Author Archives: Margaret Puckette

About Margaret Puckette

Margaret Puckette is a Certified Parent Support Partner (CPSP) with expertise in assisting families with troubled children, teens, and young adults. She is the author of "Raising Troubled Kids," and is often invited to speak at seminars, conferences, and interviewed for radio, TV, and newspaper reports on children with mental health issues and their families.

Your troubled child from birth to 18, what to expect and do

Your troubled child from birth to 18, what to expect and do
5 votes

Parents face daily challenges with a troubled child or teen, and easily overlook the future.  I know I did.  What’s going to happen as they grow and change?  What does one plan for?  It helped me to hear from parents who had already traveled this path.  Based on their experiences, these are some things you can expect–and do–before your child  reaches the pivotal age of 18.

Your child may not be ready for adulthood by age 18, but be OK with this.  Collective experience indicates your son or daughter  will continue to need your support and health care management into their mid-20’s.

If he or she reaches young adulthood with the capacity to maintain well-being on their own, you’ve done a good job.

From birth to age ~5

YouConsider yourself lucky if he or she has an identifiable behavior problem early!  You have ample time to understand your parenting needs and prepare, and use the many “special needs” services for young children.  Start a file and keep absolutely every medical and school record and contacts for people and services.  You are about to become a case manager.

Your family

  • Talk with siblings frankly.  Explain that sister or brother has a different brain and will be treated differently.  Inform them you will be distracted by their sibling’s need for appointments and other issues, and that it may feel unfair.  Ask for their patience.  Reassure them you love them very much.
  • Talk with your partner or spouse about revising expectations for your child, and accepting that your life may be harder than you planned .  Discuss how you will work together and share responsibilities, and work through disagreements about parenting the child in the future.

Everyone – Keep friends, activities, and plans the same.  Keep hobbies and interests alive.  Be as inclusive as possible of your special needs child but don’t sacrifice your family’s needs.  It’s a tricky balance.

Ages ~6-11  – young children

If your child’s behavior problems started at this age, read the above.  It still applies, except you may find fewer services, and sadly, more blame.  Seek professional help now.  Early intervention is the key to future mental health.

What to teach your family:

    • Our lives will be different from other families, but this is normal for families like ours.
    • We will support your sister or brother, but we will take care of ourselves and each other, we will have each other’s back.

What you should do:

  1. Make safety a high priority in your home, emotional safety as well as physical safety.
  2. Focus on schedules and planned time for activities every day.  Maintain this structure consistently, including weekends and holidays.
  3. Teach your child skills for managing behavior–they may not be able to stop it completely.
  4. Modify your home to reduce stress: Less noise or over-stimulation.  Better diet. A separate time-out  space.  Lock up valuables or dangerous items.  Consider a therapy pet.  Create a  tradition of whole-family activities:  Wii, playing cards, board games, exercise games, art or crafts, movie night…
  5. Take frequent “mental health breaks.”  Be generous with yourself without guilt.  Let other family members have breaks too.

 Managing resistance: tips and advice

Practical ways to calm yourself, your child, your family

From ~12-18 – ‘tweens and teens

If your child started having problems at this age, most information above still applies, but this may be the most difficult period!

Two things happen in the teen years:

  1. They enter a normal phase of development where they seek their own identity, and want freedom and a social life separate from the family.  But they take more risks, and expose themselves to more risks.
  2. Some mental disorders start at this phase, or get much worse and become quite serious:  major depression, bipolar disorder, schizophrenia and schizoaffective disorder, anorexia, borderline personality disorder… Risks include school failure, criminal activity, substance abuse, suicide, and assault.

Priorities

Safety – You may need to take unusually strong measures to ensure physical and emotional safety. Many need to lock up all knives, or allow siblings to lock themselves in their own room for protection, or search their teen’s room, or take away the cell phone and internet access.

Your well-being and that of other family members – Assertively seek outside support for your family, such as a support network of friends and family, or a religious community or support group, or mental health treatment for yourself, or all of the above.

Education – This is critical, even if it’s only for one or two classes per day.  If your teen cannot complete high school in time with their peers, it’s not a disaster. They may not graduate now, but they can finish their education eventually.  It’s never too late.

Positive peers and adult mentors – Keep your son or daughter from risky youth or adults.  Encourage activities with anyone they like and trust whom you approve of.

Ongoing mental health treatment –  your child may not believe (or accept) they have a mental health problem but they can at least comply with treatment.

By age 18

mature at 25

At a minimum, this is what your child needs–fundamental criteria for a functional adult life:

  • A steady job and income, or a meaningful activity (volunteering, school)
  • Healthy, stable relationships
  • Maintenance of health and hygiene
  • Decent housing, maintenance of housing and belongings
  • Maintenance of financial stability

6 Comments

Filed under mental illness, teenagers

Faith can help, and harm, a family’s mental health

Faith can help, and harm, a family’s mental health
5 votes

When faith helps

Most of the time, people can heal and find peace and self-acceptance through faith. All the world’s great faiths, those that have lasted centuries, are kept alive for this reason. All have common themes of healing and service to others. When things go poorly, meditation and prayer, with others or in private, lead to connection and wholeness. Faith reveals that things are better, and will be better, than they seem.

When families are in crisis because of their troubled child, parents tell me they depend on faith, even parents who don’t profess a faith practice. They say it’s their only source of strength. Most families with a child who is sick, disabled, or mentally ill will go through dark times, when a parent’s world is simply too overwhelming. Most often, no answers are forthcoming, nor any rescue. The only choice is to hand over their burden to a “higher power,” God, the Buddha, Allah, the Great Spirit… This act of “handing over” is a foundation of healing in Alcoholics Anonymous, Narcotics Anonymous, and dialectical behavioral therapy (DBT).

Few things help a family more than a supportive community of believers.  There will be one person who listens to a frightened parent on the phone, and another person who takes a traumatized sibling on an outing, and another person who provides hugs and cookies. If a mentally ill child continues to decline, a good faith-based support network will stay on. The child may not thrive, but the family does, and has the strength and forbearance to handle the years’ long task of supporting their mentally ill loved one.

Science shows that faith results in better lifetime outcomes for a child

This writer typically trusts science, but in the depths of my family’s despair, only faith and the prayers of others kept me from falling apart.

There are scientists among the faithful who have asked the question: does faith really help the mentally ill? In another blog post, Spirituality and mental health, some research are summaries of research going back 36 years.  (Follow this link for the research citations.)  The answer?  Yes, faith makes a real and measurable difference in improving mental health.

More recent scientific research shows clear evidence from brain scans that meditation and prayer change brain electrical activity, from anxious or agitated to serene and grounded.  The person actually feels and behaves better.  This article has more information on this, Yoga – Safe and effective for depression and anxiety.

Like prayer, “talk therapy” or psychotherapy also shows improvement on brain scans. Imagine, just talking with someone improves the physical brain. According to the article appended below, “When God Is Part of Therapy,” many prefer therapists who respect and encourage their faith. It just makes sense.

When faith harms

This section is a personal appeal to faith communities who have unconscionably failed families and their children with mental disorders.

Faith communities depend on people, and people have biases and foibles.  Many of ‘the faithful’ hold negative beliefs about others, right or wrong.  Children who suffer, and their families, are identified as possessed, of evil character, disbelievers, victims of abuse, or cruelest:  those who are paying for their sins. Families are repeatedly told these very things today.

“Sometimes, people hide from the Bible. That is, they use the Christian holy book as an authority and excuse for biases that have nothing to do with God.”
–Leonard Pitts Jr., Miami Herald

Stigmatization from a faith community is a cruel betrayal.

