Childhood-onset schizophrenia (COS) is rare, and the reported rate of occurrence is fewer than one case in every 10,000 children. Among adolescents ages 13 to 18 years, the rate of occurrence for schizophrenia is significantly increased. Although the core phenomenological features are the same across the ages, extremely high rates of comorbid psychiatric disorders, such as attention-deficit/hyperactivity disorder, depressive disorders, and separation anxiety disorder (ADHD), are seen in children and adolescents with COS. It is possible that certain psychosocial stressors play a role in the early stages and initial presentation of schizophrenia by interacting with biological risk factors; these same psychosocial stressors are known to influence the course of the disorder as well as playing a role in its emergence. Children who are diagnosed with COS have marked neuropsychological deficits in many basic brain functions, such as working memory, attention, and executive functions.

The clinical presentation of schizophrenia is similar in all age groups. However, a certain difficulty lies with diagnosing children who report hallucinations and apparent thought disorders, particularly when they occur in conjunction with developmental immaturity in the ability to differentiate reality from fantasy as well as immature language. Such phenomena as reported by young children can likely be attributable to immaturity rather than psychosis. The diagnostic criteria for schizophrenia in children are identical to the criteria for the adult form except that instead of showing deteriorating functioning, children may fail to achieve their expected levels of social and academic functioning. Schizophrenia in prepubertal children includes the presence of at least two of the following: hallucinations, delusions, grossly disorganized speech or behavior, and severe withdrawal for at least 1 month. Social or academic dysfunction must be present, and continuous signs of the disturbance must persist for at least 6 months.

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