CHILDHOOD SCHIZOPHRENIA

Schizophrenia is more common in boys than in girls in childhood, and it might appear with

symptoms that resemble any of the other clinical disorders. It is therefore critical to consider

the possibility of schizophrenia regardless of the clinical presentation. The concept of a

primary underlying problem, on the other hand, is required if the diagnosis is not to be made

indiscriminately and incorrectly. This might be interpreted as a lack of or impairment in one's

sense of self-identity, as well as a doubt regarding what lies within and outside the self's

orbit. This is referred to as 'dysidentity' by Rabinovitch (Goldfarb, W., et; al 1956). The

severity of the symptoms will be determined by a number of criteria, including the child's

age, the complexity of the ego functions offered, and the restitutive methods used.

Before going any further, a brief note on the process of normal personality development

should be addressed. The infant is born with a variety of physiological systems but no

discernible ego. As the weeks pass and you become more conscious of tension and

discomfort, as well as satiation and pleasure, the process of separating yourself from the non-

self begins. It's possible that repeated episodes of tension discomfort, followed by tension

relief, led to this divide.

The infant's tactile and visual exploration of his body, as well as the 'double-feeling' caused

by a finger in the mouth or other forms of self-stimulation against the single sense of

touching the non-self, are all extremely important. It's likely that the mother is first viewed as

a component object, particularly the breast and face. For a long time after the infant becomes

aware of his mother, he has only a primitive sense of his own identity. Around the age of six

months, the mother-child bond enters a symbiotic phase.

It lasts until the child is between the ages of 12 and 36 months, during which time the child

becomes increasingly aware of his separation from others. There is no separate mental or

1
psychological representation of the child and his mother during the symbiotic phase. The pre-

symbiotic and post-symbiotic phases precede and follow this phase, with a gradual shift from

one to the other.

General Consideration of Etiology

Clinical illness in children must be viewed as the outcome of a complex interaction of

numerous elements, including neurophysiological, endocrine, interpersonal, and cultural

impacts. Different aspects have impressed different workers in this discipline, but there is

growing evidence that all of these characteristics must be considered (Ekstein, R. and

Wallerstein, J. 1954).

As early as one month of age, unusually uneven neurological and psychological development

has been used to predict schizophrenia vulnerability. In childhood schizophrenia, the

occurrence of both precocious and retarded development is common, and it can be a useful

diagnostic indicator at any age.

Bergman and Escalona noted in 1949 that certain children displayed extraordinary sensitivity

to numerous stimuli from an early age (Bergman, P. and Escalona; 1949). This was linked to

a lack of consistency in growth and, as a result, psychotic disarray. The regular biological or

neurophysiological barrier against stimuli was thought to be missing, obstructing normal and

orderly personality development. According to the authors, the mother plays a critical role in

safeguarding the new-born from excessive stimulation, whether they come from the

environment or are caused by physiological distress. It was also noted that ego functions

arose prematurely on occasion, maybe as a result of the overpowering inputs. Because such

functions were not integrated with the rest of the personality, they were unstable and prone to

breakdown.

2
In many cases, there is evidence of early developmental aberration in some children,

presumably due to a genetic base, as well as family pathology. In schizophrenia, Singer

discusses organization as a unifying idea. Impaired organization can be caused by a variety of

factors, including genetically determined biological inadequacies, organic deficiencies, and

negative psychological and social experiences. It's critical to remember this multi-

dimensional perspective, because assuming that hereditary or experiential variables are

mutually exclusive will result in an incomplete picture. It would be just as erroneous to

ignore the significance of biological impairments where they can be proved, just as it would

be to ignore the impact of a highly chaotic household (Bateson, G., et; al 1956).

Some clinical syndromes can now be investigated.

Early Infantile Autism

There are two main signs to be aware of. The first is excessive self-isolation, which begins in

childhood. At first glance, the infant may appear to be quite peaceful and docile. However,

observant parents may notice that the customary anticipatory posture prior to being picked up

does not occur, and the infant appears self-sufficient and unresponsive as early as four or five

months of age. A loss of self-identity manifests itself in a surprising insensitivity to pain and

an injured finger or limb watched with detached curiosity.

Adults and other children are ignored to the greatest extent possible, and normal eye contact

is avoided. If the adult persists, a brief and limited response may finally emerge. Excessive

attempts to compel contact result in significant anxiety and high motor activity, stressing the

need for people with autism to achieve some sense of security and control over their

environment (Bradley, C. and Bowen; 1941).

