Diagnostic Assessment

Chapter
Part of the Developmental Psychopathology at School book series (DPS)

Abstract

As indicated in Chapter 1, early onset schizophrenia (EOS) cases appear before age 18 (Remschmidt, 2002), meeting the diagnostic criteria established for adults. The diagnostic assessment of EOS can be challenging for mental health professionals. First, many symptoms of EOS may also appear in other psychiatric disorders such as ADHD, autism, depression, or anxiety. Second, some warning signs or at-risk behaviors of EOS can last several months or a few years as nonspecific psychological, behavioral, emotional, and social disturbances of varying intensity, and sometimes they can be difficult to distinguish from characteristics related to normal child or adolescent development (Woods, Miller, McGlashan, 2001). Third, parents, teachers, social workers, psychologists, or primary care doctors may not be familiar with symptoms or warning signs of EOS. And fourth, stigma associated with this debilitating illness creates reluctance and delay in active help seeking. A diagnosis of schizophrenia is usually made by a child psychiatrist based on the DSM-IV-TR criteria (APA,). However, school psychologists are on the frontline in detecting at-risk behaviors for severe mental illnesses like EOS. Knowledge of the EOS diagnostic criteria, symptom onset, developmental course, and assessment instruments is essential in establishing an accurate diagnosis.

