DD has been dishonest for personal gain. What to do?

[leonairs]

DD is 15 and just sat a recent GCSE she's taken early

My ex has told me she's said to him her mental illness isn't real, and she will 'discontinue' the therapy after she's finished A Levels. This came about when I asked him to talk to her about why she wasn't taking her tablets, I'd caught her a few times having not taking them. The tablet is Risperidone so not a risk free drug!

To clarify, she gets extra time and a small % too, I believe, due to extenuating circumstances.

Ex has told me this has all been a lie to get extra marks. He was a 'crafty' younger man and DD thought she could tell him and he'd approve - This idea of being safe to tell him probably came from the many tales of his misspent youth!

He told me he didn't really know what to say and I should speak to her. Trouble is, I don't know what to say either and find it all very hard to unpick. It isn't something google will have an answer to.

It all seems very calculated.

For clarification, she's a bright student who is described as being very 'quick and intelligent' by her history teacher for example. She is popular, seems well liked

What can I do about this? Where do I start

If you recognise me then Pm me I beg you before you say anything

There aren’t any formal exams happening yet (you can easily check the timetables). So some complication there, and no you absolutely cannot take them early! It’s possible it was a time limited piece of coursework that was supervised in school.
Parents get hugely hung up about extra time. I’ve invigilated more exams than I can count, and it’s actually very rare that pupils use it anyway at GCSE. Exam timings are quite generous and it’s usually the extra time candidates who are twiddling their thumbs for the last twenty minutes.
The exception tends to be A levels like Philosophy or Sociology that need extended written answers.

It isn’t a very clever manipulation to get extra time. There would be far easier ways of doing it without having to go on any medication. It sounds far more likely that she is finding ways to get out of taking her medication. The side effects include things like weight gain and other things that people don’t really like.

First, there are not a huge number of private child psychiatrists, getting access to one is tricky, this doesn’t sound very likely.

Second, you will need to name the private schools where the majority of students have a disability and provide evidence otherwise it sounds like twaddle.

Thirdly, OP has not said DD was diagnosed with schizophrenia, but psychosis.

Yes, she sounds delusional, poor thing. I don't know how you can get the drugs into her to help but do speak to her mental health team.

If you’re concerned about your DD’s diagnosis OP, then use your right to a second opinion to get her reassessed.

It's bizarre that on a forum that is generally filled with posts saying "you know your own child best" and "trust your gut" or "trust mothers' intuition" that nearly everyone here is telling OP that she didn't know her daughter and can't trust her own eyes.

She has already said that the psych team are confused as DD isn't presenting with the day to day symptoms that they'd expect. So why are 90% of posters here more certain that the people actually treating her, and the mother who sees how she behaves every day?

We only have OP's word for it, who seems dead set on her daughter being this manipulative girl who would lie about something so serious to get some extra time on her exams.

That's a hell of a medication to take if it's not actually needed.

You need to be honest with her psychiatrist. You are witholding information that they need to have and helping paint a false picture.

State what you observe. Keep records. Date time incident observations outcome. That sort of thing. Don't include your interpretations. Just state observable facts. Asked to do x, said y, did z. That sort of thing. Physical presentation. Factual description of observed body language/posture.

When my son was prescribed quetiapine an important part of that was us giving all the information to the psychiatrist. They can't help if they don't know everything.

Consistent extreme manipulation for personal gain may be a different diagnosis.

@Haffiana is absolutely right! This is definitely not the mother writing.

Is she very nice, or does she just know how to get what she wants? Are her friendships and allegiances ones that benefit her in more than warm mushy friend feelings?

I think you need to have a franko convo with hey psych.

You see, here’s the issue. Intelligent, internet-savvy teens are able to find all sorts of information online. For example, it’s very possible to find a script online to use to ensure a doctor will prescribe puberty blockers or cross sex hormones - ‘say this, act like this and bobs yr uncle’ type of thing.
When I was at school the internet didn’t exist - but word of mouth did. We knew what to say and how to act in order to garner attention by faking an eating disorder - I regularly pretended to throw up after eating. I’d do it for attention, as at the time I felt my mum didn’t actually love me. It worked - I got lots of attention!
So how do you determine whether someone has a real mental illness or is pretending for some other purpose? After all, it’s not like you can have an X-ray or blood test to diagnose it. You’d like to think that psychiatrists can spot the genuine from the fakers, but can they always?

The way you're describing your daughter makes her sound like a sociopath. I'm not saying she's lying, or you're wrong, it all sounds very troubling.

For example, it’s very possible to find a script online to use to ensure a doctor will prescribe puberty blockers or cross sex hormones - ‘say this, act like this and bobs yr uncle’ type of thing.

If you say you’re trans you can get onto a trans pathway for puberty blockers etc without meaningful mental health assessment.

If you claim to be psychotic you will have in depth psychiatric and medical evaluation. Psychosis is not a diagnosis of itself it’s a symptom of different psychiatric, neurodevelopmental and even medical conditions. So there would be a full assessment of its presentation.

I'm not sure why people are dismissing OP out of hand and so adamant that the girl must be unwell. Some teenagers do go through stages of making up all sorts for perceived advantages and they lack the wisdom and life experience to realise what a serious thing having this diagnosis and taking the medication is.

