The Childhood schizophrenia It is a diagnostic category that has given rise to numerous controversies over its overlap with other categories, such as childhood autism.
Nowadays it is still not included in any diagnostic and classification manual for mental illness (DSM or ICD), however, cases of children with psychotic symptoms are known in childhood and early adolescence.
Characteristics of childhood schizophrenia
Although the interest in the study of adult schizophrenia began very early in the hands of authors such as Kahlbaum, Kraepelin, Bleuler or Schneider, who were responsible for defining schizophrenia according to the symptoms or the evolution of the disorder. The study of this in children was slow to start, probably because of the resistance to admitting that mental disorders could occur in childhood.
They were Kraepelin and Bleuler in 1850, the first to admit that some of the people they treated had become ill in childhood. However, it was not until the 1930s that the earliest descriptive and epidemiological studies of childhood schizophrenia began.
Potter in his work with psychotic children was the first to introduce the concept, and later authors such as Bradley and Bender tried to describe it as"that process through which there is a loss of affective contact with reality, Being determined by an autistic, regressive and dissociative way of thinking??.
The term infantile schizophrenia was continued until Kanner, described autism. Thereafter, further work included schizophrenia within childhood psychosis.
Some of the criteria that were proposed for the diagnosis of childhood psychosis were: alteration of interpersonal relationships; Concern for particular objects; Resistance to changes in the environment; Abnormal perceptual experiences; Non-acquisition of language; Absence of motor behavior or presence of mental retardation.
However, these criteria were criticized by several authors, such as Rutter, who formulated four new diagnostic criteria: beginning before 30 months of age; Deterioration of social development; Delay language development and insistence on similarity.
Along the same lines in 1964, Rimland attempted to establish a classification system between autism and schizophrenia, in order to establish a differential diagnosis between the two.
Although this system is not valid at present, the only clear differentiating characteristics now in place are that in childhood schizophrenia there are hallucinations and delusions, and there is a high incidence of family psychosis, unlike in autistic children.
Due to all the prevailing approaches at that time, there was a significant shift between the editions of DSM-I and II, which reflected autism as a variant, or the earliest expression of adult schizophrenia. Until the edition of DSM-III, which reflects the modifications that Rutter made of Kanner, placing childhood autism in the new category of developmental disorders.
Childhood psychosis ceased to appear in the diagnostic classification systems in the 1980 version of DSM III, arguing at the time that the concept of childhood psychosis was non-operative, leading to confusion and error. It was argued that psychotic disorders arise when personality and thought are formed, and can not be established before a certain age.
Even now, many children diagnosed with specific pathologies or neurodevelopmental disorders may develop into adulthood with psychosis or schizophrenia, being especially comorbid with generalized developmental disorders and Deficit Disorder Attention and hyperactivity .
Symptoms of Childhood Schizophrenia
Childhood schizophrenia has the same symptoms as the schizophrenia In adulthood, and are usually classified into positive and negative symptoms. Positive symptoms refer to aspects that occur to a greater degree than normal, and negative symptoms to aspects that occur to a lesser extent.
Certain considerations must be taken into account, such as discarding other causes of psychosis due to metabolic, endocrinological, neurological, infectious, toxic or genetic alterations.
Within the positive symptoms, we find delusions, hallucinations or disorganized thinking. And within the negative symptoms, Affective flattening , Apathy, demotivation??
In general, schizophrenic children usually present with hallucinations, delusions, thinking disorder, affective disorders, cognitive impairments, and other abnormalities premorbid.
Hallucinations
False perceptions that occur in the absence of an identifiable stimulus. They can be associated with any of the senses, but the auditory ones are the most habitual, and they appear in the form of voices that give them orders, accusations or comment on their behavior.
In the preschool age hallucinations are usually related to imaginary friends, fantasy figures and stress and anxiety promote the appearance of Visual hallucinations , Tactile and nocturnal. At school age they are usually hallucinations of monsters, pets and toys.
Delusions
These are erroneous interpretations of reality, they imply alterations in the content of thought. They occur in lesser proportion than in adults and the most common refer to delusions of persecution and somatic, and those concerning thoughts and religious are less common.
Are those typical of having abilities to fly, supernatural powers, demons, existence of people or machines inside the body??
Disorganization of thought
Here we refer to the lack of organization existing in the subject's thinking, and not its content, this is manifested through speech. Sometimes there is a total lack of language, and in others it appears around 4-5 years. The language is illogical, it lacks content and is fragmented, repetitions occur frequently and lacks communicative function.
Mina K. Duncan stated that these disorders of thought are present between 40-100% of patients younger than 13 years and who present with psychotic episodes. For its part, Caplan et al. Claim that these are not specific to schizophrenia and reflect changes in the Development of Communicative skills .
Disorders of affection
Schizophrenic children present affective flattening, that is, they show few emotions and their gestures and voice are usually inexpressive. Interaction with them is often difficult due to their affective indifference. There are also explosions of emotion for no reason at all and even acute crisis of anguish, accompanied by agitation and hetero anger and self-aggression.
Alterations in motor behavior
In some children with schizophrenia, catatonic symptoms usually occur, that is, adoption of rigid or extravagant postures for hours, showing resistance to the attempts of others to change it. These symptoms usually occur in those who are developing the spectrum and also have attention deficit hyperactivity disorder and tics.
Cognitive alterations
In general, children with childhood schizophrenia have an average IQ, that is, between 84 and 94. And only 10-20% of children with schizophrenia have an IQ at the limit of mental retardation, between 70 and 79.
