If a child is socially withdrawn and does not make eye contact when communicating with others, is the diagnosis schizophrenia or autism (Dvir & Frazier, 2011)? The two overlap because in most cases of schizophrenia, patients are often diagnosed during late adolescence to early thirties (WebMD, 2016). Therefore, a diagnosis earlier in age is rare and often becomes misdiagnosed. According to the DSM-5, schizophrenic symptoms are categorized as either positive or negative and include delusions, hallucinations, disorganized speech, and catatonia, which is an irregularity in motor movement (APA, 2013). Although this disorder is commonly diagnosed in young adults during late adolescence, there have been rare cases of schizophrenia in youth, which are those under the age of eighteen. While the likelihood of typical schizophrenia is 1% of people globally, the likelihood of childhood schizophrenia is 1 in 40,000 (Gochman, Miller, & Rapoport, 2011).
When a child is being evaluated by a psychologist, most often their early onset schizophrenia can be misdiagnosed as autism spectrum disorder, due to their overlap in social dysfunction symptoms (University of Texas at Dallas, 2012). In the first two editions of the DSM (APA, 1952 & 1968), autism spectrum disorder was a subcategory under schizophrenia . It was considered, “schizophrenia, childhood type” (Barlati, Deste, Ariu, & Vita, 2016). It was not until the publication of the third DSM that autism became its own category called “Infantile Autism”, which eventually was given the more expressive term, “Autism Disorder” (Project Autism, n.d).
According to a case study done by Shilpa A. Telgote, Shreyas Shrikant Pendharkar, Amol D. Kelkar and Sachin Bhojane, early onset schizophrenia, as opposed to typical schizophrenia is diagnosed prior to the age of eighteen. A diagnosis earlier than thirteen years of age is considered very early onset schizophrenia, or VEOS. In this case study, it is mentioned that the likelihood of a very early onset diagnosis increases if the patient has a family history of schizophrenia, or any schizophrenic spectrum disorders. Those diagnosed early on exhibit the same symptoms as those who are diagnosed later in life, however they tend to show signs of irregularities in language development, as well as motor and social development (Telgote, Shrikant, Pendharkar, Kelkar, & Bhojane, 2017).
Oprah Winfrey interviewed with Dr. Judith Rapoport, the chief of the National Institute of Mental Health’s child psychiatry (Winfrey, 2009). Rapoport gives us a little more knowledge of early onset of schizophrenia. When Oprah asked the question, “How are childhood schizophrenia symptoms different than those associated with adult schizophrenics?”, her response states that adult schizophrenia is more of sudden, whereas in childhood schizophrenia, it’s gradual. In the case study referenced before, their patient’s symptoms were also showing up gradually at the age of nine (Telgote, Shrikant, Pendharkar, Kelkar, & Bhojane, 2017). Rapoport also talks about the commonality for children to have an imaginary friend. In fact, having an imaginary friend shows that the child is functioning very well, but in the case of children suffering from schizophrenia, it becomes more of a disturbance in the home (Winfrey, 2009).
Overall, early onset schizophrenia, although rare, is possible and often mistook for autism. While the symptoms may overlap, they are considered two separate disorders in the DSM-5. It is vital that we spread awareness about this common misdiagnosis to allow children to receive the proper diagnosis so they can be treated in the best way possible.
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