Psychosis in Children and Teens

When people hear the word psychosis, they rarely think about children. However, psychosis in children – sometimes called child psychosis – is more common than most people think. Which brings us to a second point: when people hear or say the word psychosis, they rarely know exactly what the word means.

That’s no fault of their own. There’s a lack of general knowledge about mental health, mental illness, and mental health disorders in our society and culture. There’s also a lack of specific knowledge about these topics. For instance, many people don’t know that behavioral health and mental health are nearly synonyms, and that a person with a mental health disorder may receive treatment for mental illness at a behavioral health treatment center.

Many people may also be surprised to learn that, in addition to typical outpatient treatment – i.e. therapy that takes place in an office setting – there are behavioral health treatment centers for children and adolescents, psychiatric hospitals for children and adolescents, and residential treatment centers for children and adolescents with mental or behavioral health disorders.

But we digress: this article is about behavioral health treatment centers for child psychosis, which means we need to define the word psychosis. The first thing to understand is that psychosis is not a mental illness. It’s a symptom that may or may not be related to a mental illness or mental health disorder.

What is Psychosis?

Here’s a definition of psychosis from the National Alliance on Mental Illness (NAMI):

“Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing, and believing things that aren’t real or having strange, persistent thoughts, behaviors and emotions.”

In many cases, psychosis is directly related to a mental illness. At the same time, the disrupted perceptions, the seeing and hearing things that aren’t real – called hallucinating – and the believing things that aren’t real – a.k.a. delusional thoughts and beliefs – can also be an acute, short-term response to stress, illness, or injury.

When hallucinations or delusions appear briefly and then fade – and the individual returns to their previous state – clinicians call it brief psychotic disorder. Brief psychotic disorder is what we just described above: an acute reaction to illness, injury, or significant stress.

However, when psychosis is related to a serious psychiatric disorder, the initial symptoms may be warning signs that the individual who experiences them will develop a psychotic disorder such as schizophrenia. Psychosis and psychotic symptoms are not always related to a psychotic disorder, though, and may be related to mental illnesses like depression or bipolar disorder.

In the case of adolescents and children, clinicians view the appearance of psychosis or psychotic symptoms differently. Children who experience delusions or hallucinations don’t always believe them in the way someone with schizophrenia does. A child may think their mind is fooling them, or think they’re simply fantasizing or harmlessly imagining things. In these cases, the symptoms are called prodromal symptoms of psychosis. Since children might not take them seriously, they might not tell their parents about them – and that could lead to problems later.

The Symptoms of Prodromal Psychosis

It’s important for parents to know the symptoms of prodromal psychosis, because early detection of symptoms and treatment for child psychosis can minimize the impact and have a direct effect on the severity of a clinical psychotic disorder.

If you’re the parent of a teen with a mental health disorder – or think your child may experience delusions or hallucinations – here’s what to watch for:

• Significant personality changes
• Significant behavioral changes
• Disrupted sleeping patterns
• Disrupted eating patterns
• Withdrawal from friends, family, or loved ones
• Disinterest in hygiene
• Disinterest in favorite activities
• Lack of drive
• Decline in grades or interest in schoolwork
• Problems with concentration
• Difficulty with holding conversations
• Paranoia
• Notable changes in mood

It’s important for us to reiterate two things here. The first is that not all children who experience psychotic symptoms go on to develop a psychotic disorder. The second is that in some cases, the prodromal signs of psychosis are a precursor to a serious mental illness. In either case, early detection of child psychosis is crucial, because it allows parents and mental health professionals to understand whether a child needs treatment at a behavioral health treatment center for child psychosis, or treatment at a less intensive level of care.

Child Psychosis: Hallucinations and Delusions

We’ll talk about the types of mental illnesses that may be accompanied by hallucinations or delusions in just a moment. Before we get there, though, we’ll discuss the types of hallucinations or delusions common to child or adolescent psychosis.

