HomeAnswersPsychiatrypsychopathyMy 18-year-old son has substance abuse issues. Please help.

How do I deal with a sociopath child?

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Published At May 19, 2023
Reviewed AtNovember 29, 2023

Patient's Query

Hello doctor,

I need advice and possible diagnoses for my 18-year-old son. He has struggled with substance abuse issues for several years. The judge sentenced him to a court-ordered juvenile program for eight months. He decided he wanted to change before that sentencing, so I was hopeful because he wanted it. He has been out for eight days, broke into several houses last night, and stole two guns and several other things. He is facing jail time. He is always in gifted classes, and his IQ was higher than average. He knows right from wrong, but something is not clicking. He is sorry when he gets caught but not like on the floor crying and genuinely repenting. Could this be sociopathic behavior? I have taken him to every psychologist, doctor, and counselor. I do not know if he is been properly diagnosed or not. Conduct disorder, ADHD, anxiety, and depression are his diagnoses. Please suggest.

Thank you.

Hi,

Welcome to icliniq.com.

I have read your query and understand your concerns.

From everything you have mentioned, I feel he struggles with substance abuse and wants to improve himself. But out of the way, he broke into several houses and stole guns. He felt bad for that too. This behavior is unacceptable, but I think it is too early to say that it is sociopathic. Yes, this could be a conduct disorder or could be a mood disorder, or could be due to the effect of some drug.

Do you think his mood has been disturbed for the last few days? Has he shown symptoms like increased aggression, increased argumentative behavior, feeling as if he is right and others are wrong, talking big ideas, increased risk-taking behavior, etc? If these symptoms were present, this could be a mood disorder, likely bipolar disorder. I think he needs proper evaluation.

Regards.

Patient's Query

Hello doctor,

Thanks for the reply.

He has always been very argumentative and impulsive and a risk taker. This has floored us because he just spent eight months locked up and swore he would never do anything to get locked up again. He is in a new environment- living with my parents in a new state to escape the old environment and influences. He has been very excited about it and is very close to them. Then this happens. I had psychological testing done on him two years ago. That is when he was diagnosed with ADHD, depression, and anxiety. How else can they diagnose bipolar? What am I missing? What can I do? kindly suggest.

Hi,

Welcome back to icliniq.com.

He is just 18, but we must rule out all possible reasons. Since he has always been argumentative and impulsive and has shown risk-taking behavior, this could be part of his behavior. But all of a sudden, he broke into houses and stole guns and other things. This should be evaluated in detail. As I mentioned, we should rule out mood disturbance and bipolar disorder. It is not uncommon at this age. In the past, he has been diagnosed with depression and anxiety, and also ADHD (Attention deficit hyperactivity disorder). But in psychiatry, diagnoses get revised from time to time.

The symptoms like all of the sudden breaking into houses, argumentativeness (if recently increased), risk-taking behavior (if increased recently), and if these are other symptoms like big ideas, claiming big feelings that I am always right, others are wrong, and I am superior to others, or other grandiose ideas, increased demand for money or spending, etc., are typical of mania and are seen in bipolar disorder. This should be ruled out. He was repenting his actions, but usually, sociopathic individuals do not regret their actions. They may repent to save themselves from punishment.

One more thing that is needed to be ruled out is recent substance use. If he has consumed any drug like a weed, marijuana, or any of its derivatives recently, that could be due to psychosis. Of nowhere, he broke into houses, which could be psychotic behavior. This possibility should also be kept in mind. ADHD is one diagnosis, but this can not explain his mood or behavior. He should be reassessed for that.

Yes, conduct disorder, he can fit. He might have been showing symptoms of conduct disorder for some years, and in conduct disorder, an individual might steal and do illegal things. Substance use further deteriorates the symptoms. But he feels terrible about what he did, which is uncommon in conduct disorder. This means he is aware of the consequences of his actions. He might be feeling bad to save himself, but you have mentioned that he was genuinely repenting.

I hope this helps.

Regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Seikhoo Bishnui
Dr. Seikhoo Bishnui

Psychiatry

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