Running head: THE IMPACT OF CHILDHOOD ONSET SCHIZOPHRENIA 1

The Impact of Childhood Onset Schizophrenia (COS)

Taylor Pawlowski

Early Childhood Intervention

2/25/2019
Running head: THE IMPACT OF CHILDHOOD ONSET SCHIZOPHRENIA 2

Abstract

This paper describes the impact of childhood onset schizophrenia (COS) and what the child

experiences when having this disability. This paper makes sense of the rarity, causes, and

prevalence of COS. It explores all of the possible impacts that a child could experience in all

different settings in their lives. This paper uses 6 scholarly articles to show research and

information on how COS impacts a child’s life in the educational environment, home, or in

society. With the article written by Bartlett (2014), Biswas (2008), and Lattari & Dragkowski

(2011) discusses the risk factors and the misdiagnosis of COS. Gonthier & Lyon (2004) was used

to explore COS symptoms and developmental delays a child may have. Sood and Kattimani

(2008) is used in this paper to touch on the treatment of hospitalization. Lastly, Driver, Gogtay &

Rapoport (2013) was used to provide information on how the disability impacts society.

Keywords: childhood onset schizophrenia, impact, child, symptoms, development

Running head: THE IMPACT OF CHILDHOOD ONSET SCHIZOPHRENIA 3

The Impact of Childhood Onset Schizophrenia (COS)

Childhood onset Schizophrenia, (COS), is a severe and rare mental illness that occurs in

children before the age of 13. The diagnosis of Childhood Schizophrenia and Adult

Schizophrenia uses the same criteria when diagnosing. Schizophrenia causes a range of problems

with cognitive, behavior and emotional development. Those with schizophrenia may experience

a range of positive and negative symptoms that adversely effects their ability to function.

Childhood-onset-schizophrenia has a prevalence rate of about 1 in 10,000 children therefore it is

not widely studied so it is often misdiagnosed and mistreated in adolescence (Gonthier & Lyon

2004). It is also more prevalent in males than females at a 2:1 rate (Gonthier & Lyon 2004).

Also, the prevalence of COS is 50 times less than adult-onset schizophrenia (Biswas 2008). A

study was shown in the article written by Sood and Kattimani about the prevalence of COS and

they stated, “A significant increase in prevalence of schizophrenia around puberty and early

adolescence and by 18 years old, 18% of patients with schizophrenia will have the illness” (Sood

& Kattimani 2008). The premorbid signs of Childhood Onset Schizophrenia in children show

obvious early signs of delays in language, social, and motor development. The symptoms are

split in to two categories, negative and positive symptoms. Positive symptoms are not usually

found in Childhood Onset Schizophrenia, as well as not being found in the general population.

Negative symptoms and behaviors are not found regularity in the general populations such as flat

affect and disorganized speech (Gonthier & Lyon 2004). There is no known cause of COS but

there are contributions to the development of COS such as environmental stressors, family genes,

prenatal complications, and the neurodevelopment of grey and white matter in the brain. Overall,

the impact of COS is huge and it affects all aspects of a child’s life such as their family,
Running head: THE IMPACT OF CHILDHOOD ONSET SCHIZOPHRENIA 4

development, ability to function in society, treatment, future schooling and vocation and the

educational services that are needed for the child with COS.

Impact of the disability

A child who is diagnosed with COS, creates a large impact on the child’s siblings,

parents, environment, and on themselves. COS is often misdiagnosed along with having multiple

risk factors that may cause a child to develop COS. Although there is no known actual cause of

COS, it is said to be caused by family genetics, environmental stressors, prenatal complications

and the neurodevelopment of white and grey matter. One of the risk factors and or causes for a

child to develop schizophrenia is the genetics in the family. From the article written by Lattari

and Dragowski, this was first recognized by Rudin in 1916 when it was documented that, “Data

indicates that a child whose first-degree relatives have a history of schizophrenia has a 10%

chance of developing the disorder, as compared to a 1% chance among the general population”

