Can children hear voices by hallucination?

Is it the fruit of their imagination, or can auditory hallucinations of this type occur in childhood?

Hallucinations are anomalous perceptual experiences. They are often described as a sensation without a corresponding object: something that is seen, heard, smelled, tasted, touched or felt inside; but without a real stimulus that can explain it.

While it is true that they have often been framed in a psychopathological context, and specifically in disorders such as psychosis, they are experiences that can occur in any healthy individual under certain conditions.

Most of the scientific literature on the subject focuses on the adult population, for which the presence of the phenomenon has been explored with greater emphasis, but it would not be fair to overlook other periods of life in which it can also appear.

Therefore, in this article we will try to give an answer to a single question: can children hear voices by hallucination? For it we will resort to the scientific evidence on the matter.

Can children hear voices by hallucination?

There is a popular idea that, for an unknown reason, young children are able to perceive some nuances of reality that escape the experienced eye of the adult man. This belief is common in many cultures around the world, and it is very easy to find testimonies in which it is described the apparent encounter of an infant with a being that only he seems to notice, in front of the astonished gaze of an adult man.in front of the astonished gaze of those who might be on the scene. There are even viral videos on the subject, which have become popular on the net.

The explanations given for this phenomenon have been diverse. At first, we resorted to hypotheses of a paranormal nature, by means of which a spiritual or transcendental vision of childhood was raised. Nowadays, and thanks to the development of scientific knowledge, we can provide this concrete fact with a greater empirical solidity, outlining operative hypotheses that adjust to less obscure explanations and closer to reality.

Before going into more detail on the phenomenon of infantile auditory hallucination, it is essential to convey calmness on the matter. These experiences do not usually constitute an indication of mental pathology, and there are even authors who consider them as a sign of mental pathology.There are even authors who consider them an intrinsic milestone in the development of the central nervous system. In these lines we will address the knowledge on the topic in the light of scientific evidence.

Is it frequent?

Today we have a fairly accurate knowledge of the prevalence of auditory hallucinations in all age groups.

Studies that address the issue reveal that during childhood (from nine to twelve years of age) 17% of children experience them, reducing this percentage to less than half (7.5%) in adolescents. Other studies show more even percentages, so there seem to be slight discrepancies between authors.

There is a certain consensus within the scientific community that childhood is a stage prone to this type of experiences, but that it is in adulthoodHowever, it is in adulthood when their presence more clearly suggests a possible underlying mental disorder, despite the fact that the absolute prevalence rate in this age period is dramatically reduced. This fact supports theoretical models that see hallucination as a normative element for the development of the central nervous system, even though we do not yet understand the mechanisms involved.

The "physical" properties of these forms of perception are described in a variety of ways. There are children who report hearing very simple sounds, such as knocking or similar, but in some cases they report experiences of greater complexity (human voices demanding attention or conversations between two or more "invisible figures"). Sometimes they can generate fearful emotions, promoting the warmth of bonding figures.

Hallucinations have been described among children as young as five years old, and even younger, so that the classificatory subtype of "early onset" has been coined.

Why does it occur?

We will now address five of the most common causes of hallucinations in childhood according to the state of the art. Physiological, psychological and social factors will be included.

Imaginary friends

A very high percentage of children report having (or having had) imaginary friends at some point in their lives, and the literature indicates that in these cases there is a greater tendency to report visual and auditory hallucinations. This phenomenon, which is not a cause for concern, serves five purposes: regulating emotions and solving problems, exploring ideals, finding someone to have fun with, coping with loneliness, and practicing social roles or behaviors.

Most parents consider that this is not a negative situation, so they do not tend to worry excessively or consult their pediatrician. In general, it is considered one of the contexts in which hallucination can occur in a benign manner. Along the same lines, there are even testimonies claiming that imaginary companions have supported the child during evolutionary transitions, such as the birth of a younger sibling or the first contact with school or kindergarten (and the corresponding absence of attachment figures).

Finally, almost all children are able to recognize their imaginary friend as a creation of their own, which does not exist beyond their ownthat does not exist outside their own head. This ability to "realize" is a good prognostic factor for infantile hallucinations in general, and not only for the innocuous imaginary friend assumption.

2. Adverse life events and emotional distress

Emotional distress, cognitive distortions and traumatic events constitute a triad that has been associated with the appearance of positive symptoms of psychosis (hallucinations and delusions), something that has also been replicated in the child and adolescent population.