3
The urge to keep the environment of objects unchanged is the second key symptom. Even

minor alterations that most children would overlook cause the ordinarily calm and distant

child to become upset and overactive until the former arrangement is restored. Any new

pattern of behaviour is initially avoided, but once accepted, it is insisted on down to the

tiniest detail. Attempts to stop the intricate and exact process result in angry or panicked

outbursts. They have an intimate relationship with items, playing joyfully for long periods of

time, typically preferring spinning toys or other repetitive manipulations, in contrast to their

lack of involvement with other humans.

Disturbances in language are common. It does not develop or develops slowly in some

youngsters. Others appear to have the ability to accurately replicate rhymes and lists of

names, but not for the purpose of communication. The age at which communicative speech

begins is a crucial factor to consider. A history of normal early speech is frequently just

parental recollection of echolalic utterances, which can be immediate or delayed.

Words and phrases are literally repeated and cannot be recombined to create new

communications. The child indicates agreement with others by repeating their words rather

than saying "yes." The phenomenon of pronominal reversal occurs in the same way. He

repeats the personal pronouns as they were stated, referring to others as "I" and himself as

"you," for example, after hearing his mother say "I want you to come here."

Rocking, flapping upper-limb movements, leaping up and down, toe walking, and whirling

on a longitudinal axis are all common repetitive movements. The child is prone to bite

himself out of frustration and rage, and there may be moments of laughing and smiling for no

apparent reason. A handful of children appear to develop normally throughout the first

eighteen months or so of life, but subsequently exhibit extreme withdrawal and lack of

4
language, making them difficult to identify from autistic children who have had these features

from the start.

The parents are usually aloof and intellectual, with limited capacity for empathy or close

human relationships, and a mechanistic and obsessive attitude toward life. Kanner discovered

very no overt mental disease in the parents, in contrast to Bender's findings. These parental

views must have some etiological relevance, but given the severity of the condition, the

absence of such familial pathology at times, and the existence of nonpsychotic children in

households where one child is clearly autistic, some inherent element may be required.

Separating these is artificial because innate factors may only manifest in the presence of

specific environmental conditions. Eisenberg theorized that, similar to how certain children

are born with intellectual disabilities, these patients may be born with a social perception

deficit.

This is the earliest schizophrenia syndrome; the mother's relationship has never been

established, and self-identity has been severely harmed. The drive to preserve sameness could

be interpreted as a desperate attempt to preserve some semblance of identity. Changes in the

environment are likely to be seen as changes in the self if there is no persistent sense of self

that remains the same regardless of the surroundings. Whirling and repeated behaviour,

which provides a constant stream of stimuli, may also aid in maintaining a feeling of self.

Mental retardation is one of the possible diagnoses. The presence of clear capacity in some

confined areas, as well as the form of the speech impairment and the generally normal

development of the motor system, should be used to distinguish these diseases. Bender refers

to this group of children as "pseudo deficient" because of their superficial similarities. The

child's unresponsiveness may suggest deafness, but the syndrome's pathognomonic

characteristics will be present, and careful audio logical evaluation will rule out hearing loss.

5
Echolalia, pronominal reversal, literalness, and repetition of rhymes and groupings of words

will rule out congenital dysphasia. Dementia Infantilism or Heller's Disease caused by

cerebral lipoidosis is sometimes cited in the differential diagnosis, however it is extremely

uncommon. It begins at the age of two and is accompanied by a feeling of lethargy and a

sickly appearance. Dementia is progressing, and the psychotic symptoms are not present.

There appears to be little possibility of meaningful progress if communicative speech is not

achieved by the age of five years. If it has, almost half of the students are expected to make a

moderate social and academic transition. They continue to show a lack of social awareness,

as well as aloofness and obsessiveness, though these traits are less noticeable. They do not

appear to acquire hallucinations or delusions as a result, and those who progress gradually

emerge from their autistic shell. Others are encountered who, when referred by the school,

have apparent autistic traits but no history of early classical symptoms. It's unclear whether

these incidents never happened or were simply forgotten.

Symbiotic Infantile Psychosis

This syndrome, first identified by Margaret Mahler in 1952, is characterized by reasonably

normal early development; however the child may be described as being overly sensitive or

extraordinarily good on occasion. The early relationship with the mother looks to be

satisfactory, but a number of symptoms arise between the ages of two and a half and four.

