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THE ROAD AHEAD I PSYCHOSIS
Psychotic disorders are a category of symptoms where people lose touch with reality – they might see or hear things that aren’t really there, have trouble speaking clearly, or believe things that are strange or not true. Explore the questions below to learn how to recognize the signs, understand what causes it, and discover effective treatment options.
What is psychosis?
Psychosis in young children is very rare, but it gets more common as kids get into their teenage years. Some symptoms of psychotic disorders are:
These symptoms look a little different in different people with psychosis, and providers give a diagnosis based on what symptoms kids have and how long the symptoms last. These are different diagnoses people can have that fall into the category of psychotic disorders:
What caregivers might notice in their child
Psychosis is not just having a lot of imaginary friends as a child or thinking about things in creative and unusual ways. It is a serious behavioral health disorder that causes a lot of problems for people in the ways they interact with others, take care of themselves, and do everyday tasks. It’s really important to get treatment for psychosis right away, because having psychosis can change the way your brain works and it usually gets worse over time. Scientists are learning more about how to recognize psychosis before people even start to have hallucinations or delusions. You might notice your child being more withdrawn, being suspicious of others, not taking care of themselves like they usually do (showering, eating, hygiene, etc.), talking about things in strange ways, or feeling like things around them aren’t real. If you notice sudden changes like this in your child, ask a provider to assess them for psychosis right away. Kids are most likely to get better and have fewer symptoms if they get help quickly.
Kids believe things that are odd or not true. They might think other people are out to get them, things they read or see have a special meaning just for them, they have special abilities or superpowers, or there is something wrong with their bodies.
Kids experience things with their senses that aren’t really happening around them. It is most common for kids to hear things, but hallucinations can also be things you see or smell.
Kids think about things in strange ways, like switching between topics that aren’t really connected. We usually know about disorganized thinking because it comes out in the way kids talk – they might switch between topics in ways that are hard to understand, or they might even put random words together that don’t make sense in a sentence.
Kids move their bodies in strange ways, sometimes they move more than usual or do strange things with their bodies, or they might move much less or hardly at all. They might not respond to things around them, sit or stand in strange ways, or not respond at all when they are told to do something.
All the symptoms we just listed are called positive symptoms of psychosis. This means they are things that start happening when someone has psychosis. Other symptoms are called negative symptoms, which are things that stop happening or that people can’t do when they have psychosis. Negative symptoms can be things like not feeling strong emotions, not being able to do things on their own, not speaking as much, not enjoying normal activities, or not wanting to do social things.
There are a few phases that your child will go through if they have psychosis. The prodromal phase of psychosis happens before your child actually starts to see or hear things that aren’t there or starts to believe strange things about themselves or the world around them. This is the best time to start getting help for them.
Some symptoms of prodromal psychosis are:
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Withdrawing from social relationships and not wanting to do things they usually like
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Being suspicious of others or not trusting others suddenly for no reason
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Not taking care of themselves the way they usually do (not showering, not eating normally, not paying attention to the way they look)
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Talking about things in strange ways, or using words or sentences that don’t really make sense
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Saying that things around them don’t seem real, or that they aren’t sure they are real or don’t feel connected to their body
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Acting differently and seeming like their personality has changed for no reason
These initial signs might tell you that an active psychotic episode is coming. If your child is having an active psychotic episode, it means they are having trouble staying in touch with reality. They might believe things that are very strange and not true, or they might see, hear, or smell things that aren’t really there. These are some things you might notice during active psychosis:
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Trouble paying attention because they are seeing or hearing other things that aren’t really there
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Being scared of things they see or hear
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Having trouble sleeping because they are seeing or hearing things that aren’t there, or because they are worried about things
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Not wanting to be alone because they might see or hear scary things
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Having strange emotions (like laughing when it’s not appropriate to laugh)
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Not being able to think straight or solve problems well
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Not wanting to eat or refusing certain foods
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Being very worried about something that is happening in their body
Are people with psychosis dangerous?
People often think that kids and adults who have psychosis must be dangerous. We don’t always understand what is happening in their brains, and many people think that if you have been diagnosed with schizophrenia, you are probably also violent and aggressive. This is actually not true most of the time – most people with psychosis are very scared of what is going on in their brains and are not aggressive or violent at all. However, people who have psychosis are at a higher risk of suicide, so it is important to ask questions about this. They may want to kill or hurt themselves because they feel hopeless and out of control with what is happening in their brain, or because they have hallucinations or delusions that tell them to do these things. If your child is experiencing active psychosis, it’s very important to talk to your provider about safety planning and what to do in a crisis. Learn more about that here.
