15 min read

Discovering that your child or a young person you care about is experiencing unusual thoughts, perceptions, or changes in behavior can feel overwhelming. It is important to know that you are not alone, and that with early, specialized support, young people can make excellent recoveries.

Psychosis is a medical term used to describe a mental health state where a young person processes the world around them differently from those around them. It fundamentally affects how they perceive, think, feel, and behave. It is helpful to think of it as a temporary disconnect from shared reality.

Recognising the Signs: The Different Types of Symptoms

Psychosis presents differently in every young person, but clinicians generally group the experiences into two distinct categories: positive symptoms (experiences that are "added" to reality) and negative symptoms (qualities or behaviors that are "taken away" or reduced).

Positive Symptoms (Changed Perceptions)

Hallucinations: Hearing, seeing, feeling, or smelling things that others cannot. For young people, hearing voices is the most common hallucination.
Delusions: Strong, unshakeable beliefs that are not shared by others and are not supported by evidence (e.g., believing they have special superpowers or that they are being monitored or targeted).
Confused Thinking: Thoughts become jumbled, racing, or disconnected, making it hard for the young person to hold a conversation or follow a thread of logic.

Negative Symptoms (Reduced Functioning)

Becoming increasingly withdrawn, avoiding friends, and isolating themselves in their room.
Losing motivation, neglecting personal hygiene, or struggling to maintain their school or college work.
Showing less emotion, speaking in a flat tone, or losing interest in hobbies they used to love.

Types of Psychotic Profiles

Psychosis can occur on its own or as part of another overlapping mental health condition:

First-Episode Psychosis: The first time a young person experiences a sustained period of psychotic symptoms.
Schizophrenia: A diagnosis considered when psychotic symptoms have been persistently present over a longer period and heavily impact daily development. It is very rare in children under 12, with numbers rising more rapidly from age 14 onward.
Bipolar Psychosis or Psychotic Depression: Psychotic symptoms that happen exclusively during a severe episode of low mood (depression) or high energy (mania).

The Assessment and Diagnosis Pathway

National clinical guidelines stress that early recognition and rapid intervention are critical to protecting a young person's longer-term cognitive and social development.

Step 1: The Referral

If a child or young person is experiencing transient (fleeting) or mild symptoms that point toward possible psychosis, primary care providers or schools must refer them without delay to a specialist mental health service.

For children under 14, this is usually the specialist Child and Adolescent Mental Health Services (CAMHS) team.
For young people aged 14 or over, they should be referred to a CAMHS or multidisciplinary Early Intervention in Psychosis (EIP) service.

Step 2: The Specialist Clinical Evaluation

A specialist assessment is highly thorough and unhurried. For CAMHS, it must involve a consultant child and adolescent psychiatrist, while EIP assessments are conducted by a coordinated, multidisciplinary team of clinicians. The evaluation includes:

Detailed Conversations: Speaking gently with the young person and their family about what they are experiencing, how long it has been happening, and any recent life stressors.
Holistic Health Check: Looking closely at physical health, cognitive development, learning abilities, and emotional maturity.
Ruling Out Other Causes: Testing to make sure symptoms are not caused by physical conditions (like an underlying neurological illness) or substance use (such as recreational drugs or alcohol).

The Coordinated Treatment Plan

An effective treatment plan is never just about medicine; it is a holistic approach tailored to the young person's development, combining emotional, psychological, and social support.

1. Psychological Therapies (First-Line)

Psychological therapies are central to promoting lasting recovery. The primary treatments recommended include:

Cognitive Behavioral Therapy (CBT): This is a specialized form of CBT for psychosis. A trained therapist works with the young person to help them understand their unusual experiences, reduce the distress caused by voices or frightening thoughts, and build healthy coping mechanisms.
Family Intervention: A psychosis diagnosis affects the whole household. Family intervention is offered to parents, carers, and siblings to provide education about the condition, improve communication, reduce stress, and collaborate on a supportive environment that lowers the risk of relapse.
Arts Therapies: Therapies like music, art, or drama therapy are specifically considered to help alleviate negative symptoms (like withdrawal and flat emotions), typically provided in a supportive group setting by registered therapists.

2. Social and Educational Support

A major priority is keeping the young person's life as normal as possible. With appropriate consent, the care team will coordinate with the young person's school or college to secure extra educational adjustments, ensuring they do not fall behind academically or socially. Peer support groups are also introduced wherever available.

3. Pharmacological Treatment

Antipsychotic medications can be highly effective at settling jumbled thoughts and reducing the intensity of frightening voices or beliefs. However, clinical guidelines enforce a strict set of safety rules regarding their use in young people:

Guidance for Parents and Carers: How You Can Help

Stay Calm and Reassuring: If your child is seeing or hearing things you cannot, remember that these experiences feel 100% real to them. Instead of arguing about whether the voice is real, focus on validating their feelings by saying, "I know you're hearing that voice and it sounds scary, but you are safe here with me."
Create a Low-Stress Environment: High-stress, critical, or loud environments can make psychotic symptoms flare up. Keep routines predictable, speak calmly, and avoid long, complex arguments when they are feeling overwhelmed.
Look After Yourself: Caring for a young person going through psychosis requires enormous emotional energy. Engage fully with the family interventions provided, seek out carer support groups, and protect your own mental well-being.

Psychosis: A Guide for Children, Young People, and Families