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17 October 2018

Danny was ten, but the voice in his head belonged to a threatening older man

Hallucinations in children are more common than you might think.

By Phil Whitaker

Aged ten, Danny came across as a confident and happy-go-lucky lad, and seemed delighted to describe for me in detail the voices he’d been hearing. In fact, it was just one voice: not recognisable as anyone he knew, but it was male and rendered in a sinister whisper. He’d heard it in bed the night before, which had given him a heck of a fright.

He’d tried to rouse his mum but hadn’t been able to wake her, so he’d ended up checking everywhere in his bedroom until he was satisfied that whoever had been there had now gone. But then the same man started talking to him during history that morning, and looking around all he’d seen were his classmates, carrying on as normal. He burst into tears, then confided in his worried teacher, and the emergency appointment with me was the result.

Mum looked understandably concerned. It’s common knowledge that auditory hallucinations are a feature of serious psychotic conditions such as schizophrenia. Now she came to think of it, Mum also remembered Danny having mentioned hearing voices earlier in the summer, but she’d glossed over it thinking he was just attention-seeking. And then there was that time at his grandad’s when Danny had seen a flitting white shape crossing the landing out of the corner of his eye. Her anxiety was clear: was it possible that her cheeky little chap of a son was developing a major psychiatric illness?

We tend to think of schizophrenia as a late-adolescent and adult condition, but in fact there are rare cases described in children as young as four. That said, the vast majority of hallucinations in childhood are benign. And there are a lot of them. A literature review published in 2012 estimated that around one in six children of Danny’s age experience such psychotic phenomena. This prevalence roughly halves in adolescence, and falls even further into young adult life. Something about the process of brain maturation gradually ensures that our perceptual experiences roughly match up to the reality around us.

Many psychotic experiences in young children relate to imaginary friends, but these tend to be characteristically comforting, and are always under the child’s control. Danny’s voice was unsettling: telling him he was no good, and that “they” were going to get him; and it was not something he conjured up voluntarily or could dismiss.

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Stress frequently underlies his type of experience, so I undertook a quick review of major life factors. Home was good: he got on well with his stepdad; his younger siblings provided no more than the usual level of annoyance; and there was a humorous and natural-feeling interaction with his mum when he pretended to tell me how awful she was.

School was also fine, he told me – no problems with work, teachers, or friends. In fact, he was making lots of new friends. The penny dropped: his birthday is late in the academic year. Even though he was only ten, he had recently started his first term at senior school. And no, there was no one else from his primary at the same place – well, one boy, but he didn’t think of him as a friend at all.

Children of Danny’s age are rarely able to articulate stress and emotions in words. Outwardly they may appear fine, but their bodies speak for them: nausea, tummy pains, headaches. Or, as in Danny’s case, auditory hallucinations.

He understood my explanation of how our ears turn sound into electricity and send it down wires to the brain (“like a telephone!” he exclaimed). And he got how, if something else was making the electricity in his brain fizz and pop, it would seem exactly as if there was a voice somewhere that he was hearing.

I arranged to review him a few weeks later, when the huge stresses of learning to cope in a new and challenging environment with no established friendships to fall back on would be starting to dissipate. Sure enough, by then the whispering man was no longer to be heard in his ears.

A collection of Phil’s columns, “Chicken Unga Fever”, will be published by Salt in November

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This article appears in the 17 Oct 2018 issue of the New Statesman, Europe’s civil war