Childhood schizophrenia test

Childhood schizophrenia test DEFAULT

Schizophrenia | Symptoms & Causes

Schizophrenia is a major psychiatric illness that—while it is more common in adults—also affects children and adolescents. The disease is called “early-onset” schizophrenia when it occurs before the age of 18.

Schizophrenia can cause:

  • visual hallucinations of people and objects that are not actually there
  • auditory hallucinations of voices, music or other sounds that are not real
  • delusions of threats that have no basis in reality
  • severe difficulty making friends and maintaining relationships
  • impaired speech and other communication skills
  • inappropriate and damaging behavior

Though we are still learning the specifics of how schizophrenia affects the brain, it is believed that the disease may be linked to:

  • a below-normal amount of gray matter—cell material that transmits sensory and movement messages throughout the central nervous system–in the brain's temporal lobe (the part of the brain's cerebral cortex that is responsible for hearing) and frontal lobe (the front portion of the brain's cerebral hemisphere, responsible for processing emotions, retaining memories, making decisions and measuring social responses)

  • related loss of gray matter in the parietal lobe (part of the brain that processes information from the senses, makes mathematical calculations and controls how we handle objects)

In summary, schizophrenia:

  • has no known, exact cause

  • often appears to be inherited, passing down from generation to generation

  • affects boys slightly more often than girls when it develops in childhood

  • affects men and women equally when it develops in adolescence and adulthood

  • has no known cure, but can be managed well when caught early and treated with effective therapy, medications and support



What causes schizophrenia?

There is no known, exact cause for schizophrenia, but the disease is believed to be linked to the following factors:


While there is no single known cause for schizophrenia, experts believe that the disease has a strong genetic component—specifically, an inherited chemical imbalance in the brain.

A combination of genes passed down by both parents can lead to schizophrenia: If a parent has the disorder, a child has an estimated 10 to 15 percent chance of developing it; if a sibling is schizophrenic, a child has an estimated 7 to 8 percent chance of developing the disease. The risk significantly increases if more than one family member has the disease.

Environmental stresses during pregnancy

Though data is not conclusive, some experts believe a child’s schizophrenia may be linked to certain environmental factors that affect the mother during pregnancy, such as:

  • drug or alcohol use
  • exposure to particular hormonal or chemical agents
  • exposure to certain viruses or infections
  • extreme stress
  • poor nutritional health

Signs and symptoms

What are the early warning signs of schizophrenia?

The behavioral changes caused by schizophrenia can be difficult to identify in the earliest stages of the disease. Symptoms may emerge slowly, develop over time or occur suddenly, as though “out of the blue.”

The following list of possible warning signs for schizophrenia is not definitive. Many of these symptoms may be caused by a condition other than schizophrenia; some will occur in children who do not have any disorder. However, it’s important to take note of any of these behaviors in your child as soon as they arise—especially if you have a family history of schizophrenia—and, if the behaviors persist, to contact a mental health professional as soon as possible.

Possible early warning signs in infants

  • abnormal listlessness or extensive periods of inactivity
  • overly relaxed or “floppy” arms or legs
  • unnaturally still, flat posture when lying down
  • unusual sensitivity to bright lights or rapid movements

Possible early warning signs in toddlers

  • chronic high fevers

  • fixation on repeating behaviors, even play, according to a specific regimen

  • persistent state of distraction, anxiety or distress

  • pronounced and sustained fear of certain events, situations or objects (note: while nearly all children experience specific fears as a normal developmental stage, children with early-onset schizophrenia tend to experience an extreme degree of fear that does not subside)

  • weak and slumping posture

Possible early warning signs in school-aged children

  • auditory hallucinations (the perception of sounds that others do not hear); most often, these hallucinations manifest as loud noises, whispers or collective murmuring

  • claims that someone or something is “in my head” or “telling me to do things”

  • extreme sensitivity to sounds and lights

  • frequent self-talk (note: while many children will go through phases of having an “imaginary friend” or occasionally talking to themselves, children with possible early-onset schizophrenia spend the majority of their time conversing and laughing with themselves while shutting out real people and surroundings)

