If schizophrenia is suspected, your child's doctor typically asks about medical and psychiatric history, conducts a physical exam, and does medical and psychological screenings. Your doctor may also request to review school records. This process can help pinpoint a diagnosis and rule out other problems that could be causing your child's symptoms.
The diagnostic process generally involves:
- Tests and screenings. These may include blood tests that help rule out conditions with similar symptoms and screening for alcohol and drugs. The doctor also may request imaging studies, such as magnetic resonance imaging (MRI) or computerized tomography (CT) scan of the head to look for abnormalities in the brain structure, or an electroencephalogram (EEG) to look for abnormalities in brain function, such as seizures.
- Psychological evaluation. This may include observing appearance and demeanor, asking about thoughts, feelings and behavior patterns, talking to your child about any thoughts of self-harm or harming others, evaluating ability to think and function at an age-appropriate level, and assessing mood, anxiety and possible psychotic symptoms.
The path to diagnosing childhood schizophrenia can sometimes be long and challenging. In part, this is because so many other conditions can have similar symptoms, such as depression or bipolar disorder. A child psychiatrist may want to monitor your child's behaviors, perceptions and thinking patterns for six months or more.
For example, the psychiatrist will want to know whether problems occur only at home or at school, or everywhere. In some cases, a psychiatrist may recommend starting medications before an official diagnosis is made. This is especially important for symptoms of aggression or self-injury. Some medications can help limit these types of behavior and restore a sense of normalcy.
To be diagnosed with childhood schizophrenia, your child must meet certain criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
The psychiatrist may first diagnose your child with a nonspecific psychotic disorder. As thinking and behavior patterns and symptoms become clearer over time, a diagnosis of schizophrenia may be made if the criteria are met.
Diagnostic criteria for childhood schizophrenia are generally the same as for adult schizophrenia. This involves ruling out other mental health disorders and determining that symptoms aren't due to substance abuse, medication or a medical condition.
A person must have at least two of the following signs and symptoms most of the time during a one-month period, with some level of disturbance being present over six months:
- Disorganized speech
- Disorganized behavior
- Catatonic behavior, which can range from a coma-like daze to bizarre, hyperactive behavior
- Negative symptoms, which relate to lack of or reduced ability to function normally
At least one of the symptoms must be hallucinations, delusions or disorganized speech.
The person shows a significant decrease in the ability to attend school, work or perform normal daily tasks most of the time.
Feb. 28, 2014
- Schizophrenia spectrum and other psychotic disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed May 8, 2013.
- Hales RE, et al. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Washington, D.C.: American Psychiatric Publishing; 2008. http://www.psychiatryonline.com. Accessed May 8, 2013.
- Schizophrenia. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/schizophrenia/complete-publication.shtml. Accessed May 8, 2013.
- Fischer BA, et al. Schizophrenia: Clinical manifestations, course, assessment, and diagnosis. http://www.uptodate.com/home. Accessed May 8, 2013.
- Fischer BA, et al. Schizophrenia: Epidemiology and pathogenesis. http://www.uptodate.com/home. Accessed May 8, 2013.
- Stroup TS, et al. Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment. http://www.uptodate.com/home. Accessed May 8, 2013.
- Mental illness and the family: Recognizing warning signs and how to cope. Mental Health America. http://www.nmha.org/go/information/get-info/mi-and-the-family/recognizing-warning-signs-and-how-to-cope. Accessed May 16, 2013.
- Factsheet: Schizophrenia in children. Mental Health America. http://www.nmha.org/index.cfm?objectId=C7DF8F81-1372-4D20-C84C5539FAB14576. Accessed Sept. 13, 2013.
- McClellan J, et al. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry. 2013;52:976.
- Facts for families: Schizophrenia in children. American Academy of Child and Adolescent Psychiatry. http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Schizophrenia_In_Children_49.aspx. Accessed Sept. 13, 2013.
- Staying well when you have a mental health condition. Mental Health America. http://www.nmha.org/go/mental-health-month/staying-well-when-you-have-a-mental-illness. Accessed Sept. 13, 2013.
- Abidi S. Psychosis in children and youth: Focus on early-onset schizophrenia. Pediatrics in Review. 2013;34:296.
- Huxsahl JE (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 30, 2013.