Running Head: CHILD ON-SET SCHIZOPHRENIA Satterthwaite 1

The Controversy of Diagnosing Children with Child Onset Schizophrenia

Daniel Satterthwaite

Morehouse College
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Mental Disorders can affect the way an individual has the opportunity to conduct their

lives. Limited, these individuals behaviors, thoughts, and feelings are affected within their daily

functioning and maintenance of relationships and other interactions. Understanding that the basis

of the disorder may be exhibited differently in each person, the DSM creates a standard process

for which a disorder is diagnosed and treated. Schizophrenia, affecting one percent of the general

population, has been categorized to distort how a person behaves, thinks, and feels (NAMI,

2016). Diagnosed between the ages 18 and 35, this disorder consists of positive and negative

symptoms. Positive symptoms, such as hallucinations and delusions, lead those with

schizophrenia to escape different aspects of reality where they may see, hear, and have false

experiences. While negative symptoms, such as reduction of expressions, can disturb the balance

of ones normal emotions and behaviors. Additionally, individuals diagnosed with form proper

speech or to make complex thoughts or actions.

Furthermore, The DSM presents specific criteria for diagnosing individuals that may have

schizophrenia. A criterion for this disorder is that the positive and negative symptoms must

persist for at least 6 months to be considered schizophrenia opposed to the brief psychotic

disorder or schizophreniform disorder. During this active phase, people must experience

impairment in functioning along with two or more of the symptoms included in the DSM. These

include positive and disorganized symptoms. If someone is experiencing prodromal or residual

phases within schizophrenia, they may only present negative symptoms.

In order to receive a diagnosis of schizophrenia, other disorders have to be ruled out.

While some disorders may have similar symptoms, it is not possible for these disorders to be

comorbid, or in conjunction with a diagnosis of schizophrenia. Therefore, psychologists should

examine the individual factors that may influence making a distinct diagnosis of schizophrenia.
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Individual factors such as ones genes and environment, or differences in brain structures

actively can shape the effect that schizophrenia can have in various people.

Difficulty in pinpointing which factor has the most impact has found many researchers to

continually research and examine schizophrenia before making a diagnosis. Moreover, this

inability creates increasing difficulty in identifying the proper treatment for this disorder. Many

psychologists suggest an array of treatments ranging from psycho-social treatments to anti-

psychotics. Psycho-social treatments aids a patients improvement of different long-term effects

within schizophrenia. This may include family therapy, rehabilitation, and the training of social

skills.

A diagnosis of childhood-onset schizophrenia (COS) is given when the onset of the

disorder occurs before the age of 13 years old (Bartlett, 2014). A lack of information and

research supporting schizophrenia in children has made many clinicians reluctant to diagnose

children as such. If diagnosed, children with schizophrenia are often misdiagnosed. Currently,

COS has an estimated prevalence rate of approximately 1 in 10,000 persons (Bartlett, 2014).

Both occurrences present a rarity in this disorder when comparing prevalence rates in adults and

children. Furthermore, similar to schizophrenia in adults, childhood-onset schizophrenia occurs

more often in males than in females. Understanding these differences and growing research

surrounding schizophrenia in children, diagnosis remains to be very controversial.

While COS is rarely diagnosed, when diagnoses are made, there are often disturbances in

the childs psychosocial functioning prior to the onset of the illness, these prior disturbances are

often referred to as premorbid abnormalities. Some premorbid abnormalities include a myriad of

behaviors such as loneliness, depression, theft, bizarre behavior, introversion and difficulties in

school. It is important to remember that adult-onset schizophrenia develops between the ages of
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18 and 35, premorbid abnormalities are not observed in patients with adult-onset schizophrenia

(Bartlett, 2014.) However, with adult-onset schizophrenia, during the prodromal phase, some

participants do experience symptoms that are less severe than symptoms during the active phase

(Hollis, 2000).

Children who experience hallucinations and delusions tend to have less complex

exhibited positive symptoms compared to adults. Such a difference in childhood and adult

experiences with schizophrenia ultimately play a role in what makes diagnosing children with

schizophrenia controversial. Some clinicians argue that early diagnosis of schizophrenia can

allow an individuals families to be able detect and create a proper response. Most families resort

to seeking out the necessary resources to care for their child with schizophrenia (Masi et al,

2006).

Researchers who support early diagnosis of schizophrenia are likely to defend early

diagnosis because previous literature that has investigated the burdens and difficulties associated

with the experience of caring for children with schizophrenia found that schizophrenia greatly

affects the family of the ill individual (Knock, Kline, Schiffman, Maynard, & Reeves 2011).

Knock and his colleagues (2011), found that most participants related their difficulties with the

childs negative behaviors. In attempt to exemplify the strain COS can have on families, it is

important to discuss Jani, the youngest person diagnosed with schizophrenia.

