Hallucinations in Children and Adolescents: Considerations in the Emergency Setting

Gail Edelsohn, American Journal of Psychiatry, May 2006, 163, 781–785.

Abstract: 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?