of Childhood Schizophrenia
Childhood – onset
schizophrenia is a disorder of the brain that is characterized by
hallucinations, delusions, thought disturbances, disorganized behavior,
or flat affect, and significant impairment in functioning (Mash &
2002). Childhood schizophrenia can be
diagnosed with the same criteria as adult schizophrenia and it seems to
more severe form than adults. In the
early phases, children may begin to lose sleep and have difficulty
concentrating. The child may start to
avoid friends and stop doing well in school.
They may start to have
and hallucinations, believe they have powers or think they are being
watched. These children could become
violent and have suicidal thoughts.
Childhood schizophrenia has a gradual onset with
in social and academic competence and the symptoms usually stay with
adulthood (Mash & Wolfe, 2002).
with mild schizophrenia tend to be
anxious and tired. They are more
irritable than normal, and could be depressed and suicidal. They show less empathy toward others. Like childhood-onset schizophrenia, adolescent
schizophrenia is better treated if it is discovered earlier and
usually respond well to antipsychotic drugs (Bauer & Bauer, 1982).
confuse schizophrenia in children with autism.
There are, however, a few ways to tell the two apart. With schizophrenia, the problem develops at a
later age, there is less intellectual impairment, social and language
are not as severe, hallucinations and delusions are present as the
older, and there are more relapses and remissions (The National
Mental Health, 2003). Some disorders are
commonly misdiagnosed as childhood onset schizophrenia.
Children having bi-polar disorder, autism,
hyperactivity disorder, mental retardation, major depressive disorder,
disorders, organic disorders, and obsessive-compulsive disorder often
label (Werry, 1992). The most common
comorbid disorders are conduct/oppositional defiant disorder and major
schizophrenia is very rare in children under 12; it affects 1 in 40,000
children. Usually it is not diagnosed
before the age of 5, but if it is diagnosed before 5 then it usually
males ages 2-4. It occurs 100 times more
frequently in adults. The prognosis is usually not good for children
schizophrenia. In research done by Kydd
and Werry (1982), they found that 40 percent of the cases in their
in remission, which was good compared to previous research that only
had a 20
percent result. Childhood schizophrenia
is twice as common in boys as it is in girls.
This difference seems to disappear in adolescence. Research has shown that childhood
schizophrenics come from less educated families and patients have a
to average range of intelligence (Yates, 2003).
There is little information about socioeconomic
class, cultural patterns
and childhood schizophrenia.
Eighty percent of
children have auditory hallucinations and 50 percent have delusions. The National Institute of Mental Health
(2003), did research on 49 patients that did not respond to
therapy. They found that 55 percent had
language difficulties, 57 percent had motor abnormalities, 55 percent
abnormalities, and 63.3 percent had either failed a grade or required
in special education. The participants’
families had high rates of personality disorders, 45 percent had at
relative with a personality disorder.
Seventy-seven percent of the patients whose family
members had a
personality disorder had already been diagnosed with a language
of Childhood Schizophrenia
a diagnosis of childhood schizophrenia at least two or more of 5
characteristics must be met. The first
characteristic is delusions which are strong beliefs that somebody is
spying on you or following you when this is not true.
The second characteristic is hallucinations
which are seeing, hearing, or sensing that things are there when they
are not, such as bugs are crawling on the wall, or the devil is telling
kill someone. A third characteristic is
disorganized speech, which is talking about things that do not make
just saying words that do not go together.
An example would be saying “I am going to the fifth
kingdom, only I’m
allowed there and the spiders are coming with me.” The fourth
grossly disorganized or catatonic behavior, which is performing
as sitting still for hours at a time in the same position, this would
catatonic. Disorganized behaviors would
be taking all the puzzle pieces out of a box then putting them back in
hundred times. The fifth characteristic
is negative symptoms, like affective flattening, alogia, or avolition
& Wolfe, 2002). Affective flattening
is when someone shows no emotions.
Alogia is when someone does not speak very much. Avolition is when someone can not start or
complete a job. These characteristics
need to be significantly taking over a child’s life for a month or more
Psychiatric Association, 2000).
Pellegrino, & Yuhasz (No Date), said there are other
maybe associated with childhood schizophrenia.
Usually children with schizophrenia will have poor
poor coordination, poor or nonexistent social skills, and poor
executive functioning. There are
different phases of schizophrenia, the first being the prodromal phase
occurs prior to developing acute psychotic symptoms.
