS 1. Severe language deficits and motor development problems are common, with symptoms of infantile autism present in a significant portion of affected children 3.
Core Symptoms of Childhood Schizophrenia
Positive Symptoms
Positive symptoms are necessary for the diagnosis of COS and include hallucinations and delusions. Auditory hallucinations are the most frequent, occurring in up to 80% of cases, while visual and tactile hallucinations are less common 12. Delusions in children are typically less complex than those seen in adolescents and adults, often relating to childhood themes 12.
Negative Symptoms
Negative symptoms are largely predominant in children with schizophrenia. These include flat or inappropriate affect, limited motivation, and anhedonia 125. A marked deterioration from the previous level of functioning is a hallmark of the disorder, affecting the child's ability to perform daily tasks and impacting their social and cognitive development 15.
Insidious Onset and Diagnostic Challenges
The onset of COS is typically insidious, with symptoms gradually unfolding over several years. The mean age at onset of general psychiatric symptoms is around 4.6 years, with psychotic symptoms appearing by approximately 6.9 years, and a formal diagnosis often not made until around 9.5 years 2. This gradual onset can delay diagnosis, as clinicians may hesitate to diagnose schizophrenia in young children 12.
Differential Diagnosis and Comorbidities
Differentiating COS from other disorders can be challenging. Conditions such as affective disorders with psychotic symptoms, pervasive developmental disorders, severe personality disorders, post-traumatic stress disorder, and obsessive-compulsive disorder without insight can be misdiagnosed as schizophrenia 1. Additionally, about 10% of children in the community may report nonpsychotic hallucinations or delusions, further complicating the diagnostic process 1.
Genetic and Neurodevelopmental Factors
Research indicates that childhood cognitive, social, behavioral, and emotional impairments may represent early manifestations of genetic liability to schizophrenia. Polygenic risk scores have shown associations with lower performance intelligence quotient, poorer social understanding, worse language intelligibility and fluency, more irritability, and more headstrong behavior in children as young as 4 years old 4.
Conclusion
Childhood-onset schizophrenia is a rare but severe mental disorder characterized by a range of developmental impairments and core symptoms such as hallucinations, delusions, and negative symptoms. The insidious onset and overlap with other psychiatric conditions make early diagnosis challenging. Understanding the early signs and symptoms, along with genetic and neurodevelopmental factors, is crucial for timely intervention and management.
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