Psychosis is an extreme mental state. Children with the disorder show impaired thinking and emotions that cause them to lose contact with reality.

What is Psychosis? 

Childhood psychosis is rare. It is a severe mental disorder where children interpret reality abnormally.

With childhood psychosis, the early age of onset presents special challenges for diagnosis, treatment, education, and emotional and social development. Early intervention may improve a youngster’s prognosis. Unfortunately, the subtle warning signs are apt to be attributed to the normal growing pains of adolescence.

Psychosis is an extreme mental state. Children with the disorder show impaired thinking and emotions that cause them to lose contact with reality. This could mean hearing or seeing things that aren’t there (hallucinations), or believing things that aren’t true (delusions).

The illness most often associated with psychosis is schizophrenia. Schizophrenia causes people to waver between reality and their own distorted perception of reality.

Schizophrenia usually doesn’t show up until very late in adolescence or early adulthood. Recently, however, doctors have been working to identify high-risk kids whose symptoms could be early warning signs of psychosis. 

What Symptoms Should You Look for? 

Schizophrenia is the most chronic and debilitating of all psychiatric conditions. It is also the most widespread form of psychosis.

The symptoms of childhood onset schizophrenia are essentially the same as adult symptoms, but the degree of impairment tends to be greater when symptoms appear early in life. Symptoms can have a profound impact on a child's behavior and development.

Symptoms of schizophrenia vary depending on the age of the child. The earliest indications of childhood schizophrenia may include developmental problems, such as:

  • Language delays
  • Late or unusual crawling
  • Late walking
  • Other abnormal motor behaviors — for example, rocking or arm flapping

Some of these signs and symptoms are also common in children with developmental disorders such as autism. That’s why one of the first steps in diagnosing psychosis is ruling out developmental disorders.

In teenagers, schizophrenia’s symptoms are closer to those found in adults. Isolating those symptoms can still be a challenge, as some of the early symptoms of schizophrenia in teenagers are common for typical development during the teen years. These symptoms include:

  • Withdrawal from friends and family
  • A drop off in performance at school
  • Trouble sleeping
  • Irritability or depressed mood
  • Lack of motivation
  • Strange behavior
  • Substance use

Compared with the symptoms of schizophrenia in adults, teens may be:

  • Less likely to have delusions
  • More likely to have visual hallucinations

As young people with schizophrenia pass through their teen years, typical symptoms of the disorder begin to appear. These may include:

  • Delusions. These are false beliefs that are not based in reality. Delusions occur in most people with schizophrenia.
  • Hallucinations. These usually involve seeing or hearing things that don't exist. Hearing voices is the most common hallucination.
  • Disorganized thinking. Effective communication can be impaired, and answers to questions may be partially or completely unrelated.
  • Extremely disorganized or abnormal motor behavior.  This behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
  • Negative symptoms. This refers to a reduced ability or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion. Also, the person may have reduced ability to engage in activities, such as a loss of interest in everyday activities, social withdrawal or the lack of ability to experience pleasure.

What Causes Psychosis in Children?

Specific causes for most psychotic disorders are not known. However, the combination of inherited, biological, environmental, and psychological factors is thought to be involved.

How is Psychosis in Children Diagnosed?

The first step in addressing psychosis is a proper and complete diagnosis by a mental health professional with experience in assessing psychotic illness.

Diagnosis of childhood schizophrenia involves ruling out other mental health disorders. A thorough diagnosis will also determine that symptoms aren't due to substance abuse, medication or a medical condition. The process of diagnosis may involve:

  • A physical exam
  • Diagnostic investigations
  • A comprehensive behavioral health evaluation
  • Following diagnostic criteria for schizophrenia

Diagnosing psychosis in adolescents is a matter of systematic interviewing as well as ruling out other behavioral health and medical diseases. It is rather straightforward.

On the other hand, the diagnosis of psychosis in preschoolers and pre-adolescents poses developmental and language challenges. A useful technique when interviewing children under age ten is to make the parent an active participant in the inquiry process. The parent becomes the questioner under the evaluator’s guidance.

How is Psychosis in Children Treated?

A combination of medication and individual therapy, family therapy, and specialized programs (wraparound services, early psychosis treatment) is often necessary. 

When Should You Seek Help for Children Suffering From Psychosis?

Schizophrenia is a chronic condition that requires lifelong treatment. Identifying and starting treatment as early as possible may significantly improve your child's long-term outcome.