R: In the beginning in children, it usually doesn't start suddenly. In adults, there known [as] episodes, and [they] can occur quite suddenly. But that almost never happens with our child cases. Over a period of months, the children may start to lose interest in friends or activities, and they may start to have some very strange behaviors like running out of the house in the middle of the night undressed or start to say very strange things to their parents about not trusting them, talk about being poisoned. It's often strange and quite hard to explain.
Q: How are imaginary friends different for children with schizophrenia?
JR: Imaginary playmates are not rare. They typically occur in children who are functioning very well. They don't cause a disturbance at home. They're often quite pleasant, and the child finds this something entertaining. ... But [with schizophrenics] these voices are usually quite strange. The child will be looking often up, say at the ceiling, and talking and laughing in a way that seems quite inappropriate.
A lot of the time, the children will say that they have voices that are telling them very unpleasant things. Voices tend to be there almost all the time, and if you are living with a child, the families often report that they can hear them talking all the time. It just doesn't have the same feel, and often the voices are telling them very bad things—talking about death, talking about things that a child should do or that might be done to them.