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Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7663
Experience:  35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
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I am a doctoral level special ed. administrator with a 9yr.

Customer Question

I am a doctoral level special ed. administrator with a 9yr. old male student with serious behavioral issues. He does not respond to traditional behavioral modification/support techniques. We have worked with him for 3 years using counselors, behavioral specialists, and a day treatment center, all to no avail. As of today I can honestly say that we have failed in every effort. He continues to lash out at those trying work with him with such violence that he has to be restrained by 2 grown men. When he resolves from the anger episode, he often asks if that was a new record for the duration of the outburst. He uses behavioral incentives to get what he wants and then calls his teacher a fool for thinking he did his work for anything other than his own desires. After many episodes of destructive behavior that resulted in having to remove all the children from the classroom while this child destroyed everything he could get his hands on, he has been moved into a self-contained classroom with a teacher and an aide. This room has had to be stripped of everything, down to the bare walls. He will use anything he can as a weapon and recently had to start leaving his shoes at the door. For the most part, he refuses to do any academic work, but recently passed the statewide assessment for his grade. He's under the "care" of a pediatric psychiatrist that has prescribed a cocktail of psychotropic medications. As a school, we have come to the conclusion that we cannot provide the type of help this child needs. To make matters worse, I cannot find any treatment center that can offer any help for what I believe is an organic disorder. I have my own suspicions about a diagnosis(es), but due to his age, we are all reluctant to address it. He has used urine as a weapon of "shock and awe", and shows zero remorse for hurting others. He has no regard for authority and has struck and kicked his school principal on multiple occasions. He has begun striking out at other kids, something that until now he had never done. I would love to hear about some treatment option that I have not thought of or tried. I'm at the end of a difficult road with no where to turn.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Elliott, LPCC, NCC replied 1 year ago.

Elliott, LPCC, NCC :

Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Elliott, LPCC, NCC :

Dear friend,

Elliott, LPCC, NCC :

I believe that I can help.

Elliott, LPCC, NCC :

You have described a severely disturbed boy who needs to be guarded all of the time.

Elliott, LPCC, NCC :

Does he live at home or is he institutionalized? You did not mention his parents.

Elliott, LPCC, NCC :

You are reluctant to call his conduct disorder anything more, but his behavior is extreme and dangerous and criminal in nature and only his age prevents him from being called an antisocial person with dangerous psychopathic tendencies.

Elliott, LPCC, NCC :

I imagine that his psychotropic cocktail includes antipsychotic medications, but you were not clear. That would be the best short-term method of reducing his symptoms.

Elliott, LPCC, NCC :

You did not mention whether or not he received any legal consequences for his behavior. I know that it seems like giving up to label him as a criminal, but so many of the most hardened criminals do have Antisocial Personality Disorder (which is not technically the term for it because of his age).

Elliott, LPCC, NCC :

Studies of children with his behavior characteristics have show that bring such a child before a judge and court and providing some kind of sentence has a preventive effect.

Elliott, LPCC, NCC :

These studies have further shown that these children are less likely to become antisocial adults. Going through the legal system and being in a formal detention system teaches them that bad behavior has negative consequences, and they’re responsible for their actions, even as children.

Elliott, LPCC, NCC :

On the other hand, excusing their behavior keeps them from learning this important lesson.

Elliott, LPCC, NCC :

Right now, he is winning the battle, terrorizing the other children, and tying up your personnel and resources in a makeshift detention situation.

Elliott, LPCC, NCC :

I have worked inside of a juvenile detention system and have done drug programs and individual therapy with adults (often young) as the local county jail. It is a hard choice for educators and healers to send a child for incarceration, but it is often a corrective that works, despite its downside and even risk of abuse.

Elliott, LPCC, NCC :

Sometimes it is the last and best option.

Elliott, LPCC, NCC :

If I can be of further assistance, please get back to me.

Elliott, LPCC, NCC :

Warm regards,

Elliott, LPCC, NCC :

Elliott, MAE, LPCC, NCC, CCMHC

Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7663
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
Elliott, LPCC, NCC and other Mental Health Specialists are ready to help you
Customer: replied 1 year ago.

He lives with his parents and sister in a "normal" middle class home. There is no history or evidence of abuse, drug use, alcohol abuse or any event that would lead one to suspect PTSD. This includes invitro.


 


His medications include Abilify, Intuniv, and Prozac. I'm quite sure that the doses he is taking are significant. We have attended appointments with the parents and the psychiatrist trying to give him the best information we can looking for the best therapy that we can get for the student and for the parents. Other than the medication, he has been little help. You should see the child un-medicated. Holy crap!! Needless to say, he would be totally unmanageable without medical intervention.


 


We are reluctant to use the criminal justice system at his young age, but we're not so naive that we don't know that it's only a matter of time. Our goal has been to "cure" him or give him the appropriate coping mechanisms to help him integrate into the school society. He shows no interest in getting along within the school, but only want the school to get along with him: His time, his preferred activity, his schedule, his way.


 


I know that I am describing a narcissistic personality disorder and potentially sociopathic tendencies. I had one of diagnosticians review what I put in my original description to make sure I was being accurate. She sad that if anything I was understating the symptoms. So, I'm pretty sure of my own conclusions, just not comfortable with them.


 


I, too have spent a great deal of time working in a juvenile detention center. I was the school principal in a detention center for boys aged 10-16. We had everything from rapists to capital offenders. I can't imagine this little boy being there, but like you, I don't see any other options. There is so very little assistance with this type of mental health issue in my area that I don't know where else to turn. Other than the juvenile justice system, do you have any other recommendations for therapy or some other avenue that maybe I haven't explored?


 


 

Expert:  Elliott, LPCC, NCC replied 1 year ago.
Dear Steve,

Using the criminal justice system troubles me as well. In that environment, however, he will not be given free reign to have things his way.

I also think that you are understating your diagnosis if you say that he is "merely" a narcissist. While he shares many of those traits of lack of empathy and remorse, conning, lying, and self-centeredness, he goes way beyond that with his violent destruction of property and physical attacks on others. You could say a malignant narcissist, but then this approaches the APD definition. Sometimes it seems as if the two are on the same continuum.

Martha Stout, in The Sociopath Next Door (p. 134) says the following:

"....there’s evidence that sociopaths are influenced less by their early experience than are nonsociopaths. .....The sociopaths who have been studied reveal a significant aberration in their ability to process emotional information at the level of the cerebral cortex. And from examining heritability studies, we can speculate that the neurobiological underpinnings of the core personality features of sociopathy are as much as 50 percent heritable. The remaining causes, the other 50 percent, are much foggier. Neither childhood maltreatment nor attachment disorder seems to account for the environmental contribution to the loveless, manipulative, and guiltless existence that psychologists call psychopathy.”

Most unfortunately there is no known medication or treatment that will allow a psychopath to attain the neurological capacity to process emotion satisfactoraly. He will probably never become a caring and fully functional person, but rather a malicious person.

We all want to be believe that we can cure mental illness, but like most cancer, we are only able to suppress or ameliorate symptoms.

I certainly appreciate you as a caring human being. After I completed my studies I took further graduate study in special education and it is a field that I enjoy and understand.

I feel I have to thank you for being such a caring educator, on behalf of a world that seems not to understand or care much about the welfare of our children (our future).

May God bless you and allow you to prosper and help others.

Warm regards,

Elliott

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Elliott, LPCC, NCC
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