  • tendency to be very “closed off” from others

  • visual hallucinations (seeing things that are not actually there); common examples include streaks or swirls of light or flashing patches of darkness

Possible early warning signs in adolescents and teens

  • a persistently vacant facial expression (known as “blank affect”)

  • awkward, contorted or unusual movements of the face, limbs or body

  • complaints and suspicions of threats, plots or conspiracies (for example, “someone has been sent to spy on me”)

  • dwelling excessively on perceived slights, failures or past disappointments

  • extreme irritability or angry outbursts that are unprovoked or disproportionate to the situation

  • extreme or unwarranted resentment and accusations against others (“I know my parents have been stealing from me”)

  • inability to follow a single train of thought

  • inability to read nonverbal “cues” (failing to understand and respond appropriately to other people’s tone of voice, facial expressions or body language)

  • inappropriate behavior and responses to social situations (for example, laughing out loud during a sad moment)

  • incoherent speech

  • irrational thinking, including:

    • assignment of “special meaning” to events and objects with no personal significance (for example, watching a famous person on television and believing they are conveying a secret message with their words or gestures)

    • assumption of extravagant religious, political or other authority (“I am God”)

    • belief that another person or entity is controlling one's body, thoughts or movements

    • belief that an evil force, spirit or entity has “possessed” the body or mind

  • lapses in personal hygiene practices

  • long periods of staring without blinking or difficulty focusing on objects

  • rapidly fluctuating moods

  • seeing or hearing things that others do not

  • sudden, painful sensitivity to light and noise

  • sudden, significant changes in sleep patterns—either inability to fall or stay asleep (insomnia), or excessive sleepiness and listlessness (called catatonia)

  • talking aloud to oneself, often repeating or rehearsing conversations with others (real or imaginary)

  • tendency to rapidly shift topics during a single conversation

  • use of “nonsense” or made-up words

  • withdrawal from friendships and activities

It is important to note that, in the case of all of the above warning signs, a child or adolescent with schizophrenia is not aware that these behaviors pose a problem. A schizophrenic child does not have a sense of becoming ill or that something is wrong. The gravity of the situation is only apparent to outside observers.

What symptoms do people with schizophrenia develop as the disease progresses?

As the disease progresses, people with schizophrenia display symptoms that are grouped into four categories: positivesymptoms, negative symptoms, disorganized speech and disorganized or catatonic behavior.

Positive symptoms

Positive symptoms of schizophrenia involve the onset and acquisition of certain feelings, traits, and behaviors. These can include:

  • beliefs that someone, or something, poses a threat or is causing some type of harm (for example, a sense of being followed by a person or group)

  • confused thinking (for example, confusing what is happening on television with what is occurring in reality)

  • hallucinations (seeing, hearing or feeling things that are not real; for example, hearing voices giving commands or seeing people, animals or objects that are not really there)

  • delusions (ideas, situations or threats that seem real but are not actually based in reality; for example, believing a surveillance device has been installed in the body, home or car). Children with schizophrenia tend to experience hallucinations, but not delusions, until they reach early adulthood.

  • problems distinguishing dreams from reality

  • regressive behavior (for example, an older child suddenly acting like a much younger child and clinging to parents)

  • severe anxiety

  • severe changes in behavior (for example, becoming noticeably withdrawn)

  • suddenly struggling with schoolwork; inability to comprehend material that was previously familiar

  • vivid, detailed and bizarre thoughts and ideas

Negative symptoms

Negative symptoms of schizophrenia involve the lack or loss of certain capabilities and traits, such as:

  • failure to demonstrate appropriate emotional responses (for example, laughing during a somber event or an upsetting conversation)

  • inability to sustain existing friendships and relationships

  • lack of emotional expression when speaking or interacting with others (having what is known as a “blank affect” on the face or failing to make eye contact)

  • severe difficulty making friends

Disorganized speech

Schizophrenia often causes spoken and written communication that is garbled, nonsensical or otherwise impossible for others to follow. Examples of this disorganized speech may include:

