People who have schizophrenia are often very concerned that they have passed the illness on to their children. Even when their children are very young, the thought of their child experiencing a psychotic episode fills many parents with fear and dread. As a child psychiatrist in training, I am often asked to evaluate children of people with schizophrenia to see if they are having any symptoms of the illness. Sometimes, I’m referred children who don’t have any psychotic symptoms, but whose parents are concerned may develop the illness. Parents routinely want to know if there are any telltale signs that signal a problem.
These parents have the right idea. Some research shows as high as 90% of children who go on to have early onset schizophrenia have some abnormalities before the positive symptoms of the disorder (hallucinations, delusions, disorganized speech or behavior) emerge. I wish there was a clear cut set of guidelines that I could tell parents that would ease their anxiety, but the reality is, the evaluation of psychosis in children remains a controversial topic. For example, it’s sometimes quite difficult for a parent to tell whether a child is hallucinating or having imaginative play. Children who have problems communicating can sometimes also appear psychotic to parents who have a personal history with schizophrenia.
Despite the difficulties and controversies regarding early onset schizophrenia, there are some signs that the child might be in trouble. Halluciations have been consistently found in most children with schizophrenia. This is often accompanied by what’s known as "˜flattened affect’. Children with flattened affect tend not to have emotional reactivity and don’t show a lot of emotion on their face. Children who are psychotic tend to show signs of a thought disorder, meaning their manner of speaking suggests that their thinking isn’t well organized or coherent. I’ve had patients who would spontaneously list cartoon characters’ names or describe my carpeting in great detail for no apparent reason. More commonly, children with thought disorders would be talking, but I simply wouldn’t know what they were talking about, both the structure of their speech and its content would be lost to me. Impaired discourse skill is a very consistent difference between children with schizophrenia compared to children the same age without the disorder.
As I mentioned earlier, a lot of the information about the diagnosis of schizophrenia in children comes from how they communicate, so it’s very important to make sure that the child doesn’t have a speech or language disorder, nor is suffering from developmental delays. If you suspect your child has signs of schizophrenia, an evaluation by a skilled physician is warranted. It’s not predestined that a person with a parent with schizophrenia will inherit the disease but it does increase the chance the child will go on to develop a psychiatric disorder. I welcome your questions on this topic and look forward to your comments.