Manipulative and Antisocial Behavior in an 11-Year-Old Boy with Epilepsy

Abstract

Brian is an 11-year-old boy who presented to the emergency room with suicidal ideation and hearing voices. In the preceding weeks, he had escalating symptoms of oppositional defiant disorder, attention-deficit hyperactivity disorder (ADHD), and bipolar disorder. His medical history was notable for complex partial epilepsy with onset at age 4 that had been well controlled with divalproate. He had several mental health diagnoses by various practitioners including oppositional defiant disorder, ADHD, and bipolar disorder. Brian's family and social history was notable for the absence of identifiable risk factors for seizures or psychiatric problems. Over the course of a week-long psychiatric hospitalization, his complaints of depression and hearing voices seemed incongruent with his behavior. His parents endorsed a long history of Brian manipulating family and friends, such as conning his friends into stealing money and giving it to him. There was increasing suspicion that Brian was contriving his presenting symptoms for secondary gains. When his parents visited, he consistently bargained for prized items such as a long sought after cell phone and his own bedroom to improve his mood. His prior diagnoses (ADHD, a mood disorder, and oppositional defiant disorder) did not capture what seemed to be his core problem--an ability and willingness to manipulate others for his own self-serving purposes. Three months later, he was seen in the pediatric neurology clinic for increased seizure frequency. In the interim, he had several very serious altercations including setting fire to his family church, an attempted break-in-and-entry, assaulting his principal and resisting the arresting officer, and a malicious planned attack on his father where he struck him in the head with a crescent wrench "in cold blood, without any emotion."

Beasts, victims or competent agents: The positioning of children in research literature on manipulation

“…(Braet et al, 2009;Busari and Ojo, 2011;Labrador, 2004;Schiff and BarGil, 2004;Scholte and van der Ploeg, 2006). (Beeble et al, 2007;Walling et al, 2007), traumatic emotions (Goldblatt, 2013), psychological or psychiatric disorders (Jimenez, 2013;Schwartz et al, 2007;Sieswerda et al, 2013), or neurological conditions (Boes et al, 2012). Unable to act differently, the manipulator is located as a product and victim of her/his conditions or circumstances.…”

“…Conversely, if these acts were positively associated or regarded as neutral, other words were used, for example, behaviour modification, therapy, treatment, training, education and so on (Braet et al, 2009;Busari and Ojo, 2011;Labrador, 2004;Schiff and BarGil, 2004;Scholte and Van der Ploeg, 2006). Some literature explains the individual development of a manipulative attitude based on socio-pathological conditions or psycho-pathology, for example, as the result of problematic family dynamics (Beeble et al, 2007;Walling et al, 2007), traumatic emotions (Goldblatt, 2013), psychological or psychiatric disorders (Jimenez, 2013;Schwartz et al, 2007;Sieswerda et al, 2013) or neurological conditions (Boes et al, 2012). Unable to act differently, the manipulator is located as a product and victim of her or his conditions or circumstances.…”

“…Some literature explains the individual development of a manipulative attitude based on socio-pathological conditions or psycho-pathology, for example, as the result of problematic family dynamics (Beeble et al, 2007; Walling et al, 2007), traumatic emotions (Goldblatt, 2013), psychological or psychiatric disorders (Jimenez, 2013; Schwartz et al, 2007; Sieswerda et al, 2013) or neurological conditions (Boes et al, 2012). Unable to act differently, the manipulator is located as a product and victim of her or his conditions or circumstances.…”

“…Esser et al, 2016; Rimmer, 2017). Thus, manipulation is understood as a consequence or symptom of mental illness or imbalance, for example, as in personality disorders (Schwartz et al, 2007: 383), neurological deformities (Boes et al, 2012), narcissistic pathology (Summers and Summers, 2006), hyper-developed emotional intelligence (Grieve and Panebianco, 2013), biological markers (Isen et al, 2010) or lack of cognitive abilities (Walling et al, 2007).…”