Treatment for a Child with Psychosis: When to Consider Hospitalization or Residential Treatment

If you’re the parent of a child with psychosis – meaning a child or adolescent who displays one or more of a set of symptoms related to a possible psychotic, mood, or behavioral disorder – then the first thing you learn when you seek child psychosis treatment is that psychosis itself is neither a diagnosis nor a condition.

Psychosis is a symptom. In most cases, it’s a symptom associated with a mental illness. In some cases, psychotic symptoms precede serious psychiatric disorders. And in others, psychotic symptoms appear briefly, do not last, and do not lead to psychiatric disorders. They may also be related to short-term emotional or psychological stress or serious physical medical conditions, injuries, or illness.

Here’s how the National Alliance on Mental Illness (NAMI) defines psychosis:

“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.”

We’ll elaborate on specific elements of this definition in a moment, and offer a more robust, clinical definition for some of the non-clinical terms you see. However, this definition offers a good idea of what psychosis is, which is important if you’re the parent of a child with psychosis or a child or adolescent who displays psychotic symptoms. Understanding the symptoms is a key factor when seeking treatment for your child or adolescent, and can help when you’re deciding between psychiatric hospitalization or residential treatment as possible options for their psychiatric support and care.

Psychosis is a symptom: you now know that, in case you didn’t before. That leads to the question of which psychiatric or mental health disorders are associated with psychosis and/or psychotic symptoms.

Psychosis: About the Symptoms

First, we’ll elaborate on the definition above, then we’ll list which mental health disorders in children and adolescents may include psychotic symptoms.

To the symptoms: when someone experiences “disruptions to [their] thoughts or perceptions that make it difficult to realize what is real and what isn’t,” mental health professionals refer to these thoughts and perceptions as delusions or hallucinations. In shorthand, delusions are thoughts or beliefs a person has that are demonstrably not real or true, while hallucinations are sensory perceptions a person experiences in the absence of any real or identifiable external stimuli.

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Here’s a partial list of the types of delusions a child or adolescent with psychosis might experience.

Psychosis: Common Delusions

  • Grandiosity. A child or adolescent with psychosis may believe they have special powers, talents, gifts, or knowledge exclusive to them, believe they’re famous when they’re not, and/or believe they have a special relationship with a famous person when no such relationship exists. Grandiose delusions may also involve religious ideas and/or the belief that they have special – meaning far outside the dogmatically typical – connections to religious or spiritual figures, concepts, or ideas.
  • Persecution. A child or adolescent with psychosis may have delusions of persecution that involve the belief they’re being intentionally harmed by others in the absence of any evidence to support that belief. Delusions of persecution in children or adolescents with psychosis may include beliefs they’re being watched, followed, tricked, conspired against, or prevented from achieving goals or objectives in the absence of any evidence to support those beliefs.
  • Thought-related. A child or adolescent with psychosis may believe their thoughts are:
    • Controlled by others
    • Inserted into their mind by others
    • Extracted – i.e. stolen – from inside their mind by others
    • Audible or somehow made known to others
    • Read by others
  • Love/relationship-related. A child or adolescent with psychosis may believe a romantic partner is unfaithful and/or believe they’re loved by another person, typically someone they don’t know, who is of a higher status.

Now we’ll describe the types of hallucinations a child or adolescent with psychosis might experience.

Psychosis: Common Hallucinations

Auditory

Auditory hallucinations are the most common type of hallucinations an adolescent or child with psychosis might experience. These hallucinations involve hearing things that are not there. They might include voices that tell them what to do or warn them of some impending danger. They might experience these voices coming from inside their head or a voice coming from people around them who do not exist. For some, these voices are not clear and distinct, but exist as background noise.

Visual

A child or adolescent with psychosis may see things, including people or objects, that aren’t there. Some visual hallucinations may be confusing, but not extremely upsetting, such as seeing an object where no object exists, or seeing a wall, table, or chair change type or color. However, some visual hallucinations may be very disturbing and upsetting, such as seeing blood on a wall, a person who’s not there, or seeing a different person’s face in the mirror.