A child’s inappropriate behavior is not a choice, it is a verifiable medical illness, one with a higher mortality rate than cancer:  Mental illness more deadly than cancer for teens, young adults.  (A graph comparing mortality rates of cancers and mental disorders is at this link.). Families with sick children need support. From my personal experience, and from parents in my support groups over the past 13 years, our sense of loss is devastating.

Testimonials

Mother with five children, one with bipolar disorder:

“We were members of our church since we were first married, all our daughters grew up here, but when my youngest spiraled down, I was told the sins of the father are visited on the sons. Or we weren’t praying enough. I knew they thought (Dad) had done something bad to her. We left and went church shopping until we found a pastor who understood and supported us.”

Mother of two children, one with acute pervasive development disorder:

“I wish we had a “special needs” church. We’re so afraid our kid is going to say something and we’re not going to be accepted. We haven’t gone to church for years because of this. They just turned their backs on us, it happened to another family with a deaf child. They avoid parents in pain. Deep down in my heart I believe in the Lord, but there are days when I wonder “where is God?” People call out to pray for a job, or a kid’s grades, but we wouldn’t dare ask for us, no one would get it, we’d be told we were bad parents or didn’t punish him enough.”

Mother of two children, one with schizoaffective disorder:

“When I went up to the front to light a candle and ask for a prayer for my daughter, I expected people would come up afterward and give a hug or something, just like with other families with cancer and such. But it didn’t happen. No one even looked at me. I left alone and decided never to go back.”

Some good news

FaithNet

The National Alliance on Mental Illness (NAMI) has recognized the need for the mentally ill to be part of faith communities, and the negative experiences most face when they attempt to participate in a religious community. NAMI started FaithNet to encourage and equip NAMI members to engage with and share their story and NAMI resources with local faith groups, and appeal for their acceptance.

Key Ministry

Key Ministry: Welcoming Youth and Their Families at Church
Stephen Grcevich, M.D., president, Key Ministry and child & adolescent psychiatry in private practice, Chagrin Falls, Ohio

“Key Ministry believes it is not okay for youth living with mental illness and their families to face barriers to participation in worship services, educational programming and service opportunities available through local churches.”

Churches in American culture lack understanding of the causes and the needs of families impacted by mental illness, which poses a significant barrier to full inclusion.

“A study published recently by investigators at Baylor University examined the relationship between mental illness and family stressors, strengths and faith practices among nearly 5,900 adults in 24 churches representing four Protestant denominations. The presence of mental illness in a family member has a significant negative impact on both church attendance and the frequency of engagement in spiritual practices.” When asked what help the church could offer these families, they ranked “support for mental illness” 2nd out of 47 possibilities. Among unaffected families, support for mental illness ranked 42nd.

________________________________________

When God Is Part of Therapy
Tara Parker Pope, March 2011, New York Times

Faith-based therapy is growing in popularity, reports Psychology Today, as more patients look for counselors who can discuss their problems and goals from a religious frame of reference.

Studies show that people prefer counselors who share their religious beliefs and support, rather than challenge, their faith. Religious people often complain that secular therapists see their faith as a problem or a symptom, rather than as a conviction to be respected and incorporated into the therapeutic dialogue, a concern that is especially pronounced among the elderly and twenty-somethings. According to a nationwide survey by the American Association of Pastoral Counselors (AAPC), 83 percent of Americans believe their spiritual faith and religious beliefs are closely tied to their state of mental and emotional health. Three-fourths say it’s important for them to see a professional counselor who integrates their values and beliefs into the counseling process.

The problem for many patients in therapy is that many patients are far more religious than their therapists.

Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same. The majority of traditional counselor training programs have no courses dealing with spiritual matters.

When children are hospitalized with other ailments, the family draws sympathy and support from others.  But because of mental health stigma, most families like ours don’t when our child is hospitalized.  If not blame, we are second-guessed, or as bad, met with silence or a change of subject.

Leave a Comment

Filed under mental illness, stress, yoga

ARE YOU OVERREACTING?

ARE YOU OVERREACTING?
8 votes

angry-girl1

Like many parents, you might go to extremes to control situations so they won’t get out of hand. You might not intend to go overboard, but so much frustration has built up that any little irritation sets you off like a warrior on a battle for control. Or a battle to make things stop now.  Overreactions are emergency alarms without the emergency.

You can’t see it coming, in an instant you are on an unstoppable mission to fix, contain, punish, or halt anything that upsets your sense of well-being, imagined or not. Overreactions are sure signs of stress, you need a break!  Overreactions may also come from the fear of losing the day you planned, or the life you planned and came to expect.  If you are overreacting to gain control, you are actually losing control.  Your parenting choices need considered, thoughtful decisions instead of an automatic 911 call. When your blood boils, you’re not aware how your behavior creates a toxic environment around you and the rest of your family… nor how it worsens a troubled kid’s behavior.

  • Are you so stressed and traumatized that you just can’t stand it anymore and want your child to stop misbehaving now, immediately, yesterday?
  • Is every little minor thing a reason to pull out the heavy artillery and throw a fit?
  • Do you play a victim or martyr to get sympathy?  You probably deserve sympathy, but this is not the way to get it.
  • Do you overwhelm difficult situations with your own explosions?

It’s common for parents with really difficult kids to get stuck this way, so forgive yourself if you overreact, and stop and look at what this does to your relationships and interactions with your troubled child.

  • If you’ll do anything to make your child stop a challenging behavior, might you go too far with little things? Will you call the police because they slammed the door, or will you strike them because they slammed the door?
  • If you need sympathy and attention, will you share so much personal information about your child, that your child starts hearing about it from others? How will this make them feel? When others hear you constantly complaining, might they consider that the problem is you?
  • Do you mirror your child’s bad behavior to show them what it looks like? Are they interpreting this the way you hope, or are you lowering yourself?

Overreactions sabotage opportunities for improvement. They terrify everyone (all family members); your family may start to hide things from you, or downplay things, just so you won’t overreact. When family members feel a need to keep secrets, they don’t speak their minds. Someone takes sides against you to counterbalance the negativity. Now you feel less in control and receive less of the support you need for your own well-being.

If you feel exhausted and hopeless, or lash out as a way of coping, you are carrying significant stress and/or depression. Before you completely lose control, and lose your self-respect and rightful authority as a parent, take care of yourself and get help for both your physical and emotional exhaustion . Always, always make sure you are emotionally centered and healthy, or you will never be able to help your child become healthy.

Remember, your child and family needs you to be 100% together.  Let some things go for the greater peace.  Center yourself so you can notice when your child is doing well and offer praise.  When centered, you are flexible, patient, compassionate, and forgiving.   This draws people towards you, to look after you and care for you.  Go ahead, aim for sainthood.  Just starting down that path would start to make things wonderful and healing for everyone.

 

Leave a Comment

Filed under anger, defiant children, discipline, stress, teenagers

Animals that make good therapy pets

Animals that make good therapy pets
17 votes

Dogs, cats, and “pocket pets” like ferrets, birds, or lizards are therapeutic for children who struggle with any disability: physical, behavioral and developmental. A calm smiling dog, an affectionate cat, or a small pet they can hold is a great therapist. The right animal offers unconditional love and affection, and the right animal makes your child feel special. If you are considering animal therapy or a pet for your child, strategically pick the right animal. Measurable benefits have been seen with many creatures “ranging from dogs, cats, birds, and fish to goats and snakes.”

When finding a pet, monitor your child’s interactions when they are first introduced to the creature. Be honest with yourself, the animal you like may not be the best for your child. Hyperactive and barking dogs, biting cats, fearful hamsters, and noisy birds don’t work and can be outright stressful. Pay attention—people are often unaware how much stress fussy pets generate and how distracting and chaotic they can be.

