When a Child or Teen Hears Voices: What Parents Should Know

Hearing a voice or seeing something that other people cannot is more common in childhood than many parents expect. Studies of the general population suggest that around 17 per cent of children aged 9 to 12, and around 7.5 per cent of teenagers aged 13 to 18, report psychotic-like experiences such as these ^[1]. Most of these experiences pass and do not lead to a psychotic illness ^[2]. They should still be taken seriously and discussed with a professional, particularly if they are distressing, persistent, or come with other changes in your child’s behaviour or functioning.

This article explains what these experiences can mean, which signs suggest something more serious, how to respond when your child tells you, and how assessment and treatment work.

How common are these experiences?

A systematic review of 19 population studies found a median prevalence of psychotic symptoms of 17 per cent in children aged 9 to 12 and 7.5 per cent in adolescents aged 13 to 18 ^[1]. These experiences include hearing voices, seeing things, or holding unusual beliefs. In most cases they are brief and do not amount to a mental illness.

Young children may also describe imaginary friends or vivid imaginative play. These are a normal part of development and are different from hallucinations that frighten a child or that the child cannot tell apart from reality.

What is psychosis?

Psychosis is a term for experiences in which a person loses some contact with reality. It can involve ^[3]:

• hallucinations: hearing, seeing, feeling or smelling things that are not there
• delusions: strongly held beliefs that are not true and that do not change when evidence is offered, such as believing they are being followed or watched
• disordered thinking: muddled thoughts or speech that is hard to follow

Psychosis can also affect sleep, appetite and concentration ^[3].

Psychotic illness is very rare in younger children and usually begins in the late teenage years ^[3]. A UK estimate puts the prevalence of psychotic disorders among those aged 5 to 18 at about 0.4 per cent, with new cases rising most sharply from the age of 15 ^[2]. When psychosis does begin early, the outlook tends to be more serious, which is one reason early assessment matters ^[2].

Possible causes and contributing factors

There is rarely a single cause. Factors that may contribute include ^[3]:

• very stressful life events
• drug use, including cannabis, LSD, ecstasy and amphetamines (“speed”)
• severe depression or bipolar disorder

Psychosis can also be part of a longer-term condition such as schizophrenia. Our articles on warning signs of teenage alcohol and drug use and on schizophrenia give more background. A clinician will also want to understand your child’s physical health, sleep and any recent stresses as part of the assessment.

Signs that suggest more than a passing experience

Psychosis often develops gradually. Before clear symptoms appear, there may be a period of months, sometimes up to a year, in which a young person changes in less specific ways. Family members are often the first to notice ^[2]. Watch for:

• withdrawing from friends and family, or spending much more time alone
• becoming unusually suspicious or fearful of others ^[2]
• a drop in school performance or difficulty concentrating
• changes in sleep, appetite or self-care ^[3]
• speech that is hard to follow, or ideas that seem strange or out of character
• voices or visions that are frequent, distressing, or that the child acts on

Any one of these can have other explanations, including anxiety, depression or stress. The combination, and a change from how your child usually is, is what matters most.

How to respond if your child tells you

It takes courage for a child to say they are hearing or seeing things. How you respond can make it easier for them to keep talking.

• Stay calm and listen. Thank them for telling you. Try not to show alarm, even if you feel it.
• Ask gentle questions. What do they hear or see? When does it happen? How does it make them feel? Do the voices ever tell them to do things?
• Do not argue about whether it is real. To your child, the experience feels real. You can acknowledge how frightening it must be without agreeing that it is true.
• Check for safety. If the voices are telling your child to harm themselves or others, or your child is very distressed, use the urgent help guidance at the top of this page.
• Keep things predictable. Regular sleep, meals and a calm routine help, and it is important to avoid alcohol and drugs.
• Arrange an assessment. Contact your child’s doctor or a child and adolescent mental health service, and explain what you have noticed.

Keep a simple record

Before an appointment, it can help to write down what you have noticed: when the experiences started, how often they happen, what your child says they hear or see, any changes in sleep, mood, eating or schoolwork, and anything that seems to make things better or worse. Note any medicines your child takes and any concerns about alcohol or drug use. This gives the clinician a clearer picture than memory alone, especially if your child finds it hard to talk during the first appointment.

Assessment and treatment

An assessment by a child and adolescent psychiatrist or mental health team looks at what your child is experiencing, how long it has been happening, how it affects daily life, and whether there are other explanations such as anxiety, trauma, depression, drug use or a physical health problem.

If symptoms are mild or short-lived

Most children with brief or mild psychotic-like experiences do not go on to develop psychosis. They do, however, have a higher risk than other children for up to 10 years ^[2]. This is why follow-up, and treatment of any distress, anxiety or depression, is useful even if the experiences settle.

If psychosis is diagnosed

Getting help early is important, and most young people recover with early treatment ^[3]. Treatment usually combines several elements ^[3]:

• Medication. Antipsychotic medicines are an important part of treatment for psychosis. UK national guidance notes that the evidence for these medicines in children is more limited than in adults, and that children and young people are more sensitive to side effects such as weight gain, changes in metabolism and movement problems ^[2]. Careful monitoring is essential.
• Talking therapies. These are usually offered alongside medication ^[3]. Research specifically on psychological treatments for psychosis in children is still limited ^[2].
• Family support. Helping the family understand the condition and support recovery.
• Hospital care. A young person who is very unwell may need a period in hospital ^[3]. Our article on choosing between a mental hospital and a psychiatric clinic in the UAE explains the difference.

Supporting recovery at home and at school

Recovery takes time, and families play a large part in it. Keeping daily routines steady, protecting sleep, and keeping expectations realistic while your child recovers can all help. With your child’s agreement, the school may be able to offer a reduced timetable, extra time or a quiet space while they return to normal routines. Agree with the treating team which early warning signs would mean you should get in touch sooner, such as a return of poor sleep, withdrawal or unusual ideas, and keep their contact details easy to find.

How BMMC can help

Beautiful Mind Medical Center’s psychiatry service and children’s services include psychiatrists who see children and adolescents. Our psychology team lists schizophrenia and psychotic disorders among the conditions it treats, and psychological testing can help when the picture is unclear. You can read about the team on our clinicians page. If your child needs care that BMMC does not provide, such as inpatient treatment, the team can advise on next steps.

For a non-urgent appointment, call +971 2 621 2230, email info@bmmc.ae, or use the booking form. If you are worried about your child’s immediate safety, do not wait for an appointment: call 998 or 999.

This article is for general educational purposes and is not a substitute for an individual assessment, diagnosis, or treatment plan from a qualified healthcare professional. If you are concerned about a child’s or adolescent’s safety, seek urgent professional help.

References

1. Kelleher I, et al. Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychological Medicine. 2012;42(9):1857–1863. doi:10.1017/S0033291711002960. Cambridge Core
2. National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in children and young people: recognition and management. Clinical guideline CG155, Context. Published 2013, updated October 2016, last reviewed 19 September 2024. nice.org.uk
3. Royal College of Psychiatrists. Psychosis in children and young people. Published August 2022. rcpsych.ac.uk
4. The UAE Government portal. Handling emergencies. u.ae