Child psychologists needed (Child experiencing hallucinations)

Exir

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I'm toying around with a story with a lot of wacky surreal and symbolic imagery. The main character, an 8 year old girl, is preoccupied with making stuff out of cardboard boxes. She sees wacky and weird things that aren't there (hallucinations), and seems to believe that she can somehow "build" the world around her by making a miniature world of her own using cardboard (is it correct to label that as a delusion?? Or still considered a hallucination?) As the story goes on, it is revealed that most of the things she sees around her, ranging from furniture to hidden rooms to imaginary friends were all hallucinations "built" from cardboard. Indeed, these things start to fold and tear once she takes medication.

Of course, I can always keep the story on the level of imagery and symbolism, but I'm thinking if I can take a step more and actually ground it on a real life condition.

I did some research on Childhood-Onset Schizophrenia. Is what I described schizophrenia? Have I mistaken anything, or omitted important points that you think should be addressed? Are there any disorders with symptoms similar to schizophrenia that can also fit in the story as a reason for the surreal imagery to exist?
 
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Kurtz

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It sounds like what you described could be symptoms of some form of schizophrenia. It manifests itself in so many different ways that you can do whatever you want.

From what I can remember from psych class is that there are positive and negative symptoms. Positive symptoms are experiencing things normal people don't (such as the delusions, weird thought process etc) and negative is things that most people have but the patient doesn't (eg a flattened emotional state, catatonia etc).

However, it's notoriously difficult to diagnose in children because they're all pretty nuts anyway.

A delusion is a fixed false belief, like Russel Crowe in A Beautiful Mind. Your character certainly experiences these.

Looking at the DSM IV I'd say your character has the following:

1. Delusions
2. Hallucinations

If these persist for a long period of time I'd say there's sufficient grounds for a positive diagnosis for Schizophrenia.
 

Exir

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Ha, thanks Kurtz!

It manifests itself in so many different ways that you can do whatever you want.

I'm glad to hear that. Of course, my character still follows the "boundaries" of schizophrenia so it should be grounded in reality. But glad to know I have freedom ;)

From what I can remember from psych class is that there are positive and negative symptoms.

Does this count as a negative symptom: the girl has few friends and rarely interacts with those outside of her family. It's not that she really wants to but can't achieve that because she's too nutty -- it's that she doesn't even care about it. When people taunt her she, instead of reacting, just becomes more subdued, approaching a state of catatonia. Often, when someone tries to hold a conversation with her, she reacts by repeating a single word over and over again, first loud then soft then inaudible. (For example, when a boy asks if he could work on the cardboard house she's making, she says the word "mine" over and over again, without an obvious semantic context; If I understood what I read in the reference books correctly, some schizophrenic children may have speech impairment, not due to the lack of ability but because of lowered levels of response to stimuli such as someone trying to initiate a conversation. I may be wrong.) Even with her family she is pretty withdrawn. It is her frickin' birthday, and all she does is to give her parents a hug, take her presents and retire to her room. She then proceeds to dump all the presents her parents gave her (without understanding this might be tactless) just because she likes the cardboard boxes better.

Anything there that could be an inaccurate portrayal of schizophrenia?
 
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Kurtz

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Does this count as a negative symptom: the girl has few friends and rarely interacts with those outside of her family. It's not that she really wants to but can't achieve that because she's too nutty -- it's that she doesn't even care about it. When people taunt her she, instead of reacting, just becomes more subdued, approaching a state of catatonia. Often, when someone tries to hold a conversation with her, she reacts by repeating a single word over and over again, first loud then soft then inaudible. (For example, when a boy asks if he could work on the cardboard house she's making, she says the word "mine" over and over again, without an obvious semantic context; If I understood what I read in the reference books correctly, some schizophrenic children may have speech impairment, not due to the lack of ability but because of lowered levels of response to stimuli such as someone trying to initiate a conversation. I may be wrong.) Even with her family she is pretty withdrawn. It is her frickin' birthday, and all she does is to give her parents a hug, take her presents and retire to her room. She then proceeds to dump all the presents her parents gave her (without understanding this might be tactless) just because she likes the cardboard boxes better.

Anything there that could be an inaccurate portrayal of schizophrenia?

From what I can remember nothing there is out of the realm of probability. Its important to distance the character from normal child-being-screwy, which every child does at some point to full blown mental illness. If it was just the hallucinations and delusions it would be difficult to get this across but the rash of secondary syptoms make it more obvious that she is seriously mentally ill. It would also help a lot more in a positive diagnosis.
 

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From what I know, if a schizophrenic character felt compelled to do something like build with boxes, it would be because voices in her head were telling her to do it.

LA Times just had a fascinating story about a little girl with schizophrenia. http://www.latimes.com/features/health/la-he-schizophrenia29-2009jun29,0,4834892.story (warning this will probably make you sad)

Your idea sounds a bit like this weird Kathleen Turner/Tommy Lee Jones movie called "House of Cards". http://www.imdb.com/title/tt0107148/ The MC's kid has a mental illness and she's compelled to build these elaborate structures out of papers and cards. Her mental illness is never defined as anything specific, but they do figure out that a specific event has brought it on. Anyways, I don't want to give away the plot. It's a strange but decent movie!
 

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Hi exir, sorry for the long post.

