Supplement: Schizophrenia in Childhood

1 This diagnosis is often difficult to confirm, because it is quite common for children to have magical thinking or beliefs, and they often report auditory hallucinations that occur upon waking or sleeping (hypnagogia or hypnopompia, respectively). In addition, children may not be able to articulate their psychotic symptoms as clearly as adolescents or adults, thus making the diagnosis less clear-cut. So, too, can other symptoms mistakenly resemble psychosis, including idiosyncratic thi

Gholson J. LyonandHarold S. Koplewicz

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So, too, can other symptoms mistakenly resemble psychosis, including idiosyncratic thinking and perceptions associated with pervasive developmental disorder (PDD), psychotic-like symptoms arising in children with posttraumatic stress syndrome, or anxiety-related transient "phobic" hallucinations. The symptoms of psychosis in childhood differ qualitatively and quantitatively from the adult form, and these symptoms must be interpreted in relationship to the developmental age. Once you identify psychotic or quasi-psychotic symptoms in children, you look for the cause, which includes a number of disorders: autism, disintegrative disorder, affective psychoses, Asperger's syndrome, drug-induced psychosis and psychotic states caused by organic disorders, and, rarely, childhood-onset schizophrenia.

Occurring in fewer than 1 in 10,000 children, childhood-onset schizophrenia (COS) is characterized by the onset of psychosis before the age of 13 years. Most people show signs of the disease later in life: There is a dramatic increase in the frequency of schizophrenia between 13 and 18 years of age ...

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