9 Year Old Child Hears Voices

I wanted pediatric mental health, and may be in the wrong pew.  If so, can you forward this to the right specialist?

My nine year-old daughter takes Adderall (adderrall) (7-1/2 mg.) and also took 5 mg. of Prozac for anxiety and "possible" depression until last month.  Her main symptoms were sadness and long temper tantrums, inattention, and an inability to express her thoughts.  We pulled her off of the Prozac (with the psychiatrist's knowledge) five weeks ago to see if she really needed it since the newly added Adderall (adderrall) showed such an improvement in her behavior.

However, as the Prozac has left her body, she has been increasingly more prone to meltdowns and then subsequent self-beratement.  This weekend, after a long meltdown at a shopping center, she twice said she wanted to throw herself in front of a truck.  She also said the shopping center was so noisy, and then said, "you don't know how it is, with these voices, with my 5 o'clock voices". We were stunned and scared.  The inclination is to go straight to the schizophrenia diagnosis.  Since our daughter does not express herself well, could hearing voices be her way of just saying her mind is racing?  Of course we are trying not to think about the alternatives yet, such as bipolar or schizophrenia.  We have a call in to her psychiatrist.  Also, would you suggest we see a pediatric neurologist?  Thank you.

[Kevin Kennedy, Ph.D.]

You are in the correct Forum. With a child so young, it is often difficult to discern perceptual disorders, particularly auditory hallucinations. It sounds like she was achieveing benefit from the combination of antidepressant and stimulant medications. It is important to be aware of the possibility (not strong) that stimulant medications can promote some sychotic processes, but these usually take the form of thought disorder, not perceptual disorder. You're on the correct road in planning to speak with her psychiatrist. Nothing in your note indicates the need to consult pedi neurology. It never hurts to do so from a 'rule out' perspective, but it certainly does not sound compelling.