Psychosis – Children & Young People
Epidemiology and presentation: Early-onset psychosis
Onset before age 18 is rare but often severe. About 10% of psychotic disorders are diagnosed by age 18, mostly in adolescents (13-17 years); childhood onset (<13) is very rare.
History: There is frequently a prior history of other childhood mental disorders and previous presentations to CAMHS (Lång et al., 2022; O’Hare et al., 2025*).
*Full references listed under Resources and Links
Differential diagnosis:
- Psychotic experiences, such as hearing voices when no one is around, are common in the general teenage population: 7 to 8% of all teenagers report them (Kelleher et al., 2012). In CAMHS populations, 30 to 50% report psychotic experiences. They are often transient and typically occur with insight.
- Psychotic disorders, such as schizophrenia, are distinguished from psychotic experiences by a loss of insight and are accompanied by:
- Marked functional impairment (e.g., sharp decline in schoolwork, social withdrawal).
- Negative symptoms (diminished emotional expression and lack of motivation).
Cannabis (or other substance) use is frequently a precipitant of psychosis, and it is important to assess drug use when a young person presents with psychotic symptoms or experiences.
Initial Assessment and management.
Where psychotic experiences are reported, assess whether these are distressing or not.
If distressing, assess for:
- symptoms of untreated mental illness (psychotic experiences are prevalent across all mental disorder diagnoses)
- Substance use
- Stress
- Sleep problems
- Suicidal thoughts and behaviour.
Psychotic experiences often improve in line with improvement in the young person’s general mental health and wellbeing.
IK & CM 16/1/26
Who to refer
Please make an urgent referral to CAMHS for those with:
- Loss of insight (fixed, false beliefs/delusions or hallucinatory experiences are believed by the young person to be real).
- Marked and progressive functional decline.
- Prominent negative symptoms (diminished emotional expression and lack of motivation).
Please see the CAMHS welcome page and CAMHS Unscheduled Care Service for contact details if same day assessment is thought to be required.
Royal College of Psychiatry information on psychosis for parents / young people / carers: https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/psychosis-in-young-people
For a recent review on psychosis in children and adolescents, see: Kelleher I. (2025) Annual Research Review: Psychosis in children and adolescents: key updates from the past 2 decades on psychotic disorders, psychotic experiences, and psychosis risk. Journal of Child Psychology and Psychiatry; 66:460-76. https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.14088
References:
Kelleher I, Connor D, Clarke MC, Devlin N, Harley M, Cannon M. Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychological Medicine. 2012 Sep;42(9):1857-63.
Lång U, Ramsay H, Yates K, Veijola J, Gyllenberg D, Clarke MC, Leacy FP, Gissler M, Kelleher I. Potential for prediction of psychosis and bipolar disorder in Child and Adolescent Mental Health Services: a longitudinal register study of all people born in Finland in 1987. World Psychiatry. 2022 Oct;21(3):436-43.
O’Hare K, Lång U, Healy C, Kougianou I, Talukder A, Murray R, Lawrie SM, John A, Kelleher I. Psychosis and bipolar disorder risk in child and adolescent mental health services in the UK: population cohort study. The British Journal of Psychiatry. 2025 Jan 1:1-7.
