Diagnosing Schizophrenia In Teens

Medically reviewed by Majesty Purvis, LCMHC
Updated August 14, 2024by BetterHelp Editorial Team
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The teen years can be a difficult period of time for anyone. As adolescents age, they often go through periods of personal growth and setbacks. However, many teens also struggle with untreated mental health disorders, such as DSM V schizophrenia, while attempting to manage a stressful and emotional time during their young lives. Schizophrenia, in particular, can be difficult to diagnose in teenagers and young adults, especially in its early phases. Whether you are a parent, a teacher, or anyone else who regularly interacts with teenagers, it is important to educate yourself on the early warning signs of schizophrenia in a child’s behavior, as well as the later signs once the disorder has manifested. Recognizing the symptoms of early onset schizophrenia in the teenagers in your life can help them receive a diagnosis and find the right treatment before their symptoms grow out of control.

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Disordered thinking and behaving could signal schizophrenia

Schizophrenia: An overview of the mental illness

Schizophrenia is a serious mental illness that can cause distorted thinking and unusual behavior in patients. Many people with schizophrenia struggle to distinguish between what is real and what isn’t. As a result, their thoughts and views on the world are distorted or inaccurate, and they may exhibit bizarre behavior as a result. In short, many patients with schizophrenia have lost their concept of reality.

An individual can develop schizophrenia at any age; however, the average age of onset tends to be in mid to late twenties. It is extremely rare for children younger than age twelve to be diagnosed with schizophrenia. However, childhood onset schizophrenia is not impossible. 

Criteria for diagnosing schizophrenia in teens

Schizophrenia falls under the category of psychotic disorders in the Diagnostic and Statistical Manual (DSM-5). In order to receive an official diagnosis of schizophrenia, patients must present two or more symptoms from the following categories:

  • Delusions
  • Hallucinations
  • Negative symptoms
  • Disorganized speech
  • Disorganized behavior

It is important for healthcare providers to conduct a full examination in order to recognize schizophrenia, considering a person’s medical history and current symptoms. They may also conduct tests to rule out the presence of another medical condition.

Different types of schizophrenia

In the past, there were five main types of schizophrenia that physicians studied:

  • Paranoid: This type of schizophrenia is the one most often portrayed in films and TV shows, and is therefore the type most people associate with the disorder. Patients with paranoid schizophrenia often experience psychotic episodes consisting of delusions and hallucinations. Many of them have trouble distinguishing between what is real and what isn’t. It is often difficult for a patient with paranoid schizophrenia to live a normal life.

  • Catatonic: Patients with catatonic schizophrenia often exhibit unusual styles or levels of movement. A patient can either move erratically or very little. Catatonic states can last from minutes to days.

  • Undifferentiated: A patient with undifferentiated schizophrenia often exhibits behaviors that fit into two or more categories of schizophrenia. This type of schizophrenia is characterized by a decline in one’s ability to perform regular day-to-day activities. For instance, a person with undifferentiated schizophrenia may choose not to change their clothes or take a shower.

  • Residual: Residual schizophrenia is diagnosed in patients who had schizophrenia in the past but no longer present any symptoms of the disorder. Sometimes these symptoms vary in intensity over time while others present themselves in a more muted form.

  • Disorganized or hebephrenic: While this disorder is still recognized by the International Statistical Classification of Diseases and Related Health Problems, it is no longer considered an official subtype of schizophrenia. Patients with hebephrenic schizophrenia don’t experience hallucinations, but they do exhibit disorganized behavior and speech.

Nowadays, schizophrenia is viewed on a spectrum. Sometimes, physicians will use these subtypes to guide their overarching diagnosis of a patient.

Risk factors for developing schizophrenia

Researchers have not yet found a singular cause behind the development of schizophrenia in teenagers. Schizophrenia diagnosed in teens is less common than in young adulthood, but most medical scientists agree that schizophrenia is caused by a variety of genetic, psychological, and environmental factors.

