Diagnosing/Treating an Adolescent (with mental illness)

[Pixilated]

What are the possibilities of an adolescent being sociopath?

Is it a genetic trait, or a result of one’s enviroment?

Is there a way to test them to rule out other possible diagnosis?

The information I have found all base their information on people 15+ yrs old. I also understand that it is hard to truly diagnose a person with this. I also understand the reasoning for not “sticking a label” on a child, but is it possible that not doing so is preventing or detaining the chances of child developing into a better-functioning adult?

And, most of all, is there an effective treatment plan for sociopaths?

[KGS]

Sociopathy is a personality disorder, not a mental illness.

[Alex_Dubinsky]

For s&g’s, do you feel like sharing what this kid is doing? (Labels are meaningless.)

[lawoot]

Here’s a link to an article on antisocial personality disorder. Pretty accurate, in my experience (I work in an adolescent in-patient mental health treatment facility).

Something in the article that I noted:

The adult with antisocial personality disorder displays at least three of the following behaviors:

* fails to conform to social norms, as indicated by frequently performing illegal acts, and pursuing illegal occupations
* is deceitful and manipulative of others, often in order to obtain money, sex, or drugs
* is impulsive, holding a succession of jobs or residences
* is irritable or aggressive, engaging in physical fights
* exhibits reckless disregard for the safety of self or others, misusing motor vehicles, or playing with fire
* is consistently irresponsible, failing to find or sustain work or to pay bills and debts
* demonstrates lack of remorse for the harm his or her behavior causes others

We had a client recently who exhibited ALL of these.

[Alex_Dubinsky]

I have to ask, what is the purpose of “diagnosing” a person with such a “condition”? It’s not like there’s an “oh, in that case, he just need to take more calcium” answer to this. I imagine the terminology is only useful as a means for scholars or doctors to talk to one another (seeing as they mustn’t use plebian language). There can’t be any difference whether you’re a deadbeat or a Certified deadbeat.

And the question of how to deal with a kid like that would deserve its own thread. (And i’m sure many would offer their own useful advice, PhD not necessary.)

[alice_in_wonderland]

Depending on the age the child would be diagnosed with Oppositional Defiant Disorder as opposed to Antisocial Personality Disorder. Many youngsters with ODD go on to develop APD, however not all.

A child who recieves appropriate interventions when first diagnosed with ODD will tend to have better outcomes than those who don’t.

There is no accepted treatment for APD other than aging. Generally, adults with APD tend to peter out of their wild ways around the age of 40.

FWIW, APD does not mean that a person cannot be a functioning member of society. While many criminals have APD, so do many politicians, policy makers, etc. The lack of conscience can actually come in handy in some such professions and a person who is intellegent and receives good guidance could have a reasonably successful life even if their personal relationships are totally screwed up.

[Pixilated]

@KGS

Sociopathy is a personality disorder, not a mental illness.

I stand corrected, and dangit to freakin og when I mix these up! Thank you (and yes, i am being sincere).

So that brings another question… do mental disorders often coincide with personality disorders?

@Alex_Dubinsky

For s&g’s, do you feel like sharing what this kid is doing? (Labels are meaningless.) And the question of how to deal with a kid like that would deserve its own thread. (And i’m sure many would offer their own useful advice, PhD not necessary.) I have to ask, what is the purpose of “diagnosing” a person with such a “condition”? It’s not like there’s an “oh, in that case, he just need to take more calcium” answer to this.

I will consider this. As for the purposes of ‘diagnosing’ it provides hopefully a gudeline on what to watch for, how to effectively interact with the child - definately not looking for a “magic pill” remedy.

@alice_in_wonderland

A child who recieves appropriate interventions when first diagnosed with ODD will tend to have better outcomes than those who don’t.

Thank you for providing an alternative disorder, and after reviewing some information on ODD, I am seeing some light at the end of the tunnel.

[MandaJo]

@Alex_Dubinsky

I have to ask, what is the purpose of “diagnosing” a person with such a “condition”? It’s not like there’s an “oh, in that case, he just need to take more calcium” answer to this. I imagine the terminology is only useful as a means for scholars or doctors to talk to one another (seeing as they mustn’t use plebian language). There can’t be any difference whether you’re a deadbeat or a Certified deadbeat.

And the question of how to deal with a kid like that would deserve its own thread. (And i’m sure many would offer their own useful advice, PhD not necessary.)

Because you deal with the same behaviors differently depending on what the underlying cause is.

[susan]

“Personality disorders” are a subset of “mental disorders/mental illness.” They are considered to be more entrenched, pervasive problems in living.

“Sociopathy” is the broad, popular term. The diagnostic term is “Antisocial personality disorder.”

“Antisocial personality disorder” can’t be diagnosed until the person has reached a certain age, and had a previous (or retrospective) diagnosis of “conduct disorder.” Conduct Disorder is not a personality disorder.

