Hallucinations in Children
Hallucinations + Psychotic Symptoms = Disorder
Oftentimes, hallucinations in children are seen as a concern for both parents and clinicians; however, not always are they a symptom of a mental illness. In fact, hallucinations in children are quite common and part of a normal development. Some other causes of hallucinations, or false sensory perceptions unassociated with real external stimuli, are: stress, developmental difficulties, nonpsychotic psychopathology, psychotic illness, and family dysfunction. Yoshizum and colleagues studied a sample of 11-year-old children and found that while hallucinations were present in eight to 21 percent of them, two-thirds of those children did not have a DSM-IV-TR diagnosis. Other studies support the statement that children who experience hallucinations yet do not have any other psychotic symptoms will have a better mental health prognosis than children who do exhibit psychotic symptoms.
While there are other reasons children experience hallucinations, psychiatric disorders may be the root cause. For example, schizophrenia, schizophreniform disorders, and mood disorders with psychotic features all include hallucinations as symptoms. However, there are other psychiatric disorders in which hallucinations are not symptoms of, but can occur as associated symptoms.1 Examples of such disorders are ADHD, disruptive disorders, anxiety disorders, posttraumatic stress disorder, dissociative disorders, and oppositional defiant disorder.1 Also, some medicines, such as steroids, anticholinergics, and stimulants, can cause hallucinations to occur, as well as the abuse of illegal substances.1 Children may also form hallucinations to deal with abuse or in mourning of a deceased parent.
Medical Causes for Hallucinations
There are also many medical causes for hallucinations, including metabolic disorders, fever, and infections. Also, seizure disorders can cause hallucinations, although rare. Usually the hallucinations associated with seizures are unformed, such as flashing lights or rushing noises, or formed, such as images, spoken words, or music.1 Migraines, which occur in about five percent of children, often cause visual hallucinations.
Despite the cause of hallucinations, there are treatment options. First and foremost, addressing any underlying medical or psychiatric condition is imperative, including substance abuse.1 While there is no age at which it is better to begin treatment for children at risk for developing a psychotic disorder, the earlier the symptoms are noted, the better. Although many assessment scales that aid in early identification are not standardized for children, there are some that can still assess a child accurately, including the Scale of Prodromal Symptoms, Structured Interview for Prodromal Symptoms, Comprehensive Assessment of At-Risk Mental States, and the Bonn Scale for the Assessment of Basic Symptoms.1 Also, a child may be considered to be prodromal if there has been a 30 percent drop in their Global Assessment Functioning score within the past month or if a relative has affective or nonaffective psychotic disorder or schizotypal personality disorder.
Treatment for Hallucinations
While treating a child with antipsychotics should be done cautiously, the use of cognitive-behavioral therapy (CBT) is safe and effective.1 CBT is known to slow the progression of a child to psychosis, especially in high-risk patients. The focus of the therapy is on the underlying and personalized meaning of the hallucinations, and the child learns to understand what the hallucinations mean, how they began, what they are, and how the child can stop them. Coping strategies, including “normalizing” the hallucinations, are used. The therapist oftentimes explains the common reasons the hallucinations occur, including lack of sleep, isolation, extreme stress, fever, lack of food, and substance abuse.1 Also, the child learns that the voices are only real if they believe them, learning to cope with the hallucinations by humming, listening to music, reading, exercising, singing, taking medicine, and ignoring them.1 Through CBT, children are able to control their hallucinations.
 Sidhu, K.A.S.; Dickey, T.O. (2010). Hallucinations in Children: Diagnostic and Treatment Strategies. Current Psychiatry 9(10): 53-60.
 Sadock BJ, Sadock VA. Kaplan and Sadock’s concise textbook of clinical psychiatry 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008:26.
 Kotsopoulos S, Konigsberg J, Cote A, et al. Hallucinatory experiences in nonpsychotic children.- J Am Acad Child Adolesc Psychiatry. 1987;26:375-380.
 Yoshizumi T, Murase S, Honjo S. et al. Hallucinatory experiences in a community sample of Japanese children. J Am Acad Child Adolesc Psychiatry 2004;43:1030-1036.
 Rothstein A. Hallucinatory phenomenon in childhood: a critique of the literature. J Am Acad Child Psychiatry. 1981;20:623-635.
 Sadock BJ, Sadock VA. Kaplan and Sadock’s synopsis of psychiatry. 9th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2003:1276-1277,1283.
 Yates TT, Bannard JR. The “haunted” child: grief, hallucinations and family dynamics. J Am Acad Child Adolesc Psychiatry. 1988;27:573-581.
 Pao M, Lohman C, Gracey D, et al. Visual, tactile, and phobic hallucinations: recognition and management in the emergency department. Pediatr Emerg Care. 2004; 20:30-34.
 Schreier HA. Auditory hallucinations in nonpsychotic children with affective syndromes and migraines: report of 13 cases. J Child Neural 1998;13:377-382.
 McGorry PD, Yung AR, Phillips LJ. The “close-in” or ultra high-risk model: a safe and effective strategy for research and clinical intervention in prepsychotic mental disorder. Schizophr Bull. 2003;29(4):771-790.
 French P, Shryane N, Bentall RP, et al. Effects of cognitive therapy on the longitudinal development of psychotic experiences in people at high risk of developing psychosis. Br J Psychiatry Suppl. 2007;51:s82-87.
 Turkington D, Siddle R Cognitive therapy for the treatment of delusions. Advances in Psychiatric Treatment. 1998;4:235- 242.
 Sosland MD, Pinninti N. Five ways to quiet auditory hallucinations. Current Psychiatry. 2005;4:40. Hallucinations.