Olfactory

A child or adolescent with psychosis may smell things that aren’t there. Examples may be pleasant, such as perfume or comfort food, while others may be unpleasant, such as garbage or rotting eggs. In some cases, these odors are present all the time, while in others, they appear and disappear unpredictably.

Tactile

A child or adolescent with psychosis may feel things that aren’t there. They may feel like insects are crawling on their skin, or they may feel something crawling under their skin. In some cases, they may feel someone has touched them on the arm or the shoulder, only to turn and find on one is there.

When reading through these lists of delusions and hallucinations common to children or adolescents who experience psychotic symptoms, it’s important to understand that they may experience some, but not all of those listed. Also, these symptoms can vary in frequency, intensity, and duration.

Now we’ll discuss the psychiatric disorders that may be accompanied by psychosis or psychotic symptoms.

When Psychosis is a Symptom of a Psychiatric Disorder

As we mention in the opening of this article, the presence of psychosis or psychotic symptoms does not always mean a child with psychosis will develop a psychotic disorder. Child psychosis treatment is not always for a psychotic disorder. In some cases, psychosis and psychotic symptoms are related to mood disorders such as depression and bipolar disorder, as we describe below. In other cases, psychosis and psychotic symptoms in children and adolescents indicate they’re experiencing what mental health experts call the prodromal symptoms of psychosis.

This means that although a child or teen may experience delusions and/or hallucinations, they do not fully believe them, as someone with a psychotic disorder might. They may think their mind is playing tricks on them, and say nothing to their parents about their symptoms. However, it’s important to catch signs of prodromal psychosis early, because early child psychosis treatment can, in some instances, mitigate and/or alter the trajectory of a full-blown psychotic disorder.

Here’s what parents should watch for.

Prodromal Psychosis: Signs and Symptoms

To read about prodromal psychosis in children and adolescents, please read our article What Does It Mean That My Teen Has Prodromal Symptoms of Psychosis?

Parents seeking child psychosis treatment should understand that not all cases of prodromal psychosis progress to a psychotic disorder. However, in some cases, the symptoms are a precursor to a severe mental illness or psychiatric disorder.

Here’s a list of psychiatric disorders for which psychosis, psychotic features, and psychotic symptoms are common.

Psychiatric Disorders With Psychotic Features

  • Schizophrenia:
    • May include hallucinations and/or delusions
  • Schizoaffective disorder:
    • May include hallucinations and/or delusions
    • Can include symptoms of bipolar disorder or depression
    • May include psychotic features of depression
  • Schizophreniform disorder
    • In schizophreniform disorder, symptoms of schizophrenia, including hallucination and/or delusions, are of limited duration – typically between one to six months.
  • Brief psychotic disorder:
    • Extreme stress or significant life disruption may cause temporary psychosis and result in the presence of psychotic symptoms
    • In these cases, symptoms typically last less than a month and fade as time and distance from the stressful event accrues
  • Mood disorders
  • Substance-induced:
    • Extreme substance use or severe SUD may cause hallucinations or delusions
    • Symptoms that do not fade after 1-2 weeks of substance-induced psychosis may indicate an underlying psychotic disorder
  • Injury or illness-related psychotic disorder:
    • Psychosis or psychotic symptoms may be related to a head injury, brain tumor, or other neurological injuries/impairment/condition

We’ll repeat what we mentioned above: early detection of prodromal psychosis, or any psychotic symptoms, is crucial. Early detection means early diagnosis, and early diagnosis means the possibility of early and timely treatment.

Child Psychosis: Prevalence, Risk, and Treatment

NAMI indicates that roughly 100,000 young people experience psychosis or psychotic symptoms each year, and about three percent of all people – adults included – will experience psychosis or psychotic symptoms at some point during their lives. Additional research suggests that roughly 30 percent of young people who experience psychosis or psychotic symptoms go on to develop a disorder such as schizophrenia either late in adolescence or during adulthood.

That’s why it’s important for parents not only to understand the signs of prodromal psychosis, but also to know the risk factors for developing a psychiatric disorder with psychotic features.

