Recap of Part 1
In the last issue, we explained the term "conduct disorder", and gave an introduction to this youngster, who is perhaps at highest risk of extreme violence. The first part of this article emphasized how you must work differently with CDs compared to any other kids. Hopefully, we successfully conveyed how critical it is to work with CDs differently than everyone else, or risk finding yourself or others in dangerous situations. Hopefully, we also successfully emphasized how important it is for non-mental health workers who are new to the concept of conduct disorder, to thoroughly update their skills for working with these hard-to-manage youth. We offered our live and recorded workshops, and specific books as resources. Those resources are included again here (click above), and are shown below. If you want to review more of the introduction to working with this potentially dangerous youth, you can view the entire article online (both Parts 1 and 2) by clicking here.

Youth at 2nd and 3rd Risk of Extreme Violence
These youth are not nearly at as great a risk as the conduct disorder. We will cover each of these 2 types of youth separately, but must stress that the risk for both of these 2 groups drops off from that posed by conduct disorders. Remember that when any child appears to be potentially violent, you take that concern seriously, regardless of whether the child was on our list. This list is meant only to guide you when you lack any specific events or circumstances that show you how to apportion your time, supervision and other resources.

Thought Disorders
The risk posed by thought disordered children is probably far less than that of conduct disordered youth. Part of the explanation is that there are probably a lot more conduct disordered kids than thought disordered ones. The other reason that explains the somewhat distant #2 status is that the thought disordered child may be well-intentioned, kind, and loving at times. Thought disordered children do have consciences. The conduct disorder child really never is able to care about anyone else. Another reason to explain the distant #2 status is that often the thought disordered child will act in rather than act out. That means they probably pose more of a threat to self rather than others.

Unless you work in a treatment setting, just a very small fraction of the children you work with, may have what mental health professionals call a thought disorder. Like diagnosing conduct disorder, thought disorder can only be determined by a mental health professional. A lay person can do grave harm attempting to diagnose mental health disorders. While the thinking of the conduct disorder is clear and lucid, that assumption is not always true for the thought-disordered child. The child who has been diagnosed with this type of problem by a mental health worker, has very serious problems with their thinking. The child may hear voices or see visions that no one else can, for example. The child may believe demons or devils are governing them. If the voices, for instance, tell the child to hurt someone, then the child may feel compelled to do it. This is where potential danger could lie.

The thrust of working with a diagnosed thought disorder on proper medication, although focusing on skill building and structure are also important. The single most important concern will be that the child takes any prescribed medication regularly and properly, because when properly medicated, this child may function almost normally in many ways. When not correctly medicated, this child is at the mercy of any demons, visions, voices or upsetting thoughts that pop into their head.

Severely Agitated, Depressed Kids
The occurrence of extreme violence by severely depressed, agitated children probably also greatly lags behind the risk posed by conduct disorders. This term refers to a child who has experienced extremely severe problems with depression, and also struggles mightily at least once with agitation. Many kids, especially teens, struggle with depression, but this group endures some of the most prolonged, profound, deep depression; this should not be confused with typical adolescent ups and downs. Crisis, sudden changes and the usual adolescent successes and failures can quickly de-stabilize this child who is already seriously struggling. This youngster is very vulnerable to more minor vicissitudes, meaning that the youngster can blow up in reaction to moderate set-backs. Often, it is "the straw that broke the camel's back" that can light the fuse. Bullying can be the source of the blow-up, but it can be almost anything that triggers this youngster. Like all the other disorders discussed here, only mental health professionals can diagnose severe depression. Consult one if needed.

Any emotion that a child has trouble managing may get acted out or acted in. Depression is generally acted in. Many view it as anger turned inward: the child withdraws, reduces their activities, may eat less, etc. But, depression can also be acted out. Feeling cornered, unable to endure any more pain, some children will act out, sometimes lashing out in very severe ways. All things in nature strive to come to a conclusion. Storms eventually dissipate, the rain ultimately gives way to sun, and even the snow will eventually end. Humans, as part of nature, also tend to move towards resolution. For some children, extreme violence can be the flash point that offers that resolution. When there appears to be no hope, perhaps the child believes that there is nothing left to lose. Depression can be tough on adults, but couple the depression with a child's lack of time concept, lack of perspective, their impulsiveness, immaturity, and resistance to understanding the link of actions to final outcomes, extreme violence can seem to be a solution. If this vulnerable child becomes involved with a conduct disordered peer, you can see how under certain circumstances, that could become a deadly combination as the depressed, agitated child may join in the acting-out.

To help this child, alleviating some of the torment will be critical. Help to manage anger in socially acceptable ways, tempering the depression, and alleviating some of the agitation can keep this child from remaining at the level of extreme discomfort they currently experience. If this child receives useful aid to vent the agitation and can find some tempering of the depression, any risk of extreme violence can be significantly impacted. Of the three risk categories, this group's concerns are potentially the most amenable to intervention by you, and is of the three, the most hopeful diagnosis. You can have much lasting impact on this child. The three best interventions: Talking out problems, exercising and possibly anti-depressants.

Appraising the Risk
Now you can look at your class or group and not just wonder where the where potential, serious danger could come from. Now that you have more refined guesses about which youth potentially pose potential danger, here is a way to better rank that risk in your mind. A juvenile court judge in Springfield, Oregon, said after the shooting there, "These kids are like little match sticks waiting to be lit." To adapt that image a bit, here is how you can apply that thinking to the three at-risk groups listed here.

You can imagine that the conduct disorder is already lit; a flame is burning. Whether that flame becomes smaller, flares larger, or creates an inferno, is anyone's guess, but the flame is burning always, the potential for disaster is always there.

The thought-disordered child may be like a pilot light, a tiny flame that is always lit, but is fairly unlikely to inexplicably get massively bigger or out of control. Properly shepherded and assisted, this light may stay forever just a benign flicker. Unshepherded or inadequately assisted, however, this flame can get bigger, even flare out of control.

The extremely agitated depressed child may be the unlit match stick that the judge visualized. Outside factors will likely come into play to incite any flare-up. Outside forces could include peer pressure, bullying, crises, substance abuse, family woes, or just mounting problems that fuel the agitation and create a profound, all-encompassing sense of desperation that leads the child to "spontaneously" combust. Like the thought-disordered child, the severely agitated depressed youth can often be so readily aided if the community can identify them, then consistently care and effectively intervene.

In Summary
If you work with kids, but you are not a mental health professional, maybe it's time to at least learn some of the basics about children's mental health. And, no matter what your role with children, please consider it your obligation to train your kids to be peaceful. That may be the most important contribution you could make in a world that so thoroughly ensures that every child knows so much about extreme violence, and so little about anything peaceful.

Like These Interventions?
This article gave you interventions that are designed to work with conduct disorders. These methods are taken from our books and posters, especially the resources shown below. These resources are recommended as quick follow-up options. Click here to order resources online. Click here for more information. Or, call 1-800-545-5736, or reply to this email. Isn't it time to stop using yesterday's methods with today's kids?