Being Six and Schizophrenic

 

LA Times
It's been a rough week. A few days ago, at UCLA's Resnick Neuropsychiatric Hospital, 6-year-old Jani toppled a food cart and was confined to her room. She slammed her head against the floor, opening a bloody cut that sent her into hysterics. Later, she kicked the hospital therapy dog.


Jani normally likes animals. But most of her animal friends -- cats, rats, dogs and birds -- are phantoms that only she can see. January Schofield has schizophrenia. Potent psychiatric drugs -- in doses that would stagger most adults -- seem to skip off her. She is among the rarest of the rare: a child seemingly born mentally ill.


She suffers from delusions, hallucinations and paroxysms of rage so severe that not even her parents feel safe. She's threatened to climb into an oven. She's kicked and tried to bite her little brother. "I'm Jani, and I have a cat named Emily 54," she says, by way of introduction. "And I'm Saturn-the-Rat's baby sitter."


She locks her fingers in front of her chest and flexes her wrists furiously, a tic that surfaces when she's anxious.


She announces that she wants to be a veterinarian.


"I'm empathetic with rats," she says.


Asked what "empathetic" means, she smiles confidently. "It means you like rats."


The doctors have been trying a new antipsychotic medication, called Moban. Jani knows she is sick and that people want to help her.


"Is the Moban working?" her mother asks Jani during a visit.


"No. I have more friends."


Susan Schofield looks crestfallen.


She and her husband, Michael Schofield, have brought French fries. Jani takes a bite, runs around the room and circles back for another bite.


"You want the rats and cats to go away, don't you?" Susan asks, trying to make eye contact with her daughter.


Jani stuffs a French fry into her mouth.


"No," she says. "They're cool. Rats are cool."


--

About 1% of adults have schizophrenia; most become ill in their late teens or 20s. Approximately one in 10 will commit suicide.


Doctors and other mental health experts don't fully understand the disease, which has no cure. Jani's extreme early onset has left them almost helpless. The rate of onset in children 13 and under is about one in 30,000 to 50,000. In a national study of 110 children, only one was diagnosed as young as age 6.


"Child-onset schizophrenia is 20 to 30 times more severe than adult-onset schizophrenia," says Dr. Nitin Gogtay, a neurologist at the National Institute of Mental Health who helps direct the children's study, the largest such study in the world on the illness.


"Ninety-five percent of the time they are awake these kids are actively hallucinating," Gogtay says. "I don't think I've seen anything more devastating in all of medicine."


For Jani's parents, the most pressing issue is where Jani should live. She has been on the UCLA psych ward -- where she was placed during an emergency -- since Jan. 16. The ward is not designed for long-term care.


Jani can't return to her family's apartment in Valencia. Last fall, she tried to jump out of a second-story window.


Her parents -- Michael, a college English instructor, and Susan, a former radio traffic reporter -- must decide how to provide as much stability as possible for their daughter while also trying to protect their 18-month-old son.


"If Jani was 16, there would be resources," Michael says. "But very few hospitals, private or public, will take a 6-year-old."


Born Aug. 8, 2002, Jani was different from the start, sleeping fitfully for only about four hours a day. Most infants sleep 14 to 16 hours a day. Only constant, high-energy stimulation kept Jani from screaming.


"For the first 18 months, we would take her to malls, play areas, IKEA, anywhere we could find crowds," says Michael, 33. "It was impossible to overstimulate her. We would leave at 8 in the morning and be gone for 14 hours. We could not come home until Jani had been worn out enough so that she would sleep a couple of hours."


When Jani turned 3, her tantrums escalated. She lasted three weeks in one preschool and one week in another. She demanded to be called by different names; Rainbow one day, Blue-eyed Tree Frog the next. Make-believe friends filled her days -- mostly rats and cats and, sometimes, little girls.


She threw her shoes at people when angry and tried to push the car out of gear while Michael was driving. The usual disciplinary strategies parents use to teach their young children proper behavior -- time-outs, rules, positive rewards -- failed time and again for the Schofields.


"She would go into these rages where she would scream, hit, kick, scratch and bite. She could say, 'Mommy, I love you,' and seconds later switch into being really violent," Michael says.


Kindergarten lasted one week.


The Schofields consulted doctors and heard myriad opinions: bipolar disorder, attention-deficit hyperactivity disorder, ineffective parenting. No one considered schizophrenia.


In December 2007, they were referred to Dr. Linda Woodall, a psychiatrist in Glendale. Jani's medical records for the following year depict a doctor searching for effective medications while her patient slid further into a world stalked by rats and cats.


July 8, 2008: Claps hands, hops (tic-like); food can't touch; strips clothes off if she thinks they have a spot. Wants order and perfection in play, toys, stories.


Nov. 11, 2008: Talking to a "bird named 34" on her hand. Drawing on her clothes and body with permanent marker. Screaming at school and in the waiting room.


Jan. 7, 2009: Patient is psychotic; talking to rats naming them the days of the week . . . I believe it would be in the best interests of January and her family to have her placed in residential treatment. 


Continued...