The young man referred to in my last post and my collaborators on his case have inspired me to think differently about conduct disorder. He and other teenagers have been referred to (over my ten years) as “the next Hannibal Lecter,” a “budding antisocial,” a “true sociopath.” I am not questioning that these individuals exist, I am questioning how much I have heard these labels be thrown around casually.
I am not a forensic social worker so I could be proven wrong and I welcome to hear feedback on my ramblings. I feel like the diagnosis of conduct disorder in teens does little to inform us about etiology, assessment, and ultimately intervention. To me it is just a young person engaging in exceptionally risky behaviors. These could be due to trauma, bipolar, ADHD, environmental factors, substance abuse, inconsistent parents, etc. The 16 year old that I am working with currently endured intense trauma and this has been a huge elephant in the room. . The fact that he is engaging in risky behaviors certainly requires intervention. When it comes to conduct disorders, we should concentrate on the thoughts or cognitions that cause them, and avoid focusing solely on the antisocial behaviors.
As a result, conduct disorder often implies a lack of treatment options and throwing in the towel. I am not sure if others agree but this is just my observation. My plea to my colleagues is to think carefully before giving the diagnosis of conduct disorder (especially by itself) in our teenagers . Before giving that diagnosis, think critically about what this means for assessment, treatment, and intervention. Put your heads together with others on your team; think about differential diagnosis, think about what directions this will take your treatment. This really worked for us to reframe “the problem” for my current client and his family. I hope that this helps others. Some more thoughts on this tomorrow during “Scholarly Saturday”.
