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Schizophrenia is defined as “early” when the onset is observed before 18, and “very early- onset schizophrenia” if the onset occurs before 13. Under 15 years old, its incidence is equal in boys and girls but in adolescents incidence is 2 times higher with boys. Clinical aspects like sneaky onset, disorganized behavior, hallucinations are noteworthy in childhood schizophrenia and negative symptoms are more dominant compared to adulthood schizophrenia, which is the most evident difference between those ages. Therefore, the symptoms of the disease usually recognized lately or falsely. In very early-onset schizophrenia, early diagnosis and treatment would affect the long-term course positively. Today there is not a certain consensus about the antipsychotic choice in childhood and adolescent age schizophrenia. The opinions about the pharmacologic treatment of schizophrenia in child patients are limited with clinician experience, case reports and small sampled studies data. It is remarkable that there were growing evidences about the efficiency of atypical antipsychotics, especially with olanzapine, risperidone, quetiapine in recent years. The case is a 13-year-old girl presented with her biological family. The main concerns of the family were her bizarre behavior and speech, not eating or dressing on her own, loss of interest and social withdrawal. At the first interview, she did not respond to any attempt at communication and there was little random eye contact, with empty and meaningless looks She was talking to herself silently and had smiling or other facial expressions sometimes as she was speaking with someone. Her symptoms begun at the age of 10 and at the follow –up period she diagnosed as very early- onset schizophrenia. Here we discussed the patient in the light of literature, who was brought to our clinic with complaints like disorganized behavior, decrease in school success, introversion, insomnia, refusal of eating, incontinence ( both faces and urine) and followed with 4 mg/day risperidone. The one-month period of not eating or dressing on her own, social withdrawal, loss of interest and decreased psychomotor activation were possibly the elements of a catatonic picture. Risperidone was significantly effective both for positive and negative symptoms The diagnosis of very early- onset schizophrenia requires a multidisciplinary approach, a detailed and careful differential diagnosis, with particular attention to risk factors for developing very early- onset schizophrenia, exclusion of other neuropsychiatric disorders and a close long term follow up. The treatment of very early- onset schizophrenia should include psychopharmacological, social and educational approaches for both the patient and family.