What is the right animal?

  • The animal’s natural manner fits your child’s emotional needs.
    • Quiet–if child easily experience sensory overload;
    • Soft, active, or affectionate–traits that help a withdrawn or anxious child;
    • Interactive–if your child needs to maintain interest or needs attention: a bird that speaks, or a dog that follows instructions;
  • The animal likes to be with your child for long periods. The animal has a preference for your child.
  • Your child is able to treat the pet humanely. (Animals can be abused consciously or unconsciously by troubled children.)
  • You appreciate the animal too and aren’t concerned about mess, smell, hair, or feathers in your home. You should consider yourself the one responsible for its care. This pet is a therapist first, and not a lesson in responsibility for your child. They can learn responsibility later.
  • The child’s pet should still be welcome and cared for if it doesn’t work out for your child. If it’s not wanted, consider a rescue shelter or humane society that can find another caring owner.

Dogs

Most people are familiar with therapy dogs. Their natural affinity with humans is the reason why dogs are the most popular of pets.  And research shows dogs reduce depression and anxiety.  If you are interested in getting a puppy to train as a therapy dog, you can find instructions on how to train certified therapy dogs, and modify them to fit your home. Certified dogs need significantly more training because they can be used in nursing homes, hospitals, and schools. “How to train a therapy dog”

Birds

The parrots and parrot-like or hooked beak birds have marvelous personalities and will bond with their owner for life. These colorful birds love to perch on a finger or shoulder and spend time with people, other birds, even dogs and cats! The best low-cost option is a parakeet, which is low maintenance, happily chirpy, easily tamed, and easily trained to talk.

“Patients hold and stroke cockatiels so tame that they often fall asleep in a human lap.” Maureen Horton, the founder of “On a Wing and a Prayer” tells of “non-responsive patients in wheelchairs who suddenly begin speaking again while petting a cockatiel as their relatives weep at the transformation.” She described bringing her birds to visit a group of violent teenage delinquents who clamored to touch a cockatoo named Bela. “For a few minutes,” Horton says, “these hardened criminals became children again.”
— “On a Wing and a Prayer,” a pet-assisted therapy program, uses birds to visit patients.” Connie Cronley, Tulsapeople.com

Fish

Fish can’t be held, but few things beat the visual delight and serenity of a beautiful aquarium. Fish do have personalities and form interactive communities in a tank, which are fun to watch, and individuals are fun to name. There is a reason aquariums are common in waiting rooms and clinics, lobbies, and hospitals.  They help people relax and calmly pass the time.

“Pocket pets”

These are usually mammals that like to be cuddled and carried around, often in pockets: ferrets, mice, rats, gerbils, hamsters, guinea pigs, and very small dogs. It is best to select a young animal that is calm and won’t bite, and handle it gently and often so that it becomes accustomed to being held. Challenges with many pocket pets include running away or escaping their enclosures, urine smell, and unwanted breeding. As the main caretaker, you will want to be comfortable with their needs.

Reptiles

Lizards are also excellent pets and demand little attention, and they are readily accepted by children. My bearded dragon, Spike, comes with me to my support groups. Dragons are a very docile species–safe with young children and popular with teens and parents. Other good species are iguanas, and geckos.

“I’d have to say my Leopard Gecko Mindy is very much therapy for me. She really is my therapy lizard, she wants to sit with me when I’m upset and tolerates me, which even my two dogs and cat won’t. She’ll just find a place on me and curl up and be like “I’m here, I won’t leave you.””
–User name “Midori”, Herp Center Network

Horses

Properly trained horses are extraordinarily healing. certified horse therapy programs are considered medically effective treatment and often covered by health insurance. Horses benefit disabled children and teens across the board: those with physical disabilities such as paralysis and loss of limbs, mental/cognitive disabilities such as development disabilities and retardation, and children with mental and behavioral disorders. The horses are selected for their demeanor and trained to reliably respond appropriately to children who may misbehave. Therapists are specially trained also to collaborate with the horse as a team. Horses have a “large” serenity and a lack of concern with the child’s behavior. They are also intelligent and interactive like dogs, provide a warm soft hide to lean on, and they empower their riders. A child on a horse will connect with the animal’s rhythmic bodily movement, which stimulates the physical senses and keeps the child physically and mentally balanced. According to parents and children in these programs, horses change lives.  New research proves horses are genuinely effective:  Study Suggests That Equine Therapy is Effective.

–Margaret

How has your child’s pet improved mental health?
Your comments help others who read this article.


The science behind animal therapy

Are dogs man’s best therapist?
Psychiatric Times. H. Steven Moffic, MD. February 29, 2012

Note: this is an excellent article by a psychiatrist who moved from disbelief to belief that dogs have a genuine therapeutic value, healing some of the most psychiatrically challenging children. http://www.psychiatrictimes.com/blog/moffic/content/article/10168/2040421

Children’s best friend, dogs help autistic children adapt (summary)
Journal: Psychoneuroendocrinology, 2011, Universite de Montreal

Dogs may not only be man’s best friend, they may also have a special role in the lives of children with special needs. According to a new study, specifically trained service dogs can help reduce the anxiety and enhance the socialization skills of children with Autism Syndrome Disorders (ASDs). The findings may lead to a relatively simple solution to help affected children and their families cope with these challenging disorders.

“Our findings showed that the dogs had a clear impact on the children’s stress hormone levels,” says Sonia Lupien, senior researcher and a professor at the Université de Montréal Department of Psychiatry and Director of the Centre for Studies on Human Stress at Louis-H. Lafontaine Hospital, “I have not seen such a dramatic effect before.”

http://www.npr.org/blogs/health/2012/03/09/146583986/pet-therapy-how-animals-and-humans-heal-each-other?ps=sh_stcathdl

Pet therapy: how animals and humans heal each other. (summary)
by Julie Rovner, March 5, 2012, National Public Radio

“A growing body of scientific research is showing that our pets can make us healthy, or healthier. “That helps explain the increasing use of animals — dogs and cats mostly, but also birds, fish and even horses — in settings ranging from hospitals and nursing homes to schools, jails and mental institutions.”

“In the late 1970s that researchers started to uncover the scientific underpinnings animal therapy. One of the earliest studies, published in 1980, found that heart attack patients who owned pets lived longer than those who didn’t. Another early study found that petting one’s own dog could reduce blood pressure.

“More recently, says Rebecca Johnson, a nurse who heads the Research Center for Human/Animal Interaction at the University of Missouri College of Veterinary Medicine, studies have been focusing on the fact that interacting with animals can increase people’s level of the hormone oxytocin. “That is very beneficial for us,” says Johnson. “Oxytocin helps us feel happy and trusting.” Which, Johnson says, may be one of the ways that humans bond with their animals over time.”

4 Comments

Filed under animal therapy, anxiety, stress, teenagers, therapy, troubled children

Your rights as the parent of a teen with a mental disorder

Your rights as the parent of a teen with a mental disorder
7 votes

You really do have more rights than you think.

Some background: In a previous blog article on the subject of rights, I described how parents and caregivers can be shocked to learn that their troubled teenager has the right to refuse treatment, Teen rights versus parent rights when the teen has a mental disorder.

What if your teen refuses treatment?  They usually get worse, sometimes much worse. Tragically, if your teen experiences psychosis for a long period, such as in schizophrenia or bipolar disorder, their brain degenerates just as in Alzheimer’s disease.

If a teenager had any other illness besides a behavioral disorder, withholding treatment would be considered child abuse and grounds for removing the child from the home.

