Ruling out conduct disorder and bi-polar

[Think About It...]

Our 14 yr. old D just got out of a 3 week stay at state mental health facility where she had extensive psychological testing done.  While we still don't have the final reports back, they told us they still need to rule out conduct disorder and bi-polar.  We were told when our D was in K-5 that she had ADHD/anxiety.  Now they don't think she has ADHD, but she still has the anxiety issues.  Does anyone else have any thoughts/experience with conduct disorder?   

[cleanandsober]

Our 14 yr. old D just got out of a 3 week stay at state mental health facility where she had extensive psychological testing done.  While we still don't have the final reports back, they told us they still need to rule out conduct disorder and bi-polar.  We were told when our D was in K-5 that she had ADHD/anxiety.  Now they don't think she has ADHD, but she still has the anxiety issues.  Does anyone else have any thoughts/experience with conduct disorder?   

[FriedaB]

If  im  not  mistaken,  "conduct  disorder"  is  a  precursor  to  ASPD(which  cant  be  diagnosed  till  18,  at  least  in  the  US).  Im  curious,  what  behaviors  does  your  daughter  display  that  make  them  suspect  CD? 

[Thursday]

Hi cleanandsober,

Yes, like the poster above me I'm curious about your DD's behaviors.

For about a six month period my SDs behavior was really disregulated, it was almost as if she was seeing how far she could take it. It was also during this time that we had to see pDoc to satisfy health insurance that more therapy was needed. She saw the psychiatrist for all of thirty minutes and she was being very, very difficult, (she was 15) slumped in her chair, hiding her face with the hood on her shirt, pouting and not responsive to some of his questions. At one point she got defiant and started cursing, saying that being in the office was BS. Pdoc prescribed an ADHD med call Daytrana, a patch, which she used until the end of the school year...). He also diagnosed ODD, ADHD and conduct disorder.

Frankly, I didn't buy ANY of it. She was in a really bad mood, had pms and something had happened to her that day within her social circle. those of us who have lived with a teen with BPD understand these days of near total disregulation.

So, I am hoping that right now, at 14, your daughter might be doing what my SD did, she sort of tried some really out of control behavior on for size. I think she later, when her behaviors started to escalate more, decided it was too dangerous to her personal freedom to continue in this particular direction. (due to some issues at her school we opted to send her to a wilderness therapeutic camp in North Carolina. She was there was 9 weeks and came home with a few skills and a sometimes desire to try to regulate herself).

During this six month period her troubling behavior was very heightened, like she was running a laundry list of bad behaviors in her head...arrested for shoplifting, defiant to teachers, every time we left the house she invited kids over, sexting, whenever out of our line of vision her cleavage came into play (she is very busty and the cleavage thing was really bad, very exasperating, frankly obscene) hanging with "the worst kids at school" doing no schoolwork, skipping school, drinking, drugging (coracidine, hydrocodone, sniffing inhalents, pot smoking, muscle relaxers, high dosages of energy pills, etc)

Looking back it seems clear that she was seeking out the exhilaration of negative attention. Well, maybe just clear to me... ;p

Does any of this sound familiar?

thursday

[FriedaB]

Thats also what I was thinking.

[Battle Weary]

Have you looked at the DSM criteria for conduct disorder?  Many of the behaviors like truancy and stealing had to start before the age of 13, and include signs of serious disturbance like setting fires and cruelty to animals.  According to Wikipedia, the proposed revision to the DSM criteria requires kids to meet all the existing DSM criteria PLUS:

Must Show 2 or more of the following characteristics persistently over at least 12 months and in more than one relationship or setting.

1.Lack of Remorse or Guilt: Does not feel bad or guilty when he/she does something wrong (except if expressing remorse when caught and/or facing punishment).
2.Callous-Lack of Empathy: Disregards and is unconcerned about the feelings of others.
3.Unconcerned about Performance: Does not show concern about poor/problematic performance at school, work, or in other important activities.
4.Shallow or Deficient Affect: Does not express feelings or show emotions to others, except in ways that seem shallow or superficial (e.g., emotions are not consistent with actions; can turn emotions “on” or “off” quickly) or when they are used for gain (e.g., to manipulate or intimidate others)

I am inferring that by adding these additional criteria, there is a feeling out there among professionals that conduct disorder may be over-diagnosed and that the new criteria are aimed at reining this trend in.  You may wish to think about the extent your dd meets the old criteria and the new proposed ones before accepting the Pdocs' views.

