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Supporting Evidence: New Research
Supporting Jaynes' Bicameral Mind Theory

Hallucinations in Children (Imaginary Companions)

Supporting Evidence > Hallucinations in Children (Imaginary Companions)

In his theory, Julian Jaynes describes the role hallucinations played in an earlier mentality, prior to the development of subjective consciousness. He predicted that imaginary companions (formerly called imaginary playmates) were more common in the normal population than was known at the time, and this has been confirmed in dozens of studies over the past three decades. In ancient civilizations, the imaginary companion would have taken the role of one's personal god, as seen in ancient Egyptian, Babylonian, and early Roman cultures. Below is a small sample of research supporting this aspect of Jaynes's theory.

Prevalence and Correlates of Auditory Vocal Hallucinations in Middle Childhood
Bartels-Velthuis, Agna A., Jack A. Jenner, Gerard van de Willige, Jim van Os, Durk Wiersma. The British Journal of Psychiatry, 2010, 196: 41-46.
Auditory vocal hallucinations among adults are often associated with psychiatric disorders, but reviews of general population incidence and prevalence studies show that the rate of psychotic experiences, including auditory vocal hallucinations, is far greater than traditional estimates of the incidence and prevalence of psychotic disorders (systematic review van Os et al, 2009). Nevertheless, auditory vocal hallucinations may be usefully conceptualised as a risk factor for psychotic disorder, particularly if they are associated with psychological or behavioural complications. In children and adolescents, auditory vocal hallucinations occur in both clinical and non-clinical populations. Although the phenomenon of hearing voices in childhood may predict adult schizophrenia, the great majority of children with hallucinatory experiences never make the transition to clinical disorder.9 Population surveys generally involve children in late childhood or adolescence, reporting prevalence rates of auditory hallucinations between 5 and 16%.

Correlates of Auditory Hallucinations in Nonpsychotic Children
Best, Nicole T. and Peter Mertin. Clinical Child Psychology and Psychiatry, October 2007, 12 (4): 611-623.
The phenomenon of auditory hallucinations in clinical populations of nonpsychotic children is an intriguing and little understood area. To date, investigations in this area have reported on a range of correlates, including family histories of psychiatric illness, family dysfunction, and significant levels of stress in the children themselves. The current study reported on 10 nonpsychotic children drawn from a number of community-based child and family agencies that provide therapeutic outpatient services. Consistent with previous studies, the present study found strong associations with family dysfunction, specifically family break-up, as well as significant levels of anxiety and depression in the presenting children. In addition, half the children reported the presence of imaginary companions. Despite confirmation of some previous findings, many other features of this phenomenon remain unanswered, including the different psychological functions that hallucinations and imaginary companions may serve for emotionally troubled children.

Hallucinations in Children and Adolescents: Considerations in the Emergency Setting
Edelsohn, Gail. American Journal of Psychiatry, May 2006, 163: 781-785.
A 9-year-old boy with escalating behavioral problems was brought to a psychiatric emergency service. His mother described him as disrespectful to her and other adults with episodes of cursing and screaming that last for hours. He was reported to have recently kicked his pregnant sister and vandalized the house of a neighbor he dislikes. He has been taking 5 mg b.i.d. of oral methylphenidate, which was prescribed by a primary care doctor. The emergency service intake worker reported that the boy claimed to hear voices that tell him to do bad things and claimed to see ghosts. He admitted to having an explosive temper when "people mess with me," and he said that he sometimes "goes crazy." He said that he often thinks of his deceased grandmother. A 7-year-old girl who was evaluated 2 days earlier at a children"s hospital and medically cleared was brought to the psychiatric emergency service by her mother, who reported that her daughter claims to feel bugs and mice crawling over her and that during those episodes she screams and is inconsolable. The mother, the patient, and a 12-year-old sister have been living in a shelter. The patient appeared to be anxious and to have poor control of her behavior and low tolerance for frustration. She admitted that she has tactile hallucinations and obsessive thoughts of cleanliness. Her mother said that the girl is also hyperactive and restless at school. Should the hallucinations in these children be equated with psychosis? What is the differential diagnosis of hallucinations in children, and what is the prognosis for children with hallucinations? What interventions are indicated in the psychiatric emergency service for children who present with hallucinations?