Hallucinations Associated with Child Psychosis

• Auditory. Auditory hallucinations involve hearing things that aren’t there, most often in the form of voices. Voices might tell a child what to do or not to do, or warn them about something dangerous that may happen. Sometimes children report voices from people near them that aren’t really there, and sometimes they report voices coming from inside their head.
• Visual. Visual hallucinations involve seeing things that aren’t there. A child might see people or objects when there’s really nothing to see. In some cases, visual hallucinations can be disconcerting but not scary. Like seeing a car in the driveway when no car is there, for instance. Others might be very upsetting, like seeing a stranger in their home or anything involving an accident or injury.
• Olfactory. Olfactory hallucinations involve smelling things that aren’t there. Sometimes the odors are nice, like a fresh-cooked meal, but at other times, the odors may not be nice at all, like rotting food. Some children report the odors are with them all the time, while others say the odors come and go at random.
• Tactile. Tactile hallucinations involve feeling things that aren’t there. Kids with psychotic tactile hallucinations may feel unidentified things on their skin or under their skin. Or, sometimes, they may feel someone brush against them or tap them on the shoulder when no one is there.

Now we’ll offer a list of the type of delusions commonly experienced by a child or adolescent with psychosis.

Delusions Associated with Child Psychosis

• Grandeur/grandiosity. Children or adolescents with psychosis may think they possess powers, talents, or gifts of insight only they have. They might be convinced they have a relationship with a celebrity when no relationship exists or think they themselves are a famous celebrity when they’re not. Delusions may also revolve around religious concepts, figures, or ideas, such as a special connection to a historical religious person or time period.
• Persecution. Children or adolescents with delusions of persecution often believe they’ve been wronged, hurt, or damaged by others when no such thing happened. A delusional child or adolescent may think they’re being prevented from achieving important goals, or think someone is following or watching them, when no evidence to support their thoughts or beliefs exists.
• Thoughts. This involves a child or adolescent believing other people or outside forces:
  • Control their thoughts
  • Insert thoughts into their mind
  • Take or steal their thoughts
  • Can hear their thoughts
  • Can read their thoughts
• Romance/love/relationships. A child or adolescent with delusional relationship/romantic beliefs may think they’re in a relationship with a famous person, may believe someone they’ve never met is in love with them, or become convinced their significant other is cheating on them.

As mentioned above, psychotic delusions and hallucinations may be related to a psychiatric disorder such as schizophrenia, they may be a short-term response to a stressful event or series of stressful events, or they may be related to a mood disorder, a behavioral disorder, or an emotional disorder.

We’ll talk about the various mental illnesses associated with psychosis now.

Psychosis and Psychiatric Disorders

The following psychiatric disorders are commonly accompanied by psychotic features such as delusions or hallucinations:

Schizophrenia

• Symptoms often include delusions and/or hallucinations

Schizoaffective disorder

• Symptoms often include delusions and/or hallucinations
• Often also includes symptoms of bipolar disorder or depression

Schizophreniform disorder

• Hallucinations, delusions, and other symptoms are short, and last one to six months.

Brief psychotic disorder

• Hallucinations and/or delusions may appear in response to intense stress or disturbing life events, but typically fade within a month of the stressful event, and continue to fade as more time passes.

Mood disorders

• In children and adolescents, hallucinations and/or delusions may accompany bipolar disorder, major depressive disorder, and borderline personality disorder

Substance-related

• Excessive drug/alcohol use or prolonged addiction may cause hallucinations and/or delusions
• If substance-related psychotic features do not disappear within one to two weeks, they may be symptoms of an underlying psychotic disorder

Injury or illness:

• A head injury, brain tumor, or similar injury may cause psychotic symptoms

Everything on the list above may cause, be associated with, or carry an increased risk of psychotic symptoms. There’s more there than most people realize – meaning that hallucination and delusions are far more common than most people think.

