There’s nothing more beautiful to me than a little boy’s exuberance. But as the mother of two now grown sons I still get the chills thinking about living with and attempting to keep both of them alive and on track from age 14 to (if I’m honest) 21. One question that bedevils parents dealing with a child or teenager’s chronically bad and/or alienated, depressed behavior is how to know whether he’ll simply “grow out of it.” The answer is probably yes, most do. But for a significant minority of children 8 to 18 (6 to 16% of boys, 3 to 9% of girls) the “it” in question may fit the diagnosis of “conduct disorder.” Then watching and waiting is not enough.
Starting a decade ago, I took this question on as a parent and science writer. I remember voicing concern to friends about my first born Alex during the period when he was using drugs, “tagging” and opting out of school and them responding by saying I shouldn’t worry; it was normal “acting out.” It would pass. They were wrong. I was foolish not to get better advice and act sooner. A wait and see stance when a child is hurting badly turns out to be potentially very dangerous example of a parent sticking her head in the sand. The research about what can easily be called an epidemic of conduct disorder in boys is sobering. One of the leitmotifs arising out of a number of the studies I’ve seen is a warning cry from researchers (albeit couched in careful clinical language) that, while the vast majority of kids grow out of their early childhood emotional and behavioral challenges, an important minority do not get better “on their own.”
Those at highest risk are living in households where there are other serious mental health problems present. Some chilling findings have emerged from multi-generational family studies to demonstrate that when antisocial behaviors begin early in younger boys [psychologists call this "childhood-onset conduct disorder"] the boys do much worse as they age compared to those who begin showing antisocial behaviors later in adolescence. When followed to age twenty-six, the young men in a New Zealand study who had childhood-onset conduct disorders were found to have worse mental health problems. They had more psychopathic personality traits, substance dependence, financial problems, work problems, and drug-related and violent crime, including violence against women and children.” But not all of them went this route. So, again, how can you predict which ones will do this badly?
Researchers looked into this retrospectively, and found that the risk factors in their childhoods that best predicted the children who would make this negative slide from misbehaving boy to delinquent young man had little to do with the child himself, and everything to do with what was going on in his family.
[Here is more information about effective treatments available for childhood and adolescent conduct disorder.]
According to Duke and Kings College London Psychiatric Institute reseracher Terrie Moffitt: “A family history of mental health problems; alcoholism, drug addiction, ADHD, or antisocial personality, is a very accurate way to predict which youngsters who have conduct problems will grow out of them, versus which will go on to develop a more serious prognosis as young adults. Of those kids with [such a] family history, over 75 percent had persistent conduct problems that lasted into adulthood.”
Moffitt acknowledged that parents with these sorts of problems are often resistant to entering family therapy or a parent training program. However, they point out that the predictive value of this data can help social workers and mental health providers when they encounter such children-or when an agency is forced to intervene after a report of maltreatment surfaces in such a family. As if that’s not bad enough, the news from researchers looking at childhood conduct disorders gets even worse.
The bad behaviors of these young boys doesn’t just put them at risk for anti-sociality, criminality and jail time in their young adulthood. It can also spell early psychosis. I’ll write about that in a follow up post. When I did finally get help for Alex – after he failed the eighth grade and got caught with drugs – it included a six week wilderness therapy trek for him with family therapy and individual therapy for me, including a long delayed treatment of my lifelong depression. Fortunately Alex was still young enough for it to make a difference. But it wasn’t just Alex that had to change behaviors. I had to confront my own substance use and the excess of household chaos caused by my divorce and subsequent upheavals that occurred during the years directly proceeding Alex’s descent.
This article is drawn from research I did for my memoir, A Lethal Inheritance.
Here is more information about effective treatments available for childhood and adolescent conduct disorder.