Child Mental Health and Child Protection
C2.3 Children Who ‘Hearing Voices’: When to Worry and When to Refer
Identifying the Victims and the Indicators
Dr Siu-man Lam
Chief of Service,
Department of Child and Adolescent Psychiatry,
Castle Peak Hospital
Working in the field of Child & Adolescent Psychiatry for nearly 25 years, Dr Siu-man Lam is now the Chief of Service, Department of Child & Adolescent Psychiatry, Castle Peak Hospital. They are providing a comprehensive range of Child and Adolescent Psychiatric services for the population of the New Territory West Cluster of the Hospital Authority at the Tuen Mun Child & Adolescent Mental Health Centre. He is also the member of the Executive Committee of the Hong Kong Association for Child and Adolescent Psychology and Psychiatry.
‘Hearing voices’ per se are uncommon paediatric presentations, but they can be alarming to carers and lead to emergency consultations. This presentation outlines the phenomenology of auditory hallucinations, their assessment and clinical significance. Auditory hallucinations are seen in the course of acute medical disorders or episodic neurologic conditions such as migraine and temporal lobe epilepsy. Auditory hallucinations are key symptoms in psychiatric disorders such as schizophrenia spectrum and other psychotic states, but they can also present with mood disorders. In fact, hallucinations—usually simple and transient—are common in the general child populations. Auditory hallucinations become clinically significant when they occur as part of a medical disorder or in the context of acute psychotic states and schizophrenia, when they are frequent, complex, distressing and cause impairment. One special clinical population relates to that of adolescents with borderline personality disorder who commonly presented as psychiatric emergencies. The treatment of clinically relevant hallucinations is that of the primary medical or psychiatric disorder. Occasionally they require treatment in their own right with psychological treatments.
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