Childhood Auditory Hallucinations Independent Course of Childhood Auditory Hallucinations: A Sequential 3-year Follow-up Study
Escher, S., M. Romme, A. Buiks, P. Delespaul, and J. Van Os. The British Journal of Psychiatry, 2002, 181: s10-s18.
BACKGROUND: Childhood hallucinations of voices occur in a variety of contexts and have variable long-term outcomes. AIM: To study the course of experience of voices sequentially over a 3-year period in those with and those without a need for mental health care (patient status). METHOD: In a group of 80 children of mean age 12.9 years (s.d.=3.1), of which around 50% were not receiving mental health care, baseline measurement of voice characteristics, voice attributions, psychopathology, stressful life events, coping mechanisms and receipt of professional care were used to predict 3-year course and patient status. RESULTS: The rate of voice discontinuation over the 3-year period was 60%. Patient status was associated with more perceived influence on behaviour and feelings and more negative affective appraisals in relation to the voices. Predictors of persistence of voices were severity and frequency of the voices, associated anxiety/depression and lack of clear triggers in time and place. CONCLUSIONS: Need for care in the context of experience of voices is associated with appraisal of the voices in terms of intrusiveness and ‘omnipotence’. Persistence of voices is related to voice appraisals, suggesting that experience of voices by children should be the target of specific interventions.

Imaginary Companions and Young Children's Responses to Ambiguous Auditory Stimuli: Implications for Typical and Atypical Development
Fernyhough, Charles, Kirsten Bland, Elizabeth Meins, and Max Coltheart. The Journal of Child Psychology and Psychiatry, 2007, 48 (11): 1094-1101.
Background: Previous research has reported a link between imaginary companions (ICs) in middle childhood and the perception of verbal material in ambiguous auditory stimuli. These findings have been interpreted in terms of commonalities in the cognitive processes underlying children's engagement with ICs and adults' reporting of imaginary verbal experiences such as auditory verbal hallucinations. The aim of the present study was to examine these relations using improved methodology and a younger sample of children for whom engagement with ICs would be expected to be particularly salient. Method: Data on young children's (age range: 4–8 years) reporting of ICs were gathered in two studies (total N = 80). Responses to ambiguous auditory stimuli were investigated using the new Jumbled Speech task, which measures participants' likelihood of perceiving words in meaningless but speech-like auditory stimuli. Results: Reporting hearing words in the Jumbled Speech task was associated with having a parentally corroborated IC. Hearing words on the task and having an IC were unrelated to age, gender, verbal ability, and understanding of the stream of consciousness. Conclusions: Findings are consistent with the hypothesis that engaging with ICs is one aspect of a general susceptibility to imaginary verbal experiences. We consider the implications for the assumption of continuity in psychopathological experiences between childhood and adulthood.

Childhood Auditory Hallucinations Prevalence of Psychotic Symptoms in Childhood and Adolescence: A Systematic Review and Metaanalysis of Population-Based Studies
Kelleher, Ian, D. Connor, M.C. Clarke, N. Devlin, M. Harley, M. Cannon. Psychological Medicine, 2012, 9: 1–7.
Psychotic symptoms occur more frequently in the general population than psychotic disorder and index risk for psychopathology. Multiple studies have reported on the prevalence of these symptoms using self-report questionnaires or clinical interviews but there is a lack of consensus about the prevalence of psychotic symptoms among children and adolescents. Conclusion: Psychotic symptoms are relatively common in young people, especially in childhood. Prevalence is higher in younger (9 to 12 years) compared to older (13 to 18 years) children.

Hallucinatory Experiences in Nonpsychotic Children
Kotsopoulos, S., J. Kanigsberg, A. Cote, C. Fiedorowicz. Journal of the American Academy of Child & Adolescent Psychiatry, May 1987, 26 (3): 375–380.
Eleven children who experienced hallucinations were assessed and treated. The psychiatric diagnosis varied, but most children presented mood disturbance, mainly anxiety. Their level of adaptive functioning was substantially impaired. The children were either socially inept or withdrawn. The hallucinations were associated mostly with bedtime and sleep phenomena. In the absence of other symptoms of psychosis no diagnosis of psychosis could be made. The hallucinations ceased early in the course of the treatment in nine children.

