Hallucinatory Experiences in a Community Sample of Japanese Children

doi:10.1097/01.chi.0000126937.44875.6b

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 43, Issue 8, August 2004, Pages 1030-1036

https://doi.org/10.1097/01.chi.0000126937.44875.6b Get rights and content

ABSTRACT

Objective

Hallucinatory experiences in children are often thought to indicate serious psychopathology. However, they have also been reported in normally developing children and in association with temporary psychological reactions to acute stress. The aim of this study was to investigate the prevalence of hallucinatory experiences in a nonclinical population of children and to examine the relationship between the modality and content of hallucinations and psychopathology.

Method

Seven hundred sixty-one Japanese children, 11 to 12 years old, completed a battery of four measures: (1) a questionnaire about the type of hallucinatory experience, (2) the Children's Depression Inventory, (3) the State-Trait Anxiety Inventory for Children, and (4) the Adolescent Dissociative Experiences Scale.

Results

Approximately 21% of the subjects had experienced hallucinations. Subjects who had experienced hallucinations, in particular, hallucinations characterized by combined modalities, closely self-related auditory content, or concrete visual content, had more significant psychopathology than did those who had never experienced hallucinations.

Conclusions

Therapeutic intervention should be considered for children who experience hallucinations in association with depression, anxiety, or dissociation.

Section snippets

METHOD

The 761 Japanese children (400 boys and 361 girls) in this study, ranging from 11 to 12 years of age, were public school students in five elementary schools randomly selected from different areas in the Aichi prefecture in Japan. No subject attended a special class or was mentally retarded. Subjects were asked by their teacher to complete a battery of four measures in their homeroom: (1) a questionnaire designed by the authors concerning hallucinatory experiences, (2) the Children's Depression

RESULTS

Subjects who did not meet the decided criteria for hallucinations were excluded from all analysis. Subjects who failed to answer any item of any measure were also excluded because missing data occurred randomly. Consequently, of a total of 761 original subjects, 380 (49.9%) were included.

DISCUSSION

Approximately 21% of the subjects in this study reported having experienced hallucinations. The prevalence of hallucinations in this study is a little lower than that of studies that used the questionnaire method; for example, Ross et al. (1990) found a prevalence of 26% in the general population, and Altman et al. (1997) found a rate of 33% in a subclinical population aged 13 to 21 years. Nevertheless, the rate found in this study is much higher than that of previous studies that used the

