Why Do Children Hear Voices? |
Understanding Child Development
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Children can hear voices for many reasons.
These reasons can include trauma, dissociation, psychosis, normal development, and complex family dynamics.
Why do children hear voices? I have written or spoken on this topic many times. I have done so as an academic researcher, as a program director of a first episode psychosis program, and now as a psychiatrist and psychoanalyst in private practice. I am definitely experiencing an un-learning.
When I go over my talks or writings from my time as a researcher, I realize that I took great confidence from the data I presented. When I gave the talk as a clinician, actually seeing young people who experienced voices, I felt a niggling sense that there was more to the story—I didn’t understand all the reasons my patients heard voices. I hadn’t yet been exposed to a vocabulary for their experiences. Now in private practice, I have the luxury to spend more time with people than just 20-minute medication management appointments, and with the added insights of analytic training, I am more open to the richness of the voice-hearing experience, and that niggling sense I had a few years ago has blossomed into a full awareness; the more I learn, the less I know.
So I will talk about some data, a number of clinical examples, and my own conjectures. But in the end, I really don’t know very much with certainty, except this: Children hear voices for all sorts of complex reasons.
First, a story. Anna’s mom contacted me because her school had put her on a medical leave until she got evaluated by a psychiatrist. She had reported hearing voices and seeing a ghost that told her to do things. I saw Anna once. What I saw was a 10-year-old girl who was off-the-charts smart, the kind of genius that sets children too far apart to adapt to others. The world is not designed for people, especially children, who are so outside of the normal range of IQ.
Anna was so bright that the IQ difference between her and a child of average intelligence was as profound as the difference between the IQ of an average child and a child with severe developmental delay. For Anna, other children must have been so boring. Her family was boring. Most books—and she read voraciously—were boring. What wasn’t boring was her incredible, sparkling mind. For the most part, her voice-hearing experience was one of entertainment, and a bit of embellishment—sometimes you have to make your own fun. Was that the full meaning behind her voice hearing? I don’t know; I only saw her the one time.
A different little boy I saw, Jake, also heard voices. I was asked to see him by his school district, and we met many times. His mother was struggling with terrible issues: substance abuse most immediately, and a horrific trauma history more distantly. His father was not his biological father, a secret that was tearing the family apart.
In the months we worked together, his parents separated. Both parents feared Jake. His biological father had been abusive, erratic, and heard voices. Jake seemed unpredictable around his younger half-siblings. He didn’t know, but certainly sensed, that he was the odd one out of the family, half wanted, not the same. He started hearing voices and talking to his toys while insisting they talked back to him.
Unlike Anna, he was not so smart. In fact, he was on the edge of being developmentally disabled. But like Anna, he was creative, imaginative, and comforted by his voices. They kept him company in a family where he always felt like an outcast.
Here are some statistics. Childhood-onset schizophrenia has an incidence of 1 in 10,000 children. And yet between 10 and 18 percent of children hear voices. So perhaps we can jettison the reified diagnosis of schizophrenia almost entirely when we talk about children.
Here is another statistic. In a group of over 400 young people with early psychosis in a national first-episode psychosis study, over 80 percent of them reported a significant trauma. This suggests that for most young people with psychosis, their symptoms are preceded by a significant trauma.
So many of the young people I saw at PEACE, the first-episode program I started, had terrible, traumatic childhoods. Barely out of childhood when they came to us in their early teens, some had heard voices for years before the other symptoms of psychosis began to unravel them. Children with frank sexual and physical violence in their homes. Children with terrible neglect. Children who knew they were unwanted and unloved. Children who held their chaotic family together with their “crazy” symptoms.
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While if in the first part of my career I followed my training to “ignore” the content of my patients’ voices, and in the second part of my career I tried to convince them that the psychotic symptoms were like a “road bump” on their way to a more successful life, now in this part of my career I am committed to working with my patients to be curious about what their voices are trying to tell us. Sometimes this means hearing terrible stories of their violent lives. Sometimes this means experiencing the violence within them that they are trying to eject onto others.
A young woman I treated some years ago heard voices dating back to early childhood. These voices were quite distinct from one another—one led her to believe she was a Messiah, several others berated her endlessly, and one complained of being trapped in her head. She had a childhood that wasn’t overtly abusive. It took many months to sketch an image in my mind of an erratically angry and controlling father and an immature mother who confided in her young daughter all her adult worries, some highly paranoid, others real but overwhelming for a small child. Anti-psychotics improved the voice that called her a Messiah and eventually diminished the berating voices, but the voice that insisted she be called by a different name and that she was trapped in my patient’s body did not change at all with any amount of medication. The DSM is incapable of capturing the complexity of this young woman’s experience.
And then there is my own daughter. When she was 7, she told me that she heard the voice of a man reading his children a “bedtime story” that was actually a narration of her own day. While I stayed calm as she told me this, inside, I was terrified. Was this the beginning of a life of voice hearing? Despite what I already knew about the frequency with which children hear voices, I was scared. In about a year, she outgrew it. A year after that, she barely remembered it had happened.
Sometimes, voices in children are rooted in trauma; the voices a child hears echo the abuse they have lived through, or the neglect they have survived. Other voices are psychotic and improve with medication. Some voices are dissociative, a protective defense against mental overwhelm. Some are imaginative—keeping highly creative children entertained and comforted. Sometimes they are a normal part of development. Often, the origin of the voices takes many months or years to start to uncover—the voice given to family discord, the “identified patient” in a dysfunctional system. For some highly sensitive children, the voices they hear represent the trauma experienced by a parent who has disavowed their own traumatic experience.
So now, if I get a consult for a child hearing voices, I know only one thing before seeing them—I don’t yet know anything at all about that child or their experience.
Burd L, Kerbeshian J. A North Dakota prevalence study of schizophrenia presenting in childhood. J Am Acad Child Adolesc Psychiatry. 1987;26:347–50. doi: 10.1097/00004583-198705000-00012.
Volpato, E., Cavalera, C., Castelnuovo, G. et al. The “common” experience of voice-hearing and its relationship with shame and guilt: a systematic review. BMC Psychiatry 22, 281 (2022). https://doi.org/10.1186/s12888-022-03902-6
DeTore, N. R., Gottlieb, J. D., & Mueser, K. T. (2021). Prevalence and correlates of PTSD in first episode psychosis: Findings from the RAISE-ETP study. Psychological services, 18(2), 147–153. https://doi.org/10.1037/ser0000380