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You have described a severely disturbed boy who needs to be guarded all of the time.
Does he live at home or is he institutionalized? You did not mention his parents.
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.
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.
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).
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.
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.
On the other hand, excusing their behavior keeps them from learning this important lesson.
Right now, he is winning the battle, terrorizing the other children, and tying up your personnel and resources in a makeshift detention situation.
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.
Sometimes it is the last and best option.
If I can be of further assistance, please get back to me.
Elliott, MAE, LPCC, NCC, CCMHC
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?