  • using words and sentences that do not fit together
  • inventing words or terms that make no sense to others
  • inability to stay “on track” in a conversation

Disorganized or catatonic behavior

Schizophrenia may lead to impaired behaviors that have a drastic impact on daily functions and activities. These disorganized or catatonic behaviors include:

  • engaging in inappropriate activities or speech (for example, making obscene gestures or comments in public)

  • extreme moodiness and irritability

  • failure to dress in accordance with the weather (for example, wearing layers of heavy clothing on a sweltering summer day)

  • failure to practice personal hygiene (for example, not bathing or brushing teeth)

  • suddenly becoming confused or agitated, followed by sitting and staring in place as though “frozen” (this is called a catatonic state)

Your child may be diagnosed with schizophrenia if these symptoms are present for a period of at least one month.


Q: Is schizophrenia common in adults? In children?
A: According to the Society for Neuroscience, about one in 100 adults has schizophrenia. The disease is considerably rarer in children; roughly one in 40,000 people under the age of 18 are diagnosed with the disease.

Q: What are the major similarities and differences between schizophrenia in adults and childhood-onset schizophrenia?
A: As is the case for adults with schizophrenia, children who are schizophrenic are also likely to:

  • display limited or impaired emotional responses
  • fail to practice adequate personal hygiene or other aspects of self-care (such as dressing weather-appropriately)
  • have great difficulty in day-to-day functioning
  • “live in their heads,” closing themselves off from other people and their surroundings
  • suffer from hallucinations (both visual and auditory) or delusions (impressions or perceptions of situations that are not real)
  • struggle to make and maintain friendships

Unlike adults with schizophrenia, children with the disease tend to:

  • experience a gradual appearance and progression of symptoms, as opposed to a sudden and severe onset
  • display difficulty meeting age-appropriate developmental milestones in motor skills, memory and reasoning and speech and language before developing symptoms of schizophrenia

Q: Can I prevent my child from developing schizophrenia?
A: While there is no way to prevent schizophrenia, a close look at your family history and careful observation of your child’s behavior can help predict the likelihood of him developing the disease. The earlier you seek treatment, the better chance you have to improve your child’s quality of life.

If you suspect your child is displaying symptoms of schizophrenia, the most important step you can take is scheduling an immediate professional evaluation. Request an appointment at Children's today.

Q: Do people with schizophrenia really have multiple personalities?
A: Although this is a common misconception about schizophrenia, it’s not true. What many peoplerefer to as “multiple personality disorder” is altogether different and is now known as dissociative identity disorder.

A schizophrenic person does not experience memory “blackouts” and alternate identities. Instead, an individual with schizophrenia experiences a separation from reality that is characterized by:

  • visual and auditory hallucinations
  • false and irrational ideas and perceptions
  • impaired or incoherent thinking and speech
  • problems initiating and maintaining relationships
  • difficulty processing social cues and non-verbal communication
  • inability to recognize and adhere to appropriate social behaviors or personal hygiene practices
  • oversensitivity to external stimulation, such as sounds and lights
  • withdrawal from the outside world 

Q: Is it possible my child has bipolar disorder, not schizophrenia?
A: There are certain similarities between early-onset schizophrenia and pediatric bipolar disorder, particularly in the shared tendency to erupt in sudden and often unpredictable emotional outbursts.

The differentiating factor is what triggers these episodes: A child with bipolar disorder will become angry or inconsolable in response to a specific event or action). A child with early schizophrenia, by contrast, will have outbursts seemingly “out of nowhere,” with no obvious cause. In these cases, schizophrenic children are usually reacting to an overwhelming onslaught of sensation, such as sudden, unbearable sensitivity to noise in a room. They may also be frustrated by a sudden inability to communicate, think clearly or even stand or walk properly.

Q: What is the “black label warning” I keep hearing about when it comes to certain psychiatric medications?
A: Since 2004, the U.S. Food and Drug Administration has placed a black warning label on antidepressant medications. The warning label states, in part:

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.”

