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Tests and diagnosis

By Mayo Clinic staff

If your doctor or mental health provider believes your child may have childhood schizophrenia or another mental illness, he or she typically runs a series of medical and psychological tests and exams. These can help pinpoint a diagnosis, rule out other problems that could be causing your child's symptoms and check for any related complications.

These exams and tests generally include:

• Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to your child's heart and lungs; and examining the abdomen.
• Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your child's thyroid function. Other tests that may be ordered to check for other medical problems may include magnetic resonance imaging (MRI) of the head to look for abnormalities in the brain structure, or an electroencephalogram (EEG) to look for abnormalities in brain function, such as seizures.
• Psychological evaluation. A doctor or mental health provider will talk to you and your child about his or her thoughts, feelings and behavior patterns. He or she will ask about symptoms, including when they started, how severe they are, how they affect daily life and whether your child has had similar episodes in the past. The doctor may also talk to your child about any thoughts of suicide, self-harm or harming others.

Your child may be evaluated to check his or her ability to think and function at an age-appropriate level. Your doctor may also request to review school records. And your child may be asked to complete psychological questionnaires to help examine his or her mood, anxiety and possible psychotic symptoms.

A difficult and possibly long process
The path to diagnosing childhood schizophrenia can sometimes be long and challenging. In part, this is because so many other conditions can have similar symptoms, such as depression, bipolar disorder or substance abuse. Also, doctors often don't want to rush a diagnosis of such a serious condition. A child psychiatrist may want to monitor your child for six months or more.

During that time, your child's psychiatrist will monitor your child's behaviors, perceptions and thinking patterns. For example, the psychiatrist will want to know whether problems occur at home or at school, or whether they occur in all environments. In some cases, a psychiatrist may recommend starting treatment with medications even before an official diagnosis is made. This is especially important when symptoms of aggression or self-injury have occurred. Some of the medications can be very helpful in limiting these types of behavior and restoring a sense of normalcy to your child's behavior.

Diagnostic criteria for childhood schizophrenia
To be diagnosed with childhood schizophrenia, your child must meet certain symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

The psychiatrist may first diagnose your child with a nonspecific psychotic disorder, rather than schizophrenia. As thinking and behavior patterns and symptoms become more clear over time, a diagnosis of schizophrenia may be made if the criteria are met.

Diagnostic criteria for childhood schizophrenia are generally the same as for adult schizophrenia and include:

• Presence of at least two of these: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, lack of emotion, social withdrawal, inability to carry out routine daily tasks such as dressing and bathing
• Failure to achieve the expected level of academic, social or work performance
• Signs last for at least six months
• Other mental health disorders have been ruled out

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