What causes psychosis?
It’s pretty rare for young kids to have psychosis, though it does happen sometimes. Most people who have psychosis start showing symptoms for the first time between 15 and 30 years old. It’s also possible for your child to have some symptoms of psychosis when they are young but not develop schizophrenia when they are older – symptoms like this can happen in lots of other behavioral health disorders or even because of certain medications.
We know that people usually do better in the long run if they get help for psychosis really early – either in the prodromal phase before active psychosis symptoms start, or right away when they start to have delusions or hallucinations. When treatment starts right away, people usually have less symptoms later on, are able to manage their diagnosis better with therapy and medication, and are more able to do everyday tasks on their own (like have friendships, live independently, and work).
Kids have delusions, hallucinations, or disorganized speech for at least one day but less than a month. After this happens, they act normally. Sometimes this happens after a stressful event but sometimes it happens randomly and we don’t know why.
Kids have to have more than one symptom of psychosis and it has to last at least one month. If symptoms last for more than 6 months and your child doesn’t seem to be getting better, their diagnosis will probably change to schizophrenia.
Kids have more than one symptom of psychosis and it lasts for more than 6 months. Symptoms cause them problems in their everyday life (maybe they used to have a lot of friends and now they don’t, or maybe they aren’t able to go to school like their siblings did). It’s pretty rare for kids to have schizophrenia before their teenage years – most people start showing symptoms between 15 and 30 years old.
Kids have the same symptoms as schizophrenia, plus a mood episode (this could be depression or a manic episode like you would see in bipolar disorder). This is also pretty rare in kids, most people start to have symptoms of schizoaffective disorder when they are young adults.
Kids start to have psychosis symptoms because they are using drugs or chemical substances. This can happen while they are intoxicated, or actively using drugs, or during withdrawal, when they have recently used drugs and then stopped. It’s more rare for kids to have psychosis symptoms after using things like alcohol – usually people drink a lot of alcohol for many years before they have these kinds of problems. But other drugs like cannabis (marijuana/weed/pot), hallucinogens (mushrooms), or stimulants (amphetamines, cocaine) can cause psychosis symptoms more quickly, so it’s important to check in with your child if you think they might be using these kinds of drugs.
Who is affected by psychosis?
Kids who have parents, grandparents, or siblings with psychosis might be at a higher risk for psychosis too. Kids with family members who have other behavioral health problems like bipolar disorder and depression can also be at a higher risk for psychosis. Some research also tells us that being born at certain times of the year makes it more likely that people will develop psychosis. There are a lot of things that can increase risk and make it more likely that someone will have these symptoms, but there isn’t anything that tells us for sure whether or not someone will have psychosis.
Kids who experience a lot of stressful and traumatic things early in life are more likely to develop psychosis. Scientists have also found that smoking marijuana can be a big risk factor for psychosis, especially if kids start smoking when they are young and smoke a lot over a long period of time. We don’t know exactly why this is and it’s hard to prove whether marijuana can actually cause psychosis, but it’s always a good idea to monitor your child’s substance use and get support for this if you think they are smoking too much. Click here for more information on support for substance use.
Treatments that work for psychosis
There are a lot of things that you can do to help your child who is experiencing psychosis – and you’re already taking a big step by learning more! Many kids & caregivers see a lot of improvement with the right support. Here are some treatments that scientists have found to help with psychosis:
Coordinated Specialty Care (CSC) is a treatment that includes an entire care team to help teenagers and young adults who are experiencing first-episode psychosis (the first time they have had delusions or hallucinations). This is the best model for treating psychosis right away and research tells us that it can help people recover more quickly and have less problems related to psychosis later in life. If your child is over age 15 and has been diagnosed with a psychotic disorder, they are likely eligible for this service. Comprehensive Healthcare is a local provider in Yakima that offers a CSC program called New Journeys which provides therapy, school and job assistance, help for families, and medication. You can contact the program here.
Individual therapy and medication together are usually a good way to support people with psychosis, and it’s most helpful to have families involved as well. Coordinated Specialty Care (CSC) programs are typically the best way to do this, and it’s really important to make sure your child receives care from a team of providers if they are experiencing psychosis. If CSC programs are not an option for your family, make sure that you are working with providers who specialize in child psychosis and that everyone on your child’s care team is able to communicate with each other on a regular basis.