Your clinician will carefully go over the specifics of any medication prescribed for your child’s schizophrenia, as well as any potential side effects you should watch for. Our team has years of experience in managing the use of psychiatric medications in children of all ages and with a wide variety of conditions. We will closely monitor your child for any sign of a negative response to the medication, and are always here to answer your questions and address any concerns you may have.

 Q: What is the long-term outlook for my child?
A: If schizophrenia is detected and treated early, and if medications and therapies are successful, the disease has an excellent treatment rate. Lifelong monitoring by a qualified health professional is a must for anyone diagnosed with schizophrenia.

While there is no cure, children and adolescents with the disease can achieve normal—and even extraordinary—milestones at school, at work and in their personal lives. With proper treatment, many children with schizophrenia are able to go to college, hold jobs and have families as adults.

The following factors are critical in successfully treating schizophrenia:

  • building a foundation of family and school awareness and support
  • remaining under a clinician’s care for therapeutic treatment and regular monitoring
  • seeking professional treatment as soon as symptoms emerge
  • taking prescribed medications exactly as directed and for as long as directed (often long-term or throughout the lifetime)

Your treating clinician can give you specific information about your child’s condition, symptoms and recommended treatment plan.


How Childhood Schizophrenia Is Diagnosed

Childhood schizophrenia, also called childhood-onset schizophrenia (COS) or very early-onset schizophrenia, is a severe mental health disorder that is diagnosed in children under the age of 13. It is very rare, affecting less than 0.04% of children.

Childhood-onset schizophrenia is characterized by distorted thinking, altered perceptions, unusual behavior, and unusual use of language and words. It can severely affect a child's development and their ability to function on a daily basis.

What Is Childhood Schizophrenia?

Childhood schizophrenia is a difficult disorder to diagnose, partly because it is not well understood. The diagnosis requires the exclusion of other medical or mental health conditions that may have similar symptoms.

The gold standard for diagnosing childhood schizophrenia is using the American Psychiatric Association's criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

When Does Schizophrenia Usually Develop?

The symptoms of schizophrenia usually start in young adulthood, between late adolescence and the early 30s. Symptoms tend to emerge slightly sooner in men than in women. When the condition is diagnosed before the age of 18 but after age 13, it is referred to as early-onset schizophrenia (EOS). EOS is rare, with an estimated prevalence of 0.23%.

Professional Screenings

Schizophrenia typically develops slowly. The early warning signs usually start before the first severe episode (when hallucinations and delusions, called positive symptoms, are experienced for the first time).

If your child's doctor thinks your child may have schizophrenia, they will send them to a mental health provider, who will conduct a psychiatric evaluation and other tests.

Mental Health Evaluation

During an evaluation, a mental health practitioner will observe your child's appearance and demeanor. They will also ask your child about their thoughts, feelings, and behaviors, as well as get input from you about what you have observed. You will also discuss your family's medical history, particularly any mental health conditions.

A mental health professional will assess your child's ability to think and function at an age-appropriate level, as well as their mood, anxiety level, and possible psychotic symptoms.

The diagnostic criteria that are used to diagnose childhood schizophrenia are similar to those that are used to diagnose adults with schizophrenia.

What Are the Signs and Symptoms of Schizophrenia?

According to the DSM-5, a diagnosis of schizophrenia requires two or more of the following symptoms to be exhibited for a significant portion of time during a six-month period.

  • Delusions
  • Hallucinations
  • Disorganized speech (frequently derails from their train of thought or is incoherent)
  • Grossly disorganized or catatonic behavior
  • Diminished emotional expression or avolition (negative symptoms)

The DSM-5 criteria state that at least one of the symptoms must be delusions, hallucinations, or disorganized speech.

Other criteria for the diagnosis of schizophrenia in the DSM-5 include:

  • Significant problems with and failure to achieve the expected levels of interpersonal, academic, or occupational functioning
  • Symptoms are not caused by the effects of substance use, medication, or a medical condition.

What Are the Subtypes of Schizophrenia?

Ruling Out Other Conditions

The DSM-5 also requires a mental health practitioner to rule out schizoaffective disorder and depressive or bipolar disorder with psychotic features before making a diagnosis of schizophrenia.