The mother-child bond goes through a symbiotic period (in contrast to the child with early

infantile autism). It's difficult to create a solid internal psychological representation of

himself that is distinct from that of his mother and other family members (Rabinovitch, R. D.

1954).

The psychotic break is triggered by increasing motor maturation and increasing social

demands on the youngster to be independent. In an attempt to recover self-integration,

6
primitive or psychotic defence mechanisms are engaged due to the relatively undifferentiated

personality organization. Desperate clinging can be interpreted as a desperate attempt to re-

establish fusion and frenetic indiscriminate reality-testing by touching, tasting, licking, and

feeling the contours of anything in sight.

By doing so, the youngster may be attempting to retain contact and define the outside world

as distinct from himself. Whirling may be visible, appearing to be an attempt to achieve some

sense of identity, and a similar rationale may underpin imitation of others, which may

manifest itself in attire, hair style, or activities (Mahler, M. S., et; al. 1948). This isn't a true

identification, but rather a superficial mimicking of other people's characteristics. Typically,

this imitation must be accurate, develops quickly, and creates terror or wrath if interfered

with. This type of superficial identification can vary from person to person or include traits

from a variety of folks.

Withdrawal of attention and interest from the outer world, as well as the formation of

regressive interests and stereotyped concern with inner fantasy, secondary autism may occur

as a recitative mechanism. Sometimes the mother is interjected, or a fusion of key adult

figures happens, and autistic conversation occurs with them. The clinical picture may then

mimic the child with early infantile autism's autistic aloneness.

When these attempts at restitution fail, severe temper tantrum with violent motor discharge

and panic reactions occurs, with apparent projection of the child's overwhelming sentiments

to the outside environment. Speech might devolve into incoherence and then autism or it can

reveal a major misalignment of internal and external reality. Wetting and soiling, loss of

social interactions and inappropriate hobbies may all arise if previously established behaviour

patterns are lost.

7
The distinction between early infantile autism and symbiotic infantile psychosis is not always

easy to make retrospectively, and some infants who appear autistic at first may subsequently

develop symbiotic attachment, while symbiotic children may retreat into autism, as

previously indicated. It's possible that you're thinking, feeling, and acting in a deistic way.

These are "direct expressions of the basic process, the id, showing on the surface of behavior"

and can be seen in different syndromes. They are so dictated by inner meanings and

considerations, and to the ordinary spectator who does not grasp them, they appear irrational

and bizarre.

A neurotic regression, such as that which may occur with the birth of a sibling or following

separation, is the most common cause of differential diagnosis. Psychotic defense

mechanisms and disorientation of internal and external reality are not visible here, and the

general personality stays well integrated. In the schizophrenic child, severe disorganization is

frequently seen. Psychosis may appear to be triggered by physical separation from the

mother, such as being admitted to the hospital, or psychological separation, such as parental

depression or concern with a new sibling. As a result, the start of symptoms following a

stressful event should not be seen as ruling out the diagnosis. Separation anxiety and neurotic

over-attachment and dependency must also be separated. The core schizophrenia issues will

not be visible here, and the entire clinical picture will be intelligible based on the surrounding

circumstances.

Pseudoneurotic Scbizopbrenia

The neurotic defense mechanisms are dominant in this syndrome, which is most typically

seen during latency, although the underlying issues of self-identity, body image, and self-

boundaries are still present. With persistent anxiety, phobias, and anxiety episodes that aren't

explained by the child's environment, obsessive compulsive symptoms are typical. Strange

8
rituals and mannerisms may be detected, as well as persistent, repeating questioning.

Relationships are generally superficial, the youngster is shy and introverted, and reliance is

common. Excessive fantasy can lead to a blurred line between fantasy and reality, as well as

scary nightmares.

School failure as a result of inner preoccupations may be the presenting problem when the

sickness is subtle. Others may present with pan-anxiety, various phobias, psychosomatic

problems, sleeplessness, and fast withdrawal and disarray of cognition and speech, among

other symptoms. When a child has previously been diagnosed as schizophrenic, he or she

may transition from that state to one of pseudo neurotic schizophrenia. Subacute disease is

more common up until the tenth year, and no severe concerns about the child may have been

stated previously.

More sustained identification may be detected in place of the symbiotic child's compulsive

and superficial mirroring. For example, substantial distortions in sexual identification may be

shown. Other typical techniques include denial, separation, suppression, reaction creation,

and displacement. There could be an obsession with uncommon things about which a lot of

information has been gathered. There may be an increase in intense preoccupation with

schoolwork for a period of time, but this will be accompanied with social withdrawal.