The National Institute of Mental Health notes risk factors that can increase one’s likelihood of developing the condition, such as:

  • Having a family history of schizophrenia or other mental health conditions

  • Stressful or traumatic life events

  • Differences in brain chemistry and structure

  • Complications during pregnancy and birth

It has also been long believed that the dysregulation of certain brain chemicals, including neurotransmitters called dopamine, plays a role in certain symptoms of schizophrenia, including psychotic symptoms and cognitive symptoms.

Warning signs of schizophrenia in teens

Sometimes, a teen or child’s symptoms of schizophrenia appear without any warning. Other times, the disorder causes a gradual decline in a patient’s normal functioning. There are a variety of early symptoms that parents can look out for, such as:

  • Social withdrawal and trouble making or keeping friends

  • A deterioration in their child’s personal hygiene

  • Displaying hostility or paranoia

  • Having a flat, expressionless gaze

  • Depression

  • Expressing bizarre ideas or unusual thoughts

  • Difficulty concentrating

  • Laughing or crying at inappropriate times

  • Struggling to pick up on social cues, such as eye contact

  • Inability to display emotions such as joy or sadness

  • Suicidal thoughts

Suppose your child is displaying significant mood changes, behavior shifts, or other problems that raise concern. In that case, it’s essential to seek early treatment from a family doctor or your child’s pediatrician as soon as possible so that they can receive appropriate medical care. Early intervention for treating schizophrenia at the first sign of a psychotic episode could be key.

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Breaking down positive and negative symptoms of schizophrenia

Symptoms of schizophrenia are typically broken down into two categories — positive and negative symptoms. Positive symptoms are characterized by the presence of abnormal thinking and behavior, while negative symptoms refer to the absence of normal mental functioning.

Negative symptoms

Negative symptoms in patients with schizophrenia include:

  • Withdrawal or apathy: When it comes to making plans with friends or talking to others, people with schizophrenia sometimes withdraw.

  • Trouble with speech: Also known as alogia, this negative symptom of schizophrenia is characterized by the inability to show one’s feelings when talking, or even talk much at all during a conversation.

  • An inability to perform basic functions: Patients with schizophrenia may stop bathing or performing basic hygienic functions.

  • Affective flattening: This occurs when someone with schizophrenia talks in a flat tone that lacks emotion, or is unable to make normal facial expressions in response to things that happen around them.

  • Inability to stay on task or finish what they started: Some patients with schizophrenia struggle with their ability to follow through on tasks. Some doctors refer to this symptom as “avolition.”

Positive symptoms

Positive symptoms in schizophrenia patients include:

  • Hallucinations: Hallucinations occur when a patient sees, smells, hears, or feels things that no one else does. A patient might start hearing voices in their head or seeing loved ones who are dead. Tactile hallucinations, such as a patient feeling something crawl over their body, may also be observed in patients with schizophrenia.

  • Delusions: Delusions are false beliefs that are held even when there is evidence to the contrary. An example of a delusion is the belief that someone is attempting to manipulate one’s actions through their TV set, or that one is being targeted by the FBI. Patients might have a religious delusion where they think they are possessed by a demon or a grandiose delusion where they consider themselves to be a significant public figure.

  • Movement disorders: Some patients with schizophrenia appear jumpy while also staying in a catatonic state for extended periods of time. Other patients may continue to make the same movements over and over again.

  • Inability to organize one’s thoughts and speech: People with schizophrenia may have trouble organizing their thoughts or following what other people are telling them. Sometimes, their words come out jumbled when they try to speak. Other patients may appear zoned out or distracted when people try to talk to them.

Treatment for adolescent schizophrenia

Patients with schizophrenia often undergo lifelong treatment for their illness — even after their symptoms have subsided. A combination of medication and psychosocial or person-centered therapy is commonly used to treat patients and help them manage their condition. However, in some cases, patients may be required to enroll in inpatient treatment or be hospitalized.

Antipsychotic medications

Antipsychotic medications are the most commonly prescribed drugs for patients with schizophrenia. Many researchers believe that these antipsychotic drugs control a patient’s symptoms by affecting the dopamine and serotonin levels in their brain. Right now, there are first-generation and second-generation antipsychotics available on the market. Most physicians prefer prescribing second-generation antipsychotics as they pose a lower risk of causing serious side effects in patients.

