While schizophrenia sometimes begins as an acute psychotic episode in young adults, it emerges gradually in children, often preceded by developmental disturbances such as lags in motor and speech and language development. Such problems tend to be associated with more pronounced brain abnormalities. The diagnostic criteria for childhood schizophrenia are the same as for adults, except that symptoms appear before age 12 instead of in the late teens or early 20s.
Children with schizophrenia often see or hear things that do not really exist and harbor paranoid and bizarre beliefs. For example, they may think people are plotting against them or can read their minds. Other symptoms of childhood schizophrenia include:
- Problems paying attention
- Impaired memory and reasoning
- Speech impairments
- Inappropriate or flattened expression of emotion
- Poor social skills
- Depressed mood.
Such children may laugh at a sad event, make poor eye contact, and show little body language or facial expression.
Misdiagnosis of schizophrenia in children is quite common. It is distinguished from autism by the persistence of hallucinations and delusions for at least six months and a later age of onset -- seven years or older. Autism is usually diagnosed by age three.
Schizophrenia is also distinguished from a type of brief psychosis sometimes seen in affective, personality, and dissociative disorders in children. Adolescents with bipolar disorder sometimes have acute onset of manic episodes that may be mistaken for schizophrenia. Children who have been victims of abuse may sometimes claim to hear voices of or see visions of the abuser. Symptoms of schizophrenia characteristically pervade the child's life and are not limited to just certain situations, such as at school. If children show any interest in friendships, even if they fail at maintaining them, it is unlikely that they have schizophrenia.