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Schizophrenia in Children and Adolescents

By Josephine Elia, MD, Professor of Psychiatry and Human Behavior, Professor of Pediatrics; Attending Physician, Sidney Kimmel Medical College of Thomas Jefferson University; Nemours/A.I. duPont Hospital for Children

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Schizophrenia is the presence of hallucinations and delusions causing considerable psychosocial dysfunction and lasting 6 mo.

(See also Schizophrenia in adults.)

Onset of schizophrenia is typically from mid-adolescence to the mid-30s, with a peak age of onset in the 20s. Features in adolescents and young adults are similar. Schizophrenia in prepubertal children (childhood-onset schizophrenia [COS]), in which symptoms similar to those of the adolescent/young adult-onset form develop before age 12, is extremely rare.

Although the first episode usually occurs in young adults, some contributory neurodevelopmental events and experiences occur earlier (eg, during the perinatal period).

These perinatal risk factors include the following:

  • Genetic disorders (particularly those that increase risk of childhood onset)

  • Exposure to certain drugs or substances (eg, cannabis) during a vulnerable period

  • Prenatal undernutrition

  • Labor complications, hypoxia, perinatal infection, placental abruption or insufficiency

  • Childhood brain injury

Other risk factors, which occur later (eg, drug use later in adolescence), may then trigger the onset of schizophrenia.

Manifestations of childhood-onset schizophrenia are usually similar to those in adolescents and adults, but delusions and visual hallucinations (which may be more common among children) may be less elaborate. Additional characteristics also help distinguish childhood-onset schizophrenia from the adolescent/young adult form:

  • More severe symptoms

  • A strong family history

  • Increased prevalence of genetic abnormalities, developmental abnormalities (eg, pervasive developmental disorder, intellectual disability), and motor abnormalities

  • Increased prevalence of premorbid social difficulties

  • Insidious onset

  • Cognitive deterioration

  • Neuroanatomic changes (progressive loss of cortical gray matter volume, increase in ventricular volume)

Sudden-onset psychosis in young children should always be treated as a medical emergency with a thorough medical assessment to search for a physiologic cause of the mental status change; these causes include

  • Drugs (in younger children, stimulants and corticosteroids; in adolescents, drugs of abuse)

  • CNS infection or injury

  • Thyroid disorders

  • Autoimmune encephalopathies (eg, anti-NMDA [N-methyl-d-aspartate] receptor encephalitis [1])

  • SLE (2)

  • Porphyria (3)

  • Wilson disease (4)

Treatment of schizophrenia in children and adolescents is complex, with variable outcomes, and referral to a child and adolescent psychiatrist is strongly recommended.


  • 1. Dalmau J, Lancaster E, Martinez-Hernandez E, et al: Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 10 (1):63–74, 2011. doi: 10.1016/S1474-4422(10)70253.

  • 2. Muscal E, Nadeem T, Li X, et al: Evaluation and treatment of acute psychosis in children with systemic lupus erythematosus (SLE): Consultation-liaison service experiences at a tertiary-care pediatric institution. Psychosomatics 51 (6):508–514, 2010. doi: 10.1176/appi.psy.51.6.508.

  • 3. Kumar B: Acute intermittent porphyria presenting solely with psychosis: A case report and discussion. Psychosomatics 53 (5):494–498, 2012. doi: 10.1016/j.psym.2012.03.008.

  • 4. Grover S, Sarkar S, Jhanda S, et al: Psychosis in an adolescent with Wilson's disease: A case report and review of the literature. Indian J Psychiatry 56 (4):395–398, 2014. doi: 10.4103/0019-5545.146530.