ADVOCATING FOR HELP I PSYCHOSIS
Getting support for psychosis starts with knowing what to ask for. Use the questions below to find out how to get help, talk with providers, and access the tools your child may need.
How to get help
There are a few ways to figure out if your child is experiencing psychosis. Here is how you can get started:
Therapists, psychologists, and psychiatrists can help assess your child. They might do interviews with you and your child to learn more about what’s going on, they may do tests with your child, or they might have you fill out questionnaires that ask specific things about your child’s feelings and actions. Psychiatrists can also prescribe medication for symptoms of psychosis. Psychologists can offer types of testing that can help to figure out if your child is experiencing psychosis, and how it is affecting their brain.
Click here to find a provider.
Click here to learn more about psychological assessment.
They can do a basic screening, tell you whether your child’s behaviors are typical for their age, and refer you to someone else if needed. Because psychosis is usually pretty rare in kids, most pediatricians don’t see these symptoms every day – so they can usually provide some help and support, but for long-term care it’s best to find a mental health provider that has worked with child psychosis before.
Work with your child’s school. If your child is having psychotic symptoms, it’s likely these things are going to impact them in school. Teachers and school staff will need some information to know how to help your child in school, and your child may need some extra support and help at school as well. Kids with these types of disorders often benefit from accommodations at school (these are usually called IEP’s or 504 plans).
Click here to learn more on how to talk to your child’s school.
If my child has psychosis, what treatment components should I ask my provider about?
An important part of supporting your child with psychosis is involving their family and community. It’s important for kids to have family members and trusted adults that can help them when they have thoughts and perceptions that aren’t in line with reality. It’s also important for family members to understand what psychosis is and what is happening in their child’s brain, so that they can support them in helpful ways. Psychosis is hard for family members to deal with too, so family intervention provides caregivers and other family members with a space to talk about their own feelings and what they need help with. Families also learn how to manage symptoms of psychosis, communicate better, and solve problems together.
There are some strategies that providers can use to help people with psychosis better understand what is going on in their brains. Part of the problem with psychosis is that it’s hard for people to figure out what is actually real and what isn’t, because their brains tell them they see and hear things that aren’t really there. With time, support, and practice, people can sometimes learn to recognize thoughts that aren’t accurate and sensory experiences that aren’t real. People with psychosis can also learn skills in therapy that can help them with their attention, problem-solving, social skills, and coping strategies – and all of these things are helpful to deal with the symptoms they have.
Case management provides support across lots of different areas of functioning, because people with psychosis may struggle with different things including friendships, work, school, medical care, managing their medications, and accessing other resources. Including case management as a part of their treatment plan helps make sure they are getting the support they need in all areas of life, not just in therapy.
Medication is typically an important part of managing psychosis. There is so much happening in kids’ brains when they experience hallucinations and delusions, and it’s typically hard to deal with those things without medication to help their brains work in the way they should. It’s pretty common for many people with psychosis to have a hard time taking their medication, even once they find medication that works well for them – sometimes they just forget because their brains are focused on other things, or sometimes they may even be scared of doctors or of the medication itself because of the hallucinations and delusions they have. Part of treatment is making sure they take their medication regularly like they should, and if your child is living at home with you, that’s an area where you can provide some support.
It may be helpful to make a visual chart to put somewhere in your home, and add a check mark each day when your child takes their medication. Or if it’s easier for your family, apps like Medisafe and MyTherapy can give reminders to take medication and track when you miss a dose.
Every time people have an active psychotic episode, it changes their brains. It’s really important in treatment to avoid or shorten episodes of psychosis, and there are things that kids and families can learn in treatment to identify warning signs or things that they can look out for to tell them that active psychosis might be starting or getting worse. For example, some people might be more likely to have a psychotic episode when they don’t get enough sleep, are very stressed, or use certain kinds of drugs. If we understand these patterns, we can try to stop psychosis before it happens. Relapse prevention also involves building support and skills that people can use when things get tough, like making sure kids have supportive friends and adults in their lives, putting a plan in place for who to call if things get worse, and knowing what they can do on their own when they feel scared and are struggling.
PROGRESS OVER TIME I PSYCHOSIS
This section offers a few extra tools to help you along the way. Whether things are going smoothly or getting more challenging, these resources can support you as your child grows and their needs change.
