The Insane Children appeared in many parts of Wonderland including the Skool, Hatter's Domain, and the Hatter's Asylum Behind the Looking Glass. They are completely unstable, possessing multiple personalities and disorders. Often, they are seen imitating chickens, meowing like cats, impersonating a dog, swatting away bugs, dancing madly, or literally beating themselves up. Some display signs of bipolar disorder, crying one second, and then laughing in hysterics the next. The top half of their skull might be removed or they may wear lobotomizing head gear. While they appear disturbing, they are completely harmless. Unfortunately, Alice cannot do anything to help them either, despite the fact that they often plead with her to do so. However, in the Majestic Maze, one of the children helps Alice in advancing to the Queen's palace by following her to a switch that opens the next level, provided that he is found in the maze.
The Insane Children were in the Dollhouse, with both genders instead of just the males. The Children were the ones responsible for leaving Alice various warnings and pointers via Shrink Sense scribbles. While visually even more disturbing and mangled, they appear to act quite lucid. Their leader was a scar-faced little girl holding a teddy bear, who tells Alice that she was not sane enough to be rejected by the Dollmaker. Their base is a large fort made out of building blocks with the symbolic name of Fort Resistance. Here they take shelter from the sinister toys that lurk amongst the fields of colorful playthings. However, as it turns out, they are also trying to hide from the Dollmaker, who turns the children into dolls. This is in fact a reflection on Alice's psychiatrist Dr. Angus Bumby's intentions of erasing children's memories of abuse in order to make them docile prostitutes. Near the end of the level, Alice returns to find that Fort Resistance has been conquered, which symbolizes her loss of innocence; the insane children are captured and converted into dolls by the Dollmaker, except for the leader, who is found dead near the door with her eyes gouged out. However, the leader or a girl who resembles the leader can be found further on, lurking near a Train Station.
Other than their leader, there is one other child with an important individual role and speaking part in the plot. The small red-headed girl can be seen running ahead of Alice giggling in throughout the Vale of Tears. If the player stays quite far behind her, she can be seen going into an inert animation, in which she bats at the petals and leaves falling around her and turns round to see where Alice has gone. She disappears in the Foundry, and Alice only meets her again prior to entering the Dollhouse domain. She appears in Hyde Park, outside a hallucination of Alice's burning house, bleeding to death. She has been bisected, and the lower part of her body is unseen. With her dying breaths, she implores Alice to help the other children. Alice states that she didn't think the children were in danger anymore as the Queen of Hearts had been defeated, which symbolizes her failure to recognize and act upon the abuse happening to the orphans she lives with at Houndstitch. The little girl then tells her that they have many different enemies, but the new one is far worse than the Queen, before dying.
It is revealed during Alice's conversation with March Hare and Dormouse that the Mad Hatter puts these children into his killer machines, the automatons to patrol his domain. These children are possible renditions of fellow patients of Rutledge who have also been heavily mistreated by staff and patient alike in Rutledge Asylum.
The Insane Children are symbolic of the fellow orphans at Houndsditch Home for Wayward Youth that bully Alice about her past, despite the fact their background may have been worse than hers. The only child from Houndsditch that seems to give a clue about Bumby's intentions is a girl in London who recites the Dollmaker's poem (The train is coming with its shiny carts/ with comfy seats and with wheels of stars/ so hush my little ones, have no fear / the man in the moon is the engineer) while her gaze is fixated on the wall, possibly out of shame or Bumby's mental programming.
A boy in the Houndsditch Home remarks that 'Ollie pinched me smalls (dated British slang for underwear)', likely the result of Bumby's training. Alice's response, "Wear bloomers," serves to illustrate how her fixation with her own problems prevents her from seeing what is going on around her.
The player can use the Jackbomb to spew flames on any Insane Child. It won't hurt them at all, but they will briefly catch on fire and still carry on their random activities as if nothing had happened.
In addition to the Jackbomb, the player can smack the Insane Children with the Croquet Mallet, which will briefly electrocute them. Again, this has no effect on their actions.
In Queen of Hearts Land, one of the Insane Children will follow Alice around, throwing his hands up and screaming at her.
After Alice defeats the first Doll Girl and looks at the Fort Resistance, the player can see the Insane Children looking out of the windows.
If the player looks down at the floor of the Infernal Train's engine just before the player enters the Train's boiler room, the insane children's bodies are floating in the Ruin.
For some unknown reason, all main Insane Children of the first game are male.