Child Psychopathology

Joan Rosenbaum Asarnow

Robert F. Asarnow

This chapter focuses on schizophrenia with childhood onset. Schizophrenia is a psychotic disorder, or group of disorders, characterized by the presence of one or more of a series of key symptoms: bizarre delusions, mood-incongruent hallucinations, thought disorder, grossly disorganized or catatonic behavior, and flat or grossly inappropriate affect during an active phase of the illness, as well as significant impairment and/or deterioration. Consider, for example, the following description of a young girl with schizophrenia.

Mary had always been a very shy child. She would
become mute at times, had severe difficulties mak-
ing friends, was frequently oppositional, and had
occasional enuresis. By the time she reached roughly
10 years of age, Mary showed academic difficulties
in addition to continuing social isolation. She became
depressed, felt that the devil was trying to make her
do bad things, believed that her teacher was trying
to hurt her, and became preoccupied with germs.
Her behavior became increasingly disorganized; she
talked of killing herself, appeared disheveled, and
ran in front of a moving car in an apparent suicide
attempt.

This episode precipitated an inpatient psychiatric
evaluation, during which Mary continued to show
bizarre behavior. She lapsed into periods of intense
anxiety and had one episode of uncontrolled animal-
like screaming. At other times she would stare
blankly into space and was frequently mute. Al-
though Mary's functioning improved during hospi-
talization and she returned to her family, through-
out her childhood and adolescent years she was
tormented by fears, hallucinations, the belief that
others were out to get her, and occasional bouts of
depression often accompanied by suicide attempts.
She continued to be socially isolated and withdrawn,
and to perform poorly at school. At age 17 (after
several brief inpatient hospitalizations), Mary was
admitted to a state hospital, where she remained
until the age of 19. During this period her affect was
increasingly flat, and her psychotic symptoms per-
sisted. One week after discharge from the hospital,
Mary went into her room, locked the door, and
overdosed on her medications. She was found dead
the next morning.

This girl's story underscores several features of early-onset schizophrenia. First, schizophrenia does occur in children, although most cases of schizophrenia have their onsets in late adolescence or early adulthood. Second, children with schizophrenia frequently continue to struggle with schizophrenic symptoms during adolescence and adulthood. Third, because childhood is a period when crucial psychosocial competencies are developing, early-onset schizophrenia has a powerful impact on developing academic and social competence. Finally, Mary's battle with schizophrenia underscores the pain and morbidity associated with this illness.

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