anti-social personality

[blessedwithboys]

This was posted in Mental Health but I got 81-somethign views and not one single response, so I thought I'd try here.


I'm looking for personal experiences as well as resources for treatment.

A relative of mine has a young daughter with a dx of Conduct Disorder. There have been many different diagnoses, actually. ADD/ADHD, early-onset BPD, anxiety/panic issues, mild autism. Also, SPD, including hypotonia. The child has anatomic features (body and face) that caused her to be tested for genetic disorders. They all came back clear, so it was suggested that the birth mother's recreational drug use in the first trimester caused the damage.

So now they are settling on CD. The outlook is not good for my relative's daughter. She is 8 years old and already has certain people that she hates. She says she likes to "persecute" them. (Not surprisingly, she can barely read but her vocabulary is outstanding for her age. She tested at an IQ of like 79 or 80 but has amazing creative intelligence.) So, certain small people in her life are in danger of physical harm whenever she is around.

I think the family is beginning to realize that residential treatment is not out of the realm of possibilty. It was already discussed when the psychotic tendancies were first dx. While there haven't been major, prolonged breaks, this poor child lives in a constant state of being out of touch with reality. Her daily conversation is grandiose and shows she lives in a world of her own creation. She makes all the rules in that world and can't accept that society is not willing to living by them.

So...the relative in charge of this child is a great mom as far as love and affection goes. There is ZERO chance of attachment/abandonment issues. The child is never spanked. In fact, her mother doesn't even believe in speaking to her too firmly, thinking it's disrespectful. She assigns a great deal of honor to her daughter, which is wonderful, but right now it's contributing to her daughter's belief that she is (for lack of a better word) equal to adults. I know that isn't coming out right, but I'm having a hard time explaining. Of course, kids are equal as far as the value of their life, but I'm thinking in terms of kids being minors legally who are in need of guidance and direction from adults. I think many MDC parents here are more unconditional/consensual, which may be fine for mentally healthy kids. But for a child who is 8 years old and firmly believes the establishment is wrong because she is not allowed to drive, and can spend an hour ranting and raging over the subject, it would seem that a firmer, though still gentle, hand is needed.

Examples: the child is allowed to choose her own clothes. Her sensory issues drive her to wear all cotton items with soft elastic. No jeans, no button shirts, and every garment must be solid color or have a perfectly symetrical pattern. No problem there. But if she wants to leave the house without bathing or at the very least brushing her hair, or if she wants to wear a knee-length nightgown and no undies around male family members, but can't sit in a way that keeps her covered, she's alowed to. Her mother will say in front of her "Who cares what other people think? Do what makes you comfortable!". Is it a stretch to think that this isn't the best approach for a kid who already doesn't care, to the point where she is willing to perform acts of violence to get what she wants? I mean, I NIPed and didn't care who felt uncomfortable, but that doesn't mean I would also be willing to beat someone up if I liked their watch and wanted it for myself. Is it necessary for kids with CD to be raised with a firmer hand, or does it just not matter because anti-sociality isn't treatable?

I know it may not be possible to give this child the capacity for empathy, but can she be taught from a strictly intellectual point of view that there are socially-acceptable rights and wrongs with respect to how we treat people?

There is nothing quite so bone-chilling as telling an 8 year old child that it is inarguably unacceptable to hit her toddler cousin and having that child look you in the eyes, smile, and tell you her pet dragon told her it's ok to kill anyone she hates.

What types of resources and treatment are available for a child showing signes of anti-social behavior? Is there any hope? Is there less hope because of her lower IQ? How likely is it that she will need full-time residential care? Right now, she is on a cocktail of drugs that changes every time she sees the psychiatrist. They live in a small town, but I am willing to help get them to a bigger city with better care. The drugs have accelerated her weight gain and soon it may not be possible for her mother to physically control her. (In addition to her larger-than-average size, she has episodes of incredible strength. It can take two adults to get her under control).

Is there any benefit to dietary changes/restrictions? She is given complete autonomy over her food choices, which means she eats virtually no vegetables and almost all white foods. Junk is not limited at all, in fact, her mother uses it as a bribe several times a day.

TIA for suggestions on where to go for help.

[2boyzmama]

There is always hope!!!

It sounds like she's in a loving supportive family, and that's wonderful. But unfortunately, it also isn't enough to keep *everyone* safe (the child AND the adults in the home).

