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Schizophrenia and other psychotic disorders are medical illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors – like drug use and stress.

Mental health professionals rarely diagnose young children with a psychotic disorder, rather the following diagnoses are typically ascribed to children exhibiting behavioral deviancies (aggression, manipulations, deceitful acts, etc.). Children and youth who experience psychosis often say “something is not quite right”, “I don’t belong”, “there is something wrong with my brain” or can’t tell if something is real or not real. Psychosis is an uncommon psychiatric illness in young children and is hard to recognize in its early phases. The appearance of symptoms of psychosis before age 12 is extremely rare (less than 1/6 as common as the adult-onset type), but studying these cases is important for understanding this disorder.

Children that later develop psychotic disorders or schizophrenia as adults (adult-onset), it is not uncommon for them to start experiencing early warning signs during puberty or adolescence. Being vigilant of key signs and or early warning signals of psychosis is crucial. Acting early can make the difference in children who later become adults having a happy and productive future and those that may later struggle with legal issues, deviant behaviors, and abuse/addictions.

Steven

Steven by all accounts was an adorable, funny, and articulate 5-year-old child. Although, Steven was being cared for by his grandparents he received unconditional love and support as if he were with his own parents. When I first met Steven I was really impressed by his use of verbiage (well exceeding his age) and maturity. As I began to ask Steven questions about school, living with his grandmother, and other general questions I began to feel his charming demeanor was superficial. He appeared to “struggle” with the cute kid he tried to present to others and his true feelings and personality, which seemed to include underlying rage and deceit. Sensing he could no longer maintain his superficial charm he began to describe thoughts of killing his grandmother. I began to question him regarding his reasons for wanting to harm his grandmothers when he stated “it”s not me, it”s the others living inside that don”t think we need her anymore”. Steven began to describe in elaborate detail how he planned to end the life of his grandmother.

At this point in our conversation I realized this was the only time I saw “true” excitement and happiness in his voice and eyes. When he was “masking” himself earlier in our conversation I noticed his smile never quite traveled to his eyes or voice, but discussing the harm he intended to inflict on his grandmother brought about pure “joy”. Steven was involuntarily hospitalized to protect him from self and others. Upon his release he received the following diagnoses; oppositional defiant disorder, conduct disorder, and ADHD.

Interestingly enough most professionals will not give a child a “hard diagnosis” such as schizophrenia or a psychotic disorder. So like many other children exhibiting the same behaviors and thoughts he will most likely remain the school system, suffering from “conduct disorder” & “ADHD”.

Can Steven’s grandparents provide the proper care and attention needed to address Steven’s unique needs or will their age create potential limitations and barriers for effective treatment?

Is it possible Steven will enjoy a happy adolescence or have a “normal” future?