Ewen sits in a corner. He is quiet, seems abstracted, "quite in a world of his own" as his nursery teacher puts it. As Ewen got older, it became clear that there were gaps in his connection with the world.
He can do sums, for instance, but not necessarily the same sum twice. He seems a bit slow and clumsy - the sort of person no one wants in their team. In fact, he's the sort of person no one wants as a friend, either: he seems odd. Ewen is now in Year 6, facing secondary transfer, which, given his family, he may find stressful.
His family have problems of their own. Father works very hard and is never at home. Older sister is at music college but has had to take a year out because she lost so much weight. Mother has a smile for everyone - if they don't reel back from the whisky on her breath.
As Ewen sits there, quietly, in his corner - "at least he's quiet", his teachers always remark, without going into why this so - he is feeling not at all quiet inside his head. The strange lady who sometimes speaks to him is talking much more loudly and persistently, so that he can hardly hear the teacher. She is telling him to be bad, shout, throw books. A couple of times he has given in to her. Then he's been sent home - but he doesn't really like it at home and the lady doesn't leave him alone there either.
Spiky things seem to be growling in the air and his head hurts when he looks at a book. Perhaps it may ease things if he just does what the lady says. Perhaps it will be easier, too, than growing up and reading more difficult books, getting teased in more unfriendly playgrounds, crossing more roads in the wrong places. Perhaps someone will help if he can tell them. But Ewen finds it hard to talk about himself. When he's had to draw himself, he's often forgotten to draw in the face.
Early onset schizophrenia (EOS) is rarely diagnosed before nine. Before the age of 13, fewer than 1.8 in 10,000 are thought to suffer from this disease (they will almost all be boys). Between the ages of 13 and 18 the incidence rises sharply (as adults, 1 per cent of all men and women will suffer during their life). Young sufferers whose schizophrenia is not picked up and treated in the first two years are most at risk from suffering incurably.
Don't send Ewen home. Refer him for medical advice instead.
For more details on psychosis among young people, contact the Association for Professionals in Services for Adolescents (APSA), BHM, 1 Arun House, River Way, Uckfield, East Sussex TN22 1SL. Tel 01825 760886. E-mail: APSA@bhm.co.uk