Diagnostic challenges in children and adolescents with psychotic disorders

The diagnosis of psychotic disorders in children and adolescents is often complex and challenging. The symptomatic overlap between different psychotic conditions and other emotional, behavioral, and developmental disorders has led to high rates of misdiagnosis, especially at time of onset. The clinical expression and progression of diagnosable disorders are affected by maturational processes. Thus, psychotic illnesses in pediatric patients may vary from adult presentations because of developmental factors. Establishing a specific diagnosis is difficult when the differential diagnosis comprises disorders that share common symptoms and are frequently comorbid. The clinical assessment depends as much on input from parents and teachers as from the patients themselves, and there may be conflict between these different perceptions. This article reviews recent research and current concepts relating to diagnostic challenges in pediatric psychiatry.