With the appearance of massive psychotic processes and an equally abrupt return to neurotic

defenses, rapid alterations in functioning may occur. Such regressive adjustments may occur

in response to actual or perceived loss of relationships, which are necessary for maintaining

the unstable ego integration. When confronted with their own aggression, some children may

develop omnipotent illusions. Others are scared of their own rage and attack an environment

that they fear is about to destroy them.

9
It is clear that, in comparison to the previous disorders, a significant amount of ego growth

has occurred. As a result, the issues may be more clearly expressed, and a clear thought

disorder may be detected. Ask the child to make up a tale to elicit this response. It should be

highlighted that clear hallucinations and delusions occur seldom during childhood and are not

important in determining the diagnosis. The differential diagnosis includes anxiety disorders

and obsessive compulsive neurosis.

The schizophrenic component of the condition is more likely to be visible in boys than in

girls; the latter's shyness and modest withdrawal may have a certain allure, and these children

often appear emotionally elusive. Boys, on the other hand, are more prone to appear

disordered and immature during early latency. The diagnosis is made by looking for signs of

identity and body image issues, as well as a mismatch between reality and fantasy.

Incoherence or irrelevance will frequently appear in the discourse, and emotional expressions

or gestures may be inappropriate for the material. The widespread neurotic symptoms will not

appear to be adequately explained by the current life situation, and when the child's reports of

his experiences are obtained, they will be hazy and ill-defined. These kids are known for their

incessant inquiry and preoccupation. In many cases, projective tests and drawings can greatly

aid in the diagnosis.

Pseudo psychopathic Schizophrenia

The diagnosis of schizophrenia throughout adolescence is likely to be extremely difficult.

Bender's follow-up studies on children with schizophrenia have made a significant

contribution. Early in adolescence, the earlier symptoms may fade away and the child may

appear normal, though breakdown later in adolescence is common. Others have a

'pseudopsychopathic' pattern, which can be noticed during latency, according to Bender.

10
Diagnosis may be particularly difficult because these teenagers may be aware of their

condition and successfully conceal it.

Serious delinquency can manifest itself as impulsive behavior and a lack of empathy for

others. Although there may not be any outward signs of frank language or mental

abnormalities, psychological investigations and drawings may indicate the common identity

and body image issues, as well as paranoid ideation. In determining the severity of the acting

out, significant focus should be made on the early history and current life situation, as

diagnosis may be more difficult in adolescence than at any other age.

In the absence of apparent environmental factors, the start of acting out behaviour issue

throughout adolescence or latency should always raise the probability of schizophrenia,

especially if there have been no previous personality difficulties of this type. In the character-

disordered youngster whose disturbance is primarily owing to disturbed interpersonal

contextual influences, evidence of previous issues is usually obtained. Some of these

teenagers would have previously showed clear symptoms of one of the other syndromes

listed, and being aware of the shifting clinical syndromes of childhood schizophrenia can aid

in diagnosis. However, there are situations when no definitive history of a previous aberration

can be established.

The need of thorough observation of schizophrenia children's speech at all ages should be

discussed. Words with private meanings, omissions, or neologisms may appear in the

material, as well as incoherence or irrelevancy of idea. The rhythm, loudness, tone, and stress

of words, as well as the accompanying facial and bodily reactions, should all be considered.

For example, there is frequently insufficient stress or the incorrect words are stressed.

Intonation, or the rise and fall in vocal tone, is frequently aberrant. A monotonous flat

11
delivery with a lack of suitable emotional expression is one of the most typical defects.

Words may be followed by strange behaviors or awkward smiling.

When perceptual difficulties are present, chronic brain syndrome is likely to produce

diagnostic issues. Drawings may disclose body image issues, but they will not reveal internal

and external reality confusion or a loss of self-identity. Normal relational capability is intact,

albeit it may be obscured by severe hyperactivity, and the schizophrenia child's typical speech

and cognitive problems are absent. The results of subtests on the W.I.S.C. and other

intelligence scales will also help distinguish these situations. Of However, the existence of

organic indications does not rule out a diagnosis of schizophrenia, as organic causes may play

a role in the psychosis.