(Lattari & Dragkowski 2011). So therefore there is a higher risk of developing COS for a child

with a relative that has schizophrenia rather than others who have just 1% risk. The contributions

of late brain maturational processes and the stressors in childhood and adolescence is involved

with the development of COS (Biswas 2008). There is evidence that harmful experiences and

negative family interactions can contribute to the development of schizophrenia such as

childhood neglect, being ignored or rejected is associated with a child developing negative

symptoms (Bartlett 2014). The development of positive symptoms can also stem from physical

or sexual abuse (Bartlett 2014). Another risk factor that contributes to the development of COS is

the environmental stressors in the child’s life. Examples can be where they grew up, the home

they grew up in, but there is no correlation between the age of the child, socioeconomic status

and psychological trauma (Biswas 208). When looking at the risk of the grey and white matter
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development in the brain it is caused by the abnormal development of language-related brain

regions like the temporal and frontal lobes (Biswas 2008). It is extremely difficult to diagnose a

child with a severe and rare mental illness at such a young age for reasons that often lead to a

misdiagnosis. Creating a misdiagnosis on a child is impactful for the child’s daily life as well as

their social and cognitive development. If a child is misdiagnosed they are receiving the wrong

type of educational assistance, home care, and treatment. The difficulty of correctly diagnosing a

child with COS, a key difficulty a clinician may face with is distinguishing what are true

hallucinations and delusions between a child’s imaginary play (Bartlett 2014). Another difficulty

resulting in misdiagnosing a child is being able to understand poor or underdeveloped language

skills that could result in disorganized thought and speech patterns similar to the diagnosis of

schizophrenia (Bartlett 2014). An example in a study showed “a five-year-old boy who

experience auditory hallucinations received a multitude of inaccurate diagnoses before being

formally diagnosed with schizophrenia” (Bartlett 2014). Some of the most common alternate

diagnoses are pervasive developmental disorder, attention deficit hyperactivity disorder

(ADHD), bipolar disorder (BD), major depressive disorder and schizoaffective disorder (Bartlett

2014). Bipolar disorder, Autism Spectrum Disorder, and ADHD are the most common disorders

children are misdiagnosed with before being formally diagnosed with COS. These disorders

overlap with the same symptoms and characteristics that COS shows so therefore children are

often misdiagnosed with another disorder and then they receive mistreatment until it is re

diagnosed in later years.

Next, COS also impacts the child’s overall development in cognitive functioning, social

skills, basic life skills, etc. It is extremely detrimental to the child’s development and functioning

in society. A study showed that a majority of 50-66% of children show the premorbid delays in
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language, motor and social function (Biswas 2008). This also includes delayed milestones and

poor coordination (Biswas 2008). The onset of schizophrenia has four phases where the child

diagnosed continues to cycle and the symptoms worsen as each cycle increases. The first phase is

the prodromal phase, which includes “functional deterioration’ (Gonthier & Lyon 2004). The

symptoms involved are social withdrawal, isolation, bizarre preoccupations, deteriorating self-

care skills and physical complaints (Gonthier & Lyon 2004). The acute phase contains positive

symptoms such as hallucinations and delusions and decrease in cognitive and social functioning

(Gonthier & Lyon 2004). The third stage of the cycle is the recuperative or recovery phase. At

this phase a child is able to function outside of the hospital and return back to school. Also

during this phase, the positive symptoms stop and the negative symptoms increase which results

in the child is severely impaired functioning (Gonthier & Lyon 2004). The last phase is the

residual phase where the positive symptoms are still not showing and the negative symptoms are

decreasing from the previous levels but the child’s ability to function is still impaired from the

negative symptoms (Gonthier & Lyon 2004). The 4 phase cycle is used to explain the different

levels that a child with COS is at and what symptoms that are dealing with in that cycle. After 10

years, the acute phase is no longer a part of the cycle. This is a good way to keep track where the

child’s level of function and symptoms are at.

Educational needs

Children with COS struggle day to day with thinking, functioning, and completing daily

tasks. A statistic from the Child Adolescent Psychiatric Clinic wrote, “67% of children with COS

show disturbances in social, motor, and language domains as well as having a learning

disability” (Driver, Gogtay & Rapoport 2013). Children with COS have a lower intelligence IQ

scores than later onset types of schizophrenia (Biswas 2008). This is because children who are
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diagnosed early in childhood with schizophrenia, they are not exposed or taught basic language

and functional skills unlike adults who have adult onset schizophrenia. Also, a study found and

wrote, “COS patients tend to have failure to make age appropriate development because of the

illness process rather than an actual deterioration in performance” (Biswas 2008). Children with

COS who are in the acute phase need to have constant care. This phase of positive symptoms

requires children to be in an inpatient care setting and being to take medication, which is for their

protection for themselves and others (Gonthier & Lyon 2004). On the other hand, children who

do not need an inpatient setting and can go to school, need accommodations and modifications to

their education setting and educational needs. As early as preschool ages, children with COS can

display nonspecific but concerning symptoms such as small changes in behavior Gonthier &

Lyon 2014). It can also continue into early school age where in attention and behavior begin

which leads to affecting the child’s overall school performance (Gonthier & Lyon 2014).

