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mikeland
07-09-2008, 06:57 PM
Indulge me in a little role play:

The year is 1977. You're a psychiatrist. You get a new patient -- a six-year-old boy. His parents are concerned because he occasionally goes into what appear to be fugue states. Just for a few minutes at a time -- but when he goes inside his head, he goes deep, and it takes some work to get him to come back. And now they suspect that he may be hearing voices.

In all other respects, the boy seems normal -- smart, aware, curious. No problems whatsoever with behavior, cognition, speech or language acquisition or socialization. He's a bit quiet, but not abnormally so.

If this case came to you, what would you do? How would you start to treat him? What tests would you run? What questions would you ask the boy and his parents?

If you decided that the boy needed some sort of medication, what would that be and in what dosage? Given it is 1977, what medications would even be available and common for a child?

Thanks in advance for your help.

ideagirl
07-09-2008, 08:32 PM
I'd refer the kid for a neurological workup before doing anything else. What you're describing could be a form of epilepsy or another neurological disorder.

RAMHALite
07-09-2008, 08:42 PM
If the child is normal in all other respects, then emotional disturbance would rank low on my list of diagnostic hypotheses. "Spacing out" for a few minutes at a time sounds like Jacksonian psychomotor equivalency seizures. As I recall, the preferred psychiatric treatments for all types of seizures at that time were either phenobarbital (brand name Luminal) or Tegretol. Dosages: Luminal 3-8 mg. per kg. of body weight per day, in 2 doses; Tegretol 100 mg. twice daily.

As a psychologist, I would administer the Wechsler Intellignece Scale for Children-Revised (we are now up to the Wechsler-IV) to get an indication of cognitive functioning/abnormalities; Bender Gestalt Test (used to be regarded as a highly reliable neuropsych test back then, but not currently) to see if any organic problem; Vineland Social Maturity Scale, which is a strcutured interview with parents about child's development and behavior; Wide Range Achievement Test to screen for learning problems.

HTH,

RAMHALite

veinglory
07-09-2008, 08:42 PM
First thought: epilepsy--absence seizure.

I suspect the first referal would not be a psychiatrist with this diagnosis, especially in a child.

mikeland
07-09-2008, 10:40 PM
Thanks, veinglory, RAMHALite and ideagirl. This is all very helpful.

If you'll indulge me for a moment, would your first instinct, diagnosis, treatment, etc. change if there were no fugue states or spacing out?

What if the parents made an appointment with you because they believed the child was hearing voices? What if you determined that the child also believed he was hearing voices? But there were no other symptoms.

veinglory
07-09-2008, 11:13 PM
It was be rather tricky in a child that young as they are highly suggestable and haven't got a firm reality/fantasy separation. So long as the child was generally functioning adequately and not distressed by the voices or, for example, killing animals at their behest, I feel a behavioral professional would be inclined to take a hands off approach. A problem is only a problem when it is actually causing a problem, after all.

Skyraven
07-10-2008, 02:28 AM
since the child you describe has not has a traumatic incident occur, i would have to agree with veinglory. children younger than 8 would have a really difficult time distinguishing reality from fantasy. No other symptoms but voices? A professional can't diagnose based on only one symptom.

ideagirl
07-10-2008, 03:37 AM
since the child you describe has not has a traumatic incident occur, i would have to agree with veinglory. children younger than 8 would have a really difficult time distinguishing reality from fantasy. No other symptoms but voices? A professional can't diagnose based on only one symptom.

Yes, particularly with kids. "He's hallucinating that a person is there when there's no one there!"--that's another way of saying "he has an imaginary friend." Childhood is childhood, not insanity.

TerzaRima
07-10-2008, 07:13 AM
Why does everyone suspect he is hearing voices? Is he talking to the air? Does he describe actual voices? Does he do things that make no sense and then say that voices told him to do them?

Sometimes young kids with obsessive compulsive disorder will start talking about hearing voices, and when you dig a bit deeper, you find that what they are trying to describe is the introject of having OCD--it feels as if someone is telling you to keep washing your hands, checking the stove, etc, but young children don't know how to talk about that.

mikeland
07-10-2008, 05:20 PM
Thanks again for all the thoughts and insight. This has been extremely helpful to my WIP. I'm not a detailed outline kind of writer, so I'm feeling my way through the details right now as I write.

I'm not quite sure how other people know that he hears a voice yet. He'll probably end up confiding in someone -- and that person will tell his folks -- which may lead to them deciding to make a psych appointment.

However, the reader knows without a doubt that the boy is hearing one particular voice. That voice is the first-person narrator of the book. Yeah, it's a little odd (as is most of my stuff). I'm curious to see if I can pull it off for a whole novel.

I put in the little spaced-out moments (which might actually work as seizures) to give the boy's parents a concrete symptom to worry about. I need to write some more to see if that'll play out.