Delusions

Is your child:

• Seeming to be out of touch with reality?
• Believing things that don’t make sense?
• Having delusions of grandeur, meaning does your child think she is very important to the president or the queen of England?
• Hallucinating (visual or auditory); seeing or hearing things that aren’t there?
• Telling you he talks to Bon Jovi at night in his bedroom and that Jon talks back?

A delusion is a belief that is not consistent with reality. This belief could be evidence of a very serious problem and may need immediate attention. It is one thing for your child to have an active imagination and to believe that dragons are real or that Harry Potter really lives at Hogwarts. Children believe in the tooth fairy, Santa Claus and the Easter Bunny. Magical thinking is okay to a point.

If your child begins to become too wrapped up in fantasy or believes in delusions of persecution (someone is out to get me) or grandeur (I am very important and needed to protect our country), this could signal a serious problem.

If your child is anxious, sad, or exiled from peer relationships because of an obsession or belief, it may be time to seek help. Children do see shadows at night. They believe that monsters are under the bed or outside the shower. If the monsters move, talk and tell your child to act a certain way, this delusion could be a problem.

Consider religious and cultural beliefs. It may be that the family has unique beliefs that are not shared by the greater society. However, pervasive delusions that ‘haunt’ children and tell them what to do can be very serious and require immediate attention and intervention.

Children with loose associations, meaning wandering dialogue that does not follow any logical pattern and ascribing to irrational beliefs, could be experiencing early onset symptoms of schizophrenia.

Severe depression can also be accompanied by what we can psychosis. Psychosis is a detachment from reality that is directly related to a severely depressed emotional state. 

Children with autism can be very wrapped up in fantasy. They may believe more than other children that Hogwarts is real. They may take on characters from Star Wars and want to be them or to live in that fantasy world. Sometimes children with Autism use their interests or obsessions to frame their feelings about the world.

It can be helpful to translate or reframe. If a child says “I am Darth Mal inflicting my power over all!” you may say “Sounds like you’re pretty upset right now. It was a tough day.” It will be important to try to connect the metaphor back to reality.

For those with ASD, the fantasy may be more concrete, and it may make more sense.

It may be that talking to Jon Bon Jovi provides a sense of comfort to a kid who likes his music, and it may emerge through further casual conversation that this behavior is not a delusion at all, merely a coping strategy.

First, take the time to listen and learn. As a parent, it will be important to gather information in a neutral manner. Do not freak out or run around to every specialist in town. Don’t ask “are you crazy?” Instead, calmly ask, “Did this happen in real life or in your mind?” Sometimes a simple probe like this will indicate that your child knows he is imagining these things. It could be that your child is simply enjoying the fantasy world and nothing is wrong.

Follow up with calm neutral questions about the fantasy. You might ask, “So the teddy bear talks to you? What does he say?” “So he tells you that the girls at school are being mean. He tells you that he will protect you.” A belief like this is not that uncommon and may be a coping strategy.

Find out if this fantasy serves a purpose. If your child thinks she is talking to Bon Jovi, ask questions like, “Do you think maybe his music and listening to him sing makes you feel better?” This scenario is very different than the situation that leads you to believe your child is seeing and hearing things and is not connected to reality.

Be on the look-out for persecutory delusions or command hallucinations. A child who hears a voice that says to hurt someone or who believes that the CIA is coming for her is experiencing a significant mental health problem. If the delusions are telling your child to do bad things or evoking extreme fears in your child, call your doctor calmly but quickly.

