Psychotic features such as suspicion, fear of voices, concentration and sleep problems can already occur in young children. In most cases it is transient . However, for a small group the symptoms are permanent. At an older age (puberty) it can take on serious forms. There can be various causes such as heredity , trauma, drugs and smoking. Brain areas and brain chemicals then appear not to work properly. Parents and caregivers of young children should be alert and consider the extent to which the characteristics are persistent. If in doubt, expert help is recommended.
Psychosis and children
A psychosis is a short or longer period during which contact with reality is lost. A person’s own reality is created that is supplemented with their own (deviant) thoughts and feelings.
There are numerous characteristics of psychotic behavior. From about the age of 15, it can be more clearly diagnosed whether there is psychosis. Young children may have characteristics, but these are difficult to diagnose as psychosis. They often live in their own imaginary world with fairy tales and fantasy games. However, a small group of young children already appear to have long-lasting psychotic features .
Therapist S. treats a 12-year-old boy. The boy imagines that he is being blasted by aliens. As a result, he is anxious, sleeps poorly, withdraws to his room and performs below his capabilities at school. 1
Characteristics of psychotic behavior in children
The following characteristics may occur in children with psychotic behavior:
- fear, suspicion, suspicion
- delusions
- hallucinations
- confusion, illogical thinking
- somber mood
- problems in social skills: withdrawing, aggressive, irritable
- concentration and sleep problems
The above can manifest itself because the child:
- thinks they are being watched or overheard (suspicion, suspicion, fear)
- perceives people, animals, aliens who are not present (delusions)
- attributes to himself qualities that are not there (delusions)
- hears voices and may engage in conversation with them (hallucinations)
- feels unhappy, sad and withdrawn
- your thoughts are no longer in order, so that there is no longer any consistency in what you are saying (confusion, concentration problems)
- others the logic can no longer follow the story, causing them to turn away from the child (social skills problem)
- difficulty falling asleep due to hearing voices or seeing something that is not there,
- has anxiety dreams
7-year-old boy says he hears voices telling him not to do what the teacher says or something bad will happen to him.
5 year old girl sees missing flies in her bedroom. The night before she played on the iPad with her father and had to swat flies.
6 year old girl with compulsive hallucinations reports seeing snakes crawling on the ceiling several times a day .
These are three different observations of young children. In the world of young children, stories told or seen can become so real that they also think they perceive them. It is common behavior, appropriate for the age. Yet young children may already have features of psychotic behavior that can be lasting and disturbing .
A long-term Dutch study followed children aged 7/8 for 11 years. The start was in 2002/3 with the research of children aged 7/8 who did not hear voices present. The study started with 3,870 children, 9 percent of whom heard voices. After 5 years, 18.2 percent of these votes were still visible. And 6 years later, 6.2 percent of 18/19 year olds still had voices. The majority of the children’s voices were no longer heard. 2
note: psychoses as described here must be distinguished from delirium. Due to physical causes (e.g. fever), children may exhibit characteristics that occur with psychoses. These are usually transient. 3
Brain abnormality as a cause of psychosis at a young age
Too much or too little of the brain chemical dopamine can be produced by the brain area of the substantia nigra, which can lead to connection problems between brain areas. Too little white matter (myelin) around neuron pathways that provide fast connections can also be a cause.
Too much dopamine
An excess of dopamine can be produced at a young age. It is a brain chemical that functions as a messenger between numerous brain areas. Too much dopamine sends messages between brain areas too quickly . The child receives so much information that problems arise with processing it. Illogical connections can then be made. The child may appear confused.
Too little dopamine
Too little dopamine production can be the cause of too little information being forwarded, causing the person to supplement the information themselves and provide irrelevant answers. Reality and fantasy can become confused. The child can start to imagine things that are not there, such as delusions and hallucinations.
Too little myelin (white matter)
Connections between brain areas are made by neuron pathways (nerve wires). If these work well, there is white matter (myelin) around them. This ensures fast connections between brain areas. With too little white matter, connections stagnate. As a result, the emotion area (amygdala) does not work well with other brain areas such as the control area at the front of the brain (prefrontal cortex). Control over perceptions, feelings and thoughts can become disturbed.
Factors that can lead to psychotic behavior
Children who are predisposed to develop psychotic behavior can develop this behavior due to factors in the environment. It can also be amplified by other disorders such as depressive or manic behavior.
The factors are:
- Aptitude:
- Genes
- Environment:
- Traumas caused by abuse (such as incest, assault), accident, divorce, war
- Drugs
- Smoking
- Relationship with other disorders (comorbidity)
Explanation of factors causing psychotic behavior
Genes
Genes play an important role. It appears that if first-degree relatives in particular have psychotic features, there is a good chance that children are also susceptible to this.
Traumas
For example, trauma (abuse, war, accident) can disrupt the brain system. Fear, suspicion, delusions, etc. can be the result.
Researchers in Canada examined the brains of 78 adults who had committed suicide. Of this group, 27 were seriously abused as children. It also turned out that they were depressed. Twenty-five were determined to be depressed but not abused. The remaining 26 were neither depressed nor abused. Only those abused appeared to have little white matter (myelin) surrounding the neuron pathways in many brain areas. As a result, there were no good connections between the brain areas of the prefrontal cortex (the control area) and amygdala (the emotion area). Emotions can become amplified as a result, which can lead to psychosis. 4 (publication 2017)
Drugs
Drugs act as a trigger for psychoses. If children are predisposed to psychosis and they use drugs, they can quickly develop a psychosis. This is because some drugs have a strengthening effect on, among other things, the brain chemical dopamine. More is then produced than normal, which can lead to very pleasant feelings and thoughts. However, a lot of dopamine production also leads to changes in the perception of reality. Confusion, illogical connections, persecutory delusions, hallucinations can be the result.
“You are more likely to have psychotic experiences if you use it before, especially, the age of 16. Amphetamines and speed promote susceptibility to psychosis. These substances give such a feeling of: yes, I feel something nice! All uppers all work on the same chemicals in the brain. And that yes! feeling means that dopamine is released.,
(interview with psychiatrist and researcher Bart Rutten). 5
Smoking
Becoming addicted to smoking at a young age can lead to susceptibility to psychosis. Large-scale literature research shows that smokers are more susceptible to developing psychoses than non-smokers. It appears to be related to nicotine, which increases dopamine levels. 6
Relationship with other disorders
Psychoses can be associated with other disorders such as depression, anxiety, manic disorder, depression, and compulsive behavior. Such a connection is called comorbidity. Depressed children produce too little dopamine. As a result, they do not experience pleasant feelings and thoughts. For example, they may think or experience that they do not matter or that others always have to have them. Bullying behavior can cause and reinforce these feelings and mindsets. They experience a negative reality that they supplement with negative thoughts: “they will have to have me again, “I can’t do anything”, I am always laughed at . In psychosis, such thoughts and feelings determine life in such a way that it is assumed in advance that this is the case.
Approach
If parents or caregivers observe psychotic features in the young child, it is advisable:
- don’t get angry, don’t laugh at the child, don’t judge, stay calm
- Talk to the child, take the child seriously and ask what he observes, listen to it
- calmly indicate that you perceive differently than the child
- avoid discussion
- regularly check whether the child still has the psychotic features
- If the characteristics remain persistent, it is advisable to seek help from experts
Experts can help using certain therapy approaches. Medication may also be necessary. For older children (adolescents) , therapeutic help is recommended at an early stage for persistent psychotic behavior .