Diagnosis of aggression

[call me jaded]

Peaches I'm not aware of aggression being part of any diagnostic criteria. An SLT put it to me many years ago that physical outbursts were an expression of frustration at not being understood, so an effect of communication impairment rather than the cause of it. Or in the case of ADHD an effect of impulsivity rather than the cause.

[Karen A]

Peaches I'm not aware of aggression being part of any diagnostic criteria. An SLT put it to me many years ago that physical outbursts were an expression of frustration at not being understood, so an effect of communication impairment rather than the cause of it. Or in the case of ADHD an effect of impulsivity rather than the cause.

 

Hi.

I do not think I can put in a link for copyright reasons.

However the NHS library for Mental Health Specialist Library Primary Care Guidance for Conduct Disorder [including ODD] does include aggression within the diagnostic criteria for Conduct Disorder.

It also notes that ADHD may be a co-existant medical condition where differential diagnosis may be needed.

 

 

Incidently Peaches when looking up the document above I found it included some guidance for parents on management of ODD.

Whatever the view on the link between ADHD and agression I thought they included some ideas that might be helpful.

So it may be worth looking the information up.

 

 

Karen.

Edited September 18, 2010 by Karen A

[call me jaded]

Karen I nearly looked up Conduct Disorder before I posted that. Now that I have I find that aggression is one of the four criteria plus destruction of property, deceitfulness or theft, and serious violation of rules. Three out of the four criteria need to be met. The kind of aggression goes beyond the kind of lashing out associated with ADHD and autism, it's more or less criminal behaviour:

(1) often bullies, threatens, or intimidates others

(2) often initiates physical fights

(3) has used a weapon that can cause serious physical harm to others (e.g., abat, brick, broken bottle, knife, gun)

(4) has been physically cruel to people

(5) has been physically cruel to animals

(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

(7) has forced someone into sexual activity

 

More here.

 

BTW for copyright purposes you can normally post links to websites, it's wholesale copy and pastes that are problematic, especially if the original source is not credited.

Edited September 18, 2010 by call me jaded

[peaches]

Karen I nearly looked up Conduct Disorder before I posted that. Now that I have I find that aggression is one of the four criteria plus destruction of property, deceitfulness or theft, and serious violation of rules. Three out of the four criteria need to be met. The kind of aggression goes beyond the kind of lashing out associated with ADHD and autism, it's more or less criminal behaviour:

(1) often bullies, threatens, or intimidates others

(2) often initiates physical fights

(3) has used a weapon that can cause serious physical harm to others (e.g., abat, brick, broken bottle, knife, gun)

(4) has been physically cruel to people

(5) has been physically cruel to animals

(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

(7) has forced someone into sexual activity

 

More here.

 

BTW for copyright purposes you can normally post links to websites, it's wholesale copy and pastes that are problematic, especially if the original source is not credited.

 

Thank you for bringing conduct disorder to my attention. I am continuing to monitor his behaviour, a lot of it baffles me. Some actions are clear cut, others its difficult to tell when he has injured someone if its a deliberate act or just clumsiness or over exuberance.

[Karen A]

www.library.nhs.uk/SpecialistLibrarySearch/Download.aspx?resID

 

Diagnostic features

· A pattern of repetitive, persistent and excessive antisocial, aggressive or defiant

behaviour lasting six months or more.

· These features must be out of keeping with the child’s development level, norms of peer

group behaviour, and cultural context (eg isolated tantrums in a three-year-old should not

be regarded as abnormal).

· In younger children (say, three to eight year-olds), the behaviours are characteristic of the

oppositional-defiant type of conduct disorder: angry outbursts, loss of temper, refusal to

obey commands and rules, destructiveness, hitting, but without the presence of serious

law-breaking.

· In older children and adolescents (say, nine to 18 years olds), the behaviours are

characteristic of conduct disorder per se: vandalism, cruelty to people and animals,

bullying, lying, stealing outside the home, truancy, drug and alcohol misuse, and criminal

acts, plus all the features of the oppositional-defiant type.