Laws in many countries err on the side of protecting a person’s civil rights, but a teenager is likely not ready to take the responsibility that goes along with these rights. An excellent site covering laws pertaining to Special Education Law is Wrightslaw. Click on “Topics from A to Z.”

  • For safety and health reasons, you can search your teen’s room and remove or lock-up risky items like drugs, weapons, razors, pornography, or anything affecting health (rotten food, unclean garments, chemicals). Caution: this can destroy trust if done inappropriately! Inform your teen only if you find and remove unsafe items but otherwise leave everything else alone! If you call the police regarding illegal items, and if your child is charged, their criminal record can be expunged by age 18.
  • You can set any curfew time you think appropriate, and you do not have to adhere to curfew times used by law enforcement. Suggestion: compare with other parents’ curfews. Your teen will more likely follow rules that his or her peers follow.
  • You can monitor everything in your home, and on your computer and phone. You can limit cell phone services, and get GPS tracking on the phone and in the car. Prevention is more effective if your teen is informed about this, and it prevents others from taking advantage of your child, too.
  • You can report your concerns to anyone: teachers, other parents, and the local police precinct.
  • You can search for your child by calling other parents or businesses, or visiting their friends’ homes, or searching public places where your child might be.
  • You can and should call the police if your child runs away, or if your child is being harbored by someone who wants to ‘protect’ them. It is illegal to harbor runaways and subject to criminal charges.
  • You can notify anyone who encourages your teen to run away or stay away from home, or who takes your teen with them without your permission, that this is custodial interference and also subject to criminal charges.

You have the right to be involved in treatment

“Communication between providers and family members needs to be recognized as a clinical best practice.”*

  • You have the right to contact any mental health professional directly, and provide information relevant to your child, your family (e.g. marital conflict), and your family’s needs (e.g. bullied siblings). The professional can legally receive and document this information, but may not be able to discuss it with you.
  • You have the right to communicate freely and openly with a practitioner or teacher about anything you both already know—no confidentiality exists.
  • You have the right to schedule your own appointment with a professional without your teenager, and ask for information about how to get help for yourself and your family, and what kinds of help you may need.
  • You have the right to information about your child’s diagnosis and behavioral expectations, the course of your child’s treatment, and how you should interact with your child at home.
  • You have the right to a second opinion. And you have the right to change treatment or refuse treatment based on that second opinion.
  • You have to right to participate fully in medical decisions about your child. For example, you have the right to ask a doctor to stop or change medication or treatment that is creating behavior problems or side effects, which harm your ability to manage your teen.
  • You have the right to “information about the treatment plan, the safety plan, and progress toward goals of treatment.” *

“While confidentiality is a fundamental component of a therapeutic relationship, it is not an absolute.”*

“Medical professionals can talk freely to family and friends, unless the patient objects after being notified of the intended communication. No signed authorization is necessary.”

–Susan McAndrew, Deputy Director of Health Information Privacy, U.S. Department of Health and Human Services

Teachers and mental health professionals have leeway with confidentiality Providers often misunderstand the Health Information Privacy and Accountability Act (HIPAA), which defines what must be kept confidential. Many also misunderstand the Family Educational Rights and Privacy Act (FERPA) and state laws that govern confidentiality, so they tend to err on the side of confidentiality. However, the American Psychiatric Association states:

“Disclosures can sometimes be justified on the grounds that they are necessary to protect the patient. For instance, it is generally acceptable for a psychiatrist to warn a patient’s family or roommate when the patient is very depressed and has voiced suicidal thoughts”* or plans to harm others.

Professionals should provide explicit information about safety concerns: such as the warning signs of suicide; the need to adhere to medication and other treatment; an explanation of how your teen’s disorder can impair judgment; an explanation of reasons the teen must avoid substances like alcohol and drugs (including some over-the-counter drugs); and the need to remove the means for suicide, especially firearms, sharp objects, matches, chemicals, etc.

How doctors and therapists manage confidentiality

Their basic philosophy is to do what is in the best interest of their patient. For example, if the teen is in an abusive family situation or seeking care only on the condition of confidentiality, their privacy will be protected. “The default position is to maintain confidentiality unless the patient gives consent… However, [family members or friends] may need to be contacted to furnish historical information…” If the practitioner determines that the teen is (or is likely to become) harmful to him- or herself or to others, and will not consent, then they are… “justified in breaking confidentiality to the extent needed to address the safety of the patient and others.”  –The American Medical Association, 2001, “The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.”

A good professional will be honest with your teen, and tell them that they will communicate with you based on what you already know. They will also tell your child that suicide or violence risk will always be communicated to you and/0r an emergency medical service. From everyone’s perspective “It is always better to defend an inappropriate disclosure than to defend a failure to disclose with bad outcome (e.g. injury or death).”

Giving a teenager with behavioral problems the sole right to make critical medical decisions is crazy!

I hope that families and mental health advocates can someday agree on how to maintain civil rights without letting a person control their future when they are not in their right mind. Until then, work with the system as best you can. I find that teachers and practitioners do their best to help families despite the restrictive civil rights and confidentiality mandates. Good luck.

How am I doing? Please rate this article, thanks. Margaret

* Reference“The Clinician Should Maintain a Confidential Relationship With the Child or Adolescent While Developing Collaborative Relationships With Parents, Medical Providers, Other Mental Health Professionals, and Appropriate School Personnel,” developed by Jerry Gabay JD and Stewart S. Newman MD. The authors would like to acknowledge the support of the Oregon Council of Child and Adolescent Psychiatry for their support of this effort.

4 Comments

Filed under confidentiality, discipline, parent rights, teenagers

Five-minute wisdom for parenting troubled children and teens

Five-minute wisdom for parenting troubled children and teens
6 votes

From many years of  counseling parents with difficult children, I’ve found the following wisdom helps clarify one’s priorities, improve understanding, and help take the next steps.

You are not alone. All families experience the same fears no matter what the child’s challenges: guilt, anger, frustration, failure, and mental and physical exhaustion.

There is a way. The steps to finding peace in the home are the same for all families.

You can start now. You can improve behavior without having a diagnosis, and the techniques work for the majority of difficult children.

There is reason for HOPE. They have the capacity to do better. With support and treatment, difficult children improve.

Have realistic expectations: They may not be ready for adulthood, and may need extra support into their 20’s… but that’s OK. There’s time to catch up with their peers.

Plan ahead for a crisis, brainstorm options for an effective response and create a checklist. We can’t think clearly in a tension-filled moment.

GOOD Things to do for Your CHILD or TEEN

Pay attention to STRENGTHS not weaknesses. Always find something great about them.

Guide them to their gifts. Give them ample opportunity to do what they are already good at.

GOOD Things to do for YOU

o Be your own cheerleader. Silently think, “I can handle this;” “I’m the one in control.

o Regularly talk through your feelings with others who understand and won’t judge.

o Get a life, maintain personal interests, and set thoughts of the child aside without guilt.

o Commit to doing the best you can, and own that this enough – plan to let go someday.

You’ve done a good job when they are able to take responsibility for their own care. This is a monumental personal achievement!

KEYS to CALM

In a neutral patient voice, give directions or requests . You will need to repeat yourself, calmly, several times. Your voice should not communicate strong emotions. Tone of voice, not words or volume, is what creates a bad response.

Don’t rush calm. Give the child plenty of time to unwind and settle. Calm is more important than quick.

Ensure there’s a calm place to go – a time-out space, even for you.

Get an appropriate therapy animal – a calm and durable creature unlikely to be harmed.

Reduce chaos in your home: noise, disorder, family emotional upheavals, the intrusive stimulation of an always-on TV, etc.

