How Should Childhood Schizophrenia Be Treated?

Linda Caterino, in her review of Identifying, Assessing, and Treating Early Onset Schizophrenia at School, cites Asarnow, Thompson, and McGrath (2004), who indicated that there are "no published randomized controlled trials evaluating psychosocial treatments for schizophrenia in youth" (p. 184). She goes on to note that the authors of Identifying, Assessing, and Treating Early Onset Schizophrenia at School did not emphasize this point enough and recommended psychosocial treatments that have not been validated on children. Although the reviewer does not raise this issue in the context of this book, some have questioned the strength of the evidence base for pharmacologic treatment of early onset childhood schizophrenia.

Given the Cochrane Review (Kennedy, Kumar, & Datta, 2007), are Li, Pearrow, and Jimerson cautious enough about the evidence-base for pharmacologic interventions? Is this an issue of equal concern to that raised by the reviewer when referring to psychosocial treatments?

Reference

Kennedy, E., Kumar, A., & Datta, S. S. (2007). Antipsychotic medication for childhood-onset schizophrenia. Cochrane Database of Systematic Reviews 2007 (Issue 3, Art. No. CD004027). Retrieved April 19, 2011, from http://www2.cochrane.org/reviews/en/ab004027.html doi:10.1002/14651858.CD004027.pub2

Read the Review

Early Onset Schizophrenia: Resources for School Psychologists
By Linda C. Caterino
      PsycCRITIQUES, 2011 Vol 56(14)

Comments

[Jazmine McCoy]

This books sounds like a wonderful tool for the field! Specifically, it will help mental health professionals, especially school psychologists, as well as parents understand, assess and treat childhood schizophrenia. I strongly agree, that although childhood-onset schizophrenia is extremely rare, it does not mean we can ignore it; the problem is still real for the children who are diagnosed with schizophrenia and for their families. I especially liked that the authors discussed how schizophrenia affects the child’s school success, and differentiated between the academic and social aspects. It is crucial that this disorder is detected early on and treated, in order to ensure that the child is supported throughout their school experience, both academically and socially. Although the authors are criticized for recommending social skills training and other treatments that are not empirically supported, I appreciate that they offered suggestions and avenues in need of further exploration. I especially liked that they provided educational interventions, of which teachers may find extremely useful.

[Jessie Chua]

Well, although I agree with Jazmine that this book will be a good tool for professionals dealing with this clinical population, I am personally drawn to the fact that they are medicating children. Furthermore, the fact that this book is already published could not be changed but I can’t sit with the fact that the greater availability of this knowledge widens to include the public or in particular, parents of these children who are ANXIOUS to try anything that they read online or from books published by experts.

As psychologists-in-training, we understand what it means to have continual testing trials in controlled settings; we understand what it means to have side effects from medications; however, to the public or a parent, they only see the narrow light at the end of their tunnel - 'Yes, a possibility exist somewhere in this country that could treat my child. He doesn’t have to be weird anymore.'

Children below 13 have developing brains and organs and they are receiving medications that lead to undesirable side effects like neutropenia, drowsiness (Kennedy, Kumar, & Datta, 2007) makes me nervous about the future of psychotropic drugs. What will become of this world when we begin to give medications to adults AND young children? Will medications solve ALL the problems? Giving the child an understudied pill that has an equal possibility of affecting the child's school achievement, social life makes no sense to me. Why should we be doing double harm to the child’s health? Although the book tried its best to summarize the limited amount of data on EOS though some were inconclusive, I am really concerned about how current practices will change. Will more money be pumped into doing research in this area? Will practitioners continue to medicate children now that they have a published source to back them up? Seriously, where is the source of all these research grants to conduct testing come from? (Pharmaceutical firms, perhaps?)

Although I believe in the importance of attacking the host that is causing the illness but shouldn't we also pause and consider the possibility of other underlying complications while treating the person?

[Townley Peters]

Jazmine and Jesse both make strong arguments in response to Linda Caterino’s review of Identifying, Assessing, and Treating Early Onset Schizophrenia at School. I agree that this book may provide school professionals, particularly teachers, with an invaluable tool that may help them support and manage the behavior/emotions of children with Early Onset Schizophrenia (EOS). Teachers play such a vital role in the lives of children, yet unfortunately their jobs often entail far more than just teaching a curriculum. Teachers are also ‘asked’ to support and care for children with a variety of needs ranging from a child with diabetes, to the child diagnosed with EOS. As a result the more information we can arm our teachers with the more prepared they will be to successfully support these children.

The medication of children, as Jesse mentioned, is also something that concerns me. As someone that has used pharmacological interventions, I can appreciate their value. However, there is just not enough known about the long-term effects of medicating a child, whose brain is still developing. The lack of understanding about the long-term effects is something I don’t readily understand, as this is something we have been questioning for a long time now. Shouldn’t there be available research to support the safe pharmacological treatment, of at least some of the more common disorders such as ADHD? Of course the other issue is that our society in general likes ‘quick fixes’ and it is easier to offer a pill than suggest long-term therapy/behavior management, for example, which can be costly and inconvenient – yet in the end isn’t giving a pill akin to offering someone a Band-Aid?

[Gia DiNicola]

Because I think the other bloggers have successfully addressed the queries posed by Ms. Thompson, I would like to say a few words about the idea of using the school setting for identification of EOS. As a clinician working with children in a school-based setting I have doubts about using the school as a venue for early identification of EOS in children. One reason is the great responsibility asked of educators in this situation. Particularly in California, educators and paraeducators are poorly paid and overworked and should not have to add on the additional stress of learning about and identifying these issues in the children they work with.
I am often asked by teachers I work with if I agree with their assessment that a child has ADHD or an autistic spectrum disorder. Why these diagnoses specifically? I would hypothesize that it is because they are both popular topics in the media these days (e.g. television advertisements for ADHD medication and debate over whether immunizations cause autism). My fear is that if that if educators are taught how to screen for EOS, too many children will receive this diagnosis (or be stigmatized because of a teacher’s suspicion of it). The saying, “When your only tool is a hammer, everything looks like a nail,” comes to mind. If we are going to educate early childhood educators about serious mental illness, it would behoove us to educate them about other serious mental health issues such as depression, anxiety, and perhaps most importantly, trauma (which can often be mistaken for ADHD).

[toddler gymnastics]

Many are against treatment of mental illnesses especially in children. But we are facing a double edged sword here. Yes, some treatment may have an effect on the kid's development. But without treatment and medication, the condition might become more serious. I do hope specialists already have alternative medication for children with schizophrenia.