I may have missed it...but has she trialed any medications? Mental disorders are sometimes caused by true chemical imbalances that really can be helped by meds. There's no shame in that. I think that some of the more mild behavioral issues triggered by bad parenting, bad environments, bad diets, etc that are quick to use medication have given meds a bad rap. That obviously isn't the case here, she is a child in need of help. So if meds haven't been tried yet, I would suggest talking to her drs/therapists about that option.

**ETA: Oops, sorry, just re-read and saw that she is on medications. It may take a long while to get her stable on meds. Especially as she grows and her hormones change, the drugs may need constant adjusting.

Dietary changes sometimes can make a difference, and are never a bad thing to try (no harm, except in the rare case where there's an underlying medical issues metabolically, for example) but from this description, she sounds rather severe. Diet could lessen some symptoms, but probably not the underlying psychosis.

Residential programs exist for a reason, sometimes it truly is the most appropriate placement for some children/adults. That is a very complicated individual decision with way too many factors for just one post. It may be the case that she ends up in a residential program, who knows. But again, that is not shameful!! An illness is an illness...if the family needs help managing it, then so be it.

I don't have any links or novel information to share with you, I wish I did. But I do wish this family well!!

[osker]

Hmm, there are many interesting things in what you've written. For one thing, she can't actually be diagnosed with a Conduct Disorder because you have to be 18 for that... it actually sounds a bit more like Childhood Onset Schizophrenia. If her medications are indeed changing rapidly she would definitely be having trouble! Residential treatment, or at the very least a short hospitalization might be a good idea for her. I say this as someone who just finished working on an inpatient unit with adolescents. If she is actively having difficulty with reality and making unsafe choices then she would clearly benefit from more intensive services. I would hesitate to say that she's anti-social, or to think that she's making these choices because she doesn't care or wants to be mean to people. It's likely that she really doesn't know that her dragon doesn't get to make the rules, as silly as that sounds. I would encourage you to encourage her family to be sure that she's in regular therapy as well as having her medication managed. A trained professional, hopefully at higher than a master's level, will be able to help the family understand her better as well as knowing the system better and be able to help them access a greater variety of services.
Psychosis in a child is extremely difficult on everyone. It might also help to see what services your state offers for children with this high level of difficulty. For example, Massachusetts offers in-home therapy, parent partners, mentors for kids, etc...

Sorry I can't be of more help!

[blessedwithboys]

She was actually dx with Conduct Disorder, and her mother was told that in adulthood it could change to Sociopathy, or Anti-Social Personality Disorder. I'm sure of this.

Is there a big hospital or university or something that is known for treating psychotic mental illness in children?

[VisionaryMom]

Originally Posted by blessedwithboys

She was actually dx with Conduct Disorder, and her mother was told that in adulthood it would change to Sociopathy, or Anti-Social Personality Disorder. I'm sure of this. It could be that the dr. in their small town made a wrong dx, but CD is for sure in her records.

Please, please urge them not to trust a GP for this diagnosis! They really need to get to someone who specializes in behavior and mental health issues in children because it seems there are some of both going on here. As for hospitals, look up places that treat pediatric bipolar disorder because many of them also have specialists who deal with other ped psych issues.

I had lots of thoughts when I was reading - much of what you wrote sounds familiar to my own experiences and what I see in DS - but it's been a long day. I will try to re-read tomorrow morning and put something constructive together.

[blessedwithboys]

The dx was given by a Pediatric Psychiatrist. This is the dr overseeing the med trials that have been going on for the last 2 or 3 years (starting with just Ritalin, now a mix of 3 drugs)

[spedteacher30]

there was an interesting story today on NPR about brain function via MRI in people with sociopathy. apparently, there is some evidence that their brains don't activate the same way the brains of people without sociopathy do.

anyway, I don't have any great advice. I certainly think, though, that there are children who need a respectful, supportive, extrinsic system of parenting, and that for children who need more extrinsic motivation and firmer boundaries, it is neither gentle nor respectful not to give them what they need.

[blessedwithboys]

Originally Posted by spedteacher30

for children who need more extrinsic motivation and firmer boundaries, it is neither gentle nor respectful not to give them what they need.

thank you for that. i feel the exact same way.

of course, i can only offer info to my relative, what she chooses to do with her dc is up to her, but at the rate things are going, i may have to make the personal choice to refrain from associating with them any longer, for the safety of my own 2 kiddos. thats not what i want to do though, so if i can gather any helpful resources to pass along, i want to try that first.

