Is My Eleven Year Old Son with Hallucinations Heading for Antisocial Personality Disorder?

Reader’s Question

My 11-year-old son started experiencing auditory, visual and and tactile hallucinations about 2 years ago. He is maintained on Seroquel, and these seem to quell his psychotic symptoms. However, he is now exhibiting disturbing behaviors that are oppositional. These are spilling over into school (private school, therefore no accomodations or protections under 504). He is belligerent, refuses to do even simple tasks and will speak very disrespectfully to adults. He denied wrongdoing even in the face of evidence to the contrary. He is bored and demands to be ‘entertained’ when he is not fully occupied by a structured activity. He engages in repetitive activities such as walking back and forth, or making little paper ‘shots’ for his rubber band gun for hours. Also, he is VERY preoccupied with guns and weapons. Recently he was carrying around a pocket knife and obsessing that he needed it for ‘protection’. We did agree to throw the pocket knife in a lake to symbolize ‘throwing away his fear’. He will not sleep alone. He is scattered and will leave a ‘trail’ of belongings and tasks around the house. He does at times refuse to shower or brush his teeth.

Do you see the beginning of Antisocial Personality Disorder here? Besides therapy (which he hates) and pharmacological intervention, what can I do for him to reduce the stress and chaos in his mind and that of the family?

Psychologist’s Reply

Antisocial behavior in adults and children is not significantly related to brain chemistry, while the presence of auditory, visual and tactile hallucinations are directly related to the brain’s neurotransmitter system. On the surface, his behavior may appear antisocial, but there’s a significant component of agitation here — and that’s more neurotransmitter related. His need to walk back and forth may actually be akathisia, or uncontrollable restlessness. If this is present, he will not only be oppositional and explosive, but he will be unable to sit still and be quiet. People with akathisia also engage in purposeless, repetitive behavior that may involve finger drumming, restless legs, pacing, and an inability to remain seated in a chair. What does all this mean?

  • This is not Antisocial Personality Disorder. His oppositional behaviors may be related to his neurotransmitter status. Elevations in the neurotransmitter Dopamine are thought to be related to hallucinations. Elevations in Dopamine are also linked to paranoia (weapons and protection preoccupation), agitation, tic disorders, and a preoccupation with one’s own thoughts. As Dopamine elevates in the brain, you move more and more into a world of your own, paying less attention to the people and requirements of the world around you. This is why personal hygiene deteriorates.
  • His agitation probably causes the oppositional behavior which, if we think about it, is probably his overreaction to being talked to, addressed, questioned, or even paid attention to in the home and classroom. Elevated Dopamine places us in a world of our own and when this fantasy world is interrupted, a startled overreaction is very common. Elevated Dopamine would also produce problems with sleep and concentration/attention.
  • Why are these behaviors surfacing now? With the onset of hallucinations two years ago, your son has undergone two years of physical and neurological maturing. It’s quite possible that he is outgrowing his current Seroquel dosage. If this is true, hallucinations will return at some level very soon. When using medications with children, frequent readjustments are common, as children change rapidly in terms of their physical/neurological maturity and physical size. I would consult with his psychiatrist about a change or modification in his medication. Once restabilized on meds, we can expect another period of instability with the onset of puberty.
  • I’d continue both therapy and medication treatment. I’d also read my article on Chemical Imbalance on my website at It may help your son and the family understand the neurotransmitter issues related to agitation and hallucinations.
  • I sense that you are handling emerging issues, such as the pocket knife, very well. There is no reason to believe that his current misbehaviors are related to parenting or your current symptom management strategies.

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