Also, other educational implications from Gonthier and Lyon’s writes about young children’s

need and says “Very young children who are not yet experiencing hallucinations or bizarre

behaviors may need services such as speech therapy to help language delays, physical or

occupational therapy to assist with motor delays and thinking about using a behavior plan to help

with inattention and acting out behaviors” (Gonthier & Lyon 2004). Depending on the phase the

child is at as well as the severity of their symptoms, they are able to go to school with the right

accommodations and help for trained teachers who have experience with students with

disabilities such as schizophrenia. Students with schizophrenia often qualifies for services under

the IDEA category of “Emotionally Disturbed” or “Seriously Emotionally Disturbed” and

receive their individualized educational needs with an IEP (Gonthier & Lyon, 2004). A behavior

plan may need to be made and implemented if the child exhibits aggression, inattention or
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defiance (Lattari & Dragowski 2004). The most desirable form of setting for a child with COS is

the least restrictive setting where the child can effectively function. The most important factors

for a child with COS is to create and maintain a consistent and reliable structure with a routine.

This could mean in schools you can place them in classes that are highly structured but also are

sensitive to each child’s individual needs in the classroom (Gonthier & Lyon 2004). The

accommodations and modifications need to be in place as the child moves into the recuperative,

recovery phase, and the residual phase to ensure that the child’s cognitive and social functioning

is being taught in ways such as problem solving, anger management, and basic life skills

(Gonthier & Lyon 2004). Modifications may be shortening assignments, providing handouts,

increasing the time allowed for tests, etc (Gonthier & Lyon 2004). It is also important to

acknowledge the amount of stress that is being exposed to the child. Providing assistance so that

they are able to adjust to the stressors and changes in the classroom also will benefit their needs

in the classroom. Another important element of services for COS is having open communication

between the school and the child’s family so the child can have consistency and maintained at

school as well as at home. School psychologists play an important role for children with COS

and their families. School psychologists are responsible for providing the services for the

individual needs for the child, acting as the family’s initial contact with mental health personnel,

collaborating with the child’s mental health provider, providing information on the disorder to

the school, and basic support for the child with COS (Gonthier & Lyon 2004). Also, from the

article written by Lattari and Dragowski, they talked about the implication of school

psychologists and wrote, “school psychologists must be able to recognize the symptoms, make

appropriate referrals, and coordinate educational services for the affected children. In order to

properly differentiate the disorder’s earliest warning signs from the more frequent childhood
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problems, school psychologists must be especially observant of children who exhibit a

constellation of symptoms approximating a common childhood disorder” (Lattari & Dragowski

2011). This means that the school psychologist is the primary source and the most experienced

personnel in the school setting so therefore they play a vital role in recognizing the symptoms

and providing the correct services and accommodations for the individual child’s needs. After

identifying that a child may have COS, the school psychologists need to be able to “identify

when the symptoms emerge, assessing the developmental of behaviors, and considering family,

prenatal, and environmental factors during the initial evaluation process” (Lattari & Dragowski

2011). The school psychologists background knowledge of the child, the disability as well as

knowing how to provide the best services that are need will result in an appropriate psychiatric

referral which will lead to the child receiving the most effective treatment and educational

services (Lattari & Dragowski 2011). After the child is diagnosed with COS, the school

psychologists need to work with the child’s physician to monitor the child’s progress and

performance. Another important role the school psychologists hold is being able to collaborate

with mental health services to design an appropriate education plan (Gonthier & Lyon 2004).

