8 - Psychosocial factors: the social context of child and adolescent onset schizophrenia

Summary

Introduction

Scientific advances over recent years have contributed to an emerging consensus that schizophrenia is a biologically based disorder. This biologically based view has been complemented, however, by accumulating research demonstrating that: (i) the disorder has a profound effect on the adolescent's psychosocial functioning, and (ii) the psychosocial environment in which an adolescent develops has a major impact on the expression of the disorder (for review, see Asarnow, 1994). Furthermore, the current emphasis on treating adolescents within the least restrictive setting has highlighted the stressors involved in rearing adolescents with schizophrenia and the need to attend to stress levels and coping efforts among parents, siblings, and other family members who are critical partners in the treatment process.

This chapter focuses on psychosocial factors in child and adolescent onset schizophrenia with the goal of highlighting promising psychosocial treatment strategies. We begin by examining current knowledge with respect to the psychosocial functioning of adolescents with schizophrenia. Secondly, we review current models for the psychosocial treatment of schizophrenia. Thirdly, we turn to the implications of current knowledge for the psychosocial treatment of adolescents with schizophrenia and conclude by offering suggestions regarding future directions for clinical research and treatment.

Schizophrenia in adolescence: psychosocial functioning and developmental progressions

Consider the following descriptions of the psychosocial impairments experienced by adolescents with schizophrenia:

Impaired academic and school functioning

All of a sudden I couldn't read or write or do maths anymore. Everything was so confusing because I couldn't understand anything that was going on around me

(Anonymous, 1994, p. 587).