Chapter

Hallucinations in children and adolescents

Jean-Louis Goëb and Renaud Jardri

in Hallucinations

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199548590
Published online February 2013 | e-ISBN: 9780191754623 | DOI: http://dx.doi.org/10.1093/med/9780199548590.003.0015
Hallucinations in children and adolescents

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Hallucinations are a common symptom in paediatric populations, which can be a transitory phenomenon but which can also constitute a serious cause of concern since it may be a sign of physical or mental illness. Available studies in the literature effectively established that hallucinations and delusions may occur in both clinical (neurological, psychiatric, or other pathologies) and non-clinical (i.e., normal) individuals, leading some authors to question the diagnostic specificity of these experiences during childhood (Larøi et al., 2006). It is important to mention that ‘non-diagnostic hallucinations’ can constitute normal features of child development related to psychological immaturity (Schreier, 1998; Sosland & Edelsohn, 2005; Edelsohn, 2006), and it seems most appropriate to first consider hallucinations as non-specific symptoms. In this way, much attention has to be drawn to the child's global clinical presentation and his/her social and familial context. Later on in the text, we will discuss that hallucinations may also be a symptom of psychosis or future emergence of the pathology. However, since early-onset psychosis is often difficult to diagnose, the question of whether to treat and how to treat remain debatable topics. Some authors proposed that since the diagnosis-specificity longitudinally improves, time and clinical evolution constitute the best diagnostic tools (Jeammet, 2000). Various clinical presentations may be characterized by disturbances in thinking and perception that are not clearly psychotic, accompanied by non-specific conduct disorders, such as recent, abrupt, or more insidious changes in sleeping, eating, global behaviour, or mood. A first prodromal period may last several years with non-specific signs such as deteriorating academic and social performance, emerging conduct problems, including delinquency and substance misuse or abuse, and pseudo-neurotic disorders (Biderman et al., 2004). In such prodromal cases, early treatment has been shown to be associated with better prognosis (McGorry et al., 2002; Yung et al., 2005). The non-identification of this syndrome can have devastating consequences, but on the other hand, systematic medication of children with hallucinations using anti-psychotic drugs in the emergency setting should be avoided until a complete exploration has been performed. Clinicians need to be aware of the wide range of differential etiological diagnoses, including medical (mainly metabolic and neurological), or psychiatric ones (schizotypy, schizophreniform disorders, early onset schizophrenia, mood disorders, traumatic life events such as sexual abuse, bereavement, bullying, post-traumatic stress disorder (PTSD), and other anxiety disorders, ADHD). Adequate explorations, monitoring, and therapeutic guidelines for hallucinatory experiences in children and adolescents will be considered in more detail.

Chapter.  10264 words.  Illustrated.

Subjects: Psychiatry

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