Hello I believe I can help you with your concern
I am so sorry that your son has been exhibiting these symptoms/behaviors, I can understand why it would distress you
I would like to ask a couple questions to get some more information if possible, so that I can better assist you
How long has your son been having these issues of lying, not taking responsibility, and impulsivitiy?
So most likely your son is exhibiting behavioral symptoms that are typically associated with a personality disorder called Narcissistic Personality Disorder (NPD), where the person lies, manipulates, can be charming, impulsive, fails to take responsibility and in fact will blame others for their faults, and always seeks praise. Here is a good link explaining NPD in more detail for you
Now I cannot be certain if he has this disorder completely or only traits of this disorder, as both are possible, but he definitely should be evaluated by a therapist.
The best and most evidence based treatment for this disorder is called Cognitive Behavioral Therapy (CBT). CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.
But I do have to say that even with CBT treatment, it has to be intensive for around 1-2 sessions per week and usually they last for 1-3 years. And even then the success rate is not that high. Many therapists use CBT and can help your son and many therapists work on a sliding scale, so they can provide low cost therapy dependent on your income, so that can be an option
I would be more than welcome to try to find you a qualified CBT therapist that provides sliding scale fees in your area, I would just need a zip code
I see that you are offline right now, but when you get back online I would be very interested in continuing this discussion with you and talking about anything further you would like to share regarding your concern, so if you respond in the chat box I will be able to get back to you as soon as possible.
I see that you are typing, but I also wanted to recommend these books of NPD as well that I forgot to mention before
Wow I am so sorry to hear about this for your son, since this behavior started at such a young age then most likely he does not have NPD at all., but it most likely is a developmental disorder. I will wait for you to stop typing to explain what I think is the issue.
I understand that you care about your son a lot and most likely because his symptoms occurred at such a young age, he most likely has a developmental disorder that has gone undiagnosed. I would like to ask some questions to try to narrow it down
Does your son have poor eye contact when he talks to others?
Does he have a difficult time reading other's emotions?
When communicating with him, is it usually one-sided as he talks a lot and does not allow for pauses in the conversation to occur?
Also does he have poor coordination at all?
So his social interaction with others is good
And what about his coordination? Is he considered clumsy or is very well coordinated?
Does he have any fixations on routines at all?
Well with the ADHD diagnosis, and this behavior of telling stories, running off doing his own thing, and more starting at a young age, I would say that this a Conduct Disorder that has most likely gravitated to a possible personality disorder. He does not meet the criteria for a developmental disorder and Conduct Disorders occur 25 percent of the time with ADHD, 50 percent in males with ADHD, as males are more frequently hyper.
Still you asked for the best treatment and that is Cognitive Behavioral Therapy (CBT) still and for this though, it had a good prognostic factor because it is strongly related to the ADHD and can be treated very successfully
May I ask what medications is he currently on and what has he tried in the past?
Well the medications may help with his ADHD symptoms, but the CBT should be more concentrated for his lying and not taking responsibility for his actions
They are very similar, but ODD would be if he only was acting out against authority figures, but because he was acting out towards peers as well as authority figures it is more indicative of a conduct disorder. Now he is not there yet, but this conduct disorder could translate to a severe personality disorder called Antisocial Personality Disorder (ASPD) if he does not seek the treatment right now. He shows some traits of this disorder, but not the full disorder by any means, so the sooner he is in CBT therapy the better the outlook because right now he has a good prognostic shot of managing these symptoms
Well actually i do not have access to your email, the administrators keep that information to protect your confidentiality, but when you finish rating me, this chat will be sent as a link to your email, if it has not already, so you can always use it for future reference. In addition, this chat will be saved in your JA account under My Questions so you can always go back to it when you need to
Well what is your zip code, i can look for some therapists in your area if you like
Yes it definitely does explain why employment is hard for him, but also that can be the ADHD too. This is the criteria for Antisocial Personality Disorder, and like I said he does not meet the criteria for the whole disorder, but he could in the future which is why treatment is wise now.
Give me a few minutes to compile a list of therapists for you
So I believe these therapists are good to help your son as they specialize with behavioral issues and Antisocial traits like your son exhibits.
Is there anything else I can do for you or son tonight?
Like with the medication?
That is understandable, many psychiatrists can prescribe lower doses so that he does not feel like a "Zombie" or he can try a non-stimulant ADHD medication called Strattera that should not make him feel like a "zombie" either.
The CBT should help him a lot and can help him to a point where the medication may not be necessary or at the minimum doses to reduce the level of side effects too
I would also like to recommend these treatment books as well for your son too
These should help and reduce the need for medication, so that can put your son's mind at ease
Well then try a lower dose of the Concerta, that should help. Also some psychiatrists will prescribe Wellbutrin or Tricyclic antidepressants as well
So there are other options, but the CBT is important for the other behavioral symptoms that he has exhibited.
Haha, yes it is late for you, but I wanted to make sure to help you with everything. Is there anything else you need that I can assist you with?