Summary

Schizophrenia can be thought of as an organizational flaw caused by a variety of genetic,

biological, intrafamilial, and social factors. A variety of clinical syndromes are discussed, as

well as their differential diagnoses. As the child grows older, the clinical picture will likely

change. Laboratory examinations, such as EEG, are ineffective. The following obstacles are

most likely to be encountered when a schizophrenic kid is examined, regardless of age:

1. A lack of self-awareness, a distorted body image, and a lack of defined ego boundaries.

This may be obvious or determined through the use of projective methods or drawings.

These issues are the source of the problem and are crucial to the diagnosis.

2. Dereistic feelings, thoughts, and actions.

3. The presence of both impaired and precocious psychological functioning at the same

time.

4. The disappearance of regular interests or the emergence of strange or regressive ones.

5. Disturbances in content, rhythm, intonation, pitch, emphasis, or volume in the language.

12
6. Poor social relationships, with a reduced ability to empathize and a proclivity to

withdraw. Normal relationships require certainty about one's own identity and what is

outside and inside the ego.

Awareness of the developing clinical symptoms of childhood schizophrenia, as well as a

thorough assessment for basic identity issues and the difference of internal and exterior

reality, will aid in diagnosis.

REFERENCES

1. Bateson, G., Jackson, D. D., Haley, J. and Weakland, J. H.: Toward a Theory of

Schizophrenia. Behav. Sci., 1: 251-264, 1956.

2. Bender, L.: Childhood Schizophrenia. Psychiat. Quart. 27: 663- 681, 1953.

3. Bender, L.: Schizophrenia in Childhood: Its Recognition, Description and Treatment.

Amer. J. Orthopsychiat. 26: 499-506, 1956.

4. Bender, L.: The Concept of Pseudo psychopathic Shizophrenia in Adolescence. Amer. J.

Orthopsychiat., 29: 491-509, 1959.

5. Bergman, P. and Escalona, S. K.: Unusual Sensitivities in Very Young Children.

Psyohoanal. Stud. Child 3-4: 333-352, 1949.

6. Bradley, C. and Bowen, M.: Behaviour Characteristics of Schizophrenic Children.

Psychiat, Quart. 15: 296-315, 1941.

7. Eisenberg, L.: The Autistic Child in Adolescence. Amer. J. Psychiat. 112: 607-612, 1956.

8. Eisenberg, L.: The Course of Childhood Schizophrenia. Arch. Neurol. & Psychiat. 78: 69-

83, 1957.

9. Ekstein, R. and Wallerstein, J.: Observations on the Psychology of Borderline and

Psychotic Children. Psychoanal. Stud. Child 9: 344-369, 1954.

13
10. Fish, B., Shapiro, T., Halpern, F., and Wile, R.: The Prediction of Schizophrenia in

Infancy: III A Ten Year Follow-up Report of Neurological and Psychological

Development. Amer. J. Psychiat. 121: 768-775, 1965.

11. Goldfarb, W., Braunstein, P., and Lorge, I.: A Study of Speech Patterns in a Group of

Schizophrenic Children. Amer. J. Orthopsychiat. 26: 544-555, 1956.

12. Greenacre, P.: On Focal Symbiosis. In Dynamic Psycbopathology in Childhood. Ed.

jessnor, L. and Pavenstedr, E.: Grune and Stratton, N.Y. and London, 1959.

13. Hoffer, W.: Mouth, Hand, and Ego-Integration. Psychoanal. Stud. Child 3-4: 49-56, 1949.

14. Kanner, L.: Autistic Disturbances of Affective Contact. Nerv. Child 2: 217-250, 1943.

15. Lidz, T.: Schizophrenia and the Family. Psychiatry. 21:21-27, 1958.

16. Mahler, M. S.: On Child Psychosis and Schizophrenia; Autistic and Symbiotic Infantile

Psychosis. Psychoanal. Stud, Child 7: 286-305, 1952.

17. Mahler, M. S., Ross, J. R., and DeFries, Z.: Clinical Studies in Benign and Malignant

Cases of Ohildhood Psychosis.. Amer. J. Orthopsychiat. 19: 295-305, 1948.

18. Potter, H. W.: Schizophrenia in Children. Amer. J. Psychiat, 89: 1253-70, 1933.

19. Rabinovitch, R. D.: In Neurology and’ Psychiatry in Childhood, P: 468, Baltimore,The

Williams and Wilkins Co. 1954.

20. Singer, R. D.: Organization as a Unifying Concept in Schizophrenia. Arch. Gen. Psychiat.

2: 61-74, 1960

14