[BetsyNY]

Tell this person to visit www.janisjourney.com. It's a blog written by a father of a girl with Child Onset Schizophrenia. That thing you said about the dragon--that's not conduct disorder. That's schizophrenia.

[blessedwithboys]

thanks Betsy, i'm looking at it now. what they've told us so far is that she has CD (which accounts for the "bad" behavior) and also bi-polar NOS, mixed states, ultradian cycling (which accounts for the psychosis)

ok, read the whole blog. was this the family featured on dateline or 20/20 or some similar show? i watched that show twice and cried throughout both times.

obviously, january is an extreme case, but can schizophrenia be "mild"? the child in my family NEVER tries to hurt herself, she doesnt even talk about it. but she is very impulsive, which is why her dx started out ADHD, impulsive type.

i have a lot to mull over before i call my relative. i just now had a conversation with my 8yo ds (he and our relative are BFFs) that he may not be allowed to play with her anymore for a little while. see, my exdh is schizophrenic, recently dx, but has seemed "bi-polar" his entire life. his new wife thinks he will be changed to schizoaffective disorder in time. anyway, my ds has showed signs of early onset bi-polar since birth. he is in counseling now so that we can establish a baseline, and i think being around this other child may not be the best thing for him right now.

[confustication]

Originally Posted by blessedwithboys

There is nothing quite so bone-chilling as telling an 8 year old child that it is inarguably unacceptable to hit her toddler cousin and having that child look you in the eyes, smile, and tell you her pet dragon told her it's ok to kill anyone she hates.

I have an eight year old girl who could SO easily go down this exact path. She creates things like 'pet dragons' who tell her things as well, and there is a very real quality to how she is processing that. In our situation, her paternal grandmother was diagnosed with schizophrenia. I watched her father succumb to mental illness and in the course of 5 years shift from an amazing man into someone who takes great joy in creating mayhem- as well as documenting everything about weapons and gory images of animals he has killed.

Happily, my mom is a therapist, and we have worked very hard as a family to help my daughter differentiate between reality and the reality her mind tries to create. I don't know what will happen down the line, but for now, she is doing very well, and she is able to keep it separate. In order to help her to make that happen however, I've taken a MUCH firmer line than many moms on MDC would be comfortable with. I am sure, in fact, that some here would think I was very mean and restrictive, and very disrespectful because I did force her (tears, screaming and all) to conform to the reality around her. The choice was to lose her to the complexities of her own mind, or to create and enforce boundaries so she could feel safe enough and stable enough to let go of the 'pet dragon' telling her what to do.

Interestingly enough, for her it is also pet dragon- and it showed up when she was about 3. When she did something wrong, it was ok because the dragon told her to. To her that was valid reasoning. It was not the typical 'imaginary friend' thing, to her this was very real, and she very clearly described the voice, the words, etc and so on. I want to emphasize that there is a difference as it is not uncommon for kids to blame things on imaginary friends- even at 8 years old, but they know the differnence. In the case of my daughter (and likely this little girl) this was/is a very REAL thing, and it is more deeply entrenched in their thoughts and behaviors than any parent could be.

She's now a very gentle child who doesn't really comprehend violence for the sake of violence, and I think she will probably break from the genetic pattern. In both her grandmother's and father's cases- they lived lives of violence and hatred, so there really was no time to help them find firm footing within their own minds. But it took a LOT to get here, and she doesn't have the challenges in terms of understanding the world- she is exceptionally gifted. She also has aspergers, which in her case seems to help- oddly enough- in terms of managing the rest, as it demands a good structure and framework to live within.

[VisionaryMom]

Originally Posted by blessedwithboys

obviously, january is an extreme case, but can schizophrenia be "mild"?

I don't know the terminology for schizophrenia exactly, but people can live normal lives with it. My uncle is a paranoid schizophrenic, and except for a few short episodes in his early 20s, he's been medicated and mostly rational (if a little...weird) his whole life. As a child, I knew there was something odd about him, but he certainly wasn't dangerous or anything. I've met with a number of people with schizophrenia who have it under control. Some of these folks have great, professional jobs, and no one would know they'd had psychotic breaks in the past. So from a prognosis standpoint, it is possible for some people to live productive lives, though I don't know what makes the difference.