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Just over 30% of participants had at least one psychotic experience between ages 12 and 18 (coded 1; n = 623, 30.2%), whereas 69.8% reported no psychotic experiences (coded 0; n = 1440). This 30.2% prevalence is similar to the prevalence of self-reported psychotic experiences in other community samples of teenagers and young adults (Spauwen et al., 2004; Yung et al. 2009; Yoshizumi et al., 2004). These self-reported experiences capture a broader spectrum of more commonly occurring subthreshold psychotic phenomena than psychotic symptoms and have not been subject to clinical verification.
Exposure to victimization in childhood has been linked to the development of psychosis. However, little is known about how childhood victimization is translated into biological risk for psychosis. One possibility is via increased inflammation. This study aimed to investigate the association between childhood victimization, psychotic experiences (PEs) in adolescence and inflammatory markers using data from a general population cohort. Participants were 1,419 British-born children followed from birth to age 18 years as part of the Environmental Risk Longitudinal Twin Study. Childhood victimization was measured prospectively using multiple sources from birth to age 12 years. PEs were assessed during private interviews with participants at age 18 years for the period since age 12. Plasma C-reactive protein (CRP), interleukin-6 (IL-6), and soluble urokinase plasminogen activator receptor (suPAR) levels were measured from plasma samples collected from participants at 18 years. Young people with both PEs and childhood victimization were more likely to belong to a group with elevated suPAR, CRP and IL-6 levels at 18 years of age (OR = 3.34, 95% CI 1.69–6.59, p = 0.001) than those with no childhood victimization and without PEs. However, this association was attenuated when adjusted for other risk factors for elevated inflammation at age 18 (OR = 1.94, 95% CI 0.94–4.04, p = 0.075). In contrast, presence of PEs without childhood victimization was not significantly associated with age-18 inflammatory markers and neither was childhood victimization without PEs (all p’s greater than 0.05). The current study highlights that inflammatory dysregulation is mostly present in adolescents reporting PEs who also experienced childhood victimization, though this seemed to be largely due to concurrent inflammation-related risk factors.
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Around 6–7% of the general population report psychotic experiences (PEs). Positive PEs (e.g. hearing voices) may increase the risk of development of psychotic disorder. An important predictor of the transition to a psychotic disorder is secondary distress associated with PEs. We examined the moderating effect of potential protective factors on this secondary distress.
Data come from 2870 individuals of the HowNutsAreTheDutch study. PEs were assessed with the Community Assessment of Psychic Experience (CAPE) questionnaire and were divided into three subdomains (“Bizarre experiences”, “Delusional ideations”, and “Perceptual anomalies”). Protective factors explored were having a partner, having a pet, benevolent types of humor, optimism and the high levels of personality traits emotional stability (reversed neuroticism), extraversion, openness to experience, conscientiousness, and agreeableness. We examined whether these protective factors moderated (lowered) the association between frequency of PEs and PE-associated distress.
Results: Due to low prevalence of perceptual anomalies in the sample, this domain was excluded from analysis. No moderating effects were observed of protective factors on the association between bizarre experiences and distress. Having a partner and high levels of optimism, self-enhancing humor, openness, extraversion and emotional stability moderated the association between delusional ideations and secondary distress, leading to lower levels of distress.
Several protective factors were found to moderate the association between frequency and secondary distress of delusional ideations, with high levels of the protective factors being associated with lower levels of distress. A focus on protective factors could be relevant for interventions and prevention strategies regarding psychotic phenomena.
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Over the past twodecades, a growing body of literature has assisted in reshaping the perception of psychotic phenomena and their meaning within psychiatry. This shift in view is particularly owing to epidemiological research, which has steered the focus away from phenomena suffered by those with debilitating psychiatric conditions, to what is now seen as an extension of “normal” experience evident within the general population, namely psychotic-like experiences (PLEs). For most, PLEs are transient and relate to difficulties coping with current life adversity. For a minority (20%), PLEs will persist, and persistence appears to accentuate the “risk” of comorbid/subsequent psychiatric disorders and psychosocial dysfunction. PLEs seem to emerge from the interaction between genetic predisposition and certain environmental factors particularly exposure to trauma, a poor social environment, and cannabis use. While the prevalence and relevance of PLEs are increasingly understood, several questions remain: Which PLEs are pathological and/or persist? Do persistant PLEs require intervention? Finally, given the prevalence of PLEs, it is important to disseminate existing findings regarding their meaning? Guiding this narrative will hopefully cause shifts in public opinion regarding psychosis.
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A similar difference has been found in schizophrenia patient samples (Marneros, 1984; Rector and Seeman, 1992). However, representative population samples of normal 7–8-year-old children (Bartels-Velthuis et al., 2010), as well as 11–12-year-old (Yoshizumi et al., 2004), found no gender difference in AVHs. Studies of overall prevalence of hallucinations (both auditory and others) have also failed to find gender differences (Scott et al., 2009).
