Thursday, January 24, 2008

Childhood-Onset Schizophrenia Has High Rates of Comorbid Diagnoses Including Autism and ADHD

Research backs up what some parents of children with childhood-onset schizophrenia (COS) have observed. They have noticed that COS, which is characterized by an onset of psychosis prior to age thirteen, seems to have many overlapping symptoms of autistic-spectrum disorders, sensory issues and attentional problems.

An article in the Psychiatric Times [1] discusses some interesting statistics about this highly biological disorder.

The article says COS occurs in fewer than 1 in 10,000 children (I’ve read that it is about 1 in 40,000). Fewer than 1% of patients with schizophrenia receive this diagnosis in childhood. COS is 50 times less likely to occur than adolescent-onset schizophrenia.

There is a high rate of “soft neurologic signs” preceding the onset of COS. A “soft neurologic sign” is a neurological abnormality that is not associated with a specific neurologic disorder. An example of a “soft neurologic sign” would be something like abnormal eye tracking or excessive startle response.

The article goes on to say that COS also typically preceded by characteristics that overlap with features autism spectrum disorders (34%), as well as some other “disorders” in the areas of speech and/or language (60%), attention, and mood.

Not only that, but almost all COS kids (a whopping 99%) had a comorbid (co-existing) diagnosis.

Here are 4 frequent comorbid diagnosis listed in the article with the caveat that I feel uncomfortable with the diagnostic label of “Oppositional defiant disorder” being applied to a child with all these other issues.
  • Attention-deficit/hyperactivity disorder (ADHD): 84%,
  • Oppositional defiant disorder (ODD): 43%
  • Depression: 30%
  • Separation Anxiety Disorder: 25%
I want to make the comment that a child can have all this and never have it escalate to the point of having the diagnosis of COS. Yes, they may have a very difficult biology to live with, and yes, many children with COS have these other problems. But not all children with a multitude of other problems get chronic psychosis, delusions, catatonia, deteriorating cognition, etc.

The multitude of other problems, however, can add a tremendous amount of stress to the child and the entire family. Stress in chronic disorders tends to worsen outcomes, and one of the biological problems of children with COS may be an extreme oversensitivity to stressors.

The whole child, with all his/her collective issues must be addressed in an integrative manner, to the best of our ability. An integrative manner in some cases can require an almost super-human feat using creative thinking, and an enormous amount of time and financial resources. It requires the implementation of a “bio-psycho-social” model. The bio-psycho-social model of treatment is extremely important in any severe, chronic illness ranging from multiple sclerosis and diabetes to schizophrenia and cancer.

It is difficult for many families with these extremely high special needs children to find the social supports necessary to cope day-to-day, let alone provide the low-stress, yet intense interventions, the child needs to deal with their multiple areas of difficulty. Even many families with children with autism alone find themselves adrift, waiting years during a critical developmental window for an “opening” in a program.

In many ways, for parents of children with COS and multiple comorbid disorders, the “bio” part—i.e. treating their child's complex biology—can be the most daunting task since it is likely that the doctors do not even know all the complex biological problems underlying the multiple “disorders” the child is displaying. For instance, even the autism disorder which is often comorbid with the COS is itself a puzzle. The communication problem of autism must be addressed. It is often accompanied by autoimmune problems requiring special diets, and that must be addressed. Their child's innate sensitivities to sensory stimuli and stressors has to be addressed at the same time that the autism itself, along with any commonly associated allergy, nutritional, and intestinal problems are causing them stress.

[1]Childhood-Onset Schizophrenia: Diagnostic and Treatment Challenges Psychiatric Times 01 February 2007 Vol. 24 No. 2

Genetics and Epigenetics:

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