It is true that it is difficult to establish whether these alterations are the result of mental illness or are premorbid conditions.
Bedwett, in 1999, stated that post-psychosis cognitive impairment is due to the inability to acquire new learning and skills, and not to the existence of a possible dementia.
Premorbid alterations
As for existing alterations in schizophrenic subjects, before the diagnosis of the disease we found behavioral symptoms, social problems, academic difficulties, Language disorders , Developmental delays and other psychiatric disorders.
According to Watt, in 1984, there are a number of high-risk indicators for schizophrenia to occur, including the following:
- Problems at birth : Low weight and difficulties.
- Lack of close relationship With the mother during the first three years.
- Poor motor coordination .
- Separation of parents Or foster care in an adoptive institution or home.
- Intellectual deficits : Poor performance on intelligence tests or verbal skills.
- Cognitive deficits : Distraction and problems to focus attention.
- Social deficits : Aggressive behavior and anger.
- Confusion and hostility In the paternal-filial communication.
Once the clinical characteristics associated with childhood schizophrenia are seen, it is important to bear in mind that none of these manifestations taken in isolation is a determinant of this disorder, but it is the combination of these plus the persistence or aggravation over time, The fundamental criteria to consider the appearance of the same in the child or adolescent.
Epidemiology
Childhood psychosis has a low incidence (1 per 10000), but it increases in late adolescence (17/18 years), reaching 17 per 10000. That is why, before establishing a specific diagnosis, it is necessary to be sure of The characteristics that the patient presents.
Very rare in children before 5 years, until puberty is more prevalent in males, then the prevalence is even.
Regarding social class, some studies indicate that the highest rates of childhood schizophrenia occur in families with lower education and professional success, but data on social class are confusing and may be biased.
Course and forecast
The course is gradual or sudden. Those that begin before adolescence usually appear insidiously with negative symptoms (language delays, sensory, withdrawal??). Positive symptoms appear as age increases and become more complex. As for the prognosis, 1/3 recover, 1/3 deteriorates and 1/3 severe deterioration.
Causes
Several postures are posed based on the etiology of schizophrenia, one more biological, one more environmental and one integrative.
As for the factors involved in the onset of childhood schizophrenia, we find the following:
- Factors related to the nervous system . A ventricular dilation is usually observed; Anomalies in other brain areas such as prefrontal or limbic; Abnormalities in the EEG; Prefrontal area with little activity; Excess dopamine in schizophrenia.
- Genetic factors . Parents of children with schizophrenia have higher rates of schizophrenia (10%) and complications can occur during pregnancy and childbirth.
With regard to psychological and social factors we find the importance and interest for the family, with emphasis on the interactive model of development.
In families there is a presence of an abnormal communication, defined as a vague communication, without focusing on anything and distorted; A high level of hostility, criticism and excessive emotional involvement and parents with a high level of emotional expression.
On the other hand, from the integrating diastasis-stress model, importance is given to the interaction between biological and environmental factors, both of which are involved in the etiology of schizophrenia. From here it is stated that no single biological or environmental factor can explain children's schizophrenia completely.
Assessment of childhood schizophrenia
When assessing the presence of childhood schizophrenia in a child or adolescent, it is important to consider the following aspects:
- Evolutionary history and symptomatology .
- Level of development of the subject : Evaluation of intelligence and personality.
- Level of communication : Comprehensive, expressive language and conversational skills assessment.
- Executive functions : Assessment of care, organization and planning, and interference and cognitive rigidity.
- Personality : Behavioral assessment, social relations, coping skills, personality traits, social skills, relationships with the environment.
- Basic skills : Evaluation of the presence of stereotypies, rituals, anticipation difficulties, interests, resistance to changes, sensory hypersensitivity??
Final Considerations
- In many cases children / adolescents diagnosed with ADHD, Autism Spectrum Disorders , Asperger syndrome , Behavioral disorders or difficulty of social skills , May develop into adulthood with some psychotic disorder.
- Early diagnosis has a better prognosis.
- It is necessary to inform the family well and once issued the diagnosis, seek help.
- The difference in the very early age between childhood psychosis and autistic spectrum disorder is going to be the presence of delusions or hallucinations.
- The multidisciplinary diagnosis is important, so it is necessary to refer to other specialists, if the presence of a disorder is diagnosed from a private psychological center, for example.
- Medication as well as psychological intervention are necessary.
CONCLUSIONS
Throughout this article we have been able to verify the uncertainty still existing as to what is the schizophrenia child, and in what can be differentiated of other entities like the autism.
To all this, it is necessary to add the difficulties existing when the disorder appears in the childhood since the negative impact is even greater.
Therefore, it is important to continue to increase research, since it is well known the impact of schizophrenic disorders on people, both personally; family; Social and economic, due to the high costs that it generates in the health services.
Bibliography
- Agüero, A., Agüero Ramón-Llin, C. Prepuberal schizophrenia, a forgotten clinical picture in adult psychiatry and"confused"? In child psychiatry. (1999). Psychiatry Journal
- . Childhood psychosis: from autism to psychotization. Virtualia: Digital magazine of the Lacanian Orientation School.
- González Barrón, R. (2000). Psychopathology of the child and the adolescent. Editions Pyramid.
- Wicks-Nelson, R and Israel, A.C. (1997). Psychopathology of the child and adolescent . Madrid: Prentice-Hall.