Special Groups to Consider

People of any age, gender, race, or ethnicity can have schizophrenia. It is most commonly diagnosed in young adults, so a lot of research focuses on this age group. But children and older adults can be diagnosed with schizophrenia, too. And it may affect these different age groups differently. Schizophrenia also may impact people of different races and ethnicities in unique ways.^1,2

Schizophrenia in kids

The two most common forms of schizophrenia in kids are called childhood-onset and early-onset schizophrenia. Childhood-onset is diagnosed before the age of 13. Early-onset is diagnosed between the ages of 13 and 18. These are both very rare, with childhood-onset being the rarest.³

Stronger genetic risk factors or brain development issues are often present in these cases. Autism, problems with social functioning, and learning difficulties are more common in those with childhood-onset schizophrenia as well. Trauma during birth or a parent’s drug use may play a role in the development of schizophrenia in kids, too.^3-5

Symptoms of schizophrenia in kids are usually more severe than those in adults. Treatment is similar across age groups, though. Antipsychotic drugs and therapy are the main options. But kids may be more sensitive to drugs than adults. Doctors must work to find the right dose and schedule for each person.⁶

Spotting the symptoms in kids

Kids with schizophrenia are more likely to have hallucinations than delusions. Having hallucinations means perceiving things that are not there. Having delusions means believing things that are not true. A common hallucination in kids is hearing commanding voices.^3,4

It can be hard to diagnose kids with schizophrenia. Each child develops differently, and behavioral and learning challenges are common. It is also normal for kids to have magical beliefs or play pretend. Children will have difficulty differentiating between internal monologue from hearing voices. This can make spotting actual hallucinations and delusions more challenging.^3-5

In adolescents, some early signs of schizophrenia may be considered normal and thus dismissed by loved ones. These signs may include but are not limited to moodiness and lack of motivation. But the earlier a child receives a diagnosis and starts treatment, the better. Delays in diagnosis can lead to more severe symptoms later on.^4-6

Schizophrenia in older adults

Being diagnosed with schizophrenia after age 40 is rare, but it can happen. This is called late-onset schizophrenia. Women are more likely to be diagnosed later in life than men are. New onset symptoms later in life may also be a sign of an underlying illness and needs to be assessed by a doctor. Late-onset schizophrenia is very rare without something else going on like substance use or neurological changes.⁷

In late-onset cases, delusions, hallucinations, and disorganized symptoms are present. But these symptoms have less impact on daily life than in earlier-onset cases.⁷

There are special things to think about when treating older adults for schizophrenia. Doctors have to consider:^7-9

• Changes in the way the body processes drugs as people age
• Increased sensitivity to drug side effects
• Co-occurring health issues that limit which drugs can be used
• Social changes (like the loss of loved ones or loneliness) that can impact motivation
• Changes in income or health insurance
• Changes in cognitive function (thinking) or other disability that makes it hard to understand treatment plans

This is not a full list of issues that should be considered for older adults with schizophrenia. Your healthcare team will work with you to create a plan that meets all of your needs, no matter what stage of life you are in.

Childhood-, early-, and late-onset schizophrenia can take a unique toll on overall health. Drug side effects and co-occurring health issues are common. These factors can shorten a person’s life span. But a growing number of people are living longer with serious mental health issues like schizophrenia than ever before. Nearly 5 percent of adults over 65 have at least 1 serious mental health condition.^7,8

Schizophrenia, race, and ethnicity

Race and ethnicity play a role in schizophrenia treatment and diagnosis, too. For example, in the United States, Black people are more often diagnosed than white people who have the same symptoms. But they are less often prescribed mental health drugs. On the other hand, white people are more likely to be diagnosed with mood disorders like depression.^2,9

Medical bias among healthcare workers exists and must be considered when looking at these trends. For example, there is some evidence that psychotic disorders are over-diagnosed in Black Americans. But research has found that people of color also are more likely to have common risk factors for schizophrenia. These risk factors include having:^2,9-12

• Higher stress levels
• Lower income
• History of trauma
• Language barriers and other troubles accessing healthcare that cause delays in care

Delays in diagnosis and treatment can lead to worse overall outcomes. Combating differences in schizophrenia care related to race and ethnicity are key to creating better outcomes for all.¹⁰