I have two kids - both teens now. One of my kids is easy going, easy to discipline, great sleeper, etc. My first child was none of those. My first child had huge tantrums, told me everyone was mean to her - so she responded with mean-ness, she never slept, she would have hour long tantrums, follow me around the house sobbing - you get the picture. It wasn't until she was a teenager did we discover that she had a mental health issue and struggles with what's called "borderline personality disorder". It could have just as easily been bipolar disorder or schizophrenia, or any other disorder. The thing is - people who end up as adults with a mental illness have always had it. If intervention, medical help, mental health help and family learning can take place early that child has the best chance to become a fully functioning wonderflly adapted adult.
As much as I thought my kid was just a high-need kid, highly senstive, easy to cry it wasn't until she tried to take her life at age 14 that we realized we needed help. We went through two years of deep trials and errors, bad doctors - eventually a great doctor - medication changes, and lots of learning on my & my husband's part. Oh I wish we had known 10 years ago, what we know now! How much difficulty my child could have avoided. BUT - by God's grace we found an excellent doctor who has worked with us, guided us, found the right medication. I went online and read everything I could, I bought books, I did research and I learned how best to help my child.
My daighter is now a high school senior and is doing really, really well. We've adapted her schooling in a way that meets her needs and avoids pressures that can be avoided. She volunteers in a number of things, she works, has a B+ average (she's smart enough to have an A average - but the pressure is too much for her). She's planning for college in a way that will work best (commuter school for the first year or two until she adjusts to the style, freedom, etc.) Three years ago I wondered if we would get to this place!
Kindly suggest to your sister that she try out dififerent doctors / counselors until she finds the right one. She should ask every social worker, psychologist she knows or comes across for recommendations, and not to discount anyone. From our experience, the one with the nicest office, and great support staff was the worst - just interested in billing the insurance company & writing out a prescription and nudging you out the door. These doctors never asked me about my 14 yr old - her histroy, how things were from our perspective. Then we were recommended to a doctor by a counselor/social worker (who felt she could no longer help us - it was over her head). The doctor had this small, very unimpressive office he shared with others, he was this tiny guy with an accent. BUT - he properly diagnosed my child in the first visit and has been wonderful, super flexible in helping us find the right treatment & medication. He interviewed us and asked questions about our child for as long a period of time as he did with our daughter. It was the first doctor that actually asked us about our child, her personality, how she dealt with things, her earlier childhood, etc.
Finding the right doctor makes all the difference. Tell your sister to trust her gut. If one doctor jsut doesn't seem to be the right fit - try someone else. Even with our wonderful doctor, I felt that my daughter would be better off going to her last 2 years of high school online. He didn't agree. I trusted my instinct - and he now agrees that it was the best decision for our child.
Finally - it's hard to find a good child psychiatrist - and most good ones are not in your insurance company's network (although they may be). But consider what things we value that we would go into debt for. What would we use a credit card for? A large screen TV, a car, a vacation, etc. How much more precioius is our child? My husband and I decided early on that we would go into debt, if needed, to help our much loved daughter. Our wonderful doctor wasn't in any netowrk. Oh well. We put the money aside in our FSA and paid it out of that.
I wish you the best with your nephew. He's probably just bewildered about life, things don't make sense and he's in pain. He needs to be loved and encouraged and disciplined according to how his brain is wired. Once he's figured out it's like turning the lights on in dark basement - he'll be able to find his way out.
Please private message me if I can help in any way.