Children and young people

Research on the topic of hearing voices and related issues amongst children and young people.

Altman, H., Collins, M. & Mundy, P. (1997) Subclinical hallucinations and delusions in nonpsychotic adolescents. Journal of Childhood Psychology and Psychiatry, 38, 413-420

Bettes B. A. & Walker, E. (1987) Positive and negative symptoms in psychotic and other psychiatrically disturbed children. Journal of Childhood Psychology and Psychiatry, 28, 555-568

Del Beccaro, M. A., Burke, P. & McCauley, E. (1988) Hallucinations in children: a follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 462-465

Sandra Escher , Marius Romme, Alex Buiks, Philippe Delespaul, Jim van Os (2002)., Formation of delusional ideation in adolescents hearing voices: A prospective study. American Journal of Medical Genetics, Neuropsychiatric Genetics, Volume 114, Issue 8 , Pages 913 – 920

Previous work suggests that auditory hallucinations in children and adolescents occur frequently in the absence of psychotic illness, although a number of such children go on to develop more severe psychotic symptomatology and need for care. We examined prospectively what factors are associated with formation of delusions in adolescents who are hearing voices. Eighty adolescents (mean age 12.9 years, SD = 3.1) who reported hearing voices were examined at baseline and followed-up three times over a period of 3 years. Fifty percent were receiving professional care, but 50% were not in need of care. Baseline measurement of voice appraisals, attributions, psychopathology, global functioning, dissociation, stressful life events, coping mechanisms, and receipt of professional care were used as predictors of delusion formation, measured as a score of 6 or greater on the extended BPRS items: suspiciousness, unusual thought content and grandiosity.

Thirteen children (16%) displayed evidence of delusional ideation over at least one of the three follow-up periods, of which seven (9%) de novo. Adjusting for presence of baseline delusional ideation, delusion formation over the follow-up period was associated with baseline voice appraisals and attributions such as tone of the voice (hazard ratio voice variably friendly and hostile compared to always friendly: HR = 6.8, 95% CI: 1.1, 41.0), perceived location of the voice (outside vs. inside head: HR = 2.9, 95% CI: 1.0, 8.7), and whether the voice resembled that of a parent (HR = 3.5, 95% CI: 1.0, 12.0); baseline BPRS anxiety/depression (HR = 6.4, 95% CI: 1.9, 21.4), baseline BPRS disorganization (HR = 5.0, 95% CI: 0.98, 26.1) and the baseline amount of reported recent stressful life events (HR continuous life events score: 1.8, 95% CI: 1.0, 3.3). In addition, in older children, the perceived influence of the voices on emotions and behavior was strongly associated with delusion formation (HR = 5.1, 95% CI: 1.0, 25.9).

Delusion formation in children hearing voices may be responsive to triggering events and facilitated by feelings of anxiety/depression. The results also highlight the role of attributions associated with external sources, authority figures, perceived influence or power over the person, as well as emotional appraisal processes and cognitive disorganization.

S. Escher, M. Romme, A. Bunks & P. Delespaul, J Van Os; Independent course of childhood auditory hallucinations: a sequential 3-year follow-up study (2004), The British Journal of Psychiatry (2002) 181: s10-s18

Childhood hallucinations of voices occur in a variety of contexts and have variable long-term outcomes.

To study the course of experience of voices sequentially over a 3-year period in those with and those without a need for mental health care (patient status).

In a group of 80 children of mean age 12.9 years (s.d.=3.1), of which around 50% were not receiving mental health care, baseline measurement of voice characteristics, voice attributions, psychopathology, stressful life events, coping mechanisms and receipt of professional care were used to predict 3-year course and patient status.

The rate of voice discontinuation over the 3-year period was 60%. Patient status was associated with more perceived influence on behaviour and feelings and more negative affective appraisals in relation to the voices. Predictors of persistence of voices were severity and frequency of the voices, associated anxiety/depression and lack of clear triggers in time and place.

