Expert: Dr Billy Levin - 9/25/2008

Question
Good day. The one thing that got me to write to YOU specifically out of the other choices was the phrase "co morbid conditions". To start, I would be grateful if you explained, might have something to do with my question.

I have a 9y/o brohter (I'm 28), he's been diagnosed with ADHD and has been taking ritalin for about a year or two. My mom takes him to his pdoc for his therapy, but given certain circumstances, I have come to realize there might be some things she can't talk to the pdoc about. I explain myself further...

My mom (as well as my siblings, who have been the audience) was/is, victim of domestic violence. The one brohter in  question seems to have been the most affected. With his ADHD he's of course never still, always jumping, running etc. That's "normal" for a child, and even more so for one with ADHD as I have come to understand.

He does though seem to have a very serious problem with authority, any kind of authority, he simply disregards, rejects, refuses, and even retaliates. Normally if asked to do something (even if he's in a good mood) he can simply reply "no! stupid!" his mood doesn't change when he replies, if he's in a good mood he'll just say it with a smile on his face. Nevertheless, he always objects to rules, commands, favors etc.

My mom had told me once, that about three years ago or so, they had kittens in the house, and that my brother had taken some of the liquid hibachi fuel, and just showered the kittens with it. Someone was there to stop him from maybe doing something worse, but yet, he was aware that liquid was not something to play with as he had seen it being used before. The kittens died, he showed no remorse. He has great lack of compassion towards others. And one thing I've come to see, the one thing that my mom refuses to talk to his pdoc about, is that when he's being too unruly and my mom spanks him (I disagree, but there's very little I can do about it) he doesn't cry. Just says it doesn't hurt him, he smiles and/or laughs as if he was being tickled. Seems as if he's enjoying pain, as if he likes it. And that scares me. He likes to slap women's butts, no matter who, in spite of having been told not to do that countless times. I really need some advice on how to handle the situation, or how I can go about this.

Any help appreciated, and sorry if it sounds like a big mess...

Answer
Unfortunately without examining, I can only speculate. Your description suggests ADHD and the unfortunate complication of Oppositional Defiant disorder (O.D.D.). Whatever the diagnosis the treatment is  not working and a second opinion is suggested.  As you have not even mentioned what dose of Ritalin he gets or how it is  being monitored, makes my opinion a little bit of guessing game. His total lack of compassion might suggest something even more serious and sinister. I am unable to advise without a formal diagnosis or more exact details of his medical treatment.