The longer the delay the more difficult it might be to treat the condition, they warned. They acknowledge, however, that schizophrenia would usually be hard to detect in early childhood.

“Some children may just be misbehaving while others might actually have a serious mental disease like schizophrenia,” said Azizah Othman, an associate professor at Universiti Sains Malaysia.

According to her, it does no good to punish a misbehaving child if he happens to have schizophrenia.

She said this was the reason it was important for parents to seek professional advice once they had noticed “weird patterns of thoughts or emotions” in a child.

“If the child seems more irritable, impulsive or just generally more difficult compared with his or her siblings, then seek advice from a doctor and ask for a proper diagnosis,” she said in an interview with FMT.

Another associate professor, Wan Salwina Ismail of Universiti Kebangsaan Malaysia, said parents must help such children manage and cope with stress efficiently.

“Being overprotective or highly critical or harsh does not help,” she said.

“Parents must follow the advice of a doctor and administer the medication given. Psycho-education is usually given to parents who have to handle such children.”

How common is schizophrenia among children?

Schizophrenia is rare in children below the age of 13, according to Azizah. She added, however, that the reason for this belief was that doctors would usually diagnose the disease only in adolescent and adult patients.

“The tell tale signs, such as delusions or hallucinations, are hard to diagnose among children below 13. So doctors usually make other diagnoses until it becomes very clear during adolescence or adulthood that it is indeed schizophrenia.”

What are the early signs?

Among the earliest signs parents should look out for are abnormal behaviour, abnormal thinking, abnormal speech and poor sleep, according to Wan Salwina.

“Also, they must be alert to deterioration in functioning, such as academic deterioration, deterioration in terms of personal hygiene, a refusal to go to school and social withdrawal.”

Azizah said it was often hard to tell whether a child was suffering from schizophrenia as the symptoms were similar to common problems associated with developmental behaviour.

“Weird patterns of thought and behaviour, which are present in those suffering from schizophrenia, can also happen in children with basic developmental disorders like autism.”

Wan Salwina, however, said there was a major difference between developmental disabilities and schizophrenia.

“In developmental disabilities, the children develop slower than normal children. So a child with autism, for example, may learn speech only at the age of four. The normal age for this would be between one and two years.

“In schizophrenia, however, children may have normal development at first and then suddenly develop problems. Of course, children with developmental problems could develop psychosis symptoms at the same time.”

What causes schizophrenia among children?

Although there is no one definite answer to the question of what causes schizophrenia in children, it is usually attributed to genetics or brain disease, according to Azizah.

“An adult who suffers from schizophrenia usually does so because there is a lot of stress in his life and he cannot cope with it. This is less likely in children because they are yet to experience this kind of stress.

“Usually, for children, we will look at genetic factors or whether there is something wrong in the brain because the brain structure is often a little different from normally functioning children.”

Wan Salwina disagreed with Azizah over the question of stress. She said children could face academic stress and this could be enough to cause mental illness.

“You have to understand that mental illness is multifactorial. Most mental illnesses have genetic contributions. So people can be vulnerable when they have the gene and then other factors will add on to it, which then leads to mental illness.”

What kinds of treatment are available?

Wan Salwina said effective medications for the treatment of schizophrenia were available but she added that relapses could occur, as in other serious illnesses.

However, she said medications could minimise relapses and sometimes prevent them.

“There is medication such as anti-psychotics, which would be the mainstay treatment. And the doctor will also look at psycho-social interventions such as psychotherapy, stress management and the development of coping skills.

“Rehabilitation, such as going back to school and redeveloping social skills, is another thing the doctor may suggest.”

Wan Salwina pointed out that most government hospitals would have child and adolescent psychiatric units.