My child has a diagnosis, now what?
Once your child has been diagnosed and is getting treatment, there are still more ways you can support them – and yourself. Here are some next steps to consider:
Know that you don’t have to figure this out alone. Parenting a child with psychosis can be a huge challenge and can leave you feeling frustrated, ashamed, or burned out. Joining a parent support group (such as Parent to Parent at Children’s Village, or a Parenting Skills Class through Catholic Charities) can help you learn new strategies and get encouragement and support from other parents who are on a similar journey.
There are some excellent, practical reads written for parents like you.
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“The First Episode of Psychosis: A Guide for Young People and Their Families” by Beth Broussard, MPH & Michael T. Compton, M.D., MPH
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“If Your Adolescent Has Schizophrenia: An Essential Resource for Parents” by Raquel E. Gur, M.D. & Ann Braden Johnson, Ph.D.
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Psychotic disorders are hard to understand, and it’s important for you to have a space to talk about your experiences, thoughts, and emotions as you walk alongside your child on this journey.
Many psychotic disorders don’t fully go away, but they can often be managed successfully. When your child begins treatment, ask about how they will track progress and what are some signs you can look for that will tell you your child is improving. Also ask about long-term care – what kind of support does your provider think your child may need in the next 1-2 years? 5 years? 10 years? It’s hard to predict exactly how your child will respond to treatment and what their symptoms will look like in the future, but knowing what treatment options are available and helpful for others can help you plan for the future.
My child is getting worse, what can I do?
It’s hard to see your child struggling, especially when it feels like things are getting more intense, not better. You’re not alone—and there are steps you can take to get support and stabilize things.
Every family should have a plan for what to do if things get worse or if you or your child feel unsafe. This might include knowing who to call during a crisis (like a mobile crisis team or behavioral health urgent care), when to head to the ER, or how to calm things down safely at home. Your provider can help you build a plan that fits your family. Every child with psychosis should have a crisis plan.
Let them know what’s changed. Sometimes therapy needs to be more frequent or focused differently, or something needs to be changed in your child’s routines or environment. Be specific about what you’re seeing: more hallucinations, bigger meltdowns, school issues, more frequent outbursts, etc. This will help your provider to identify areas of change that might help your child.
Child psychosis is a rare diagnosis, and there are other things that can cause psychotic symptoms in kids, like medications, drugs, or certain health conditions. Ask your provider to screen for other things that could be causing your child’s symptoms, or making them worse.
If medication is part of your child’s treatment plan, know that it can sometimes take a bit of time and a few tries to find the medication that is going to work best for them. If your child has been on a medication for a while and things seem to be getting worse, ask your provider if it could be the medication – and what other medication options you could look into instead.
If your child is not already part of a Coordinated Specialty Care (CSC) program for early psychosis, now’s a great time to look into that. Many people with psychosis need more support (at least at first) than just going to therapy once a week. If your child is part of a CSC program and they still seem to be getting worse, talk to their care team. Identify specific symptoms and areas where you’re seeing problems, and ask if there is additional support the CSC team can provide, or whether it might be time to look into a higher level of care (like an inpatient treatment program that can provide more services for your child).
Talking with my child’s school
Your child spends a big part of their day at school—so it’s important that their learning environment supports their needs. You don’t have to be an expert in education law to advocate for your child. Here’s how to get started:
If your child already has a 504 Plan or IEP, you can call a meeting anytime – not just during annual reviews. Share your concerns, ask for updates, and discuss if changes need to be made. If your child doesn’t have a plan yet, you can formally request an evaluation to see what supports they qualify for.
Click here to learn more.
Schools respond best to clear examples. Keep track of patterns—like missed assignments, behavior changes, or stress around certain subjects. You can also ask your provider to write a summary of concerns or diagnoses to share.
Resources like Wrightslaw explain special education laws in parent-friendly language. Knowing your rights helps you feel more confident in meetings and ensures your child gets what they’re entitled to.
Understood.org and wapave.org is a great website full of free tools, templates, and stories from families navigating similar school challenges. It can help you figure out what to ask for and how to phrase it.
A behavioral health consultant or educational advocate can go to meetings with you, help interpret school evaluations, and suggest goals that actually match your child’s needs. This kind of support can make a big difference—especially if meetings feel overwhelming or you’re not sure what to ask for.
