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How do you know if your child is psychotic?

It can be extremely difficult for parents to determine if their child’s behavior is just part of normal childhood development or a sign of something more serious like psychosis. Psychosis is a mental health problem where someone loses contact with reality. The early signs can be subtle and confusing. But getting help as soon as possible is critical, so learning the warning signs is important. Here are some tips on recognizing whether your child may be experiencing psychosis.

What is Psychosis?

Psychosis refers to a loss of contact with reality. The main symptoms are delusions and hallucinations. Delusions are false beliefs that the person holds despite clear evidence to the contrary. Common delusions include paranoia, grandiose ideas, or thoughts of being persecuted. Hallucinations refer to seeing, hearing, feeling, tasting or smelling things that aren’t really there. Auditory hallucinations like hearing voices are most common.

Psychosis is associated with mental health conditions like schizophrenia, bipolar disorder, severe depression or drug abuse. It can also be caused by traumatic experiences, lack of sleep or medical conditions like thyroid problems. Psychotic episodes are characterized by a certain duration of active symptoms like delusions and hallucinations.

Age of Onset

Psychosis typically emerges in late adolescence to early adulthood. The average age of onset is:

  • Males: 18-25 years old
  • Females: 25-35 years old

But early onset psychosis before age 18 is possible too. About one-third of psychoses start before adulthood. Cases of childhood-onset psychosis under age 13 are very rare. If psychotic symptoms emerge in children under 12 years old, there is likely an underlying medical issue or substance use.

Risk Factors

Certain factors increase the likelihood of psychosis emerging:

  • Genetics – Having a first-degree relative with psychosis increases risk.
  • Drug/alcohol abuse – Psychoactive substances can trigger psychosis.
  • Trauma – Emotional, physical or sexual abuse may contribute.
  • Isolation – Lack of social support networks.
  • Stress – High levels of emotional stress.

If your child has any of these risk factors, be extra vigilant about monitoring their mental health. Seek help from a doctor or mental health professional right away if any unusual symptoms emerge. Early intervention improves outcomes.

Warning Signs

In children and teens, the early signs of psychosis can be subtle at first. Changes often unfold gradually over weeks or months. Here are some common early warning signs:

1. Withdrawing socially

Kids experiencing psychosis start pulling away from friends, family and activities they used to enjoy. They isolate themselves in their room more and avoid social interaction. This withdrawal tends to get worse over time.

2. Decline in self-care

Poor hygiene, lack of interest in appearance, and reduced motivation to shower or change clothes regularly can indicate emerging psychosis. Kids may also experience disrupted sleep patterns and appetite changes.

3. Irritability or aggression

Psychosis often causes increased anger, irrational irritation, and even verbal/physical aggression. The child may seem to flip between calm and enraged states. Angry outbursts start occurring more frequently.

4. Strange ideas or magical thinking

Kids with psychosis start expressing odd beliefs that don’t match reality. For example, believing they have special powers or are on a special mission. Odd rituals, repetitive behaviors or intrusive thoughts may emerge too.

5. Speech and thought changes

Look for rambling, disjointed or incoherent speech patterns. Responses may seem completely unrelated to questions. Kids experiencing psychosis often have racing, jumbled thoughts.

6. School issues

Problems with concentration, motivation and performance at school often indicate emerging psychosis. The child may act disruptive or get suspended suddenly.

7. Sensory changes

Complaints of random smells or sounds that aren’t real can signal psychosis. Kids may also become sensitive to light, cover their ears a lot, or say things look differently.

8. Mood changes

Rapid, inexplicable mood swings between depression, mania, laughter and crying can occur. The child may seem constantly agitated and anxious or extremely silly and giddy.

9. Paranoia

Psychosis often involves irrational suspiciousness and fears of being harmed or persecuted. Kids may start feelingwatched or controlled. Concerns that loved ones are imposters or «out to get them» are common.

10. Hallucinations

Seeing, hearing, tasting, feeling or smelling things others can’t is a core symptom of psychosis. Auditory hallucinations likehearing voices are most common. The voices may provide a running commentary on thechild’s behavior, issue commands, or have arguments with each other.

When to Seek Help

Trust your instincts if something seems «not quite right» with your child. Don’t write it off as just a phase. Any bizarre thoughts, behaviors or complaints of sensory changesdemand an immediate evaluation. Early intervention is so important with psychosis. Thelonger it goes unchecked, the more ingrained delusions become.

See your primary care provider right away if your child exhibits any psychotic symptoms. Ask for referrals to a psychiatrist and psychologist for specialized mental health treatment. With appropriate care, many kids show significant improvement. Catching psychosis early on offers the best chances of effective management. Don’t delay seeking help for your child.


Psychosis has multiple contributing factors, including:


Genes play a clear role, likely by increasing susceptibility in some people. Those with a first-degree relative who has experienced psychosis are at higher risk.

Brain Chemistry

Imbalances in certain neurotransmitters that allow brain cells to communicate, like dopamine and glutamate, influence psychosis risk. These imbalances can run in families.

Environmental Stress

High stress, traumatic experiences, discrimination, social isolation, and substance abuse may trigger psychotic breaks in susceptible individuals.

Medical Conditions

Seizure disorders, brain tumors, stroke, HIV, Alzheimer’s, Parkinson’s and autoimmune diseases can rarely cause psychotic symptoms.

Substance Abuse

Intoxication and withdrawal from alcohol or recreational drugs often induce temporary psychosis. Long-term substance abuse increases risk too.