Ideas for MANAGING resistance

You want your child to be resistant to the negative things they’ll face in life. It represents willpower, and is a strength to cultivate.

o Be quiet and LISTEN. If you respond, address how they feel, not what they say.

o Use reverse psychology-ask them to do something you don’t want them to do, so they can defy you and do the opposite.

o Choose your battles. Let them think they’ve won on occasion.

o For an ODD child, give multiple instructions at once, including things they do and don’t want to do. It becomes too much work to sort out what to defy.

o Actively ignore – Stay in the vicinity but don’t respond, look away, act like you can’t hear. They eventually give up. Works best for ages 2 – 12.

o Mix it up – Be unpredictable. Give a reward sometimes but not all the time. Try new ways to use incentives or set boundaries and structure.

Nine COMMON Parenting MISTAKES

1. Treat your home like a democracy, let your child have an equal say in decisions.

2. Find fault with them and tell them about it repeatedly. If they do something positive, it’s not good enough.

3. Pretend your child has no reason for their behavior. Ignore his or her needs or challenges. Are they being bullied? Are they having a hard time sleeping? Is your home too chaotic?

4. Make rules and only enforce them once in a while, or have consequence come later.

5. Don’t treat your child appropriately for his or her age. Make long explanations to a 3-year-old about your reasoning. Assume a teen wants to be just like you.

6. Expect common sense from children who are too young (5), or from young adults with a long track record of not showing common sense.

7. Keep trying the same things that still don’t work. Repeat yourself, scream, show how frustrated you are with them.

8. Jump to conclusions that demonize the child. “You are manipulative and deceitful,” “You don’t listen to me on purpose,” “I’m tired of your selfishness…”

9. Make your child responsible for your feelings. If you lose your cool, insist they apologize.

Problem SYMPTOMS, not problem children

– Does not show common sense and is not influenced by reason and logic;

– Has no instincts for self-preservation, and poor personal boundaries;

– Has no well-adjusted friends; has friends who are risky or troublesome;

– Doesn’t respond to rewards and consequences;

– Has limited character strengths: honesty, tolerance, respect for others, self-control;

– Does not make plans they can realistically achieve, hangs on to fantasies;

– Acts younger than their peers. Will not be ready for adulthood by 18;

– Lives in the here and now; doesn’t think about the past or future;

– Does not notice their effect on others.

Your PRIORITIES in Order

1. You and your primary relationship(s)

2. Basic needs and responsibilities: housing, clothing, food, income, health

3. Your challenged child or teen.

Keep your energy in balance so you can maintain your family's foundation. Too much spent on your child affects everything else your family needs to survive.

Keep your energy in balance so you can maintain your family’s foundation. Too much spent on your child affects everything else your family needs to survive.

 

 

 

 

 

1 Comment

Filed under ADD, ADHD, discipline, mental illness, parenting, stress, teenagers, troubled children

Good messages for siblings (and parents) of a troubled child or teen

Good messages for siblings (and parents) of a troubled child or teen
4 votes

Your other children already know something is terribly wrong, and they deserve to hear the truth from you.

Most are old enough. They see other children in school and discover other families are nicer, so they don’t talk about their own. They are afraid to bring friends over to visit because of how their troubled brother or sister behaves–pestering them, upsetting them–then those friends talk about it with fellow students and their own parents. Word gets out about your family and people form opinions, especially teachers.

Siblings also feel unsafe and insecure. They never know what’s going to happen! Tell them the truth and trust them to understand and appreciate your candor.

  • You cannot cure a mental disorder for a sibling.
  • No one is to blame for the illness.
  • No one knows the future; your sibling’s symptoms may get worse or they may improve, regardless of your efforts.
  • If you feel extreme resentment, you are giving too much.
  • It is as hard for the ill sibling to accept the disorder as it is for you.
  • Separate the person from the disorder.
  • It is not OK for you to be neglected. You have emotional needs and wants, too. The needs of the ill person do not always come first.
  • The illness of a family member is nothing to be ashamed of.
  • You may have to revise your expectations of your sibling. They may never be ‘normal’ but it’s OK.
  • Acknowledge the remarkable courage your sibling may show when dealing with a mental disorder. Have compassion, they suffer and face a difficult life.
  • Strange or upsetting behavior is a symptom of the disorder. Don’t take it personally.
  • Don’t be afraid to ask your sibling if he or she is thinking about hurting him or herself. Suicide is real.
  • If you can’t care for yourself, you can’t care for another.
  • It is important to have boundaries and to set clear limits. You should expect your sibling to show respect for others.
  • It is natural to experience many and confusing emotions such as grief, guilt, fear, anger, sadness, hurt, confusion, and more. You, not the ill person, are responsible for your own feelings.
  • You are not alone. Sharing your thoughts and feelings in a support group has been helpful and enlightening for many.
  • Eventually you may see the silver lining in the storm clouds: your own increased awareness, sensitivity, receptivity, compassion, and maturity. You may become less judgmental and self-centered, a better person.

Excerpted from “Coping Tips for Siblings and Adult Children of Persons with Mental Illness,” from the National Alliance on Mental Illness (NAMI), 2001, www.nami.org.

4 Comments

Filed under mental illness, Siblings, troubled children

Bullying and how to stop it – for parents and teachers

Bullying and how to stop it – for parents and teachers
4 votes

Most of us have bullied someone and have been bullied at some time in our lives. We have an aggressive trait that helps us stand up to a threat. We are emboldened to fight when we fear for ourselves or family, or simply when we’re “not going to take this anymore!” Mature people don’t do this without cause, but children and teens lack maturity and can engage in bullying throughout their school years. (Even the nicest children can bully another person.) Victims of bullying usually don’t have the power and skills to prevent it or to protect themselves.

“This is a huge problem in the schools… it’s particularly common in grades 6 through 10, when as many as 30 percent of students report they’ve had moderate or frequent involvement in bullying.”
–Dr. Joyce Nolan Harrison, assistant professor of psychiatry, Johns Hopkins School of Medicine.

Bullying occurs when others aren’t paying attention… or when there is an audience
In schools, bullies target victims where and when authorities can’t see, isolated but in crowds: hallways, the school lunch room, the playground or gym, and the bathroom or dressing room, not in plain sight of others who might report an incident. Or they have an audience that supports the bully or ignores the situation and doesn’t want to get involved… or tell.

Bullies target those they consider “weak” or simply “different”
What makes a target child “weak” could be so many things. Bullies seize on anything: a physical, emotional, or mental vulnerability–children with learning disabilities or autism spectrum disorders are often targets. But any “different” child is at risk: a child from another culture is different, a boy who seems effeminate or a girl who seems masculine. The list of reasons children are bullied is so long that it is impossible to proactively avoid attracting the attention of a motivated bully or bullies: physical features, small stature, younger age, shy or meek personalities, bad fashion sense (or perfect fashion sense), even being a Straight “A” student is cause for being victimized. A child’s family member might be perceived as an embarrassment that elicits bullying (a brother is in prison, a father lost his job). Or a child might be a member of a group that’s hated by the parents, who teach their child to hate the group. Some victims are chosen simply because they are at the wrong place at the wrong time:

A teen walks his usual route home from school. He is reasonably well liked but doesn’t stand out. Ahead are three troublesome youth he doesn’t know. No one is around. He’s still at a distance, but starts to feel uncomfortable. They stand side-by-side on the walk ahead of him and stare.

What would a street-wise kid do?

He crosses the street without breaking stride, but also watches them—they have to know he sees them. If he pretended to ignore them it could inflame their anger. They start taunting. Meanwhile, the teen has been thinking of ways to protect himself just in case: there’s a store is nearby or within running distance, there’s a neighbor who’s usually at home. If he has a phone, he pulls it out and is ready to dial 911. He stays alert and looks confident, and they eventually drop the effort and let him move on.