Auditory Hallucinations in "Non-Psychotic" Children
Levin, Max. American Journal of Psychiatry, May 1932, 88: 1119-1152.
Four cases are presented of boys who had true auditory hallucinations. The boys were "non-psychotic," in the sense that they showed no acute psychotic disturbances, differing in this respect from the vast majority of the cases already recorded—cases which concern children who develop unmistakably psychotic states with hallucinations, usually at puberty. Altogether 24 episodes were reported by these boys. The episodes are recorded in detail, attention being given to setting, content, etc.

Hallucinations in Nonpsychotic Children
McGee, Rob, Sheila Williams, and Richie Poulton. Journal of the American Academy of Child & Adolescent Psychiatry, 2000, 39 (1): 12-13.

Auditory Hallucinations in Nonpsychotic Children: Diagnostic Considerations
Mertin P. and S. Hartwig. Child and Adolescent Mental Health, February 2004, 9 (1): 9-14(6).
BACKGROUND: Auditory hallucinations in childhood and adolescence are not necessarily an indication of psychosis, but are more frequently associated with a range of other mental health problems. Although not specifically linked to abuse as an aetiological factor, the literature reporting on hallucinations in children alludes to a range of family dysfunction and disruption. METHOD: This study reports on the auditory hallucinations of 13 children referred to a community-based child and family mental health service exhibiting a variety of emotional and behavioural difficulties. The presence of the hallucinations was generally revealed during the course of the initial assessment. RESULTS: None of the children were considered psychotic at initial presentation; however, all were experiencing high levels of stress and/or anxiety in their lives. Following the initial assessments children were given diagnoses ranging from generalised anxiety disorder, through adjustment disorder, to posttraumatic stress disorder. The hallucinations gradually disappeared over the course of therapy. Two case studies describe the hallucinations and family histories in more detail. CONCLUSIONS: The present study adds further confirmation of the presence of auditory hallucinations in nonpsychotic children. The clinical presentation of the children in the present study indicates an association between hallucinations and high levels of stress and anxiety, suggesting that mental health professionals should enquire more routinely about auditory hallucinations, particularly with those children from abusive and violent backgrounds.

Auditory Hallucinations in Normal Child Populations
Pearson, David, Andrea Burrow, Christina FitzGerald, Kate Green, Gary Lee, and Nicola Wise. Personality & Individual Differences, Aug. 2001, Special Issue, 31(3): 401–407.
It has been accepted for some time that normal adult populations can report hallucinatory experiences. Such experiences can be generated in the laboratory setting. The current study was based upon methodology used by Feelgood and Rantzen (Feelgood, S. R., & Rantzen, A. J. (1994). Auditory and visual hallucinations in university students. Personality and Individual Differences, 17(2), 293–296), that exposed adult participants to ambiguous stimuli which in turn generated hallucinatory experiences. The current study used similar methodology, but applied to child participants, which yielded similar results. The results suggested a developmental continuum of hallucination experiences between children and adults. The implication of this is that children can experience hallucinations in a similar way to adults. Links between childhood imaginary companions and hallucinatory experiences were also suggested.

Non-Psychotic Auditory Hallucinations in Children and Adolescents
Perera, Hemamali, Udena Attygalle, Chandima Jeewandara, Vijini Jayawardena. Sri Lanka Journal of Psychiatry, 2011, 2 (1).
Non-psychotic auditory hallucinations are described in children and adolescents in association with a range of psychopathological and social circumstances, including disorders of emotions and conduct, abuse and family dysfunction. A variety of phenomena and aetiological factors have been identified in scientific literature to explain the existence of non-psychotic auditory hallucinations. We present a series of twelve cases where auditory hallucinations were prominent. The objective of the discussion is to draw attention to the range of presentations, the influence of underlying psychosocial factors in symptom formation, the inadequacies of the main diagnostic classifications, the importance of diagnostic accuracy, the level of clinical skills required and the cultural factors influencing clinical presentation.