Cause Details
Genetics Family history increases risk, likely through inherited brain differences.
Brain Chemistry Imbalances in neurotransmitters like dopamine and glutamate contribute.
Stress Trauma, discrimination, isolation, and high stress levels can trigger psychotic breaks.
Medical Conditions Seizures, tumors, HIV, autoimmune disorders and neurodegeneration may rarely induce psychosis.
Substance Abuse Intoxication, withdrawal, and long-term use of alcohol or recreational drugs increase risk.

Screening and Diagnosis

If warning signs of possible psychosis emerge, it’s essential to have your child evaluated by a mental health professional. Psychiatrists, psychologists, licensed therapists or clinical social workers can screen for psychosis and help make an accurate diagnosis. The evaluation will include:

  • Physical exam to check for medical causes
  • Lab tests to rule out drugs, infections, hormone disorders, etc.
  • Interview about symptoms, thoughts, and behaviors
  • Mental health history assessment
  • Questionnaires to measure psychosis severity
  • Observation of appearance and behavioral warning signs

Based on the results, the psychiatrist will determine if your child meets diagnostic criteria for a psychotic disorder like schizophrenia or bipolar-related psychosis. Getting the right diagnosis is crucial for effective treatment and management.

Possible Diagnoses

Psychotic disorders that may emerge in children/teens:

  • Schizophrenia – Hallmark symptoms are delusions, hallucinations, disorganized speech and behavior. Onset is typically adolescence/early adulthood.
  • Schizoaffective Disorder – Features schizophrenia symptoms along with mood disorder episodes of mania and depression.
  • Bipolar-Related Psychosis – Experiencing manic/depressive episodes plus psychotic symptoms.
  • Major Depressive Disorder with Psychotic Features – Psychosis triggered by severe major depression.
  • Schizophreniform Disorder – Schizophrenia-like symptoms lasting over a month but less than 6 months.
  • Brief Psychotic Disorder – Temporary psychotic episode lasting under a month, often triggered by stress.
  • Delusional Disorder – Persistent delusional beliefs lasting over a month but no other psychosis symptoms.
  • Psychosis Due to Medical Condition – Psychosis caused by an underlying medical illness.
  • Substance/Medication-Induced Psychotic Disorder – Psychosis triggered by intoxication or withdrawal from drugs, alcohol or medications.

Getting the specific diagnosis right is key for guiding treatment and providing prognosis information.

Co-occurring Conditions

Other mental health disorders commonly co-occur with early onset psychosis:

  • Depression – About 50% of adolescents with psychosis have depression.
  • Anxiety – Many kids with psychosis also have some type of anxiety disorder.
  • ADHD – Attention issues often predate psychosis and remain present afterwards.
  • Substance Abuse – Teens with psychosis have high rates of drug and alcohol abuse.
  • Eating Disorders – Poor body image and dangerous eating behaviors may co-occur.
  • Self-Harm – Cutting, burning or reckless behavior is more likely.
  • Suicidal Thoughts – Psychotic kids have elevated risk of suicide attempts.

Assessing for co-occurring conditions provides a fuller picture of the child’s mental health. Treating accompanying issues alongside the psychosis improves overall prognosis and quality of life.

Treatment Options

Effective management of early onset psychosis requires an integrated treatment approach:


Antipsychotic medications help reduce the severity of symptoms like hallucinations, delusions and paranoia. They work by regulating neurotransmitter imbalances in the brain. Finding the most effective antipsychotic with minimal side effects takes some trial and error. Kids also often need antidepressants or mood stabilizers.


Counseling provides coping strategies for residual symptoms, helps identify triggers, and improves family communication. Cognitive behavioral therapy is often used to manage hallucinations and irrational thoughts. Group or family therapy also helps.

Family Support

Parental education and family therapy ensures the child feels supported. A strong family unit improves treatment compliance and outcomes. Parents need info to provide a stable home environment.

Social Skills Training

Learning strategies to improve social functioning, recreational interests and independent living skills leads to greater community integration and improved quality of life.

Education/Employment Support

Tutoring, special education programs and job coaches facilitate continued education and workplace success appropriate to the child’s abilities.

Lifestyle Management

A structured schedule, regular exercise and sleep, and limited screen time helps minimize emotional stress. A healthy diet supports brain and physical health. Avoiding recreational drugs and alcohol is imperative.

Ongoing coordination between parents, schools, doctors, therapists and social services provides comprehensive care. Consistency, patience and compassion leads to the most favorable outcomes.

Coping Tips for Parents

Having a child experiencing early psychosis can be frightening and overwhelming for parents. Here are some tips that may help:

  • Learn about psychosis so you understand what your child is going through.
  • Join a local NAMI support group to connect with other parents facing similar challenges.
  • Work closely with your child’s treatment team and follow their recommendations.
  • Provide a low-stress home environment to minimize emotional upset.
  • Encourage your child to open up to you about what they are thinking/feeling.
  • Remain patient, flexible and compassionate on difficult days.
  • Don’t blame yourself or your child – focus on moving forward with treatment.
  • Make time for self-care so you don’t become burned out as a caregiver.
  • Help your child feel loved, accepted and supported throughout their mental health journey.

Caring for a child with psychosis is challenging but rewarding. With your help, many kids can gain stability and go on to lead fulfilling lives.


Determining if concerning thoughts or behaviors in your child are signs of psychosis can be difficult. Dramatic changes in personality, self-care, social interaction, speech, thinking, mood and beliefs demand an immediate evaluation. Don’t write things off as just a phase – trust your instincts if something seems “not quite right.” Getting a comprehensive mental health assessment quickly is essential. Prompt treatment helps minimize the impacts of psychosis and improve prognosis. With compassionate support from loved ones and access to effective therapies, many children can successfully manage psychotic disorders. Early intervention offers the best chances of recovery and future well-being for your child.