Differential diagnosis and co-existing conditions

Co-existent disorders are common and do not rule out the diagnosis; they are easily missed so

should be carefully checked for:

· Attention-deficit/hyperactivity disorder - F90.

· Hyperactivity.

 

 

 

 

This is as good as I can get.

I think you are looking at the criteria for adults or older children.

However I have checked the site I posted from and have only quoted it.

It is an NHS library web site.

In any case you said you were not aware of aggression being part of any diagnostic criteria.

You did not state the level of aggression.

 

I would not in any way wish to suggest that aggression is associated with ADHD or ASD.

Regardless of anything else Ben is the victim of aggression by other NT children rather than being aggreessive himself.

I am aware that many teenagers on our estate do fit the criteria for conduct disorder as posted by yourself.

 

However the reality is that I could probably find that aggression at some level comes within the diagnostic criteria of several mental health conditions .

The fact that the NHS information for diagnosticians clearly states that ADHD and ODD can be confused and careful differential diagnosis is needed specifically in young children shows that it is possible for doctors to make the mistake.

I would be the last person to accept a diagnosis of Conduct Disorder from a professional.I think it is probably an unhelpful label.

 

However it is just not true that aggression is not part of any diagnostic criteria.

 

I will try to find some way to post the guidance for Peaches which may be very helpful if we can step round the label it is attached to.

Edited September 18, 2010 by Karen A

[Karen A]

· Promote daily play and positive joint activities between parent and child for at least 10

minutes per day, despite both sides’ initial reluctance.

· Encourage praise and rewards for specific, agreed desired behaviours. If appropriate,

monitor with a chart. Negotiate rewards with the child and change target behaviours

every two to six weeks and rewards more often.

· Set clear house rules and give short specific commands about the desired behaviour, not

prohibitions about undesired behaviour (eg 'Please walk slowly', rather that 'Don’t run').

· Provide consistent and calm consequences for misbehaviour. Many unwanted

behaviours can be ignored, and will then stop (but may increase when this technique is

first tried). Distracting the child from an unwanted behaviour is likely to be more effective

than saying, 'Don’t do it'. If neither ignoring nor distraction is appropriate, ‘time out’ (to

avoid the unwanted behaviour receiving positive reinforcement) may be effective. This

can involve leaving the child alone to calm down or sending them to a quiet, boring ‘time

out’ room (or other space in the house) for no more than one minute per year of age, and

10 minutes maximum. Avoid getting into arguments or explanations with the child, as this

merely provides additional attention for the misbehaviour.

· Reorganize the child’s day to prevent trouble. Examples include asking a neighbour to

look after the child while going to the supermarket, ensuring that activities are available

for long car journeys, and arranging activities in separate rooms for siblings who are

prone to fight.

· Monitor the whereabouts of teenagers. Telephone the parents of friends whom they say

they are visiting.

· Liaise with school and suggest similar principles are applied. Parents should put pressure

on the child’s school to look hard for specific learning difficulties such as dyslexia.

[Karen A]

Thank you for bringing conduct disorder to my attention. I am continuing to monitor his behaviour, a lot of it baffles me. Some actions are clear cut, others its difficult to tell when he has injured someone if its a deliberate act or just clumsiness or over exuberance.

 

I thought I would add and hope it is helpful.

I know very few details about how you came to care for your grandson and do not need to know, <'>

However there is a known recognised link between aggression and challenging behaviour and difficult very early childhood experiences.

Diagnostic criteria do not allow for differential diagnosis of ASD and attachment disorder.

However a couple of posters on the Forum in the last few months have suggested it has been suggested as a possibilty by professionals.

If you think that difficult behaviour could be associated with early difficulties please do request some CAMHS input.

It helped Ben hugely.

Karen.

[call me jaded]

For clarity I totally accept that I was not aware the diagnostic criteria for Conduct Disorder included aggression.

The diagnostic criteria for ADHD does not - that I knew.

Edited September 18, 2010 by call me jaded

[Karen A]

For clarity I totally accept that I was not aware the diagnostic criteria for Conduct Disorder included aggression.

The diagnostic criteria for ADHD does not - that I knew.

 

I just also want to be absolutely clear that I did not wish to get into a debate about diagnostic criteria.

