Don't Panic if your child is hearing voices - It´s not the end of the world 0
Page updated 04/07/2008
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Information about Children and Young People who Hear Voices for Parents and Carers
Dr. Sandra Escher is from the Netherlands, she is an expert on the issue of children who hear voices and has spent the last fifteen years talking to children who hear voices and to their parents and carers. Sandra has carried out the most detailed and thorough research into the phenomenon in the world to date. In this article she offers a new perspective on what the voices may represent and how you can help your child cope if they are hearing voices.
Why we have written this information leaflet
Introduction
How do most parents react when their child talks about hearing voices?
“Normal” children and adults hear voices
Hearing voices and traumatic experiences
Voices as messengers
For many children voices disappear over time
The voices may stay but children can cope with them
Supporting your child
More information
A 10 point check-list
Further reading
Why we have written this information leaflet
We have written this information leaflet for parents and carers in the hope that it will enable you to develop a new and more empowering way of thinking about the your child's experiences and that it will help you in finding ways to assist your child in their emotional development and recovery from hearing overwhelming voices.
Unfortunately, there is very little practical advice available about children who hear voices that addresses your needs as parents and family members, this is a shame because you are the most important form of support to your child. So, we wanted you to know that there are some simple common sense things that you can do to help your child. We hope you will find the information helpful.
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Introduction
First things first, From the research that we have carried out into the experience of adults and children who hear voices it has became apparent that:
How do most parents react when their child talks about hearing voices?
When you find out that your child hears voices it can be devastating. Some parents have said it “felt like my whole world had collapsed." This reaction is understandable, for as parents we are naturally very protective of our children and do not want to see them distressed, hurt or confused. However, there is a crucial question that needs to be asked about why we react in this way when we discover a child is hearing voices.
Our reactions are based on information we have picked up about the meaning of hearing voices. Mostly these are based on assumptions held by society, especially the widely held belief that to hear voices is the same as the mental illness “schizophrenia”.
The good news is that this belief is not correct. Whilst it is the case that hearing voices is apparent in about 60% of the persons who have been diagnosed with schizophrenia. It is not the other way around! If you hear voices that does not mean you have schizophrenia.
There is an even more important issue that you may not be aware of: hearing voices in itself is normal - but – it is possible to become ill from hearing voices if you cannot cope with them. This means that it is coping with hearing voices that is the problem and not the voices in themselves.
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Normal” children and adults hear voices
This little known fact is based on a lot of research. Several large scale population (epidemiological) studies have shown that about 4 % of the population hears voices. Of these 4% of the people who hear voices about 30% seek assistance from mental health services. Amongst children however, even more of the “normal” population hears voices (8%) and as with adults about 30% are referred to mental health services.
What this means is that there are apparently many more people who hear voices who do not require the support of mental health services then those that do. This is because they can cope with the voices and function well in in their everyday lives.
Unfortunately, most of the information that we have about the experience of hearing voices comes exclusively from research with patients; people who obviously cannot cope with the voices and needed help. These are people who feel that the voices made them feel powerless and who were overwhelmed by them. This is the case for research for adults and children who are hearing voices. However, in other articles on this site you can find out more about people who can cope with their voices or even have positive experiences.
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Hearing voices and traumatic experiences
In our research we found that a common theme in both groups (adults and children) is the high percentage of traumatic experiences that have been found to have been the trigger for hearing voices. In adults around 75% began to hear voices in relationship to a trauma or situation that made them feel powerless.
Examples of the kinds of traumas that trigger voices include the death of a loved one, divorce, losing a job, failing an exam, but also longer lasting situations like being physically, emotionally or sexually abused. With children the percentage was even higher at 85%, with some traumas specifically related to childhood. These traumas might include being bullied by peers or teachers, or being unable to perform at a certain level at school, another commonly reported traumatic incident related to hearing voices is being admitted to a hospital for long periods because of a physical illness.
I would say that hearing voices is mostly a reaction to a situation or a problem the child or young person cannot cope with.
It is a signal.
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Voices as messengers
Another striking finding is that what the voices say often gives an indication of the problem that the child has.
An example:
The voices told an 8-year-old boy to blind himself. This frightened his mother. But when we discussed whether there was something in the life of the boy he could not face, she understood the voices message. The boy could not cope with the problematic marriage of his parents. He did not want to see it.
What we saw in our research is that if attention was given to the problems the child was facing, they will be able to establish a more constructive kind of relationship with the voices. As a result children become less afraid of their voices. When a child is able to consider the problems that are at the root of their distress and with the emotions and feelings involved, the voices stop being the child's only focus of attention.
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For many children voices disappear over time
Recently I conducted a 3-year follow up study on 80 children who heard voices who were aged between 8 and 19 years of age. Half of this group of children were receiving mental health care because of their voices, however, the other half were not in care at all. I interviewed the children 4 times at yearly intervals. At the end of the research period 60% of the children I interviewed reported that the voices had disappeared.
