What Are Common Schizophrenia Symptoms in Teens?

Learning how to tell early schizophrenia symptoms in teens apart from typical adolescent strife can help your teen receive timely treatment.

Schizophrenia is a mental health disorder characterized by psychosis, a state of inaccurate reality perception that involves major symptoms like hallucinations, delusions, and disorganized thinking.

As a progressive, lifelong condition, however, schizophrenia often starts subtly with mild changes to mood, social function, and thinking. This early phase is known as the prodromal period.

In teens, symptoms of the prodromal period can look similar to depression or anxiety, making it challenging to know when your child may need mental health support.

In order to determine a schizophrenia diagnosis, mental health professionals use criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).

The DSM-5-TR focuses on the symptoms of fully developed schizophrenia, as not everyone experiences a prodromal phase.

The problem isn’t a shortage of people wanting to be doctors, but rather, too few opportunities for training. Medical schools have increased class sizes by 30% since 2002, but federal funding for residency training – an essential step in the process of becoming a practicing physician – has not increased since 1997, according to Inside Higher Ed.

Under the guidelines, schizophrenia can be diagnosed when the following symptoms have been present for the majority of time during a 1-month period and are persistent for at least 6 months:

delusions (rigid adherence to beliefs that can be proven untrue)
hallucinations (false sensory experiences)
disorganized thinking (disconnected, often incomprehensible thoughts and speech patterns)
disorganized motor function (agitation or catatonia)
negative symptoms

At least one of these symptoms must be delusions, hallucinations, or disorganized thinking.

Negative symptoms

Negative symptoms in mental health disorders are symptoms that imply a loss of natural function.

diminished emotional expression
decrease in purposeful, self-motivated activities (avolition)
diminished speech output (alogia)
inability to experience pleasure from positive stimuli (anhedonia)
social withdrawal or lack of interest in being social (asociality)

Other common experiences in schizophrenia that support diagnosis include:

inappropriate emotional responses (e.g., laughing for no reason)
anxiety and phobias
anger or irritability
sleep disturbance
refusing food
depersonalization
derealization
impaired cognitive function (poor memory, language impairment, difficulty learning)
inability to accurately interpret the intent in others’ words and actions
unawareness of the disorder (anosognosia)

Early symptoms

The early symptoms of schizophrenia in teens can be easily missed — or dismissed — because of how unassuming they often are.

In teens, early symptoms can appear as:

changed friend groups
difficulty making or keeping friends
mood changes
academic decline
disinterest in sports, hobbies, or other activities they used to enjoy
self-isolation from family and friends
a decline in personal hygiene
uncharacteristic beliefs or magical thinking
poor sleep
low energy
emotional coldness
fearfulness
uncharacteristic behaviors
unusual perceptual phenomena (e.g., feeling like they don’t recognize themselves or loved ones)

Research suggests that prodromal symptoms in adolescents occur over 1 year before classic symptoms of psychosis, and many are early manifestations of negative symptoms.

While anyone, at any age, can develop schizophrenia, women tend to see onset in their late 20s to early 30s, while men are more likely to experience onset during the late teens to early 20s.

Early-age-onset schizophrenia is rare and, therefore, understudied. Childhood-onset schizophrenia occurs in approximately 0.04% of the population.

You don’t have to wait until your child is experiencing symptoms of psychosis to seek a schizophrenia diagnosis.

A mental health professional starts the diagnostic process with a detailed history, both of prior medical concerns and of everyday changes that might contribute to symptoms.

Because many early schizophrenia symptoms in teens are nonspecific, part of making a diagnosis involves ruling out all other possible underlying causes.

Neurodegenerative disorders, developmental conditions, and other mental health disorders, such as severe depression, anxiety, and post-traumatic stress disorder (PTSD), can have similar presentations.

Your teen may need:

baseline psychometric testing
blood work
urine screenings
developmental testing
psychological or neuropsychological assessment (or both)

When everything else has been ruled out and schizophrenia is the most likely cause, this is when a diagnosis is made.

Schizophrenia without psychosis?

The DSM-5-TR states that hallucinations or delusions must be present for a schizophrenia diagnosis.

However, this manual is just a clinical standard that helps classify and identify disorders. In the prodromal phase, many hallmarks of schizophrenia aren’t evident, but that doesn’t mean you aren’t living with schizophrenia.

You can still receive a diagnosis when enough factors come together to suggest schizophrenia in its early stages.

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There’s no cure for schizophrenia, but treatment can significantly improve the severity of the symptoms throughout life.

Most people, including teens, benefit from the use of antipsychotic medications. These will be customized to your teen’s specific needs and closely monitored for any adverse side effects.

Medication can help control symptoms of psychosis, but schizophrenia is a lifelong condition that involves much more than reality perception.

Psychosocial treatments are just as important as medications in symptom management.

Family therapy can help everyone learn more about schizophrenia, how to recognize its symptoms, and which ways to best support a teenager with the diagnosis. Family therapy can also address group function and concerns.

For your teen, cognitive behavioral therapy (CBT) is the gold standard of psychotherapy in schizophrenia. A therapist works with your teen to develop coping strategies and to change unhelpful thoughts and behaviors into helpful ones. Other therapies, including acceptance and commitment therapy (ACT) and psychodynamic therapy, are treatment options as well.

Over time, your teen can learn how to self-manage many of the symptoms of schizophrenia, but they may need help in other ways.

As a parent, you can also:

advocate for academic accommodations, like tutors
connect your teen to support groups
help them find ways to stick to medication schedules
offer to participate with them in therapy sessions
check in with them regularly to ensure their needs are being met
encourage healthy lifestyle habits like exercise and a balanced diet