“Oppositional defiant disorder” is a different childhood disruption of conduct. It can become conduct disorder, but can’t be diagnosed simultaneously. If oppositional defiant disorder continues into adulthood, it can still be diagnosed, but only if the person doesn’t meet the criteria for antisocial personality disorder. (I’ve never seen an adult with an ODD diagnosis, though–it is generally a childhood diagnosis, and often progresses into CD and then APD, especially if not treated.)

These are all comments about nomenclature. For a discussion that looks like it will answer some of your questions, try here.

[Washoe]

There was an interesting line in an episode of Criminal Minds last season, and ever since I heard it I’ve wondered how true it is, and if it is true, exactly what it means. I can’t remember the exact context or content of the conversation, but Morgan and Reed are having some sort of disagreement over a kid who’s killed his family, and Morgan testily says something to the effect that “all teenagers profile as sociopaths; that’s why sociopathy isn’t diagnosed prior to the age of eighteen.”

[susan]

Not true, but many teens are more extreme (in a variety of domains) than they’ll wind up being as adults. A good comic summation, though.

[Alex_Dubinsky]

@MandaJo

I have to ask, what is the purpose of “diagnosing” a person with such a “condition”?

Because you deal with the same behaviors differently depending on what the underlying cause is.

I haven’t seen from anyone’s posts here how the label has any concept of the cause in it. It’s just a description of the symptoms.

I agree, if this actually had something to do with a cause, then that’d be meaningful.

But it if it’s just the symptoms, then it’s a meaningless “label” in the full, dirty sense of the word. (Especially when used by someone for whom it isn’t everyday jargon.) To the untrained mind, it gives precisely the sort of clinical air that conveys pseudo significance. Deadbeats are a dime a dozen. But a “diagnosed sociopath,” now that is an pitiful twig in the tree.

[Gorgonzola]

Diagnostic labels are sought for a number of reasons, not all of them driven by the practitioner. In psychiatry, accurate diagnosis via meeting criteria doesn’t lead inexorably to clear understanding of cause and clear direction for treatment in the way that viewing cocci under the microscope will. This causes distress for everyone involved, but it is where the state of the art remains.

People do continue to require diagnostic labels, though, for a wide variety of reasons. Schools want to “code” kids based on label to determine how much cash is attached to the child as s/he moves along the school system. Treatment providers want labels in order to compare them to their inclusion/exclusion criteria and see whether the presenting concerns fall within their specific mandate and profferred expertise. Families want labels in order to have some sort of explanation for why their loved one doesn’t meet their expectations. Again, this is far from a perfect arrangement for everyone involved, but it is where the state of the art is at.

[Nametag]

An important reason for accurate diagnosis is applying the appropriate standard of care. Some of the same behaviors that lead to an APD diagnosis can also lead to a diagnosis that might be successfully treated with medication and/or psychotherapy. Failure to do so is medical malpractice, and can lead to lawsuits or the loss of the right to practice.

[Pixilated]

@Nametag

An important reason for accurate diagnosis is applying the appropriate standard of care. Some of the same behaviors that lead to an APD diagnosis can also lead to a diagnosis that might be successfully treated with medication and/or psychotherapy. Failure to do so is medical malpractice, and can lead to lawsuits or the loss of the right to practice.

What about the parents/guardians responsibilities?

If they deny their child the much needed help because they themselves are in denial, are they legally responsible in any way (assuming that the family has the funds/insurance to get this kind of help)?

[AHunter3]

Sticking a label on something — even if it enables you to categorize it as being akin to a large batch of other ‘somethings’ to which you have given the same label — is not the same thing as understanding or explaining something.

Medical and para-medical professionals may be decently aware of that, but the average person, IMHO, is not. Person goes to the doctor with a complaint of a sore red throat. Doctor writes down “pharyngitis”. Person goes home and tells family “The doctor figured out what’s wrong with my throat! I’ve got pharyngitis, that’s what’s causing my throat to be sore! And I got these pills to fix it!” Doctor did nothing of the sort. Pharyngitis is just another way of saying “sore red throat”. Nothing has been explained. And the pills are not specific to some tightly defined bacterial or viral agent, you know, pharyngococcus Strain L-14, but rather generic remedies for sore throats and/or broad-spectrum “attack any infectious bacteria that might conceivably be causing this” pills that are not at all tailored to the specific problem at hand.

In no subcategory of medical practice is this more strongly manifest than in the mental health professions. People really really want to believe that there is a well-understood narrowly defined set of psychiatric ailments for which we know the etiology, the likely trajectory, and the perfectly tailored intervention.

In reality, most of the diagnoses are on the level of specificity of “pharyngitis” and the available remedies are broad clumsy things. If you replaced all psychiatric services with the following automatic one-size-fits-all approach, you’d scarcely be able to observe a difference:

• If person has not done anything dangerous or socially disruptive, has not threatened to do so, and you have no strong gut feeling they will despite lack of concrete evidence, require them to talk to you on a reg basis and keep them under observation but don’t do anything yet; otherwise proceed directly to steps below. If during talk or observation you perceive sufficient reason, also proceed to steps below.

