Treating Children and Teens Diagnosed with Schizophrenia

In this article, I will focus on treatment considerations regarding the diagnosis of schizophrenia in children and adolescents. This article on assessment of schizophrenia concerns the nature of psychological tests that evaluate the prevalence of schizophrenic symptoms in an individual child or adolescent. These specific tests, which rely on interview and self-report, are described as potentially useful in formulating a diagnosis of schizophrenia by a qualified clinician.

There are several treatment strategies for helping one’s child or adolescent cope with a diagnosis of schizophrenia. These avenues to treatment may include psychiatric medication, individual therapy, behavioral intervention, such as a token economy, and family therapy.

Medications for psychotic illnesses have revolutionized the treatment for schizophrenia and psychotic disorders of all types. While some parents may be reluctant to medicate their child for very good reasons, medication nevertheless may be an extremely important piece of a configuration of treatment strategies. The fact is that medication has evolved since the times when medication was viewed by some as “psychiatric straight jacket”. 

While past antipsychotics have been termed “major sedatives”, newer, atypical antipsychotics increase cognitive organization, and, in conjunction with other medications, such as appropriately prescribed antidepressant and mood stabilizing medication, these medications may help the child or adolescent. For this reason, the use of medication should be considered as treatment for children and adolescents who manifest schizophrenic symptoms. It might make them feel better, and it might increase their subjective well-being.

While medication seems to be the treatment of choice for psychotic disorders, other interventions bear scrutiny. Sometimes clinicians underestimate the value of psychotherapy in treating schizophrenia. The reality exists that even the most well-intended parents will have difficulty dealing with their schizophrenic child. However, if a child therapist treats a child, she may have more success in diminishing the overt symptoms of schizophrenia in a child, precisely because she is not one of the child’s parents.

A therapist can be warm and detached, simultaneously. While these two characteristics may seem dichotomous, they can be combined by a therapist so that she does not forfeit her objectivity, but nevertheless nurtures the child. The element of emotional detachment in a therapist is crucial for both parties. One can see that parents and their youths may lack detachment from each other to an extent that creates negative feelings in both the parents and their children. This is why bringing the child in for individual therapy may be crucial to the child’s or the adolescent’s well-being. If nothing else, the therapist might serve as a trusted and caring adult or role model. This type of relationship clearly will benefit the child or adolescent who becomes involved in individual therapy. It should be noted that therapy of any modality, relational, behavioral or eco-systemic, will likely benefit the child or adolescent.

One intervention that relies on the principles of behaviorism is the token economy. A token economy can be described as a system of positive and negative reinforcement by which a child may earn and lose privileges as a result of his behavior. This means that the child essentially enters into a contract with the facilitator of the token economy, who would likely be his parent. The contract between the child and his parent would specify what the child may gain or lose privileges, contingent on whether he did his chores or his homework, as examples. As such, the child may earn one hour of playing video games, as an example, in return for completing his homework.

If the rewards are meaningful to the child, and the system of the token economy seems fair to the child, the token economy will work to change maladaptive behavior. Note, also, that the rules of the token economy may be determined before it is implemented, and the child’s or adolescent’s feelings, as well as his parents’ feelings, should not enter into what and when rewards will be forthcoming. This allows for some detachment, on the part of both the child and the parent, which will assist the process entailed by the token economy, overall.

Family therapy is efficacious in treating the schizophrenic child or adolescent for several reasons. Clearly, by means of family therapy, the schizophrenic child or adolescent will feel supported by her parents in terms of the concern that they demonstrate in gathering together in an effort to help the client, who is the identified patient. Moreover, the family can be guided and monitored by the therapist in such a way that the family members can express their feelings about the issues surrounding the impact of the diagnosis on the family without angering other family members. Lastly, the therapist will be able to normalize the experience of family members, thus clarifying their expectations about living with the diagnosis of the child or adolescent.

Overwhelmingly, however, it is the support of the schizophrenic individual by her family members as evidenced by the choice to engage in family therapy that will have the greatest positive therapeutic effect on that individual. He will know that his family cares about him.

The diagnosis of schizophrenia regarding a child or adolescent is incredibly difficult for the entire family to endure. However, this may be the case largely because the parents do not know how to negotiate the process of beginning with observation of odd behavior in their child, then seeking an assessment for a schizophrenic diagnosis, and culminating in treatment for all family members to help them deal with the situation.

No one expects to have a schizophrenic child. The anger, sadness and grief associated with this diagnosis are extreme. However, parents should note that their child may feel this anger and sadness and grief more poignantly than they do. The odd, confusing and inappropriate behavior of their child or adolescent may be compounded simply because he has received this diagnosis, and he is likely to be treated differently by family members as a result of this diagnosis.

The appropriate behavior of the schizophrenic individual’s family members is crucial to dealing well with this diagnosis. Perhaps the discussion by this writer has in some way illuminated the path for the families of schizophrenic children and adolescents so that they will be able to cope effectively with this diagnosis that need not equate with tragedy.

Image via Nikola Solev / Shutterstock.

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.
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