[confustication]

People with schizophrenia can be amazing and productive and live pretty normal lives- most of the time. Of course, we hear all about the horror stories of uncontrolled mental illness, but that certainly isn't the definitive path things will take.

[VisionaryMom]

Originally Posted by blessedwithboys

There have been many different diagnoses, actually. ADD/ADHD, early-onset BPD, anxiety/panic issues, mild autism. Also, SPD, including hypotonia.

For people with mental health issues, especially early ones, I think multiple diagnoses is the norm, rather than the exception. I have, over time, been diagnosed with the spectrum of anxiety disorders, borderline personality disorder (which is considered the female equivalent to anti-social personality), schizo-affective disorder, bipolar disorder, etc.

I think it's because dealing with mental health problems is so much more subjective than physical issues. I'm glad you said that a pediatric pdoc gave the diagnosis. Do you know what his credentials are? That often, in my experience, will affect the way he diagnoses. So my son, who has every.single.symptom of juvenile bipolar, saw someone who tried to push ADHD on us because that's his specialty. You have to be careful with pdocs because they tend to have tunnel vision.

Originally Posted by blessedwithboys

She is 8 years old and already has certain people that she hates. She says she likes to "persecute" them. (Not surprisingly, she can barely read but her vocabulary is outstanding for her age. She tested at an IQ of like 79 or 80 but has amazing creative intelligence.) So, certain small people in her life are in danger of physical harm whenever she is around.
...
But for a child who is 8 years old and firmly believes the establishment is wrong because she is not allowed to drive, and can spend an hour ranting and raging over the subject, it would seem that a firmer, though still gentle, hand is needed.

The thing I find interesting is the low IQ, and I wonder if that's accurate. An 8YO making the arguments about not being able to drive and using words like persecute doesn't sound like someone with an IQ of 80. There are some people for whom IQ tests are useless, so I wonder if your experiences with her confirm the idea that she is, essentially, cognitively delayed.

I absolutely believed (and still do) that the establishment is wrong on many, many things. I didn't care about driving, but I would've (and did) ranted about voting at that age. It's not entirely abnormal for gifted kids, which is probably why people didn't think it was weird for me, but ime, it's not really anti-social-type behavior. She does seem all over the map, but then again, her brain's still developing.

Originally Posted by blessedwithboys

But if she wants to leave the house without bathing or at the very least brushing her hair, or if she wants to wear a knee-length nightgown and no undies around male family members, but can't sit in a way that keeps her covered, she's alowed to. Her mother will say in front of her "Who cares what other people think? Do what makes you comfortable!".

The only thing that would bother me would be the no underwear while sitting inappropriately around other people. (I actually don't care about the no underwear by itself, just the lack of sitting properly.) Not brushing your hair & those things are not problems that I think play into the mental health issues, and I'd probably let them go. Perhaps her mother is overwhelmed at any rate and just doesn't want those battles.

Originally Posted by blessedwithboys

Is it necessary for kids with CD to be raised with a firmer hand, or does it just not matter because anti-sociality isn't treatable?

Originally Posted by blessedwithboys

I know it may not be possible to give this child the capacity for empathy, but can she be taught from a strictly intellectual point of view that there are socially-acceptable rights and wrongs with respect to how we treat people?

Sociopathy isn't treatable, but it's a different classification of mental health problem entirely. Everything I'd ever read has suggested that it's impossible to change a sociopath. The other side, and I think one that's greatly misunderstood, is that being a sociopath isn't necessarily a problem. There are studies that show that the highest levels of sociopathic tendencies show up in people who work as stockbrokers, day traders, high-level sales people. The same traits that *can* become violence in some mean high risk-tolerance & good sales technique in others. So separating "anti-social" and "sociopath" is important because they're not the same.

As for anti-social personality, I don't think it can be change, but I don't think it always needs to be either. Some of these diagnoses are, to me, a way to pathologize someone who thinks and acts differently. Speaking from a borderline personality perspective, because again, they're related, I will say that one of the hallmarks is that we don't grant second chances often. That's someone a problem to others, but to me it makes sense. You'll never see me in a crappy, dead-end relationship where I keep accepting a BS apology, and I don't think that's a problematic trait.

