question for Dr Ruth

My daughter is 14, is in 4ème at collège. I am not sure if she is just being a teenager or if there is a more serious issue. She has recently had a nightmare where she woke up crying saying there were voices in her head but could not say what the voices were. 

She also gets these voices when she is alone in quiet places, e.g. if she is in her room with no music on. I ask her not to have tv or music on when doing homework but she is frightened that if she does not have background noise the voices will come. We were recently in the UK and it happened there and has happened again since being back.

We have been in France 4 years and in general she does not like living here and does not have many good friends here. She is in contact with her freinds in UK and wishes she was back there with them. She says she feels sad a lot of the time and angry with people for no real reason. 

She also has quite a low self esteem at the moment. Things can feel worse at certain times of the month for her which I guess is normal but I think that her feeling down is occuring more often and I do not want to keep putting it down to being a teenager incase it is something more serious.

She does not like school very much. Her marks are not bad but she does struggle with homework and at the moment has a 'can't be bothered' attitude. We seem to have a battle every evening to get her to do her work and if she does not understand something she refuses offers of help and would rather not do the work. 
My husband says we should leave her to take responsibility for her homework but I feel that I need to keep an eye on what she is or is not doing.  

I am hoping this is just a phase but looking at the whole picture I wonder if there is something underlying. I realise that it is difficult for her here and that she is not happy because she would rather be in the UK but are the voices normal?
I worry that she may be getting depressed and I do not know where to go with this.

(name witheld by request)

Dr Ruth Dennis replies:

It is clear from your email that you are very concerned about your daughter’s wellbeing.  Firstly, let me reassure you that whilst hearing voices is an unusual experience it is quite normal. Large scale studies have found that up to 8% of children have heard voices at one time or another. As a society we tend to view hearing voices negatively and as being synonymous with mental illness and schizophrenia.  This however, is not always the case. The same study showed that only 30% of the children hearing voices went on to consult mental health services and receive any type of diagnosis. 
Most children who hear voices either grow out of it or learn to live with the voices. Some people who hear voices describe this as an affirmative experience but for others the voices are a negative influence. Hearing voices in itself is normal but it is possible to become ill from hearing voices if you cannot cope with them.  If at any point your daughter reports that the voices are telling her to harm herself or if her symptoms deteriorate it is important that you seek medical help. 
From what you say though, there are a number of factors including your move to France, and difficulties in school, that may be conspiring to make your daughter feel down or depressed.  It is common for symptoms such as hearing voices and obsessive behaviours to be prompted by times of stress.  In children who hear voices, around 80% report this as starting in relationship to a trauma or situation that made them feel powerless. As such, the voices are a signal that your daughter is unhappy or troubled. 
Your first step is to acknowledge this and try to find out what is at the root of the problem.  Once you have identified this, focusing on the problem rather than the voices will probably help.
The way in which you respond to your daughter’s symptoms is also significant. You are clearly anxious about what is happening to her, but it is important not to communicate this to your daughter. Reassure her that she is not ‘crazy’ or ‘going mad’ and that lots of other children have similar experiences such as hearing voices or feeling stressed. Ask if she would like to talk about what is going on and gently enquire about the voices – what do they say – when do they come?  Do this in a non judgemental way and accept what she says. Some young people find it easier to talk whilst they’re walking or doing an activity. There is no right way to communicate – you will know best what works for you and your daughter.
From the situation you describe, your daughter is in a negative spiral of anxiety and self doubt. Whilst not dismissing this, try to focus on the things that are going well for her and encourage her to see these things. Small successes such as completing a piece of work or helping out at home need to be recognised and acknowledged. You may also want to think about how much control your daughter has over her own life. Are there some situations where she can start to make real choices about what happens to her? These do not have to be major life changes but small things such as being able to choose the menu for supper, or where to go on a day out. Let her take charge of planning the event and support her to ensure its success.  
Normalising the experience of hearing voices will reduce your daughter’s anxiety about this and help you and her to cope with this situation. Try not to think of it as a terrible disaster, but as a signal that something is troubling her and that this can be resolved. 

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