Delusions usually require a combination of therapies from a psychologist and a psychiatrist. Medications are available to treat psychosis. Psychotherapy can be helpful, and an evaluation may help to really understand the symptoms.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• Emotional regulation: a child trying to distract him or herself with reality, to the extent that it impacts day-to-day functioning, could be feeling sad, depressed, and/or overwhelmed. Psychosis can occur within depression if the beliefs are related to mood states. Psychosis is marked by delusions and hallucinations. Sad children may seem moody and may have strong reactions or act irritable
• Perseverating: the tendency to obsess over objects or interests. Here, we can consider the obsession with Harry Potter or the belief in the Jedi (Star Wars). Children with Autism may become obsessed with these things. Repetitive and perseverative behavior can be a sign of an Autism Spectrum Disorder. A client once told me that it would be so nice to live in the movie. He would know who the characters are, what they think, and how everything will turn out in the end. This alternate reality could be so much easier than real life for a child with ASD
• Severe depression: as noted above, severe depression can be accompanied by psychosis, including delusions or hallucinations. Medications are available to treat these symptoms, and these medications can be combined with psychotherapy in an outpatient or inpatient setting, depending on your child’s safety. If your child is suicidal, call 911 or take him or her to your nearest emergency room to seek help
• Cultural factors: some children are taught beliefs that may seem delusional. Belief that the house is haunted, that a certain pair of socks will make the baseball team win, or that a man in a red suit comes down the chimney once a year are all possible cultural factors. It will be important to separate out cultural factors from a true delusion. Consider the impact the belief has on the child and her day-to-day life
• Magical thinking: children hold beliefs that do not fit with reality, like Santa, the Easter Bunny, etc. Some religious beliefs may feel magical. Some adults think if they wear the same socks and sit on the same sofa cushion then the Braves will win the World Series. Thus, if a child also believes in Harry Potter, this belief is not necessarily cause for concern, particularly if the belief is not causing distress, discomfort or having an impact on day-to-day functioning

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this does not serve as a diagnosis in any way. See ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Depression: significant emotional symptoms as well as psychosis could be a part of severe depression.
• Autism Spectrum Disorder: social communication challenges and restricted and repetitive behaviors due to a neurodevelopmental disability. Children with ASD can become obsessed with a topic and may seem delusional. This behavior could be a way of making the world concrete and easier to understand or a way of sharing feelings that your child does not know how to communicate otherwise.
• Severe trauma leading to symptoms of Dissociative Identity Disorder (DID) (trauma and attachment): after experiencing severe trauma in childhood like recurrent physical or sexual abuse DID (used to be called multiple personality disorder) may develop in a tiny percentage of individuals. If PTSD is not treated or if a child continues to live in fear or danger, sometimes children or adults detach as a coping mechanism. It is important to get help processing trauma and for a child to feel safe and protected.
• Schizophrenia spectrum and other psychotic disorders: delusions are a criteria of a SS Disorder. Schizophrenia is marked by delusions, hallucinations or disorganized speech. Seek out a comprehensive neuropsychological evaluation, and speak with your primary care doctor if you have concerns that your child meets these criteria.

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
• Psychotherapist or Play Therapist: to treat symptoms of trauma, depression
• Psychologist or Neuropsychologist: to seek a full assessment to understand what is going on for your child
• Pediatrician: to provide diagnosis, treatment, and prescribe medication or help you find a psychiatrist
• Psychiatrist: to provide and manage medication, communicate with other doctors and psychologists.
• Parenting consultation with Psychologist: to help with parenting. Some children may be more challenging to raise. Behaviorally challenging kids may need extra support from parents
• ABA Therapist: to teach adaptive behaviors and to set up a behavior plan at home

These professionals may recommend or administer the following tests for this symptom:

• Roberts, BASC-3, Interview, RCMAS, CDI-2, Human Figure Drawing, Brief Projectives: emotional assessment through drawing tasks, open-ended questions, interviews, rating scales, storytelling
• WISC-V: cognitive assessment to establish a baseline of intellectual abilities
• TOL-2, CTMT, WCST, TOVA: executive functioning and attention assessment. Know the child’s strengths and weaknesses that could impact learning
• ADOS-2: social-communication assessment for related concerns indicating an autism diagnosis should be considered

Torrey, E. Fuller (2006). Surviving Schizophrenia: A Manual for Families, Patients, and Providers (5th Edition) Publisher: Quill; 5th edition ISBN: 006084259

Seligman, Martin E.P. (1995). The optimistic child: A revolutionary program that safeguards children against depression and builds lifelong resilience.

Amazon: https://www.amazon.com/Optimistic-Child-Revolutionary-Safeguards-Depression/dp/B0028UJKPQ/

Knaus, William & Ellis, Albert (2012). The cognitive behavioral workbook for depression: A step-by-step program.

Amazon: https://www.amazon.com/Cognitive-Behavioral-Workbook-Depression-Step/dp/1608823806

Image Credit:
Description: Wrong ideas
Stock Photo ID: #531056006 (iStock)
By: stock_colors
Delusions
Previously Licensed on: May 21, 2017
Stylized by Katie Harwood exclusively for Clear Child Psychology

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