What are Delusions or Fantasy in Childhood?
A delusion in childhood is a belief that is not consistent with reality.
Delusions can look different depending on if they are caused by young age, autism, bipolar, drugs, or childhood psychosis. Very young children tend to engage in fantasy play frequently and this is generally not of concern. A pair of second graders galloping around the playground, pretending to be horses, is completely normal. A child under the age of six who tells outlandish stories is also demonstrating typical behavior. Delusions are different because the child believes the delusion is real and there is significant distress in the family as a result.
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Symptoms of Delusions and Magical Thinking in Children
Symptoms of fantasy & magical thinking
- Change character when angry: your child might say they are “Voldemort” during angry moments, and curse you in the character’s voice
- Threats in character: your child may pretend to have a lightsaber and say that he is going into battle with you. This has a much more serious tone than a child playing like a pretend Jedi
- Claims to be a mythical or pretend character: your child tells you how they are a certain character from Disney, Star Wars, or Harry Potter in a way that is more unusual and persistent than in typical make-believe play
- Makes up stories: your child may be struggling to engage in conversation with peers and will fabricate a story to fill in gaps in the dialogue. Often, these made-up stories go on and on and have no point. You may have the sense that your child knows the stories are untrue but will go to extreme lengths to convince you otherwise
- Erroneously believes they see things you can’t see: your child sees a shadow in the room and is unaware that you also see the same shadow
- Overly dramatic enactments: your child becomes so engrossed in their own world and imagination that you wonder if they are playing making believe or believing the scenarios are happening in real life
Symptoms of delusions
- Bizarre thoughts: your child seems to be out of touch with reality, saying things that are untrue and hard to follow
- Cognitive symptoms: your child believes in things that don’t make sense, seems foggy, and confused. Another symptom is ‘loose associations’ which means that the thoughts your child expresses do not go together or sound coherent. They may be jumping between ideas and expressing thoughts in a random and jumbled up sequence
- Delusions of grandeur: your child thinks their actions are more important on a national or global level than they are
- Hallucinating (visual or auditory): your child indicates that they see or hear things that are not there
- Drug-induced psychosis: your child starts acting very confused or dissociated after using drugs. Be aware that prescribed stimulant medications can cause psychosis. The potential for psychosis is much higher if your child is on prescribed psychotropic medications and also uses THC or other substances. See Addiction in Teens for more on symptoms of drug use in children and teenagers
Causes of Delusions in Childhood
Causes of fantasy delusions and magical thinking
- Autism spectrum disorder: children with ASD may have a strong preference for fantasy topics. This tendency is often related to poor perspective taking, or not understanding how their own thoughts and ideas might relate to thoughts and ideas of others. When a child reports they see or hear things others do not, sometimes they are truly surprised to hear that others can read that sign across the room too, or see that interestingly shaped cloud. Sometimes the thoughts and ideas in their heads may feel like an outside voice, but it is really their imagination or conscience. Some teenagers on the Spectrum become engrossed in cosplay or character play and this can be a great source of connection with other children who share similar interests
- Pervasive developmental disorder (PDD): although the term PDD is not used clinically anymore, there are certainly children with developmental issues who may be thinking differently or taking a unique perspective. Their cognitive development may be on a different track than other children. You may see amazing creativity in your child who does not quite know how to bring it back home to reality
- Normal development: children who really enjoy fantasy can be going through a typical developmental phase. It is not unusual for a child to become quite excited about a certain cartoon character, movie, or fantasy book. The important thing to watch for is whether or not your child knows that these characters are not real. It is also necessary to ensure that your child is able to shift away from these fantasy topics if they realize that peers are not particularly interested
“In normal development, you will see that the child readily admits they are playing make-believe and is completely willing to switch to something else when a friend has a different idea for a conversation topic.”