Gonthier and Lyon added examples of ways the two can work together and wrote, “determining

proper placement, work modifications, and any necessary supports that may be required”

(Gonthier & Lyon 2004). Working together with all personnel involved with the child with COS

is vital for the child’s developmental needs and services. Examples of services are creating small

class sizes, social skills training, speech/language therapy, and physical or occupational therapy

(Lattari & Dragowski 2011). Lastly, the school psychologist can play a role in providing

trainings for school staff, administration, etc. There are a lot of misconceptions about

schizophrenia so by providing trainings to those in a school setting can help the staff become
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more knowledgeable on the subject as well as positively impact the way the child with COS

performs in a school setting. The trainings may provide information on the symptoms, treatment

options, and long term outcomes (Gonthier & Lyon 2004). Children with COS struggle with

basic life skills so creating trainings for one on one instruction or group interventions Gonthier &

Lyon 2004). All in all, school psychologists play a very important role and a leaves a large

impact in a child’s life and their family with COS.

Treatments and medication

Depending of the severity of COS on the child, the type of treatment and medication

differs. The treatment of COS has a team of health care professionals such as psychiatrists,

psychologists, pediatricians, social workers and psychiatric nurses (Bartlett 2014). There are a

variety of treatments that are used with schizophrenia such as therapeutic interventions that may

range from individual therapy, family therapy and social skills training (Bartlett 2014). The most

severe of cases where a child with COS cannot function in a regular public setting then they are

referred to use an inpatient center or psychiatric hospitalization. The changes in the environment

for a child with COS can use family therapy and special education, but for children with more

severe symptoms, utilizing a day treatment program or residential setting may be needed for their

individual care (Gonthier & Lyon 2004). Inpatient facilities are often utilized because they

provide a multidisciplinary approach and the also provide the close monitoring and supervision

in a controlled setting (Gonthier & Lyon 2004). When hallucinations and delusions begin, most

children require an inpatient setting so they can have constant care and monitoring because

children begin taking medication for the symptoms and to watch for the negative side effects

(Gonthier & Lyon 2004). From the article written by Sood and Kattimani, they mentioned a

study where they found durations of hospital stays from patients with schizophrenia and wrote,
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“A study from Vyas reported that in their early onset childhood schizophrenia patients the mean

duration of untreated psychosis was 2.95 months and the subjects had an average of 2.09

hospitalizations” (Sood & Kattimani 2008). This study measured their diagnosis and outcomes to

see if the patients had progress of not being admitted into the hospital or showing signs of

improvement and concluded that on average the patients spent almost 3 months in

hospitalization. Also, another study from the same article recorded a sample of patients with

schizophrenia and wrote, “Krausz and Muller-Thomsen found that 5 years follow up about half

of their sample of childhood schizophrenia patients had spent almost half of the follow up period

in the hospital with an average of four to five stays” (Sood & Kattimani 2008). All in all, this

study found that it is average that their progress stayed the same or worsened over time. TO

conclude the studies and reasons for hospitalization for COS, is that the most common reason for

hospitalization is that children can injure themselves or someone else during their psychotic

episodes that it is highly needed to have hospitalization so they are able to be closely monitored

(Gonthier & Lyon 2004). Aside from choosing the type of treatment the child needs, there are

debates on whether the child with COS should be medicated at such a young age. Atypical

antipsychotics are the first medications used to treat COS and they have fewer side effects.

Typical side effects are weight gain, diabetes, high cholesterol, seizures, and rarely movement

disorders (Bartlett 2014). The popular types of atypical antipsychotics that are prescribed are

Clozapine, Risperidone, and olanzapine (Bartlett 2014). Clozapine is said to be the most

dangerous with the most amount of side effects and studies would not recommend using

Clozapine because of the side effects as well as a chance of the child developing neutropenia

which is a significant drop in white blood cells (Bartlett 2014). Antipsychotics are known to have

severe side effects the most severe are the moto and movement disorders that causes involuntary
Running head: THE IMPACT OF CHILDHOOD ONSET SCHIZOPHRENIA 12

movements of the face, tongue, limbs, and hands. Other side effects include weight gain,

restlessness, anxiety, irritability and drowsiness Bartlett 2014). Atypical antipsychotics are the

first medications used to treat COS and they have fewer side effects. Typical side effects are

weight gain, diabetes, high cholesterol, seizures, and rarely movement disorders (Bartlett 2014).

From the articles and studies, it is concluded that there are a variety of options that are available

for children with COS to be closely monitored and help not only the child but the families that

are also impacted by the disability.

