Personality Disorders

As is often the case, the primary take away from this chapter is the value of early intervention.  “The hope is that such interventions in the lives of children and adolescents can, at least to some extent, prevent the later development of the more serious personality disorders of adult life, especially the antisocial disorders.”  (Netherton, Holmes, & Walker, 1999, p. 477)  The issue at hand is that it is difficult to translate the benefits of early intervention into public policy/services for those at risk… especially in cases where there is no definitive causal relationship between the childhood manifestations of the disorder and the adult versions.

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Clinicians are currently wary of diagnosing personality disorders in children due to the assumption that they are, by definition, enduring.  This may suggest that we as clinicians are suitably unwilling to deliver the gloomy prognosis due to the fact that it may in fact become a self-fulfilling prophecy.  However, evidence us abound that suggests that “early diagnosis improves the chances of appropriate treatment and education and results in a prognosis that is less gloomy than it might appear.”  (Netherton et al., 1999, p. 478)  I don’t understand what the issue is, I would call a spade a spade do our best to rectify the situation, but that’s just me.

The text suggests that “equivalence between personality disorders of childhood and those of adult life must rely on a similarity of essential symptoms and signs,” just as they do with with other disorders.  (Netherton et al., 1999, p. 479)  I found it ironic that Zeitlin found personality disorder symptoms to have greater continuity over time than diagnoses… doesn’t it seem like we are systematically mis-diagnosing children in an effort not to label them?  I am starting to get that impression.

Temperament is generally regarded as one of the “constitutional” building blocks of personality, and therefore is also loosely associated with personality disorders in young adulthood.  I was particularly interested in the nine dimensions of temperament that were deemed by Chess & Thomas’s New York Longitudinal Study (1984).  Among those dimensions were activity level, approach/withdrawal to novelty, positive or negative mood, threshold of sensitivity to stimuli, intensity of reactions, rhythmicity of biological function (what does this mean?), adaptability to novel situations and people (why double load novelty?), distractability, and persistence (how do you measure this, exactly?).  Please refer to the in-line comments, as they really speak to my questions on the how and the why regarding this particular study.

I found the following suggestion to be of value in the future when suggesting how can successfully modify or change their parenting methods: “Children are best socialized when parents use inductive, that is, reasoning methods but do so with an emotional charge.”  (Netherton et al., 1999, p. 486)  This really reminded me of the “teach around a behavior” cognitive method that we are taught as direct support professionals whom support individuals with developmental disabilities.  Matter of fact, it mirrors the kind of guidance I provide every day.

I was surprised that we as a society are not doing more with regard to home visitation programs for vulnerable mothers.  “Numerous experimental programs have shown that specially trained and supported home visitors can help poor, unmarried, young mothers to achieve better health for their babies, better educational and work status for themselves, and more sensitive and less punitive care for their children, with the result that the children have better early language skills, make better school progress, and have fewer later behavior problems, including antisocial interaction.”  (Netherton et al., 1999, p. 488)  Is anyone aware of any comparable programs like this in the Omaha area?  I think this would be a great community resource, something we should investigate?

Although it is not entirely clear at the present time whether this is still valid (since the text was written in 1999), there is a consistent theme in the NHW book.  “This disorder has been adequately explored in the adult population but it’s application to children has not been fully explored.”  I am beside myself with the number of disorders that we could substitute in the above sentence for “this disorder.”  It’s literally all of them.  The other thing I notices, and maybe this is more of a personal observation than anything… but if there is any single population that clinicians choose NOT to work with, its kids.  Why is that?

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Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

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