Monday, July 22, 2019
American Psychiatric Association Essay Example for Free
American Psychiatric Association Essay The dynamics of the child who kills likely differ depending on the type of killing. On one hand we might expect the typical youngster involved in a gang killing to have antisocial traits and a history of gang involvement or wanna-be gang behavior. On the other hand the child who kills a mother or father is more likely to have had a history of serious physical or sexual abuse. A girl who kills her infant, if not in a postpartum depressed or psychotic state, is likely to have hidden the pregnancy from others and to have very poor coping skills; often she has completely denied the pregnancy to herself and others. Now we are learning about the dynamics of children who kill at school: many are said to be socially isolated, alienated, and the objects of bullying by others. Research samples of children who kill are often small and are samples of convenience: for example, a sample might be all the convicted children being held in a particular facility. Nevertheless, there may be some data to be gleaned from these studies even though the findings may not be entirely generalizable. Ewing (1990) notes that most children who kill are evaluated by mental health experts, because homicide by a young person is almost automatically thought of as the result of mental disturbance. Most are not found to be psychotic, and many seem to receive diagnoses of relatively mild disorders. Also most are not intellectually limited, but a disproportionate number have learning disorders. Cornell, Benedek, and Benedek (1987) studied seventy-two children charged with homicide and classified them into three groups: adolescents who manifested overt psychotic symptoms at the time of the offense, adolescents who killed in the course of another criminal activity such as robbery or rape, and adolescents involved in an interpersonal conflict or dispute with the victim. Corder, Ball, and Haizlip (1976) compared adolescents who had committed parricide to those who had killed another relative or a close acquaintance and to those who had killed a stranger. They found that all could be characterized as having backgrounds of serious family maladjustment (defined as marital conflict, child abuse, and parent substance abuse or other criminal activity), but those who killed parents were less likely to have a history of poor impulse control and aggressive behavior and more likely to be overly attached to their mother. The small sample size (ten children in each group), however, limits the generalizability of this study. A portion of children who kill appear to have abnormal brain functioning. In more clinical terms, they have neurological impairment (Lewis, Shanok, Grant, Ritvo, 1983). This comes from a variety of causes, including exposure to drugs in utero, head injuries from childhood accidents, high fevers, other medical conditions, and child abuse. Lewis et al. (1988) conducted extensive neurological evaluations on fourteen death row juveniles convicted of murder and found that every one had a history of symptoms consistent with brain damage. Lewis, Shanok, Grant, and Ritvo (1983) also studied ninety-seven incarcerated juvenile delinquents. They compared more violent offenders to less violent, using a global rating scale, and found that the more violent delinquents were more paranoid, more loose and illogical in their speech, and more likely to have neurological dysfunction. They were also more likely to have witnessed extreme violence. One of the most common findings in the histories of children who kill parents is child abuse. In some studies this is defined as witnessing domestic violence (Ewing, 1990), but more commonly the child has been a victim of abuse, often brutal in nature (Ewing, 1990; Mones, 2001). McCloskey and Walker (2000), in a large sample of children from violent households, found a high incidence of posttraumatic stress disorder (PTSD). Thirty-eight percent of the abused children met criteria for PTSD, and all of those who were abusedand also saw their mothers abused met criteria for PTSD. This disorder presents with a range of serious symptoms, including flashbacks and hypervigilance to danger. Sometimes children kill to protect their battered mother; often this is after years of severe violence and the mothers increasing debilitation. More typically, the child kills to escape what is a physically and psychologically intolerable situation. Meaning the abused child finds him/herself Ã¢â¬Å"lockedÃ¢â¬ in a highly conflictual, dependent relationship that he or she could no longer sustain or give up, making homicide a Ã¢â¬Å"solutionÃ¢â¬ to intense conflict. Children and adolescents who kill are often misdiagnosed as having antisocial personality disorder (ASPD). Many have a history prior to the homicide of antisocial conduct, substance abuse, truancy, running away, and problems getting along with others. Truancy and running away from home were especially likely to be found in children who eventually killed one of their parents (Ewing, 1990). Some evaluators use the act of homicide itself to support a diagnosis of ASPD, but this results from faulty logic and a lack of knowledge of the diagnostic criteria for the disorder. It is important to note, also, that in addition to meeting these criteria the patient must have a childhood history of conduct disorder for a diagnosis of ASPD and that the DSM-IV (American Psychiatric Association, 2004) is quite specific that ASPD not be diagnosed in adolescence. In general, the strongest predictors of school violence are neighborhood conditions such as poverty, population turnover, and crime rates, and the greatest risk factor for killing a parent is a history of severe, inescapable child abuse (Mones, 2001). With these caveats, accumulated data from clinical and research studies suggest the following as warning signs of homicidal violence: Exposure to violence, either in the home or in the community. Although exposure to television violence is not commonly cited, it is a factor in a number of homicides, and preoccupation with violent imagery is a particular warning sign. A lack of success with the normal tasks of adolescence: for example, failing in school, having no extracurricular involvement. Social rejection and poor social supports. Alienation and lack of empathy develop in large part from social deprivation. Many school shooters have been described as Ã¢â¬Å"loners. Ã¢â¬ These youngsters have intense feelings of being alone, and the absence of social support also reduces their general ability to cope with the ups and downs of adolescent life. Ã¢â¬ ¢ Intense anger that has accumulated from past painful events, usually surrounding relationships (rejection, failure, or other narcissistic wounds). Ã¢â¬ ¢ An inability to express or resolve intense feelings in adaptive ways, and a proclivity for externalizing defenses, or acting out. References American Psychiatric Association. (2004). Diagnostic and statistical manual of mental disorders (7th ed. ). Washington, DC: Author. Corder, B. F. , Ball, B. C. , Haizlip, T. M. (1976). Adolescent parricide: A comparison with other adolescent murder. American Journal of Psychiatry, 133, 957Ã¢â¬â961. Cornell, D. G. (1989). Causes of juvenile homicide: A review of the literature. In E. P. Benedek (Ed. ), Juvenile homicide (pp. 3Ã¢â¬â36). Washington, DC: American Psychiatric Press.