I'm a child psychiatrist, and the only thing slightly off so far about your post is that psychologists have psychology degrees and tend to be therapists. Psychiatrists have medical degrees and tend to take the lead in treating mental illness. Psychologists can't prescribe medication

You're painting a picture that would ring true with me. Every presentation is unique so you don't have to be able to medicalise every single aspect of your child's world. Not only is she experiencing symptoms, she will be trying to make sense of them in a way that fits with what she already knows about the world. She also has a whole raft of defence mechanisms she'll use to protect herself when things seem overwhelming.


8 year old girl, is preoccupied with making stuff out of cardboard boxes. She sees wacky and weird things that aren't there (hallucinations), and seems to believe that she can somehow "build" the world around her by making a miniature world of her own using cardboard (is it correct to label that as a delusion?? Or still considered a hallucination?)

Your girl is experiencing both hallucinations and a secondary delsuion that is slightly grandiose
A hallucination is purely sensory, but people do try to make sense of what they see or hear. Thinking that she can influence the world is a logical secondary delusion if she sees the world as being made of cardboard. A secondary delusion is one that has a logical link to something. A primary delsuion doesn't (e.g. my pen is green so my parents are trying to kill me) The world is made of cardboard so I can change it by playing with cardboard is logical.

My biggest thought is about your descripion of the hallucinations. and this is in part becuase most hallucinations only involve one of the five senses. Most visual hallucinations are silent, most auditory hallucinations are invisible. You can't touch them, or smell them or taste them. They also tend not to last very long, they come and go. This is going to be your biggest challange if many things in her world appear solid. What happens if she tries to touch them?

You can get around this by linking the hallucinations to real objects, i.e. making a real table look like it's cardboard and appear to rip, but if the whole table is a hallucination then your child's hand should pass right through it.

To have your girl exist in this world you're going to have to blend together her symptoms, her interpretation of them and her imagaination, but this is what would probably happen. In this way her imaginary friend could talk to her, and she could explore an imaginary room instead of walking into the wall. Don't try to overexplain this, it will feel true so long as you're writing from your girl's point of view.....but if she is exploring a room that is a hallucination in its entirity then that will have to be imagination. might be easier to have one room in her house change, but leave it as a real room.

As an aside, most hallucinations in psychosis are auditory. Generally speaking, visual hallucinations are more common in organic illness eg brain tumours. People with psychosis do sometimes see things, but any doctor will want to do quite a through physical workup including MRI whenever visual halucinations are so prominent.

Does this count as a negative symptom: the girl has few friends and rarely interacts with those outside of her family. It's not that she really wants to but can't achieve that because she's too nutty -- it's that she doesn't even care about it. When people taunt her she, instead of reacting, just becomes more subdued, approaching a state of catatonia. Often, when someone tries to hold a conversation with her, she reacts by repeating a single word over and over again, first loud then soft then inaudible. (For example, when a boy asks if he could work on the cardboard house she's making, she says the word "mine" over and over again, without an obvious semantic context;

Anything there that could be an inaccurate portrayal of schizophrenia?


This is good too.
You're describing a combination of negative symptoms and defence mechanisms. It's easy for someone with psychosis to feel overwhelmed. A possible negative symptom is thought disorder, and that can just slow people up a bit. Some people describe it as thinking through treacle. Figuring things out can just be hard and it can take all your energy to stay focused.

your girl might be easily overwhelmed by someone interfering and not know what to do so just try to protect herself by withdrawing. Her lifestyle might also change as she may be better able to focus alone in her room without a million distractions.....just like sometimes we write better by stopping people interupting us and taking oursleves off somewhere quiet. isolation is a normal behaviour for a lot of us when we're stressed, psychois means your girl is alrady dealing with more than she can understand and isolation is a very natural response.


Basically, if you don't try to make every single aspect of your girl's behaviour a symptom, and remember that like the rest or us she has defence mechanisms, an imagination, and that how she perceives things is coloured by her experiences then you're good. Someone with psychosis doesn't stop being human, they just suddenly have a lot of frightening things to deal with at a time when their memory, concentration and ability to think clearly is impaired. The entire expereince can be overwhelming and isolation is a good way to respond to that.

I'd be happy to answer anything more specific if i can help.......but you're definately on the right lines.

Craig
 

Chalula88

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I almost think it would be more interesting if it was a delusion brought on by her imagination, maybe caused by a trauma, but not a mental disorder. She retreats into a world of cardboard boxes...sounds more like a trauma story rather than a schizophrenic story to me.

That's just my opinion though! :)
 

TabithaTodd

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Reminds me of the movie Mirrors...

Good luck in finding a solution - no psych here but does sound like schizophrenia, maybe bipolar with it? Hubbs has a cousin with schizophrenia and bipolar 2, he was much the same before medication and got diagnosed in Juvie.
 

rtilryarms

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you may also consider the association between epilepsy and psychosis
 

veinglory

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Um, and also that magical thinking is completely normal in children? Eight would be the upper end of the range for full-on magical thinking but not that uncommon.

Most psychologists and psychiatrists would strongly resist a firm diagnosis at that age and many conditions cannot be considered in children--they are defined in the DSM to exclude people under a certain age.

Unless the child is diagnosed in the story I wouldn't worry about the label that could be applied. It isn't an exact science anyway....