“Can You Call a 9-Year-Old a Psychopath?”

In her May 2012 article, “Can you Call a 9-year Old a Psychopath?“, Jennifer Kahn explores the therapeutic and parental challenges that seems to surround children whose behavior falls well outside the bounds designated typical. Specifically, she looks into the nature of ‘fledgling psychopaths,’ whether their behavior is immutable or responsive to intervention, and the evolving understandings of who these kids may become.
Kahn explores the diagnostic nuances of conduct disorder, callous-unemotional children, and the complexities when a clinician must work to distinguish between confounding behaviors.

“Over the last six years, Michael’s parents have taken him to eight different therapists and received a proliferating number of diagnoses. “We’ve had so many people tell us so many different things,” Anne said. “Oh, it’s A.D.D. — oh, it’s not. It’s depression — or it’s not. You could open the DSM and point to a random thing, and chances are he has elements of it. He’s got characteristics of O.C.D. He’s got characteristics of sensory-integration disorder.Nobody knows what the predominant feature is, in terms of treating him. Which is the frustrating part.””

“One of the challenges of working with severely disturbed children, Waschbusch noted, is figuring out the roots of their behavioral problems. This is particularly true for callous-unemotional kids, he said, because their behavior — a mix of impulsivity, aggression, manipulativeness and defiance — often overlaps with other disorders. “A kid like Michael is different from minute to minute,” Waschbusch noted. “So do we say the impulsive stuff is A.D.H.D. and the rest is C.U.? Or do we say that he’s fluctuating up and down, and that’s bipolar disorder? If a kid isn’t paying attention, does that reflect oppositional behavior: you’re not paying attention because you don’t want to? Or are you depressed, and you’re not paying attention because you can’t get up the energy to do it?””

This should speak clearly to the frustration parents face in knowing where and how to get their children help. It also speaks very clearly to the challenge of finding the right help for these children. (Another under-addressed aspect in this story is the degree to which very young children come to manipulate even their therapists.) If a child can’t be diagnosed correctly, and the help that is available is not productive, what is left for families to do? Where do families go? And even when intensive, appropriate interventions are found and afforded, what level of certainty can be felt that the child’s potentially under-developed impulse-control and empathy will be sufficiently addressed?

Not only is it important for these interventions to be more fully researched and available to everyone who needs them (not just those who can afford paying for them privately), it’s essential that all of us who comprise the communities of these families continue to be compassionate and supportive, not isolating and judgmental. In providing support and building awareness, we can raise the likelihood of success in helping these families, broaden the network in which they can find support, and hopefully help to address emotional and behavioral concerns effectively before they become more problematic. It takes a village.

So how can we be mindful and proactive in our support of the families in our communities raising these children? Are there ways for us to speak out to offer support without sounding judgmental and hurtful? What are the roles we can play that will be supportive and productive? How can we address our concerns with the parents of these children, and when might we be stepping out of bounds in doing so? What is our responsibility to say something, do something; and, when is it not? We all will have different questions, answers and view points. We all have different resources, energies and ideas to offer. These are questions worth considering and discussing with your family, your friends and your peers. And with those who might need your support.

As a dear friend Nahoko points out, one of the strongest ways to reach out is to model reaching out – as a support and as one in need of support. “We live in a world in which we are expected to be strong, to solve our own problems – a world in which asking for help is a sign of weakness or failure. It’s important to recognize how much humility and courage it takes to ask for help.” She notes, as offering help is important and serves as a model for others, asking for help for ourselves, modeling reaching out for help, is essential to create a culture in which we can ask for support without fear of judgment or rejection.

The easiest way to find answers is to ask the questions aloud. Though it’s uncomfortable at first, speaking up, asking politely and offering support and help will go much further than ignoring, scoffing or judging. Your reaching out is what makes your community stronger and healthier.
Do you have other recommendations or ideas? Responses to the article and what I’ve said here? Please let me know.