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Ask the Mental Health Expert Archives 2001-2004

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Adult-Child Personality Disorder

Q. I am looking for guidance and resources for how a parent should interact/deal with an adult child (21+) with a personality disorder, especially antisocial behavior. Our child was tested and diagnosed as being antisocial. I've read endless info on the subject and I understand that very few adults seek help because they don't want to change.

So what does a parent do? Do they let them live in their home with the child continuing to lie, steal, and is often very rude and verbally abusive? Or do they close the doors knowing the child is on the street? Do they bail them out of jail and pay the countless fines? Is there any actions by parents and/or others that have helped the antisocial personality?

In talking to other parents with similar problems, I have not found the best solution. The only way to keep communication open is to totally ignore wrongdoing, lies and rudeness. What's a parent to do?

A. I appreciate that this is a very frustrating and confusing situation for you--I certainly have no easy answers. The very first thing I would advise, however, is that you obtain a second expert opinion re: your child's diagnosis. The term "antisocial" covers a lot of diagnostic ground--not everybody whose behavior is in some sense antisocial has antisocial personality disorder (APD).

By definition, APD is a virtually life-long pattern of behavior, often diagnosed in childhood as a conduct disorder. But children can exhibit antisocial behavior--e.g., always testing limits, breaking rules, lying, forging checks, acting aggressively--in the context of other conditions. These include undiagnosed bipolar disorder or attention deficit hyperactivity disorder (ADHD).

So--a complete re-evaluation by a well-qualified psychiatrist would be in order. That said, there are no magic answers for dealing with true APD. As you note, most adults with APD have little motivation to change, except for the complaints of others. Thus, dealing with APD individuals is, well, a big challenge. (Few psychiatrists think that conventional psychotherapy is of much use, though some do persevere with the hope that the underlying sense of vulnerability and loneliness may lend itself to exploration and working through, given enough time and patience!).

Probably the most successful program to deal with conduct disorder/APD involves two forms of behavior therapy: parent management training and training in problem-solving skills. Parent management training is the treatment of choice for younger children, while for older children it should be supplemented with training in problem-solving skills (Brezinka V, 2002). As Brezinka notes, "Parent management training is one of the best-researched therapy techniques for conduct disorder, deserving the criterion 'empirically supported treatment' defined by the American Psychological Association. Training in problem-solving skills has led to therapeutic change in clinical samples and is qualified as 'probably efficacious treatment'. Limitations of both treatments include the high drop-out rate among parents and the fact that many youth improve but remain outside the range of normative functioning."

Two programs that have made special contributions to the literature include those of:

Dr. Gerald Patterson
Oregon Social Learning Center
207 East 5th Avenue, Suite 202
Eugene, OR 97401

and

Dr. Carolyn Webster Stratton
Department of Parent and Child Nursing
University of Washington
Seattle, WA 98195

This latter research program has generated and evaluated video-taped versions of PMT that can be used to train professionals and facilitate treatment sessions with parents. You might want to contact these facilities to see if they could be of help to you.

You may also find some help at the website http://www.parenttrainingcenter.com/ which does provide some instruction to parents, though usually of younger kids. You may also be interested in the book, Bad Boys, Bad Men: Confronting Antisocial Personality Disorder, by Donald W. Black and C. Lindon Larson. This is more an academic work than a training manual, but it will give you some background on APD. Your situation is certainly complicated, but not hopeless. The key lies in appropriate limit setting practiced with total consistency, and reliable consequences for bad behavior.

Other Resources:

June 2003

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