It would be relatively easy to lie about - it's not like there's a blood test, and a bright teenager would be more than capable of reading groups with other people's personal experiences of psychosis as well as lists of symptoms.

Also psychiatrists are very far from infallible and a lot of the diagnosis and treatment of mental health conditions seems to be guesswork and even trends. Think of how many autistic women are initially diagnosed with other things and heavily medicated.

I'm not saying the girl definitely doesn't have psychosis because I'm not in a position to know for certain either way but I don't understand the certainty that she definitely is, to the point of some posters suggesting that her dosage of a drug with a pretty bad side effect profile actually gets increased.

I'd ask ex to contact dd medical professional and tell them what she said. She could be faking, she could be delusional.

Honestly - will people please stop throwing the term sociopath around!!!!!

Of course kids fake stuff for all sorts of reasons, they’re also misdiagnosed - a lot. She might be psychotic, she might not. A bunch of randoms on the internet who have never met the girl (and it’s to be hoped) not worked in mental health should not be laying into OP and throwing labels around.

@leonairs

I'll start by saying, you need to speak with your daughter's mental health team. Nobody here knows your daughter or has assessed her, so we can't tell you whether or not she's actually unwell. Her psychiatrist hopefully can speak with you.

It's very common for people with psychotic illnesses to believe that they are not unwell - it's called lack of insight. Even when someone is otherwise symptom-free, they can still have that lack of insight and believe that their symptoms didn't exist, or that they had/have control over them.

It's also very common for people, especially adolescents, to have a degree of denial about having a serious health problem and/or to not want to take prescribed medications. Actual concordance with oral medication is pretty bad among the general population (think back, and I'm fairly confident most of us can remember missing an antibiotic dose or similar).

Rather than assuming she must be accurate in what she's allegedly said to your ex, it might be sensible to tell her psychiatrist and ask them to try to find out what's going on. It could be that she's trying to play the system, but it could be that she's got an insight-impairing major mental illness; specialist assessment is probably the only way to find out for sure. Until then, I'd continue to support her and encourage her to engage with the supports in place for her.

The common/very common side effects of Risperidone are:

Anxiety; appetite abnormal; asthenia; chest discomfort; conjunctivitis; cough; depression; diarrhoea; dyspnoea; epistaxis; fall; fever; gastrointestinal discomfort; headache; hypertension; increased risk of infection; joint disorders; laryngeal pain; muscle spasms; nasal congestion; nausea; oedema; oral disorders; pain; skin reactions; sleep disorders; urinary disorders; vision disorders

What impact did the 'psychosis' have on your daughter's life that was so detrimental that it outweighed the side effects of the medication prescribed to treat it?

A competent clinician using an evidence-based approach should not be using guesswork or trends. Psychiatry as a medical speciality is as evidence-based as other specialities when practised competently.

Risperidone is sometimes prescribed to under 25s.

The obvious flaw in your logic, OP, is that you say your DD is bright and manipulative. If that was the case, she wouldn't have opted for a psychosis diagnosis. There are many much easier conditions to 'fake' with a much quicker diagnosis, that allow extra time in exams with less risks attached to their medication and less stigma attached to them. So if your DD has 'faked' this then she isn't as smart as you think because she'd have opted for something else. And if she isn't that smart, then she would be unable to fake psychosis convincingly to a psychiatrist and a MH team.

Your DD saying she isn't ill, is a recognised symptom of the illness she has been diagnosed with. She really needs you to be in her corner, advocating for her - not side-eyeing her as some kind of charlatan.

We have a young person with psychosis in our family. Their hygiene is impeccable. There are lots of periods of time when you - a lay person - wouldn't realise they had this diagnosis. They're articulate, funny, etc.

Is it impossible for a DC to fake illness? No but it's unlikely and especially with the motivation you have given. Is it common for people with psychosis to think they're well and create arbitrary timeframes for giving up medication? Yes, it's part of the illness. You need to contact your DD's MH team. They need to know she is saying she isn't ill and her medicine taking is sporadic.

Anti psychotics are widely used for insomnia, for anxiety, for agitation, for all kinds of issues. Some are used for mood stabilization or depression or as an adjunct to another medication. They are not only used for psychosis. They are not this rare medication that requires extensive hoops and assessments to access. There were over 12.5 million prescriptions written for antipsychotics in one year (20/21) in the UK.

https://nhsbsa-opendata.s3.eu-west-2.amazonaws.com/mumh/mumh_annual_2020_21_v001.html

Interrator reliability when it comes to psychiatric diagnosis is notoriously low. It rarely achives an even good rate of agreement in most studies.

Halfway down this page you will see a table with the Kappa scores for various diagnosis. A .7 is considered good agreement.

https://www.madinamerica.com/2013/03/the-dsm-5-field-trials-inter-rater-reliability-ratings-take-a-nose-dive/#:~:text=For%20those%20who%20might%20not,with%20the%20same%20clinical%20picture.

Psychiatry as a medical speciality is as evidence-based as other specialities when practised competently

Competently, though, which the diagnosing clinician may or may not be.

The lack of insight into one's own illness is called anosognosia. It definitely exists however it would be very rare to see anosognosia as the only active symptom - particularly if someone isn't taking their medications. You would see an increase in other symptoms in addition to a worsening of insight.