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When my son was 12 he’d “snap” into one of two personalities – a ballerina or a thug – by shaking like a wet dog. As a ballerina he’d loop his arms over his head and plie across the lawn, deftly ignoring calls to come in for shower time. His thug personality was less benign. He’d curse and swagger, punching walls and sometimes people. 

Like many moms, I fancy myself a bit of a human-lie-detector, and was pretty sure my son was faking these “personalities.” This was confirmed by the results of a neurological exam, brain scan, and full psychological evaluation. No indications of psychosis. What he had been diagnosed with, however, was Reactive Attachment Disorder (RAD), also called Developmental Trauma Disorder (DTD). 

This left me wondering if there is a link between DTD and psychosis, and what parents can do to get their child the best possible treatment.

Is there a correlation between DTD and psychosis?

Up to 3.5% of the general population experiences psychosis. Psychotic symptoms most commonly include: 

• Visual hallucinations – seeing things that aren’t there.
• Auditory hallucinations – hearing things that aren’t there.
• Sensory hallucinations – feeling things that aren’t there.
• Delusions – beliefs that are not true and are irrational.

DTD is a brain injury caused by early childhood trauma (and RAD is just one related diagnosis). DTD can have wide ranging symptoms with varying severity depending on the stage of brain development the child was in when the trauma occurred. Symptoms can include attention deficits, poor impulse control, developmental delays, underdeveloped cause-and-effect thinking, aggression, and more. 

Psychosis, however, is not a symptom of DTD.

Though psychosis is not a symptom of their developmental trauma, some children with DTD do report hearing voices, seeing “beings,” or seem delusional. To delve deeper, I conducted a survey on this topic. Out of 184 parents, over 1/3 said their child reports symptoms of psychosis. 

This is a significant number and a concern for many families. Since psychosis is not a symptom of DTD, if your child has reported any of these concerning symptoms the first step is understanding the possible causes. 

Potential causes of “psychotic” symptoms

1. The psychotic symptoms may be made up.

When a person fakes psychotic symptoms it is called malingering psychosis. Manipulation and lying are common behaviors of children diagnosed with DTD. These strategies are often used to gain a sense of control in what feels like an unsafe and unpredictable world. This was the case with my son. 

Tracy, another mom, says her son faked multiple personalities and was even diagnosed at one point with dissociative identity disorder (DID). After professional psychological evaluations, the clinician identified it as malingering psychosis. “He knew exactly what he was doing,” she says. 

Qualified psychologists are equipped to discern between malingering and true psychotic symptoms. Don’t rely on your own gut feelings. It’s always best to get a professional evaluation. In addition, if your child is faking symptoms they need treatment for the underlying reasons for this behavior.

For help with malingering psychosis, find a therapist who has extensive experience working with adopted or foster kids who have developmental trauma.

2. The psychotic symptoms may be a drug side effect. 

Children with DTD are commonly diagnosed with RAD, PTSD, ADHD, ODD, and more. They are frequently on a cocktail of serious medications, some of which may have psychosis as a potential side effect. 

Jessica’s son saw “little goblin creatures” when he was taking medications. “The last time, he said a naked man woke him up and told him to go outside,” she says. “Praise God he didn’t listen! That was a scary time.”

Psychotic symptoms may be a side effect of a drug, the result of drug interactions, or due to abruptly stopping or inconsistently taking the medication. Remember too, illicit drug use like LSD and marijuana can cause psychotic symptoms. While appropriate medications have been helpful for many children, it can takes some time to find the right combination.

For the best treatment insist on seeing a psychiatrist for medication management.

3. The psychotic symptoms may indicate a co-morbid disorder.

Disorders including schizophrenia, schizoaffective disorder, and bipolar with psychotic features. According to Dr. John F. Alston, MD. who has decades of experience working with RAD kids, bipolar is the most likely inherited disorder these children have. These can be particularly difficult to diagnose in children because adoptive parents don’t have knowledge of hereditary mental illnesses that may run in the family. 

Furthermore, developmental trauma paired with a co-morbid disorder with psychotic symptoms can be a dangerous combination. “Developmental trauma disorder alone does not deem a child dangerous,” says Forrest Lien, Director of the Institute for Attachment and Child Development. “Furthermore, not all children with DTD have a mental illness. Yet, some do. Children with complex developmental trauma often feel angry and can lack empathy. When you combine a child who feels slighted and vengeful with [for example] a misdiagnosed or poorly-treated severe bipolar disorder with psychotic features, it can be dangerous.”

Children truly experiencing psychosis may believe they can time travel, read minds, or that they have other superpowers. They may believe the TV is “talking to them” or hear other voices. They may see visual hallucinations. Often, they cannot distinguish between delusions and reality. In one case I am personally aware of, a teenager became convinced their sibling was a clone and made multiple attempts to kill them. They believed their mother was non-verbally communitcating with them and instructing them to do this. Fortunately, this dangerous situation was discovered in time and the child was admitted to a psychiatric facility. Within days of being put on antipsychotic medication, their psychotic symptoms went away.

The good news is that antipsychotics can be very effective. However, many people who struggle with these types of mental illness do not stay on their medications. Often, they embrace the psychosis as a “superpower” or what makes them special, and do not like how the medication quiets or eliminates the voices and other symptoms. If your child is prescribed an antipsychotic, it is essential that you remain vigilant in ensuring they stay on their medication.

For correct diagnoses, a professional evaluation is essential. 

Don’t panic – but do get professional help.

If your child is reporting psychotic symptoms, don’t panic – but do get professional help. Whether your child has malingering psychosis, is suffering a drug side effect, or has a co-morbid disorder they are signaling for help. With proper treatment and early intervention these children can grow and thrive.