I think you will find from the experience of many here, it is important to listen to your own instincts in dealing with the professionals.  After all, you, not them, are the one living with your dd and you have access on a daily basis to all sorts of data they don't have. Do not hesitate to present professionals with data you have "collected' (by living with your dd) to challenge their views.

As for bi-polar, I have heard from a therapist who leads DBT groups that a major problem they have with Pdocs is that they don't want to entertain a BPD diagnosis, but rather bi-polar.  My dd's Pdoc has her on lithium, a bi-polar drug, which she threw in recently because other things weren't working, but I don't buy the bi-polar dx either.  DD's old therapist tried on for me an ultra-rapid cycling bi-polar dx but it really doesn't fit and she now agrees BPD is way more likely.  As I understand it, the highs and lows of bi-polar occur independent of the environment.  My dd's mood swings are totally dependent on environmental factors--a friend did something, I said something, etc.  She does rage, but there is always a proximate cause, it is not random. (DD is seeing new Pdoc in a few weeks with a goal of a gomplete evaluation.)

I advise you you to read up as much as you can about conduct disorder, bi-polar, and BPD to come to your own views and to equip yourself to challenge the view of the Pdocs if yours are different.  Many of us here dx'ed our kids before the professionals.  Personally, when I first heard of BPD and went through the criteria, it felt like coming home--this was the first dx that actually made sense to me.

[Reality]

Battle Weary
I am in tears reading of your feeling of coming home when you heard about the dx for BPD.  I feel the same way and I can't believe the difference it makes to have the dx and to learn about DBT and to have so many friends here in our little cyber-community, a place where I don't need to pretend and where people have compassion for our struggles. 
Yes, I have read about that defining feature of BPD emotional dysregulation, that it stems from actual daily events.  There are many fast mood changes, even within one conversation.  That behavior, which looks a bit like schizophrenia, but is very different as it is situation dependent.
I agree wholeheartedly with your advice to cleanandsober.  Well put. 
Thursday
I love your perspective on the crazy behavior.
Reality

[INFORMATION ABOUT THE 'SUPPORTING A CHILD' BOARD]

INFORMATION ABOUT THE 'SUPPORTING A CHILD' BOARD Our objective is to learn how to support our loved ones and to find peace and understanding in our own lives. There is real help and real hope available for families. For information and guidelines please click here :

[Battle Weary]

Reality,

Even though we don't have formal dx yet, nothing else hangs together.  And I agree--acting as though this is it and reading up on BPD and finally finding this board, this cyber community has helped ever so much.

Thursday,

Could it be the laundry list of behaviors your dd went through was an attempt to find one that could perhaps finally ease her pain, at least just a little?  I think my dd went through a number of types of bad behaviors too and abandoned a lot of them because they really didn"t help.

DD is not busty but that low cut thing really is awful.  Same for the bare tummy--mine cuts off her t-shirts for this look.  Ugh! At least she takes good-naturedly my rather mild but oft-repeated comment that modesty is an under-rated virtue.  Way too many other things to address before going after the attire though.

[cleanandsober]

Thanks for all your posts...very helpful.  I forget to say that the conduct disorder is adolescent onset, which is different than child.  They said the reason they want to r/o conduct disorder is because of her stealing my credit card, running away and calling cab.  (She did this 4 times).  Because of her history, the county helps us with family and individual therapy.  We had a private doctor (who thought BPD and ADHD), but now we are going thru the county doctor who we see next week.  They say he is very conservative.  I like the fact that they took her off the Adderall and Citalapram.  She is only taking Abilify right now to get her mood stabilized.  From what I have read, our D fits the profile for BPD.  Hopefully in a few weeks we will have a diagnosis.  Thanks for listening...   

[Battle Weary]

Cleanand sober,

Sounds like the credit card stealing was not the goal in itself but a necessary incidental to help her achieve her objectivel of running away.  I think this is a very difficult line.  Lack of remorse is a sign of conduct disorder as well as anti-social personality disorder.  But when psBPD steal they may not have remorse because what ever the money was for was so urgent to them.  Why should they feel sorry for doing whatever they had to do meet their bottom line absolute needs essentail for them to continue living, like getting out of Dodge, buying drugs, paying for friends so they stay close to you etc.?

It has been suggested to me that my DD19 might have sociopathic tendencies because she has stolen numerous times from me.  I am holding this to the side--not embracing it, but not disowning it either.  She has newly started DBT therapy and we'll see where that goes before I take  a serious look at whether she has co-morbid antisocial personality disorder.  Interestingly, a lot of what I've read is that BPD may be underdiagnosed in males because they get dxed antisocial personality disorder instead.