A glass and a half of wine later and I can get back on the computer and I will try to make the point I want to make probably not very well.

 

My view on aggression comes not from anything to do with the Forum at all.

I remember even now with fear and dread the most aggressive person I ever met.

She was challenging in the extreme.

Threw things at me,language that would put the most open minded person to shame,kicked,spat at me,hit me,no awareness of what belonged to her,took her clothes off all the time,completely inappropriate with strangers.

She died many years ago but I still remember her nearly twenty years later.

Her behaviour which was nothing short of appalling.

I do not know whether aggression is within the diagnostic criteria for senile dementia but trust that since she was eighty that her behaviour had nothing to do with parenting.

 

I was thinking tonight I have nursed people with dementia,end stage cancer,parkinson's disease,renal failure,MS,HIV,CVA,epilepsy,diabetes,COAD,spinal injury to name but a few conditions.

Without exception in all of the physical illnesses I mention there have been times when patients have been aggressive.

I do not know whether the diagnostic criteria for these illnesses include aggression.However the physiological impact of the illness itself or the psychological or emotional impact of the disease certainly may result in aggression.

 

The answer to the problem is to investigate the reason behind why the person is exhibiting aggressive behaviour not to get into a lengthy debate about whether aggression fits within the diagnostic criteria .

 

On some occasions relatives have not helped at all however even in those cases where relatives have done things that just make things worse more often than not what they need is support.

 

I was once told about the most difficult women a hospice had to care for.It was my mum.

I had done my best.

.

Edited September 19, 2010 by Tally

[call me jaded]

Dimentia is horrible to see close up.

 

What I am genuinely surprised at is that aggression is part of any diagnostic criteria, but won't sidetrack the thread to discuss that.

[Mumble]

I was thinking tonight I have nursed people with dementia,end stage cancer,Parkinson's disease,renal failure,MS,HIV,CVA,epilepsy,diabetes,COAD,spinal injury to name but a few conditions.

Without exception in all of the physical illnesses I mention there have been times when patients have been aggressive.

I do not know whether the diagnostic criteria for these illnesses include aggression.However the physiological impact of the illness itself or the psychological or emotional impact of the disease certainly results in aggression.

I wonder if you would mind tempering the end of the above? Certainly implies inevitability. Whilst your argument has a logical basis, the inevitable conclusion, even where the patient is struggling psychologically or emotionally with their condition, is not aggression. I have had to prove that I am not violent or aggressive because some people have assumed that I must be that way as a result of, or as a reaction to, my medical conditions. I have had to start from the place of guilty until proved otherwise purely because of others' preconceived opinions and expectations. I am not a violent or aggressive person, in fact I am at times perhaps too passive for my own good and I abhor violence of any type, and having to prove that I'm not violent and having my opportunities limited because others assume I may be a risk to others is a really horrible position to be in particularly when it comes about because of the actions and reactions of others rather than from looking at me as an individual. Sorry if this seems harsh, but I was concerned that someone reading this who doesn't know someone with one of the conditions you list may assume or add to their already formed assumptions that such patients are going to be aggressive; the diagnosis and its assumed meaning comes before an individual understanding of the patient.

[baddad]

Totally agree with mumble's post, and would add that there's a very casual 'cause and effect' association being made with all of the illnesses being mentioned. Effectively, people who are very ill may not have the same sort of self control they exhibited prior to becoming seriously ill. That seems perfectly understandable to me, without making any sort of assumption that the aggression is a 'symptom' of their illness. Additionally, unless you have known someone intimately for their entire lives it would be impossible to draw any realistic conclusions regarding the onset or cause of any aggressive tendencies, though of course, as previously mentioned, illness itself can be a 'trigger' without the aggrssion being a 'symptom'. I do, of course, agree that the response to aggression should include investigating why the person is exhibiting aggressive behaviour. That, to me, is an holistic process, and not one that exclusively considers the diagnostic criteria of any illness, disorder or syndrome they might have or potentially have.

I don't know anything about conduct disorder but do find the implications of such a diagnosis disturbing, because it would seem to cover just about any sort of violent or aggressive behaviour that cannot be explained by an alternative diagnosis, which, to my mind seems the ultimate in 'get out of jail free cards'.