Bullies punish kids who try to stop the bullying

Those who “snitch.” Victims who ask for help are often targeted by the bully more intensely, and often joined by associates who simply jump the bandwagon (curious behavior described as “the madness of crowds”). The culture of tweens and teens has low tolerance for those who tell on others. Those who join the bullying episode against the victim can do it without thinking, or perhaps they feel empowered to vent anger on someone, or just want to fit in.

Those who try to stop them. A heroic bystander steps in to stop a bullying episode and becomes the target themselves.

Those who want to leave the bullying group. Some kids have second thoughts and feel uncomfortable about the bullying and try to leave, but they can’t. Leaving attracts intense, relentless bullying for “voting with their feet”—this is a hallmark of gang behavior

Sadly, some children appear to “set themselves up” for bullying. This victim is a child with a fatalistic attitude and low self-esteem, who doesn’t recognize when others take advantage of them. They feel they must endure and don’t take steps to protect themselves out of excessive fear of drawing retribution. These are the kind of children who can become victims of physical or emotional domestic violence as adults.

Parents

If your child is a victim, be aware that they live between a rock and a hard place. Be careful that your involvement doesn’t make things worse for them

Armor your child with multiple skills
There is no one way to handle every bully situation so flexibility is key. Together, develop a list of multiple options:

  • Ask friends to accompany them
  • Go to a place where people are and find an adult to help. Walk the other way, walk down different hall, walk to other side of street, use a different bathroom.
  • Request loudly “LEAVE ME ALONE” when there’s an audience to witness the bullying, such as on a bus or standing in line.
  • Use body language to project a firm stance. This can be the way your child stands or the loudness of their voice when the bully is present to show confidence, alertness, and empowerment.
  • Let your child know you take them seriously and will do something about it. Give them emotional support.
  • Let your child know you will back them up by working with the school.
  • Use the situation as a learning opportunity to help your child develop a backbone and inner strength. Even with your support, this will not be easy for your child to handle. Be a model of strength and resolve rather than of vengeance or anger.
  • Consider mental health issues that might be making things worse for your child: ADHD, ODD, depression, bipolar disorder, borderline personality disorder, chaos and stress at home, PTSD, substance abuse, and others.

Help the bullied kids find each other. If there are a bunch of them together, they can stand the bully down. They don’t have to beat the bully up. They just have to say, ‘Why are you treating my friend this way?’ The bully will often move on… Parents can appropriately take matters into their own hands. You need to enlist the help of all the other parents of bullied children… Parents have to work as a group. One parent is a pain in the [butt]. A group of parents can be an educational experience for school authorities.”
–William Pollack, assistant clinical professor of psychiatry, Harvard Medical School

Don’t

  • Don’t tell your child to “let it go, ”or “it’s no big deal,” or “it happens, deal with it.”
  • Don’t tell your child to be tough. What does “tough” mean? What do you want them to do?
  • Don’t punish or dismiss a child who complains too much, or blame him/her for setting themselves up and asking for it. Ironically, a victim is sometimes treated as the problem child.
  • Don’t bully your child at home! Are you doing this? Think. Your child learns to accept the inevitability of bullying because he or she is accustomed to it at home.

How things can go wrong: A boy is in the shower after PE class and gets slapped on the butt most days. He is too proud/embarrassed to tell his parents, or he tells and they react poorly. Perhaps he’s blamed for not standing up for himself, or a parent shows up outraged at school and yells at the bully or school staff. Now the boy’s parent is the problem and may be suspected of bullying their child. Or school staff overreact with swift punitive actions to the bully. Time passes and the bully starts up again bit by bit, only much more subtly. The boy is afraid to report it again because the encounters are more secretive. The bully denies his behavior and recruits others to advocate for him. They jump on the bandwagon because they don’t know the history, and the boy doesn’t want to tell everyone he is being sexually harassed. It’s a vicious cycle.

Teachers and schools

“You can’t learn if you’re being bullied, if every day you’re frightened of how you’re going to be treated.”
–William Pollack, cited above

Teachers, pay attention to signs that there’s a skilled, secretive bully at the school.

  • Notice who others avoid.
  • Notice a child coming into the class who’s upset and ask them about it later, promise you’ll protect their anonymity if you can get them to reveal a bully, but don’t pressure them.
  • Observe the problem kid and their subtle interactions with others.
  • Allow a victim(s) to have distance from bully, permission to use a different bathroom, to have their desk placed farther apart, to have a locker farther apart, or even a different class if possible.
  • Inform the parents of your concerns in addition to the principle and school counselor.
  • Focus your behavioral interventions on the bully (not the victims)

Avoid diagnosing the situation. You are not the expert. You don’t know why a bully is a bully, or why a victim is a victim, or anything about their parents. Ensure a school counselor is involved in any discussion about how to manage a bully problem in the school.

Avoid jumping to conclusions! Your actions can unintentionally undermine or harm either the child or their parents. You don’t know until you know.

“Bullies are like the lion looking for a deer that’s left the herd,” says Patrick Tolan, director of the Institute for Juvenile Research at the University of Illinois. “They try to single out the weakest kid. The best way to stop this is to work on increasing inclusion by helping the bullied kids with social skills.”

Bullies are usually bullied themselves (see another article Bullies like their victims, are also at risk). Only very small percentage are sociopathic, or who are intrinsically cruel and without empathy, perhaps 1 in a 100. How do you tell? If someone sets a clear boundary with punitive consequences, the disturbed bully will relentlessly target a victim regardless of how much trouble they get in.

I wish to personally thank Barry Diggs, probation and parole officer for the Oregon Youth Authority, for his insights into bullying behavior, which helped me develop this article. Margaret

If you have helped a child effectively cope with bullying, please share your story in the Comments below so others can learn from your story.


Research

Bullying Linked to Violence at Home
April 2011

Bullying is pervasive among middle school and high school students in Massachusetts and may be linked to family violence, a new study finds. In a survey of 5,807 middle-school and high-school students from almost 138 Massachusetts public schools, researchers from the Massachusetts Department of Health and US Centers for Disease Control and Prevention found that those involved in bullying in any way are more likely to contemplate suicide and engage in self-harm compared to other students. Those involved in bullying were also more likely to have certain risk factors, including suffering abuse from a family member or witnessing violence at home, compared to people who were neither bullies nor victims.

Cyberbullying (this is a superb and comprehensive article by an expert on cyberbullying)

http://www.psychiatrictimes.com/display/article/10168/1336550?GUID=32E9A484-0468-4B38-8A03-0EE478D3256C&rememberme=1

Survey: Half of High Schoolers Report Bullying or Teasing Someone
“Ethics of American Youth Survey”, Josephson Institute of Ethics

Half of U.S. high schoolers say they have bullied or teased someone at least once in the past year, a new survey finds. The study also found that nearly half say they have been bullied during that time. The study surveyed 43,321 teens ages 15 to 18, from 78 public and 22 private schools. It found 50 percent had “bullied, teased or taunted someone at least once,” and 47 percent had been “bullied, teased or taunted in a way that seriously upset me at least once.” The survey asked about bullying in the past 12 months: 52% of students have hit someone in anger. 28% (37% of boys, 19% of girls) say it’s OK to hit or threaten a person who angers them. “There’s a tremendous amount of anger out there,” Michael Josephson says. (Founder of the Institute of Ethics)

Victims of Cyberbullying More Likely to Suffer Depression than Perpetrators:
ScienceDaily, September 2010

Young victims of cyber bullying, which occurs online or through cell phones, are more likely to suffer from depression than their tormentors, a new study finds. Researchers at the Eunice Kennedy Shriver National Institute of Child and Human Health Development in the US looked at survey results on bullying behavior and signs of depression in 7,313 students in grades six through 10. Victims reported higher depression than cyber bullies or bully-victims, which was not found in any other form of bullying. Researchers say it unclear whether depressed kids have lower self-esteem and so are more easily bullied or the other way around.