Keywords

Depression Dementia Influenza Schizophrenia Measle 

References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.Google Scholar
  2. Brown, A. S., Begg, M. D., Gravenstein, S., Schaefer, C. A., Wyatt, R. J., Bresnahan, M., et al. (2004). Serologic evidence of prenatal influenza in the etiology of schizophrenia. Archives of General Psychiatry, 61, 774–780.PubMedCrossRefGoogle Scholar
  3. Brown, A. S., Cohen, P., Haravy-Friedman, J., Babulas, V. S., Malaspina, D., Gorman, J., et al. (2001). Prenatal rubella, premorbid abnormalities, and adult schizophrenia. Biological Psychiatry, 49, 473–486.PubMedCrossRefGoogle Scholar
  4. Buckley, P. F., Miller, B. J., Lehrer, D. S., & Castle, D. J. (2009). Psychiatric comorbidities and schizophrenia. Schizophrenia Bulletin, 35, 383–402.PubMedCrossRefGoogle Scholar
  5. Burke, L., Androutsos, C., Jogia, J., Byrne, P., & Frangou, S. (2008). The Maudsley early onset schizophrenia study: The effect of age of onset and illness duration on frontal-parietal gray matter. European Psychiatry, 23, 233–236.PubMedCrossRefGoogle Scholar
  6. Caplan, R. (1994). Thought disorder in childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 605–615.PubMedCrossRefGoogle Scholar
  7. Corcoran, C., Davidson, L., Sills-Shahar, R., Nickou, C., Malaspina, D., Miller, T., et al. (2003). A qualitative research study of the evolution of symptoms in individuals identified as prodromal to psychosis. Psychiatry Quarterly, 74, 313–332.CrossRefGoogle Scholar
  8. Davidson, M., Reichenberg, A., Rabinowitz, J., Weiser, M., Kaplan, Z., & Mark, M. (1999). Behavioral and intellectual markers for schizophrenia in apparently healthy male adolescents. American Journal of Psychiatry, 156, 1328–1335.PubMedGoogle Scholar
  9. Delisi, L. E. (1992). The significance of age of onset for schizophrenia. Schizophrenia. Bulletin, 18, 209–215.PubMedCrossRefGoogle Scholar
  10. Eggers, C., & Bunk, D. (1997). The long-term course of childhood-onset schizophrenia: A 42 year followup. Schizophrenia Bulletin, 23, 105–117.PubMedCrossRefGoogle Scholar
  11. Fields, J. H., Grochowski, S., Lindenmayer, J. P., Kay, S. R., Grosz, D., Hyman, R. B., et al. (1994). Assessing positive and negative symptoms in children and adolescents. American Journal of Psychiatry, 151, 249–253.PubMedGoogle Scholar
  12. Gourovitch, M. L., Goldberg, T. E., & Weinberger, D. R. (1996). Verbal fluency deficits in patients with schizophrenia: Semantic fluency is differentially impaired as compared with phonological fluency. Neuropsychology, 10, 573–577.CrossRefGoogle Scholar
  13. Hollis, C. (1995). Child and adolescent (juvenile onset) schizophrenia. A case control study of premorbid development impairments. British Journal of Psychiatry, 166, 489–495.PubMedCrossRefGoogle Scholar
  14. Jones, P., Rodgers, B., Murray, R., & Marmot, M. (1994). Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet, 344, 1398–1402.PubMedCrossRefGoogle Scholar
  15. Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children – present and lifetime version (KSADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.PubMedCrossRefGoogle Scholar
  16. Kaufman, J., Birmaher, B., Brent, D., Rao, U., & Ryan, N. (1996). The schedule for affective disorders and schizophrenia for school-age children. Pittsburgh, PA: University of Pittsburgh Medical Center.Google Scholar
  17. Kelsey, J. E., Newport, D. J., & Nemeroff, C. B. (2006). Principles of psychopharmacology for mental health professionals. Hoboken, NJ: Wiley.CrossRefGoogle Scholar
  18. Kodish, I., & McClellan, J. (2008). Early-onset schizophrenia. In M. Hersen & D. Reitman (Eds.), Handbook of psychological assessment, case conceptualization, and treatment, Vol. 2: Children and adolescents (pp. 405–443). Hoboken, NJ: Wiley.Google Scholar
  19. Kolvin, C., Ounsted, M., Humphrey, M., & McNay, A. (1971). The phenomenology of childhood psychoses. British Journal of Psychiatry, 118, 385–395.PubMedCrossRefGoogle Scholar
  20. Lachar, D., & Gruber, O. P. (1995). Personality inventory for youth (PIY) manual: Administration and interpretation guide. Los Angeles, CA: Western Psychological Services.Google Scholar
  21. Lachar, D., Randle, S. L., Harper, R. A., Scott-Gurnell, K. C., Lewis, K. R., Santos, C. W., et al. (2001). The Brief Psychiatric Rating Scale for Children (BPRS-C): Validity and reliability of an anchored version. Journal of American Academy Child and Adolescent Psychiatry, 40, 333–340.CrossRefGoogle Scholar
  22. Lewis, D. A., & Levitt, P. (2002). Schizophrenia as a disorder of neurodevelopment. Annual Review of Neuroscience, 25, 409–432.PubMedCrossRefGoogle Scholar
  23. Li, H. (2004). Fears and related anxieties in children having a disability. Dissertation Abstracts International Section A: Humanities and Social Sciences, 64(9-A), 3190.Google Scholar
  24. Lindamer, L. A., Lohr, J. B., Harris, M. J., & Jeste, D. V. (2004). Gender, Estrogen, and Schizophrenia. American Psychiatric Association, 2, 138–145.Google Scholar
  25. Malmberg, A., Lewis, G., David, A., & Allebeck, P. (1998). Premorbid adjustment and personality in people with schizophrenia. British Journal of Psychiatry, 172, 308–313.PubMedCrossRefGoogle Scholar
  26. Margari, F., Presicci, A., Petruzzelli, M. G., Ventura, P., Di Cuonzo, F., Palma, M., et al. (2008). Very early onset and greater vulnerability in schizophrenia: A clinical and neuroimaging study. Neuropsychiatric Disease and Treatment, 4, 825–830.PubMedCrossRefGoogle Scholar
  27. Maurer, K., & Hafner, H. (1995). Methodological aspects of onset assessment in schizophrenia. Schizophrenia Research, 15, 265–276.PubMedCrossRefGoogle Scholar
  28. Muratori, F., Salvadori, F., D’Arcangelo, G., Viglione, V., & Picchi, L. (2005). Childhood psychopathological antecedents in early onset schizophrenia. European Psychiatry, 20, 309–314.PubMedCrossRefGoogle Scholar
  29. Opler, M. G. A., & Susser, E. S. (2005). Fetal environment and schizophrenia. Environmental Health Perspectives, 113, 1239–1242.PubMedCrossRefGoogle Scholar
  30. Patterson, Ph H. (2007). Maternal effects on schizophrenia risk. Science, 318, 576–577.PubMedCrossRefGoogle Scholar
  31. Remschmidt, H. (2002). Early-onset schizophrenia as a progressive-deteriorating developmental disorder: Evidence from child psychiatry. Journal of Neural Transmission, 109, 101–117.PubMedCrossRefGoogle Scholar
  32. Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior assessment system for children (2nd ed.). Bloomington, MN: Pearson.Google Scholar
  33. Riecher, A., Maurer, K., Loffler, W., Fatkenheuer, B., van der Heiden, W., Munk-Jorgenson, P., et al. (1990). Gender differences in age at onset and course of schizophrenic disorders. In H. Hafner & W. F. Gattaz (Eds.), Search for the causes of schizophrenia (pp. 14–33). Berlin Heidelberg: Springer.CrossRefGoogle Scholar
  34. Seiferth, N. Y., Pauly, K., Kellermann, T., Shah, N. J., Ott, G., Herpertz-Dahlmann, B., et al. (2009). Neuronal correlates of facial emotion discrimination in early onset schizophrenia. Neuropsychopharmacology, 34, 477–487.PubMedCrossRefGoogle Scholar
  35. Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of American Academy Child Adolescence Psychiatry, 39, 28–38.CrossRefGoogle Scholar
  36. Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A children’s global assessment scale(CGAS). Archives of General Psychiatry, 40, 1228–1231.PubMedCrossRefGoogle Scholar
  37. Vourdas, A., Pipe, R., Corrigall, R., & Frangou, S. (2003). Increased developmental deviance and premorbid dysfunction in early onset schizophrenia. Schizophrenia Research, 62, 13–22.PubMedCrossRefGoogle Scholar
  38. Walder, D. J., Seidman, L. J., Cullen, N., Su, J., Tsuang, M. T., & Goldstein, J. M. (2006). Sex differences in language dysfunction in schizophrenia. American Journal of Psychiatry, 163, 470–477.PubMedCrossRefGoogle Scholar
  39. Walker, E., Kestler, L., Bollini, A., & Hochman, K. (2004). Schizophrenia: Etiology and course. Annual Review of Psychology., 55, 401–430.PubMedCrossRefGoogle Scholar
  40. Woods, S. W., Miller, T. J., & McGlashan, T. H. (2001). The prodromal patient: Both symptomatic and at risk. CNS Spectrums, 6, 223–232.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Huijun Li
    • 1
  • Melissa Pearrow
    • 2
  • Shane R. Jimerson
    • 3
  1. 1.Department of Public PsychiatryCommonwealth Research Center Harvard Medical School Beth Israel Deaconess Medical CenterBostonUSA
  2. 2.Department of Counseling and School PsychologyUniversity of MassachusettsBostonUSA
  3. 3.Gevirtz Graduate School of Education Department of Counseling, Clinical, and School PsychologyUniversity of CaliforniaSanta BarbaraUSA

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