“Incorrigible.” “Assaultive.” “Belligerent.” What’s the difference between a mental health disorder and a behavioral health disorder? At the root of any diagnosis is a potentially frightened, angry adolescent whose brain hasn’t matured and is incapable of making sound decisions and complying with reasonable behaviors- for whatever reason. It might be genetics, trauma, brain chemistry or environmental considerations or a combination. Abuse, a lack of love or inadequate parenting at crucial developmental milestones, hereditary or bio-chemical issues might be contributors, or a combination of factors. Sometimes, the cause is simply unknown.
The DSM V spells out several categories and classes of disorders. The resource site Psy-Web explains, “The Diagnostic and Statistical Manual of Mental Disorders (DSM) actually lists a wide range of psychiatric conditions, including everything from primary insomnia to nicotine dependence. Yet most people would never regard someone who’s been having trouble sleeping for the past month or a two-pack-a-day smoker as having a “mental disorder”. Mental disorders are quite prevalent; they affect far more people than you might think. Granted, some disorders like stress disorder, last for only a few days to a few weeks and then subside. Some mental disorders are recurring – which is often the case with disorders like major depressive disorder. But some, like schizophrenia, typically last a lifetime – even with treatment. The traditional treatment of most mental disorders usually involves psychotropic medication, psychotherapy or a combination of both.” http://www.psyweb.com/DSM_IV/jsp/DSM_VCodes.jsp
On that continuum of ‘mental to behavioral’, the National Institute of Health’s Medicine Plus resource says, “All kids misbehave some times. And some may have temporary behavior problems due to stress. For example, the birth of a sibling, a divorce, or a death in the family may cause a child to act out. Behavior disorders are more serious. They involve a pattern of hostile, aggressive, or disruptive behaviors for more than 6 months. The behavior is also not appropriate for the child’s age. Warning signs can include:
- Harming or threatening themselves, other people or pets
- Damaging or destroying property
- Lying or stealing
- Not doing well in school, skipping school
- Early smoking, drinking or drug use
- Early sexual activity
- Frequent tantrums and arguments
- Consistent hostility towards authority figues” http://www.nlm.nih.gov/medlineplus/childbehaviordisorders.html
Children are often labeled for life or the suggestion is made that they are ‘incorrigible’ – not ‘fixable’. Rusty’s dad used to threaten his mischievous 5-year old, ‘If you don’t straighten up, you’re going to wind up like that man, digging sewers!’ (Other threats were, ‘picking up garbage- like the men in orange jumpsuits’, or whatever handy reference he could come up with at the time that would register an impact on an impressionable wide-eyed child).
Behavioral health disorders include oppositional defiant disorder, conduct disorder, various other adjustment disorders. “Roughly half of the children who exhibit conduct problems do not become delinquent adolescents (Lahey, Loebere, Burke, & Rathouz, 2002). When examining adult outcomes, Caspi and Moffitt (1995) found that about 85% of adolescents who engaged in conduct problems stopped by the time they reached adulthood. However, even when antisocial behavior decreased, adults still experienced problems with family and work. When antisocial behavior fails to decrease, adults’ symptoms progress to the point where they engage in criminal behavior and are more likely to be diagnosed with psychiatric problems (Moffitt, Caspi, Harrington, & Milne, 2002). Upon examination of the course of conduct disorder it becomes clear that untreated conduct problems are a cause for serious concern because the disorder is harmful to both the patient and society. Luckily, there are several options for treatment including intervention, parent management training, cognitive behavioral treatment, pharmacological, and multi-systemic treatment.” [Childhood disorders Wiki-Massachusetts college for liberal arts] (italics ours)http://web2.mcla.edu/index.php/psyc387/Treatment_for_conduct_disorder/
Back to ‘incorrigible’. According to dictionary reference, the term means: “adjective 1. not corrigible; bad beyond correction or reform: incorrigible behavior; an incorrigible liar. 2. impervious to constraints or punishment; willful; unruly” … The definitions go on to state in ‘your dictionary’: “someone who is naughty or bad (or who engages in generally unacceptable behavior) and who cannot be corrected.”
Increasingly, those in the juvenile justice system recognize that for many teens, incarceration is NOT the answer for many mental and behavioral health disorders as well as developmental and socio-economic factors. Caught early and treated properly and consistently, outcomes are vastly more positive. At the 31st Annual Intercourt Conference, Lucas County Juvenile Court Rachael Gardner and Kendra Kec put together a presentation on JDAI or Juvenile Detention Alternatives Initiative founded by the Annie E. Casey Foundation. This is a ‘reform driven’ process which is designed to ‘safely reduce reliance on secure detention. It is based NOT on letting all kids go free, but to reduce the over-reliance on secure detention when it’s unnecessary, and to minimize delinquent behavior,’ as explained by Rachael.
The JDAI initiative discovered that ‘roughly a quarter of children detained are acutely mentally ill; less than a third of youth in detention were charged with violent crimes; almost two-thirds of detained youth were youth of color; eighty percent of girls detained report physical abuse; fifty percent of girls reported sexual abuse . . . ‘ The statistics are dramatic: ‘In the pre-JDAI days 13,984 youth were placed in state juvenile corrections facilities annually; in 2013 the number is 7,633 or a 45% decrease (in Franklin County a 54% decrease).’ The alternatives include day treatment, reception centers and better screening assessments, linkage to assistance, home detention, treatment with monitoring, diversion programs, and keeping kids accountable in new ways. See www.jdaihelpdesk.org; and www.aecf.org for more information.
MedlinePlus links to health information from the National Institutes of Health:
Conduct disorders: http://www.nlm.nih.gov/medlineplus/ency/article/000919.htm
Oppositional defiant disorder: http://www.nlm.nih.gov/medlineplus/ency/article/001537.htm
Temper tantrums: http://www.nlm.nih.gov/medlineplus/ency/article/001922.htm Discipline: http://www.nlm.nih.gov/medlineplus/ency/article/002211.htm
Dual Diagnosis: http://www.nlm.nih.gov/medlineplus/dualdiagnosis.html
From American Association of Pediatrics Healthy Children site: http://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Disruptive-Behavior-Disorders.aspx
[photo credit: hooded teenage girl by jmpaget/Dreamstime 25719839]