Cyberbullying Teens and Victims More Likely to Have Psychiatric Troubles
Archives of General Psychiatry, July 2010

Teens who cyberbully others through the Internet or cell phones are more likely to have both physical and psychiatric problems, and their victims are at heightened risk for behavioral difficulties, a new study finds. Researchers collected data on 2,215 Finnish teens 13 to 16 years old. The survey found that teens who were victims of cyberbullying were more likely to come from broken homes and have emotional, concentration and behavior problems. In addition, they were prone to headaches, abdominal pain, sleeping problems and not feeling safe at school, the researchers found. Cyberbullies were also more prone to suffer from emotional and behavior problems, according to the survey.

Bullying And Being Bullied Linked To Suicide In Children
International Journal of Adolescent Medical Health; July 2008

Being a victim or perpetrator of school bullying, the most common type of school violence, has been frequently associated with a broad spectrum of behavioral, emotional, and social problems. According to international studies, bullying is common, and affects up to 54 percent of children. Researchers at Yale School of Medicine reviewed studies from 13 different countries and found signs of a connection between bullying, being bullied. and suicide in children. Suicide is third leading cause of mortality in children and adolescents. Lead author of this report, Young-Shin Kim, M.D. said “the perpetrators who are the bullies also have an increased risk for suicidal behaviors.”

Kids with ADHD more likely to bully
Linda Carroll, MSNBC, reporting on the Journal of Developmental Medicine and Child Neurology, February 2008

A new study shows that children with attention deficit hyperactivity disorder are almost four times as likely as others to be bullies. And, in an intriguing corollary, the children with ADHD symptoms were almost 10 times as likely as others to have been regular targets of bullies prior to the onset of those symptoms.

A study followed 577 children for a year. After collecting data on bullies and victims and identifying those children ADHD, there was a corollary between ADHD and bullying. Study co-author Dr. Anders Hjern, a professor in pediatric epidemiology at the University of Uppsala in Stockholm said “These kids might be making life miserable for their fellow students. Or it might turn out that the attention problems they’re exhibiting could be related to the stress of being bullied.”

Unfortunately, treating ADHD won’t remedy the bullying because drugs for the condition impact a child’s ability to focus, but not the aggression that leads to bullying, says Kazdin, a professor of psychology and child psychiatry and director of the Parenting Center and Child Conduct Clinic at Yale University, and president of the American Psychological Association.

Bullying Tied to Sleep Problems
Sleep Medicine, June 2011

Children who are aggressive and disruptive in class are more likely to have sleep-disordered breathing than well-behaved children, according to new research. Conduct problems, parent-reported bullying, and school disciplinary problems were all associated with higher scores on a measure of sleep-related breathing disorders, according to researchers. The study collected data from parents on each child’s sleep habits and asked both parents and teachers to assess behavioral concerns. The findings suggest that bullying may be prevented by paying attention to some of the unique health issues associated with aggressive behavior.

3 Comments

Filed under Bullying, discipline, parenting, PTSD, suicide, teachers, troubled children

Therapy types explained: DBT, CBT, CPS, and others

Therapy types explained: DBT, CBT, CPS, and others
3 votes

The fantastic news about the brain is that it can heal itself by talking with someone! And there is ample evidence to back this up.

The therapist or psychologist who works with your child or teen will use a type of therapy or “modality” based on their symptoms or diagnosis, because some work better for mood disorders, some work better for defiant children, some work better for borderlines, and so forth. (In thought disorders like autism and schizophrenia, talk therapy has limits. Those on the autism spectrum need specialized interactions due to their processing issues. Those on the schizophreniform spectrum need medication to think logically before starting

Therapy models. Each type of therapy follows a model, and five are covered in this article. Your child’s therapist must be trained and practiced in any model they use. Why? It’s a matter of quality control. A therapist who has fidelity to a model (adheres to protocol) will help the most people most of the time, because that model has data to prove that the majority will benefit–the ones in the center section of the Bell Curve. (Therapists include psychiatrists, psychologists, and psychotherapists with MSW (Masters in Social Work), LCSW (Licensed Clinical Social Worker) and other licensure.)

Therapy models

CBT – cognitive behavioral therapy
CBT works when the child can examine their own feelings and make sense of them—the “cognitive” part. They learn to understand what affects them and why. The therapist will guide your child to create a list of options for themselves for when they face the next stressful situation that pops up in their lives. CBT helps a person think their way out of the confusion and have plans in place for appropriate actions. It works for mood disorders and anxiety, and some thought disorders if person has ‘insight’ (able to notice when they are behaving or thinking irrationally). CBT is one of the most widely used therapeutic models because it works for people who are relatively stable but enduring a difficult life situation (divorce, medical illness, job loss, and other big stressors).

DBT – dialectical behavioral therapy
DBT is unusual in that it can help anyone for any reason! The term “dialectical” describes how a patient learns to hold two opposing truths in their mind and respond effectively to the discomfort and emotions this causes. DBT is the one therapy model that can work for people with borderline personality disorder, who are considered the hardest to treat. It also helps those with mood dysregulation, those who’ve thought about or attempted suicide, or those with uncontrollable and negative responses to the world, such as oppositional defiant disorder. DBT relies less on personal self-examination and analysis, and instead concentrates on self calming, tolerating stress without overreacting, accurately perceiving the nature of a conflict, and communicating with others appropriately. Anyone can benefit from DBT. Notice how commonly people hear bad news and immediately expect the worst, then act to address the worst possible outcome? Does your child do this, only to extremes?

EMDR – eye movement desensitization and reprocessing
The goal of EMDR therapy is to help a person process extremely distressing memories of trauma and mitigate their torturous subconscious influence so children and adults can adapt and cope when memories are triggered in the future. EMDR is used for people with PTSD (physical, sexual, or emotional abuse) and other traumas such as from war, accidents, and major disasters. The therapy process uses rhythmic stimuli as a distraction during the precise moments when the person relives the traumatic memory—eye movement back and forth (by following a swinging object or a therapist’s hand), clapping, or listening to tones switching from ear to ear through headphones. The person does not have to talk about the horrible memory, so EMDR is less stressful—so important for a trauma survivor! EMDR works but there are no acceptable explanations. It is based on a belief that the memory and associated stimuli of the event must be processed to remove it from “an isolated memory network” where it creates havoc.

Parents as therapists

There are two proven models of therapy that are taught to parents to practice with their children in the home. Like the other models, they don’t work for every child, but they work for most children with a certain range of behaviors, rages, resistance, and physical violence, which can be caused by ODD, ADHD, and depression/bipolar disorders.

CPS – collaborative problem solving
CPS can be learned by anyone to manage an intensely frustrated child who goes into uncontrollable fits or tantrums, and the parent can do nothing to calm them down. The fits may last hours, and must run out of steam on their own. Afterwards, the child is often remorseful. Why? Their brain is “chronically inflexible” and has difficulty with the unexpected, switching from one situation to another or one plan to another. Using CPS, a parent doesn’t enforce rules per se, but negotiates with child so that they together come up with a win-win solution. This is very counterintuitive! The parent does not give away their authority, but offers the child an acceptable choice. For example, if a child can’t get a red jacket because there aren’t any in their size, and they must have red (!), the parent asks the child if they want to order one and wait 2 weeks, or if they will accept another color. This seems fair to the child because they have a say, and much easier on the parent because the child accepts the outcome they’ve chosen.