• Drug person up to make it less likely that they will do dangerous or disruptive things.

• If drugged person is still dangerous or disruptive, increase dose and/or try short-term incarceration in an isolated environment.

• If that doesn’t work, just keep them incarcerated.

Lest I be misconstrued, I am not recommending this as an ideal approach. I’m saying this is the approach, shown here without the shiny spraypaint coating.

[susan]

• If person has not done anything dangerous or socially disruptive, has not threatened to do so, and you have no strong gut feeling they will despite lack of concrete evidence, require them to talk to you on a reg basis and keep them under observation but don’t do anything yet; otherwise proceed directly to steps below. If during talk or observation you perceive sufficient reason, also proceed to steps below.

There are steps before that: 1A. If the person expresses distress or discontent, provide them with options if they wish. 1B. If other people are distressed or discontented, and attribute that to the person, provide those other people with an opportunity to sort out their concerns and/or learn to mind their own business, unless there is compelling reason to evaluate the person.

I worked in mental health/counseling for 20 years, in both private and hospital settings. I have supported involuntary hospitalization once (probably a drug-induced agitated psychosis) voluntary hospitalization perhaps three times, and have assessed some people as not yet ready to attend groups on the open unit. I’m not unusual in my professional decision-making, nor am I suggesting that some professionals aren’t abusive or too quick to constrain clients/patients. However, the vast majority of mental health intervention in this country is collaborative and mutually-agreed to. I know that you’ve had some experiences that are not like that, and it pains me to know it.

[Alex_Dubinsky]

@AHunter3

Sticking a label on something — even if it enables you to categorize it as being akin to a large batch of other ‘somethings’ to which you have given the same label — is not the same thing as understanding or explaining something.

Medical and para-medical professionals may be decently aware of that, but the average person, IMHO, is not. Person goes to the doctor with a complaint of a sore red throat. Doctor writes down “pharyngitis”. Person goes home and tells family “The doctor figured out what’s wrong with my throat! I’ve got pharyngitis, that’s what’s causing my throat to be sore! And I got these pills to fix it!” Doctor did nothing of the sort. Pharyngitis is just another way of saying “sore red throat”. Nothing has been explained. And the pills are not specific to some tightly defined bacterial or viral agent, you know, pharyngococcus Strain L-14, but rather generic remedies for sore throats and/or broad-spectrum “attack any infectious bacteria that might conceivably be causing this” pills that are not at all tailored to the specific problem at hand.

In no subcategory of medical practice is this more strongly manifest than in the mental health professions. People really really want to believe that there is a well-understood narrowly defined set of psychiatric ailments for which we know the etiology, the likely trajectory, and the perfectly tailored intervention.

In reality, most of the diagnoses are on the level of specificity of “pharyngitis” and the available remedies are broad clumsy things. If you replaced all psychiatric services with the following automatic one-size-fits-all approach, you’d scarcely be able to observe a difference:

• If person has not done anything dangerous or socially disruptive, has not threatened to do so, and you have no strong gut feeling they will despite lack of concrete evidence, require them to talk to you on a reg basis and keep them under observation but don’t do anything yet; otherwise proceed directly to steps below. If during talk or observation you perceive sufficient reason, also proceed to steps below.

• Drug person up to make it less likely that they will do dangerous or disruptive things.

• If drugged person is still dangerous or disruptive, increase dose and/or try short-term incarceration in an isolated environment.

• If that doesn’t work, just keep them incarcerated.

Lest I be misconstrued, I am not recommending this as an ideal approach. I’m saying this is the approach, shown here without the shiny spraypaint coating.

That is incredibly well put.

[AHunter3]

@susan

There are steps before that: 1A. If the person expresses distress or discontent, provide them with options if they wish. 1B. If other people are distressed or discontented, and attribute that to the person, provide those other people with an opportunity to sort out their concerns and/or learn to mind their own business, unless there is compelling reason to evaluate the person.
…The vast majority of mental health intervention in this country is collaborative and mutually-agreed to. I know that you’ve had some experiences that are not like that, and it pains me to know it.

The context of this thread does not appear to be one in which an adolescent doper is seeking help with his or her own distress or discontent.

I’m happy to contribute to the amelioration of distress as experienced by others who are distressed by that person, and/or to participate in telling them to mind their own business.

[Pixilated]

What about these “evaluation tests” that are usually done at a counseling center?
I took one for the fun of it and I was tempted to answer the questions dishonestly. i do not know what the results were but should know sometime next week. There were interesting questions and all answers were true or false.

I also took a written questionaire where you write down your feelings in reference to the word or sentence provided. I really honestly made an effort to be serious but there was one question that I just could not help but to answer using a gaming reference:

I WISH… I wouldnt have failed the charisma roll. Thank goodness for articles of clothing and whatnots that give bonuses.

I’m still uncertain on how this evaluation/test thing works, for all they know I couldve answered a fraction of the questions in truth. And if the person’s truth is distorted???

I got to peek at a child’s questionaire and, imo, the questions seemed a little more down to earth.