Hearing Voices in Childhood Common, Signals Trouble in Teens

Fran Lowry

April 13, 2012

April 13, 2012 — Auditory hallucinations occur commonly in children, but when they persist into the teenage years, they are often associated with complex mental health problems, such as depression, anxiety, and conduct problems, new research shows.

Investigators from the Department of Psychiatry, Royal College of Surgeons in Ireland, in Dublin, found that nearly 80% of older adolescents who heard voices had a psychiatric disorder — showing a clear association between auditory hallucinations and serious mental illness.

The study is published online April 12 in the British Journal of Psychiatry.

More Common Than Realized

Senior author of the study, Mary Cannon, MB, PhD, from the Royal College of Surgeons in Ireland, told Medscape Medical News that psychotic symptoms such as auditory hallucinations are much more common among young people than had previously been realized.

Dr. Mary Cannon

"In our study, 21% to 23% of 11- to 13-year-olds and 7% of 14- to 16-year-olds reported having experienced such symptoms. For many adolescents, these symptoms are transitory and are not associated with other mental health problems, but for some, about 50% in one study, these symptoms were associated with other mental health problems, and the young people who reported auditory hallucinations were more likely to have more than 1 mental disorder," Dr. Cannon said.

The link between auditory hallucinations and other mental disorders is stronger in older adolescents aged 14 to 16 years than among the younger adolescents, those in the 11- to 13-year age group, she added.

Dr. Cannon and colleagues were prompted to conduct their study after becoming aware of evidence from large population-based studies in the United States and New Zealand that reported up to 17% of adults said that they experienced psychotic symptoms.

"We had no idea how many young people might also experience such symptoms, so we decided to investigate this in the Irish population and also find out whether these symptoms might mean something in terms of risk for mental illness," she said.

Ask Directly

Led by Ian Kelleher, PhD, of the Royal College of Surgeons in Ireland, the researchers assessed 2666 children aged 11 to 16 years in 4 separate studies.

They found that psychotic symptoms such as auditory hallucinations were reported by 239 (21%) of the 11- to 13-year-old children in one study, and in 53 (22.6%) in another study, and by 77 (7%) of the 13- to 16-year-old children in the mid-adolescence studies.

The prevalence of psychotic symptoms was higher among boys in the younger cohort (P < 0.01) and tended to be more prevalent in the older boys (P = 0.057).

In the younger group, the researchers found that 57% of the children who reported auditory hallucinations were found to have a psychiatric disorder following clinical assessment.

In the older group, nearly 80% of the children who reported auditory hallucinations were found to have a psychiatric disorder, including affective, anxiety, and behavioral disorders.

Health professionals dealing with young people should inquire about these symptoms, Dr. Cannon said.

"If the answer is positive, they should note that this young person may also have other mental health difficulties."

They should also screen for psychotic symptoms among children and teens with mental health problems, she said.

"These symptoms are rarely volunteered by young people unless they are specifically enquired about."

Persistent Voices Mean Greater Risk

Jon A. Shaw, MD, professor and director of child and adolescent psychiatry at the Miller School of Medicine, University of Miami, in Florida, told Medscape Medical News that the study is a "real contribution that substantiates empirically" what was previously known.

"There's always been this idea that adolescent turmoil is a developmental phase that adolescents will grow out of. We know that's not true. Psychological and emotional behavior problems in adolescents are often a harbinger of emotional and behavioral problems in adult life," he said.

"It's a great paper. We always had this argument clinically about what auditory hallucinations mean in children. It's clear that the more they persist through adolescence, the greater the risk, and I think that's a real contribution," Dr Shaw said.

Cheryl Corcoran, MD, from Columbia University, New York City, told Medscape Medical News that the study's methodology was one of its strengths.

"It was remarkable how prevalent psychotic symptoms were among adolescents, particularly in adolescents who had nonpsychotic psychiatric diagnoses. This study requires replication in other populations outside of Northern Europe," she added.

Dr. Cannon, Dr. Shaw, and Dr. Corcoran have disclosed no relevant financial relationships.

Br J Psychiatry. Published online April 12, 2012. Abstract

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