Childhood-onset schizophrenia is an exceedingly rare mental illness whose complex, multifaceted behavioral presentation can disrupt child development and raise diagnostic and treatment difficulties for attending clinicians. The disorder, affecting one in 30,000 children, shares the same diagnostic criteria and symptoms as its adult counterpart, including delusions, hallucinations, and disorganized behavior. However, with symptoms appearing prior to the age of 13, there are important differences between early-onset and late-onset schizophrenia, where "the former may be characterized by poor premorbid adjustment, a predominance of insidious versus acute onset, and poor prognosis." Children with early onset schizophrenia are often misdiagnosed and treated for myriad other disorders, leaving the underlying illness unidentified and contributing to the deterioration of health. This reality impels researchers to understand what causes schizophrenia. Family history is only a part of the equation when it comes to childhood schizophrenia. Environmental stressors have been shown to increase the risk of developing schizophrenia, even in individuals with a confirmed genetic predisposition. Childhood-onset schizophrenia may be especially influenced by "a combination of factors which in some cases leads to clinically recognizable symptoms at an unusually young age". Questions about prenatal and early developmental experiences contributing to pathological alterations in brain structure are evolving among the clinical and research community. Although treatment and management of childhood-onset schizophrenia does not fall within the required scope of competencies of most school psychologists, they must be able to recognize the symptoms, make appropriate referrals, and coordinate educational services for the affected children. In order to properly differentiate the disorder's earliest warning signs from the more frequent childhood problems, school psychologists must be especially observant of children who exhibit a constellation of symptoms approximating a common childhood disorder, in addition to atypical behaviors that do not seem to fit with it. This includes paying attention to the context(s) in which symptoms emerge, assessing the developmental appropriateness of presenting behaviors, and considering family, prenatal, and environmental factors during the initial evaluation process. Appropriate identification of the disorder will result in not only an appropriate psychiatric referral but also in effective treatment and educational services. In this article, the authors critically review the recent literature examining the contribution of environmental and prenatal factors to the development of schizophrenia. These factors include (a) maternal stress response; (b) maternal infection; and (c) prenatal nutrition.