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            Jani, a five-year-old girl, physically attacked her infant brother because “Wednesday”, a rat, told her to hit him and it would not stop biting her until she complies. Wednesday was only one of Jani’s over a hundred hallucinations from her imaginary world she calls Calalini, according to an article from Oprah in 2009. Jani’s friend from the University of California Los Angeles (UCLA) psychiatric ward, Becca Stancil, has also been having hallucinations for years. She has been seeing terrifying creatures like wolves as indicated by Stohler (2011), and particularly, a six-foot tall man who follows her everywhere as documented by Weinraub (2010). Another child, an eight-year-old Morgan Frank, wanted to kill their family dogs and ran after them with a knife, Frank reported in 2015.  Jani, Becca, and Morgan have all been suffering from a severe mental disorder – schizophrenia.  According to Nordqvist (2017), schizophrenia manifests more commonly in early adulthood, from ages 16 to 30. However, Gochman and colleagues (2011) posited that in extremely rare cases, it can also be diagnosed during childhood with a prevalence rate of 1 in 40,000. Diagnosed prior to the age of 13, child schizophrenia, as stated by Bartlett (2014), is marked by the deterioration of affective, behavioral, and cognitive processes which significantly disrupts the child’s overall functioning and development.

            Schizophrenia, in both children and adults, has two broad categories of symptoms – positive symptoms and negative symptoms; positive symptoms include delusions, hallucinations, disorganized speech, thinking, and behavior; whereas, negative symptoms include blunt or flat affect, avolition (the lack of motivation), alogia (diminished speech patterns), asociality (the loss of interest in social interactions), and anhedonia (the inability to experience pleasure), as indicated in the 5th revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) by the American Psychiatric Association (2013). The main difference between child schizophrenia and adult schizophrenia is its clinical presentation as stated by MacGill (2017); he asserted that the initial phase, more aptly referred to as the prodromal phase, is particularly more striking and evident in children than in adults. During this phase, which may start at the first months to years of life, a child may exhibit some of the earliest signs which could lead up to psychotic symptoms. According to an article from MayoClinic.org (2016), these may include language delays, social deficits, unusual crawling, late walking, and other abnormal motor behaviors — rocking, posturing, or arm flapping. Visual and auditory hallucinations are very common and therefore should be distinguished from normal imaginative play as explained in the DSM–V (2013). Delusions are simpler and are usually related to childhood themes according to Cobert (2010). Other indications of childhood schizophrenia may include decline in academic performance, social withdrawal, decreased ability to perform self-care and daily activities, bizarre hygiene and eating behaviors, lethargy, hostility, and aggression, Masi, Mucci, & Pari reported in 2006. All these symptoms and features may appear to be very specific; however, as Bartlett (2014) stated, diagnosis remains difficult and challenging for mental health professionals, as most of these symptoms overlap with other disorders (autism spectrum disorder, attention deficit hyperactivity disorder, etc.).

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            Thus far, there has been no definite etiology found for the development of schizophrenia in children according to Bartlett (2014); she stated that most theories suggest biological and environmental factors for the causation of the disorder. Some experts believe that it could be explained through genetics, Coghill ascertained in 2009. Svrakic and associates (2013) supposed that a child is genetically predisposed to developing schizophrenia with 10-15% risk if either of the parents is schizophrenic, and with 35-46% risk if both parents are schizophrenic. According to an article from ChildrensHospital.org (n.d.), other researchers believe that child schizophrenia may be linked to environmental specifically, prenatal factors that include exposure to harmful chemicals or viruses, poor nutrition from unhealthy diet, drug or alcohol use, and extreme stress. Also, a study conducted by Arseneault and colleagues (2011) revealed that childhood trauma was significantly associated with childhood psychotic symptoms.

            Similar with the etiology, there has also been no known cure for childhood-onset schizophrenia to date as indicated by Cobert (2010). Khurana and associates (2007) indicated that available treatments focus on managing and mitigating the positive and negative symptoms of the disorder. Bartlett (2014) stated that antipsychotic medications are utilized as the first-line of treatment; specifically, atypical antipsychotics, which include risperidone, olanzapine, and clozapine, as these have been found to be more effective and bring about lesser side effects than the typical antipsychotics. According to Mayo Foundation for Medical Education and Research, (2013), side effects may include high cholesterol, weight gain, diabetes, and seizures. Another form of treatment for child schizophrenia is psychotherapy which generally targets social, interpersonal, and developmental problems; and may include individual therapy, family therapy, and social skills training according to an article from MayoClinic.org. Khurana and associates (2007) explicated that clinical studies support the combination of these two forms of treatment in addressing childhood-onset schizophrenia. Moreover, changes in lifestyle such as minimizing stress and taking fish oils have also been considered helpful as stated in an article by MentalHealthAmerica.net (n.d.).

            Generally, the long-term functioning of patients with childhood-onset schizophrenia has been found to be worse, compared to those with adult-onset schizophrenia and even those with other psychotic disorders, as contended by Clemmensen, Vernal, and Steinhausen (2012). According to Loth and Dunn (2014), schizophrenic children may experience few close relationships, less academic achievement, unemployment, and less capacity to live independently in their adulthood. They are also at a high risk of death from suicide with a mortality rate of 5-11% according to longitudinal studies. Fortunately, with early detection and proper treatment, they may have the opportunity to study in college, work, and build families as adults, as stated in an article from ChildrensHospital.org (n.d.). Huey and associates (2007) indicated that support and care from the family of a schizophrenic child is also highly critical in the treatment process. This is very much evident in the case of Jani Schofield, the schizophrenic child who had hallucinations of animals telling her to hurt her younger brother. Schofield Productions (2015) has been chronicling Jani’s daily life; showing the activities of the now fifteen-year-old girl, attending school, playing sports, and even doing volunteer work at a horse ranch. Albeit a bit overweight and having some eye problems which could be side effects from the medications she has been taking, Jani has been getting better and trying to live life as normally as she can.

            Childhood-onset schizophrenia is indeed a devastating and highly debilitating disorder affecting children under the age of 13 (Bartlett, 2014). It is characterized primarily by delusions, hallucinations, disorganized thinking, speech, and behavior, as well as the lack of appropriate affect (APA, 2013) which severely and adversely affects a growing child. Due to its rare occurrence (1 in 40,000) (Gochman et al., 2011), childhood-onset schizophrenia remains understudied and poorly understood; and as such, there is still no definite cause and cure found to date (Cobert, 2010).  Experts attribute its etiology to biological and environmental factors; whereas, treatment approaches include medications (Bartlett, 2014) and psychotherapy (Mayoclinic.org). The outlook for the schizophrenic child is regarded as insidious with a high risk of mortality from suicide (Loth & Dunn, 2014). Fortunately, with early detection and proper treatment, schizophrenic children may grow up to be functioning adults (Childrenshospital.org). 

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