From Phenomenology to Neurophysiological Understanding of Hallucinations in Children and Adolescents

Abstract

Typically reported as vivid, multisensory experiences which may spontaneously resolve, hallucinations are present at high rates during childhood. The risk of associated psychopathology is a major cause of concern. On the one hand, the risk of developing further delusional ideation has been shown to be reduced by better theory of mind skills. On the other hand, ideas of reference, passivity phenomena, and misidentification syndrome have been shown to increase the risk of self-injury or heteroaggressive behaviors. Cognitive psychology and brain-imaging studies have advanced our knowledge of the mechanisms underlying these early-onset hallucinations. Notably, specific functional impairments have been associated with certain phenomenological characteristics of hallucinations in youths, including intrusiveness and the sense of reality. In this review, we provide an update of associated epidemiological and phenomenological factors (including sociocultural context, social adversity, and genetics, considered in relation to the psychosis continuum hypothesis), cognitive models, and neurophysiological findings concerning hallucinations in children and adolescents. Key issues that have interfered with progress are considered and recommendations for future studies are provided.

Auditory top-down control and affective theory of mind in schizophrenia with and without hallucinations

“…Hugdahl suggested hallucinations to be partly caused by reduced inhibitory top-down control in the auditory domain, and proposed that for adequate perception of auditory information, interaction of bottom-up and top-down processes was important (Hugdahl, 2009;Jardri et al, 2014). The findings of this study support the idea of affective ToM impairments as a trait marker of schizophrenia (Bora et al, 2009).…”

“…It is well established that poor ability to attribute mental states (e.g., beliefs, emotions, intentions) to oneself and to others (theory of mind, ToM; Frith, 1992) causes unsuccessful social interactions and social functioning (Brüne, 2005), and impaired ToM was frequently shown in schizophrenia (Hirao et al, 2008;Irani et al, 2006;Kelemen et al, 2005;Kington et al, 2000;Lam et al, 2014;Russell, 2000;Scherzer et al, 2012; for meta-analyses see Bora et al, 2009;Chung et al, 2014;Sprong et al, 2007). Several studies showed that impaired ToM skills were associated with the severity of psychotic symptoms (Bora et al, 2009;Guastella et al, 2013; but see Abdel-Hamid et al, 2009;Urbach et al, 2013), especially with delusions and hallucinations (Corcoran et al, 1995;Frith, 1992;Harrington et al, 2005a;Jardri et al, 2014; for a critical review see Harrington et al, 2005b).…”

Prevalence and classification of hallucinations in multiple sensory modalities in schizophrenia spectrum disorders

“…As noted in a review (Waters et al, 2014) the nature of the relationship between hallucinations of different sensory modalities has hardly been examined. Although this situation is not unique for schizophrenia spectrum disorders (Waters et al, 2014), some studies indicate that the prevalence of multimodal hallucinations may be severely underestimated in this group (Goodwin et al, 1971) while others indicate that the presence of MMHs may be indicative of an underlying organic etiology (Roberts, 1984;Albert, 1987), or, in children and adolescents, of a more severe expression of schizophrenia (David et al, 2011;Jardri et al, 2014;Cachia et al, 2015).…”

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“…It is stated in many sources that these hallucinations might inhibit, excite or converse stimulants (Ozakkaş, 1985;Jardri, 2014;Kaya et. al., 2015).…”