[FriedaB]

cleanandsober:  is  it  possible  she  stole  from  you  to  get  drugs?  Thats  a  very  common  addict  behavior.

[Thursday]

Battle Weary,

Thursday,

Could it be the laundry list of behaviors your dd went through was an attempt to find one that could perhaps finally ease her pain, at least just a little?

I think being the center of attention and talk at school and the attention she recieved at home after getting in trouble for bad behavior, talking about her bad behavior to her therapist were all serving to ease her pain...the pain she feels when she feels no one has her at the center of their focus.

My SD lost her Mom to a long illness. Prior to her Moms illness SD was the focus of her Mom's attention and after Mom's cancer diagnoses, surgeries, altered physical state the focus was very much on Mom and SD was all but abandoned. Five years after diagnoses, her Mom died. SD was 12, a month away from being 13. This started when she was 7 yrs old, almost 8.

Her need to be the center of attention, especially when she was in the young teen range, was manic. It was, for a long time and really until she found drugs, the need she was intent upon feeding. I shouldn't really give the age range as I didn't know her before the young teen range. Once she found drugs things quickly escalated to being high easing her pain.

Thursday

[Battle Weary]

Thursday,
Interesting take.  I was going to add to my previous post but didn't that my DD seemed to go through two years or so of various bad behaviors, taking up one then rejecting it, then taking on another.  Now she seems mostly to have settled on pot.  Funny your response was so similar.  I'm not happy about the pot, but it is not as bad as many other things I can think of so I tolerate it for now.

[lbjnltx]

dear cleanand sober,

my daughter was dx w/odd at age 11.  has your d been dx w/odd?  look at the criteria for oppositional defiant disorder.  many children w/add/adhd go on in their preteen years to develope odd from there many boys progress(or regress) into conduct disorder followed by a dx of aspd. girls who have adhd then odd often go on to meet the criteria for BPD.  i have read a study on this line of development and the ratios are staggering 

i agree with the other posters in not just accepting a dx...get the right one and battle to keep eroneous dx out of her records.

before the age of 18 i think the vast majority of kids w/BPD (emerging, traits of, etc ) are dx rapid cycle bi polar...i wish the pdocs would get over themselves and stop stigmatizing these young people and their families!

 
lbjnltx

[almostvegan]

Amen sister!
Here's to no more stigma!

[Kidnapped]

My own experience with DD was similar.  As a young child, I kept asking about her extraodinary energy levels and wilfulness, only to have that dowpalyed and invalidated by pediatricians. a coundelor claimed she was 'depressed' at age 6. But she was a bedwetter.  At age 9, a doctor gave her mipramine to help with that - and I got a whole new, happy child all of a sudden!  I asked for more imipramine, and got met with the same kind of invalidation I'd seen before.  At 14, during the first hospitalizaion I had asked about bipolar because of the wild and sudden mood swings.  I was told that the only way to know was to try her on lithium.  But she didn't want to try that, and somehow, the opinion of a 14 year-old was allowed to rule despite my objections.  The second hospitalization cam e very shortly after, and suddenly, it was ODD.  I objected to ALL of this.  It was just words, and I still had an unhappy kid who was a risk to herself.

When DD failed to grow out of it all, as I had been assured she would, she basically just floundered, and refused any further help.  Finally, she was dx'd with Hashimoto's thyroiditis and  was being treated for an 'anxiety disorder'.  I never doubted the anxiety part itself - that much was obvious.  But an 'anxiety disorder' in the company of rollercoaster thyroid levels and meds, a stressful pregnancy, and all seemed downright sloppy.  Maybe even lazy.  I found my way here...and it all fit at long last.  Honestly, I don't care which words anyone chooses to use.  I got over my own any anyone else's denial or prejudices ages ago.  I only care that the SOLUTIONS are real and knowledgeable!   Getting her thyroid regulated has helped some - but even for that, she ended up going with independent labs because the doc was not following up closely enough to be of sufficient use.  Getting a better grip on how I handle her has helped some.  Mine's grown, so we may never actually hear an official dx.  I'm ok with that, barring her getting more directed medical care.  I'm just working on trying to build out the relationship so that if/when she does get ready to do more with it I'll be in the loop and a trusted source.

So, if your daughter can get into a decent therapeutic program? Good!  If whatever meds are suggested show real improvements, good!  You know the names of the therapies employed with BPD now, so you've talking points and practical tools.  I understand the drive to get a proper dx, but the goal is IMPROVEMENT for her.  Simply hanging a name on it isn't going to magically improve anything one way or the other.   Just imho - but if it comes down to it, I wouldn't let the words get in the way.