I would reiterate that I am in no way commenting on conduct disorder in relation to the OP's grandson but purely on the wider issues of conduct disorder and assumptions about the root of aggression in other illnesses that have arisen from the OP.

 

 

L&P

 

BD

Edited September 19, 2010 by baddad

[Karen A]

I wonder if you would mind tempering the end of the above? Certainly implies inevitability. Whilst your argument has a logical basis, the inevitable conclusion, even where the patient is struggling psychologically or emotionally with their condition, is not aggression. I have had to prove that I am not violent or aggressive because some people have assumed that I must be that way as a result of, or as a reaction to, my medical conditions. I have had to start from the place of guilty until proved otherwise purely because of others' preconceived opinions and expectations. I am not a violent or aggressive person, in fact I am at times perhaps too passive for my own good and I abhor violence of any type, and having to prove that I'm not violent and having my opportunities limited because others assume I may be a risk to others is a really horrible position to be in particularly when it comes about because of the actions and reactions of others rather than from looking at me as an individual. Sorry if this seems harsh, but I was concerned that someone reading this who doesn't know someone with one of the conditions you list may assume or add to their already formed assumptions that such patients are going to be aggressive; the diagnosis and its assumed meaning comes before an individual understanding of the patient.

 

 

Hi Mumble.

I am sorry I did not explain very well at all what I was attempting to get across.

I will try again to explain.

I attempted to come up with a list of conditions where aggression may be a symptom of the person being unwell.

 

It has nothing at all to do with blame and it is obviously not inevitable that people with these conditions will be aggressive.

So some people who have a stroke may be aggressive either because the stroke has affected part of the brain to do with emotions or because they are frustrated with their limitations or because they cannot communicate.These people are not aggressive people it is just the effect of the stroke.

Aggression may not be within the diagnostic criteria for stroke.However diagnostic criteria are not intended for the public to use to diagnose.They are a tool for doctors.

If a person with no history of aggression suddenly became aggressive then doctors would investigate what the aggression was a symptom of and one option could be that the person had had a stroke.

 

If a person with diabetes has unstable blood sugar levels they may become aggressive.If doctors knew the person had diabetes they would ensure blood sugar levels were checked.The aggression could be a symptom of unstable blood sugar levels.

 

Some patients who struggle psychologically with their condition can become aggressive.It is not inevitable by any means.However where they are aggressive in my opinion the aggression is part of the profile of the illness.Any good health professional would ask why the person was being aggressive and investigate what support could be provided.They would not dissociate the aggression from the illness.

 

I realised last night that there is another medical condition where there is an absolute recognised link between aggression and the condition.

Last night hundreds of people will have ended up in A and Es following fights which were caused by aggression following excessive consumption of alcohol.Nobody would disagree that people become aggressive because of the effect of alcohol on the brain.

So if a person attends A and E in an aggressive state questions would be asked about how much alcohol had been consumed.

If there was no recognised link between alcohol consumption and its effect on the brain and aggression there would not be campaigns about drinking.

 

.I was very careful not to include in the list several mental health conditions because I think it is appalling that people always associate those conditions with aggression.However the reality is that some people with these conditions may be aggressive and where this is the case the answer is to explore what is causing the aggression not deny that the aggression may be a symptom of the person being unwell.

 

I am too late to Edit myself.However if it would help I am happy for the mods to edit to can,may or sometimes or even remove it all together.

Karen.

[Karen A]

Totally agree with mumble's post, and would add that there's a very casual 'cause and effect' association being made with all of the illnesses being mentioned. Effectively, people who are very ill may not have the same sort of self control they exhibited prior to becoming seriously ill. That seems perfectly understandable to me, without making any sort of assumption that the aggression is a 'symptom' of their illness. Additionally, unless you have known someone intimately for their entire lives it would be impossible to draw any realistic conclusions regarding the onset or cause of any aggressive tendencies, though of course, as previously mentioned, illness itself can be a 'trigger' without the aggrssion being a 'symptom'.