If there is a history of autism spectrum disorder (ASD) or a communication disorder of childhood onset, schizophrenia can be diagnosed only if there are prominent delusions or hallucinations in addition to the other required symptoms of schizophrenia. These symptoms must have been present for at least one month (or less if the symptoms are successfully treated).

What Causes Schizophrenia?

Childhood-Onset vs. Adult-Onset Schizophrenia

People who develop schizophrenia at a young age might be more likely to experience certain symptoms compared with people who develop it later in life.

Children might also be less likely to experience paranoid delusions (the belief that others are out to harm you) than people who develop schizophrenia at an older age.

Labs and Tests

A diagnosis of childhood schizophrenia requires the exclusion of other conditions. Certain tests can be performed to help make the correct diagnosis.

Is There a Schizophrenia Test?

Physical Examination

A physical exam helps clinicians rule out medical conditions that might explain a child's symptoms. It also lets them assess the child for any health complications.

Imaging Studies

Differences in the brain structure and the central nervous system have been found to be associated with schizophrenia. Imaging studies to look for these changes and to rule out other neurological conditions might be performed.

Differential Diagnosis

A differential diagnosis is a crucial factor when diagnosing childhood schizophrenia. The presence of symptoms that are similar to those seen in other mental health conditions, the presence of comorbid conditions (where a child has more than one condition), and the early age at which children experience psychotic-like symptoms can all make it difficult to accurately diagnose childhood schizophrenia.

High rates of comorbidity have been found in children with schizophrenia—specifically, attention deficit hyperactivity disorder (ADHD) and affective disorders.

Three disorders overlap with and can be difficult to distinguish from childhood schizophrenia:

  • Mood disorders with psychotic features: These conditions can present with psychotic symptoms, which can be misdiagnosed as childhood schizophrenia. The DSM-5 specifically requires that a diagnosis of childhood schizophrenia is made only when schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out.
  • Autism spectrum disorder (ASD):Symptoms such as abnormal speech and flat affect (not expressing emotions, particularly the lack of facial expression) that are seen in ASD can be misdiagnosed as the negative symptoms of schizophrenia. If a child has ASD or a childhood-onset communication disorder, the DSM-5 requires the presence of prominent delusions or hallucinations in addition to the other required symptoms, that last for at least one month, before a diagnosis of schizophrenia is made.
  • Attention deficit hyperactivity disorder (ADHD):The attentional and behavioral symptoms of ADHD might be misdiagnosed as childhood schizophrenia.

There are also other more common mental health conditions that might be misdiagnosed as childhood schizophrenia:

Certain medical conditions can also be misdiagnosed as childhood schizophrenia:.

  • Seizure disorder
  • Anti-NMDA (N-methyl D-aspartate) receptor encephalitis
  • Herpes simplex encephalitis (HSE)
  • Lysosomal storage diseases
  • Neurodegenerative disorders
  • Central nervous system (CNS) tumors
  • Progressive organic CNS disorder (e.g., sclerosing panencephalitis)
  • Metabolic disorders
  • Chromosomal disorders (22q11 deletion syndrome)

Behaviors in Healthy Children

Some of the symptoms of childhood schizophrenia appear in healthy children. For example, having a vivid imagination and fantasies are typical parts of childhood.

However, they might be misunderstood to be hallucinations and taken as a symptom of schizophrenia. Similarly, children who have poor or underdeveloped language skills may be perceived as having the disorganized thought and speech patterns that are observed in schizophrenia.

Self/At-Home Testing

The only way to obtain an accurate assessment and diagnosis of childhood schizophrenia is to be evaluated by a trained mental health provider. However, parents and caregivers should be aware of the early warning signs to ensure they seek care as soon as possible.

What Are the Early Signs of Schizophrenia?

Children often develop changes in behavior before the onset of schizophrenia. These changes in behavior are normally noticed when children start school at age 5 or 6. However, many families report that disruptive behavior began before their child started school.

