When a Child with “Sees Things”: Understanding Trauma-Linked Hallucinations

Children who have experienced early, severe abuse and neglect often face a complex array of emotional and psychological challenges. When those children are diagnosed with both Reactive Attachment Disorder (RAD) and Post-Traumatic Stress Disorder (PTSD), clinicians are prepared to see signs of emotional dysregulation, detachment, hypervigilance, and difficulty forming relationships. But what happens when such a child begins “seeing things” that aren’t there?

Is this a symptom of psychosis? A trauma-related hallucination? Or something else entirely?

This article explores the intersection of RAD, PTSD, and trauma-induced perceptual disturbances—unpacking what current research tells us about how and why children in these circumstances might experience hallucinations or related phenomena.

Understanding the Diagnoses

Reactive Attachment Disorder (RAD)

RAD typically develops in children who have experienced grossly inadequate caregiving, such as severe neglect, frequent changes in caregivers, or emotional unavailability. These children often struggle to form healthy attachments and display emotional withdrawal, social difficulties, and dysregulation.

Post-Traumatic Stress Disorder (PTSD) in Children

PTSD in children may follow exposure to traumatic experiences, such as physical abuse, sexual abuse, or witnessing violence. Symptoms can include:

• Intrusive memories or flashbacks

• Nightmares

• Avoidance of trauma reminders

• Hyperarousal and irritability

• Emotional numbing or detachment
  

Children with both RAD and PTSD are often dealing with overlapping symptoms—making diagnosis, treatment, and assessment of new or unusual symptoms particularly complex.

"Seeing Things": A Red Flag or a Trauma Symptom?

When a child begins reporting that they’re “seeing things,” it naturally raises concern. Visual hallucinations (perceiving things that aren’t present) are typically associated with psychotic disorders. However, in trauma-affected children, such experiences might not indicate psychosis in the traditional sense.

In fact, hallucination-like experiences are surprisingly common among children with severe trauma histories, and the explanation may lie in the brain’s adaptation to overwhelming stress.

What the Research Tells Us

1. Trauma and Hallucinations Are Closely Linked

Numerous studies suggest that childhood abuse—particularly sexual and physical abuse—is correlated with an increased risk of hallucinations, both visual and auditory. The connection may be dose-dependent: the more severe and prolonged the trauma, the greater the risk of perceptual disturbances later in life.

Source: Varese et al., 2012; Read et al., 2005

2. PTSD-Related Intrusions Can Look Like Hallucinations

Children with PTSD may experience:

• Flashbacks that feel real and present

• Trauma-related intrusive images

• Dissociative episodes with vivid perceptual distortions
  

These are not true psychotic hallucinations but may be interpreted as such, especially by caregivers or teachers unfamiliar with PTSD symptomatology.

3. Dissociation as a Trauma Response

Trauma can cause a child to mentally "check out" during overwhelming experiences. Chronic dissociation may later result in a fragmented sense of reality, which can include:

• Visual disturbances

• Feeling disconnected from the body or environment

• Emotional numbness or confusion about what is real
  

Children with high dissociation scores are more likely to report hallucination-like experiences.

4. Attachment Trauma and Emotional Dysregulation

Children with RAD often exhibit:

• Difficulty trusting others

• Inability to regulate emotions

• Impulsivity or fear-based behaviors
  

While RAD itself is not linked to hallucinations, the emotional chaos and disrupted development associated with it may exacerbate PTSD symptoms or increase susceptibility to misinterpreting internal experiences as external.

Possible Explanations for "Seeing Things"

Several mechanisms may explain hallucination-like experiences in children with RAD and PTSD:

Cause	Description
Flashbacks	Vivid reliving of traumatic scenes that feel real in the moment.
Dissociation	Disconnection from surroundings; may include visual distortions.
Sleep Disruption	Poor sleep can cause hallucinations or hypnagogic experiences.
Hypervigilance	Misperceptions under fear (e.g., seeing shadows as people).
Cognitive Confusion	Trauma can impair memory and perception, blurring imagination and reality.

Clinical Considerations

If a child with RAD and PTSD is reporting hallucinations, a thorough and trauma-informed assessment is crucial:

1. Assess the Nature of the Experiences

• Are the visions flashbacks or truly novel hallucinations?

• Does the child recognize that these experiences aren’t real?

• When do the episodes occur? During stress, night-time, or all day?
  

2. Explore Triggers and Patterns

• Are certain environments or topics triggering the symptoms?

• Is there a connection to anniversaries or trauma reminders?
  

3. Evaluate for Dissociative Symptoms

Tools like the Child Dissociative Checklist (CDC) or Trauma Symptom Checklist for Children (TSCC) can help identify dissociation levels.

4. Rule Out Other Causes

• Neurological conditions

• Vision/hearing issues

• Side effects of medications

• Exposure to substances

Treatment and Intervention Strategies

Treatment should be trauma-focused, attachment-sensitive, and aimed at stabilization first. Useful approaches include:

• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

• EMDR (Eye Movement Desensitization and Reprocessing) (with pediatric adaptation)

• Attachment-Based Family Therapy

• Psychoeducation for caregivers around trauma responses

• Grounding and safety techniques to manage flashbacks or perceptual symptoms
  

In some cases, a psychiatric consult may be warranted to evaluate for comorbid psychotic disorders or consider short-term medication for severe symptoms.

Final Thoughts

When a child with RAD and PTSD reports “seeing things,” it should never be dismissed—but neither should we rush to label it psychosis. Trauma, especially when experienced early and intensely, can have profound effects on how a child perceives the world.

By understanding the underlying causes—flashbacks, dissociation, cognitive distortions, and more—we can better support these children with compassion, clarity, and evidence-based interventions.

Recommended Reading & Resources:

• The Body Keeps the Score by Bessel van der Kolk

• Treating Traumatic Stress in Children and Adolescents by Judith A. Cohen, Anthony Mannarino & Esther Deblinger

• National Child Traumatic Stress Network (NCTSN)

• Cleveland Clinic – Reactive Attachment Disorder