In 2010, Oprah and Discovery Fit and Health Television began film the journey of a six

year old and her parents as they try to sustain their life as well as provide Jani with the treatment

and resources she needs. Throughout this journey, the show documents the childs hallucinations

of rats named Wednesday, a little girl named 24 Hours, and attempts of suicide, the family lack

of comfortability with having her near newborn brother, Bodhi (Donaldson-James, 2014). This
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fear forced her parents to purchase separate homes. She was only able to visit her brother at

certain times. After medication and therapy, the family was soon able to move in the house

together. As time went on, it seemed that the brother showed similar symptoms to his sister,

hinting that this could be hereditary. Already diagnosed with autism, his doctors do not suspect

that he has schizophrenia, but his parents disagree. They feel that since they show similar

symptoms, he will eventually be diagnosed as such (Donaldson-James, 2014).

Most family members have found that suggested mental health services did not want to

help their child because of the stigma surrounding children with schizophrenia. Some parents

shared that they feel like they are cannot parent their other children as well as they should due to

their devotion and attention spent to the child with schizophrenia. Moreover, families that have a

child diagnosed with schizophrenia often experience major adjustments and sacrifices into their

daily lives. In contrast, others argue that over-diagnosis of schizophrenia may result in

unnecessary anxiety and stigmatization for the families of misdiagnosed children.

Ultimately, leading to unnecessary social and medical treatment that these children do not

need. While social treatment deals with the stigma and the way the child will be treated, medical

treatment includes receiving antipsychotic drugs (Masi, Mucci & Pari 2006). Some risks

associated with children taking antipsychotics include weight gain, hyperglycemia and

hypercholesterolemia. There is currently little research being done to look at children taking

antipsychotic agents. In addition, when diagnoses are made sometimes that are misdiagnoses.

For the most part, a diagnosis for childhood-onset schizophrenia consist on the same

criteria that adult-onset schizophrenia is based on. Nonetheless, there is an aspect found in

children that is not examined in adults. While a diagnosis for COS is made based on the same

criteria for adult-onset schizophrenia, according to Bartlett, there is an exception for Criteria B.
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Criteria states that the individuals level of functioning must be diminished. Assessing childrens

level of functioning is very difficult, as a result, the child must fail to meet the expected level of

functioning for a child according to their age (Bartlett, 2014). For Example, clinicians may

assess a childs language and comprehension at certain age to ensure that children are

functioning and exhibiting behavioral language to children their age. If a child is struggling with

poor or undeveloped language skills, the child may be unable to reliably discuss their

experiences and symptoms with a clinician (Bartlett, 2014).

Moreover, when assessing childrens level of functioning, many clinicians have found it

to not be their only difficulty in attempting to accurately diagnose children with schizophrenia.

Another main difficulty many clinicians face when attempting to make a diagnosis is

distinguishing between positive symptoms such as hallucinations or delusions and normal, casual

childhood imagination. For example, many children have imaginations that they can only see

experience. There, children create friends, pets, homes, and worlds. These imaginary figures

such as friends, pets and homes may be confused with psychosis with during this diagnosis.

Other symptoms such as disorganized speech and disorganized behavior can also be

mistaken for psychosis by clinicians. For example, children often like to play dress up and put

clothing items together that would not traditionally be paired together. As a result, if a child

presents his or herself to a clinician with an odd pairing of clothes, the clinician may view this as

disorganized behavior. As previously discussed, in conjunction with disorganized behavior,

children with underdeveloped or even undeveloped language skills may seem like disorganized

thought and speech patterns typically observed in individuals with schizophrenia (Bartlett, 2014).

This can be very problematic for a clinician because they can be unable to gather the necessary

information to make the accurate diagnosis. A clinicians research decides to seek out
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information that will provide helpful assistance in coming up with an accurate diagnosis.

Unfortunately, most times there is not enough information to create a diagnosis for schizophrenia

in children.

An overlap of symptoms, comorbid disorders, and the early age at which children have

an experience that aligns with psychotic symptoms make it difficult to accurately diagnosis.

Some alternate diagnoses typically include pervasive development disorder or autism, attention

deficit hyperactivity disorder (ADHD), bipolar disorder (BD), major depressive disorder and

schizoaffective disorders (Schaeffer & Ross, 2002; Bartlett, 2014). Ironically, researchers found

high rates of comorbidity among patients with COS, specifically with ADHD and affective

disorders (Schaeffer & Ross, 2002).

Although COS is very uncommon, there is an importance to research and discover more

on the topic of COS. Studying COS can propel numerous major advances for the mental health

community on this disorder. Moreover, it can provide answers and solutions to questionable

information available to many families, clinicians, and the larger mental health community. COS

is more progressive and appears more like a homogenous illness than that of the adult onset

disorder where individual differences make it harder to treat everyone alike. (Sporn & Rapoport,

2001). Due to the young age in which COS is diagnosed, it is recognized that children with COS

share more similar risk factors. Moreover, children with COS tend to have less striking

environment effects than the adult onset disorder. This allows researchers to study the biological

etiology factors of COS more closely.