This phase happens when the child starts to
perform poorly on things at school and has no friends, and everything
different and starts to go wrong. The
second phase is the acute phase which is when a child goes for
usually happens when psychotic symptoms are present and level of
goes down. The third phase is the
recovery phase which is marked by the active phase and psychotic
still present with confusion, disorganization, and/or dysphoria. The fourth and last phase is the residual
phase where positive psychotic symptoms are minimal, but negative ones
still there (DeCesare, Pellegrino, & Yuhasz, No Date).
Positive symptoms are a presence of unusual
perceptions, thoughts, or behaviors, such as, delusions,
disorganized thought or speech, and disorganized or catatonic behavior. Negative symptoms involve the absence of
behaviors, rather than the presence of behaviors, such as affective
alogia, and avolition (Nolen-Hoeksema, 2004).
signs of childhood schizophrenia are low cognitive functioning, low
socioeconomic class, immature thinking and behaving, low academic
social interactions, less likely to live independently as an adult,
risk for substance abuse, increased suicide rates, increased anxiety,
problems, attention problems, and bizarre thoughts (DeCesare,
Yuhasz, No Date).
Schizophrenia in the Classroom/Treatment for the
Kaprowy, Kilgour, & Pilek, (1968) did a study with autistic
behavior in the classroom. Children with
autism and schizophrenia can show similar behaviors so the treatment
could also be effective with certain schizophrenic behaviors. One child in their study was named Peter and
he had a lot of tantrums which they believe were reinforced by
attention from whoever
was around him. They did the therapy
sessions at the Manitoba
Training School. The sessions were for 1 ½ hours in the
and afternoon with each session having a 15 minute break.
They used the child’s breakfast and lunch as
reinforcers. In the first week the
trainers conducted session in a small room with one trainer per child
arranged it so the children could not get up and leave easily. They focused on reducing tantrum behavior,
quietly, teaching more words, and using a token system.
In the second week the session in the morning
was still in the same room and the afternoon session was in a regular
classroom. They still had one trainer
per child and tried to reduce the disturbance of moving to the regular
classroom. In the third week, to the
sixth week, they moved the desks to look like a normal classroom and
the number of children in the class to seven.
Also, the child had more trainers with him or her
for certain tasks in
the classroom. In the seventh through
twelfth weeks the children had to begin with sitting quietly in their
classroom. One trainer gave verbal
training to seven children for 30 minutes.
Some of the children went to other rooms for 30
minute periods to learn
matching, tracing, or copying. The
children who were left in the class were taught by one trainer on
and commands (Martin et al., 1968).
researcher found with initial behavior problems, such as tantrums, by
this behavior and eliminating the attention given, the tantrums were
completely eliminated. In order to use
tokens as reinforcers, the researchers had to first pair a token with
then they worked as reinforcers and when the child received five tokens
could cash them in for a piece of food.
Then they used the tokens to reinforce sitting
quietly. They received a token for sitting
15 seconds. After several reinforced
periods of time the seconds it took to get a token were increased. By the end of three week most of the children
would sit still and quietly in their seats (Martin et al., 1968).
Next they looked
at the verbal training and they used something called fading. Fading is basically teaching a child to
respond to something and switching it so they respond to a different
stimuli. An example would be point to
your nose and say nose enough times so the child says nose when you
it. Now start saying what is this and
point to your nose, then say nose. Keep
doing this until the child can say nose when you ask what is this. This procedure worked for most of the
children and helped them gain a small naming vocabulary.
Next the researchers measured tracing and
copying abilities. In these procedures
they taught the children to trace lines and figures and then copy them
picture. First, the researchers guided
the child’s hand while tracing a shape.
Then eventually faded out holding the child’s hand. After they traced the line correctly then
were asked to trace a picture that had dotted lines.
This procedure was not as successful with all
the children. Some traced the lines and
copied pictures and others did not. Next
they taught the children how to match two things that were alike. They would show pictures of objects and ask
the child to show them, one shoe then two shoes. Two
of the children acquired this skill, but
the remaining children did not (Martin et al., 1968).
