Sunday, May 13, 2012


Happy Mother's Day, everyone.  I've had an exhausting day.  I asked to go hiking and spent three hours on a mountain.  Oh...I'm tired.

Okay, you know that none of us are child psychiatrists, but a number of kiddy issues have hit my radar, so just a very quick recap:

Over on Clinical Psychiatry News, I did a book review of Kaitlin Bell Barnett's new book Dosed: the Medication Generation Grows Up.  If you care about kids and meds, this is an excellent read, no sensational tone and she does a good job of giving a balanced presentation of the issues. 

We got an email from Stuart Kaplan, a child psychiatrist at Penn State, who's written a book called Your Child Does Not Have Bipolar Disorder.  I don't know Dr. Kaplan and I haven't read his book, but I wondered how he knows my child doesn't have bipolar disorder!  Check out his blog (linked to the book title) and let us know what you think.  I imagine that at least a few of the kids who are diagnosed with bipolar disorder might actually turn out to have it, but our readers know that I feel we need to re-think the bipolar diagnosis, especially with regard to the recommendation for lifelong treatment for those spectrum-y people.  I'm thinking that Dr. Kaplan and I may be on the same page. 

The New York Times has a ClinkShrink type article on Can You Call A 9 Year Old a Psychopath by Jennifer Kahn.  It's an interesting article, mostly because it doesn't have any real conclusions. She talks about children who lack empathy and are behavioral nightmares, and notes that half of these disaster children grow up to normal (meaning not psychopathic) adults-- including the father of the child who was featured.  She  reports on an intensive program to treat these children in an 8 week-long summer camp to teach empathy and modify behavior.  There's nothing about the article that indicates that the treatment is effective, though, granted it's all a research protocol and the stakes here are high.  The question is raised about labeling children as 'psychopaths,' a typically stigmatizing, untreatable, and damning diagnosis, and the case is made that the diagnosis would be useful if it led to interventions that prevented these children from becoming adult psychopaths (and perhaps criminals).  Personally, until there's a way to know who won't outgrow the problem, and an effective and accessible treatment to be offered, I'm voting "no" on labeling children as psychopaths.  I haven't been terribly impressed by the idea that childhood extrapolates to adulthood.  Won't every misbehaving teenager in foster care be given this label when there is no one around to recall that an angry/irritable/misbehaving teen was not lacking in empathy as a younger child?


Sunny CA said...

The description of the summer program led me to think about my job as a teacher. The kids described and the Asperger's/Autistic and ADHD kids and the "bipolar" kids end up in our classrooms and we are considered "bad teachers" if we do not "manage" their behavior. Perhaps the researcher, at least, might now have some insight into the life of the classroom teacher in a time when kids of all ability levels and behavioral types are tossed in together, and we are supposed to "differentiate instruction" (translation...teach multiple different levels of instruction at the same time) and simultaneously "manage" behavior and we are "bad teachers" if we can't do that plus have this year's kids perform better than their siblings did last year. I empathize with the parents. It horrifies me to think that perhaps psychopaths are born that way, and there may nothing we can do to bring about in them a concern for other people.

Liz said...

fascinating article in the new york times. thanks for heads up. in my work as at a residential treatment facility, i took care of kids with ALL KINDS of diagnoses. during their time with me, however, their behavior was, for the most part, absolutely ordinary. in that structured, loving setting, they did just fine. sure-- there were some crazy moments, but in general, most of the kids were okay....

Sunny CA said...

So, Liz, are you saying that if their parents just provided a structured, loving setting that the kids would act normally?

I certainly see a wide variety of behaviors in a classroom setting, but then in a classroom each child is expected produce work. It is not just a loving setting. There are boundaries and behavioral expectations.

Jane said...

Honestly Sunny, I felt like teachers just didn't want to teach special needs kids when I was in school. I get that it's really hard to teach a diverse group, but they just straight up would not make accommodations for the kids. I got confused as a kid when some parents would show up with a lawyer to an IEP meeting. But now that I'm older, I get why they were doing that. You would literally have needed to hire a lawyer to get the teachers (and the school) to do anything. I think there is more to it than just that the kids are special needs and so that's why they fail. Because there are lots of people with Bipolar disorder, Tourettes, etc who end up going to major universities. They take the same classes, pass the same tests, etc. I think it was on here a long time ago that I posted about taking an exam in a room for disabled students who get extra time...and I swear it was all the people with tic disorders and attention problems. People were making noises, pacing, etc...Some people have someone reading the test to them, some have to read it aloud, some just need to hum while they work, others just can't sit still for long and need to get up. I started humming along with some other guy and he occasionally had to get up and pace while reading his test. They had noise cancelling headphones for everyone, but it still didn't work because (I don't know why) the sound would be blocked in the room but you could still hear echoes and whatnot from the office surrounding the room. I don't how that's possible. If someone was reading a test aloud next to me, I couldn't hear any of it with the headphones on. But the noise outside was a different matter.

