Child and adolescent (early onset) schizophrenia: a review in light of DSM-III-R.
Early-onset schizophrenia is adult schizophrenia that starts sooner, so treat the behavior, not just the label.
01Research in Context
What this study did
Blough (1992) looked at every paper on kids and teens with schizophrenia. The goal was to see if early-onset cases are a different illness or just the adult form starting sooner.
The review used DSM-III-R rules. It kept the focus on true schizophrenia, not just any psychosis.
What they found
The paper says early-onset schizophrenia is the same disease as in adults. It shows up earlier, but the core signs do not change.
Because of this, the author argues we do not need a special child category in the manual.
How this fits with other research
Castañe et al. (1993) followed 39 youth with first-episode psychosis. Labels shifted a lot over time. This supports the review’s warning that early diagnoses can be shaky.
Pakenham et al. (2004) studied kids with ID and suspected psychosis. Most lost the psychosis tag after a second look. Together, these papers show that careful re-assessment is vital before settling on schizophrenia.
Ando et al. (1979) remind us to scan the brain first. Their patient looked schizophrenic until a CT scan revealed Davidoff-Dyke-Masson syndrome. Organic causes must be ruled out before you blame behavior.
Why it matters
For BCBAs, the key point is caution. A teen who shows odd speech, flat affect, or social withdrawal may get a schizophrenia label. Keep tracking data, but stay open to updates. Push for full medical work-ups and re-evaluation. Your behavior program can stay stable while the team refines the diagnosis.
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02At a glance
03Original abstract
Early onset schizophrenia (EOS) is defined as that beginning in childhood or adolescence (under 16 or 17). Studies of EOS are infrequent, and comparative adult figures not always available, but tentative conclusions may be drawn. EOS is more common in males; symptomatology is often undifferentiated; frequencies of homotypic family disorder, premorbid schizotypal personality, and neurodevelopmental abnormalities high; outcome poor but only slightly worse than in adults; response to psychotropic drug treatment probably similar though not properly tested; and confusion with psychotic bipolar disorder particularly common. Onset before language is developed presents special diagnostic difficulties. There are a few reports of autistic children developing schizophrenia but this requires replication. Differences from adult schizophrenia are more marked when onset is in childhood than in adolescence but all are quantitative rather than qualitative suggesting that the disorders are the same and that there should be no separate category for children or adolescents.
Journal of autism and developmental disorders, 1992 · doi:10.1007/BF01046330