PMT – parent management training
PMT refers to a proven intensive educational program for parents to teach them skills for managing extremely difficult children, especially those with ODD. PMT helps parents assert consistency and predictability at home and in school, and promote positive social behavior in their child. The parents are also trained to change their own behavior towards their child, and taught how to analyze different home/school situations, “then apply moment-to-moment positive reinforcement or punishment” (called interventions) based on what is happening. The punishments are humane, such as taking time outs. It is hard on the parents, but works for children with serious behavior problems in addition to ODD: Conduct disorder, ADHD, and autism spectrum disorders.

What makes a good therapist? Because multiple models are out there, a really skilled therapist will figure out which model your child needs once they get to know them, and they will apply parts of different models depending on your child’s individual challenges. That same skilled therapist will also be a cheerleader for your child, helping them feel good about themselves (and you), helping them discover their talents, and helping them to stay committed to their need for self-care. This is the very definition of a good therapist! Therapy is hard to take for anyone, but your child will trust a good therapist if they feel they have their best interests. Chemistry is important. If your child doesn’t like the therapist or make progress, it’s worth spending the time to find someone else who’s a better match. If the therapist has professional ethics; they will recognize they are not a fit and recommend someone else.

I know of a 10-year old child whose therapist dragged out appointments for a year with zero progress or results. From the start, the child didn’t like her and simply refused to talk with her. And this child, now 11, refuses any therapy because “it’s boring and a waste of time.” What an unfortunate consequence!

How you know you have a good therapist. A good therapist will be able to discover something valuable that brings light on your child’s situation after the very first session. They should ask you for background information about your child, and listen to you when you talk about recent problematic situations. They cannot talk to you about your child’s therapy, but they can encourage you to partner with them, and should recognize your need (your family’s need) for your child to function as normally as possible. You can ask to have therapy together with your child if its appropriate. If the therapist can’t connect meaningfully with your child after a few weeks, ask them about this. If you have any doubts about the therapist, share them, and expect to have a thoughtful, respectful explanation.

Which therapy is best for your child?

Seek a therapy provider with knowledge of all of them, and with experience treating children and teens. Ask about a specialty when you make the initial contact, and ask about a model you think fits your child’s behaviors (based on their descriptions). You can get a one-time assessment from a therapist for an opinion on which model to use. The best way to find a good therapist is through personal referrals: your child’s doctor or psychiatrist, support groups, school counselors, and other parents.

2 Comments

Filed under mental illness, parenting, teens, therapy

What to do when they stop listening

What to do when they stop listening
4 votes

You don’t have to feel this frustrated.

At some point in their development, all kids stop listening. It’s frustrating but normal. There are lots of good advice for getting normal children and teens to listen, or at least follow the rules and directions given by the parent.But it’s different when your child has serious behavioral disorder, and when their behaviors are extreme or outright risky. Your priority may be to prevent destructive behavior and family chaos when they hate you, blame you, or are willing to take extreme risks. Then who cares about the dishes or homework?

First things first, avoid upsetting yourself.

Avoid repeating things over and over, raising your voice, or expressing your frustration. It really matters.  This stresses you as much as it stresses them. Children and teens with disturbances have a hard time tracking, and it may be pointless to expect them to listen. Your child or teen is overwhelmed by brain noise and does not hear even hear you.

But what if they are refusing to listen?  That’s a different issue.  They ARE listening, and they are definitely communicating back to you.  This is resistance and defiance.  (see Managing resistance – tips and advice )

Things to do when they stop listening

Use technology: texting and email.

This mother should be texting her daughter instead

This approach is so simple and so effective that therapists encourage high-conflict parent-teen pairs to communicate exclusively using email and texts, even if the parties are in close proximity, like at home together! Think about this. You are using their chosen medium; you can keep it brief and concise; both you and your child have time to reflect on your response. Your conversation is documented, right there for both of you to track. No one is screaming or repeating themselves.Word of caution
Watch what you write. Don’t use emotionally charged words or tone. Be sure to read texts and emails over and over before sending! “The Journal of Personality and Social Psychology 2006 revealed that studies show e-mail messages are interpreted incorrectly 50% of the time.”

Move somewhere closer or farther, change your body language
Instead of communicating with your voice, use your body. For some children and teens, an arm around their shoulders calms them quickly. Or try standing calmly and quietly. Or put some distance between you and your child’s personal space, even if it means stopping and getting out of the car and taking a short walk. Experiment to see what works for your situation.

Use a third-party
Maybe you are the wrong person to carry the message and settle a tense situation. Don’t be too proud to admit that, for whatever reason, your child will not listen to you no matter how appropriately you modify your approach. So use a substitute or third-party. Is there another person who has a better rapport and can convince your child to complete a chore, do homework, leave little sister alone—a spouse, a grandparent, a teacher or counselor, a therapist? What about a friendly animal, live or stuffed? For young children, you can bring out Kitty and ask her to tell Joey that mommy and daddy only want him to do this one simple chore.

Draw a picture, make a sign

As a young child, I recall my parents hounding me for something, I don’t even remember what.  Then they’d ask, “What do you want me to do, draw a picture?” Well, yes in fact, I understood pictures and they didn’t frighten me as much as my parents yelling at me. Pictures and signs work, put them up where the family can see them (and your troubled child won’t feel singled out).  Maybe a funny comic gets a point across in a non-threatening way.  Some sign ideas: “It’s OK to be Angry, not Mean,” “STOP and THINK,” “Our family values Respect and Kindness,” “This is a smoke-free, drug-free, and a-hole free home.”

Time outs for you
.
Take your own sweet time to calm down and think things through what to say when you’re challenged by your offspring. Consider how you’ll respond to swearing. Put him or her on hold. Don’t return texts or email right away, “I’m busy and I’ll reply in 30 minutes.” Be specific on time, then follow through, or they might learn to blow you off with the same casual phrase, expecting you to forget. 

A Precaution

Watch your tone of voice
From infancy, we are wired to pick up emotions in the voice—it’s literally in our brain.  Your tone is very powerful and can be calming or destructive. Think about asserting strength and caring in your voice without lecturing. Be assertive but forgiving. Be firm and not defensive. Don’t get caught apologizing for upsetting your child or justifying your rules. 90% of parents know the right thing to say, but its common to say it the wrong way.

Is your child bullying you with their behavior?
I’ve observed child verbally bully and abuse their parents. This is not communicating and not negotiable. You have options for standing up to this without making things worse. Temporarily block their email or calls, or ignore and let them go to voicemail. Declare bullying unacceptable. Pull rank and apply a consequence. You cannot let their harassment continue because they will use it on others.
About that mean-spirited voicemail or email.
When you get an ugly message, tell yourself you are hearing from a scared, frightened person, and you’re the one whose feelings they care about the most. See this as a good thing. They are trying to communicate but it’s mangled and inappropriate. You want them to stay in contact and engage with you even if its negative. When a disturbed child stops communicating is when you must worry.  It hurts, but your hurt will pass.  You can handle it.  They will still love you , and some day they will show you.  Be very patient.
If the things they communicate hurt.
It is best that you take your feelings out of the picture and seek other sources of affirmation and support—this can’t come from your child. If they write “I hate you,” maybe they are really saying “you make me mad because you are asking me to do something I can’t handle now.”

Good luck out there,
–Margaret

How am I doing?  Please rate this article at the top, thanks!

3 Comments

Filed under anger, defiant children, discipline, parenting, stress, teenagers, teens