These changes can manifest in a variety of different ways, including:

  • Introversion
  • Loneliness
  • Depression
  • Aggression
  • Suicidal ideation
  • Bizarre behavior

Behavioral difficulties can lead to children struggling in school—one of the most common issues reported in people diagnosed with schizophrenia at an early age.

The warning signs may start when a child is very young. People diagnosed with schizophrenia in childhood have more developmental difficulties than those diagnosed later in life.

Very early developmental warning signs include:

  • Delayed motor development (e.g., not walking until over 18 months old)
  • Delayed speech and/or language development (e.g., not speaking meaningful two- or three- word phrases until over 36 months old)
  • Impaired social development at an early age (e.g., not using gestures to communicate or failing to regulate facial expressions)

A Word From Verywell

Childhood schizophrenia is rare. Most behavioral changes or early warning signs associated with the condition will have other more common causes. However, if you are concerned about any behaviors or changes that your child is showing, it's important to talk with their doctor.

Your child can be referred to a mental health provider for a careful evaluation and tests that will rule out other causes for their symptoms. If a diagnosis of schizophrenia is made, you will be able to ensure they get the treatment that is best suited to them.

How Schizophrenia Is Treated

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Driver DI, Gogtay N, Rapoport JL. Childhood-onset schizophrenia and early-onset schizophrenia spectrum disorders. Child Adolesc Psychiatr Clin N Am. 2013;22(4):539-555. doi:10.1016/j.chc.2013.04.001

  2. National Institute of Mental Health. Schizophrenia. Updated May 2020.

  3. Petruzzelli MG, Margari L, Bosco A, Craig F, Palumbi R, Margari F. Early onset first episode psychosis: dimensional structure of symptoms, clinical subtypes and related neurodevelopmental markers.Eur Child Adolesc Psychiatry. 2018;27(2):171-179. doi:10.1007/s00787-017-1026-7

  4. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. June 2016.

  5. Häfner H. From onset and prodromal stage to a life-long course of schizophrenia and its symptom dimensions: how sex, age, and other risk factors influence incidence and course of illness. Psychiatry Journal. 2019;2019:1-15. doi:10.1155/2019/9804836

  6. Bartlett J. Childhood-onset schizophrenia: what do we really know?. Health Psychology and Behavioral Medicine. 2014;2(1):735-747. doi:10.1080/21642850.2014.927738

  7. McClellan J, Stock S. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry. 2013;52(9):976-990. doi:10.1016/j.jaac.2012.02.008

  8. Parellada M, Gomez-Vallejo S, Burdeus M, et al. Developmental differences between schizophrenia and bipolar disorder. Schizophr Bull. 2017;43(6):1176-1189. doi:10.1093/schbul/sbx126

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Identifying Schizophrenia in Children

Learning your child has schizophrenia—or suspecting your child may have it—can feel overwhelming and scary. But early identification and treatment are important in managing the symptoms and improving your child’s long-term prognosis.

Schizophrenia is a mental illness that causes people to interpret reality abnormally. It involves a range of cognitive, emotional, and behavioral problems that impair a child’s ability to function.


Onset usually occurs between the late teens and the mid-thirties. The peak age of onset for males is the early twenties and for females the late twenties, but it may occur at any age. According to the Institute of Mental Health, about .25 to .64% of Americans have schizophrenia.

Childhood schizophrenia, characterized by onset before age 13, is only found in 1 in 40,000 children. Childhood schizophrenia presents special challenges in terms of diagnosis and treatment.


Scientists haven’t found a single set of causes for schizophrenia. It’s suspected that there are multiple genetic and environmental factors that play a role:

  • Genetic Factors - Family, twin, and adoption studies support a strong genetic component in schizophrenia. Parents of children with schizophrenia are ten times as likely to also develop schizophrenia. If an identical twin has the illness, the likelihood that the other twin will develop schizophrenia is over 40 percent.
  • Environmental Factors - There may be some environmental factors that contribute to schizophrenia in children, especially if there are already genetic components at play. Prenatal infections, obstetric complications, and maternal malnutrition may play a role.


Hallucinations, thought disorder, and flattened affect have been consistently found in children with schizophrenia. Delusions and catatonic symptoms occur less frequently.

