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Ask the Mental Health Expert Archives 2001-2004

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Troubled Child

Q. My daughter is 11 years old and has attention-deficit/hyperactivy disorder (ADHD), kleptomania and depression. I am very close to her and try to support her in all ways. Her appetite has always been very poor. She takes Clonidine, Adderall and Remeron. She sleeps very poor at night and in the morning cannot wake up. If she is hungry she will eat one bite of food twice a day, most days. You can see all her bones so clearly. I cannot stop her from stealing. I took her to the police station to scare her but she stole again the next day. I have considered a boot camp but I would miss her too much and I don't feel it would help. She is a loving child who is always in mischief. What do I need to do?

A. This sounds like an incredibly difficult situation for you, your daughter, and your family. I don't have any easy answers, but I think the most important first step is to ensure that your daughter's diagnosis and treatment are correct and optimal. Stealing as such is fairly common in young children. The causes of stealing include a desire for possessions, attention-seeking behavior, revenge, or significant psychological or psychiatric problems. A lack of clear-cut and consistent consequences for this behavior can also reinforceit over time.

Kleptomania is a very specific disorder, and not all forms of stealing are due to this condition. Kleptomania is an impulse control problem that involves the compulsive stealing of items not needed for their monetary value. Usually, the items are not stolen to express anger or vengeance. There is usually a feeling of tension before stealing, and a sense of pleasure at the time of the theft. The person with kleptomania does not want to steal, and feels guilty about the behavior. Other than the focus on an illegal act, this disorder has many features in common with Obsessive Compulsive Disorder. But in the presence of a mood disorder and ADHD, I think the diagnosis of kleptomaniais open to re-examination.

In addition, the poor sleep and appetite--and the difficulty waking up--in your daughter's case require more intensive investigation and treatment; e.g., could these problems be medication side effects, or are they part of the disorders themselves? For information on kleptomania and other conditions leading to stealing, you may find the website of Dr.Will Cupchik of interest (http://www.whyhonestpeoplesteal.com). His website also provides information on intensive treatment programs for theft disorders. Similarly, you may be interested in the book, Kleptomania: The Compulsion to Steal - What Can Be Done by Marcus J. Goldman. However, I want to emphasize that stealingmay be due to many factors besides kleptomania. Therefore, I would encourage you and your daughter's doctor to discuss the possibility of obtaining a second opinion on her diagnosis and treatment.

This need not be a confrontational or disrespectful discussion. No doctor, no matter how good, has all the answers. If your daughter's doctor is professionally secure, he or she will be open to such a request. Ideally, evaluation by an expert in childhood psychiatric disorders would occur. The possibility of a brief, inpatient evaluation should be considered, both to aid diagnosis and to stabilize and adjust your daughter's medications--as well as to prevent your daughter form getting into further trouble. It would also be important to take a fresh look at the type of counselingyour daughter is getting--what is the nature of the therapy, and is it carried out by someone with expertise in dealing with childhood behavioral problems? I realize all this may seem a bit overwhelming--but there is simply no substitute for thorough diagnosis and evaluation. Sometimes, even when the patient is in the hands of an excellent clinician, a fresh pair of eyeson the problem is very helpful. Meanwhile, setting out clear and consistent negative consequences for stealing is a crucial part of helping your daughter change her behavior.

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July 2003

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