background In a baseline study among seven- and eight-year-old children with auditory vocal hallucinations (avh), only limited functional impact was observed (Bartels-Velthuis e.a. 2010). Recent studies show that transitory hallucinatory experiences during development may become pathological (in the sense of secondary delusional ideation and clinical need) following exposure to environmental risks.
aim To assess avh 5-year course and its predictors, as well as avh 5-year incidence and its risk factors.
method A sample of 337 12- and 13-yearold children (mean age 13.1 years) was reassessed on avh, after a mean follow-up period of 5.1 years. Parents again completed the Child Behaviour Checklist (cbcl). Measures of cognitive functioning were primary school test scores and secondary school level. Children were questioned about delusional ideation and social adversity (i.e. traumatic experiences [te] and stressful events [se]).
results The avh 5-year persistence and incidence rates were 24% and 9% respectively, more new cases arising in urban areas. Both persistent and incident avh were associated with problem behaviour in the (cbcl) clinical range, particularly at follow-up, as well as with other psychosis-like symptoms, particularly at baseline. avh persistence was predicted by baseline avh severity, mainly in terms of external attribution of voices and hearing multiple voices, and was associated with worse primary school test scores and lower level secondary school.
Early social adversity was associated with both incident and persistent avh, and was related to greater avh severity at follow-up. The combination of avh and delusions was strongly associated with traumatic and stressful events. avh severity mediated the association between te (but not se) and delusion formation.
conclusion First-onset avh in middle and later childhood is neither rare nor neutral in terms of psychopathological and behavioural comorbidity. Experience of social adversity is associated with persistence and onset of new avh closer to puberty, and with onset of delusional ideation.