Childhood schizophrenia is often associated with cognitive delays. Cognitive decline typically occurs at the time of onset of schizophrenia. Intellectual deficits appear to be stable over time without continued deterioration.

Here are the symptoms of schizophrenia:

  • Hallucinations – Seeing or hearing things that aren’t actually there
  • Delusions – Fixed false ideas that are believed by the individual but not by others
  • Disorganized thinking - Evidenced by derailed or incoherent speech
  • Flat affect – Monotone, diminished facial expressions, and appear apathetic
  • Paucity of speech or thought – Only speaking when prompted and replying with short answers
  • Bizarre behavior – Inappropriate, disorganized, or odd behavior inappropriate for a child’s age


The course of schizophrenia varies from person to person. But, there are hallmark phases that individuals tend to experience.

  • Prodrome phase – Most individuals with schizophrenia experience some functional deterioration before the onset of psychotic symptoms. Social withdrawal, bizarre preoccupations, unusual behavior, academic failure, or a decline in hygiene and self-care may begin before any signs of psychosis.
  • Acute phase – This phase is marked by prominent symptoms, such as hallucinations, delusions, disorganized speech and behavior, and a serious deterioration in functioning. This phase may last several months depending on the response to treatment.
  • Recuperative/Recoveryphase – After the acute psychosis subsides, there is generally a period when the individual continues to experience a significant impairment. Flat affect and social withdrawal are often present.
  • Residual phase – Children with schizophrenia may have extended stretches of time between acute phases. However, most individuals will continue to be at least somewhat impaired. Some individuals never progress to residual symptoms and continue to have acute symptoms despite treatment.

When to See a Doctor

It’s hard to identify schizophrenia in children. Young children have excellent imaginations so it’s common for them to have imaginary friends with whom they carry on conversations. That type of pretend play doesn’t mean your child is having hallucinations.

Kids also aren’t good at telling adults about their symptoms. When young children are asked questions about hallucinations or delusions, many of them say yes. But, that doesn’t mean they have psychosis.

Instead, in a paper published in 2013, researchers believe kids may report having those symptoms because they have overactive imaginations, cognitive limitations, or they simply misunderstand the question. So asking your child questions like, “Do you ever see things that no one else sees?” isn’t likely to give you much insight into whether your child should see a doctor.

Symptoms also tend to begin gradually. Over time, however, a child may develop psychosis and the symptoms become much more obvious. If you notice developmental delays, strange eating rituals, bizarre behavior or ideas, change in academic performance, or social isolation, consult your child's doctor.

Since schizophrenia in children is rare, there’s a good chance the symptoms may stem from something else. But it’s important to find out the reasons for the changes that you’re seeing.


There isn’t a lab test that identifies schizophrenia. Mental health professionals make the diagnosis based on several factors, after gathering a full history, observing the child, and interviews with the parent and child. Other conditions must also be ruled out.

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Many of the symptoms of schizophrenia in children are also found in other disorders, such as autism spectrum disorders, mood disorders with psychotic features, or obsessive compulsive disorder.

Medical conditions may also result in psychosis. Central nervous system infections, endocrine disorders, genetic syndromes, autoimmune disorders, and toxic exposures may cause children to exhibit symptoms similar to those found in schizophrenia.

Drug use may also cause psychosis. Hallucinogenic mushrooms, stimulants, inhalants, and cannabis are just a few of the drugs that may lead to psychotic symptoms. Prescription drug misuse may also lead to acute psychosis. Symptoms generally resolve within a few days to weeks after the offending drug is discontinued.

All of those other conditions must be ruled out before a diagnosis of schizophrenia can be made.

How Mental Health Professionals Use the DSM Today


Antipsychotic medication is the primary treatment for schizophrenia in children as well as adults. Individuals with schizophrenia are at significant risk of relapse if antipsychotic medication is discontinued. It’s essential for parents to maintain contact with physicians to monitor symptoms, side effects, and adherence.

Talk therapy may also be helpful to children with schizophrenia. Children and their parents may benefit from psychoeducation and problem-solving sessions. It may be important for siblings to get involved in therapy so they can understand their brother or sister’s behavior.