Of course figures and statistics like this do not directly relate to you. But the overall message is that the chance that the voice might disappear is quite high.
We saw that the children's problems often stopped their development through the voice experience. However, if the problems were handled or their situation changed; for example because the child changed schools, the voices disappeared.
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The voices may stay but children can cope with them
It is important that we appreciate that the the desire to make the voices disappear is a goal of the mental health care services and not necessarily that of the children themselves. There are some children who did not want to lose their voices. This is OK, for the most important thing is that the voices no longer remain at the centre of their attention. This is because as the relationship with the voices changed and became more positive, instead of hindering the child the voices start to take on an advisory role. If children find within themselves the resources to cope with their voices and the emotions involved with hearing them then they can lead happy and balanced lives.
Supporting your child
The most important element in the process of positively changing your child's relationship with their voice is the support they got from the family. Unfortunately, our research has shown that being in the mental health care system had no positive effect on the voices, although we did find that being referred to a psychotherapist who accepted the reality of the voices and were prepared to discuss their meaning with the child did have a positive influence on how the child coped with their voices.
We also saw that “normalising” the experience can help parents to deal with the voices – try not to think of it as a terrible disaster, but as a signal for something that is troubling your child and that can be resolved. On the other hand, if parents cannot accept that voice hearing in itself is normal, but believe the voices to be an illness and are afraid of the voices, then the child naturally picks up this feeling. Imagine for a moment if you were the child and were afraid of the voices and when you looked for support from your Mum and Dad you found that they were even even more afraid of the voices then you were. This would obviously put you under great pressure and probably mean that you would become reluctant about talking about your experiences at all.
There is a second problem,at if you are afraid of the voices then you can become obsessed with the fear of the voices alone and not what the voices mean. When you are distressed and anxious you cannot listen very well to the story your child tells about their experiences and may fail to pick up on the related problems and emotions that the voices represent.
In our experience what helps children the most is a systematic approach to understanding the voices. So to help we have developed an interview to help map the experience. This can be used as a way to understand the stress the child is under and then to work together to find solutions for the problems raised by the voice hearing experience..
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More information
This information is just a brief introduction to a new way of thinking about children who hear voices that might help you to face the problems you have. If you want more information about the research, about the elements of the therapy that helped the children or you want a copy of the interview form we used to in our research to help you with your child please let us know.
Sandra Escher, MPhil, PhD.
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A 10 point check-list
1. Try not to over react, although you will be understandably worried, work hard not to communicate your anxiety to your child.
2. Accept the reality of the voice experience for your child: Ask them about their voices, how long they have been hearing them, who or what they are, do they have names, what they say etc.
3. Let your child know that lots of children hear voices and mostly they go away after a while.
4. Even if the voices do not disappear your child can learn to live in harmony with his/her voices
5. It is important to breakdown your child's sense of isolation and differentness from other children. Your child is special, unusual perhaps, but normal.
6. Find out if your child has any difficulties or problems that they are finding very hard to cope with and work on trying to fix these problems. Think back to when the voices first started, what was happening to your child when they first heard voices? When did the voices arise for the first time? Was there anything unusual or stressful that might have occurred?
7. If you think you need outside help, find a therapist who is prepared to accept your child's experience and work with your child in a systematic way to understanding and cope with their voices better.
8. Be ready to listen to your child if they want to talk about their voices and use drawing, painting, acting and other creative ways to help them describe what is happening to them.
9. Get on with your lives and try not to let the voice experience become the centre of your child's life or your own.
10. Most children who live well with their voices have supportive families living around them who accept the experience as part of who their child is. You can do this too!
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More articles about children and young people who hear voices here.