There are two prevalent hypotheses that researchers have come up with while studying

COS. The first hypothesis is that there is a severe more biological based variant of the illness.

Suggested and exemplified by Janis story. Clinicians think that COS could be hereditary
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because Bodhi, her brother is beginning to demonstrate similar traits and behaviors she once

experienced before her diagnosis. Furthermore, during the show, Janis parents discussed how

they had family members that suffered from other mental disorders (Donaldson-James, 2014).

The second hypothesis is that the atypical onset of COS is associated with potentiating factors

include severe psychosocial or biological stressors (Asarnow, Tompson, & Goldstein, 1994). For

instance, harsh criticism from a parent and the effect of different parenting styles on children

with COS can be studied as well. COS may be controversial but vital in understanding the long

term outcome of early onset schizophrenia. This leaves room to research what other stressors

may be present in a childs life.

The path or direction in which this disorder can take is important in understanding

different onset periods of schizophrenia within numerous individuals. Many long term studies on

patients that had COS is being conducted. This will build a stronger case for the validity of COS

and help strategize ways to combat the progression and worsening of schizophrenia symptoms

within individuals with the disorder. Stronger information on COS and consideration of this as a

valid disorder would help to advance and improve treatment methods to treat or even cure

schizophrenia.

Childhood Onset-Schizophrenia is still a topic that is being researched and developed.

The controversial nature discussed in this paper originates because mental health providers are

unsure where to draw the line between normal childhood behaviors and behaviors that may put a

child at risk for COS. Having an imaginary friend or dressing to fit a childs imagination are both

things that almost all children experience at some point. These behaviors, if not observed and

monitored critically, can suggest abnormalities where there is not any. By placing this stigma and

responsibility on a child and their family can be detrimental to the fostering and guidance the
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child may or may not receive. Yet, not realizing that a child may be suffering from COS could

put the childs health at risk. While there are many controversies surrounding childhood onset-

schizophrenia, the important thing to address the situation head-on and be proactive and critical

about how clinicians and other members of the mental health community stigmatize, treat and

diagnose individuals. This means educating and working to critique the narrative around child

on-set schizophrenia. Future studies should look into the successes and positive nature of

critiquing the illness. In these studies, researchers could focus on the impact early detection can

provide for the patient and their families. These results can further the field and information

around the illness, progressing the world and the patients.

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References

Asarnow, J. R., Tompson, M. C., & Goldstein, M. J. (1994). Childhood-Onset Schizophrenia: A

Followup Study. Schizophrenia Bulletin, 20(4), 599-617.

Bartlett, J. (2014). Childhood-onset schizophrenia: what do we really know? Health Psychology

and Behavioral Medicine, 2(1), 735747. http://doi.org/10.1080/21642850.2014.927738

Clemmensen, L., Vernal, D. L., & Steinhausen, H. (2012). A systematic review of the long-term

outcome of early onset schizophrenia. BMC Psychiatry, 12(150).

doi:10.1186/1471-244X-12-150

Donaldson-James, S. (2014). 'Born Schizophrenic': 2 Mentally Ill Children Threaten To Tear

Family Apart. Retrieved December 6, 2014, from http://abcnews.go.com/Health/born-

schizophrenic-mentally-ill-children-threaten-tear-family/story?id=23687000tions of rats

named

Hollis, C. (2000). Adult outcomes of child- and adolescent-onset schizophrenia: Diagnostic

stability and predictive validity. American Journal of Psychiatry, 157, 16521659.

Knock, J., Kline, E., Schiffman, J., Maynard, A., & Reeves, G. (2011). Burdens and difficulties

experienced by caregivers of children and adolescents with schizophrenia-spectrum

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disorders: a qualitative study. Early Intervention In Psychiatry, 5(4), 349-354.

doi:10.1111/j.1751-7893.2011.00305.x

Masi, G., Mucci, M., & Pari, C. (2006). Children with Schizophrenia: Clinical Picture and

Pharmacological Treatment. CNS Drugs, 20(10), 841.

Schaeffer, J. L., & Ross, R. G. (2002). Childhood-onset schizophrenia: Premorbid and prodromal

diagnostic and treatment histories. Journal American Academy of Child and Adolescent

Psychiatry, 41, 538545. doi:10.1097/00004583-200205000-00011

Sporn, A., & Rapoport, J. L. (2001). Childhood Onset Schizophrenia. Child and

Adolescent Psychopharmacology News, 6(2). doi:10.1521/capn.6.2.1.22964