Need for care in the context of experience of voices is associated with appraisal of the voices in terms of intrusiveness and ‘omnipotence’. Persistence of voices is related to voice appraisals, suggesting that experience of voices by children should be the target of specific interventions.

Feelgood, S. R. and Rantzen, A. J. Auditory and Visual Hallucinations in University Students Personality and Individual Differences, 1994, Vol. 17 (2): 293-296

One-hundred and thirty-six univeristy students were administered the Launay-Slade Hallucination Scale (LSHS). Low and high scorers then completed a visual and an auditory task that utilized non-hypnotic suggestion and ambiguous stimuli. The high LSHS group reported a significantly greater number of meaningful visual and auditory experiences in response to the ambiguous stimulation. It is argued that these phenomena are hallucinations and demonstrate the possibility of researching hallucinations in non-psychotic populations in a laboratory setting.

Fennig, S., Susser, E. S., Pilowsky, D. J., et al (1997) Childhood hallucinations preceding the first psychotic episode. Journal of Nervous and Mental Disease, 185, 115-117

Garralda, M. E. (1984a) Hallucinations in children with conduct and emotional disorders: I. The clinical phenomena. Psychological Medicine, 14, 589-596

Garralda, M. E. (1984b) Hallucinations in children with conduct and emotional disorders: II. The follow-up study. Psychological Medicine, 14, 597-604

Harvey, N. A. Imaginary Playmates and Other Mental Phenomenon of Children Ipsilanti: Michigan State Normal College, 1918

Kotsopoulos, S., Kanigsberg, J., Cote, A., Fiedorowicz, C., Hallucinatory Experiences in Nonpsychotic Children Journal of the American Academy of Child & Adolescent Psychiatry, May 1987, 26 (3), 375–380

McGee, R., Williams, S. & Poulton, R. (2000) Hallucinations in nonpsychotic children (letter). Journal of the American Academy of Child and Adolescent Psychiatry, 39, 12-13

Mertin P., Hartwig, S (2004) Auditory Hallucinations in Nonpsychotic Children: Diagnostic Considerations Child and Adolescent Mental Health, February 2004, Vol. 9, No. 1, pp. 9-14(6)

Auditory hallucinations in childhood and adolescence are not necessarily an indication of psychosis, but are more frequently associated with a range of other mental health problems. Although not specifically linked to abuse as an aetiological factor, the literature reporting on hallucinations in children alludes to a range of family dysfunction and disruption.

This study reports on the auditory hallucinations of 13 children referred to a community-based child and family mental health service exhibiting a variety of emotional and behavioural difficulties. The presence of the hallucinations was generally revealed during the course of the initial assessment.

None of the children were considered psychotic at initial presentation; however, all were experiencing high levels of stress and/or anxiety in their lives. Following the initial assessments children were given diagnoses ranging from generalised anxiety disorder, through adjustment disorder, to posttraumatic stress disorder. The hallucinations gradually disappeared over the course of therapy. Two case studies describe the hallucinations and family histories in more detail.

Conclusions: The present study adds further confirmation of the presence of auditory hallucinations in nonpsychotic children. The clinical presentation of the children in the present study indicates an association between hallucinations and high levels of stress and anxiety, suggesting that mental health professionals should enquire more routinely about auditory hallucinations, particularly with those children from abusive and violent backgrounds.

Pearson, D., Burrow, A., FitzGerald, C., Green, K., Lee, G., Wise, N. (2007) Auditory Hallucinations in Normal Child Populations Personality & Individual Differences, Aug. 2001, Special Issue, 31(3), 401 -407

Schreier, H. A. Hallucinations in Nonpsychotic Children: More Common Than We Think? Journal of the American Academy of Child & Adolescent Psychiatry, May 1999, 38 (5), 623–625

Vickers, B., Garralda, E. (2000) Hallucinations in Nonpsychotic Children Journal of the American Academy of Child & Adolescent Psychiatry, Sept. 2000, 39 (9), 1073

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