The key to dealing with any of the personality and/or conduct disorders is to know what's okay and what needs work. Yes, it's possible to teach someone that there are "non-negotiable social conventions" (to borrow from Big Bang Theory) to which it's polite to adhere. That doesn't mean she'll accept them, but she may on some.

Originally Posted by blessedwithboys

There is nothing quite so bone-chilling as telling an 8 year old child that it is inarguably unacceptable to hit her toddler cousin and having that child look you in the eyes, smile, and tell you her pet dragon told her it's ok to kill anyone she hates.

This part scares me more than anything else you've posted. That said I know that it's sometimes difficult for parents to see when there children are being children & pretending (after all, my daughter often claims she can fly but doesn't mean that) and when there is something going wrong. There also is a serious need to reject that kind of thing as "a joke" because it's so scary. Still, it's the sort of thing that perhaps you could discuss with her mom as part of the bigger problem.

Originally Posted by blessedwithboys

What types of resources and treatment are available for a child showing signes of anti-social behavior? Is there any hope? Is there less hope because of her lower IQ? How likely is it that she will need full-time residential care? Right now, she is on a cocktail of drugs that changes every time she sees the psychiatrist. They live in a small town, but I am willing to help get them to a bigger city with better care. The drugs have accelerated her weight gain and soon it may not be possible for her mother to physically control her. (In addition to her larger-than-average size, she has episodes of incredible strength. It can take two adults to get her under control).

I would consider having a thorough intellectual exam done. There are scores of testing that may give you a better idea than a single-number IQ. Once that's done, you'll have a better idea of how to begin treating her.

The other big thing that stands out to me is that her meds change often. Most psych meds take 6-8 weeks to reach full therapeutic levels, and if hers are changing more often than that, then she's never really being treated. Getting on the right psych drugs is a process that takes months - years (and sometimes never happens) for most people.

Originally Posted by blessedwithboys

Is there any benefit to dietary changes/restrictions? She is given complete autonomy over her food choices, which means she eats virtually no vegetables and almost all white foods. Junk is not limited at all, in fact, her mother uses it as a bribe several times a day.

I don't personally believe that food can correct a mental health issue, though there are people who disagree. That said, I know that for me, eating the right foods does make me feel more energy to handle my health problems. So I think it can have a benefit but does not necessarily cause harm not to do it.

[*clementine*]

I haven't read all of the responses because I'm being climbed on.
That said, I have a daughter with the same issues. She was diagnosed with oppositional defiant disorder from ages 6-14, and from there they diagnosed her with conduct disorder. My understanding is that they bump up the diagnosis to Conduct disorder once the child starts getting in trouble with the law etc....which usually starts in the teenage years, if my dd were to continue at this rate, she'd be diagnosed with the later stuff you mentioned......
Anyway, not saying that's not the diagnosis she was given, just how I understand it to work.
I hung in there and did all the stuff you're saying her mom is doing- kindness, flexibility etc... because that is what I believed to be best too. In the end, I had to put her in residential treatment- she's been there a year now. She's now 16. She was putting her life in danger almost every weekend and I couldn't keep her safe.
A couple of things that have been key for us- she has grown into a sweet girl. My parenting did plant seeds and did pay off. She's almost ready to get out of treatment. She's now kind the to the littler kids, and is helpful and she's a sweetheart. She's always telling me how much she loves me. I didn't think I'd ever see this out of her. So hang in there.
The thing about being too flexible- I think you're right. If I could go back and do it all over again, I wouldn't be as flexible with her as I was. It's harmed her and it's not good for her personality type. I'm all about boundaries now. The problem was.....no conventional parenting worked with her, and I was exhausted and hopeless a lot of the time. I think if her mom can know that there's a very real possibility of her dd pulling through, then it boundaries aren't so hard to lay down.
(I'm just hitting send without proof reading- because I'm still getting climbed on.)

[*clementine*]

A quick p.s.
I actually copy/pasted this part of your post:
"Her daily conversation is grandiose and shows she lives in a world of her own creation. She makes all the rules in that world and can't accept that society is not willing to living by them."
Because upon release my dd thinks her boyfriend is moving in with us.
Your quote is going to be my response to her request. We're still dealing with large issues, but now at 16, she's at least stopped screaming and bullying her way into getting what she wants every time. I think now I can tell her the above and she intellectually gets it.
These kids are hard.