I don't know anything about conduct disorder but do find the implications of such a diagnosis disturbing, because it would seem to cover just about any sort of violent or aggressive behaviour that cannot be explained by an alternative diagnosis, which, to my mind seems the ultimate in 'get out of jail free cards'.

I would reiterate that I am in no way commenting on conduct disorder in relation to the OP's grandson but purely on the wider issues of conduct disorder and assumptions about the root of aggression in other illnesses that have arisen from the OP.

 

 

L&P

 

BD

 

I fully recognise that there may not be a clear ''cause and effect''.

However if an individual suffers a traumatic head injury that may result in neurological changes which result in aggression.

 

If a person arrives in casualty in an aggressive and confused state [because more often than not the aggresssion is the result of confusion rather than aggressive tendencies or lack of self-control] following a head injury then the aggression would be the symptom of a head injury.

That person may have been a pleasant individual or an angry old sod previously but the A and E doctors would request a CT scan and various other investigations.

 

I worked in stroke rehabilitation for many years and also with patients who had suffered traumatic head injury.

In both of these groups I came across many patients who had been happily married for many years who the partners would honestly describe as different people after their illness where the person was almost impossible to manage.

There are patients who develop alzhiemers disease who have been married for forty years who become aggressive to the point where the partner can no longer care for them.

 

Aggression may not be one of the diagnostic criteria for these conditions however it is widely recognised that the aggression is clearly the result of specific neurological changes which are recognised and diagnosed on CT scan.

 

I will not be getting into a debate about conduct disorder.

I just made a point that it is a diagnosable condition where the diagnostic criteria include aggression.

 

I should be very clear that in all the cases I have talked about I do not believe that agression had anything to do with lack of self-conrol or aggressive tendencies.Some people do become aggressive because they cannot cope with a trauma.Anger is a very normal part of grief and some of the most aggressive people I have come into contact with have been aggressive because I just told them their relative has died.That makes them bereaved people not lacking in self-control or to have aggressive tendencies.

 

A large proportion of people who suffer any terminal illness will be angry at some point.Many of them are aggressive towards staff and certainly towards their relatives.It is perfectly normal.

 

Perhaps I should at some point start a new thread on ''The use of diagnostic criteria'' or ''Symptoms''.

In brief they are not intended for use by the general public.

They are intended for use by qualified doctors.

 

Any medical professional would recognise that aggression could be related to changes in neurological function,infection,the side effect of prescribed medication,the effect of an anaesthetic or the impact of any one of the major organs not functioning as well as they might be.That is why nurses are faced with aggression on a frequent basis.

 

This may sound very off topic.

However I would suggest that it is not as off topic as people might think.

I had a friend who has a son with AS who has now also been diagnosed with epiliepsy.

He was diagnosed with epiliepsy because she gave me an account of how her son was waking regularly in a drousy and agitated state and was aggressive in the mornings.It was pressumed that he was waking in an agitated state because he did not like school.

 

Following advice from myself she talked to CAMHS about the aggression in the mornings.

 

He was diagnosed with epilepsy and it was recognised that he was having noctornal seizures which lefy him disorientated in the morning and hence the aggression.

 

I do not know whether the OPs grandson could have epilepsy or whether his aggression could be the result of side effects of medication nor do I have any idea whether he could have any one of many mental health conditions that co-exist or can happen by coincidence in people who have AS.

 

However I would never pressume that because he has AS the only possible reason for aggression is that there is some difficiency in behaviour management or parenting which is what appears to be being pressumed.

 

Regardless of anything else there are numerous books available on managing challenging behaviour in people with AS,the NAS run a course on the subject and the guidance for managing challenging behaviour in school mentions ASD.

 

Surely this suggests that even if aggression does not come within the diagnostic criteria for ASD it is recognised as an issue that requires specific guidance.

 

As I said before Ben is far more likely to be a victim of aggression now than to be aggressive.

However if he was aggresive I would hope that the Forum would be a place where I could be honest without feeling I had mentioned the unthinkable.

[Karen A]

Dimentia is horrible to see close up.

 

What I am genuinely surprised at is that aggression is part of any diagnostic criteria, but won't sidetrack the thread to discuss that.