Child or Adolescent Psychosis/Psychotic Disorders: Risk Factors

  • Genetics/Family history
    • The presence of specific genes
    • A family history of psychotic disorders
  • Prenatal adversity:
    • Complications during pregnancy
    • Exposure to viral pathogens in utero
  • Early life adversity/environment
    • Abuse
    • Neglect
    • Head injury
    • Parental loss
  • Adolescent adversity/environment
    • Extreme substance use/SUD
    • Extreme social and/or personal stress

All the factors above increase the likelihood of developing a psychiatric disorder with elements of psychosis.

With that said, if you’re the parent of a child or adolescent with psychosis, we understand that it can be overwhelming and scary. But you need to know this critical fact: these are treatable conditions, and people can and do learn to manage their symptoms and live productive lives.

Common Treatments for Child and Adolescent Psychosis or Psychotic Disorders

  • Medication
    • Typical psychotics
    • Atypical antipsychotics
  • Cognitive Behavioral Therapy (CBT)
    • Individual
    • Group
    • Family
  • Psychosocial support
    • Simplified environment
    • Reduced stimulation
    • Structured interaction

These treatments and supports typically begin in an outpatient setting and/or in the school or home. Ideally, parents take their children to treatment with a therapist once or twice a week, receive prescriptions for appropriate medication, and arrange psychosocial supports with family members, teachers, and friends. Some children and adolescents with psychosis will respond relatively quickly to these approaches, and show significant improvement sooner rather than later.

However, this is not always the case. The outpatient level of child psychosis treatment is not always sufficient. When prodromal psychosis progresses to a full-blown psychiatric disorder with psychotic features, children and adolescents may need a more intense and immersive level of treatment.

When Outpatient Treatment is Not Enough

The symptoms of psychosis and mental health disorders with psychotic features can lead to aggression, anger, hostility, disordered thinking, suicidal ideation, non-suicidal self-injury, and suicide attempts. If your child or adolescent experiences symptoms that are so severe they present a danger to themselves, their friends, or family, then you may need to consider a more intensive and immersive level of care than typical outpatient therapy.

For young people with severe symptoms, two options are best:

Psychiatric Hospitalization

Mental health professionals provide this level of care in a specialized treatment facility such as a general hospital, a children’s psychiatric hospital, or a general psychiatric treatment center. Children or adolescents live on-site and receive round-the-clock medical and psychiatric treatment and support. This is the most immersive level of treatment available. The goals of psychiatric hospitalization are twofold: stabilization and safety – treatment comes next. Therefore, when hospital staff determines a child is stable and safe enough to begin treatment, they may begin treatment in the hospital or step-down to residential treatment.

Residential Treatment 

Mental health professionals provide this level of care in specialized residential psychiatric treatment centers. Children and adolescents live on-site and receive 24-hour treatment and monitoring. These children are stable enough that they’re not a danger to themselves and others.  They’ve learned to manage their symptoms well enough to allow them to begin therapy, counseling, and other modes of support.

Getting Help: Seek Treatment Early, Communicate Often

The most important thing that you can do, as the parent of a child with psychosis or psychotic symptoms, is act sooner rather than later. If you’re just now learning about child psychosis – and you think your child or teen needs help – then you should arrange for a full evaluation as soon as possible. Once your child receives an evaluation, it’s crucial to start treatment at the appropriate level. It’s also crucial to stay in contact with your child’s treatment team and participate as much as you can. For teens who are a danger to themselves and/or others, treatment may mean psychiatric hospitalization or residential treatment. For teens with symptoms that are less severe, outpatient treatment may suffice.

In every case, early diagnosis and treatment gives your child the best chance of treatment success. Children and adolescents can and do learn to manage the symptoms of these mental health disorders and go on to live productive lives. We know, because we see it happen every day.

Ready to Get Help for Your Child?

Evolve offers CARF and Joint Commission accredited treatment for teens with mental health disorders and/or substance abuse. Your child will receive the highest caliber of care in our comfortable, home-like residential treatment centers. We offer a full continuum of care, including residential, partial hospitalization/day (PHP), and intensive outpatient treatment (IOP).
To speak with our admissions coordinators, call: (800) 665-4769