Gender differences in language can be signs of cognitive differences, but can also by themselves be the cause for such differences. Females have a slight linguistic advantage over males, but effect sizes are small, and gender explains very little of the variance seen in the normal population (1%–2%). However, males outnumber females in the lowest 10th percentile in language tests (2:1), causing males to more often be diagnosed with developmental disorders, which rely on tests of language development.
Thus, gender differences in language are negligible, if you focus on the whole population, but if you focus on language deficits, gender differences are outspoken. Differences in voice and word use can be observed among the genders, making it possible to predict gender from these measures with a high degree of certainty. A subtle finding is that women use more first person pronouns. This is also observed in depression, which is more prevalent in females, opening up a potential link. Sex chromosome trisomies are often accompanied by language deficits, but the causes for this are not known. No gender differences are observed in the linguistic symptoms of neurodegenerative disorders. Poststroke aphasia is more prevalent among women than among men, but this seems to be an age-effect. A link between the brain and gender differences in language is thus missing.
Psychotic-Like Experiences in Offspring of Parents With Bipolar Disorder and Community Controls: A Longitudinal Study
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To compare the prevalence and risk factors associated with psychotic-like experiences (PLE) in offspring of parents with bipolar disorder (BP) and offspring of community control parents.
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In all, 95 offspring (14.9%) reported PLE at some point of the study, 16.9% of BP parents and 11.7% of controls, without statistically significant differences. Psychotic disorders were less frequent, with 16 (2.5%) in both groups. During follow-up, three variables remained as the most significant associated with PLE in the multivariate models: (1) presence of any psychiatric disorder (hazard ratio [HR] = 3.1; p = .01); (2) low psychosocial functioning (HR = 2.94; p < .0001); and (3) current or past history of physical or sexual abuse (HR = 1.85; p = .04). There were no effects of any subtype of BP, IQ, history of medical illnesses, exposure to medications, or perinatal complications.
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Just over 30% of participants had at least one psychotic experience between ages 12 and 18 (n = 623, 30.2%). This is similar to the prevalence of self-reported psychotic experiences in other community samples of teenagers and young adults (Kelleher et al., 2012b; Yoshizumi et al., 2004). The presence (30.2%) versus absence (69.8%) of one or more “definitely present” psychotic experiences is used as a dichotomous dependent variable in the current study.
Experiencing multiple types of victimization (poly-victimization) during adolescence is associated with the onset of psychotic experiences (such as hearing voices, having visions, or being extremely paranoid). However, many poly-victimized adolescents will not develop such subclinical phenomena and the factors that protect them are unknown. This study investigated whether individual, family, or community-level characteristics were associated with an absence of psychotic experiences amongst poly-victimized adolescents. Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of 2232 UK-born twins. Exposure to seven different types of victimization between ages 12–18 was ascertained using a modified version of the Juvenile Victimization Questionnaire at age 18. Adolescents were also interviewed about psychotic experiences at age 18. Protective factors were measured at ages 12 and 18. We found that exposure to poly-victimization during adolescence was associated with age-18 psychotic experiences (OR = 4.62, 95% CI 3.59–5.94, P < 0.001), but more than a third of the poly-victimized adolescents reported having no psychotic experiences (40.1%). Greater social support was found to be protective against adolescent psychotic experiences even amongst those exposed to poly-victimization. Engaging in physical activity and greater neighborhood social cohesion were also associated with a reduced likelihood of age-18 psychotic experiences in the whole sample, with non-significant trends in the poly-victimized group. Increasing social support and promoting physical activity appear to be important areas for future research into the development of preventive interventions targeting adolescent psychotic experiences. This adds further weight to calls to increase the promotion of these factors on a public health scale.

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: The authors thank Barry Nurcombe, M.D., and Per-Anders Rydelius M.D., Ph.D., for suggestions for improving this article and Nagoya City's education board, the elementary schools, and the students for their cooperation with the research.

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ArticlesHallucinatory Experiences in a Community Sample of Japanese Children

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

METHOD

RESULTS

DISCUSSION

J Am Acad Child Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Gen Hosp Psychiatry

Child Abuse Negl

J Am Acad Child Psychiatry

J Am Acad Child Psychiatry

J Am Acad Child Psychiatry

The experienced reality of hallucinations and other psychological phenomena: an empirical analysis

Acta Psychiatr Scand

Subclinical hallucinations and delusions in nonpsychotic adolescents

J Child Psychol Psychiatry

The Sidran Traumatic Stress Foundation Web site

Hallucination in Clinical Psychiatry: A Guide for Mental Health Professionals (Clinical Psychiatry Series, No. 2)

Psychotic symptoms in prepubertal major depressive disorder

Arch Gen Psychiatry

Articles
Hallucinatory Experiences in a Community Sample of Japanese Children