What we might learn from another tragic story of mental health help given too late, too little

Caleb, 11, was thin with blond hair, glasses, and a big smile where crooked teeth jockeyed for space. He and his brother, Elijah, were adopted by Martin and Dena Lishing when Elijah was a toddler and Caleb was a baby. Their young birth mother struggled from addiction.

Born a preemie at 24-weeks-old and weighing only 1 pound, Caleb beat the odds. His 5th grade teachers remember him as shy, inquisitive and loving. He wore cowboy boots to school every day. He was fascinated by all things Titanic. A classmate says, “He was really funny. He always had jokes and puns to tell.”

It was a warm, overcast evening on April 23, 2018–Caleb was asleep in his bed. An adult babysitter was in a nearby room. Meanwhile, 13-year-old Elijah dismantled their grandfather’s locked gun cabinet to access a .357 Magnum. Caleb was sleeping on his stomach when Elijah shot him in the back, killing him.

This tragedy was the first murder in the small, sleepy town of Streetsboro, Ohio in 20 years. But it wasn’t the first time police were called to the Lishing home on Alden Drive.

Martin was convicted of domestic violence in 2012. In court documents, Dena states her husband had anger issues and frightened Elijah and Caleb. The couple subsequently divorced.

Mental health interventions, too late

Over the years, the family had attempted – unsuccessfully – to get mental health treatment for Elijah although details are not public. Reports indicated Elijah tried to commit suicide twice. In 2017, Elijah was charged with indecent exposure on the school bus. In 2018, his stepmother called police because he became “unruly.” When he told officers he was thinking of harming himself, they transported him to a local behavioral health center for evaluation.

Only four days later, Elijah shot and killed his little brother Caleb. Police have not disclosed Elijah’s motive but say it was premeditated.

Psychologist Dr. Amy Thomas testified at the sentencing hearing that Elijah suffered early childhood abuse. Elijah claims, in addition to neglect from his birth mother, he was subsequently abused in the Lishing home. He details harsh punishments from a young age and says his adopted mother was more devoted to premature Caleb than to him.

Thomas diagnosed him with reactive attachment disorder (RAD), also called developmental trauma disorder (DTD). This often occurs when a child experiences chronic abuse or neglect before the age of 5. A child with DTD has disrupted brain development and, if not provided early and highly-specialized intervention, can suffer long-term and devastating impacts. They have difficulty forming healthy attachments with caregivers and others which can lead to familial, social, educational and legal issues. Dr. Thomas also diagnosed Elijah with post-traumatic stress disorder and conduct disorder, both common diagnoses for children with DTD.

Elijah’s situation is even more complex than DTD alone, however. Dr. Thomas testified that Elijah also suffers from paranoia and stated that a previous clinician had diagnosed him with schizophrenia. Reflecting on the time of the murder, Elijah told the court, “I was living inside my head, unable to determine the difference between imagination and reality.” This points to serious mental illness in addition to complex DTD.

The worrisome correlation of complex developmental trauma and mental illness

Dr. John Alston, psychiatrist for the Institute for Attachment and Child Development, finds a strong correlation between complex DTD and co-morbid mental illness. In his studies, Dr. Alston recognized that adults who abuse or neglect their children often do so as a result of a mental illness. Thus, their children may suffer the unfortunate combination of both the nature (genetics) and nurture (attachment) consequences.

And when children with complex DTD inherit a mental illness, it is often in a profound way according to Dr. Alston. He gives the analogy of more commonly-known childhood health issues. “You never hear of symptoms of childhood diabetes in a mild form, you never hear of childhood asthma in a mild form. They are always inherited in a severe or profound form and therefore the earlier the onset, the more severe the disorder, the more intensive the treatment needs to be,” said Dr. Alston. “It is exactly the same when we are talking about mental health disorders.”

Elijah told the court, “I was living inside my head, unable to determine the difference between imagination and reality.” This points to serious mental illness in addition to complex DTD.

Forrest Lien, Director of the Institute for Attachment and Child Development, is adamant that not all children with developmental trauma are dangerous. Rather, it is often the unfortunate combination of specific and severe disorders. “Developmental trauma disorder alone does not deem a child dangerous. Furthermore, not all children with DTD have a mental illness. Yet, some do,” Lien says. “Children with complex developmental trauma often feel angry and can lack empathy. When you combine a child who feels slighted and vengeful with a misdiagnosed or poorly-treated severe bipolar disorder with psychotic features, it can be dangerous.”

Neuroscience is an emerging science and this link between early trauma and mental illness is not well known. However, given the potential for sometimes dangerous antisocial behavior, it is critical that clinicians still give careful consideration to these correlations. It is vital, Dr. Alston says, to differentiate the impact of severe trauma from potential mental illness symptoms in order to properly diagnose and treat the whole child. 

The case for better mental health support

Unfortunately, Elijah’s developmental trauma and co-morbid disorders were not accurately diagnosed until after he was incarcerated—not in time to prevent this horrific incident. He did not receive appropriate treatment and the costs to his family and himself have been enormous.

Martin and Dena are heartbroken having suffered the loss of their children. Innocent 11-year-old Caleb’s life has been cut short. And they must now grapple with the incarceration of their other son.

“When you combine a child who feels vengeful and slighted with a misdiagnosed or poorly-treated severe bipolar disorder or schizophrenia with psychotic audio and visual hallucinations, it can be dangerous,” said Institute for Attachment and Child Developmental Executive Director Forrest Lien.

Elijah, now 13, is a convicted murderer facing a lifetime of struggles. He has been sentenced to juvenile detention until he turns 21 and at that time his case will be reevaluated with the potential for adult detention time. According to the Record Courier, “Judge Robert Berger said that despite abuse the boy suffered as a child, it did not excuse shooting and killing his brother.”

Perhaps with earlier diagnosis and interventions, Elijah wouldn’t be sitting in a prison cell today. Caleb might be running around the playground instead of being memorialized by the Titanic-shaped play fort the community is erecting in his memory.

Published originally by IACD here. Updated 1/28/2019 after sentencing.

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