Further reading about children who hear voices from Sandra and other researchers
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
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
Kotsopoulos, S., Kanigsberg, J., Cote, A., Fiedorowicz, C., Hallucinatory Experiences in Non psychotic 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 non psychotic 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)
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 Non psychotic 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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Normal people and hearing voices
Barret T.R and Etheridge J.B (1992) Verbal hallucinations in Normals I: People who hear voices Applied Cognitive Psychology, Vol. 6, pp. 379-387
Vanessa Beavan, John Read and Claire Cartwright (2006)Angels at our tables: A summary of the findings from a 3-year research project into New Zealanders’ Experiences of Hearing Voices, University of Auckland, New Zealand
Eaton W.W., Romanoski A., Anthony J.C., Nestadt G. (1991), Screening for psychosis in the general population with a self report interview, Journal of Nervous and Mental Disease, No. 179, pp 689 693
Feelgood, S. R. and Rantzen, A. J. Auditory and Visual Hallucinations in University Students Personality and Individual Differences, 1994, Vol. 17 (2): 293-296
Honig, A.; Romme. M.; Ensink, B.; Escher, S.; Pennings, M.; Devries, M.W. (1998): Auditory Hallucinations: A Comparison between Patients and Nonpatients. The Journal of Nervous and Mental Disease, 186 (10), 646-651 Posey T.B. and Losch M.E. (1984), Auditory hallucinations of hearing voices in 375 normal subjects Imagination, Cognition and Personality, vol 3, no.2, pp. 99 113
Tien A.Y. (1991) Distributions of hallucinations in the population Social Psychiatry and Psychiatric Epidemiology, No.26, pp. 287 292
John Watkins: Hearing voices - A Common Human Experience: published in 1998 by Hill of Content Publishing, Melbourne, Australia, ISBN 0-85572-288-6
J. Watkins; M. Romme; S. Escher (2003). Hearing voices: A common human experience. Nordic Journal of Psychiatry, Volume 57, Issue 2 March 2003 , pages 157 - 159
Copyright 2008 Sandra Escher
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Children hearing voices study 1996 - 2001, The Guardian, 16/11/2001 2
Last updated 11/06/2007
Extract from the Guardian (UK) Newspaper, 16/11/2001
A groundbreaking four-year study of 80 children aged between eight and 18 by researchers at Maastricht University in Holland, may well change both public and professional attitudes about voices.
Although 40 of the children were receiving mental health care when the research began, this number more than halved to 18 after four years - challenging the traditional view that voices are a sign of long-term illness.
The study was led by one of Europe's most eminent psychiatrists, Professor Marius Romme, researcher Sandra Escher and psychologist Alex Buiks, who first proposed that voices should be treated as real experiences rather than delusions.
After interviewing hundreds of adult voice hearers in the 1990s - many of whom had no mental health diagnosis - Romme and Escher concluded that many people could learn to control disturbing voices if they talked back to them.
They decided to examine voice hearing in children as many patients revealed that their voices had first emerged in childhood. The aim was to see whether early therapeutic intervention could prevent people from being labelled with a diagnosis and condemned to spending years in the psychiatric system.
For graph of progress of children during study click here
For review of the research study click here
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Most children hearing voices stop within three years, Royal College of Psychiatry, 03/09/2002 6
Last updated 11/06/2007
This press release was made to announce the findings into the research into children who hear voices conducted by Dr. Sandra Escher and colleagues:
3 September 2002, Press Release Royal College of Psychiatry:
The majority of children hearing voices stop reporting the experience over the course of three years, according to a new study.
Voice appraisals, and associated anxiety and depression, are better predictors of voice persistence than ‘traditional’ measures of psychotic symptoms and problem behaviour.
The aim of the study, published in a supplement to the September 2002 issue of the British Journal of Psychiatry , was to examine the course of experience of voices sequentially over a three-year period in children with and without a need for mental health care. Childhood hallucinations occur in a variety of psychiatric states, such as schizophrenia, anxiety and depression, migraine and trauma.
Long-term follow-up studies have suggested variable outcomes for hearing voices. It is known that there are pathological and non-pathological hallucinatory experiences.
A recent study found that around 8% of children reported hearing voices, of whom only a third had a psychiatric illness. In this study baseline measurements were made among a group of 80 children with an average age of 12.9 years who were hearing voices, of whom about half were not receiving mental health care.
Voice characteristics (e.g. volume, tone and frequency), voice attributions, psychopathology, stressful life events, coping mechanisms and receipt of professional care were then used to predict what would happen over the next three years.
It was found that rate of discontinuation of the voices over the three year period was 60%. Those children receiving mental health care more often reported the presence of emotional triggers to the voices and more often reported childhood adversity. They had more negative feelings about their voices, and more often felt that the voices influenced their emotions and behaviour.
There was no difference between those receiving and not receiving mental health care in terms of total coping score, but children receiving care made use less often of passive problem solving, like ignoring the voice, listening selectively or doing something. This is in line with the view that the need for care is related to the way the person interacts with their experience of voices, rather than just the experience itself.
Severity and frequency of the voices predicted whether they would persist over time, as did anxiety and depression associated with hearing the voices and lack of clear triggers of time and place for the voices. If children are able to identify triggers of time and place (e.g. hearing voices only at school, or when alone in their bedroom at night), they are more likely to overcome the experience than if the voices are around all the time. Children who need professional help are more likely to feel overpowered by the voices.
The more people the children had told about the voices, the more likely they were to persist. This suggests that the need for mental health care is to a large extent associated with the child’s (and parents’) appraisal of the voices rather than the perception itself. Having mental health care did not in itself make it more likely that the voices would stop. This may be because at the time of the study, most care appeared to be directed towards suppressing voices rather than coping with them.
The authors comment that as persistence of voices is related to voice appraisals, the experience of voices by children should be the target of specific interventions.
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