 

I do not want to take this thread off topic any further.

But thought I would just clarify that the lady with dementia was not my mum.

Although my mum was very difficult for staff at the hospice to manage she did not have dementia and was not as difficult as the lady described.

Karen.

[Mumble]

Karen, I'm sorry that you appear to be cross with me, I just wanted to point out the potential negative implications of what was, in your post I first commented on, cause and effect language with the assumption that anyone with any one of the list of conditions you gave would be aggressive. You've also talked about the certainty of aggression in terminal illness towards relatives in your more recent post. I have no problem with talking about 'may' and discussing possible reasons. I think this is very important and we should be open-minded to think about why someone may be acting in an aggressive manner, but in many cases that is a decision for doctors to make and importantly the aggression is not a symptom of the illness as such - if someone was being aggressive you wouldn't say 'oh head injury can lead to aggression therefore this person must have a head injury' - that's going the wrong way with diagnosis.

I have one of your list of conditions. I'm not aggressive either as a person or as a result of my illness. I am not a danger to other people but I have to deal with the attitudes of people and people who think they know what it's all about and the violence/aggression link is really hard to shake off. I've had people in some situations insisting I need 2 - 1 care, that's even if they let me do the proposed activity. The number of risk assessments and care plans I've had written is ridiculous. I'm not allowed to lead a normal life because of people's assumptions about me based solely on diagnosis - they're disabling me by trying to protect themselves and others from something that isn't a real threat because they won't stop and look at me as an individual but go straight to the diagnosis and inherent assumptions. I find it very hurtful when those assumptions are added to and given credence on a supposedly supportive forum.

Incidentally if I ever was violent I wouldn't want someone to say, oh it's okay, she's X, Y or Z, violence is expected. I would expect to face the consequences of my actions and therefore to learn appropriate responses.

[Karen A]

I don't know about behaviour, but I would agree with this in terms of my experiences with severe anxiety. I was receiving support and theoretically I knew and could regurgitate verbatim how to handle particular situations that were causing anxiety, but the anxiety was so extreme that when actually placed in that situation I just shut down and couldn't apply all that I knew theoretically. Medication allowed me to stay and to 'be' in a situation long enough to apply the theoretical stuff I had been working on and to begin to see its effect. Gradually as I became more confident that such strategies could help, I could reduce the medication and see the behavioural strategies working on their own and beginning to bring about changes that could be more permanent in the way I view, understand and respond to a situation.

 

In new situations I may require medication for that initial coping but I also know that I can transfer to other strategies. Medication wears off but behaviour changes can be long lasting and I guess it's about finding the right balance, but for me, neither in isolation would have worked.

 

Mumble.

Sorry what I also did not say before was that I have always nursed adults.

I was very careful to try to include conditions in the list that were recognised adult conditions so that people here would not think I was refering to their children.But obviously did not consider adults well enough. <'>

[Karen A]

Karen, I'm sorry that you appear to be cross with me, I just wanted to point out the potential negative implications of what was, in your post I first commented on, cause and effect language with the assumption that anyone with any one of the list of conditions you gave would be aggressive. You've also talked about the certainty of aggression in terminal illness towards relatives in your more recent post. I have no problem with talking about 'may' and discussing possible reasons. I think this is very important and we should be open-minded to think about why someone may be acting in an aggressive manner, but in many cases that is a decision for doctors to make and importantly the aggression is not a symptom of the illness as such - if someone was being aggressive you wouldn't say 'oh head injury can lead to aggression therefore this person must have a head injury' - that's going the wrong way with diagnosis.

I have one of your list of conditions. I'm not aggressive either as a person or as a result of my illness. I am not a danger to other people but I have to deal with the attitudes of people and people who think they know what it's all about and the violence/aggression link is really hard to shake off. I've had people in some situations insisting I need 2 - 1 care, that's even if they let me do the proposed activity. The number of risk assessments and care plans I've had written is ridiculous. I'm not allowed to lead a normal life because of people's assumptions about me based solely on diagnosis - they're disabling me by trying to protect themselves and others from something that isn't a real threat because they won't stop and look at me as an individual but go straight to the diagnosis and inherent assumptions. I find it very hurtful when those assumptions are added to and given credence on a supposedly supportive forum.