Social skills training, relapse prevention, and basic life skills training may be helpful. Some children with schizophrenia may need specialized education programs or vocational training programs.

If a child becomes a danger to herself or others, a psychiatric hospitalization may be necessary. Inpatient treatment can be helpful in getting symptoms under control.

The 7 Best Online Therapy Programs for Kids


Childhood-onset schizophrenia is associated with low intellectual functioning and higher rates of negative symptoms across the lifespan. According to a 2011 study published in Pediatric Clinics of North America, childhood-onset schizophrenia is associated with greater social deficits in adulthood compared to those with other mental illnesses.

It’s also been linked to lower level of employment and a lesser likelihood of living independently, compared to other psychiatric disorders.

Adolescents are at a higher risk of suicidal behavior during their first episode of psychosis. At least 5 percent of people who exhibited symptoms of schizophrenia before age 18 die by suicide or accidental death directly related to behaviors caused by their psychotic thinking.

Individuals with schizophrenia also are at a higher risk of physical health conditions such as heart disease, obesity, hepatitis, diabetes, and HIV. There isn’t a cure for schizophrenia, but symptoms can be managed with treatment. Early intervention is key to improving the outcome for children with schizophrenia.

Coping and Support

Learning your child has schizophrenia—or suspecting that he or she may have it—can feel scary and overwhelming. It’s important to learn as much as you can about schizophrenia in children, however, so you can best support and advocate for your child.

Ask your child’s doctor for resources on schizophrenia. Attending support groups for people who have a family member diagnosed with schizophrenia could serve as a wealth of information.

The National Alliance on Mental Illness, NAMI, may also be a valuable resource. NAMI is a mental health organization who has local affiliates who provide support, education, and services in communities throughout the United States. NAMI may be able to help you locate the resources, tools, and information you need to help your child.

It’s important to take care of yourself as well. Attend a support group or seek therapy for yourself. Managing your stress level will be key to helping you be best equipped to support your child.

What to Know About Child Psychology and Development

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Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Cannon TD. How schizophrenia develops: Cognitive and brain mechanisms underlying onset of psychosis. Trends Cogn Sci. 2015;19(12):744-756. doi:10.1016/j.tics.2015.09.009

  2. National Institute of Mental Health. Schizophrenia.

  3. Gochman P, Miller R, Rapoport JL. Childhood-onset schizophrenia: the challenge of diagnosis.Curr Psychiatry Rep. 2011;13(5):321–322. doi:10.1007/s11920-011-0212-4

  4. Bartlett J. Childhood-onset schizophrenia: what do we really know?Health Psychol Behav Med. 2014;2(1):735–747. doi:10.1080/21642850.2014.927738

  5. Narayan CL, Shikha D, Shekhar S. Schizophrenia in identical twins. Indian J Psychiatry. 2015;57(3):323–324. doi:10.4103/0019-5545.166635

  6. Larson MK, Walker EF, Compton MT. Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders.Expert Rev Neurother. 2010;10(8):1347–1359. doi:10.1586/ern.10.93

  7. NICE Clinical Guidelines, No. 155. National Collaborating Centre for Mental Health (UK). Leicester (UK): British Psychological Society; 2013.

  8. Mcclellan J, Stock S. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013;52(9):976-90. doi:10.1016/j.jaac.2013.02.008

  9. Driver DI, Gogtay N, Rapoport JL. Childhood onset schizophrenia and early onset schizophrenia spectrum disorders.Child Adolesc Psychiatr Clin N Am. 2013;22(4):539-55. doi:10.1016/j.chc.2013.04.001

Additional Reading
  • Falcone T, Mishra L, Carlton E, et al. Suicidal Behavior In Children And Adolescents With First Episode Psychosis. Schizophrenia Research. 2008;102(1-3):153.

  • Gochman P, Miller R, Rapoport JL. Childhood-Onset Schizophrenia: The Challenge of Diagnosis. Current Psychiatry Reports. 2011;13(5):321-322. 

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