Some mental health specialists prescribe antipsychotic medications along with a treatment plan for person-centered therapy for their patients. Always consult with a child psychiatrist or another professional trained in adolescent psychiatry before taking any medications.

Person-centered therapy and counseling

Psychosocial interventions such as client-centered therapy and mental health counseling have also proven to be effective for patients when their psychosis recedes. In addition to medication, physicians could encourage their patients to undergo:

  • One-on-one person-centered therapy: A client-centered therapist can use talk therapy to teach clients how to cope with stress, identify early signs of a relapse, and normalize their thought patterns. This treatment allows the patient to achieve personal growth as they continue with their therapy.

  • Family therapy: When it comes to therapy, a family-centered approach is often highly effective in helping your teen or child cope with their diagnosis.

  • Training in social skills: Social skills training focuses on teaching patients how to improve their communication skills and their ability to participate in social activities. This person-centered approach to therapy gives them the proper skills and training that can help them improve their social lives and relationships.

Many mental health counselors follow the main components of person-centered therapy when treating their clients. Person-centered therapy aims to treat people with compassion and without judgment. Many individuals prefer working with physicians who specialize in person-centered therapy for this reason.

Hospitalization

During severe crisis periods or relapses, a patient may need to undergo hospitalization for their symptoms. This step is taken to ensure their safety and minimize health risks. Patients might also undergo treatment such as person-centered therapy or electroconvulsive therapy (ECT) during their stay.

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Disordered thinking and behaving could signal schizophrenia

Electroconvulsive therapy (ECT)

Electroconvulsive therapy, or ECT, may be prescribed for patients who have not experienced success with drug therapy. During an ECT session, a medical specialist will give the patient general anesthesia as well as a drug to relax their muscles. They will then attach electrodes that send a controlled electric current to the patient’s scalp.

Common misconceptions about schizophrenia

There are a variety of stereotypes and misconceptions attached to patients with schizophrenia. Some people mistake schizophrenia with multiple personality disorder, which is now referred to as dissociative identity disorder, a mental illness that is quite rare. Inaccurate media depictions of schizophrenia may contribute to people confusing TV and movie portrayals of the disease, which often portray people with schizophrenia as violent and dangerous, with actual schizophrenia patients, who are more likely to be victims of violent crime than to perpetrate such crimes themselves. To remove the stigma around this mental health disorder, it is important that teens, parents, and teachers educate themselves on the myths that continue to follow it.

Mental health help for parents: Online therapy with BetterHelp

If your teen has recently been diagnosed with schizophrenia, it may take a toll on your mental health as their parent. In this case, it can be beneficial to lean on someone who can help, such as a therapist. You can connect with a professional on BetterHelp, an online counseling platform. You can even search for someone who has experience with teens and/or schizophrenia to ensure you’re receiving care tailored to your needs. 

As a parent, you may have a lot of different responsibilities. Since much of your time may be going toward finding your teen appropriate care, you may feel you don’t have enough time to go to therapy sessions. Online therapy allows you to receive care from the comfort of your home. You can talk to your therapist over the phone, through a video chat, or by utilizing an in-app messaging feature. 

The effectiveness of online therapy for managing mental health

Online therapy can be an effective tool for managing a variety of mental health disorders. One study assessed the efficacy of an internet-based intervention for people with psychosis. Researchers found that those with schizophrenia who took part in the study experienced significant improvements in social functioning. They also reported a decline in comorbid depressive symptoms, including their severity.

Takeaway

Although schizophrenia is rarely diagnosed in teenagers, it’s still important to look out for the common signs and symptoms associated with this serious disorder. If you have a child who has recently been diagnosed with schizophrenia, it can have a significant impact on your child’s life and yours. A team of professionals can help your child manage the symptoms associated with this disorder with a treatment plan customized to their needs. Likewise, an online therapist can work with you, as the parent, to cope with the difficult emotions that may arise from your teen’s diagnosis.
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