A rare glimpse of childhood schizophrenia

The LA Times has an article and video about a young girl who has one of the very rare cases of childhood schizophrenia. In this instance, it is particularly unusual because the affected child is only six years old.

One of the biggest mysteries in psychiatry is why psychosis, the occurrence of delusions and hallucinations, doesn’t typically first appear until about 17 years of age for males and about 20 for females.

It’s curious because from a psychological perspective, all the things that are supposed to ‘go wrong’ – thinking, belief, perception, motivation, emotion – are already in place many years before.

To give a clumsy example, it would be like finding out that kids never broke their arms until they were teenagers, despite having perfectly functional limbs for years before.

There are some clues from studies of ‘neural migration’ that have shown that people with schizophrenia, on average, don’t show the same patterns of connections between cortical layers in the frontal lobes – which are built during brain development and continue maturing well in the early 20s.

However, these are still no more than clues, as no-one has a well worked-out idea of how this explains the fact that psychosis doesn’t typically appear until early adulthood.

In very rare cases, however, psychosis does seem to appear earlier – like in the early teenage years – and in rarer cases still, it appears in children younger than 12.

Clearly, kids have a rich fantasy life and imaginary friends are normal (and, in case you’re worrying, are usually associated with better adjustment later in life). In addition, some kids are just a bit eccentric. This can make it difficult to say for certain whether, for example, a child is hallucinating or just being whimsical.

But despite these difficulties, there are some kids who do seem to have persistent troubling delusions and hallucinations along similar lines to schizophrenia.

These occasional cases pose something of a challenge for psychiatrists, not least because the first-line treatment for schizophrenia, antipsychotic drugs, have some rather nasty side-effects, but also because very few studies have tested the effectiveness of these medications in children.

One study that has been doing this, however, is the Treatment of Early-Onset Schizophrenia Spectrum (TEOSS) study, which just reported it latest results.

Sadly, they are a huge disappointment for anyone hoping for a easy solution as they showed that the pills generally caused more problems than they solved, produced serious health risks, and were poorly in dampening down the delusions and hallucinations.

From a more personal angle, the LA Times piece is both a rare look at the condition and a rarer look into the emotional life of a family trying to make sense of their child’s unpredictable and sometimes distressing world.

Link to LA Times piece on childhood schizophrenia.