Future schooling and jobs

When discussing the long term functioning of further education and vocational

opportunities of a child with COS, it is something that is not guaranteed. From the article of

Childhood Onset Schizophrenia: an overview, it states “A diagnosis of COS is predictive of

lower educational achievement, less financial and emotional independence, a low likelihood of

employment unless it was within a sheltered labor market or clinical settings, poor social

relationships and a persistent need to receive either outpatient or inpatient treatment” (Gonthier

& Lyon 2004).Childhood onset Schizophrenia has an overall tremendous impact in their

functioning in all aspects of their life. It has been researched that children with COS is worse

than those with adult schizophrenia for multiple reasons. One reason being that it interrupts a

child’s cognitive, social, educational, and adaptive skills (Gonthier & Lyon 2004). When

someone is diagnosed with adult schizophrenia they have learned throughout their lives the

typical and important life and social skills, but children with COS do not develop those skills

(Gonthier & Lyon 20014). Children with schizophrenia have severe impairments in social

relationships and it’s very difficult for them to live independently but children with other

psychotic disorders and bipolar disorder at a similar age are able to do so (Sood & Kattimani
Running head: THE IMPACT OF CHILDHOOD ONSET SCHIZOPHRENIA 13

2008). Taking into consideration of school at higher levels such as college and a career, COS

impedes a child’s ability to attend school, get an education and guiding them to get a job and

supports themselves independently (Gonthier & Lyon 2004). Majority of children with COS tend

to drop out of school before they graduate and work a job that does not require much skill or

effort or not having a job because the impact of COS stops them from holding a job (Gonthier &

Lyon 2004). This all leads to the child being dependent on their families and relatives to provide

the essentials of living (Gonthier & Lyon 2004). The severity of COS affects what the child can

and cannot do in the future such as simple as maintaining a job or living in their own place as an

adult. It effects how they live their daily lives and their future tremendously.

Impact on society

In society, those with schizophrenia are viewed as dangerous and crazy because of the

external symptoms that they show. How they act in public depicts how others seen them for their

disability but not how they actually are as a person. The presence of the symptoms likes

hallucinations, aggressive behavior, and psychotic episodes are seen as dangerous and crazy

behavior to most without being fully educated on the illness. The rarity of COS leaves society

without knowledge or research on the disability so those in the community have a negative look

at COS. COS is often misdiagnosed because those studying it often excludes children from

schizophrenia until after the age of 13 (Driver, Gogtay & Rapoport 2013). A lot of children

display some of the COS symptoms as a part of being young so the symptoms in children who

will have COS are often dismissed and viewed by society as crazy or a wild child instead.

Conclusion

To summarize everything up, COS immensely impacts the child’s family, diagnosis,

educational needs and services, treatment and medication, future living and vocation, and
Running head: THE IMPACT OF CHILDHOOD ONSET SCHIZOPHRENIA 14

society. A child diagnosed with COS hinders a child’s overall development and function in their

day to say life and their future. With the correct services, mental health professionals and

knowledge on COS, one is able to help create a functional life for a child who may have this

disability.
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References

Bartlett, J. (2014). Childhood-onset schizophrenia: What do we really know? Health Psychology

and Behavioral Medicine, 2(1), 735-747. doi:10.1080/21642850.2014.927738

Biswas, P. (2008). Neurobiology of Childhood-Onset Schizophrenia. Indian Association for

Child & Adolescent Mental Health, 4(3), 55-61. Retrieved 2008.

Driver, D. I., Gogtay, N., & Rapoport, J. L. (2013). Childhood Onset Schizophrenia and Early

Onset Schizophrenia Spectrum Disorders. Child and Adolescent Psychiatric Clinics of

North America, 22(4), 539-555. doi:10.1016/j.chc.2013.04.001

Gonthier, M., & Lyon, M. A. (2004). Childhood-onset schizophrenia: An overview. Psychology

in the Schools, 41(7), 803-811. doi:10.1002/pits.20013

Lattari, F., & Dragowski, E. A. (2011). Prenatal and Early Life Risk Factors of Schizophrenia

[Abstract]. The Newspaper of the National Association of School Psychologists, 39(8),

21-24. Retrieved June, 2011.

Sood, M., & Kattimani, S. (2008). Childhood Onset Schizophrenia: Clinical Features, Course,

and Outcome. Indian Association for Child & Adolescent Mental Health, 4(2), 28-37.