Actually though, on a side note, I strangely preferred that environment. It didn't feel like testing to me. It just felt like getting some paperwork paying bills I guess. I felt less anxious about test taking.

I wonder what kind of environment the "psychopathic" kids would thrive best in. Michael came off as pretty smart to me in the article. He said something like, "Daddy don't do this! You know I have a greater bond with you than Mommy!" And I thought, A 9 year old said that??? That's awfully formal. Usually it's just, "I love you more than Mommy/Daddy" depending on which parent needs manipulating. And then when he nabbed the recorder I thought the article read too much into that. Apparently, the article states 9 year olds don't normally have that kind of planning ability. That was what made him psychopathic? Someone recorded him without his knowledge, so he found a way to get the device and erase what was on it??? That sounds normal. The only abnormal thing is that he was smart enough to figure out how to do that. The only thing separating him from impulsive ADHD kids is his ability to think ahead, scheme, and manipulate. All kids are manipulative and immature. But they normally can't scheme on such a grand scale...He may yet grow out of this. Even the little girl L. The girl who paid children with her toys to act out on command and played with the hearts of all the little boys. You can't be stupid and think something like that up. I wonder if their EQs just needs time to catch up with their IQs. Once they get less emotionally shallow, maybe they can settle down more.

Dinah said...

I believe that parenting and a stable environment are a lot of what goes influences a child's behavior.

That said, some children are just harder than others. Some kids come easy and go-with-the-flow. And some very loving reasonable parents have disaster children, while other horrible parents get really great kids. I haven't figured it out.

I do think the author made an effort to find really hard kids and that the kids in this camp are not ones where a love and structure are the answers. I don't think it was one act in isolation (turning off the recorder, for example), but the non-stop nature of it and things like holding up a chair to attack his brother, or the kid who cut off the cat's tail a little at a time--there's just no way that's normal.
A couple of years ago, around here two a couple of kids killed their mothers. One had killed the entire family. Everyone was shocked. I think these are the kind of kids the author is talking about.

The author was pretty clear that some of these kids outgrow it, including Michael's father.

Sunny CA-- I can't imagine a harder job. Years ago, my son's preschool teacher was complaining about his behavior and I went to watch the classroom (3 year olds, the girls all sat still and listened, the boys ran around, except for one boy who sat quietly and every now and then turned and smacked the kid next to him). After 2 hours, I was exhausted. And this was a day care center with no special needs issues.
My hat goes off to anyone who teaches, and to teach special needs have my admiration. I don't think the red tape and paperwork demands make this easy and I think good, caring teachers get jaded and worn down by the system, and the system has a lot of demands on it.

In other words, I think you're all right,

Jane said...

My problem with the article was actually the fact that Michael's behavior was not nonstop and that she didn't feature a harder kid. When she mentioned children who did do really sadistic things (like with the cat) it was not children that she actually interviewed or focused on. She does observe Michael losing it, but the most violent things that she sees him do are with the chair and when he grabs something from his brother Allen (the one who mocks him for crying) and throwing it at the wall. I noticed both of those acts were directed at Allen and he doesn't ever mention or display having a problem with the other siblings. It's only Allen he claims to have a problem with. Notice how he paused with the chair in time for Dad to save Allen (perhaps this was on purpose? The article says he is not impulsive). But even the Dad admitted that Allen provokes Michael and mocks him.

When Michael's at the camp, he actually looks really depressed and is not much of a behavior problem until the last weeks when he starts swooning over L and tries to get her attention by doing as she asks (acting out). He was definitely not a nonstop behavior problem at the camp. He usually just looks really bored. There are even times at home when he shows affection, but the readers are led to believe that these acts are just manipulations and look forced.

I could probably go on, but I didn't think Michael was the correct kid to focus on at the camp. And I definitely don't know that I would have had him featured in an article stating that he might be a psychopath if I were his mother. I wouldn't go on record either saying I thought my kid would either be a Nobel Prize winner or a serial killer when he grows up. I'm sure they changed his name for the article, but he could still figure it out when he's older. I know the article was not written to be sympathetic to Michael, but I really hope he never sees this article. Especially because it's obvious that he doesn't like being recorded.

Sunny CA said...

Jane, we DO make accommodations and modifications for identified students, and I also do for kids who are not formally identified, but seem like they ought to have been identified. I also make 3 different lesson plans, 3 different worksheets, have 3 different activities, etc, so kids can be challenged at "the appropriate level" and still there are kids who stand up and bob up and down,or bang on the bottom of the table, or lose it and run screaming across the room to grab something from another kid, etc. Meanwhile, I am trying to keep education moving forward for everyone at every different ability level.

Jane said...

@Sunny: Oh wow, that is really bad. If you actually needed remediation, they just pulled you out of class. Same for gifted kids. Or they had "cluster classes" when I was young. Those were for gifted children and children who could keep up with them I guess.