Causes of delusions and psychosis in childhood
- Depression: some children, teens, and adults who have depression will also have hallucinations or delusions. Mike Wallace, the 60-Minutes correspondent talked openly about his experience with depression and delusions, indicating that it was not a sense of sadness but the sense of feeling crazy that caused the most distress. He describes, “I was out of my mind. I was a little crazy.” Public figures who have bravely shared their personal experiences with depression are shedding light on such challenges, reducing stigma, and allowing others who are struggling to make sense of their own stories [1-3]
- Bipolar disorder: children with bipolar disorder have been misdiagnosed and misunderstood for decades. The recognition of bipolar in children was largely attributed to the excellent work of Demitri Papolos, MD, and Janice Papolos in the Bipolar Child. Children with Bipolar often have erratic behaviors, outbursts, meltdowns, hyperactivity, thought disturbances, attention problems, and extreme challenges functioning in school and social relationships. In this important book, these doctors describe the detrimental effects of many psychotropic medications that were erroneously prescribed due to a misdiagnosis of Depression or ADHD. These medications are not only ineffective but can make bipolar symptoms much worse
- Drug-induced psychosis: children with drug induced psychosis will often have disorganized thoughts which means confusion and the inability to express their own ideas. They may appear to be talking gibberish or to act in an extremely uncharacteristic manner. Keep in mind that prescription medications, particularly stimulants, can cause psychosis. The use of THC or other drugs can increase the incidence of psychosis dramatically
- Marijuana use: children who experiment with drugs such as marijiana and THC may experience delusions or psychosis. There is a growing body of research showing that for children who have a family history of psychosis, bipolar disorder, and schizophrenia, marijuana and other drug use can trigger the onset of these disorders [4-5]. It is important for families to also be aware that the marijuana that teenagers use today is much different than the substance used prior to the 1970s because of the dramatically increased potency . The THC percentage in marijuana was less than 1% in previous decades and now can be as high as 95% in commercial concentrates. If your child is using cannabis, particularly vaping or dabbing, be aware that marijuana products could underlie any psychotic symptoms observed
- Severe trauma: after a child experiences severe trauma like recurrent physical or sexual abuse, delusions may develop in a small percentage of individuals. If PTSD is not treated, or if a child continues to live in fear or danger, sometimes children or adults detach from reality as a coping mechanism. It is important to get your child help to process the trauma and for your child to feel safe and protected to begin the recovery process
- Schizophrenia spectrum (SS) and other psychotic disorders: delusions are a criteria of a SS Disorder. Schizophrenia is a rare condition in childhood. It 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
What to Do about Delusions in Childhood
Do 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 is possible that your child is simply enjoying the fantasy world and nothing is wrong.
Do 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.
Do 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 from the situation that leads you to believe your child is seeing and hearing things and is not connected to reality.
Do be on the lookout 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 right away.
DO take delusions seriously: 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. Parents need to understand if their child is using fantasy to cope, having trouble taking perspective, or experiencing psychosis. A licensed professional can help you determine the cause and provide solutions.
Do address drug problems: it is incredibly important to get your child help and to take action against further use. Drug use that triggers delusions can be like playing roulette when there is a history of mental illness in your family. Be aware that your child may not understand the risks of long-term mental health problems. Further, know that it is common for kids to go to great lengths to hide drug use from you. If your child appears to be under the influence, take this as a sign of trouble. There are many resources in this article to help your family immediately and the love first website is a great place to start.
DO talk to your child: as a parent, it can be helpful to translate or reframe. If a child says, “I am Darth Mal inflicting my power over all!” you may say, “It 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. If this works for the child, they are more likely to be using the fantasy as a coping strategy, rather than experiencing psychosis.
DO talk about real vs. pretend: talk about things that are real and things that are in our imagination. Discuss how we can use our imagination to have fun and be playful. Help your child to say, “I am pretending” or “What if…this happened” in order to clarify that this is a make-believe story. Remember that in kids under the age of six, it is not unusual for them to tell some tall tales. These are not lies but rather your child’s creative mind in action. If your child is young and these fantasies are not interfering with day-to-day life, these made up stories are not a reason for concern.
DO have time for fantasy and the real world: using a balanced approach, parents can allow some time for real and pretend. It is great for a child to pretend, but not great, if they hide in books and characters and movies all of the time. Help your child balance fantasy and pretend with activities that are more in the here-and-now, like going for a walk, a scooter ride, or playing a board game.
When to Seek Help for Magical Thinking In Childhood
Many children love the fantasy world and that can be perfectly fine for young children. Some kids love Disney princesses, dragons, Harry Potter, or quirky cartoon characters. Oftentimes, they are indulging in this fantasy for fun and know that it isn’t real. If your child just loves certain fictional characters, that’s not necessarily a cause for concern.
Remember that kids under six may also tell elaborate stories that are not necessarily representing any mental health issue or behavior problem. Especially in gifted children, parents may find that their children like to make up stories about their school day, and may be fairly resistant to admitting that they are untrue. Generally, this behavior is not problematic. Parents can watch closely to ensure that the child is not obsessed with telling these stories, is able to shift to other topics, and seems to move on from this behavior after a while.