CAREGIVER TOOLKIT I PSYCHOSIS
This section offers simple, practical tools to help you support your child—from building routines and healthy habits to improving communication and recognizing their strengths. It’s also a reminder that taking care of yourself is part of the plan—you’re not alone on this journey.
Daily habits that help
Most kids thrive on routine and consistent structure, and this is especially true for your child with psychosis. In the middle of everything they are dealing with and experiencing, having routines and clear expectations at home lets them know what to expect and helps them feel safe. Kids who have psychosis might also struggle to remember to take care of themselves on their own: things like brushing their teeth, showering, taking medication, and eating can be hard to do when you have psychotic symptoms. Making these things part of a routine can make them easier to do independently over time as well.
While we can’t always predict when a psychotic episode is coming, many people are able to learn their triggers (things that make it more likely they will have symptoms or struggle with their thoughts and emotions). Part of treatment can be learning what types of things are triggers for your child: are they upset by certain noises? Do they struggle when others talk to them in a certain way? Is there a place or situation that makes their symptoms worse? Once you know what these things are, you can find safe spaces for your child to spend time when they feel upset or scared.
Encourage physical activity and exercise, healthy eating, and sleep. These things are good for all kids, but kids who struggle with psychosis can benefit even more from healthy habits. Part of healthy living with psychosis also likely means avoiding alcohol and drugs – things like this can make symptoms worse for people.
Kids with psychosis will usually struggle to pay attention to things and concentrate on what is going on around them. It can be hard for them to listen to complicated instructions and it can be especially hard for them to focus on listening and learning new information when they are in loud situations with a lot going on. To avoid frustration for both you and your child, try giving short instructions and sharing information in short sentences. Be clear and brief in what you ask your child to do, and repeat yourself as often as they need you to.
Caregiver self-care
Parenting a child with psychosis is a big job. It’s okay to ask for help, and it’s good for your child to learn that they can also ask others for help when they need it!
It may be hard for you and your child to stay calm in the midst of psychotic symptoms, but it’s important for caregivers to model calm responses for kids. If you are having trouble controlling your emotions in front of your child, it’s likely they will have trouble too. It’s okay to cry or scream or do whatever you need to when you have strong emotions, but if you can, do these things away from your child and focus on staying calm in the moment.
The more you know about what’s going on in your child’s brain, the better you can understand and deal with their symptoms. If your child talks about things they are experiencing, even if you know those things aren’t true or real, it’s usually most helpful to respond calmly and be curious. It can be easy to say “That’s not true!” or “It’s not really there, don’t worry about that.” Instead, try saying things like “That sounds really scary, I’m sure you feel really upset about that” or “I know it really feels like that’s true and you’re safe here with me right now.” Give your child the option to talk about what they’re experiencing, if they feel comfortable sharing with you.
It’s hard to manage symptoms like psychosis because they are unpredictable, and you don’t always know when things will get worse. However, it’s also not realistic for you to be available 24/7 and constantly ready to help in case of a crisis. Build in times to get some rest for yourself, whether that means partnering with another caregiver, leaving extended family members in charge for a day, or doing something for yourself while your child is in a therapy session. Even small breaks can really make a difference, so if you only have 5 or 10 minutes, make sure you’re using those times to recharge and do something to calm yourself down.
Kids with psychosis can definitely get a lot better, especially if you’re getting help early. It’s important to celebrate victories they have in treatment, whether those things are big (like getting a first job or graduating high school) or small (like remembering to brush their teeth, taking a shower, or doing a chore independently for the first time). It’s also important to be realistic and honest about what you and your child can expect as they deal with psychosis. You can talk to your provider about this too. Some people with psychosis are able to manage their symptoms well on medication and they might keep going to therapy as adults but also be able to work and have families. Other people with psychosis continue to need more support in treatment and might not be able to hold a regular job or do some things on their own. Figure out what progress is realistic for where your child is at and talk to your provider about ways to work towards those goals. Then when you reach those important milestones – celebrate them together!
Psychosis is a challenging and complicated illness, and even scientists aren’t totally sure what causes it in some people and not others. Don’t blame yourself as a caregiver – you did not cause this to happen to your child. There are lots of complicated things happening in their brains that they (and you!) can’t fully control or understand. Also, don’t be ashamed to reach out to others to share what’s going on. The illness is the problem, not you or your child. Connect with other people who already understand or are willing to learn about what psychosis is, and who can encourage you on this journey. Your child will also benefit from having more relationships with others who are willing to be a part of this journey with them.
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