Should children hear voices in their heads?

The Pediatric Insider

© 2016 Roy Benaroch, MD

Missy wrote in: “My daughter casually mentioned last night that there is a person who is mean. I asked her more about it this morning and she says this person in her head tells her to say bad things. She says it sometimes scares her. She is 5 1/2 and is very imaginative. Mental illness does run in both sides of the family. How serious should we take this? What can we do? My daughter is funny, brilliant, and the sweetest child I have ever known. What can we do to help her?”

“Hearing voices” is common in children. A study of 3780 grade-school children in The Netherlands in 2009 found that over the course of a year, 9% of children reported hearing voices in their heads. Most of them weren’t bothered by it, though about 15% of them reported that the voices were troubling or disruptive. In a later study, the same authors found that most of these children (75%) said that the voices stopped within 5 years. So these voices are not usually a problem, and typically go away on their own.

Still, since Missy’s daughter is bothered by the voices, and they’re telling her to say “bad things,” I think a little more exploring is a good idea. I’d encourage the family to use these voices as a starting point to talk about what’s troubling her daughter, and (more importantly) what she can do about it. After all, for everyone, there’s always something that’s a problem. The goal isn’t to eliminate your child’s concerns or worries, but rather to teach them how to deal with them.

I’d start by telling the child that a lot of kids hear these things, or that Mommy used to hear them, too. (If that’s true – you might have to ask grandma.) How do the voices make you feel? Can the voices really make you do anything? What can you do if you don’t want to do the thing the voices say? Help your child understand that bad thoughts happen to everyone – but she doesn’t actually have to listen to them, and that she has the power to say to the voice, “No.” (Keep in mind that little kids are very concrete thinkers, and they are used to listening and obeying “rules”, and doing what they’re told. You may have to give her explicit permission, this time, to “disobey” the voice, and not feel badly about that.)

Ask her, “What is the voice telling you to do?” The answer might help both of you learn about what kinds of things are on your child’s mind. If the voice says “Push my little sister,” you could say, “I’ll bet sometimes you feel a little mad at your sister, and that’s OK. You can think those things, and that doesn’t make you bad.”

“Why” questions can sometimes be helpful, especially as kids grow a little older. “Why do you think a voice is telling you to steal candy?” Can open up a way to talk about the kinds of conflicting feelings that everyone has. On the one hand, you want the candy, because it tastes good; on the other hand, you know it’s not good for your teeth. These are tough dilemmas, for all of us, thinking things at the same time that contradict each other. Kids can start to understand how internal conflicts make all of us feel uncomfortable.

If the voices continue bothering a child, or seem to be contributing to behavior problems, the next step would be to get a referral to a mental health professional, typically a psychologist experienced with children. Ask your child’s doctor for references in your community.

While many children hear internal voices, it’s uncommon for teens and adults to continue to hear these (most of us perceive that our “internal monologue” is actually part of our own minds, and not projected from somewhere else.) As children mature into adults, continued thoughts “from outside”, especially if they’re “command thoughts” that tell you to do something, can be a sign of more-serious trouble. Other warning flags to look for include disturbances in mood or interactions with other people, hostility or paranoia, a lack of outward emotions, or unusual sleeping habits. While “hearing voices” isn’t especially worrisome in a child, seek additional help if this happens in teens or adults, especially when accompanied by other problems.

You're sort of confusing me, so, uh, begone... or, uh, y'know, however I get rid of you guys.

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