Which brings us to our next topic: the prevalence of psychotic disorders among children and adolescents. We’ll give you the statistics, then close the article by discussing the most common treatments for child psychosis.

How Many Children and Teens Have Psychosis?

Here’s the latest data from the National Alliance on Mental Illness (NAMI) on the prevalence of psychosis in children and young adults:

• Roughly 100,000 people under the age of 25 report psychotic symptoms each year
• About 3% of all people in the U.S. report psychotic symptoms at some point during their lives.
• Close to 30% of young people who report psychotic symptoms develop a psychotic disorder later in life

Here’s additional data on adolescents from a meta-analysis (a study that collates data from all available and relevant studies on the same subject) of the prevalence of teen psychosis:

• 17% of children age 9-12 reported psychotic symptoms
• 7.5% of adolescents age 13-18 reported psychotic symptoms

In two different studies cited in this paper, researchers found trends that show significantly larger – and more concerning – rates of prevalence:

• A study in which adolescents answered self-reporting questionnaires showed a 25% prevalence of psychotic symptoms in adolescents
• A long-term study on the relationship between psychotic symptoms in adolescence and later suicide attempts showed that 34% of high school students who reported psychotic symptoms later reported attempting suicide.

That last bullet point gets our attention. While not all children who experience psychosis go on to develop a significant mental health disorder, parents of children who show psychotic symptoms need to understand that the risk is real. They also need to know that early intervention has the potential to mitigate the course and severity of any subsequent mental illness.

We’ll now discuss the treatment options available to children and adolescents with psychosis.

Child Psychosis and Adolescent Psychosis: Evidence-Based Treatment

When your child or teen has psychosis or a mental health disorder with psychotic features, it can be frightening. However, you need to know something important: all the psychiatric disorders we list above are treatable. What that means is that evidence shows specific types of support work to reduce the duration, frequency, and intensity of their symptoms. Appropriate treatment and support can also minimize the disruption these disorders cause.

We’ll say that in a simpler way. People with psychotic disorders can learn to manage their disorder and live full and productive lives.

Evidence-based treatments for psychosis and psychotic disorders include:

• Pharmaceutical intervention. Medications may include:
  • Typical psychotics
  • Atypical antipsychotics
• Psychotherapeutic intervention (talk therapy)
  • Cognitive Behavioral Therapy (CBT)
    • Individual
    • Group
    • Family
  • Other approaches:
    • Psychosocial support (changing environment and circumstances)
      • Simplified environment
      • Reduced stimulation
      • Structured interaction

The major takeaway here is that there are evidence-based treatments for psychosis and mental health disorders with psychotic features that work. For parents of children or teens with psychosis, early detection and treatment are crucial.

Treatment for Child or Adolescent Psychosis: The Sooner the Better

Mental health professionals provide the approaches to treatment mentioned above at behavioral health treatment centers for children and adolescents. After receiving a full assessment and diagnosis, a clinician may recommend support in an outpatient treatment program, an intensive outpatient program (IOP), a partial hospitalization program (PHP), or a residential treatment center (RTC).

Many children and adolescents will respond well to treatment and show improvement in their symptoms relatively quickly. However, in some cases, mental health disorders with psychotic features can lead to additional problems. In some cases, teens may display aggression, hostile behavior, anger, disruptive behavior, and/or engage in non-suicidal self-injury (cutting) and suicide attempts.

That’s why early detection and intervention are important. In the absence of appropriate treatment and support, the likelihood of negative consequences increases. If your child or teen displays the signs and symptoms of psychosis and receives a clinical diagnosis for prodromal psychosis or a mental health disorder such as depression, it’s imperative to begin treatment as soon as possible. The earlier your child receives support, the more likely they are to learn to manage their symptoms and live a life of their choosing.

To learn how to find the best available treatment for your child or teen, please visit this page and download A Parent’s Guide to Mental Health Treatment for Teens.