Hallucinations in Nonpsychotic Children: More Common Than We Think?
Schreier, Herbert A. Journal of the American Academy of Child & Adolescent Psychiatry, May 1999, 38 (5): 623–625.
Hallucinations have been described in a variety of childhood psychiatric conditions, and although considered by some to be synonymous with psychopathology, they may also be found in healthy children. There is reason to believe that hallucinations are underreported in both clinical and nonclinical populations. The National Institute of Mental Health Epidemiulogical Catchment Area study, cited by Fennig et al. (1997), found that 2.8% of adults reported hallucinating before they were 21 years old. Our knowledge of the nature and consequences of hallucinations in childhood is biased by the populations in which they have been studied, and we often do not know whether our patients hallucinate because we do not ask. Furer et al. (1957) found that children were only mildly reluctant to talk about voices they heard, and in their study of a group of child psychiatric inpatients they reported that the children's long-term therapists rarely knew about the hallucinations!

Hallucinations in Children Hallucinations in Children: Diagnostic and Treatment Strategies
Sidhu, Kanwar Ajit S. and T. O. Dickey III. Current Psychiatry, Oct. 2010, 9 (10).
Hallucinations in children are of grave concern to parents and clinicians, but aren't necessarily a symptom of mental illness. In adults, hallucinations usually are linked to serious psychopathology; however, in children they are not uncommon and may be part of normal development.

Hallucinations in Nonpsychotic Children and Adolescents
Simonds, John F. Journal of Youth and Adolescence, 1975, 4 (2): 171-182.
The case histories of ten nonpsychotic patients (nine female and one male) who had experienced hallucinations are summarized. Significant anxiety and depression were found in the majority of the patients, five of whom expressed suicidal ideas. Stress factors were primarily family and school. Eight children had combined auditory and visual hallucinations, which involved dead relatives in five cases. The aims or purposes of the hallucinations were multiple, but escape mechanisms were most common. A profile of the nonpsychotic patient most likely to experience hallucinations would be a socially immature teenage girl who is experiencing depression and anxiety due to stress within the family.

Hallucinations in Children and Adolescents
Sosland, Morton D. and Gail A. Edelsohn. Current Psychiatry Reports, 2005, 7 (3): 180-188.
Clinicians need to consider a wide range of differential diagnoses when children and adolescents present with hallucinations. This includes considering whether it is a developmentally normal phenomenon or if there is a psychiatric, medical, or neurologic diagnosis. Nonpsychotic children with hallucinations can be differentiated from psychotic children. Nonpsychotic children who are at risk (or prodromal) for future psychosis can be differentiated from nonprodromal healthier children. We examine the epidemiology, prognosis, and neurobiological research. Lastly, we discuss treatment approaches, including medication and cognitive behavioral therapy.

Hallucinations in Nonpsychotic Children
Vickers, Bea and Elena Garralda. Journal of the American Academy of Child & Adolescent Psychiatry, Sept. 2000, 39 (9): 1073.

Hallucinatory Experiences in a Community Sample of Japanese Children
Yoshizumi, Takahiro, Satomi Murase, Shuji Honjo, Hitoshi Kaneko, Takashi Murakami. Journal of the American Academy of Child & Adolescent Psychiatry, August 2004, 43 (8): 1030–1036.
Hallucinatory experiences in children are often thought to indicate serious psychopathology. However, they have also been reported in normally developing children and in association with temporary psychological reactions to acute stress. The aim of this study was to investigate the prevalence of hallucinatory experiences in a nonclinical population of children and to examine the relationship between the modality and content of hallucinations and psychopathology. even hundred sixty-one Japanese children, 11 to 12 years old, completed a battery of four measures: (1) a questionnaire about the type of hallucinatory experience, (2) the Children's Depression Inventory, (3) the State-Trait Anxiety Inventory for Children, and (4) the Adolescent Dissociative Experiences Scale. Approximately 21% of the subjects had experienced hallucinations. Subjects who had experienced hallucinations, in particular, hallucinations characterized by combined modalities, closely self-related auditory content, or concrete visual content, had more significant psychopathology than did those who had never experienced hallucinations. herapeutic intervention should be considered for children who experience hallucinations in association with depression, anxiety, or dissociation.