Dr. Judith Rapoport
Schizophrenia is a chronic, disabling brain disorder. While it typically affects men and women in their 20s and 30s, children can also develop this mental illness. Young or old, schizophrenics often hear voices and misinterpret the world around them.

Dr. Judith Rapoport, chief of the National Institute of Mental Health's child psychiatry branch, answers questions about childhood schizophrenia.
Q: How often are children diagnosed with schizophrenia?

Dr. Judith Rapoport: We've been studying childhood onset schizophrenia for the past 20 years, it is very rare. It's only 1/300th of 1 percent of the rate for the adults.

So we know that it's really very rare, but we think that it's really important because when the diseases start in childhood, often they have much stronger genetic effects. You can understand the biology because it's a stronger effect.

Q: What causes schizophrenia?

JR: There is a lot of information on risks for schizophrenia, generally, that includes children and adults. It's a bewildering array, suggesting that first of all, it's in part genetic, but only part. Identical twins are only both ill in a little less than half the cases, and since they have the same genes, that means you need something else in order to have the disorder.

Then, in addition to that, there are studies of pregnancy that suggest that if you have some problems like infections early in pregnancy, you may have a higher rate. ... There are other studies that show that children with certain developmental delays and speech and language [problems] have a higher risk for later, when they get to be adults, having schizophrenia.

And there are other studies that suggest living in cities as opposed to the country increase your risk. Part of the problem is that there's been a lot of very excellent research, and it's harder to know how to put all this together.
Q: How are childhood schizophrenia symptoms different than those associated with adult schizophrenics?

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.
Q: Why do some children with schizophrenia become depressed?

JR: I think this is a very taxing, a very stressful condition for the child to have. The children are aware that they've lost many of their abilities. Some of the children, a fraction of ours for example, were students. It's not just that the voices interfere, but there's something about the process that does make it harder for them to think and concentrate.

The children are very sad. They see that they don't have friends, and that they're different and not all of them, but many of them, are actually very aware of what they are losing by having this disorder.

Q: What's the long-term prognosis for children with this mental illness?

JR: It's a chronic disease, and the prognosis depends on several things, but very few really ever reach a point that no one knows they have schizophrenia. We do have maybe a fifth of our sample who, on medication, function almost completely normally. But some degree of impairment remains, and the degree of support that they have from their school, their family, their community, makes a huge difference on what the rest of their life is going to be like.

Q: What warning signs can parents look for in children?

JR: If a child comes up with ideas and beliefs and behaviors that are significantly interfering with his or her life, I think you do want to get psychiatric or psychological consultation. If whatever they tell you doesn't help a few months later, you probably need to get another one.

These [children] tend to be violent, and they tend to be very bizarre. For example, a child who insists that their parents are not their real parents ... that's not a healthy thing. And [if they're] very concerned and very suspicious of their parents, that's more likely to be a paranoid problem.

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