Auditory hallucinations in youth:occurrence, clinical significance and intervention strategies

The thesis ‘Auditory Hallucinations in Youth’ is about auditory hallucinations in children and adolescents (hereafter ‘youth’). Experiencing an auditory hallucination means that someone hears something in the absence of an identifiable stimulus (‘sound’). Auditory hallucinations can differ from undefinable sounds or mumbling to hearing clear music and/or hearing voices whispering or shouting. In the case of ‘hearing voices’, this is also called auditory verbal hallucinations. Previous research points to the frequent occurrence of auditory hallucinations. However, prevalence rates varied widely. Auditory hallucinations in youth are often transient. Nevertheless, while present, they can cause severe suffering and even be a symptom of psychopathology. Research following this thesis shows that almost one in ten people ever experience an auditory hallucination, with higher rates in children (12.7%) and adolescents (12.4%) than in adults (5.8%) and the elderly (4.5%). About a quarter (23.6%) of young adolescents hearing voices is in need of clinical care. Youth seeking help for hearing voices suffer highly consequent to the impact of their voices, but also to the presence of various and often multiple psychiatric diagnoses. Therefore, youth hearing voices warrant a broad clinical assessment. Treatment should always first aim at possible underlying causes and psychoeducation regarding auditory hallucinations. The newly developed psychotherapy Stronger Than your Voices is effective to increase coping regarding hearing voices and subsequently reduce the impact of the voices

Stronger than your voices:A cognitive behavioral therapy for youth suffering from auditory verbal hallucinations

Objective: Auditory verbal hallucinations (AVHs) are a common feature in youth and mostly transient. Nevertheless, while present, AVH can cause considerable distress. Children and adolescents seeking help for distressing AVH represent a heterogeneous group in terms of underlying factors, yet they consistently suffer from their AVH. Until now, a youth-specific psychotherapeutic intervention for AVH was lacking. Experts in the field of treating AVH in both adults and youngsters collaborated with service users to develop the cognitive behavioral therapy (CBT) "Stronger Than Your Voices" (STYV). We investigated feasibility and clinical outcomes of the STYV therapy. Methods: Patients were derived from children and adolescents seeking help for AVH at the UMC Utrecht outpatient clinic with an indication for STYV therapy. Therapists preferably originated from referring health care facilities and were required to have sufficient general knowledge and experience with CBT. They received a short individual training to apply STYV. After, patients and their therapists could participate this naturalistic pilot study, assessing feasibility, tolerability, and clinical change when applying the STYV therapy. Results: Six participants (10-16 years old), all suffering from comorbid psychopathology, provided pre and post measures, all completing STYV therapy without experiencing an aggravation of symptoms. AVH total impact decreased 40% with Cohen's d within-group effect size (1.28) also suggesting clinically meaningful change. Therapists were positive about STYV therapy and manual. Conclusion: The STYV therapy is feasible for youth with distressing AVH. First results indicate that STYV may be clinically effective. A trial to further test effectiveness in a larger sample is needed

Children seeking help for auditory verbal hallucinations; who are they?

Background Auditory Verbal Hallucinations (AVH) in children and adolescents are a relatively common and mostly transient feature in community samples. However, it should not be regarded as a merely benign phenomenon, as childhood AVH are associated with psychopathology. Little is known about the clinical group of children seeking help for AVH. This brings uncertainty on how to assess and treat these children. Methods This study describes the characteristics of 95 help-seeking children (aged 6 to 18 years) with AVH attending an outpatient clinic specifically dedicated to help youth with this complaint. We aim to provide pointers regarding diagnostic assessment and interventions. Results Children seeking help for AVH suffered from a diversity of co morbid psychiatric diagnoses and consistently experienced high stress from AVH. When the DSM-IV-TR criteria for psychotic disorder NOS were used, all 95 children obtained this diagnosis. However, when a psychotic disorder was defined using the A-criterion of schizophrenia, only a minority of 11 cases (11.6%) was diagnosed as having a psychotic disorder. All children were in need of psycho-education and coping strategies and only the minority (11.6%) fulfilling criteria for a more narrowly defined psychotic disorder was prescribed antipsychotic medication. Conclusions Children seeking help for AVH form a heterogeneous group with high stress and reduced functioning. Even though only a minority (11.6%) suffers from a psychotic disorder, all children warrant clinical care due to their burden and multi morbid psychopathology

Treatment outcomes of dialectical behaviour therapy for adolescents presenting with characteristics of borderline personality disorder: A naturalistic study

This naturalistic study investigated treatment outcomes of Dutch dialectical behaviour therapy for adolescents (DDBT-A) in a sample of 93 adolescents (95.4% female, mean age = 16.20 years) presenting with borderline characteristics, treated at Levvel (a Dutch mental health institution). From baseline to posttreatment significant decreases were found on severity of the borderline symptoms, passive coping style, internalizing and externalizing behavioural problems, and a significant increase on self-worth. Overall, three different therapy formats (outpatient, part-time therapy, and day therapy) showed similar improvements at posttreatment. Concluding, DDBT-A seems promising in reducing borderline related symptoms for adolescents