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It's worth noting that to the best of my knowledge, no one here is a doctor. Therefore, although we can give our opinions and provide some personal insights that might help guide you in our decision, we're not professionals. That doesn't mean that what we might have to say is of a lesser quality than what a doctor might have to offer, it could, in fact, be of a superior quality. My only point is that we're not doctors.

All of the children, including my fiance, have been moved around to various caretakers because of their irresponsible parents. His brother, the youngest, has been moved around about 5 times in the past 6 years. Every time his stay has ended due to his behavior. His normal actions consists of, not listening, lies incessantly, is disrepectful to others etc. All of the "typical" behaviors of a teenager.

....

The doctors say he has textbook symptoms of schizophrenia, and after educating myself I see that he does have some attributes. His main symptoms are: flat effect, lack of pleasure in everday life, hygiene neglect, poor executive functioning and working memory.

Here's a question of my own. How did the description of his behavior go from "typical behaviors of a teenager" to "schizophrenia"?

His main symptoms are: flat effect, lack of pleasure in everday life, hygiene neglect, poor executive functioning and working memory.

Those are what might be called "negative effects". My next question is, where's the "positive effects"?

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One of the puzzling things about medicine is the language used and I don't just mean the technical stuff. For example, a positive result in medicine often means that there is something wrong whereas a negative result means you're o.k. - or does it?

When it comes to considering positive and negative symptoms in schizophrenia, the meanings do change somewhat. In this context, ‘positive' actually refers to symptoms in addition to what might be considered standard behavior. Delusions and hallucinations would be considered examples of positive symptoms. By contrast, ‘negative' symptoms refer to components that are reduced or missing from the normal repertoire. Social withdrawal and poverty of speech would be two such examples.

Source: Positive & Negative Symptoms: a helpful concept?


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My concern would be that this is a clearly troubled young person who's not known any consistency of structure over the past several years and has probably not felt a lot of love, acceptance, and understanding during much of that period either. I think these factors could just as easily contribute to the "negative effects" that are being seen. As noted, I'm no expert but when first reading your post my thought was oppositional defiant disorder or perhaps something in a related vein, but not schizophrenia unless you've managed to miss seeing some fairly obvious symptoms in the positive line. Given that this boy has lived in multiple settings over the past few years, that's a possibility but without evidence of those positive symptoms, I think a diagnosis of schizophrenia or even psychosis would be premature.

I would strongly suggest a second opinion but not from the same hospital or same group of caregivers he currently sees. I would also suggest a consultation with a child psychologist who specializes in teen behavior. Note that I said psychologist not psychiatrist. Psychiatry's speciality is dispensing medication, not talking, and talking to someone might be of more benefit than medication.

I would also suggest that you contact his previous caregivers and try to put together a bigger picture of possible symptoms over the past few years if you haven't already done so. There may be something you've missed or misunderstood. Based on your own reports this child is a real handful so I would expect you're going to hear the awful side of his history -- the lies he told, the things he might have stolen, etc. Try to keep it in context. It might also help to ask those individuals to describe any positive qualities. Maybe he was always gentle with younger kids or pets in the home; maybe he has a hidden talent for drawing or computer graphics or building motors; maybe he's a creative cook or budding musician. There is a human being in there somewhere.

As long as you're talking with past caregivers, see if any of them seem willing to give him another shot. A stable loving environment would probably be best for him, preferably in the company of someone he cares for and feels cared for by them.

I can't speak much to the possibilities for foster care. I suspect that many of us have an idealized vision of what foster care really looks like but many children who have emerged from that system tell a very different story. Before making any decisions about foster care I suggest you research all the options available in your area. Go out and visit those enviroments. Spend a couple hours hanging out. Talk with the people who work there and especially, talk to the kids that live there! Are they happy? Would they recommend the place to other kids like them? Even though you may be at your wits end, I hear that you want to help this boy if you can. It's possible the right kind of environment could help, it's equally possible that the wrong kind could do more harm than good.

Once you've sought a second opinion, consulted with a child psychologist, and reviewed your local options, I would say it's time to sit down with your fiance and your brother-in-law-to-be and make some decisions about what you're going to do next.

Please post more if you think it will help. Otherwise, best of luck to you, your fiance and his brother.