Understanding Psychosis in Children: Signs, Symptoms, and Considerations for Parents

Psychosis, though often associated with adults, can also occur in children, albeit less frequently. Recognizing the signs and symptoms of psychosis in children is crucial for early intervention and support. In this article, we'll explore the manifestations of psychosis in children, the prevalence of hearing voices, and when psychosis may be indicative of a severe mental illness versus a transient experience.

Signs and Symptoms of Psychosis in Children

Psychosis in children can present with a range of signs and symptoms, which may vary in severity and duration. These factors may represent early signs of schizophrenia in children. Some common indicators include:

Hallucinations: Children experiencing psychosis may report hearing voices, seeing things that aren't there, or having other sensory perceptions that aren't based in reality.

Delusions: Fixed false beliefs that are not based on reality may manifest in children with psychosis, such as beliefs of being persecuted, having special powers, or experiencing unusual connections to others.

Disorganized Thinking and Speech: Children may exhibit difficulty organizing their thoughts, speaking coherently, or following a logical conversation.

Disorganized Behavior: Erratic or unpredictable behaviors, such as agitation, aggression, or catatonia, may be observed in children with psychosis.

Negative Symptoms: Reduced emotional expression, social withdrawal, lack of motivation or pleasure in activities, and difficulty maintaining personal hygiene or self-care may be present in some children with psychosis.

Prevalence of Hearing Voices in Children

Hearing voices, or auditory hallucinations, is a common experience in childhood and may not necessarily indicate psychosis or severe mental illness. Research suggests that up to 17% of children may report hearing voices at some point, with the majority experiencing transient or benign auditory hallucinations. These voices may be linked to heightened stress, imagination, or normal developmental processes rather than underlying psychopathology. These symptoms are often transient and come and go. Many children who experience symptoms such as hearing voices do not go on to develop a mental illness such as schizophrenia.

Differentiating Normal Experiences from Severe Mental Illness in Children

While hearing voices and other psychotic symptoms can occur in children without underlying mental health concerns, it's essential to recognize when these experiences may indicate a more severe mental illness:

Duration and Severity: Persistent or distressing hallucinations, delusions, or disorganized behaviors that significantly impair daily functioning and last for an extended period may suggest a severe mental illness.

Impact on Functioning: Psychotic symptoms that interfere with a child's ability to engage in age-appropriate activities, maintain relationships, or perform academically may warrant further evaluation and intervention.

Context and Developmental Stage: Understanding the context in which psychotic symptoms occur and considering the child's developmental stage is crucial. Some experiences, such as imaginary friends or fantasy play, are developmentally appropriate and may not indicate psychosis.

Differentiating Between Imaginary Friends and Psychotic Symptoms in Children

Imaginary friends and fantasy play are common aspects of childhood development, fostering creativity, social skills, and emotional expression. However, it's essential for parents and caregivers to distinguish between normal imaginative experiences and potential signs of psychosis in children. Here's how you can differentiate between the two:

Imaginary friends typically emerge during early childhood, between the ages of 2 and 7, and gradually fade as the child matures. They often serve as companions for imaginative play and may represent an extension of the child's creativity and exploration of social relationships.

Imaginary friends are generally harmless and contribute positively to a child's development. They can provide comfort, companionship, and a safe space for emotional expression. Children may engage in elaborate conversations and activities with their imaginary friends, enriching their imaginative play.

Parents are typically aware of their child's imaginary friends and may even participate in conversations or activities involving them. Imaginary friends are openly discussed and integrated into the child's daily life, often seen as a natural part of their imaginative world.

Psychotic Symptoms in Children:

Psychotic symptoms, such as hallucinations or delusions, persist beyond the developmental stage when imaginary friends are common and may cause distress or disruption in the child's life. These experiences often intensify over time and interfere with daily functioning and may indicate early warning signs of schizophrenia.

Unlike imaginary friends, psychotic symptoms involve perceptions or beliefs that are disconnected from reality and cannot be explained by normal imagination. Children experiencing psychosis may report hearing voices that are distressing or threatening, or hold fixed false beliefs that persist despite evidence to the contrary.

Psychotic symptoms may lead to social withdrawal, isolation, or changes in behavior as the child struggles to make sense of their experiences. They may become preoccupied with their hallucinations or delusions, withdrawing from interactions with peers or family members.

How Can I Help My Child with Psychosis?

If you're concerned about your child's mental health or suspect they may be experiencing psychosis, it's essential to seek evaluation and support from a qualified mental health professional. Early intervention and appropriate treatment can help alleviate symptoms, support the child's well-being, and improve long-term outcomes. Remember, every child is unique, and seeking timely support can make a significant difference in their journey toward mental wellness.

Diagnosing Psychosis in Children

The first step to getting help for psychosis is evaluation and diagnosis. At Zephyr Care, we specialize in psychological testing for children and adults. We can help your child receive the correct diagnosis so that that they can get the right treatment. We provide mental health evaluations in Nashville for those local to us, as well as virtual evaluations for people in most states. We also provide neurodiversity-affirming testing for autism, ADHD, and general mental health concerns. Contact us today!

Author: Heather Joppich, PhD

Dr. Joppich is a Licensed Psychologist and owner of Zephyr Care Mental Health. She specializes in neurodiversity-affirming assessments for autism, ADHD, and mental health concerns.