This risk factor would be directly linked to the diathesis-stress hypothesis, and would be linked to genetic factors of some kind. The model suggests that only the vulnerability for psychosis is transmitted from parent to child, but not the disorder itself (through specific alterations in neuronal migration during development).

However, the experience of intense stress would act as a triggering element, precipitating its ultimate clinical expression.precipitating its definitive clinical expression (from genotype to phenotype).

Not all children who report hallucinations have suffered situations of a traumatic nature, nor do all those who have experienced such events end up experiencing them. What has been corroborated is that when this phenomenon occurs in a child without evidence of psychosis, as a result of the adversity he/she may be experiencing, the symptom tends to dilute in a directly proportional manner as the conflict situation is resolved.

3. Sleep deprivation

Sleep deprivation has been related to hallucinations in all age periods, from adulthood to childhood. There is evidence that the absence of sleep generates cognitive alterations (in memory, attention, etc.), changes in mood and distortions of perception.. All this happens in healthy children, without diagnosis of any psychic disorder, and also among adults. Situations such as extreme sensory isolation can also provoke them, as well as intense fatigue and hyperthermia.

4. Metacognition: distinction between what is mental and what is real

Metacognition is the ability of human beings to become aware of their internal processes, such as thoughts and emotions. It is a way of thinking about what one thinks, or even feeling about what one feels. This higher function is essential for discriminating what is created "inside" from what is perceived outside, and has been postulated as a key element in understanding why hallucinations occur.

Research on metacognition locates all the functions that are integrated in it (mnesic, perceptual, etc.) in the prefrontal cortex, precisely in the prefrontal cortex. the prefrontal cortex, precisely the region of the brain that takes the longest to mature (until well into the second decade of life). (until well into the second decade of life). Perhaps this delay would explain the age gradient for the prevalence of hallucination (more common in early childhood and progressively more infrequent). Thus, as this circuit would become more developed, the subject would be better able to differentiate correctly between his thoughts and external stimuli, and hallucinations would be definitively diluted.

Other studies point out that hallucinations in childhood are more common in children who have difficulty with children with difficulty in the normative development of the theory of mind, i.e., in the (theory of mind), i.e., the ability to know themselves as individuals separate from their environment and to attribute to others internal states other than their own. Although very interesting, both this theory and the theory of metacognition need further research in the future.

5. Neurophysiology

Neuroimaging studies with children presenting with auditory hallucinations point to a functional alteration in the Default Neural Network, which is responsible for the things we think and feel when the mind is in a state of rest. It is a set of structures that are activated when the mind is in a resting state. a set of structures that are activated when apparently "we are not doing anything", and that seem to have the purpose of activatingand which seem to have the purpose of preparing the central nervous system to activate spontaneously in case of need.

It has also been described that the primary/secondary auditory cortex, which respond to the perception of an objective sound stimulus, would be activated at the same moment when children indicate hearing a hallucination.

As a conclusion, and recovering the question with which we opened this text (can children hear voices by hallucination?), the answer would be yes. However, there are still many unanswered questions regarding the causes and factors that determine prognosis.

Complications

Hallucinations in childhood are usually a benign and transient phenomenonwhich tends to resolve completely as time progresses. Even so, in some cases complications may arise that should be taken into account, as they may require a specific therapeutic approach.

It has been observed that the hallucinatory experience in childhood may be associated with significant distress. can be associated with significant affective distress and the emergence of other clinically relevant emotional problems. of clinical relevance. In adolescence, a higher frequency of suicidal ideation has been described among those who report suffering the symptom, after having controlled concomitant health problems. Therefore, as long as the symptom persists and generates some suffering to the person, it will be necessary to seek professional help.

Referencias bibliográficas:

• Garralda, M.E. (2016). Hallucinations and Mental Health in Children. Oruen the CNS Journal, 2(2), 32-36.
• Fleming, S. y Dolan, R.J. (2012). The Neural Basis of Metacognitive Hability. Philosofical Transactions The Royal Society Publishing, 367(1954), 1338-1349.
• Kanwar, A. (2010). Hallucinations in children: Diagnostic and treatment strategies. Current Psychiatry Archives, 9(10), 53-56.
• Maijer, K., Hayward, M., Fernyhough, C., Calkins, M., Debbané, M., Jardr, R…. Bartels-Velthuis, A. (2019). Hallucinations in Children and Adolescents: An Updated Review and Practical Recommendations for Clinicians. Schizophrenia Bulletin, 45(1), 5-23.