The problem is when a child truly can’t separate fiction from reality and gets very caught up and obsessed with the fantasy world. In these cases, an obsession with fantasy can impact peer relationships, focus at school, and family life. If your child is truly struggling to ‘snap out of’ their fantasy scenarios, you should get help.
A testing psychologist or clinical, counseling or school psychologist who evaluates children can help you rule autism or any other concern in or out if you have these concerns. Do not hesitate to take this step. It can be extremely helpful for your family.
When to Seek Help for Delusions in Childhood
Because delusions and hallucinations are unusual and can be a sign of serious mental health problems, it is important to look into your concerns early and often. A telltale sign that this is worth a second look is a family history of mental health issues, particularly Bipolar Disorder and Major Depression. These conditions can be inherited from family members and your child may have unique brain chemistry causing their challenges.
As previously mentioned, it is extremely important to seek help if your child is experiencing psychosis and has been using or experimenting with drugs. Remember that even prescribed medications can cause psychosis in some children. For children with other mental health issues or who are on prescribed psychotropic medications, the use of other substances can lead to psychosis and other serious issues. There is a long list of resources in this article to help your family if you are facing psychosis in your child who is also using substances.
Further Resources on Delusions in Childhood
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.
- Psychotherapist or play therapist: to treat symptoms of trauma, depression, anxiety, bipolar and ADHD
- Psychologist or neuropsychologist: to seek a full assessment to understand what is going on for your child, to assess for autism as well as mood disorders and trauma
- 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 a psychologist: to help with behavior issues, mental health challenges, or other difficulties in your family. Some children may be more challenging to raise. Behaviorally challenging kids may need extra support and most parents are not able to handle these issues alone
- ABA therapist: to teach adaptive behaviors and to set up a behavior plan at home
References on Delusions in Childhood
 Mikaela Conley (April 2012). Mike Wallace’s Battle With Depression and Suicide
 Brainline (February 2022) Depression with Mike Wallace
 Demitri Papolos, MD, and Janice Papolos (2018). The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder
 Jodi Gilman, Ph.D., Director of Neuroscience at Center for Addiction Medicine at Massachusetts General Hospital. Marijuana and the young brain
 Ben Cort (November 2017) What commercialization is doing to cannabis
 Carroll County Public Health Department (May 2019). Vaping Dabbing Advisory.
Resources for Delusions and Mental Health Issues in Childhood
Torrey, E. Fuller (2006). Surviving Schizophrenia: A Manual for Families, Patients, and Providers (5th Edition) Publisher: Quill; 5th edition ISBN: 006084259
Knaus, William & Ellis, Albert (2012). The cognitive behavioral workbook for depression: A step-by-step program.
Schab, Lisa M (2008) Beyond the blues: A workbook to help teens overcome depression.
Cook, Julia (2018) A flicker of hope
Cook, Julia (2012) Blueloon
Cook, Julia (2013) Blueloon Activity and Idea Book
Other resources for drug-induced psychosis or addiction
- Love First.net: A site with resources for recovery and intervention for family members who are serious about taking action against addiction. From the authors referenced throughout this article (Jeff Jay and Debra Jay)
- Charlie Health: an affordable online treatment program for teens, young adults, and families. Counselors are available 24/7 (866-540-1828)
- Coaching options for your family:
- Turnbridge residential treatment center: a holistic long-term treatment center for teens and adults. This recovery model encourages development of self-empowerment, fitness, physical health, mental health, academics and career planning
- Family First Adolescent Services: a residential program for teenage boys in a non-traditional, non-hospital, homey style setting. Therapy is combined with ocean kayaking, deep-sea fishing, trampoline, and other healthy thrills to develop relationships with staff and foster self-esteem. This program uses the Neuroaffective Relational Model (NARM) to address developmental traumas that may influence a teen’s addiction and recovery
- Hazelden Betty Ford Foundation (800-257-7810) Nonprofit chemical dependency treatment center with an emphasis on child and family issues
- Sustain Recovery: Adolescent treatment and long-term recovery residential placement in southern California. Includes ocean adventures. Uses a 12 step model.
- Alcoholics Anonymous: Welcomes anyone who wishes to stop drinking
- Johan Hari (June 9, 2015). Ted Talk. Everything you think you know about addiction is wrong
- Debra Jay (2006). No More Letting Go: The Spirituality of Taking Action Against Alcoholism and Drug Addiction
- Debra Jay (April 2021). Love first: A family’s guide to intervention (Love First Family Recovery)