Boys Behaving Badly: What Does it Mean?

Source: Victoria Costello

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There's nothing more beautiful to me than a little boy's exuberance. However, I still get the chills when I remember the trials of keeping my oldest son Alex alive and on track through his rocky adolescence. Although I didn't know it then, by the time Alex reached the tween years, his behavior fit the description of "conduct disorder" (see definitions below). One question that bedevils parents coming to terms with a child or teenager's chronically bad behavior-meaning verbally or physically aggressive, mean and self-destructive actions committed on a regular basis-is how to know whether the child or tween will simply grow out of it-perhaps by a parent using firmer and more consistent discipline. From the available research on early onset conduct disorder, the answer is probably yes, since most kids do grow out of these tendencies. But, for a significant minority of children ages 8 to 18-6 to 16% of them boys, and 3 to 9% girls-who don't grow out of their early conduct problems, watching, waiting and adding more discipline is not an adequate parental response. 

Back when Alex began getting into trouble-receiving his first F's, staying out past curfew, smoking marijuana, and tagging (painting graffiti on buildings)-I voiced my concerns to close friends who were also parenting teenagers. To a person, they assured me that beyond dishing out appropriate punishment for his misdeeds, I shouldn't worry too much since Alex was just "acting out" in ways typical of this age group. "It will pass," my friends and fellow parents told me. As it turns out, they were very wrong, and I was at fault for not seeking more informed responses to my concerns. Within six months Alex failed two out of his five classes, barely passing the eighth grade. By then, he had my complete attention and I knew we needed professional help.

On the recommendation of one psychotherapist I called who specialized in problem teens, I sent him on a mandatory six-week wilderness therapy trek in Bend, Oregon. Sitting trailside on a fallen log with a dozen other parents and their kids at a joint parent-camper meeting, I heard this staggering admission from my son:

"I stole about seven bikes and gave 'em to my guys to buy our pot. Oh, and one time I threw a little kid off his bike and took it from him. Then we all laughed at him crying on the ground."

I was horrified. How did my sweet once shy and introspective first born child turn into this bully? I would discover the answer to this question several years later. But in the immediate aftermath of his eighth grade meltdown, Alex's wilderness therapy experience appeared to give him his conscience back and stop his worst behaviors-permitting him to go on to high school. Only later would I understand how this immersion in therapy at age fourteen had also effectively delayed a deeper psychological disease process that may have begun in the womb and would rear its head again by his senior year of high school.

What the Research Tells Parents

Some worrisome findings have emerged from multi-generational family studies to demonstrate that when antisocial behaviors begin early in younger boys the boys do much worse as they age compared to those who begin showing antisocial behaviors in adolescence. When followed to age twenty-six, the young men in a New Zealand study who had childhood-onset conduct disorders (meaning disorders that began by first to third grades) were found to have worse mental health problems in adolescence and adulthood. 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 they predict which young males will get worse, not better? Researchers looked into this retrospectively, and found that the risk factors in childhood that best predicted which children would make this negative slide from misbehaving boys to delinquent young men had very little to do with the child himself-and everything to do with what was going on in his family. According to Duke University researcher 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 and her colleagues who have studied this issue in multigenerational studies of families in New Zealand and the U.K. 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.

The Link to Psychosis in Adolescence

As if that's not bad enough, outcomes of early childhood conduct disorders can be even worse-as I discovered with Alex. The bad behaviors of young boys doesn't just put them at risk for anti-sociality, criminality and jail time in their young adulthood. It can also spell a high risk for early psychosis-which can then be triggered by their frequent use of marijuana. At age 16, Alex began losing the ability to complete a coherent sentence, wear shoes, sleep through the night, or go to school. Within a year he was diagnosed with psychosis, an initial stage of paranoid schizophrenia. Fortunately, by then he was regularly seeing a psychotherapist who directed us to an early intervention program for adolescent psychosis that put him on the road to recovery.

Lessons learned

Mental illness and mental health are family affairs. In order to treat a child with a mental disorder, his parents must participate in treatment and recovery. For that matter, as parents we should treat ourselves first for any undiagnosed and untreated symptoms of mental disorders or addictions. That means we need to become educated about symptoms and diagnoses and become advocates for the mental health care needs of our families. Often, we will have to go up against unwilling doctors and insurance companies to get the right treatment. Far too often psychotropic medications are the only options offered for childhood or adolescent mental disorders. And while they are often essential and effective despite frequent side effects, psychotherapy can also be the best first course of treatment for children and adolescents, or it may be an important adjunct to taking medication.

Here's my most important message for parents based on personal experience and the research I did later. When signs of conduct disorder and other childhood mental disorders are recognized and treated early, less invasive, non-medication approaches are more likely to be sufficient to treat them. Frequently, parent education does the trick. A newer modality called parent-child interaction therapy, in which a therapist works with both the mother (and/or father) to show them ways to intervene before the child's negative behaviors escalate, is now showing promise when used for childhood ADHD and conduct disorder.

Definitions:

Conduct disorder (CD) applies when a youngster violates the rights or physical person of others. CD includes bullying, harming animals, destroying property, theft, assault, and other serious harmful behaviors.

Oppositional defiant disorder (ODD) consists of more than six months of rule breaking, temper tantrums, hostility toward authority, and school and home disruptions committed by a child.

Antisocial personality disorder (ASPD) is defined as a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. Some professionals use the term antisocial to refer to behaviors that could fit into any of these three named disorders.

Victoria Costello is an Emmy Award winning psychology and parenting writer, who can be read weekly on her blog on PsychologyToday.com. Her new memoir of parenting two sons with special needs, A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness, is due out in Jan/2012. To learn more about Victoria's new book, visit her YouTube channel.