One thing that
made this program effective was the reinforcement program they used. Another thing they thought was effective was
the control they had over the children’s food before breakfast. After the end of this study, the researchers
implemented the following changes, the breakfast and lunch were
eliminated as reinforcers and replaced with candy, chips, and popcorn. Instead of using poker chips for tokens, they
used stars, and the children began meeting as a group with a
teacher at the Manitoba
for a 1 ½ a
day. The researchers concluded that the
children were not close to being able to be in a normal kindergarten
they could sit still and respond with only one teacher (Martin et al.,
Riester (1986) did
research on how to teach the schizophrenic child. He
developed a questionnaire that he used to interview
teachers. Five questions were about
behaviors shown by schizophrenic children and 1 question was about the
personal attributes. The teachers chosen
to answer these questions had worked with schizophrenic children and
emotionally disturbed children for years and were considered experts. Together they came up with a summary of the
things they considered to work best with teaching the schizophrenic
found one of the most important things to be having a very clearly
system and rules. Intervention for
reality testing, in school, causes poorly oriented time and space and
children are unable to set limits and boundaries. One
suggestion they gave for this problem is
to have clear rules and consequences, and to give the child a highly
learning environment. Another problem is
children with schizophrenia have selective attention.
A way to increase selective attention is to
put a student in a desk that is free of distractions, and divide longer
assignments into shorter ones. Another
problem that schizophrenic children have in school is not having any
the ability to make them. A way to help
with this is to engage in frequent interactions to gain trust, and tell
friends interact with one another (Riester, 1986).
organization skills and not setting schedules occur often in children
schizophrenia. To help this, they
suggested putting up schedules in the class and keeping the classroom
organized. The last problem the
teachers talked about
was verbal and nonverbal behavior does not match the conversation and
children do not learn interpersonal skills.
Ways to improve this are to use positive
reinforcement and model and
teach appropriate behavior. Riester
(1986) concludes with saying these intervention strategies are not
they do seem to be effective. He
believes that in the future students in college going for teaching
a class on teaching the schizophrenic child.
Jalaludeen (1982) did research on treating schizophrenic children. They developed a treatment program and used
one child as a case study. There were
three goals in this program, the first being to improve emotional
with others. The second was to get rid of habit behaviors, behavior
and phobias. The third was to improve
his academic skills. The researchers
used eye contact training and imitation training. The
children were taught to share, to reduce
habit disorders, and repetitive behaviors.
They treated phobias and improved their academic
abilities using token
reinforcers. Finally the children were
taught to manage their classroom problems.
It is important to include parents in training and
teaching. Nine months after treatment the
maintained his achievements. The
researchers concluded that overall, his academic abilities improved
dramatically (Rangaswamy & Jalaludeen, 1982).
In Alaska, Konopasek (1984)
did research on their only residential psychiatric facility for
children. At this place they have a school
teach the children when they are admitted.
They have a two teachers and an aide.
When the child is admitted the staff assesses their
level of academic
functioning and decides what classroom they will be in.
Konopasek (1984) says early signs of
schizophrenia are deteriorating academic functioning and psychotic
episodes. When a child becomes psychotic
a change in medicine is usually needed. The
children start school at the same time everyday and with the same
they follow the same schedule each day. It
is important for the teachers to be aware of the side-effect of the
medicine. Medicine could make the child
appear tired or not interested. Usually
the child is interested and does not want to be tired, but the side
cause them to be that way. Teachers
should conform to each individual student’s need to help with academic
performance. Another suggestion in the
arranging the child’s desk to be free of distractions.
Children that are having delusions or
hallucinations need support. Not support
for their delusions and hallucinations, but to know they are safe and
help to see
their thoughts and beliefs are not real.
Teachers need to know what their student’s
hallucinations and delusions
are and plan the lessons so they do not bring on these hallucinations
delusions. These interventions are
intended to be useful in general classroom and are not a prevention or
They are only intended to help assist with a child during a psychotic
Medication has, in
most cases, been the most successful in treating childhood
although there can be side-effects. The
most serious side effect is tardive dyskinesia, but it is usually rare
children very rare. Tardive dyskinesia
seems to progress with age. Most
patients do well on medicine although it may take a while to find the
combination and dose level. One problem
with medication is some people are unwilling to take it (Werry, 1992). Combining antipsychotic drugs with these
behavior programs in school will turn out to be the best possible
children with schizophrenia.
In conclusion, the
best programs for treating childhood schizophrenia in the classroom
seem to be
behavioral in nature. They seem to share
in common some sort of point or token system with positive
reinforcement. All of the programs also
defining the rules in the classroom and what is expected from the child
token system. Another suggestion for
treating schizophrenia is make sure to know how long the child has been
experiencing it and how often the child has relapsed.
For childhood schizophrenia, an absolute in
treatment is always medicine. The stress
and pain on the families of children with childhood schizophrenia is
devastating. There is still so much to
learn about this very complex, rare disorder, therefore more research
done in the future.