And I get why they did the cluster classes. This is gonna sound crazy, but my brother was a genius. And his elementary school teacher wanted his IQ tested, because she thought he needed to be placed in a class for gifted children. She wasn't even teaching him. He was so advanced that she just had him grade papers for her and would use him to help the other kids. My Dad walked into the class once and asked why my brother wasn't doing the same math assignment as everyone else, and she said it's because he already knew how to do it and she just used him for grading.

When the school gave him the IQ test, he was a genius...but the people in the gifted program said he was too shy. They thought his personality would not click with the other students. His teacher was pissed. My Dad was pissed. I didn't believe that at first, but I read later that if your too shy they don't take you because gifted classes are usually small and involve a lot of group work. The kids have to be social because they spend so much time with each other. They ended up putting him in a cluster class, when the gifted program got bigger. He sat around grading the papers of gifted children, because he was still smarter than them.

In middle school, his teachers could not understand how he had never been put in a gifted program. They had him in high school algebra, the highest you could get in middle school, and it was still too easy. My Dad explained it was because he was too shy, and the gifted program didn't think he would fit in. His algebra teacher was completely bewildered. She made sure the high school skipped him up to higher level math when he got there, and he took a lot of college courses when he got to high school. There was no gifted program to exclude him, s he could finally take classes at his own level.

K said...

Dinah, I teach special ed and just want to comment that while a loving, stable home environment is one of if not the biggest factor in a child, I can't count the number of kids I've had who either came out of an environment that was so loving there were no boundaries and the kids were all over the place, or out of home environments that were disasters. That said, the stability and love (albeit of a different sort) and most of all, consistency, that was present in my classroom created huge behavior changes. By the third (or so) month of school, we routinely have children who started the year acting like monsters behaving like angels. Sadly, that only carries over into the home setting so much.....

Anonymous said...

Jane, your brother was probably better off not being in the gifted program. I was in that, and all it meant was extra busy work and group projects. I'm introverted, and I hate group projects. If I had it to do over again, I would opt out of that program.

At my school the gifted program was simply about how the student did on standardized tests. Funny to see students who were supposedly not gifted one year suddenly become gifted the next. Goofy.


Sophia said...

I think it takes some kids longer than others to wrap their head around the idea of empathy. It's a pretty abstract notion, if you really think about it. I also wonder if some kids don't necessarily have empathy but know they'll get their butts kicked if they do something mean, whereas some kids can get pretty smart and question the whys of things.

I've noticed there's less emphasis on telling kids they can lead more or less regular lives with mental stuff and more emphasis on caregivers learning to tolerate kids' mental stuff. Us Recovery Movement folks really need to start paying attention to the under eighteen crowd, because a lot of caregivers are convinced their kids are going to Hell in a hand basket. They do have the stats to back that up, but I can't help but wonder if some of those stats could get a bit better if we started to give kids a bit more credit in their ability to live and be happy.

I view mental stuff in kids as normal on uber-steroids: we all want attention and validation, we all get angry and want to lash out, we all have people in our lives we can't stand, we all question authority to a degree, we all want romantic relationships, and so forth. The ability to manage these feelings varies amongst folks, and wildly varies amongst kids based on temperament, maturity, inherited mental stuff, and what was reinforced or not reinforced by their caregivers.

Dinah said...

Jane: The Last Psychiatrist agrees with you:

Okay, so you've all sold me, the author could have found a kid with more notable behavioral disturbances. I saw somewhere that there are more people in prison then in Nebraska. It can't be hard to find psychopaths. I know some difficult kids, but I don't know any that are cutting off the cat's tail inch by inch.

Jane said...

Friggin' blogger took my comment. Some kind of error. Anyhow, shortened version is that I had no clue that they used the real first names. As TLP pointed out, using the real first names, where they live, and the name of their doctor was unwise. I feel much worse for Michael now.

I also think there is something fishy about the mom (as people on TLP's site noted). She has very little compassion for her son, and speaks about him in a way that is unusual. Most mothers don't sell their kids so short. At least that is not something I often see. She thinks he is a psychopath, incapable of showing real affection (even when he tries to give it to her), and may one day be a serial killer :/

Another good observation from someone else was that Michael's most violent acts tend to be against himself. He tears at his clothes and yanks out his own hair in frustration. Psychopaths are famous for hurting other people. Self harm isn't something they are famous for.

Personally, this kind of reminded me of David Allen's blog. He writes about people borderline personality disorder. He noticed that a lot of people with BPD have parents who are really overinvolved (but not in a good way). He calls it hostile overinvolvment. And then they become totally disconnected and out to lunch the next. That was what I thought the mom was like. She is super involved in getting her kid "better" but then she totally writes him off the next. If he does something good, such as show affection, she chalks it up to a manipulation. Then she tries really hard to get him help and send him to a special camp and she really seems to believe in him (again, the involvement is hostile because she is only doing it because she thinks he is a problem. She's not doing it as a positive. Sending him to art camp because he likes to draw blue dragons would have been a positive). She then disconnects herself again by emphasizing that he is a psychopath, likely to become a serial killer, and there is nothing she can do.

I wonder if the father did not produce a psychopath. Perhaps the mother produced a borderline?