Incidentally if I ever was violent I wouldn't want someone to say, oh it's okay, she's X, Y or Z, violence is expected. I would expect to face the consequences of my actions and therefore to learn appropriate responses.

 

I am very sorry. <'> <'> <'>

Please believe I am not cross with you.

I had already posted the apology before I read your last post and do apologise.

I certainly do not believe that it is ok to make generalisations about everyone with particular conditions.

I do not work now.Most of my time in the last few years has been spent supporting Ben.He is never aggressive but his biggest problem is being bullied by pupils who do not have AS while people expect him to be a problem because he has AS.

 

I consider myself to have had a mental health condition and still have private therapy.I have been honest about that and am all too aware of the stigma attached to the issue.

I completely agree that decisions about why people are aggressive are for doctors to make.

 

However it can be extremely difficult to admit to having a child that has difficulties with aggression.

Doctors are not in many cases able to offer any support or make a diagnosis because parents feel so bad about admiting they are not coping.

If parents cannot even ask a question on the Forum without feeling judged then they will not even feel able to talk to anyone.

They are just left to cope with a situation alone feeling they are the only one with the problem that is so bad it cannot even be mentioned.

 

I have tried to put my point as best I can which is very difficult when I do not want to offend anyone,do not want to go more off topic and do not want to post anything that is not helpful to the original poster whilst not making myself too vulnerable.

I am also poorly today. <'>

 

I will ask the mods to do an edit and change the wording to ''may ''.

Karen.

Edited September 19, 2010 by Karen A

[baddad]

 

However I would never pressume that because he has AS the only possible reason for aggression is that there is some difficiency in behaviour management or parenting which is what appears to be being pressumed.

 

 

Hi karen -

 

I agree, the presumption that peaches's grandson's aggression probably had bad parenting at it's root would be a dangerous one - which is precisely why i said it was wrong to blame the child's aggression on Peaches husband's responses. As I said in my first post, I think, given the nature of the attacks being made, that anger is an entirely natural, normal and healthy reaction - provided that it does not duplicate the aggressive element it is a reaction to. I did not (if you feel I am one of the people making judgements about parenting - something I refuted already in my second post?) assume that bad parenting could be the only reason, but I did - in the assumption that the grandfather's responses were the root of the problem - see a potential flaw that was more than worthwhile of consideration, and that, in the same position, I would certainly want to consider more fully before looking to medication.

 

I hope that clarified my comments, if, in fact, the 'assumptions of bad parenting' arose from misinterpretation of my first post.

 

L&P

 

BD

[Karen A]

An alteration in mental status refers to general changes in brain function, such as confusion, amnesia (memory loss), loss of alertness, loss of orientation (not cognizant of self, time, or place), defects in judgment or thought, poor regulation of emotions, and disruptions in perception, psychomotor skills, and behavior. While an altered mental status is obviously characteristic of a number of psychiatric and emotional conditions, medical conditions and injuries that cause damage to the brain can also cause mental status changes. Confusion, lethargy, delirium, dementia, encephalopathy, and organic brain syndrome are all terms that have been used to refer to conditions hallmarked by mental status changes.

 

I thought I would explain one thing that I had taken for granted as an ex NHS professional.

Aggression is not usually detailed as a symptom because it is taken for granted by professionals that aggression is an alteration in mental status.I have not been in the NHS for over ten years.However all the time I worked as a nurse nurses used the Glasgow coma scale.On that scale aggression would be detailed as an alteration in mental status.

If anyone googles ''Alteration in mental status '' they would find it is a symptom of hundreds of conditions including the ones I detailed.

 

That is I hope a more helpful way of explaining my previous posts.

 

Oh and just Edited to say Thanks Tally for the edit.

Karen.

Edited September 19, 2010 by Karen A

[call me jaded]

The above has been transferred from peaches thread as the discussion split into two distinct topics.

Edited September 21, 2010 by call me jaded

[Karen A]

The above has been transferred from peaches thread as the discussion split into two distinct topics.

 

 

Thanks.